bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term oncologic result of laparoscopic versus open gastrectomy for gastric cancer: a propensity score matching analysis
Authors: Wu Si-Yuan , Ho Meng-Hsing , Chang Hao-Ming , Hsu Kuo-Feng , Yu Jyh-Cherng , Chan De-Chuan
Published: April 2021

Background

Laparoscopic gastrectomy is an acceptable procedure for early-stage gastric cancer; however, most patients are diagnosed at an advanced stage and older age in Taiwan. The feasibility and safety of applying laparoscopic gastrectomy in daily practice remain unclear. This study aimed to examine the short- and long-term outcomes of laparoscopic gastrectomy versus open procedures.

Methods

From 2007 to 2015, 192 patients who underwent open gastrectomy and 189 patients who underwent laparoscopic gastrectomy for gastric cancer at a single center were included. Propensity score matching analysis was used to adjust selection biases associated with age, preoperative hemoglobin, the extent of resection, tumor size, and stage of the disease. The demographics, perioperative parameters, short-term postoperative results, and 5-year survival data were analyzed.

Results

Open gastrectomy was more frequently performed in the elderly, larger tumor size, advanced stage of the disease, and disease requiring total gastrectomy or combined organ resection. After propensity score matching, 108 patients with laparoscopic gastrectomy were compared to 108 patients with open gastrectomy. The morbidity rates were not different in both groups (25.9%), while hospital stay was shorter in the laparoscopic group (16.0 vs. 18.8 days, p = 0.04). The 5-year overall survival and disease-free survival were superior in the laparoscopic group (p = 0.03 and p = 0.01, respectively); however, the survival differences were not significant in the subgroup analysis by stage. Laparoscopic gastrectomy had fewer recurrences than open gastrectomy. The pattern of recurrence was not different between the groups.

Conclusions

Laparoscopic gastrectomy can be safely applied in both early and locally advanced gastric cancer without compromising oncologic outcomes.

Trial registration

Retrospective registration.
Applying systematic review search methods to the grey literature: a review of education and training courses on breastfeeding support for health professionals
Authors: Navarro Ivette , Soriano Jose M. , Laredo Salomé
Published: April 2021

Background

Currently, lactation training courses aimed at health professionals are important for informing and supporting mothers who are breastfeeding. In this review, we seek to analyze similarities and/or variations in course content, modes of delivery, costs, teaching style and learning strategies among courses. To our knowledge, a review of lactation training courses available worldwide is lacking. Thus, the aim of this review is to describe course models aimed at training health professionals in lactation support for mothers.

Methods

Through searching grey literature, training courses were obtained from several directories, including the Alaska Breastfeeding Coalition, International Board of Lactation Consultant Examiners (IBLCE), International Lactation Consultant Association (ILCA), Lactation Education Accreditation Association and Approval Review Committee (LEAARC), World Alliance for Breastfeeding Action (WABA), World Health Organization (WHO), and United Nations Children’s Fund (UNICEF).

Results

Descriptions of ten training programs were included in the final review. Our group found variations in costs, modes of delivery and duration among courses.

Conclusions

Certified training for health professionals in lactation is a promising approach for increasing and protecting breastfeeding. Breastfeeding mothers might also benefit from specifically trained health professionals, yet, well-conducted research on such training courses is still required. The variability in the mode of teaching, tuition costs and course content in breastfeeding education programs around the globe must be kept in mind when considering providing training on the optimal competency for health professionals.
Assessing the impact of Indiana legislation on opioid-based doctor shopping among Medicaid-enrolled pregnant women: a regression analysis
Authors: Joshi Sukhada S. , Adams Nicole , Yih Yuehwern , Griffin Paul M.
Published: April 2021

Background

States have passed various legislative acts in an attempt to reduce opioid prescribing and corresponding doctor shopping, including prescription drug monitoring programs. This study seeks to determine the association between two state-based interventions enacted in Indiana and the level of doctor shopping among Medicaid-enrolled pregnant women.

Methods

Indiana Medicaid claims data over the period of January 2014 to March 2019 were used in a regression model to determine the longitudinal change in percentage of pregnant women engaged in doctor shopping based on passage of Indiana Administrative Code Title 884 in 2014 and Public Law 194 in 2018. The primary reasons for prescribing were also identified.

Results

There were 37,451 women that had both pregnancy and prescription opioid claims over the time horizon. Of these, 2130 women met the criteria for doctor shopping. Doctor shopping continued to increase over the time between the passage of the two interventions but decreased after passage of Public Law 194.

Conclusion

The decrease in doctor shopping among Medicaid-enrolled pregnant women after passage of Public Law 194 points to the importance of addressing this issue across a broad set of healthcare professionals including nurse practitioners and physician assistants. It is also possible that the potential punitive component in the Law for non-compliance played a role.
The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review
Authors: Kobeissi Elsa , Menassa Marilyne , Moussally Krystel , Repetto Ernestina , Soboh Ismail , Hajjar Marwan , Saleh Shadi , Abu-Sittah Ghassan
Published: April 2021

Background

Antibiotic resistance (ABR) is a major global threat. Armed and protracted conflicts act as multipliers of infection and ABR, thus leading to increased healthcare and societal costs. We aimed to understand and describe the socioeconomic burden of ABR in conflict-affected settings and refugee hosting countries by conducting a systematic scoping review.

Methods

A systematic search of PubMed, Medline (Ovid), Embase, Web of Science, SCOPUS and Open Grey databases was conducted to identify all relevant human studies published between January 1990 and August 2019. An updated search was also conducted in April 2020 using Medline/Ovid. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. The Newcastle-Ottawa Scale was used to assess study quality. Data extraction and analysis were based on the PICOS framework and following the PRISMA-ScR guideline.

Results

The search yielded 8 studies (7 publications), most of which were single-country, mono-center and retrospective studies. The studies were conducted in Lebanon (n = 3), Iraq (n = 2), Jordan (n = 1), Palestine (n = 1) and Yemen (n = 1). Most of the studies did not have a primary aim to assess the socioeconomic impact of ABR and were small studies with limited statistical power that could not demonstrate significant associations. The included studies lacked sufficient information for the accurate evaluation of the cost incurred by antibiotic resistant infections in conflict-affected countries.

Conclusion

This review highlights the scarcity of research on the socioeconomic burden of ABR on general populations in conflict-affected settings and on refugees and migrants in host countries, and lists recommendations for consideration in future studies. Further studies are needed to understand the cost of ABR in these settings to develop and implement adaptable policies.
Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients
Authors:   PRONA-COVID Group, Langer Thomas , Brioni Matteo , Guzzardella Amedeo , Carlesso Eleonora , Cabrini Luca , Castelli Gianpaolo , Dalla Corte Francesca , De Robertis Edoardo , Favarato Martina , Forastieri Andrea , Forlini Clarissa , Girardis Massimo , Grieco Domenico Luca , Mirabella Lucia , Noseda Valentina , Previtali Paola , Protti Alessandro , Rona Roberto , Tardini Francesca , Tonetti Tommaso , Zannoni Fabio , Antonelli Massimo , Foti Giuseppe , Ranieri Marco , Pesenti Antonio , Fumagalli Roberto , Grasselli Giacomo
Published: April 2021

Background

Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave.

Methods

Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position.

Results

Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities;
however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively).

Conclusions

During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching.

Trial registration: clinicaltrials.gov number: NCT04388670
PCIP-seq: simultaneous sequencing of integrated viral genomes and their insertion sites with long reads
Authors: Artesi Maria , Hahaut Vincent , Cole Basiel , Lambrechts Laurens , Ashrafi Fereshteh , Marçais Ambroise , Hermine Olivier , Griebel Philip , Arsic Natasa , van der Meer Frank , Burny Arsène , Bron Dominique , Bianchi Elettra , Delvenne Philippe , Bours Vincent , Charlier Carole , Georges Michel , Vandekerckhove Linos , Van den Broeke Anne , Durkin Keith
Published: April 2021

The integration of a viral genome into the host genome has a major impact on the trajectory of the infected cell. Integration location and variation within the associated viral genome can influence both clonal expansion and persistence of infected cells. Methods based on short-read sequencing can identify viral insertion sites, but the sequence of the viral genomes within remains unobserved. We develop PCIP-seq, a method that leverages long reads to identify insertion sites and sequence their associated viral genome. We apply the technique to exogenous retroviruses HTLV-1, BLV, and HIV-1, endogenous retroviruses, and human papillomavirus.
Ultrasound-guided erector spinae plane block versus thoracic paravertebral block on postoperative analgesia after laparoscopic nephroureterectomy: study protocol of a randomized, double-blinded, non-inferiority design trial
Authors: Xu Zhen-Zhen , Li Xue , Zhang Zhen , Liu Zheng-Ye , Song Lin-Lin , Li Xue-Ying , Zhang Hong
Published: April 2021

Introduction

Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Regional block is advocated in order to decrease opioid consumption and improve analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy.

Methods and analysis

This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB and TPVB will be performed with an injection of 0.375% ropivacaine 0.4 ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24 h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24 h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption, and pain NRS scores at different preset timepoints within 48 h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and diet, and adverse events, as well as length of stay in hospital and anesthesia cost.

Discussion

Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and TPVB in urological surgery are still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score.

Trial registration

Chinese Clinical Trial Registry ChiCTR 2000031916. Registered on 14 April 2020.
How ‘place’ matters for addressing the HIV epidemic: evidence from the HPTN 071 (PopART) cluster-randomised controlled trial in Zambia and South Africa
Authors:   on behalf of the HPTN071 (PopART) study team, Bond Virginia , Hoddinott Graeme , Viljoen Lario , Ngwenya Fredrick , Simuyaba Melvin , Chiti Bwalya , Ndubani Rhoda , Makola Nozizwe , Donnell Deborah , Schaap Ab , Floyd Sian , Hargreaves James , Shanaube Kwame , Fidler Sarah , Bock Peter , Ayles Helen , Hayes Richard , Simwinga Musonda , Seeley Janet
Published: April 2021

Background

In a cluster-randomised trial (CRT) of combination HIV prevention (HPTN 071 (PopART)) in 12 Zambian communities and nine South African communities, carried out from 2012 to 2018, the intervention arm A that offered HIV treatment irrespective of CD4 count did not have a significant impact on population level HIV incidence. Intervention arm B, where HIV incidence was reduced by 30%, followed national guidelines that mid trial (2016) changed from starting HIV treatment according to a CD4 threshold of 500 to universal treatment. Using social science data on the 21 communities, we consider how place (community context) might have influenced the primary outcome result.

Methods

A social science component documented longitudinally the context of trial communities. Data were collected through rapid qualitative assessment, interviews, group discussions and observations. There were a total of 1547 participants and 1127 observations. Using these data, literature and a series of qualitative analysis steps, we identified key community characteristics of relevance to HIV and triangulated these with HIV community level incidence.

Results

Two interdependent social factors were relevant to communities’ capability to manage HIV: stability/instability and responsiveness/resistance. Key components of stability were social cohesion; limited social change; a vibrant local economy; better health, education and recreational services; strong institutional presence; established middle-class residents; predictable mobility; and less poverty and crime. Key components of responsiveness were community leadership being open to change, stronger history of HIV initiatives, willingness to take up HIV services, less HIV-related stigma and a supported and enterprising youth population. There was a clear pattern of social factors across arms. Intervention arm A communities were notably more resistant and unstable. Intervention arm B communities were overall more responsive and stable.

Conclusions

In the specific case of the dissonant primary outcome results from the HPTN 071 (PopART) trial, the chance allocation of less stable, less responsive communities to arm A compared to arm B may explain some of the apparently smaller impact of the intervention in arm A. Stability and responsiveness appear to be two key social factors that may be relevant to secular trends in HIV incidence. We advocate for a systematic approach, using these factors as a framework, to community context in CRTs and monitoring HIV prevention efforts.

Trial registration

ClinicalTrials.gov NCT01900977. Registered on July 17, 2013.
Publisher Correction to: Rickettsia spp. in bats of Romania: high prevalence of Rickettsia monacensis in two insectivorous bat species
Authors: Matei Ioana A. , Corduneanu Alexandra , Sándor Attila , Ionica Angela Monica , Panait Luciana , Kalmár Zsuzsa , Ivan Talida , Papuc Ionel , Bouari Cosmina , Fit Nicodim , Mihalca Andrei Daniel
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Esophageal cancer responsive to the combination of immune cell therapy and low-dose nivolumab: two case reports
Authors: Takimoto Rishu , Kamigaki Takashi , Gotoda Takuji , Takahashi Toshimi , Okada Sachiko , Ibe Hiroshi , Oguma Eri , Goto Shigenori
Published: April 2021

Background

Blocking the programmed death 1 pathway by immune checkpoint inhibitors induces dramatic antitumor activity in patients with malignant tumors. However, the clinical response to immune checkpoint inhibitors remains limited owing to the patients’ immunological status, such as the number of lymphocytes, programmed death ligand 1 expression, and tumor mutation burden. In this study, we successfully treated two patients with advanced esophageal cancer who responded to the combination of adoptive immune cell therapy and a low-dose immune checkpoint inhibitor, nivolumab.

Case presentation

Two Asian (Japanese) patients with advanced esophageal cancer who were resistant to conventional chemoradiation therapy were referred to our hospital for immune therapy. Case 1 was a 66-year-old woman who was diagnosed as having esophageal cancer. She received concurrent chemoradiation therapy and then underwent subtotal esophagectomy, after which she became cancer free. However, she relapsed, and cancer cells were found in the lung and lymph nodes 6 months later. She enrolled in a clinical trial at our institution (clinical trial number UMIN000028756). She received adoptive immune cell therapy twice at a 2-week interval followed by low-dose nivolumab with adoptive immune cell therapy four times at 2-week intervals. A follow-up computed tomography scan showed partial response, with mass reduction of the metastatic lung and mediastinal lesions. Case 2 was a 77-year-old man. He received concurrent chemoradiation therapy with fluoropyrimidine/platinum, and gastroscopy revealed complete remission of esophageal cancer. He was disease free for 5 months, but routine computed tomography revealed multiple metastases in his lungs and lymph nodes. He visited our clinic to receive adoptive immune cell therapy and immune checkpoint inhibitor combination therapy. Radiographic evidence showed continuous improvement of lesions. There was no evidence of severe adverse events during the combination therapy.

Conclusion

The combination of adoptive immune cell therapy and an immune checkpoint inhibitor might be a possible treatment strategy for advanced esophageal cancer.

Trial registration UMIN000028756. Registered 14 September 2017
Shelter cats host infections with multiple Trypanosoma cruzi discrete typing units in southern Louisiana
Authors: Dumonteil Eric , Desale Hans , Tu Weihong , Duhon Brandy , Wolfson Wendy , Balsamo Gary , Herrera Claudia
Published: April 2021

Trypanosoma cruzi is a zoonotic parasite endemic in the southern US and the Americas, which may frequently infect dogs, but limited information is available about infections in cats. We surveyed a convenience sample of 284 shelter cats from Southern Louisiana to evaluate T. cruzi infection using serological and PCR tests. Parasites from PCR positive cats were also genotyped by PCR and deep sequencing to assess their genetic diversity. We detected a seropositivity rate for T. cruzi of at least 7.3% (17/234), and 24.6% of cats (70/284) were PCR positive for the parasite. Seropositivity increased with cat age (R2 = 0.91, P = 0.011), corresponding to an incidence of 7.2% ± 1.3 per year, while PCR positivity decreased with age (R2 = 0.93, P = 0.007). Cats were predominantly infected with parasites from TcI and TcVI DTUs, and to a lesser extent from TcIV and TcV DTUs, in agreement with the circulation of these parasite DTUs in local transmission cycles. These results indicate that veterinarians should have a greater awareness of T. cruzi infection in pets and that it would be important to better evaluate the risk for spillover infections in humans.
Acoustic DOA estimation using space alternating sparse Bayesian learning
Authors: Bai Zonglong , Shi Liming , Jensen Jesper Rindom , Sun Jinwei , Christensen Mads Græsbøll
Published: April 2021

Estimating the direction-of-arrival (DOA) of multiple acoustic sources is one of the key technologies for humanoid robots and drones. However, it is a most challenging problem due to a number of factors, including the platform size which puts a constraint on the array aperture. To overcome this problem, a high-resolution DOA estimation algorithm based on sparse Bayesian learning is proposed in this paper. A group sparse prior based hierarchical Bayesian model is introduced to encourage spatial sparsity of acoustic sources. To obtain approximate posteriors of the hidden variables, a variational Bayesian approach is proposed. Moreover, to reduce the computational complexity, the space alternating approach is applied to push the variational Bayesian inference to the scalar level. Furthermore, an acoustic DOA estimator is proposed to jointly utilize the estimated source signals from all frequency bins. Compared to state-of-the-art approaches, the high-resolution performance of the proposed approach is demonstrated in experiments with both synthetic and real data. The experiments show that the proposed approach achieves lower root mean square error (RMSE), false alert (FA), and miss-detection (MD) than other methods. Therefore, the proposed approach can be applied to some applications such as humanoid robots and drones to improve the resolution performance for acoustic DOA estimation especially when the size of the array aperture is constrained by the platform, preventing the use of traditional methods to resolve multiple sources.
Correction to: An integrated MVDR beamformer for speech enhancement using a local microphone array and external microphones
Authors: Ali Randall , van Waterschoot Toon , Moonen Marc
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Correction to: Efficient and rapid conversion of human astrocytes and ALS mouse model spinal cord astrocytes into motor neuron-like cells by defined small molecules
Authors: Zhao An-Dong , Qin Hua , Sun Meng-Li , Ma Kui , Fu Xiao-Bing
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Evaluation of von Willebrand factor as a marker for early diagnosis of Acute Respiratory Distress Syndrome in comparison to Interleukin-6
Authors: ELfawy Dalia M. , Elkalek Mohmmed Abd , Hamed Ehab , Ibrahem Samer , ELzoghby Doaa M. A. , Abdalla Waleed
Published: April 2021

Background

Acute respiratory distress syndrome (ARDS) constitutes a clinical phenotype of severe lung injury associated with many causes. Endothelial activation and injury is a component of ARDS. The release of von Willebrand factor (vWF) indicates direct endothelial cell damage has occurred, and this can be used as a marker of endothelium injury. The aim of the study was to investigate the diagnostic value of vWF antigen as a determinant of early detection of ARDS in comparison to interleukin-6 (IL-6) as a control biomarker. vWF antigen and IL-6 were measured in 60 patients who were at risk of developing ARDS on T0 (at the start of the study), T48 (after 48 h), and T72 (after 72 h).

Results

Higher vWF Ag levels were seen in patients at risk of developing ARDS with direct cause of lung injury than those with indirect causes. Include groups I and II. There was a highly significant increase between the “at risk of developing ARDS” patients, VWF Ag, and IL-6 levels. The results were recorded at T0 (i.e., at start of the study baseline reading), T48 (after 48 h), and T72 (after 72 h), p 0.001 and p 0.05, respectively. A value of vWF Ag of 447% on the 3rd day of ARDS showed a sensitivity of 94.9% and specificity 56.7% compared to IL-6 at 246 pg/ml with 79.5% sensitivity and 52.4% specificity. As a comparison between VWF and IL6 levels among ARDS patients, they both show statistical correlation together.

Conclusion

The results of our study point out to VWF as a sensitive and good diagnostic marker for ARDS diagnosis.
Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema
Authors: Kharabish Ahmed , Hosny Mohamed , Hassan Mohamed , Mahrous Mary Rabea , Elbayoumy Megahed , Ahmed Asmaa Elsayed , Deyaa Nahla , El Mozy Wesam , Behairy Noha
Published: April 2021

Background

There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema.

Results

Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping < 60 ms). No statistical significance was found between the TIRM and the T2 mapping neither in the total amount of edema (p = 0.79), nor in the LV basal, mid, and apical segments’ edema (p = 0.69, 0.5, and 0.8 respectively). The upper and lower limits of agreements were tested between the TIRM and the T2 mapping of total edema mass, basal segments, mid, and apical ventricular segments were = 18 and − 7.7 g, 11.3 and − 5.1 g, 12.3 and − 5.2 g, and 15.5 and − 7.8 g respectively.

Conclusion

This study supports the proof of the principle that there is no statistical significant difference per myocardial segments between the T2 mapping and routine edema’s sequences. Larger studies are recommended to assess the impact in clinical outcome.
Proposal to protect patients and healthcare professionals undergoing elective surgery during COVID-19 outbreak
Authors: Arslan Gülten , Saraçoğlu Kemal Tolga , Aydiner Ömer , Demirhan Recep
Published: April 2021

Background

The aim of this study was to investigate the reliability of COVID-19 Reporting and Data System (CO-RADS) scale on chest computerized tomography (CT) in addition to the reverse transcriptase-polymerase chain reaction (RT-PCR) test in diagnosis of COVID-19 on patients who will undergo elective surgery to protect patients and healthcare professionals during the intense pandemic period and the correlation between CO-RADS scale and Total Severity Score (TSS).  During the intensive pandemic until normalization, 253 patients aged ≥ 18 years who underwent elective surgery with two negative RT-PCR results within the last 5 days and CO-RADS scale ≤ 3 on chest CT were included in the study. Demographic characteristics, American Society of Anesthesiologists classification, type of anesthesia and surgery, department of clinic, chest CT findings, scale of CO-RADS and TSS on CT, patients’ postoperative hospital stay, follow-up time, and vital status (whether or not COVID-19 disease) at the hospital and discharge information were collected for each patient.

Results

The most frequently calculated CO-RADS score was found to be 1 (73.1%). It was followed by scale of CO-RADS 2 (20.9%). Regarding TSS, the most common TSS for the right and left lungs was 0 (91.7% and 92.5%, respectively). COVID-19 was not detected in any of the patients who were hospitalized for an average of 4.9 ± 6.4 days and followed-up for an average of 14.3 ± 8.2 days. It was observed that the CO-RADS score and TSS were positively and moderately correlated with each other (p < 0.001).

Conclusion

It was concluded that in early diagnostic of COVID-19, chest CT scans serve like a complementary diagnostic method in addition to RT-PCR testing to keep safe both the patients and health professionals and the scale of CO-RADS and TSS on CT are valuable in correlation with each other.
Natural Language Processing to Identify Cancer Treatments With Electronic Medical Records
Authors: Zeng Jiaming , Banerjee Imon , Henry A. Solomon , Wood Douglas J. , Shachter Ross D. , Gensheimer Michael F. , Rubin Daniel L.
Published: April 2021

PURPOSE

Knowing the treatments administered to patients with cancer is important for treatment planning and correlating treatment patterns with outcomes for personalized medicine study. However, existing methods to identify treatments are often lacking. We develop a natural language processing approach with structured electronic medical records and unstructured clinical notes to identify the initial treatment administered to patients with cancer.

METHODS

We used a total number of 4,412 patients with 483,782 clinical notes from the Stanford Cancer Institute Research Database containing patients with nonmetastatic prostate, oropharynx, and esophagus cancer. We trained treatment identification models for each cancer type separately and compared performance of using only structured, only unstructured ( bag-of-words, doc2vec, fasttext), and combinations of both ( structured + bow, structured + doc2vec, structured + fasttext). We optimized the identification model among five machine learning methods (logistic regression, multilayer perceptrons, random forest, support vector machines, and stochastic gradient boosting). The treatment information recorded in the cancer registry is the gold standard and compares our methods to an identification baseline with billing codes.

RESULTS

For prostate cancer, we achieved an f1-score of 0.99 (95% CI, 0.97 to 1.00) for radiation and 1.00 (95% CI, 0.99 to 1.00) for surgery using structured + doc2vec. For oropharynx cancer, we achieved an f1-score of 0.78 (95% CI, 0.58 to 0.93) for chemoradiation and 0.83 (95% CI, 0.69 to 0.95) for surgery using doc2vec. For esophagus cancer, we achieved an f1-score of 1.0 (95% CI, 1.0 to 1.0) for both chemoradiation and surgery using all combinations of structured and unstructured data. We found that employing the free-text clinical notes outperforms using the billing codes or only structured data for all three cancer types.

CONCLUSION

Our results show that treatment identification using free-text clinical notes greatly improves upon the performance using billing codes and simple structured data. The approach can be used for treatment cohort identification and adapted for longitudinal cancer treatment identification.
Non–Small-Cell Lung Cancer: Real-World Cost Consequence Analysis
Authors: Buja Alessandra , Pasello Giulia , De Luca Giuseppe , Bortolami Alberto , Zorzi Manuel , Rea Federico , Pinato Carlo , Dal Cin Antonella , De Polo Anna , Schiavon Marco , Zuin Andrea , Marchetti Marco , Scroccaro Giovanna , Baldo Vincenzo , Rugge Massimo , Guarneri Valentina , Conte PierFranco
Published: April 2021

PURPOSE:

The present work aimed at conducting a real-world data analysis on the management costs and survival analysis comparing data from non–small-cell lung cancer (NSCLC) cases diagnosed in the Veneto region before (2015) and after (2017) the implementation of a regional diagnostic and therapeutic pathway including all new diagnostic and therapeutic strategies.

METHOD:

This study considered 254 incidental cases of NSCLC in 2015 and 228 in 2017 within the territory of the Padua province (Italy), as recorded by the Veneto Cancer Registry. Tobit regression analysis was performed to verify if total and each item costs (2 years after NSCLC diagnosis) are associated with index year, adjusting by year of diagnosis, sex, age, and stage at diagnosis. Logistic regression models were run to study overall mortality at 2 years, adjusting by the same covariates.

RESULTS:

The 2017 cohort had a lower mortality odd (odds ratio, 0.93; P = .02) and a significant increase in the average overall costs ( P = .009) than the 2015 cohort. The Tobit regression analysis by cost item showed a very significant increase in the average cost of drugs (coefficient = 5,953, P = .008) for the 2017 cohort, as well as a decrease in the average cost of hospice care (coefficient = –1,822.6, P = .022).

CONCLUSION:

Our study showed a survival improvement for patients with NSCLC as well as an economic burden growth. Physicians should therefore be encouraged to follow new clinical care pathways, while the steadily rising related costs underscore the need for policymakers and health professionals to pursue.
Thyroid Cancer and Telemedicine During the COVID-19 Pandemic
Authors: Chablani Sumedha V , Sabra Mona M
Published: April 2021

The COVID-19 pandemic has forced endocrinologists to utilize telemedicine to care for their patients. There is limited information on the experience of endocrinologists in managing patients with thyroid cancer virtually. We sent a 9-item questionnaire to endocrinologists and endocrine surgeons at our institution to better understand the barriers and benefits of caring for patients with thyroid cancer via telemedicine, as well as how we can incorporate telemedicine into our future care of patients with this malignancy. Among the 9 physicians who responded, the majority listed technological issues with the virtual platform as a challenge in caring for patients with thyroid cancer remotely. Additional barriers included difficulty in expressing empathy, decreased ability to coordinate care with the interdisciplinary team, and lack of the physical examination. Benefits included compliance with social distancing measures and convenience for patients with American Thyroid Association (ATA) low-risk thyroid cancer who presented for follow-up visits. Overall, physicians were satisfied or strongly satisfied with caring for patients with thyroid cancer remotely, especially low-risk patients on long-term follow-up. That said, they recommend that some patients be seen in person after the pandemic, including symptomatic patients and ATA high-risk patients. While the COVID-19 pandemic has allowed endocrinologists to manage patients with thyroid cancer remotely, the providers have faced challenges, some of which can be improved upon. Further studies will help determine how telemedicine affects patient outcomes, including satisfaction, disease progression, and survival, which will inform how we may incorporate this practice into our future care of patients with thyroid cancer.
A Primer for Pediatric Emergency Front-of-the-Neck Access
Authors: Berger-Estilita Joana , Wenzel Vivian , Luedi Markus M. , Riva Thomas
Published: April 2021

“Cannot intubate, cannot oxygenate” situations in healthy children are uncommon but are often associated with poor outcomes. Clinical assessment, anticipatory planning, and the use of algorithms can lessen the likelihood of untoward outcomes, but the common final pathway of many algorithms for a difficult pediatric airway involves obtaining emergency tracheal access. The airway practitioner must have the know-how and training needed to invasively secure the airway when confronted with this rare but potentially devastating emergency. We provide practitioners with an overview of pediatric emergency front-of-the-neck access strategies and a structure for their management.
“No Man’s Ocean Ever Did Get the Best of Me”
Authors: Cannon Nissa Ren
Published: April 2021

By the late 1920s steam travel was faster, more comfortable, and more affordable than ever before, and there were more shipping lines, operating more ships, than in the past. The major lines could not compete with one another in terms of cost or speed, so they wooed customers by focusing on passenger comfort, attempting to one-up each other’s luxury. It is in this context that Claude McKay wrote a novel about an African seaman who makes two miserable passages across the Atlantic—the first as a stowaway, the second in first class. This article reads McKay’s novel as a revision of the narrative of liberating and luxurious ocean travel promoted by the shipping lines and argues that Romance in Marseille offers novel possibilities and implications for maritime and oceanic studies because it asks readers to recognize overlaps between different forms of mobility and, in characteristic McKay fashion, to resist reductive interpretation.
Mud therapy and rehabilitation - scientific relevance in the last six years (2015 – 2020)
Systematic literature review and meta-analysis based on the PRISMA paradigm
Authors: MUNTEANU Constantin , ROTARIU Mariana , DOGARU Gabriela , IONESCU Elena Valentina , CIOBANU Vlad , ONOSE Gelu
Published: April 2021

Abstract
Background. Balneotherapy is a stimulation - adaptation treatment method applied in the forms of bathing, drinking, and inhalation cures performed with natural therapeutic factors, a method which is acting in three main ways: thermally, mechanically, and chemically. Mud or peloids are natural therapeutic factors formed by natural processes under the influence of biological and geological phenomena, which in a finely dissolved state and mixed with water (mud) are used in medical practice in the form of baths or local procedures.
Objective. This systematic review aims to rigorously select related articles and identify within their content, the main possible uses of therapeutic mud and physiological mechanisms, to see the main region of scientific interest for pelotherapy, and to discuss the value of mud therapy in rehabilitation medicine.
Methods. The working method is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for open-access articles published in English, between January 2015 and December 2020, from the following databases: Cochrane, Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science (the latter was also used to identify ISI indexed articles). The contextually searched syntax used was ”Pelotherapy/Peloidotherapy/Mud-therapy/ /Fango-therapy AND Rehabilitation”. The selected articles were analyzed in detail regarding pathologies addressed by mud therapy and country scientific relevance for this therapeutic method. The meta-analysis proceeded was designated to estimate the prevalence of various pathologies in the use of mud therapy.
Results. Our search identified, first, 394 articles. Based on the successive filtering stages and, respectively, on the classification criteria of the Physiotherapy Evidence Database (PEDro), we finally identified/retained and analyzed 68 articles. Although, in principle, a rigorous method – and we have followed the PRISMA type paradigm – there still might be some missing works of our related article selection. On the other hand, to augment/ consolidate our documentation base, we have used also 40 papers freely found in the literature, and even – aiming, too, at an as exhaustive knowledge underpinning as possible – derogatively, we have also considered some articles which, probably being very new, couldn't yet have reached the PEDro threshold score we have settled.
Conclusions. This paper overviews the current state-of-the-art knowledge in the approach of peloidotherapy in rehabilitation, with a focal point on the therapeutic properties of peloids.

Keywords: mud-therapy, pelotherapy, peloidotherapy, fango therapy, rehabilitation, balneotherapy, natural therapeutic factors,
Quantifying the functional diagnosis in the rehabilitation of postural problems of biomechanical junior female players in table tennis
Authors: IORDAN Daniel-Andrei , MOCANU Mircea-Dan , MEREUȚĂ Claudiu , STAN Zenovia , MOCANU George-Dănuț , ONU Ilie
Published: April 2021

Abstract
We have lived in an era in sports history in which due to the intensity of the confrontations between athletes, disorders manifested by headaches, shoulder, pelvis and knee aches etc. appear more often. The performers during puberty require special attention on their morpho – functional development from the kynesiotherapist who is part of the multidisciplinary team, due to many transformations of the human body specific at this age category. 13 juniors female athletes have participated to the study, being assessed anthropometric, plantar pressures and posture with softwear FreeStep by Sensor Medica, biomechanical analysis and from technical & tactical point of view by 5 tests with DartFish 360S. Within the statistical – mathematical analysis, we have used Pearson correlation coefficient which favoured the identification of the strongest correlations resulted from the technical – tactical - anthropometric – plantar pressures and postural unbalances (r > 1.00 at test 1 and r > 0.84 at test 2). Assumption: It is assumed that by using established methods and means to assess postural deficiencies and to assess the level of consolidation of the topspin attack, we can identify the correlations between them which would facilitate the creation in the future of an efficient postural improvement program. The goal is to improve the quality of life and sports performance in junior female table tennis players. The conclusions of this study demonstrate the fact that the mobility of the spine in frontal plan, high thoracic elasticity and an increased lateral mobility on the opposite side of the active arm represent advantages intended to optimize the attack by topspin, while the supraponderability, the pain in lumber area and the shoulder’s asymmetry constitute disruptive factors of attack’s performance.
Keywords: plantar pressures, postural unbalances, baropodometric platforms, topsin attack efficiency, dartfish 360s,
Dorsalgia rehabilitation in static disorders of the spine by therapeutic swimming
in young adults
Authors: VIZITIU Elena , CONSTANTINESCU Mihai
Published: April 2021

The purpose of this paper is to point out and propose the most effective means of therapeutic swimming in the use of work programs for patients with dorsalgia in spinal static disorders. The knowledge degree of therapeutic swimming is not sufficiently promoted and used, which is why we propose the following hypothesis: we start from the premise that therapeutic swimming can reduce the dorsalgia in the spine, improve lung capacity and physical condition in young adults. The objectives of this work are to identify subjects with spinal static dorsalgia and to establish the sample for the experiment; in the selection of therapeutic swimming means for the elaboration of the work program; in the registration and interpretation of the data in the form of tables and charts. The experiment took place at the Kinetic Therapy Practice of Mr. Constantinescu Mihai, as well as at the swimming pool in Cornisa, Botoşani county, with a sample consisting of 15 subjects aged between 18 and 22, all of whom suffered dorsalgia (in the spine). In this respect, we set out to implement a therapeutic swimming program for 6 months to achieve positive results.

Keywords: dorsalgia, spinal static disorders, therapeutic swimming,
The importance of early and long-lasting medical rehabilitation in patients with brachial plexus injury
Authors: SCHEAU Roxana , IELCIU Gabriela , ILIESCU Madalina Gabriela
Published: April 2021

Introduction. Brachial plexus lesions vary in severity, depending on the etiopathogenic mechanism and the level of force to which the plexus is exposed. In the same patient, several nerves of the plexus can be damaged in varying degrees of severity. Brachial plexus injuries lead to upper limb paralysis and disability. Material and Methods. We present the case of a 68-year-old woman diagnosed a year ago with multiple myeloma, clavicular plasmacytoma and secondary spontaneous clavicle fracture. At the same time she presented several dislocations of the shoulder and was diagnosed with brachial plexus palsy after the last dislocation. The patient was hospitalized in our department with a large motor deficit in the upper limb. A comprehensive motor rehabilitation program has been established three weeksafter installing the palsy. Results and discussion. The evolution of the patient was favorable. It was noticed the reduction of the symptoms and slight improvement in motor deficit of the affected upper limb. Thepatient rehabilitation should continue for several months because the nerve regenerates slowly. Conclusion. In patients with brachial plexus injury, motor rehabilitation should be instituted as early as possible and continued for a longer periodoftime until nerve regeneration occurs.It results that early and continuous medical rehabilitation is essential in patients with brachial plexus injury.
Keywords: Brachial plexus injury, shoulder dislocation, rehabilitation,
Semidefinite Programming Relaxations of the Traveling Salesman Problem and Their Integrality Gaps
Authors: Gutekunst Samuel C. , Williamson David P.
Published: April 2021

The traveling salesman problem (TSP) is a fundamental problem in combinatorial optimization. Several semidefinite programming relaxations have been proposed recently that exploit a variety of mathematical structures including, for example, algebraic connectivity, permutation matrices, and association schemes. The main results of this paper are twofold. First, de Klerk and Sotirov [de Klerk E, Sotirov R (2012) Improved semidefinite programming bounds for quadratic assignment problems with suitable symmetry. Math. Programming 133(1):75–91.] present a semidefinite program (SDP) based on permutation matrices and symmetry reduction; they show that it is incomparable to the subtour elimination linear program but generally dominates it on small instances. We provide a family of simplicial TSP instances that shows that the integrality gap of this SDP is unbounded. Second, we show that these simplicial TSP instances imply the unbounded integrality gap of every SDP relaxation of the TSP mentioned in the survey on SDP relaxations of the TSP in section 2 of Sotirov [Sotirov R (2012) SDP relaxations for some combinatorial optimization problems. Anjos MF, Lasserre JB, eds., Handbook on Semidefinite, Conic and Polynomial Optimization (Springer, New York), 795–819.]. In contrast, the subtour linear program performs perfectly on simplicial instances. The simplicial instances thus form a natural litmus test for future SDP relaxations of the TSP.