bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Fistula Formation and Velopharyngeal Insufficiency in Early Versus Standard Cleft Palate Repair
Authors: Eliason Michael J. , Hadford Stephen , Green Lauren , Reeves Travis 
Published: March 2020

Abstract
The goals of cleft palate repair are well-established; however, there does exist difference in practice patterns regarding the most appropriate patient age for palatoplasty. The optimal timing is debated and influenced by cleft type, surgical technique, and the surgeon's training. The objective of this study was to compare the rates of post-operative fistula formation and velopharyngeal insufficiency (VPI) in “early” versus “standard” cleft palate repair in a cohort of patients treated at a single craniofacial center.
A retrospective chart review identified 525 patients treated for cleft palate from 2000 to 2017 with 216 meeting inclusion criteria. “Early repair” is defined as palatoplasty before 6-months of age (108 patients). “Standard repair” is palatoplasty at or beyond 6-months old (108 patients). Rates of fistula formation were found to be significantly higher in early repairs (Chi-square statistic 9.0536, P value = 0.0026). Development of VPI was not significantly different between the 2 groups (Chi-square statistic 1.2068, P value = 0.27196). As expected, the incidence of post-palatoplasty VPI was significantly higher in patients who had a post-operative fistula when compared to those who healed without fistula formation (Chi-square statistic 4.3627, P value = 0.0367).
There is significant debate regarding the optimal timing of cleft repair to maximize speech outcomes and minimize risks. The authors’ data show that post-operative fistula formation occurs at a higher rate when performed prior to 6 months old. Furthermore, while the rate of VPI was not significantly affected by age at time of surgery, it was significantly higher in those who experienced a post-operative fistula.
Effects of a Glycogen Synthase Kinase 3 Inhibitor Tideglusib on Bone Regeneration With Calvarial Defects
Authors: Lektemur Alpan Aysan , Çalişir Metin , Kizildağ Alper , Özdede Melih , Özmen Özlem 
Published: March 2020

Abstract
Tideglusib is a glycogen synthase kinase 3 (GSK-3) inhibitor which has shown the effects of bone regeneration, used for the treatment of Alzheimer disease. The aim of the study was to determine the effects of Tideglusib in the apoptosis and the bone regeneration in rats with calvarial defects. Twenty male Wistar rats (aged 11–13 weeks) were used for the study. Full-thickness flap elevated to exposure calvarial bone. Two 5 mm critical size calvarial defects were created on each rat calvarium. The defects were divided into 4 study groups: 1-Control (n = 10); 2- Gelatin sponge+Tideglusib (Gs+TDG; n = 10); 3- Autogenous bone (AB; n = 10); 4-Autogenous bone+Tideglusib (AB+TDG; n = 10). Then, the rats were sacrificed at fourth week. Three-dimensional imaging, histopathologic and immunohistochemical examinations were performed to evaluate the samples. The most increased bone formation and interaction between graft and new bone were observed in AB+TDG group. Bone morphogenic protein-2 (BMP-2), alkaline phosphatase (ALP), collagen type 1 (Col 1) and osteocalcin (OCN) was determined significantly higher in Tideglusib received groups compared with those of Control and AB groups (P < 0.05). Osteoclast numbers found to be higher in Gs+TDG and AB+TDG groups as well as RANKL expression dis not affected in Gs+TDG group but decreased in AB+TDG group comparing those of Control and AB groups. In addition, Tideglusib increased the Bcl-2 levels (P < 0.05) and decreased Bax levels (P > 0.05) in Tideglusib received groups compared with their controls. The administration of Tideglusib in calvarial bone defects increased bone mineral density, new bone area and total bone area by decreasing apoptosis and increasing osteoblastogenesis.
Intraoperative Hemorrhagic Shock in Cancer Surgical Patients: Short and Long-Term Mortality and Associated Factors
Authors: Hamon Annabelle , Mokart Djamel , Pouliquen Camille , Guibert Jean Manuel de , Cambon Sylvie , Duong Lam Nguyen , Lambaudie Eric , Sannini Antoine , Chow-Chine Laurent , Bisbal Magali , Ewald Jacques , Turrini Olivier , Faucher Marion 
Published: March 2020

ABSTRACT

Background:
Management of hemorrhagic shock is well codified by international guidelines. These guidelines are predominantly based on trauma patients. We aimed to evaluate factors associated with 30-day mortality and long-term survival after intraoperative hemorrhagic shock during major oncological surgery.

Methods:
This retrospective study was conducted in a cancer referral center from January 2013 to February 2018. All adult cancer patients admitted in the operative room for scheduled or emergency oncological surgery associated with an intraoperative hemorrhagic shock were included.

Results:
Eighty-four patients were included in this study. The 30-day mortality rate was 26% (n = 22), the mean follow-up from the time of ICU admission was 20 months (95% CI, 15–25 months), 39 (46%) patients died during this period. Using logistic regression for multivariate analysis, factors independently associated with 30-day mortality were SAPS II score (odds ratio (OR) =1.056, 95% confident interval (CI) =1.010–1.1041), delta SOFA (SOFA score at day 3 – SOFA score at day 1) (OR= 1.780, 95% CI 1.184–2.677) and ISTH-DIC score (OR = 2.705, 95% CI 1.108–6.606). Using Cox multivariate analysis, factors associated with long-term mortality were delta SOFA (hazard ratio (HR) =1.558, 95% CI 1.298–1.870), ISTH-DIC score (HR = 1.381, 95% CI 1.049–1.817), hepatic dysfunction (HR = 7.653, 95% CI 2.031–28.842), and Charlson comorbidity index (HR = 1.330, 95% CI 1.041–1.699).

Conclusion:
The worsening of organ dysfunctions during the first 3 days of ICU admission as well as intraoperative coagulation disturbances (increased ISTH-DIC score) are independently associated with short and long-term mortality. Comorbidities (Charlson comorbidity index) and postoperative hepatic dysfunction were independently associated with long-term mortality. Early perioperative bundle strategies should be evaluated in order to improve patient's survival in this specific situation.
Time to Hemorrhage Control in a Hybrid ER System: Is It Time to Change?
Authors: Tatum Danielle , Pereira Bruno , Cotton Bryan , Khan Mansoor , Brenner Megan , Ferrada Paula , Hörer Tal , Kauvar David , Kirkpatrick Andrew , Ordonez Carlos , Pirouzram Artai , Roberts Derek , Duchesne Juan 
Published: March 2020

ABSTRACT
Time to hemorrhage control is critical, as mortality in patients with severe hemorrhage that arrive to trauma centers with sign of life remains over 40%. Prompt identification and management of severe hemorrhage is paramount to reducing mortality. In traditional US trauma systems, the early hospital course of a severely hemorrhaging patient typically proceeds from the trauma resuscitation bay to the operating room or angiography suite with a potential stop for radiological imaging. This protracted journey can prove fatal as it consumes valuable minutes. In contrast to the current US system is a newly developed and increasingly adopted system in Japan called the hybrid emergency room system (HERS). The hybrid ER is equipped to allow resuscitation, imaging, and damage control intervention to occur in the ER without the need to transport the patient to a subsequent destination. The HERS is relatively new and remains restricted to a small number of institutions, limiting the ability to robustly examine impact(s) on patient outcomes. Even if proven to yield superior outcomes, there are significant obstacles to adopting the HERS in the US. Challenges such as the high cost of building and implementing a HER system, return on investment, and the significant differences between the US and Japan in terms of physician training, trauma center, and reimbursement schemes may render the hybrid ER system to be unfeasible in most current trauma centers. Barriers aside, the Japanese hybrid ER system remains the most novel recent advancement in the quest to reduce potentially preventable mortality from hemorrhage.
Validation of the American Association for the Surgery of Trauma grading system for acute appendicitis severity
Authors: Mouch Charles A. , Cain-Nielsen Anne H. , Hoppe Beckie L. , Giudici Maria P. , Montgomery John R. , Scott John W. , Machado-Aranda David A. , Hemmila Mark R. 
Published: March 2020

OBJECTIVE
The American Association for the Surgery of Trauma (AAST) developed an anatomic grading system to assess disease severity through increasing grades of inflammation. Severity grading can then be utilized in risk-adjustment and stratification of patient outcomes for clinical benchmarking. We sought to validate the AAST appendicitis grading system by examining the ability of AAST grade to predict clinical outcomes used for clinical benchmarking.

METHODS
Surgical quality program data were prospectively collected on all adult patients undergoing appendectomy for acute appendicitis at our institution between December 2013 and May 2018. The AAST acute appendicitis grade from 1 to 5 was assigned for all patients undergoing open or laparoscopic appendectomy. Primary outcomes were occurrence of major complications, any complications, and index hospitalization length of stay. Multivariable models were constructed for each outcome without and with inclusion of the AAST grade as an ordinal variable. We also developed models using International Classification of Diseases, 9th or 10th Rev.—Clinical Modification codes to determine presence of perforation for comparison.

RESULTS
A total of 734 patients underwent appendectomy for acute appendicitis. The AAST score distribution included 561 (76%) in grade 1, 49 (6.7%) in grade 2, 79 (10.8%) in grade 3, 33 (4.5%) in grade 4, and 12 (1.6%) in grade 5. The mean age was 35.3 ± 14.7 years, 47% were female, 20% were nonwhite, and 69% had private insurance. Major complications, any complications, and hospital length of stay were all positively associated with AAST grade (p < 0.05). Risk-adjustment model fit improved after including AAST grade in the major complications, any complications, and length of stay multivariable regression models. The AAST grade was a better predictor than perforation status derived from diagnosis codes for all primary outcomes studied.

CONCLUSION
Increasing AAST grade is associated with higher complication rates and longer length of stay in patients with acute appendicitis. The AAST grade can be prospectively collected and improves risk-adjusted modeling of appendicitis outcomes.

LEVEL OF EVIDENCE
Prospective/Epidemiologic, Level III.
Disparities in rural versus urban field triage: Risk and mitigating factors for undertriage
Authors: Deeb Andrew-Paul , Phelos Heather M. , Peitzman Andrew B. , Billiar Timothy R. , Sperry Jason L. , Brown Joshua B. 
Published: March 2020

BACKGROUNDThere are well-known disparities for patients injured in rural setting versus urban setting. Many cite access to care; however, the mechanisms are not defined. One potential factor is differences in field triage. Our objective was to evaluate differences in prehospital undertriage (UT) in rural setting versus urban settings.METHODSAdult patients in the Pennsylvania Trauma Outcomes Study (PTOS) registry 2000 to 2017 were included. Rural/urban setting was defined by county according to the Pennsylvania Trauma Systems Foundation. Rural/urban classification was performed for patients and centers. Undertriage was defined as patients meeting physiologic or anatomic triage criteria from the National Field Triage Guidelines who were not initially transported to a Level I or Level II trauma center. Logistic regression determined the association between UT and rural/urban setting, adjusting for transport distance and prehospital time. Models were expanded to evaluate the effect of individual triage criteria, trauma center setting, and transport mode on UT.RESULTSThere were 453,112 patients included (26% rural). Undertriage was higher in rural patients (8.6% vs. 3.4%,p< 0.01). Rural setting was associated with UT after adjusting for distance and prehospital time (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.82–6.78;p< 0.01). Different triage criteria were associated with UT in rural/urban settings. Rural setting was associated with UT for patients transferred to an urban center (OR, 3.32; 95% CI, 1.75–6.25;p< 0.01), but not a rural center (OR, 0.68; 95% CI, 0.08–5.53;p= 0.72). Rural setting was associated with UT for ground (OR, 5.01; 95% CI, 2.65–9.46;p< 0.01) but not air transport (OR, 1.18; 95% CI, 0.54–2.55;p= 0.68).CONCLUSIONUndertriage is more common in rural settings. Specific triage criteria are associated with UT in rural settings. Lack of a rural trauma center requiring transfer to an urban center is a risk factor for UT of rural patients. Air medical transport mitigated the risk of UT in rural patients. Provider and system interventions may help reduce UT in rural settings.LEVEL OF EVIDENCECare Management, Level IV.
Giving Voice to Patients Through Interviews and Qualitative Analysis- A Pilot Study
Authors: Loxton Matthew H , Okoli Ebele 
Published: March 2020

AbstractModern healthcare is drowning in data, and burdened by quality, safety, financial, and operational metrics, but few relate directly to how patients experiences their care. The literature lacks sufficient specificity on how care processes are seen through the eyes of the patient.To fill a gap in awareness of the patient experience of the radiology processes, we used a multimethod qualitative approach to elicit the patient view of their radiology experiences and insights from the patient voice. We developed a typology of patient experiences of the radiology processes that centered on communication gaps, and reflected opacity, fragility, and unpredictability of administrative and care processes in radiology that failed to interconnect efficiently or effectively, and did not work well as an end-to-end patient journey. Care processes were described by participants as fragile, solitary, and opaque, and required constant vigilance, supervision, and assistance by patients. Participants described a need for improved communication between radiology staff and patients that focuses on the patient journey and helps to identify and mitigate causes of process opacity and fragility.
Regaining perspective on SARS-CoV-2 molecular tracing and its implications
Authors: Mavian Carla , Marini Simone , Manes Costanza , Capua Ilaria , Prosperi Mattia , Salemi Marco 
Published: March 2020

AbstractDuring the past three months, a new coronavirus (SARS-CoV-2) epidemic has been growing exponentially, affecting over 100 thousand people worldwide, and causing enormous distress to economies and societies of affected countries. A plethora of analyses based on viral sequences has already been published, in scientific journals as well as through non-peer reviewed channels, to investigate SARS-CoV-2 genetic heterogeneity and spatiotemporal dissemination. We examined all full genome sequences currently available to assess the presence of sufficient information for reliable phylogenetic and phylogeographic studies. Our analysis clearly shows severe limitations in the present data, in light of which any finding should be considered, at the very best, preliminary and hypothesis-generating. Hence the need for avoiding stigmatization based on partial information, and for continuing concerted efforts to increase number and quality of the sequences required for robust tracing of the epidemic.
Automatic multi-object organ detection and segmentation in abdominal CT data
Authors: Mietzner Oliver , Mastmeyer Andre 
Published: March 2020

AbstractThe ability to generate 3D patient models in a fast and reliable way, is of great importance, e.g. for the simulation of liver punctures in virtual reality simulations. The aim is to automatically detect and segment abdominal structures in CT scans. In particular in the selected organ group, the pancreas poses a challenge. We use a combination of random regression forests and 2D U-Nets to detect bounding boxes and generate segmentation masks for five abdominal organs (liver, kidneys, spleen, pancreas). Training and testing is carried out on 50 CT scans from various public sources. The results show Dice coefficients of up to 0.71. The proposed method can theoretically be used for any anatomical structure, as long as sufficient training data is available.
Machine Learning the Phenomenology of COVID-19 From Early Infection Dynamics
Authors: Magdon-Ismail Malik 
Published: March 2020

AbstractWe present a robust data-driven machine learning analysis of the COVID-19 pandemic from its early infection dynamics, specifically infection counts over time. The goal is to extract actionable public health insights. These insights include the infectious force, the rate of a mild infection becoming serious, estimates for asymtomatic infections and predictions of new infections over time. We focus on USA data starting from the first confirmed infection on January 20 2020. Our methods reveal significant asymptomatic (hidden) infection, a lag of about 10 days, and we quantitatively confirm that the infectious force is strong with about a 0.14% transition from mild to serious infection. Our methods are efficient, robust and general, being agnostic to the specific virus and applicable to different populations or cohorts.
High-risk Human Papillomavirus (16, 18) are not the most common genotypes associated with cervical pre-cancer lesions: a retrospective study at a University Hospital in the Eastern-Province of Saudi Arabia
Authors: Kussaibi Haitham , Dossary Reem Al , Badar Ayesha , Muammar Aroub Omar , Aljohani Raghad Ibrahim 
Published: March 2020

AbstractObjectiveHigh-risk HPV (human papillomavirus) is found to be responsible for 4.5% of all cancer, especially cervical cancer. The prevalence of high-risk HPV associated with cervical lesions is not well- known in Saudi Arabia. This study aims to highlight the genotypes of high-risk HPV associated with pre- malignant cervical lesions.MethodsOver 6 years (2013 - 2018), 5091 Pap (Papanicolaou) smears results and 170 high-risk HPV test results were collected from the Information System at King Fahd University Hospital. Statistical analysis was performed using the software SPSS (Statistical Package for Social Sciences).ResultsOut of 5091 Pap smears, only 1.89% (n=96) were abnormal; 0.18% (n=9) were malignant (7 Squamous cell carcinomas and 2 adenocarcinomas), while 1.7% (n=87) showed pre-cancerous lesions, 44 ASCUS (Atypical Squamous Cells of Undetermined Significance), 17 LSIL (Low-grade Squamous Intraepithelial Lesions), 12 HSIL (High-grade Squamous Intraepithelial Lesions), and 14 AGC (Atypical Glandular Cells). Out of 170 patients co-tested for high-risk HPV, only 13.5% (n=23/170) had positive results (5 cases were positive for HPV16, 1 case was positive for both HPV16 and 18, while the remaining 17 cases were positive for high-risk HPV other than 16 or 18), among them, 6.47% (n=11/170) had normal Pap smear, while 7.06% (n=12/170) patients had abnormal Pap smear; 4 ASCUS, 6 LSIL and 2 HSIL. Statistical analysis showed a significant correlation between HPV findings and the Pap smear results (P- value 0.000), however, no significant correlation was found with the patients’ age and/or nationality.DiscussionOur study showed a unique distribution of high-risk HPV genotypes which reflects different geographical infection patterns. Furthermore, the high association of high-risk HPV with normal Pap smears highlights the need, for all women at risk, to be co-investigated for high-risk HPV. These findings could help in customizing regional vaccine-combinations and screening programs.
Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis
Authors: Ma Chaoqun , Gu Jiawei , Hou Pan , Zhang Liang , Bai Yuan , Guo Zhifu , Wu Hong , Zhang Bili , Li Pan , Zhao Xianxian 
Published: March 2020

AbstractBackgroundRecently, Coronavirus Disease 2019 (COVID-19) outbreak started in Wuhan, China. Although the clinical features of COVID-19 have been reported previously, data regarding the risk factors associated with the clinical outcomes are lacking.ObjectivesTo summary and analyze the clinical characteristics and identify the predictors of disease severity and mortality.MethodsThe PubMed, Web of Science Core Collection, Embase, Cochrane and MedRxiv databases were searched through February 25, 2020. Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations were followed. We extracted and pooled data using random-e□ects meta-analysis to summary the clinical feature of the confirmed COVID-19 patients, and further identify risk factors for disease severity and death. Heterogeneity was evaluated using the I2method and explained with subgroup analysis and meta-regression.ResultsA total of 30 studies including 53000 patients with COVID-19 were included in this study, the mean age was 49.8 years (95% CI, 47.5-52.2 yrs) and 55.5% were male. The pooled incidence of severity and mortality were 20.2% (95% CI, 15.1-25.2%) and 3.1% (95% CI, 1.9-4.2%), respectively. The predictor for disease severity included old age (≥ 50 yrs, odds ratio [OR] = 2.61; 95% CI, 2.29-2.98), male (OR =1.348, 95% CI, 1.195-1.521), smoking (OR =1.734, 95% CI, 1.146-2.626) and any comorbidity (OR = 2.635, 95% CI, 2.098-3.309), especially chronic kidney disease (CKD, OR = 6.017; 95% CI, 2.192-16.514), chronic obstructive pulmonary disease (COPD, OR = 5.323; 95% CI, 2.613-10.847) and cerebrovascular disease (OR = 3.219; 95% CI, 1.486-6.972). In terms of laboratory results, increased lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer and decreased blood platelet and lymphocytes count were highly associated with severe COVID-19 (all for P < 0.001). Meanwhile, old age (≥ 60 yrs, RR = 9.45; 95% CI, 8.09-11.04), followed by cardiovascular disease (RR = 6.75; 95% CI, 5.40-8.43) hypertension (RR = 4.48; 95% CI, 3.69-5.45) and diabetes (RR = 4.43; 95% CI, 3.49-5.61) were found to be independent prognostic factors for the COVID-19 related death.ConclusionsTo our knowledge, this is the first evidence-based medicine research to explore the risk factors of prognosis in patients with COVID-19, which is helpful to identify early-stage patients with poor prognosis and adapt effective treatment.