bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Perceptions and Risk Thresholds Among Surgeons in the Management of Intraductal Papillary Mucinous Neoplasms
Authors: Sacks Greg D. , Shin Paul , Braithwaite R. Scott , Soares Kevin C. , Kingham T. Peter , D’Angelica Michael I. , Drebin Jeffrey A. , Jarnagin William R. , Wei Alice C. 
Published: February 2023

Objectives:
We aimed to determine whether surgeon variation in management of intraductal papillary mucinous neoplasm (IPMN) is driven by differences in risk perception and quantify surgeons’ risk threshold for changing their recommendations.

Background:
Surgeons vary widely in management of IPMN.

Methods:
We conducted a survey of members of the Americas HepatoPancreatoBiliary Association, presented participants with 2 detailed clinical vignettes and asked them to choose between surgical resection and surveillance. We also asked them to judge the likelihood that the IPMN harbors cancer and that the patient would have a serious complication if surgery was performed. Finally, we asked surgeons to rate the level of cancer risk at which they would change their treatment recommendation. We examined the association between surgeons’ treatment recommendations and their risk perception and risk threshold.

Results:
One hundred fifty surgeons participated in the study. Surgeons varied in their recommendations for surgery [19% for vignette 1 (V1) and 12% for V2] and in their perception of the cancer risk (interquartile range: 2%–10% for V1 and V2) and risk of surgical complications (V1 interquartile range: 10%–20%, V2 20–30%). After adjusting for surgeon characteristics, surgeons who were above the median in cancer risk perception were 22 percentage points (27% vs 5%) more likely to recommend resection than those who were below the median (95% CI: 11%–4%; P<0.001). The median risk threshold at which surgeons would change their recommendation was 15% (V1 and V2). Surgeons who recommended surgery had a lower risk threshold for changing their recommendation than those who recommended surveillance (V1: 10.0 vs 15.0, P=0.06; V2: 7.0 vs 15.0, P=0.05).

Conclusions:
The treatment that patients receive for IPMNs depends greatly on how their surgeons perceive the risk of cancer in the lesion. Efforts to improve cancer risk prediction for IPMNs may lead to decreased variations in care.
Characteristics for Machine Learning Detection of Large Vessel Occlusion on Computed Tomography Angiography
Authors: Lingam Sneha , Remedios Lucas W. , Remedios Samuel W. , Landman Bennett A. , Davis Larry T. , Clark Stephen W. 
Published: February 2023

AbstractDetection of large vessel occlusion (LVO) using machine learning on computed tomography angiography (CTA) may help stroke triage, yet applicability across varied patient and image characteristics has not been examined. The study will examine which characteristics are important when using a convolutional neural network to identify LVO on CTA. A retrospective cohort study (November 2017–May 2019) at a comprehensive stroke center evaluated 677 stroke-alerted patients with an LVO of the internal carotid artery, M1, or M2 (n=150) and a matching number without LVO were included. An Inception module-based network was trained for binary classification of LVO presence. Results were examined by LVO location, window settings, non-LVO findings, demographics, risk factors, presentation status and times, interventions, and outcomes. Three hundred patients were included (48% women; median age 65). Mean±95% CI for cross-validation test and external validation, respectively, are area under precision-recall curve 0.871±0.094 and 0.742±0.018 and area under receiver operating characteristic curve 0.920±0.051 and 0.852±0.004. 145 true positive (TP), 5 false negative (FN), 39 false positive (FP), and 111 true negative (TN) patients were identified. Significant comparisons (P<0.05) identified: lower window settings for misclassifications, smoking history for all FN versus 33% TP (P=0.005), and tissue plasminogen activator treatment for 41% FP versus 20% TN (P=0.017). Our LVO detection tool had high performance across patient characteristics with few exceptions. FP had pathology warranting detection, including distal occlusions. Lower window settings among misclassifications highlight the need for image quality when using machine learning for decision support.
A Bayesian Perspective Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest
Authors: Brophy James M 
Published: February 2023

AbstractBackgroundWhether extracorporeal CPR (eCPR) has survival benefits over conventional CPR (cCPR) in patients with refractory out-of-hospital cardiac arrest is an unresolved clinical question. Performing trials in this environment is exceedingly challenging and inferences need careful examination.ObjectiveDetermine if a Bayesian perspective provides additional inferential insights.MethodsThe INCEPTION trial of patients with refractory out-of-hospital cardiac arrest reported eCPR and cCPR had similar effects on the primary outcome, 30 day survival with a favorable neurologic outcome. Herein the probability of eCPR superiority, equivalence or inferiority to cCPR is re-evaluated with a Bayesian analysis using both vague and informative priors (from previously completed randomized clinical trials (RCTs)).ResultsDepending on the chosen prior, the Bayesian reanalysis of the INCEPTION intention-to-treat (ITT) data suggests an equivalence probability < 10% (defined as an absolute risk difference (RD) < 1%) but a clinical superiority probability of 66 - 99 % (defined as RD > 1.0). An INCEPTION per protocol (PP) analysis with a vague prior suggested a 1% probability of clinical benefit but this posterior probability increased to 86% when informative PP data from previous RCTs were considered.ConclusionBayesian INCEPTION trial re-analyses provide additional quantative insights. The totality of the ITT evidence reveals a high probability for a clinically meaningful eCPR benefit over cCPR at 30 days. A PP analysis shows a less definitive probability of benefit. (Abstract word count 197, Manuscript word count 1477)
Association between aspirin dose and outcomes in patients with acute Kawasaki disease
Authors: Suzuki Takanori , Michihata Nobuaki , Hashimoto Yohei , Yoshikawa Tetsushi , Saito Kazuyoshi , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo 
Published: February 2023

AbstractBackgroundThe most effective dosage of aspirin to prevent coronary artery abnormalities in patients with acute Kawasaki disease remains unknown. Using a Japanese national inpatient database, this study aimed to identify the appropriate dose of aspirin to be prescribed to patients with acute Kawasaki disease.MethodWe used the Diagnostic Procedure Combination database to identify patients with Kawasaki disease treated with intravenous immunoglobulin between 2010 and 2021.The outcomes included the occurrence of coronary artery abnormalities and intravenous immunoglobulin resistance, length of stay, and medical costs. Restricted cubic spline functions were performed to examine the association between aspirin dose and the outcomes.ResultsData of 82109 patients were extracted from the database. Non-linear associations were observed between aspirin dose and the outcomes. In comparison with an aspirin dose of 30 mg/kg/day, the odds ratio (95% confidence interval) for coronary artery abnormalities was 1.40 (1.13–1.75) at 5 mg/kg/day. An aspirin dose of ≥30 mg/kg/day did not significantly change the odds ratio for coronary artery abnormalities. Compared with a dose of 30 mg/kg/day, the odds ratio (95% confidence interval) for intravenous immunoglobulin resistance was 0.87 (0.76–1.00) at 5 mg/kg/day and 0.59 (0.36–0.98) at 80 mg/kg/day. An increase in aspirin dose was associated with a shorter length of stay and lower medical costs.ConclusionsLow-dose aspirin may increase the risk of coronary artery abnormalities in patients with acute Kawasaki disease; however, increasing aspirin doses beyond the standard doses may not be associated with a reduction in coronary artery abnormalities. High-dose aspirin showed the potential to reduce hospital stay and medical costs without increasing complications.Article SummaryThe study showed by restricted cubic spline that the dose of aspirin was no significant association between aspirin escalation and CAAs in patients with acute KD.What’s Known on This SubjectAspirin is standard treatments used with IVIG of acute Kawasaki Disease (KD), Few studies have shown the most effective dosage of aspirin to to prevent CAAs.What This Study AddsThe dose of aspirin was no significant association between aspirin escalation and CAAs in patients with acute KD.
Genetic variation supports a causal role for valproate in prevention of ischemic stroke
Authors: Mayerhofer Ernst , Parodi Livia , Narasimhalu Kaavya , Wolking Stefan , Harloff Andreas , Georgakis Marios K , Rosand Jonathan , Anderson Christopher D 
Published: February 2023

AbstractValproate is a candidate for ischemic stroke prevention due to its anti-atherosclerotic effects in vivo. Although valproate use is associated with decreased ischemic stroke risk in observational studies, confounding by indication precludes causal conclusions. To overcome this limitation, we applied Mendelian randomization to determine whether genetic variants that influence seizure response among valproate users associate with ischemic stroke. We derived a genetic score for valproate response using genome-wide association data of seizure response after valproate intake from the Epilepsy Pharmacogenomics Consortium. We then tested this score among valproate users of the UK Biobank for association with incident and recurrent ischemic stroke using Cox proportional hazard models. Among 2,150 valproate users (mean 56 years, 54% females), 82 ischemic strokes occurred over a mean 12-year follow-up. Higher valproate response genetic score was associated with higher serum valproate levels (+5.78 µg/ml per one SD, 95% CI [3.45, 8.11]). After adjusting for age and sex, higher valproate response genetic score was associated with lower ischemic stroke risk (HR per one SD 0.73, [0.58, 0.91]) with a halving of absolute risk in the highest compared to the lowest score tertile (4.8% vs 2.5%, p-trend=0.027). Among 194 valproate users with prevalent stroke at baseline, a higher valproate response genetic score was associated with lower recurrent ischemic stroke risk (HR per one SD 0.53, [0.32, 0.86]) with reduced absolute risk in the highest compared to the lowest score tertile (3/51, 5.9% vs. 13/71, 18.3%, p-trend=0.026). The valproate response genetic score was not associated with ischemic stroke among the 427,997 valproate non-users (p=0.61), suggesting minimal pleiotropy. In an independent cohort of 1,241 valproate users of the Mass General Brigham Biobank with 99 ischemic stroke events over 6.5 years follow-up, we replicated our observed associations between the valproate response genetic score and ischemic stroke (HR per one SD 0.77, 95% CI: [0.61, 0.97]). These results demonstrate that a genetically predicted favorable seizure response to valproate is associated with higher serum valproate levels and reduced ischemic stroke risk among valproate users, providing causal support for valproate effectiveness in ischemic stroke prevention. The strongest effect was found for recurrent ischemic stroke, suggesting potential dual-use benefits of valproate for post-stroke epilepsy. Clinical trials will be required in order to identify populations that may benefit most from valproate for stroke prevention.
Neuroimaging-based analysis of DBS outcome in pediatric dystonia: Insights from the GEPESTIM registry
Authors: Al-Fatly Bassam , Giesler Sabina , Oxenford Simon , Li Ningfei , Achtzehn Johannes , Krause Patricia , Visser-Vandewalle Veerle , Krauss Joachim K. , Runge Joachim , Tadic Vera , Bäumer Tobias , Schnitzler Alfons , Vesper Jan , Wirths Jochen , Timmermann Lars , Kühn Andrea A. , Koy Anne 
Published: February 2023

AbstractIntroductionDeep brain stimulation (DBS) is an established treatment in patients with pharmaco-resistant neurological disorders of different ages. Surgical targeting and postoperative programming of DBS depend on the spatial location of the stimulating electrodes in relation to the surrounding anatomical structures and on electrode connectivity to a specific distributed pattern of brain networks. Such information is usually collected using group-level analysis which relies on the availability normative imaging-resources (atlases and connectomes). To this end, analyzing DBS data of children with debilitating neurological disorders like dystonia would make benefit from such resources, especially given the developmental differences between adults and children neuroimaging data. We assembled pediatric, normative neuroimaging-resources from open-access neuroimaging datasets and illustrated their utility on a cohort of children with dystonia treated with pallidal DBS. We aimed to derive a local pallidal sweetspot and explore a connectivity fingerprint associated with pallidal stimulation to exemplify the utility of the assembled imaging resources.MethodsA pediatric average brain template was implemented and used to localize DBS electrodes of twenty patients of the GEPESTIM registry cohort. Next, a pediatric subcortical atlas was also employed to highlight anatomical structures of interest. Local pallidal sweetspot was modeled and its degree of overlap with stimulation volumes was calculated as a correlate of individual clinical outcome. Additionally, a pediatric functional connectome of neurotypical subjects was built to allow network-based analyses and decipher a connectivity fingerprint responsible for clinical improvement in our cohort.ResultsWe successfully implemented a pediatric neuroimaging dataset that will be made available to public use as a tool for DBS-analyses. Overlap of stimulation volumes with the identified DBS-sweetspot model correlated significantly with improvement on a local spatial level (R = 0.46,permuted p= 0.019). Functional connectivity fingerprint of DBS-outcome was determined as a network correlate of therapeutic pallidal stimulation in children with dystonia (R = 0.30,permuted p= 0.003).ConclusionsLocal sweetspot and distributed network models provide neuroanatomical substrates for DBS-associated clinical outcome in dystonia using pediatric neuroimaging surrogate data. The current implementation of pediatric neuroimaging dataset might help improving the practice of DBS-neuroimaging analyses in pediatric patients.
Development and Evaluation of a Clinical Guideline for a Pediatric Telemedicine and Medication Delivery Service: A Prospective Cohort Study in Haiti
Authors: Klarman Molly B. , Chi Xiaofei , Cajusma Youseline , Flaherty Katelyn E. , Capois Anne Carine , Vladimir Dofiné Michel Daryl , Exantus Lerby , Friesen Jason , Beau de Rochars Valery M. , Becker Torben K. , Baril Chantale , Gurka Matthew J. , Nelson Eric J. 
Published: February 2023

ABSTRACTObjectiveDespite the emergence of telemedicine as an important model for healthcare delivery, there is a lack of evidence-based telemedicine guidelines, especially for resource-limited settings. We sought to develop and evaluate a guideline for a pediatric telemedicine and medication delivery service (TMDS).MethodsA prospective cohort study was conducted at a TMDS in Haiti; children ≤10 years were enrolled. Among non-severe cases, paired virtual and in-person exams were conducted at the call center and household; severe cases were referred to the hospital. The primary outcome was the performance of the virtual exam compared to the in-person exam (reference standard).FindingsA total of 391 cases were enrolled. Among 320 cases with paired exams, no general World Health Organization (WHO) danger signs were identified at the household; problem-specific danger signs were identified in 6 cases (2%). Cohen’s kappa for the designation of mild cases was 0.78 (95%CI 0.69-0.87). Among components of the virtual exam, the sensitivity and specificity of a reported fever were 91% (87%-96%) and 69% (62%-74%), respectively; the sensitivity and specificity of ‘fast breathing’ were 47% (21%-72%) and 89% (85%-94%), respectively. Kappa for dehydration assessments indicated moderate congruence (0.69; 95%CI 0.41-0.98). At 10 days, 95% (273) of the 287 cases reached were better/recovered.ConclusionThis study, and resulting guideline, represents a formative step towards an evidence-based pediatric telemedicine guideline built on WHO clinical principles. In-person exams for select cases were important to address limitations with virtual exams and identify cases for escalation.
The contribution of sub-optimal prescription of preoperative antiplatelets and statins to race and ethnicity-related disparities in major limb amputation
Authors: Kalbaugh Corey A. , Witrick Brian , Howard Kerry A. , Sivaraj Laksika Banu , McGinigle Katharine L. , Cykert Samuel , Robinson William P. , Lesko Catherine R. 
Published: February 2023

ABSTRACTBackgroundPeople undergoing revascularization for symptomatic peripheral artery disease (PAD) have a high incidence of major limb amputation in the year following their surgical procedure. The incidence of limb amputation is particularly high in patients from racial and ethnic minority groups. The purpose of our study was to investigate the role of sub-optimal prescription of preoperative antiplatelets and statins in producing disparities in risk of major amputation following revascularization for symptomatic PAD.MethodsWe used data from adult (≥18 years old) patients in the Vascular Quality Initiative (VQI) registry who underwent a revascularization procedure from 2011-2018. Patients were categorized as non-Hispanic Black, non-Hispanic White, and Hispanic. We estimated the crude probability of a patient being prescribed a preoperative antiplatelet and preoperative statin. We calculated one year risk incidence of amputation by prescription groups and by race/ethnicity. We estimated the amputation risk difference between race/ethnicity groups (the proportion of disparity) that could be eliminated under a hypothetical intervention where a pre-operative antiplatelet and statin was provided to all patients.ResultsAcross 100,579 revascularizations recorded in the Vascular Quality Initiative, a vascular procedure-based registry in the United States and Canada, 1-year risk of amputation was 2.5% (95% CI: 2.4%,2.6%) in White patients, 5.3% (4.9%,5.6%) in Black patients and 5.3% (4.7%,5.9%) in Hispanic patients. Black (57.5%) and Hispanic patients (58.7%) were only slightly less likely than White patients (60.9%) to receive recommended antiplatelet and statin therapy prior to their procedures. However, the effect of antiplatelets and statins was greater in Black and Hispanic patients such that, had all patients received the appropriate guideline recommended medications, the estimated risk difference comparing Black to White patients would have reduced by 8.9% (−2.9%,21.9%) and the risk difference comparing Hispanic to White patients would have been reduced by 17.6% (−0.7%,38.6%).ConclusionsEven though guideline-based care appeared evenly distributed by race/ethnicity, increasing access to such care may still decrease health care disparities in major limb amputation.
Prevalence of Elevated NT-proBNP and its Prognostic Value by Blood Pressure Treatment and Control- National Health and Nutrition Examination Survey, 1999-2004
Authors: Daya Natalie R. , McEvoy John W. , Christenson Robert , Tang Olive , Foti Kathryn , Juraschek Stephen P. , Selvin Elizabeth , Echouffo Tcheugui Justin B. 
Published: February 2023

ABSTRACTBackgroundThe prognostic utility of NT-proBNP in the setting of hypertension has not been well-characterized in the general US adult population.MethodsWe measured NT-proBNP among adults aged 20 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. In adults without a history of cardiovascular disease, we assessed the prevalence of elevated NT-pro-BNP by blood pressure (BP) treatment and control categories. We examined the extent to which NT-proBNP identifies participants at higher risk for mortality across BP treatment and control categories.ResultsThe number of US adults without CVD with elevated NT-proBNP (≥125 pg/ml) was 6.2 million among those with untreated hypertension, 4.6 million among those with treated controlled hypertension, and 5.4 million among those with treated uncontrolled hypertension. After adjusting for age, sex, body mass index, and race/ethnicity, participants with treated controlled hypertension and elevated NT-proBNP had increased risk of all-cause mortality (HR 2.29, 95% CI 1.79, 2.95) and increased risk of cardiovascular mortality (HR 3.83, 95% CI: 2.34, 6.29), compared to those without hypertension and with low levels of NT-proBNP (<125 pg/ml). Among those on antihypertensive medication, those with SBP 130-139 mm Hg and elevated NT-proBNP had increased risk of all-cause mortality, compared to those with SBP<120 mm Hg and low levels of NT-proBNP.ConclusionsAmong a general population of adults free of cardiovascular disease, NT-proBNP can provide additional prognostic information within and across categories of BP. Measurement of NT-proBNP may have potential for clinical use to optimize hypertension treatment.