bluuebunny/crossref_metadata_2025_split huggingface dataset:
Switching to Versus Addition of Incretin‐Based Drugs Among Patients With Type 2 Diabetes Taking Sodium‐Glucose Cotransporter‐2 Inhibitors
Authors: Lau Kristy T. K. , Wong Carlos K. H. , Au Ivan C. H. , Lau Wallis C. Y. , Man Kenneth K. C. , Chui Celine S. L. , Wong Ian C. K. 
Published: March 2022

Background
Evidence is limited in comparing treatment modification by substitution or add‐on of glucose‐lowering medications in patients with type 2 diabetes. This observational study aims to compare switching versus add‐on of incretin‐based drugs among patients with type 2 diabetes on background sodium‐glucose cotransporter‐2 inhibitors (SGLT2i).

Methods and Results
This population‐based, retrospective cohort study was conducted using the IQVIA Medical Research Data, including adults with type 2 diabetes on background SGLT2i from 2005 to 2020. New users of incretin‐based drugs were allocated into the “Switch” group if they had discontinued SGLT2i treatment, or the “Add‐on” group if their background SGLT2i was continued. Baseline characteristics of patients were balanced between groups. Study outcomes were all‐cause mortality, cardiovascular diseases, kidney diseases, hypoglycemia, and ketoacidosis. Patients were observed from the index date of initiating incretin‐based drugs until the earliest of an outcome event, death, or data cut‐off date. Changes in anthropometric and metabolic parameters were also compared between groups from baseline to 12‐month follow‐up. A total of 2888 patients were included, classified into “Switch” (n=1461) or “Add‐on” group (n=1427). Median follow‐up was 18 months with 5183 person‐years. Overall, no significant differences in the risks of study outcomes were observed between groups; however, patients in the “Add‐on” group achieved significantly greater reductions in glycated hemoglobin, weight, percentage weight loss, and systolic blood pressure than their “Switch” counterparts.

Conclusions
Initiating incretin‐based drugs as add‐on among patients with type 2 diabetes on background SGLT2i was associated with risks of clinical end points comparable to switching treatments, in addition to better glycemic and weight control observed with the combination approach.
Low Risk of Dementia in Patients With Newly Diagnosed Atrial Fibrillation and a Clustering of Healthy Lifestyle Behaviors: A Nationwide Population‐Based Cohort Study
Authors: Park Sang‐Hyeon , Lee So‐Ryoung , Choi Eue‐Keun , Lee HuiJin , Chung Jaewook , Choi JungMin , Han Minju , Ahn Hyo‐Jeong , Kwon Soonil , Lee Seung‐Woo , Han Kyung‐Do , Oh Seil , Lip Gregory Y. H. 
Published: March 2022

Background
Limited data are available on the clinical impact of healthy lifestyle behaviors on the risk of dementia in patients with new‐onset atrial fibrillation (AF). Here, we aimed to evaluate the association between a combination of healthy lifestyle behaviors and the risk of incident dementia in patients with AF.

Methods and Results

Using the Korean National Health Insurance database between 2009 and 2016, we identified 199 952 adult patients who were newly diagnosed as AF without dementia. Patients were categorized into 4 groups by healthy lifestyle behavior score (HLS) with 1 point each being assigned for no current smoking, alcohol abstinence, and regular exercise. The HLS 0, 1, 2, and 3 groups included 4.4%, 17.4%, 53.4%, and 24.8% of the patients, respectively. We performed an inverse probability of treatment weighting to balance covariates between HLS groups. The HLS 1, 2, and 3 groups were associated with a lower risk of dementia compared with the HLS 0 group (hazard ratio [HR], 0.769; 95% CI, 0.704–0.842 for HLS 1; HR, 0.770; 95% CI, 0.709–0.836 for HLS 2; and HR, 0.622; 95% CI, 0.569–0.679 for HLS 3). The risk of dementia showed a tendency to decrease with an increase in HLS (
P
‐for‐trend <0.001).

Conclusions
A clustering of healthy lifestyle behaviors was associated with a significantly lower risk of dementia in patients with new‐onset AF. These findings support the promotion of a healthy lifestyle within an integrated care approach to AF patient management.
Information Extraction From Electronic Health Records to Predict Readmission Following Acute Myocardial Infarction: Does Natural Language Processing Using Clinical Notes Improve Prediction of Readmission?
Authors: Brown Jeremiah R. , Ricket Iben M. , Reeves Ruth M. , Shah Rashmee U. , Goodrich Christine A. , Gobbel Glen , Stabler Meagan E. , Perkins Amy M. , Minter Freneka , Cox Kevin C. , Dorn Chad , Denton Jason , Bray Bruce E. , Gouripeddi Ramkiran , Higgins John , Chapman Wendy W. , MacKenzie Todd , Matheny Michael E. 
Published: March 2022

Background
Social risk factors influence rehospitalization rates yet are challenging to incorporate into prediction models. Integration of social risk factors using natural language processing (NLP) and machine learning could improve risk prediction of 30‐day readmission following an acute myocardial infarction.

Methods and Results
Patients were enrolled into derivation and validation cohorts. The derivation cohort included inpatient discharges from Vanderbilt University Medical Center between January 1, 2007, and December 31, 2016, with a primary diagnosis of acute myocardial infarction, who were discharged alive, and not transferred from another facility. The validation cohort included patients from Dartmouth‐Hitchcock Health Center between April 2, 2011, and December 31, 2016, meeting the same eligibility criteria described above. Data from both sites were linked to Centers for Medicare & Medicaid Services administrative data to supplement 30‐day hospital readmissions. Clinical notes from each cohort were extracted, and an NLP model was deployed, counting mentions of 7 social risk factors. Five machine learning models were run using clinical and NLP‐derived variables. Model discrimination and calibration were assessed, and receiver operating characteristic comparison analyses were performed. The 30‐day rehospitalization rates among the derivation (n=6165) and validation (n=4024) cohorts were 15.1% (n=934) and 10.2% (n=412), respectively. The derivation models demonstrated no statistical improvement in model performance with the addition of the selected NLP‐derived social risk factors.

Conclusions
Social risk factors extracted using NLP did not significantly improve 30‐day readmission prediction among hospitalized patients with acute myocardial infarction. Alternative methods are needed to capture social risk factors.
Tubastatin A Improves Post‐Resuscitation Myocardial Dysfunction by Inhibiting NLRP3‐Mediated Pyroptosis Through Enhancing Transcription Factor EB Signaling
Authors: Xu Jiefeng , Zhao Xue , Jiang Xiangkang , He Lu , Wu Xinjie , Wang Jiangang , Chen Qijiang , Li Yulin , Zhang Mao 
Published: March 2022

Background
Myocardial dysfunction is the leading cause of early death following successful cardiopulmonary resuscitation (CPR) in people with cardiac arrest (CA), which is potentially driven by cell pyroptosis mediated by NOD‐like receptor pyrin domain 3 (NLRP3) inflammasome. Recently, histone deacetylase 6 (HDAC6) inhibition was shown to exert effective myocardial protection against regional ischemia/reperfusion injury. In this study, we investigated whether tubastatin A, a specific histone deacetylase 6 inhibitor, could improve postresuscitation myocardial dysfunction through the inhibition of NLRP3‐mediated cell pyroptosis and its modulation mechanism.

Methods and Results
Healthy male white domestic swine were used to establish the model of CA/CPR in vivo, and the H9c2 cardiomyocyte hypoxia/reoxygenation model was used to simulate the CA/CPR process in vitro. Consequently, tubastatin A inhibited NLRP3 inflammasome activation, decreased proinflammatory cytokines production and cell pyroptosis, and increased cell survival after hypoxia/reoxygenation in H9c2 cardiomyocytes in vitro. In addition, tubastatin A increased the acetylated levels of transcription factor EB and its translocation to the nucleus, and its protective effect above was partly abrogated by transcription factor EB short interfering RNA after hypoxia/reoxygenation in H9c2 cardiomyocytes. Similarly, tubastatin A promoted cardiac transcription factor EB nuclear translocation, inhibited NLRP3‐mediated cell pyroptosis, and mitigated myocardial dysfunction after CA/CPR in swine.

Conclusions
The inhibition of histone deacetylase 6 activity by tubastatin A limited NLRP3 inflammasome activation and cell pyroptosis probably through the enhancement of transcription factor EB signaling, and therefore improved myocardial dysfunction after CA/CPR.
Fine Fibrillatory Wave as a Risk Factor for Heart Failure Events in Patients With Atrial Fibrillation: The Fushimi Atrial Fibrillation (AF) Registry
Authors: Kawaji Tetsuma , Ogawa Hisashi , Hamatani Yasuhiro , Kato Masashi , Yokomatsu Takafumi , Miki Shinji , Abe Mitsuru , Akao Masaharu ,   the Fushimi AF Registry investigators
Published: March 2022

Background
The clinical significance of fibrillatory wave on electrocardiography during atrial fibrillation (AF) is poorly understood. The aim of the current study was to explore the association of fine fibrillatory wave with heart failure (HF) in AF.

Methods and Results

The current study enrolled 2442 patients with AF whose baseline ECG during AF rhythm was available from a community‐based prospective survey, the Fushimi AF Registry. The impact of fine fibrillatory wave, defined as the amplitude of fibrillatory waves <0.1 mV, on the primary composite HF end point (a composite of hospitalization attributable to HF or cardiac death) was examined. Fine fibrillatory wave was observed in 589 patients (24.1%). Patients with fine fibrillatory wave were older, and had a higher prevalence of sustained AF, preexisting HF, and larger left atrial diameter than those with coarse fibrillatory wave. During the median follow‐up duration of 5.9 years, the cumulative incidence of the primary composite HF end point was significantly higher in patients with fine fibrillatory wave than in those with coarse fibrillatory wave (5.3% versus 3.6% per patient‐year, log‐rank
P
<0.001). The higher risk associated with fine fibrillatory wave was consistent even for individual components of the primary composite HF end point. On multivariable analysis, fine fibrillatory wave became an independent predictor for the primary composite HF end point (hazard ratio, 1.31; 95% CI, 1.07–1.61;
P
=0.01).

Conclusions
Compared with coarse fibrillatory wave, fine fibrillatory wave was more prevalent in patients with a larger left atrial diameter or those with sustained AF and was independently associated with a higher risk of HF events.

Registration

URL:
https://www.umin.ac.jp/ctr/
; Unique identifier: UMIN000005834.
PSG7 and 9 (Pregnancy‐Specific β‐1 Glycoproteins 7 and 9): Novel Biomarkers for Preeclampsia
Authors: Kandel Manju , MacDonald Teresa M. , Walker Susan P. , Cluver Catherine , Bergman Lina , Myers Jenny , Hastie Roxanne , Keenan Emerson , Hannan Natalie J. , Cannon Ping , Nguyen Tuong‐Vi , Pritchard Natasha , Tong Stephen , Kaitu’u‐Lino Tu’uhevaha J. 
Published: March 2022

Background
Preeclampsia is pregnancy specific, involving significant maternal endothelial dysfunction. Predictive biomarkers are lacking. We evaluated the biomarker potential, expression, and function of PSG7 (pregnancy‐specific β‐1 glycoprotein 7) and PSG9 (pregnancy‐specific β‐1 glycoprotein 9) in preeclampsia.

Methods and Results

At 36 weeks gestation preceding term preeclampsia diagnosis, PSG7 and PSG9 (in Australian cohorts of n=918 and n=979, respectively) were significantly increased before the onset of term preeclampsia (PSG7,
P
=0.013; PSG9,
P
=0.0011). In samples collected at 28 to 32 weeks from those with preexisting cardiovascular disease and at high risk of preeclampsia (Manchester Antenatal Vascular Service, UK cohort, n=235), both PSG7 and PSG9 were also significantly increased preceding preeclampsia onset (PSG7,
P
<0.0001; PSG9,
P
=0.0003) relative to controls. These changes were validated in the plasma and placentas of patients with established preeclampsia who delivered at <34 weeks gestation (PSG7,
P
=0.0008; PSG9,
P
<0.0001). To examine whether PSG7 and PSG9 are associated with increasing disease severity, we measured them in a cohort from South Africa stratified for this outcome, the PROVE (Preeclampsia Obstetric Adverse Events) cohort (n=72). PSG7 (
P
=0.0027) and PSG9 (
P
=0.0028) were elevated among patients who were preeclamptic with severe features (PROVE cohort), but not significantly changed in those without severe features or with eclampsia. In syncytialized first trimester cytotrophoblast stem cells, exposure to TNFα (tumor necrosis factor α) or IL‐6 (interleukin 6) significantly increased the expression and secretion of PSG7 and PSG9. In contrast, when we treated primary endothelial cells with recombinant PSG7 and PSG9, we only observed modest changes in
Flt‐1
(FMS‐like tyrosine kinase‐1) expression and
Plgf
(placental growth factor) expression, and no other effects on proangiogenic/antiangiogenic or endothelial dysfunction markers were observed.

Conclusions
Circulating PSG7 and PSG9 are increased before preeclampsia onset and among those with established disease with their production and release potentially driven by placental inflammation.
Association of Night‐to‐Night Adherence of Continuous Positive Airway Pressure With Day‐to‐Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea
Authors: Hoshide Satoshi , Yoshida Tetsuro , Mizuno Hiroyuki , Aoki Hiroyoshi , Tomitani Naoko , Kario Kazuomi 
Published: March 2022

Background
The aim of this study was to investigate the association between night‐to‐night adherence to continuous positive airway pressure (CPAP) therapy and both home blood pressure (BP) level on the following day and seasonal variation in home BP in patients with obstructive sleep apnea.

Methods and Results

We analyzed 105 participants who had been diagnosed with obstructive sleep apnea (average apnea‐hypopnea index, 49.7±18.4 per hour) and who were already receiving CPAP therapy. Home BP (twice every morning and evening) and CPAP adherence data were automatically transmitted to a server for 1 year. A mixed‐effects model for repeated measures analysis was used to examine associations of night‐to‐night good CPAP adherence with day‐to‐day home BP within the same patient after adjusting for covariates. The average number of days in which patients achieved both CPAP adherence and morning or evening home BP measurement was 206.6±122.7 days (21 487 readings) and 191.2±126.3 days (20 170 readings), respectively. Good CPAP adherence (>4 hours per night of use) was achieved on the evening or morning before home BP measurements (86.8% and 86.9%, respectively). After adjustment for confounders, good CPAP adherence was negatively associated with morning home systolic BP (β, −0.663;
P
=0.004) and diastolic BP (β, −0.829;
P
<0.001). Morning home systolic BP in winter in the individuals with good CPAP adherence was significantly lower than that in individuals without such adherence (
P
<0.05). These associations were not found in evening home BP.

Conclusions
Good adherence to CPAP therapy was negatively associated with morning home BP on the following day in patients with obstructive sleep apnea. The association was remarkable in the winter season.
Impact of Shunting Practice Patterns During Carotid Endarterectomy for Symptomatic Carotid Stenosis
Authors: Squizzato Francesco , Siracuse Jeffrey J. , Shuja Fahad , Colglazier Jill , Balachandran Wilkins Parvathi , Goodney Philip P. , Sands Brooke Benjamin , DeMartino Randall R. 
Published: March 2022

Background:
We aimed to assess the effect of surgeons’ shunting practice and shunt use on the early outcomes of carotid endarterectomy (CEA) in recently symptomatic patients.

Methods:
We conducted a retrospective observational study based on a multicenter national prospective database. The Vascular Quality Initiative database (2010–2019) was queried for CEAs performed within 14 days after an ipsilateral stroke or transient ischemic attack. Surgeons were gauged as routine shunters if they shunted in >95% of CEAs, otherwise were classified as selective shunters. In-hospital stroke and death rates were compared between routine and selective shunters, stratifying by type of index event (transient ischemic attack versus stroke) and timing of CEA (≤2 versus >2 days).

Results:

Thirteen thousand four hundred sixty-nine CEAs were performed after a transient ischemic attack (43%) or stroke (57%), 3186 (24%) by routine shunters, and 10 283 (76%) by selective shunters. Comparing routine and selective shunters, in-hospital stroke (1.9% versus 2.4%;
P
=0.09) and death (0.4% versus 0.5%;
P
=0.73) rates were similar. A lower stroke rate (1.5% versus 4.2%;
P
=0.02) was achieved by routine shunters for CEA performed <2 days after an ischemic stroke. Among selective shunters, a higher stroke rate occurred in case of shunt use (2.9% versus 2.3%;
P
<0.01), mainly due to cases presenting with stroke (3.5% versus 2.4%;
P
<0.01) but not transient ischemic attack (1.8% versus 1.5%;
P
=0.57). Awake anesthesia was adopted in 7.8% of cases by selective shunters and in 0.8% by routine shunters, without impact on the perioperative stroke rate (1.8% versus 2.3%;
P
=0.349).

Conclusions:
In this large national cohort, the overall outcomes of CEA were similar between routine and selective shunters. A lower postoperative stroke rate was achieved by routine shunters in CEA performed <2 days after an ischemic stroke. Among selective shunters, intraoperatively indicated shunting determined an increased stroke rate, likely due to intraoperative hypoperfusion. These data may guide the decision regarding timing of CEA and shunting intention in symptomatic patients.
Association of the 24‐Hour National Institutes of Health Stroke Scale After Mechanical Thrombectomy With Early and Long‐Term Survival
Authors: Kurmann Christoph C. , Beyeler Morin , Grunder Lorenz , Lang Matthias F. , Piechowiak Eike I. , Meinel Thomas R. , Jung Simon , Hoffmann Angelika , Seiffge David J. , Heldner Mirjam R. , Dobrocky Tomas , Mordasini Pasquale , Arnold Marcel , Gralla Jan , Fischer Urs , Kaesmacher Johannes 
Published: March 2022

Background
The National Institutes of Health Stroke Scale (NIHSS) obtained 24 hours after ischemic stroke is a good indicator for functional outcome and early mortality, but the correlation with long‐term survival is less clear. We analyzed the correlation of the NIHSS after 24 hours (24h NIHSS) and early clinical neurological development after mechanical thrombectomy with early and long‐term survival as well as its predictive power on survival.

Methods
We reviewed a prospective observational registry for all patients undergoing mechanical thrombectomy between January 2010 and December 2018. Vital status was extracted from the Swiss Population Registry. Adjusted hazard ratio (aHR) and crude hazard ratios were calculated using Cox regression. To assess predictive power of the 24h NIHSS, different Random Survival Forest models were evaluated.

Results
We included 957 patients (median follow‐up 1376 days). Patients with lower 24h NIHSS and major early neurological improvement had substantially better survival rates. We observed significantly higher aHR for death in patients with 24h NIHSS 12 to 15 (aHR, 1.78; 95% CI, 1.1–2.89), with 24h NIHSS 16 to 21 (aHR, 2.54, 95% CI, 1.59–4.06), and with 24h NIHSS >21 (aHR, 5.74; 95% CI, 3.47–9.5). The 24h NIHSS showed the best performance predicting mortality (receiver operating characteristic area under the curve at 3 months [0.85±0.034], at 1 year [0.82±0.029], at 2 years [0.82±0.031], and at 5 years [0.83±0.035]), followed by NIHSS change.

Conclusions
Patients with acute ischemic stroke achieving a low 24h NIHSS or major early neurological improvement after mechanical thrombectomy had markedly lower long‐term mortality. Furthermore, 24h NIHSS had the best predictive power for early and long‐term survival in our machine learning–based prediction.
The Impact of Delays in Interfaculty Transfer on Outcomes in Elderly Trauma Patients
Authors: Quinn Seth A. , Edwards Jacob D. , Buccini Peter , Parmley Michael K. , Leonard Kenji , Irish William , Toschlog Eric A. 
Published: March 2022

Background Delay to definitive treatment is a significant and persistent challenge to trauma systems across the United States, especially in rural communities with limited resources. We hypothesized that elderly trauma patients with delay in transfer would have increased morbidity and mortality. This study evaluates the relationship between inter-facility transfer time and outcomes in elderly trauma patients, and the validity of the 4-hour dwell time as a performance improvement benchmark. Methods The National Trauma Registry and Emergency Medical Services Database were queried from January 2010 to January 2018. Inclusion criteria included age ≥65, blunt mechanism, and transfer from another facility. Correlation analysis was used to evaluate the association between clinical and demographic variables and transfer time. Multicollinearity was evaluated using the variance inflation factor. Results 1535 patients were identified. This cohort was further subdivided into 4 cohorts based on dwell time: 0-1.5 hours (n = 384), ≥1.5-1.9 hours (n = 379), 1.9-<2.5 hours (n = 383), and ≥2.5 hours (n = 388). Analysis revealed that shorter dwell time was associated with male gender ( P = .0039), higher ISS (injury severity score) ( P < .0001), lower RTS (revised trauma score) ( P < .0001), higher pre-hospital arrest ( P = .0066), lower initial GCS (Glasgow Coma Scale) ( P = .0012), higher mortality, longer ICU, and ventilator length of stay ( P < .0001). Longer dwell times were associated with discharge from the hospital to home or skilled nursing facility as well as lower mortality ( P < .0001). Discussion Longer dwell time was inversely related to outcome. More severely injured patients were rapidly transferred. This represents a mature rural trauma system. In addition, dwell time should be scrutinized as a meaningful indicator within a performance improvement program.
Quantification of Lanthanides in a Molten Salt Reactor Surrogate Off-Gas Stream Using Laser-Induced Breakdown Spectroscopy
Authors: Andrews Hunter B. , Myhre Kristian G. 
Published: March 2022

To enable the deployment of molten salt reactor technology, the development of off-gas treatment systems and advanced monitoring tools capable of operating with high temperatures and radiation fields while delivering near real-time information is necessary. This study aims to fulfill this requirement and proposes laser-induced breakdown spectroscopy (LIBS) for monitoring molten salt aerosol streams. A sheath gas measuring method was developed to protect optical elements from aerosol particles and to ensure a relatively constant aerosol stream for measurement. An aqueous system was studied to demonstrate the utility of LIBS for monitoring possible fission products in an aerosol stream: Gd, Nd, and Sm up to 2000 parts per million (ppm). A calibration model was built using partial least squares (PLS) regression with five, six, and nine latent variables for Gd, Nd, and Sm, respectively. This calibration model successfully estimated the concentrations of three test samples, which were validated with inductively charged plasma optical emission spectroscopy measurements at a 99.9% confidence interval. To enhance these models, a genetic algorithm was used to filter the spectra before entering the PLS model, thereby limiting the spectral features being regressed to those with greater correlations to concentration. This allowed for the number of latent variables used in the PLS models to be reduced to four, three, and three for Gd, Nd, and Sm, respectively. Lastly, the genetic algorithm-filtered PLS models were used to predict the concentrations of the aerosol stream on a real-time dataset and resulted in a 73%, 18%, and 25% improvement in root mean squared error of prediction compared to the original PLS models developed.