bluuebunny/crossref_metadata_2025_split huggingface dataset:
“You tell him that ‘baby, I am protecting myself’”: Women’s agency and constraint around willingness to use pre-exposure prophylaxis in the Masibambane Study
Authors: Harrison Abigail , Bhengu Nonhlonipho , Miller Lori , Exner Theresa , Tesfay Nonkululeko , Magutshwa Slindile , Khumalo Silindile , Bergam Scarlett , Hoffman Susie , Hanass-Hancock Jill 
Published: March 2022

Objectives: To explore women’s willingness to consider using pre-exposure prophylaxis for HIV prevention in the context of gendered relationship dynamics, in Durban, South Africa. Methods: As formative research prior to development of a gender-informed intervention to introduce pre-exposure prophylaxis to young, urban, educated women, we conducted six focus-group discussions and eight in-depth interviews with 46 women ages 18–25 years, who were not current pre-exposure prophylaxis users. Women were recruited from clinic and community settings using a criterion-based snowball sampling technique. Qualitative data were coded and analyzed thematically, with a team-based consensus approach for final coding, analytical decisions, and data interpretation. Results: Women clearly understood the benefits of pre-exposure prophylaxis for themselves and their partners, focusing on promoting health and their right to protect themselves from HIV infection. At the same time, and in accordance with findings from other studies, women were realistic about the concerns that would arise among male partners, including disapproval, loss of trust, possible loss of the relationship, and in some instances, the potential for violence, if they were to propose pre-exposure prophylaxis use. To resolve this tension, some women advocated for covert use as the best option for themselves and others argued for disclosure, proposing various approaches to working with partners to adopt pre-exposure prophylaxis. The suggestion that both partners use pre-exposure prophylaxis was made repeatedly. Thus, women sought to avoid discussions of trust or lack of trust and a partner’s possible infidelities, choosing instead to focus on preserving or even building a relationship through suggesting pre-exposure prophylaxis use. Conclusion: Women offered diverse narratives on agency and constraint in relation to choosing pre-exposure prophylaxis as a future prevention strategy, as well as ways to engage with their male partners about pre-exposure prophylaxis. These findings speak to the need for interventions to bolster women’s confidence, sense of empowerment, and their communication and decision-making skills for successful HIV prevention.
Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study
Authors: Melamed Roman , Paz Francisco , Jepsen Stacy , Smith Claire , Saavedra Ramiro , Mulder Maximilian , Masood Adnan , Huelster Joshua , Kirkland Lisa , Guenther Alena , Boland Lori 
Published: March 2022

Background: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients. Methods: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as  > 17 days of MV. Results: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO2/FiO2 ratio, higher PCO2, and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO2/FiO2 ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance. Conclusion: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO2/FiO2 ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.
Modulation of Inflamed Synovium Improves Migration of Mesenchymal Stromal Cells in Vitro Through Anti-Inflammatory Macrophages
Authors: Wesdorp Marinus A. , Bastiaansen-Jenniskens Yvonne M. , Capar Serdar , Verhaar Jan A.N. , Narcisi R. , Van Osch Gerjo J.V.M. 
Published: March 2022

Objective Inflammation is known to negatively affect cartilage repair. However, it is unclear how inflammation influences the migration of mesenchymal stromal cells (MSCs) from the underlying bone marrow into the defect. We therefore aimed to investigate how synovial inflammation influences MSC migration, and whether modulation of inflammation with triamcinolone acetonide (TAA) may influence migration. Design Inflamed human osteoarthritic synovium, M(IFNγ+TNFα) pro-inflammatory macrophages, M(IL4) repair macrophages, M(IL10) anti-inflammatory macrophages, or synovial fibroblasts were cultured with/without TAA. Conditioned medium (CM) was harvested after 24 hours, and the effect on MSC migration was studied using a Boyden chamber assay. Inflammation was evaluated with gene expression and flow cytometry analysis. Results Synovium CM increased MSC migration. Modulation of synovial inflammation with TAA further increased migration 1.5-fold ( P < 0.01). TAA significantly decreased TNFA, IL1B, and IL6 gene expression in synovium explants and increased CD163, a gene associated with anti-inflammatory macrophages. TAA treatment decreased the percentage of CD14+/CD80+ and CD14+/CD86+ pro-inflammatory macrophages and increased the percentage of CD14+/CD163+ anti-inflammatory macrophages in synovium explants. Interestingly, MSC migration was specifically enhanced by medium conditioned by M(IL4) macrophages and by M(IL10) macrophages treated with TAA, and unaffected by CM from M(IFNγ+TNFα) macrophages and synovial fibroblasts. Conclusion Macrophages secrete factors that stimulate the migration of MSCs. Modulation with TAA increased specifically the ability of anti-inflammatory macrophages to stimulate migration, indicating that they play an important role in secreting factors to attract MSCs. Modulating inflammation and thereby improving migration could be used in approaches based on endogenous repair of full-thickness cartilage defects.
Location-Specific Study of Young Rabbit Femoral Cartilage by Quantitative µMRI and Polarized Light Microscopy
Authors: Batool Syeda , Hammami Mouhamad , Mantebea Hannah , Badar Farid , Xia Yang 
Published: March 2022

Objective Microscopic magnetic resonance imaging (µMRI) and polarized light microscopy (PLM) are used to characterize the structural variations at different anatomical locations of femoral cartilage in young rabbits (12-14 weeks old). Design Four intact knees were imaged by µMRI at 86 µm resolution. Three small cartilage-bone specimens were harvested from each of 2 femoral medial condyles and imaged by quantitative µMRI (T2 anisotropy) at 9.75 µm resolution ( N = 6). These specimens, as well as the other 2 intact femoral condyles, were used for histology and imaged by quantitative PLM (retardation and angle) at 0.25 µm to 4 µm resolutions. Results Quantitative MRI relaxation data and PLM fibril data revealed collaboratively distinct topographical variations in both cartilage thickness and its collagen organization in the juvenile joint. Cartilage characteristics from the central location have a 3-zone arcade-like fibril structure and a distinct magic angle effect, commonly seen in mature articular cartilage, while cartilage at the anterior location lacks these characteristics. Overall, the lowest retardation values and isotropic T2 values have been found in the distal femur (trochlear ridge), with predominant parallel fibers with respect to the articular surface. Central cartilage is the thickest (~550 µm), approximately twice as thick as the anterior and posterior locations. Conclusion Distinctly different characteristics of tissue properties were found in cartilage at different topographical locations on femoral condyle in rabbits. Knowledge of location-specific structural differences in the collagen network over the joint surface can improve the understanding of local mechanobiology and provide insights to tissue engineering and degradation repairs.
Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis
Authors: Ali Mohammed Usman , Fong Kenneth Nai-Kuen , Kannan Priya , Bello Umar Muhammad , Kranz Georg S. 
Published: March 2022

Objective: To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB). Data Sources: Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021. Review Methods: Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors. Results: Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): −0.614; 95% confidence interval (CI): −1.023, −0.206; p = 0.003) and stroke (SMD: −2.639; 95% CI: −3.804, −1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): −12.406; 95% CI: −16.015, −8.797; p = 0.000) and BT (WMD: −9.117; 95% CI: −14.746, −3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson’s disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: −0.751; 95% CI: −2.426, 0.924; p = 0.380) and BT (WMD: −0.597; 95% CI: −1.278, 0.083; p = 0.085) on UUI due to Parkinson’s disease. Conclusions: Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson’s disease, although the effects of PFMT and BT on UUI warrant further investigation.
Urinary Potassium Excretion and Progression From Advanced CKD to Kidney Failure
Authors: Hundemer Gregory L. , Sood Manish M. , Ramsay Tim , Akbari Ayub 
Published: March 2022

Background: Increased dietary potassium intake has well-proven beneficial effects on cardiovascular health and mortality. However, the association between dietary potassium intake and chronic kidney disease (CKD) progression remains unclear with prior studies reporting conflicting results. Objective: To study the association between 24-hour urinary potassium excretion (a surrogate for dietary potassium intake) and progression to kidney failure. Design: Retrospective cohort study. Setting: Ottawa, Canada Patients: Patients with advanced CKD referred to the Ottawa Hospital Multi-Care Kidney Clinic from 2010 to 2020. Measurements: Twenty-four-hour urinary potassium excretion measured upon referral to the Ottawa Hospital Multi-Care Kidney Clinic as part of routine clinic protocol. Methods: Multivariable Cox and Fine and Gray models provided hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the association between quartiles of 24-hour urinary potassium excretion and progression to kidney failure. A restricted cubic spline analysis examined the possible nonlinear relationship between 24-hour urinary potassium excretion (as a continuous variable) and progression to kidney failure. Results: Overall, 432/695 (62%) patients progressed to kidney failure. Across all models, there was no significant difference in kidney failure risk by quartile of 24-hour urinary potassium excretion (all P values for trend ≥.05). Hazard ratios (95% CIs) from the multivariable-adjusted Cox model were as follows: quartile 1, referent; quartile 2, 0.95 (0.71-1.27); quartile 3, 1.00 (0.76-1.33); and quartile 4 0.85 (0.63-1.14); P value for trend = .36. Restricted cubic spline analysis showed an overall linear and nonsignificant relationship between 24-hour urinary potassium excretion as a continuous variable and progression to kidney failure. Limitations: Observational design, single center. Conclusions: We found no association between 24-hour urinary potassium excretion and progression to kidney failure in patients with advanced CKD. Therefore, we identified no clear evidence that increasing or decreasing dietary potassium intake significantly associates with CKD progression in this population. Trial Registration: Not registered.
Protocol for a Process Evaluation of the Quality Improvement Intervention to Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) Cluster-Randomized Clinical Trial
Authors: Yohanna Seychelle , Wilson Mackenzie , Naylor Kyla L. , Garg Amit X. , Sontrop Jessica M. , Belenko Dmitri , Elliott Lori , McKenzie Susan , Macanovic Sara , Mucsi Istvan , Patzer Rachel , Voronin Irina , Lui Iris , Blake Peter G. , Waterman Amy D. , Treleaven Darin , Presseau Justin 
Published: March 2022

Background: Many patients who would benefit from a kidney transplant never receive one. The Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) pragmatic, cluster-randomized clinical trial is testing whether a multi-component quality improvement intervention, provided in chronic kidney disease (CKD) programs (vs. usual care), can help patients with CKD with no recorded contraindications to kidney transplant complete more steps toward receiving a transplant (primary outcome of the trial). The EnAKT LKD intervention has 4 components: (1) quality Improvement teams and administrative support, (2) improved transplant education for patients and healthcare providers, (3) access to support and (4) program-level performance monitoring. Objective: To conduct a process evaluation of the EnAKT LKD quality improvement intervention to determine if the components were delivered, received, and enacted as designed (fidelity), and if the intervention addressed intended barriers (mechanisms of change). Design: A mixed-methods process evaluation informed by new practice implementation and theories of behavior change. Setting: Chronic kidney disease programs in Ontario, Canada, began receiving the EnAKT LKD intervention on November 1, 2017 and will continue to receive it until December 31, 2021. The process evaluation (interviews and surveys) will occur alongside the trial, between December 2020 to May 2021. Participants: Healthcare providers (eg, dialysis nurses, nephrologists, members of the multi-care kidney clinic team) at Ontario’s 27 CKD programs. Methods: We will survey and interview healthcare providers at each CKD program, and complete an intervention implementation checklist. Quantitative data from the surveys and the intervention implementation checklist will assess fidelity to the intervention, while quantitative and qualitative data from surveys and interviews will provide insight into the mechanisms of change. Limitations: The long trial period may result in poor participant recall. Conclusion: This process evaluation will enhance interpretation of the trial findings, guide improvements in the intervention components, and inform future implementation. Trial registration: Clinicaltrials.gov; identifier: NCT03329521.
Does the Canadian Orthopaedic Foot and Ankle Society Postoperative COFAS End-Stage Ankle Arthritis Classification System Correlate With Pre- and Postoperative PROMIS Scores for Total Ankle Arthroplasty?
Authors: Shlykov Maksim A. , Savage-Elliott Ian , Lonergan Timothy M. , Klein Sandra E. , Backus Jonathon D. , Johnson Jeffrey E. , McCormick Jeremy J. 
Published: March 2022

Background: Recently, the Canadian Orthopaedic Foot and Ankle Society (COFAS) proposed a classification system addressing adjunct procedures in the treatment for end-stage ankle arthritis. We reviewed Patient-Reported Outcome Measures Information System (PROMIS) data to determine if outcomes of total ankle arthroplasty (TAA) correlated with postoperative COFAS classification. We hypothesize that as COFAS classification increases, patients will demonstrate greater improvement in the change between pre- and postoperative PROMIS scores. Methods: From June 2015 to December 2018, a total of 127 patients underwent 132 TAA. Demographic factors and preoperative and most recent postoperative PROMIS scores were collected. Univariate, multivariate and post hoc analyses with a significance threshold of P <.05 were performed. Results: Eighty-seven patients with a mean follow-up of 13.6±7.3 months and complete PROMIS scores were classified into COFAS types 1-4. Significant differences were identified in the PROMIS Pain Interference domain comparing COFAS types 2 and 4 and COFAS types 3 and 4. These results demonstrate that more complex ankles with a higher COFAS score had worse interval improvement in PROMIS scores. Additionally, multivariate linear regression showed that age and BMI were associated with worse physical function and depression, whereas diabetes and a history of prior surgeries were associated with improved postoperative function. Conclusion: The COFAS postoperative classification system is useful for categorizing end-stage ankle arthritis. Further research into the ideal timing of surgery and higher-level studies to better determine TAA efficacy with different classification systems is warranted. This information can be helpful with preoperative counseling about treatment outcomes. Level of Evidence: Level IV, retrospective analysis of prospectively collected data.
Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea
Authors: Cohen Samuel M. , Howard Javier J.M. , Jin Michael C. , Qian Jason , Capasso Robson 
Published: March 2022

ObjectiveDetermine risk factors for failure to receive surgical treatment among patients with obstructive sleep apnea.Study DesignPopulation‐based observational longitudinal cohort study.SettingPopulation‐based database.MethodsMultivariate analysis of 500,792 individuals with obstructive sleep apnea from Optum’s deidentified Clinformatics Data Mart database (2004‐2018).ResultsBlack race, increased age, diabetes, atrial fibrillation, obesity, and congestive heart failure were independently associated with a decreased rate of surgery for obstructive sleep apnea. Asian race, hypertension, arrhythmias other than atrial fibrillation, pulmonary disease, and liver disease were independently associated with an increased rate of surgery for obstructive sleep apnea.ConclusionRacial disparities in health outcomes related to health care access and in economic resources have an enormous impact on public health and social equity. We found differences in rates of surgery for obstructive sleep apnea based on race. These data are consistent with others demonstrating disparities in medical treatment of sleep apnea with positive pressure and underline a need for a change in awareness and treatment in these populations.
Early intraocular pressure changes following different keratoplasty techniques and association with cornea parameters and anterior chamber depth
Authors: Gumus Gulsah , Altan Cigdem , Yildirim Yusuf , Beşek Nilay Kandemir , Genç Selim , Kirgiz Ahmet , Durusoy Gonul Karatas , Ağca Alper 
Published: March 2022

Background: Corneal transplantation surgery is associated with an increased risk of intraocular pressure (IOP) elevation. Increased IOP may cause irreversible vision loss and graft failure. Objective: We aimed to evaluate early IOP changes following different keratoplasty techniques and to investigate the relationship between corneal thickness (CT), keratometry values, anterior chamber depth (ACD), and IOP changes. Methods: We included patients who underwent penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and Descemet membrane endothelial keratoplasty (DMEK) in this observational study. ACD, CT, and keratometry measurements were repeated postoperatively at hour 24, week 1, and month 1. IOP measurements were repeated at postoperative hours 6 and 24, week 1, and month 1 by Tono-Pen XL. Results: In total, 22 patients underwent PK, 12 patients underwent DALK, and 19 patients underwent DMEK. The difference between the IOP preoperatively and postoperatively hour 6, and between the IOP preoperatively and postoperatively hour 24 was statistically significant in the three types of surgery ( p < 0.05 for each). The difference between preoperative and postoperative week 1 IOP was statistically significant only in the PK group ( p = 0.023). When the IOP was compared between the three types of surgeries, the IOP at postoperative week 1 in the PK group was significantly higher than the DALK and DMEK groups ( p = 0.021). There was no correlation between ACD, CT, K values, and IOP in any group. Conclusion: IOP may increase in all types of keratoplasty during the first hours after surgery, but PK has a risk of high IOP longer in the early postoperative period. PK patients should be followed more carefully during postoperative week 1 to check for an increase in IOP.
Predictors of postoperative recurrence in a cohort of Tunisian patients with Crohn’s disease
Authors: Hammami Aya , Harbi Raida , Elleuch Nour , Meddeb Khaled Ben , Ameur Wafa Ben , Dahmani Wafa , Braham Ahlem , Ajmi Salem , Ksiaa Mehdi , Slama Aida Ben , Jaziri Hanen , Jmaa Ali 
Published: March 2022

Background: The aim of our study was to evaluate the frequency and risk factors of clinical postoperative recurrence in Tunisian patients with Crohn’s disease (CD). Methods: Clinical data of 86 patients with CD who underwent ileocolonic resection at University Hospital of Sahloul in Tunisia were retrospectively reviewed. Continuous data are expressed as median (interquartile range), and categorical data as frequencies and percentages. Multivariate Cox proportional hazard regression analysis was conducted to identify the risk factors of postoperative clinical recurrence. Results: A total of 86 patients with CD were included in this study. During follow-up, 21 patients (24.4%) had clinical recurrence. The cumulative clinical recurrence rate was 9.3% at 1 year and 20.9% at 5 years. In univariate analysis, predictive factors of postoperative clinical recurrence were active preoperative smoking ( p = 0.008), ileal location of the disease ( p = 0.01), active CD [Crohn’s Disease Activity Index (CDAI) > 150] ( p = 0.04), duration of disease before first surgery <9.5 months ( p = 0.027), and limited resection margins (<2 cm) from macroscopically diseased bowel ( p = 0.005). In multivariate analysis, only smoking ( p = 0.012), duration of disease before first surgery <9.5 months ( p = 0.048), and limited resection margins (<2 cm) from macroscopically diseased bowel ( p = 0.046) were confirmed to be independent factors of clinical relapse. Conclusion: Smoking, duration of disease before first surgery <9.5 months, and limited resection margins (<2 cm) from macroscopically diseased bowel were independent risk factors for clinical recurrence. Based on these factors, patients could be stratified in order to guide postoperative therapeutic options.