bluuebunny/crossref_metadata_2025_split huggingface dataset:
Significant reduction in the visits to the emergency room department during the COVID-19 pandemic in a tertiary hospital in Greece
Authors: Kastritis Efstathios , Tsitsimpis Konstantinos , Anninos Ektoras , Stamatelopoulos Kimonas , Kanakakis Ioannis , Lampropoulos Christos , Chatzidou Sofia , Michopoulos Spyros , Papamichail Christos , Kostis Evangelos , Manios Efstathios , Kontogiannis Sofoklis , Paraskevaidis Ioannis , Terpos Evangelos , Mitrakou Asimina , Dimopoulos Meletios A. 
Published: December 2020

Abstract
COVID-19 pandemic caused a major crisis, affecting and straining health care systems, including some very advanced ones. The pandemic may have also indirectly affected access to health care for patients with other conditions, not related to COVID-19, even in countries not overwhelmed by an outbreak.
We analyzed and compared visits to the emergency room (ER) department during the same calendar period of 2019 and 2020 (from March 1 to March 31 of each year) in our hospital, a medium size, tertiary center, located in the center of Athens, which is not a referral center for COVID-19.
Total ER visits were reduced by 42.3% and the number of those requiring hospitalization by 34.8%. This reduction was driven by lower numbers of visits for low risk, non-specific symptoms and causes. However, there was a significant decrease in admissions for cardiovascular symptoms and complications (chest pain of cardiac origin, acute coronary syndromes, and stroke) by 39.7% and for suspected or confirmed GI hemorrhage by 54.7%. Importantly, number of ER visits for infections remained unchanged, as well as the number of patients that required hospitalization for infection management; only few patients were diagnosed with COVID-19.
During the initial period of the pandemic and lock-down in Greece, there was a major decrease in the patients visiting ER department, including decrease in the numbers of admissions for cardiovascular symptoms and complications. These observations may have implications for the management of non-COVID-19 diseases during the pandemic.
Background parenchymal enhancement on contrast-enhanced spectral mammography does not represent an influencing factor for breast cancer
Authors: Yu Liangliang , Wang Yongtao , Xing Dong , Gong Peiyou , Chen Qianqian , Lv Yongbin 
Published: December 2020

Abstract
To compare the relationship between background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM), mammographic breast density (MBD), age, in the group with benign vs malignant breast lesions.
Four hundred thirty three non-high-risk patients from January 2018 to May 2019 were retrospectively analyzed. Patients were assigned into 4 groups: premenopausal benign lesions, premenopausal malignant lesions, postmenopausal benign lesions, and postmenopausal malignant lesions. The differences in CESM BPE and MBD between premenopausal benign lesions and premenopausal malignant lesions, between postmenopausal benign lesions and postmenopausal malignant lesions, between premenopausal and postmenopausal benign lesions, and between premenopausal and postmenopausal malignant lesions were evaluated. Pearson Chi-Squared test was used to analyze the differences between the above groups. Spearman rank correlation analysis was used to evaluate the correlations between BPE, MBD, and age. Multiple logistic regression was used to analyze the influencing factors of breast cancer. P < .05 was considered statistically significant.
There was no significant difference in CESM BPE or MBD of benign and malignant lesions regardless of premenopausal or postmenopausal status, but there was a significant difference in CESM BPE and MBD of premenopausal and postmenopausal patients regardless of the presence of benign or malignant lesions. The intensity of CESM BPE was positively correlated with MBD, and the intensity of CESM BPE and MBD were negatively correlated with age. Multiple logistic regression analysis showed that age was an influencing factor for breast cancer in both premenopausal and postmenopausal patients.
For non-high-risk women, CESM BPE and MBD were not correlated with benign or malignant breast lesions, and age was an influencing factor for breast cancer.
Identification of Serum microRNA-25 as a novel biomarker for pancreatic cancer
Authors: Yu Yiwen , Tong Ying , Zhong Ailing , Wang Yanchun , Lu Renquan , Guo Lin 
Published: December 2020

Abstract
To identify serum microRNA-25 (miR-25) as a diagnostic biomarker for pancreatic cancer (PCa) and to evaluate its supplementary role with serum carbohydrate antigen 19-9 (CA19-9) in early identification of cancers.
Eighty patients with pancreatic cancer and 91 non-cancer controls were enrolled in this study. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression level of miR-25. Levels of CA19-9, carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125) were measured by chemiluminescent immunoassay. The logistic model was established to evaluate the correlation of miR-25 with clinical characteristics. A risk model for PCa was conducted by R statistical software. Diagnostic utility for PCa and correlation with clinical characteristics were analyzed.
The expression level of miR-25, in the PCa group was significantly higher (P < .05). Risk Model illustrated the relation between miR-25 and pancreatic cancer. With the combination of CA19-9, the performance of miR-25 in early stages (I+II) in the diagnosis of PCa was profoundly better than CA19-9 and miR-25 alone. This combination was more effective for discriminating PCa from non-cancer controls (AUC-ROC, 0.985; sensitivity, 97.50%; specificity, 90.11%) compared with CA19-9 alone or the combination of CA19-9 and CA125.
The expression level of miR-25 among pancreatic cancer patients was significantly higher than that in the control group. miR-25 existed as one of the most relevant factors of PCa. miR-25 can serve as a novel noninvasive approach for PCa diagnosis, and with the supplementary of CA19-9, the combination was more effective, especially in early tumor screening.
Efficacy and safety of Qishen granules for chronic heart failure
Authors: Liu Junjie , Xu Zixuan , Yang Shuangjie , Du Kangjia , Zhang Yili , Tan Nannan , Sun Xiaoli , Zhao Huihui , Wang Wei 
Published: December 2020

Abstract

Background:
Qishen granules (QSG) is a famous traditional Chinese Medicine (TCM) formula used to treat chronic heart failure (CHF). The objective of this protocol is to clarify the efficacy and safety of QSG for treating CHF.

Methods:
Six databases will be electronically searched up to November 1, 2020 for randomized controlled trials (RCTs) in English and Chinese languages. Two independent reviewers will complete tasks of literature retrieval and data extraction. After that, the Cochrane Collaboration risk of bias tool will be utilized to assess methodological quality. The primary outcomes are left ventricular ejection fraction, left ventricular fractional shortening, and N-terminal B-type natriuretic peptide. The secondary outcomes consist of composite cardiac events, adverse effects, and quality of life. Meta-analysis will be performed using the Revman version 5.3.

Results:
This study will provide a high-quality synthesis of current evidence of QSG for CHF from primary and secondary outcomes.

Conclusion:
This study will provide evidence for the effectiveness and safety of QSG in the treatment of CHF.

PROSPERO registration number:
CRD42020150442.
HLA-A∗24:02 associated with lamotrigine-induced cutaneous adverse drug reactions
Authors: Li Wanshu , Wang Jie , Lin Hangjuan , Shen Gang 
Published: December 2020

Abstract

Background:
Several studies demonstrated a connection between human leukocyte antigen (HLA)-B∗1502 and lamotrigine (LTG)-induced cutaneous adverse drug reactions (cADRs). The correlation between the HLA-A∗24:02 and LTG-cADRs remains controversial. To examine the associations between HLA-A∗24:02 and LTG-cADRs, we conducted a systematic review and meta-analysis.

Methods:
We performed a comprehensive search of the literature in several electronic database systems including Cochrane Library, EMBASE and PubMed from inception to January 2020. Review Manager was used to compare the frequencies of HLA-A∗24:02 carriers between the subgroups.

Results:
A total of 5 studies were eligible, including 197 LTD-cADRs, 396 LTD-tolerant controls, and 2068 population controls. Compared with the LTG-tolerant controls, there was a statistically significant association between the HLA-A∗24:02 allele and LTG-induced cADRs (odds ratios: 1.94, 95% confidence intervals 1.06–3.54; P = .03). Compared with the general population, the relationship between the HLA-A∗24:02 genotype and LTG-induced cADRs was statistically significant (summary odds ratios: 2.12, 95% confidence intervals 1.04–4.30; P = .04).

Conclusions:
HLA-A∗24:02 may be a risk factor for LTG-cADRs.
Evaluation and comparison of the indoor air quality in different areas of the hospital
Authors: Lee Hyun-Joo , Lee Kang Hyun , Kim Dong-Kyu 
Published: December 2020

Abstract
The levels of indoor air pollutants are increasing. However, the indoor air quality of only operating rooms, intensive care units, and radiology departments is usually monitored in hospitals. Hence, we aimed to evaluate the indoor air quality of an otorhinolaryngology outpatient clinic and compare air quality indices among different areas in a hospital.
We prospectively measured indoor air quality using air quality sensors in different areas of a hospital from February 1, 2019 to January 31, 2020. Carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter with diameter of <2.5 μm (PM2.5), and nitrogen dioxide concentrations were measured in the otorhinolaryngology clinic, orthopedic clinic, and reception area. The intervention efficacy was compared between otorhinolaryngology clinics employing and not employing air-cleaners.
The overall concentrations of CO2, VOCs, and PM2.5 in the otorhinolaryngology clinic were significantly higher than those in the orthopedic clinic or reception area. The indoor air quality was the worst in winter. The intervention effect was observed only in PM2.5 concentrations in otorhinolaryngology clinics employing an air-cleaner.
Medical practitioners and patients are frequently exposed to ambient indoor air pollution in otorhinolaryngology clinics. Hence, health-related strategies to protect against ambient indoor air pollution in otorhinolaryngology clinics are warranted.
A systematic review and meta-analysis comparing arthroplasty and internal fixation in the treatment of elderly displaced femoral neck fractures
Authors: Deng Junhao , Wang Guoqi , Li Jia , Wang Song , Li Miao , Yin Xiaohong , Zhang Licheng , Tang Peifu 
Published: December 2020

Abstract

Background:
Currently, there are 2 mainstream treatments for displaced femoral neck fracture, including internal fixation and arthroplasty. However, there are still some controversial problems as to which treatment should be primarily chosen.

Methods:
The relevant studies comparing arthroplasty with internal fixation were searched in the databases of PubMed, Embase, and Cochrane Library. Finally, 31 relevant randomized controlled trials were included in this meta-analysis. The quality of studies was evaluated and meta-analyses were performed using RevMan 5.3 software. We also assessed the heterogeneity among studies and publication bias via the I-squared index and forest plots.

Results:
There was no significant difference between arthroplasty and internal fixation groups in patient mortality at both short-term and long-term points. However, patients treated with arthroplasty showed significantly lowered risks of reoperation both at short-term (5.6% vs 31.5%; relative risks (RR)  = 0.19; 95% CI, 0.13–0.28; P < .00001) and long-term follow-up (9.5% vs 45.9%; RR = 0.23; 95% CI, 0.17–0.33; P < .00001). Similarly, arthroplasty-treated patients demonstrated a significant decrease in the risk of postoperation complications at short-term (10.3% vs 34.4%; RR = 0.37, 95% CI, 0.24–0.57; P < .00001) and long-term follow-up (11.7% vs 42.5%; RR = 0.30, 95% CI, 0.16–0.57; P < .0002). Besides, patients in the arthroplasty group were associated with better alleviation of pain postoperation (18.3% vs 31.1%; RR = 0.50, 95% CI, 0.33–0.78; P = .002).
In trial sequence analyses, all cumulative Z curves except that of mortality crossed the trial sequential monitoring boundaries and conventional boundaries, and required information size has been reached.

Conclusions:
Arthroplasty leads to a lower rate of reoperation, a reduced risk of complications, and a better alleviation of postoperation pain both at short-term and long-term follow-up. Most importantly, and according to trial sequence analyses, more than enough evidence has been achieved that arthroplasty does show better outcomes than internal fixation in terms of reoperation rate, complications, and postoperation pain.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Solitary Vulvar Involvement of Ovarian Non-Hodgkin Lymphoma Mimicking Bartholin’s Abscess on 18F-FDG PET/CT
Authors: Beyhan Ediz , Ergül Nurhan , Bektaş Sibel , Erol Özge , Çermik Tevfik Fikret 
Published: December 2020

Abstract
A 49-year-old woman was diagnosed with diffuse large B-cell lymphoma of the left ovary. Two months after the hysterectomy and bilateral salpingo-oophorectomy operation, the patient was referred to 18F-FDG PET/CT for staging. A mass lesion measuring 2.8 × 3 cm with intense 18F-FDG uptake was observed at right labium majus, which could be considered as a Bartholin’s cyst or abscess. The lesion was excised, and non-Hodgkin lymphoma involvement of vulva was revealed by histopathology.
Exploring the Experience of the Surgical Workforce During the Covid-19 Pandemic
Authors: Mavroudis Catherine L. , Landau Sarah , Brooks Ezra , Bergmark Regan , Berlin Nicholas L. , Blumenthal Blanche , Cooper Zara , Hwang Eun Kyeong , Lancaster Elizabeth , Waljee Jennifer , Wick Elizabeth , Yeo Heather , Wirtalla Christopher , Kelz Rachel R. 
Published: December 2020

Objective:
To explore the impact of the Covid-19 pandemic on the stress levels and experience of academic surgeons by training status (eg, housestaff or faculty).

Background:
Covid-19 has uniquely challenged and changed the United States healthcare system. A better understanding of the surgeon experience is necessary to inform proactive workforce management and support.

Methods:
A multi-institutional, cross-sectional telephone survey of surgeons was conducted across 5 academic medical centers from May 15 to June 5, 2020. The exposure of interest was training status. The primary outcome was maximum stress level, measured using the validated Stress Numerical Rating Scale-11 (range 0–10).

Results:
A total of 335 surveys were completed (49.3% housestaff, 50.7% faculty; response rate 63.7%). The mean maximum stress level of faculty was 7.21 (SD 1.81) and of housestaff was 6.86 (SD 2.06) (P = 0.102). Mean stress levels at the time of the survey trended lower amongst housestaff (4.17, SD 1.89) than faculty (4.56, SD 2.15) (P = 0.076). More housestaff (63.6%) than faculty (40.0%) reported exposure to individuals with Covid-19 (P < 0.001). Subjects reported inadequate personal protective equipment in approximately a third of professional exposures, with no difference by training status (P = 0.557).

Conclusions:
During the early months of the Covid-19 pandemic, the personal and professional experiences of housestaff and faculty differed, in part due to a difference in exposure as well as non-work-related stressors. Workforce safety, including adequate personal protective equipment, expanded benefits (eg, emergency childcare), and deliberate staffing models may help to alleviate the stress associated with disease resurgence or future disasters.
County-level Social Vulnerability is Associated With Worse Surgical Outcomes Especially Among Minority Patients
Authors: Diaz Adrian , Hyer J. Madison , Barmash Elizabeth , Azap Rosevine , Paredes Anghela Z. , Pawlik Timothy M. 
Published: December 2020

Objective:
We sought to characterize the association between patient county-level vulnerability with postoperative outcomes.

Summary Background Data:
Although the impact of demographic-, clinical- and hospital-level factors on outcomes following surgery have been examined, little is known about the effect of a patient's community of residence on surgical outcomes.

Methods:
Individuals who underwent colon resection, coronary artery bypass graft (CABG), lung resection, or lower extremity joint replacement (LEJR) were identified in the 2016 to 2017 Medicare database, which was merged with Center for Disease Control social vulnerability index (SVI) dataset at the beneficiary level of residence. Logistic regression models were utilized to estimate the probability of postoperative complications, mortality, readmission, and expenditures.

Results:
Among 299,583 Medicare beneficiary beneficiaries who underwent a colectomy (n = 88,778, 29.6%), CABG (n = 109,564, 36.6%), lung resection (n = 30,401, 10.1%), or LEJR (n = 70,840, 23.6%).
Mean SVI score was 50.2 (standard deviation: (25.2); minority patients were more likely to reside in highly vulnerable communities (low SVI: n = 3531, 5.8% vs high SVI: n = 7895, 13.3%; P < 0.001). After controlling for competing risk factors, the risk-adjusted probability of a serious complication among patients from a high versus low SVI county was 10% to 20% higher following colectomy [odds ratio (OR) 1.1 95% confidence intervals (CI) 1.1–1.2] or CABG (OR 1.2 95%CI 1.1–1.3), yet there no association of SVI with risk of serious complications following lung resection (OR 1.2 95%CI 1.0–1.3) or LEJR (OR 1.0 95%CI 0.93–1.2). The risk-adjusted probability of 30-day mortality was incrementally higher among patients from high SVI counties following colectomy (OR 1.1 95%CI 1.1–1.3), CABG (OR 1.4, 95%CI 1.2–1.5), and lung resection (OR 1.4 (95%CI 1.1–1.8), yet not LEJR (OR 0.95 95%CI 0.72–1.2). Black/minority patients undergoing a colectomy, CABG, or lung resection who lived in highly socially vulnerable counties had an estimate 28% to 68% increased odds of a serious complication and a 58% to 60% increased odds of 30-day mortality compared with a Black/minority patient from a low socially vulnerable county, as well as a markedly higher risk than White patients (all P > 0.05).

Conclusions:
Patients residing in vulnerable communities characterized by a high SVI generally had worse postoperative outcomes. The impact of social vulnerability was most pronounced among Black/minority patients, rather than White individuals. Efforts to ensure equitable surgical outcomes need to focus on both patient-level, as well as community-specific factors.
The role of metabolic comorbidity in COVID-19 mortality of middle-aged adults. The case of Mexico
Authors: Dominguez-Ramirez Lenin , Rodriguez-Perez Francisco , Sosa-Jurado Francisca , Santos-Lopez Gerardo , Cortes-Hernandez Paulina 
Published: December 2020

AbstractBackgroundIn contrast to developed countries, in Mexico more than half of COVID-19 deaths have occurred in adults <65-years-old, with at least a million years of life lost to premature mortality (YLL) in eight months. Mexico has a young population but a high prevalence of metabolic diseases like obesity and diabetes that contribute to COVID-19 adverse outcomes. COVID-19 could be particularly risky in population with specific comorbidity combinations that haven’t been analyzed.MethodsTo explore what contributes to the high COVID-19 mortality in Mexican middle-aged adults, we calculated age-stratified COVID-19 case fatality rates, YLL and relative risk (RR) of 9 comorbidities and 23 comorbidity combinations in a retrospective Mexican cohort with 905,579 PCR-confirmed COVID-19 cases/89,167 deaths, until Nov/2/2020.FindingsChronic kidney disease (CKD) had the highest RR for COVID-19 fatality, followed by diabetes and immunosuppression, that in turn had higher RR than obesity or hypertension as single comorbidities. The combination diabetes/hypertension with or without obesity had RR as high as CKD as a single comorbidity (>3 in <60-year-olds). Notably, the RR of comorbidities decreased with age, tending to values near 1 after age 60; suggesting that in Mexico, comorbidities increase COVID-19 fatality mostly in young and middle-aged adults. Our analysis suggests that advanced metabolic disease, marked by multimorbidity (more than one chronic disease per individual) or diabetes before age 60, contribute particularly to the younger age of COVID-19 fatalities in Mexico. Around 38% of YLL to COVID-19, were attributable to the synergy between COVID-19 and pre-existing diseases, mainly combinations between obesity, diabetes and hypertension. Yet, ¼ of deaths and 1/3 of YLL have occurred in individuals without known comorbidities.ConclusionsThe Mexican COVID-19 outbreak illustrates that middle-aged adults 45-64-yo can have high COVID-19 mortality during large outbreaks, especially if they present chronic metabolic comorbidities, but also in their absence, making them an important group of concern after elders. COVID-19 mortality in middle-aged adults is likely proportional to the gradual decline in health that accompanies ageing, which presents earlier in poorer populations that also get more exposed to SARS-CoV-2 and have less access to specialized medical attention.
Fundamental Limitations of Contact Tracing for COVID-19
Authors: Tupper P. , Otto S. , Colijn C. 
Published: December 2020

AbstractContact tracing has played a central role in COVID-19 control in many jurisdictions and is often used in conjunction with other measures such as travel restrictions and social distancing mandates. Contact tracing is made ineffective, however, by delays in testing, calling, and isolating. Even if delays are minimized, contact tracing can only prevent a fraction of onward transmissions from contacts. Without other measures in place, contact tracing alone is insufficient to prevent exponential growth in the number of cases. Even when used effectively with other measures, occasional bursts in call loads can overwhelm contact tracing systems and lead to a loss of control. We propose embracing approaches to COVID-19 control that broadly test individuals without symptoms, in whatever way is economically feasible – either with fast cheap tests that can be deployed widely, with pooled testing, or with screening of judiciously chosen groups of high-risk individuals. Only by ramping up testing of asymptomatic individuals can we avoid the inherent delays that limit the efficacy of contact tracing.
Transmission of SARS-CoV-2 before and after symptom onset: impact of nonpharmaceutical interventions in China
Authors: Bushman Mary , Worby Colin , Chang Hsiao-Han , Kraemer Moritz , Hanage William P. 
Published: December 2020

AbstractNonpharmaceutical interventions, such as contact tracing and quarantine, are currently the primary means of controlling the spread of SARS-CoV-2; however, it remains uncertain which interventions are most effective at reducing transmission at the population level. Using serial interval data from before and after the rollout of nonpharmaceutical interventions in China, we estimate that the relative frequency of presymptomatic transmission increased from 34% before the rollout to 71% afterward. The shift touward earlier transmission indicates a disproportionate reduction in transmission post-symptom onset. We estimate that, following the rollout of nonpharmaceutical interventions, transmission post-symptom onset was reduced by 82% whereas presymptomatic transmission decreased by only 16%. These findings suggest that interventions which limit opportunities for transmission in the later stages of infection, such as contact tracing and isolation, may have been particularly effective at reducing transmission of SARS-CoV-2.