bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of arterial properties with left ventricular morphology and function in the community
Authors: Mukai Yasuhiro , Nakanishi Koki , Daimon Masao , Sawada Naoko , Hirose Kazutoshi , Iwama Kentaro , Yamamoto Yuko , Yoshida Yuriko , Ishiwata Jumpei , Koyama Katsuhiro , Nakao Tomoko , Morita Hiroyuki , Di Tullio Marco R. , Homma Shunichi , Komuro Issei 
Published: August 2022

Objectives:
Arterial structural and functional remodeling is recognized as a key determinant of incident heart failure, although the contribution of arterial properties on left ventricular (LV) remodeling is not fully studied. Aortic dilatation is an early manifestation of arterial remodeling and estimated pulse wave velocity (ePWV) is emerging as a simple measure of arterial stiffness. This study aimed to characterize the association of aortic size and ePWV with LV morphology and function.

Methods:
The study cohort consisted of 539 participants without overt cardiac disease who underwent extensive cardiovascular examination. Aortic root diameter was measured by two-dimensional echocardiography and ePWV was calculated from a regression equation using age and mean blood pressure. LV global longitudinal strain (LVGLS) was obtained by speckle-tracking echocardiography.

Results:
Aortic root diameter and ePWV were correlated with LV mass index and LVGLS, while only ePWV was related to E/e′ ratio. In multivariable analysis, aortic root diameter and ePWV were significantly related to LV mass index and LVGLS (all P < 0.05), and the association of aortic root size and ePWV with LVGLS was independent of LV mass index and E/e′ ratio. Individuals with both aortic root enlargement and increased ePWV had significantly larger LV mass index and reduced LVGLS compared with those either or those with normal aortic size and ePWV (both P < 0.05).

Conclusion:
Aortic root size and ePWV were independently associated with unfavorable LV remodeling in individuals free of cardiac disease, which might provide useful information into the pathogenesis-linking arterial remodeling and heart failure.
Optimal office blood pressure levels in younger (<50 years old) Korean hypertensive patients: a nationwide cohort study in South Korea
Authors: Kwon Chang Hee , Lee Hae-Young , Lee Jun Hyeok , Kim Minkwan , Sung Ki-Chul 
Published: August 2022

Background:
It is unclear what thresholds and targets of office blood pressure (BP) for treatment are appropriate in younger (<50 years old) hypertensive patients. Thus, the aim of this study was to evaluate associations of office BP levels with major cardiovascular events (MACEs) in these patients.

Methods:
Using the Korean National Health Insurance Service database, data of 98 192 younger (<50 years old) hypertensive patients having BP measurements available without any history of cardiovascular events from 2002 to 2011 were extracted. This cohort study evaluated associations of BP levels (<120/<70, 120–129/70–79, 130–139/80–89, 140–149/90–99, and ≥150/≥100 mmHg) with MACEs. The study outcome was MACE, a composite of cardiovascular death, myocardial infarction, stroke, and heart failure.

Results:
In all patients, those treated with antihypertensive medication accounted for 34.7% and those who achieved BP less than 130/80 mmHg accounted for 35.5%. During a mean follow-up of 9.5 ± 2.8 years, 4918 (5%) MACEs were documented in our cohort. The risk of MACE was the lowest [adjusted hazard ratio: 0.77, 95% confidence interval (CI) 0.66–0.89] for those with BP level of less than 120/less than 70 mmHg. It was the highest (hazard ratio 2.0, 95% CI 1.83–2.19) for those with BP level of at least 150/at least 100 mmHg in comparison with those with BP level of 130–139/80–89 mmHg. These results were consistent for all age groups (20–29, 30–39, and 40–49 years) and both sexes.

Conclusion:
Elevated BP level from less than 120 mmHg/less than 70 mmHg is significantly correlated with an increased risk of MACE in younger (<50 years old) Korean hypertensive patients. Lowering BP to less than 120 mmHg/less than 70 mmHg is needed for these patients.
LONGITUDINAL ASSESSMENT OF CHOROIDAL STRUCTURE IN PATIENTS WITH MACULAR NEOVASCULARIZATION
Authors: Lee Kanghoon , Chin Hee Seung 
Published: August 2022

Purpose:
To investigate morphologic changes of choroidal structure through chronologic aspect in progression of macular neovascularization (MNV) with pachychoroid features.

Methods:
One hundred seventy-one MNV participants above 50 years old with or without pachychoroid features were included in the analysis. Age-matched 132 normal patients were analyzed as control group. The total choroidal area and ratio of Sattler's layer area to total choroidal area, derived by summing 25 horizontal raster scans of the 30° × 20° scan area on enhanced depth imaging optical coherence tomography, were calculated to compare the difference among the normal eyes and the MNV eyes with/without pachychoroid features.

Results:
The mean ratio of Sattler's layer area to total choroidal area is maintained at around 40% in normal eyes and MNV eyes without pachychoroid features. In MNV with pachychoroid features, the ratio of Sattler's layer area to total choroidal area changes according to the disease activity. Ratio of Sattler's layer area to total choroidal area is 34.1 ± 4.4% at the time of onset, 37.2 ± 4.8% at the time of remission, and decreases during recurrence from 36.8 ± 3.8% to 33.4 ± 3.8% (all P < 0.001).

Conclusion:
MNV with pachychoroid features is a disease whose development and progression are related to a change in the choroidal interlayer area ratio following the relatively larger dilation of Haller's layer vessels.
360 DEGREE ENDOLASER VERSUS FOCAL ENDOLASER IN PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Mathai Mariam , Godwin Kristen S. , Albarracin Julio , Levinson Joshua , Broderick Kevin , Melamud Alexander 
Published: August 2022

Purpose:
To determine the efficacy of the 360-degree endolaser (360EL) versus focal laser during primary vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair.

Methods:
A single-site retrospective chart review was performed on 241 patients who underwent PPV for primary RRD. Patients were assigned to two groups, PPV with 360EL (n = 183) and PPV without 360EL (n = 59). Only cases where surgeons performed 360EL on all RRDs or surgeons who never perform 360EL on RRDs were included.

Results:
The single surgery anatomical success rate in the 360EL group was 90.2% compared with 86.5% with focal laser (P = 0.619). Epiretinal membrane formation in 360EL group at 1 year was 44.4% versus 37% with focal laser (P = 0.429). Cystoid macular edema formation within 1 year of surgery was 25.8% in 360EL group versus 11.9% with focal laser (P = 0.04).

Conclusion:
The use of 360EL in PPV for RRD repair does not improve single-surgery anatomical success in routine RRDs when compared with PPV with focal laser.
Mechanisms of chronic pain in inflammatory rheumatism: the role of descending modulation
Authors: Trouvin Anne-Priscille , Simunek Arielle , Coste Joël , Medkour Terkia , Carvès Sandrine , Bouhassira Didier , Perrot Serge 
Published: August 2022

Abstract
Persistent pain despite satisfactory disease treatment is frequent in rheumatoid arthritis (RA) and spondyloarthritis (Spa) and may result from specific changes in central pain processing. We assessed these mechanisms further by systematically comparing thermal pain thresholds and conditioned pain modulation (CPM) between patients with active RA or Spa and healthy controls. We included 50 patients with RA and 50 patients with Spa and 100 age-matched and sex-matched controls. Heat and cold pain thresholds (HPT-CPT) were measured on the dominant forearm, and CPM was assessed by applying conditioning stimuli (immersion in a cold-water bath) to one foot and the nondominant hand in 2 successive randomized sequences. Descending pain modulation was assessed as the difference in HPTs (in °C) before and after conditioning. Larger HPT differences (ie, a larger CPM effect) reflected more efficient descending inhibition. Potential associations between changes in CPM and clinical data, including disease activity, pain intensity, and psychological and functional variables, were systematically assessed. Heat pain threshold and cold pain threshold were similar in patients and controls. The mean CPM effect was significantly weaker in patients than that in controls for conditioning applied to either the foot (0.25°C ±2.57 vs 2.79°C ±2.31; P < 0.001) or the nondominant hand (0.57°C ±2.74 vs 2.68°C ±2.12; P < 0.001). The smaller CPM effect in patients was correlated with average pain intensity, but not with disease activity or other clinical characteristics, suggesting a significant pathophysiological role for changes in endogenous pain modulation in the mechanisms of chronic pain associated with inflammatory rheumatism.
Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record
Authors: Skeff Kelley M. , Brown-Johnson Cati G. , Asch Steven M. , Zionts Dani L. , Winget Marcy , Kerem Yaniv 
Published: August 2022

Goal:
Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR.

Methods:
In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR “distressing events” were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies.

Principal Findings:
Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed.

Practical Applications:
Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.
Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States
Authors: Shanafelt Tait , Trockel Mickey , Wang Hanhan , Mayer Thom , Athey Leslie 
Published: August 2022

Goal:
The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics.

Methods:
Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment—as well as a sleep-related impairment and self-valuation—were assessed using standardized instruments.

Principle Findings:
Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0–10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0–10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19–1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57–0.68]; p < .001) were independently associated with burnout after adjusting for all other variables.

Applications to Practice:
Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one-third of healthcare leaders had burnout scores that fell in the high range. At the individual level, sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.
Bone densitometry in children with idiopathic nephrotic syndrome on prolonged steroid therapy: A tertiary multicenter study
Authors: Soliman Ahmed S.A. , Abukhatwah Mohamed W. , Kamal Naglaa M. , Sweed Enas M.M. , Alelyani Abdullah M. , Althobaiti Sami D. , Alzaedi Mazen A , El-Rebigi Amany M. , Besher Nehad T. , Abukhatwah Omar M.W. , Alharbi Abdullah O. , Afifi Wesam E. 
Published: August 2022

Long-term glucocorticoids administration inhibits bone mineralization and has a negative impact on basic cellular mechanisms that are critical in the development and maintenance of bone strength. Steroids can cause osteoporosis in children and have a negative impact on bone mineral content (BMC) and bone mineral density (BMD).
We aim to determine the BMD of children with idiopathic nephrotic syndrome (INS) who are on corticosteroids therapy.
This cross-sectional study included 90 patients on corticosteroids therapy and 50 apparently healthy age and sex-matched children served as a control group. Renal functions, bone biochemistry, and parathyroid hormone (PTH) were measured in patients and controls. BMD was measured at the lumbar spinal region (L2–L4) using Dual-energy X-ray absorptiometry (DEXA) scan in both patients and controls groups.
Serum PTH, phosphorous, and alkaline phosphatase levels were significantly higher in patients than in controls. There was a statistically significant reduction in blood calcium levels in patients compared to controls. Osteopenia was diagnosed by DEXA scan in 24 patients (26.7%) and osteoporosis in 12 patients (13.3 %). There was a statistically significant decline in BMD-z score, BMD, and BMC in patients compared to the healthy group.
Patients with INS on corticosteroids treatment have a lower BMD than their peers. Pediatric INS patients had a high prevalence of osteopenia and osteoporosis as measured by DEXA. Steroid therapy has a deleterious impact on bone mineralization in children with INS.
Diagnosis and treatment of primary hyperparathyroidism with pathological fracture of the limbs: A retrospective observational study
Authors: Liu Huijiang , Luo Kai , Liao Shijie , Tang Haijun , Mo Jianming , Xie Tianyu , Li Chong , Li Boxiang , Liu Yun , Zhan Xinli 
Published: August 2022

Primary hyperparathyroidism (PHPT) with pathological fracture is rare, and the early symptoms of PHPT lack specificity, leading to misdiagnosis. Therefore, this study aimed to summarize the clinical characteristics and treatment of PHPT patients with pathological fractures and to improve the attention of orthopedic clinicians to PHPT.
It is a retrospective study, 2226 patients with hyperparathyroidism in our hospital from 2009 to 2019 were screened, excluding secondary hyperparathyroidism and patients without limb fracture, and the remaining 20 patients with PHPT accompanied by pathological fractures were finally analyzed. Parathyroid hormone (PTH) and calcium levels were compared on the first postoperative day, and the prognosis of the patients was assessed by bone mineral density and Visual Analogue Scale scores at 3 and 12 months postoperatively.
The early symptoms of PHPT patients in this study included urinary calculi (80%), bone pain (30%), and digestive tract symptoms (25%). Fourteen (70%) cases were misdiagnosed at the initial diagnosis. After parathyroidectomy, the blood calcium and PTH levels decreased significantly in all patients (P < .05). For the treatment of fracture, 9 of the patients underwent surgical treatment of the fracture, while the remaining patients received splint external fixation. The follow-up time was 4.60 ± 0.62 years (1–10 years). All patients recovered well from the fracture, the symptoms of systemic bone pain were markedly improved, and bone mineral density was significantly improved after surgery.
Orthopedic surgeons need to avoid misdiagnosis and pay attention to the early symptoms in PHPT patients with pathological fracture, and better therapeutic effects can be obtained by combining parathyroidectomy with fractures fixation.
Analysis of the impact of noninvasive prenatal testing for trisomies 21 and 18 in twin pregnancies undergoing artificial reproductive technology
Authors: Yang Cuiyu , Hu Linhua , Jiang Shudan , Liang Fengbing , Zhang Songying 
Published: August 2022

Purpose:
The purpose of this study was to evaluate the performance and impact of noninvasive prenatal screening (NIPS) on twin pregnancies.

Patients and methods:
Twin pregnancies after artificial reproductive technology(ART) were tested by NIPS for screening trisomy 21, 18, and 13 in a single medical center in Hangzhou. Positive NIPS results were confirmed by karyotyping, while negative results were interviewed after delivery.

Results:
From January 2019 to December 2020, 474 twin pregnancies were tested by NIPS for screening trisomy 21, 18, and 13 in a single medical center in Hangzhou. The performance of NIPS had been evaluated compared to the invasive diagnostic results. The positive predictive value (PPV) of NIPS for chromosome 21 and 18 aneuploidies is 80% (95CI, 36.09–96.59) and 100%, respectively. The incidence of trisomy 21, and 18 chromosome aneuploidies among the twin pregnancies undergoing ART was 0.84% and 0.21%, respectively.

Conclusion:
The performance of NIPS was substantially accurate among the twin pregnancies after ART in this study, and NIPS potentially avoided a considerable part of aneuploidies liveborn in twin pregnancies in Hangzhou.
Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis
Authors: Chen I-Wen , Li Yu-Yu , Hung Kuo-Chuan , Chang Ying-Jen , Chen Jen-Yin , Lin Ming-Chung , Wang Kuei-Fen , Lin Chien-Ming , Huang Ping-Wen , Sun Cheuk-Kwan 
Published: August 2022

Background:
Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization.

Method:
The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage.

Results:
Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89–1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93–1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: –8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16–1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23–0.9, P = .02).

Conclusion:
Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.
The efficacy and safety of oxycodone in treating the uterine contraction pain after negative pressure aspiration: A randomized, compared, multicenter clinical study
Authors: Wang Yi-Nan , Xu Ming-Jun , Feng Ying , Chen Xin-Zhong , Yao Fei , Shen Ming-Kun , Zou Lu-Wen , Feng Hua , Zhao Lei , Xu Jian-Guo 
Published: August 2022

This study aims to evaluate the efficacy and safety of oxycodone hydrochloride in treating postoperative uterine contraction pain in dysmenorrhea patients undergoing negative pressure aspiration.
This study is a multicenter randomized controlled clinical trial. Two hundred patients with history of moderate or severe dysmenorrhea for negative pressure aspiration were divided into 4 groups evenly (n = 50): the control group (group P, isotonic saline), the low-dose oxycodone group (group O1), the medium-dose oxycodone group (group O2), and the high-dose oxycodone group (group O3). All the 4 groups were followed by slow (45–60 seconds) static push of propofol until eyelash reflex disappeared (a maximum dose of 2.5 mg/kg). Additional propofol (0.6–1 mg/kg) was added if body movement occurred during operation.
The postoperative VAS scores in different groups showed that there was no statistical difference between groups P and O1, while there were statistical differences when groups O2 and O3 were compared with group P (P < .01), and when group O3 compared with O1 (P < .01). Furthermore, there was no significant differences in HR and BP among the 4 groups, but the intraoperative respiratory frequency in groups O1, O2, and O3 was significantly higher than in group P (P < .01). The SPO2 after operation in groups O2 and O3 was higher than in group P (P < .05). There was a significant difference in the VAS ≥ 4 between group O2 or O3 and Group P (P < .01). The incidence of respiratory depression in P group was significantly higher than in O1, O2, and O3 groups (P < .01). The dilatation time and the number of dilatation bar used in group O3 is lower than that of group P and group O1 (P < .01). The difficulty of dilatation in group P was 26% as assessed by clinicians, with significant differences with groups O1, O2, and O3 (P < .01).

Conclusion:
Oxycodone hydrochloride injection could be safely and effectively applied to negative pressure aspiration, and a 0.08 mg/kg dose could significantly reduce postoperative uterine contraction pain of patients with dysmenorrhea.