Miracle-dz/UniFAR-FTUs huggingface dataset:
Feasibility of a trauma quality-of-life follow-up clinic

BACKGROUND Little effort has been made to address long-term quality of life, chronic pain (CP), posttraumatic stress disorder (PTSD), and functional disability in trauma survivors. This quality initiative was developed to determine feasibility of a coordinated, comprehensive, patient-centered follow-up clinic for those at risk for poor long-term outcomes. METHODS A convenience sample from 649 hospitalized trauma patients at a Midwestern level 1 trauma center between February 2018 and August 2018 was screened for risk of PTSD and CP. Thirty-six patients were randomized into a standard follow-up clinic (standard of care [SOC]) (2-week postdischarge surgical clinic) or a new trauma quality of life clinic (TQOL). The TQOL was developed to provide comprehensive care to patients at high risk for PTSD (Injured Trauma Survivor Score, ≥2) and/or CP (discharge pain score, ≥4). Trauma quality of life clinic included a nurse practitioner or surgeon (physician), psychologist, social worker, and physical therapist at 1-week post discharge. All providers saw the patient independently, developed a care plan collaboratively, and communicated the plan to the patient. The SOC involved a visit only with a nurse practitioner or surgeon (medical doctor). Measures of pain, PTSD, depression, quality of life, physical functioning, and life satisfaction were completed at time of the TQOL/SOC or over the phone. RESULTS There were no differences in demographics, readmissions, or emergency department visits after discharge between groups. However, no show rates were almost twice as high in SOC (40%) compared with TQOL (22%) and those in TQOL completed 23 additional psychology visits versus one psychology visit in SOC. This clinic structure is feasible for high-risk patients, and TQOL patients demonstrated improved engagement in their care. CONCLUSIONS A comprehensive multidisciplinary TQOL addressing issues affecting convalescence for trauma patients at high risk for developing PTSD and CP can improve follow-up rates to ensure patients are recovering successfully. LEVEL OF EVIDENCE Therapeutic, Level IV.
The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review

Objective: To identify and review the literature on the psychosocial patient-reported outcomes (PROs) of surgery at the end of the cleft treatment pathway. Design: A systematic literature search was performed using electronic databases (Medline, PubMed, EMBASE, PsycInfo, Web of Science, and Science Direct) from database inception to September 2017, to identify studies measuring and reporting the psychosocial PROs of end of pathway cleft surgery. Results: Of 263 identified papers, 22 studies were eligible for inclusion. Apart from one randomized controlled study, studies were largely observational and adopted a cross-sectional or retrospective design. The majority (n = 16) were small-scale studies. The methodological quality was variable in terms of what, how, and when psychosocial outcomes were measured and reported. None of the studies utilized a psychosocial PRO measure validated in the cleft population, and few studies measured outcomes prospectively. A high proportion of studies utilized bespoke measures of patient satisfaction. Taken together, findings from the included studies are tentative but seem to suggest patients derive some benefit from undergoing end of pathway cleft surgery, in terms of increased satisfaction, quality of life, social interactions, and decreased appearance-related distress. Conclusions: Due to methodological challenges and the heterogeneity of what, how, and when outcomes are measured and currently reported, it is difficult to determine the psychosocial PROs of end of pathway cleft surgeries. Consequently, this review advocates the conduct of well-designed, longitudinal studies using cleft-sensitive tool/s to capture the psychosocial PROs of end of pathway cleft surgery at various time points.
Diabetic foot ulcer classifications: A critical review

Classification and scoring systems can help both clinical management and audit outcomes of routine care. The aim of this study was to assess published systems of diabetic foot ulcers (DFUs) to determine which should be recommended for a given clinical purpose. Published classifications had to have been validated in populations of > 75% people with diabetes and a foot ulcer. Each study was assessed for internal and external validity and reliability. Eight key factors associated with failure to heal were identified from large clinical series and each classification was scored on the number of these key factors included. Classifications were then arranged according to their proposed purpose into one or more of four groups: (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) aid clinical management decision making for an individual case, and (d) audit to compare outcome in different populations. Thirty‐seven classification systems were identified of which 18 were excluded for not being validated in a population of >75% DFUs. The included 19 classifications had different purposes and were derived from different populations. Only six were developed in multicentre studies, just 13 were externally validated, and very few had evaluated reliability.Classifications varied in the number (4 ‐ 30), and definition of individual items and the diagnostic tools required. Clinical outcomes were not standardized but included ulcer‐free survival, ulcer healing, hospitalization, limb amputation, mortality, and cost. Despite the limitations, there was sufficient evidence to make recommendations on the use of particular classifications for the indications listed above.
Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)

The International Working Group on the Diabetic Foot (IWGDF) has been publishing evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This publication represents a new guideline addressing the use of classifications of diabetic foot ulcers in routine clinical practice and reviews those which have been published. We only consider systems of classification used for active diabetic foot ulcers and do not include those that might be used to define risk of future ulceration.
Correlation between tumor budding, microvascular density, and &bgr;-catenin expression in colorectal carcinoma

Background Colorectal cancer is one of the leading causes of cancer death worldwide. Therefore, identification of the clinicopathological prognostic factors associated with tumor growth, invasion, and metastasis is critical to develop proper therapeutic interventions. Tumor budding is a high-grade undifferentiated component of a tumor at the leading invasive edge that appears as small clusters (<5) or single infiltrating cancer cells. Patients and methods The current study included 50 cases of colorectal carcinoma studied histologically for tumor budding and immunohistochemically for &bgr;-catenin expression and microvascular density (MVD) with CD34. Results Tumor budding was observed in 62% of cases, and it showed a statistically significant correlation with advanced Dukes’ stage, positive lymph node metastasis, and increasing stage of lymph node metastasis. &bgr;-Catenin expression was positive in 34% of cases. There was no statistical relationship between &bgr;-catenin expression and different clinicopathological findings, except when associated with concomitant budding and lymph node metastasis. MVD showed significant correlation only with the sex of the patient but no correlation with tumor budding or &bgr;-catenin expression. Conclusion This study suggests that tumor budding might play a role in the ability of colon cancer cells to invade locally and metastasize and thus may be used as a prognostic marker to predict poor outcome in patients; hence a scoring system for pathological reporting of tumor budding may be beneficial. Our study also supports a potential role for &bgr;-catenin in the process of budding and metastasis. It will be necessary to carry out similar studies on a larger sample size to predict the possible prognostic significance of &bgr;-catenin and MVD.
Differential Change in Size of Human Papillomavirus–Positive Cystic Versus Solid Squamous Cell Carcinoma Lymph Node Metastases in Response to Induction Chemotherapy

Purpose According to certain cancer treatment protocols, the response to induction chemotherapy of lymph node metastases based on radiographic measurements guides further management. The aim of this study is to verify the observation that cystic metastatic lymph nodes tend not to shrink as rapidly as solid metastatic lymph nodes in response to induction chemotherapy in patients with human papillomavirus–related oropharyngeal squamous cell carcinoma. Methods The lymphadenopathy in a cohort of patients from a clinical trial with human papillomavirus–related oropharyngeal squamous cell carcinoma with both baseline and postinduction chemotherapy (carboplatin/paclitaxel/cetuximab) contrast-enhanced neck computed tomography was retrospectively reviewed. The appearance of the metastatic lymph nodes on computed tomography was characterized as cystic or solid. A cystic lymph node was defined as having a hypoattenuating component greater than 20% of the total volume. The rates of short-axis and volume changes of cystic and solid lymph nodes were compared using 1-tailed t test. Results A total of 46 patients were included in this study, comprising 39 solid and 45 cystic lymph nodes. The rate of short-axis decrease was significantly greater for solid (1.33% per day) than cystic (1.08% per day) lymph nodes (P = 0.036). Likewise, the rate of volume decrease was significantly greater for solid (2.13% per day) than cystic (1.87% per day) lymph nodes (P = 0.014). Conclusions This study suggests that in patients with human papillomavirus–related oropharyngeal squamous cell carcinoma solid lymph node metastases generally decrease in size at a greater rate than cystic lymph nodes after induction chemotherapy.
Surgically induced astigmatism and refractive outcomes following phacotrabeculectomy

Purpose: To objectively evaluate surgically induced astigmatism (SIA) after phacotrabeculectomy using keratometry and topography and to compare the magnitude of SIA and the refractive outcomes of single-site and twin-site phacotrabeculectomies. Methods: Forty prospective subjects were enrolled in the study and were randomized into single-site and twin-site cohorts. SIA was objectively assessed using keratometry and Orbscan before and at three months after surgery. For both cohorts, the changes in SIA were assessed using power vector analysis compared at the third month after surgery. Results: Each cohort consisted of 20 eyes. The preoperative parameters and postoperative IOP were comparable and similar, respectively, in both the cohorts (P = 0.1). Majority of the patients in both the cohorts had preoperative against-the-rule (ATR) astigmatism. The median change in SIA at the three-month postoperative visit was similar in both the cohorts, with a small increase in ATR astigmatism. Although the SIA change measured by keratometry in the J0 component was similar in both the groups (P = 0.54), that of J45 was significantly different (P = 0.01). However, the median change in SIA was similar in both the groups for both the J0 (P = 0.52) and J45 components (P = 0.94) when measured by Orbscan. The SIA in both the groups measured with keratometry (P = 0.62) and topography (P = 0.52) were clinically and statistically similar. In both the groups, the refraction was similar at 1 month and 3 months. Conclusion: The SIA as measured with keratometry and topography was similar in the single-site and twin-site phacotrabeculectomy cohorts at the end of 3-months. The postoperative refraction was stabilized in 1-month in both the groups.
Cardiopulmonary exercise testing in chronic obstructive pulmonary disease: An update on its clinical value and applications

Chronic obstructive pulmonary disease is a debilitating disorder, characterized by airflow limitation, exercise impairment, reduced functional capacity and significant systemic comorbidity, which complicates the course of the disease. The critical inspiratory constraint to tidal volume expansion during exercise (that may be further complicated by the presence of dynamic hyperinflation), abnormalities in oxygen transportation and gas exchange abnormalities are the major pathophysiological mechanisms of exercise intolerance in COPD patients, and thus, exercise testing has been traditionally used for the functional evaluation of these patients. Compared to various laboratory and field exercise tests, cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise physiology, involving the integrative respiratory, cardiovascular, muscle and metabolic responses to exercise. This review highlights the clinical utility of CPET in COPD patients, as it provides important information for the determination of the major factors that limit exercise among patients with several comorbidities, allows the assessment of the severity of dynamic hyperinflation, provides valuable prognostic information and can be used to evaluate the response to several therapeutic interventions.
Effects of Intravenous Tranexamic Acid During Rhytidectomy: A Randomized, Controlled, Double-Blind Pilot Study.

BACKGROUND Tranexamic acid (TXA) is an anti-fibrinolytic agent shown to decrease intraoperative bleeding, reduce transfusions, and improve outcomes across multiple specialties. Within plastic surgery, initial reports are encouraging but formal studies are lacking. A study was designed to assess whether TXA demonstrates noticeable benefit for rhytidectomy to warrant further investigation. OBJECTIVE To determine whether intravenous (IV) TXA has effect on intraoperative bleeding, or postoperative sequelae in patients undergoing a deep-plane facelift. METHODS This is a prospective, randomized, double-blind, case series in a private practice surgery center. Participants included 44 patients undergoing rhytidectomy with the senior authors (R.A.G. or M.J.G). Treatment group received 1 gram of IV TXA prior to skin incision, and 4 hours later (vs saline). Bleeding was rated mild, moderate, or severe. Postoperative ecchymosis and edema were subjectively evaluated by patient and surgeon and scores were aggregated for analysis. RESULTS The TXA group showed decreased intraoperative bleeding but did not reach statistical significance. Postoperative ecchymosis/edema ratings were lower for patients who received TXA, including a statistically significant decrease in surgeon-rated bruising. TXA resulted in a statistically significant decrease in postoperative collections in this study and no major complications occurred. CONCLUSIONS TXA is a safe, low-cost, addition to any existing surgical protocol and may lead to less surgical sequelae and improved satisfaction. Although, we did not observe a dramatically different intraoperative experience, postoperative bruising and collections were significantly reduced. Tranexamic acid may have great value in the management of patients undergoing rhytidectomy and warrants further study.
ADHD, suicidal ideation, depression, anxiety, self-esteem, and alcohol problem in Korean juvenile delinquency

Abstract The purpose of this study is to evaluate the prevalence rates of externalizing symptom, ADHD, as well as internalizing symptoms, depression, anxiety, suicidal ideation, self-esteem, and alcohol problem in Korea juvenile delinquency for the first time in Korea. A case–control study design was used. It also examined the associations with ADHD, suicidal ideation, depression, anxiety, self-esteem, and alcohol problem between the Juvenile Delinquency group and the comparison group in Korea. A series of questionnaires were provided to a total of 251 participants (149 from the juvenile delinquency group and 102 from the comparison group) from October 2015 to December 2015 in Korea. All participants were evaluated using KARS, SSI, BDI, BAI, RSI, and CAGE. This study showed the relationship between ADHD, suicidal ideation, depression, anxiety, self-esteem, and alcohol problem in Korean juvenile delinquency. Also this study showed that ADHD and self-esteem were important factors in predicting juvenile delinquency. Therefore, in order to prevent juvenile delinquency, special attention, and consideration are needed for adolescents with high ADHD or low self-esteem.
Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

Abstract Background As the number of patients increases, there is a growing understanding of the form of pneumonia sustained by the 2019 novel coronavirus (SARS-CoV-2), which has caused an outbreak in China. Up to now, clinical features and treatment of patients infected with SARS-CoV-2 have been reported in detail. However, the relationship between SARS-CoV-2 and coagulation has been scarcely addressed. Our aim is to investigate the blood coagulation function of patients with SARS-CoV-2 infection. Methods In our study, 94 patients with confirmed SARS-CoV-2 infection were admitted in Renmin Hospital of Wuhan University. We prospectively collect blood coagulation data in these patients and in 40 healthy controls during the same period. Results Antithrombin values in patients were lower than that in the control group (p < 0.001). The values of D-dimer, fibrin/fibrinogen degradation products (FDP), and fibrinogen (FIB) in all SARS-CoV-2 cases were substantially higher than those in healthy controls. Moreover, D-dimer and FDP values in patients with severe SARS-CoV-2 infection were higher than those in patients with milder forms. Compared with healthy controls, prothrombin time activity (PT-act) was lower in SARS-CoV-2 patients. Thrombin time in critical SARS-CoV-2 patients was also shorter than that in controls. Conclusions The coagulation function in patients with SARS-CoV-2 is significantly deranged compared with healthy people, but monitoring D-dimer and FDP values may be helpful for the early identification of severe cases.
Can You Understand Your Child? Reliability and Validity of a Parent Questionnaire: The Intelligibility in Context Scale: Italian

Introduction: The Intelligibility in Context Scale (ICS) is a parent-report scale by which parents can rate their child’s functional speech intelligibility according to seven different communicative partners. Translations, linguistic adaptations, and psychometric and norming data for ICS have been achieved in different languages. Objective: To evaluate the psychometric properties of the Italian version of the ICS (ICS-I) in terms of internal consistency, test-retest reliability, criterion validity (correlation with speech measures), and construct validity, and to investigate potential differences between mothers’ and fathers’ subjective ratings in ICS-I. Methods: Italian-speaking children aged 3.0–5.11 years (n = 364), without major developmental impairment, were recruited in kindergartens. All children were independently rated by their mothers (ICS-Im) and fathers (ICS-If). A subsample of parents (n = 127) rated ICS-I twice after 3 weeks (test-retest reliability). Children were administered a naming and a word repetition task, by which speech measures were calculated: percentage of phonemes correct (PPC), percentage of consonants correct (PCC), and percentage of vowels correct (PVC). Results: High internal consistency (α = 0.92) and good test-retest reliability (rs = 0.78) were found. A high (r > 0.67) correlation between the ICS-I total scores and single-item scores was found (construct validity), except for parental perception in ICS-Im and ICS-If. Moderate correlations (rs > 0.38) between the ICS-I and the PPC and PCC tasks suggested adequate criterion validity. Mothers’ and fathers’ ratings showed an appropriate agreement in the items acquaintances and teachers, but overall parent ratings were significantly different, with higher mean scores in ICS-Im (median = 4.57) than in ICS-If (median = 4.46), Z = –2.852, p < 0.01. Conclusions: As for other previous international studies, ICS-I presents good psychometric properties, but some differences in mothers’ and fathers’ scores suggest a potential parental influence in rating a child’s intelligibility. Findings support cross-linguistic research, and further investigation could promote the application of ICS-I as an outcome measure in children with speech sound disorders.
Whole transcriptome expression profiles in placenta samples from women with gestational diabetes mellitus

Non‐coding ribonucleic acids (ncRNAs) have recently been shown to be involved in various biological processes. However, most of these ncRNAs are of unknown function or without annotation. This study first investigated the whole transcriptome profiles of placentas to identify the potential functions that ncRNAs exerted in gestational diabetes mellitus (GDM).
Base Excess usefulness for prediction of immediate mortality in severe trauma patients admitted to the Emergency department.

BACKGROUND Trauma is a leading cause of death in young people and hemorrhagic shock is a leading mechanism of this mortality. Hypoperfusion can be difficult to diagnose clinically, especially in younger patients. Arterial Base Excess (BE) has been used as an early indicator of hypoperfusion. AIM To evaluate the prognostic value of admission BE in severe trauma patients admitted to the emergency department (ED). METHODS In this prospective study, severe trauma patients meeting high velocity criteria admitted to the ED during the study period were included. BE was calculated from arterial blood gas samples. Multivariate analysis was performed for Day-1 and Day-7 post trauma mortality. ROC characteristics and survival curves were used. RESULTS We included 479 patients. Median age was 37 (18-90). Eighty-one per cent were male. Clinical characteristics n(%): GCS<13: 170(35); SBP<90 mmHg: 64(13) and SpO2 <90%: 82(17). Mean ISS was 22 ± 13. Mortality was at days 1 and 7: 2.2% and 27.3%, respectively. Median BE was -3.2 mmol/l (-25; 28). Forty-five per cent had a BE ≤ -3.5 mmol/l. In multivariate analysis, initial BE ≤ -6.5 mmol/l was predictive of first day mortality with an Odds Ratio; [CI95%] = 3.17; [1.4-7.1]; p=0.005. Similar results were found at Day 7: Odds Ratio; [CI95%] = 1.5; [1.14-1.96]; p=0.003. BE showed high prognostic value for both mortality rates. Survival curve was significant for BE> -6.5mmol/l. CONCLUSION in this study, a high BE above 6.5mmol/L showed a significant prognostic value in immediate and early mortality and is proposed as a marker of injury severity in trauma patients admitted to the ED. Prediction was better for the immediate mortality and thus could be proposed as a triage tool in the ED.