bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized Comparison of Carbon Nanoparticles in Endoscopic Lymph Node Dissection Via the Bilateral Areola Approach for Papillary Thyroid Cancer
Authors: Zhang Daqi , Fu Yantao , Dionigi Gianlorenzo , Hu Yu , Zhang Jiao , Wang Tie , Xue Gaofeng , Sun Hui 
Published: April 2020

Objective:
We assess the value of carbon nanoparticles (CNP) staining in patients undergoing endoscopic thyroidectomy and central compartment lymph node (CLN) dissection via the bilateral areola approach [endoscopic thyroidectomy via bilateral areola approach (ETBAA)].

Methods:
This was a prospective randomized study. Three hundred two consecutive early-stage thyroid cancer patients eligible for ETBAA were recruited at the Division of Thyroid Surgery, China-Japan Union Hospital, Jilin University, China. CLN were mapped and retrieved under the guidance of stained or unstained CNP. The location, detection rates, positive nodes, and number of stained lymph nodes were compared.

Results:
ETBAA patients were randomly divided into a CNP group (n=152) and a control group (n=150). In the CNP group, the imaging of lymphatic flow could be observed in 1016 (95.9%) lymph nodes, whereas 43 (4.1%) were unstained. The mean number of stained lymph nodes in each procedure was 6.68 (range, 3 to 12). The total number of dissected lymph nodes was 1059 in the CNP group and 872 in the control group (P=0.00). There was a significant difference of inadvertent parathyroidectomy between the 2 groups: 0.5% versus 3.9% in lobectomy (P=0.035) and 0.6% versus 5.2% in total thyroidectomy (P=0.012). However, the rates of hypoparathyroidism were not significantly different (P>0.05). There were no cases of CNP-related adverse effects.

Conclusions:
The lymphatic navigation by CNP increases the number of detected CLN without the involvement of radioactive isotopes. However, CNP did not lower hypocalcemia, did not improve parathyroid hormone range, and there was no significant difference in the percentage of metastatic lymph nodes between the 2 groups.
Does circadian rhythm influence gastrointestinal toxicity?
Authors: Hofmeister Elisa N. , Fisher Sophie , Palesh Oxana , Innominato Pasquale F. 
Published: April 2020

Purpose of review
The current review outlines the existing research on the impact of circadian rhythm on gastrointestinal toxicity associated with cancer treatment and explores clinical evidence for utilizing circadian-based approaches in addressing gastrointestinal symptoms such as nausea, vomiting, diarrhea, mucositis, and hepatotoxicity.

Recent findings
Recent evidence highlights circadian control of gastrointestinal physiology of appetite, digestion, nutrient absorption, and cellular proliferation in the digestive system. In addition, animal models support the mechanistic rationale of using chronotherapy (a type of anticancer therapy delivered at specific times with the goal of producing less toxicity and greater treatment response) to minimize gastrointestinal-impact of systemic cancer treatments. In addition, earlier research demonstrates that many chemotherapeutic agents are responsive to circadian timing in animals. On the contrary, clinical trials focused on minimizing gastrointestinal toxicity using chronotherapy have been limited in recent years and have not yielded the efficacy initially hoped for. Instead, researchers focused on understanding circadian rhythm's influence on the gastrointestinal system at a mechanistic level as well as measuring circadian rhythm at an individual level.

Summary
Although using circadian timing is a promising target for reducing gastrointestinal toxicity, recent evidence suggests that more research is needed to understand circadian rhythm before circadian-based interventions can be developed that will result in lessening of gastrointestinal toxicity.
Does Living With Human Immunodeficiency Virus Increase Pelvic Reconstructive Surgery Perioperative Complication Risk? A Multicenter Retrospective Cohort Study
Authors: Petrikovets Andre , Weber Lebrun Emly E. , Carlos Daniela M. , Perlman Barry , Florian-Rodriguez Maria E. , Bochenska Katarzyna , Eto Chidimma u , Lespinasse Pierre , Mahajan Sangeeta T. , El-Nashar Sherif , Crisp Catrina C. , Sheyn David 
Published: April 2020

Objective
To determine if women with human immunodeficiency virus (HIV) undergoing pelvic reconstructive surgery (PRS) have an increased risk of perioperative and postoperative complications compared with HIV-negative controls.

Study Design
Multicenter, retrospective matched cohort study of patients with and without HIV infection who underwent PRS between 2006 and 2016. Cases were identified using International Classification of Disease, 9th edition Clinical Modification and 10th edition Clinical Modification and current procedural terminology (CPT) codes encompassing HIV diagnoses and pelvic reconstructive surgeries. Controls were identified as patients without HIV who underwent similar procedures, performed by the same surgeon during the same 1-year period as surgeries performed on patients with HIV. Cases were matched to controls at a ratio of 1:3. The primary outcome was composite complication rate within 1 year of surgery.

Results
Sixty-three patients with HIV and 187 controls were identified. There was no difference in the composite complication rate between women with HIV and HIV-negative women (36.5% vs 30.0%, P = 0.15) over 1 year. However, 19.1% of patients with HIV compared with 5.4% controls had Clavien Dindo Grade I complications (P = 0.002), and 11.1% of HIV patients had urinary retention within 6 weeks of surgery compared with 3.2% of controls (P = 0.02). After multivariable logistic regression used to adjust for confounders, living with HIV was not associated with an increased risk of complications.

Conclusions
Patients living with HIV are not at an increased risk of complications within 1 year of PRS compared with patients without HIV.
The Geriatric Nutritional Risk Index is a powerful predictor of adverse outcome in the elderly emergency surgery patient
Authors: Jia Zhenyi , El Moheb Mohamad , Nordestgaard Ask , Lee Jae Moo , Meier Karien , Kongkaewpaisan Napaporn , Han Kelsey , El Hechi Majed W. , Mendoza April , King David , Fagenholz Peter , Saillant Noelle , Rosenthal Martin , Velmahos George , Kaafarani Haytham M.A. 
Published: April 2020

BACKGROUNDThe degree to which malnutrition impacts perioperative outcomes in the elderly emergency surgery (ES) patient remains unknown. We aimed to study the relationship between malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), and postoperative outcomes in elderly patients undergoing ES.METHODSUsing the 2007 to 2016 American College of Surgeons National Surgical Quality Improvement Program database, all patients 65 years or older undergoing ES were included in our study. The GNRI, defined as (1.489 × albumin [g/L]) + (41.7 × [weight/ideal weight]) was calculated for each patient in the database. Patients with missing height, weight, or preoperative albumin data were excluded. Patients were divided into four malnutrition groups: very severe (GNRI < 73), severe (GNRI, 73–82), moderate (GNRI, 82–92), and mild (GNRI, 92–98). Geriatric Nutritional Risk Index greater than 98 constituted the normal nutrition group. Risk-adjusted multivariable logistic regressions were performed to study the relationship between malnutrition—measured using either GNRI, albumin level, or body mass index less than 18.5 kg/m2—and the following postoperative outcomes: 30-day mortality, 30-day morbidity (including infectious and noninfectious complications), and hospital length of stay. The relationship between GNRI score and 30-day mortality for six common ES procedures was then assessed.RESULTSA total of 82,725 patients were included in the final analyses. Of these, 55,214 were malnourished with GNRI less than 98 (66.74%). Risk-adjusted multivariable analyses showed that, as malnutrition worsened from mild to very severe, the risk of mortality, morbidity, and the hospital length of stay progressively increased (allp< 0.05). Patients with very severe malnutrition had at least a twofold increased likelihood of mortality (odds ratio [OR], 2.79; 95% confidence interval [CI], 2.57–3.03), deep vein thrombosis (OR, 2.07; 95% CI, 1.77–2.42), and respiratory failure (OR, 1.95; 95% CI, 1.81–2.11). Geriatric Nutritional Risk Index predicted mortality better than albumin or body mass index alone for ES.CONCLUSIONMalnutrition, measured using GNRI, is a strong independent predictor of adverse outcomes in the elderly ES patient and could be used to assess the nutrition status and counsel patients (and families) preoperatively.LEVEL OF EVIDENCEPrognostic study, Level IV.
Noninvasive SpO2/FiO2 ratio as surrogate for PaO2/FiO2 ratio during simulated prolonged field care and ground and high-altitude evacuation
Authors: Batchinsky Andriy I. , Wendorff Daniel , Jones John , Beely Brendan , Roberts Teryn , Choi Jae Hyek , Harea George , Cancio Leopoldo C. , Davis Michael , Cannon Jeremy , Sams Valerie 
Published: April 2020

BACKGROUND
Diagnosis of lung injury requires invasive blood draws to measure oxygen tension in blood. This capability is nonexistent in austere settings and during prolonged field care (PFC), that is, medical care characterized by inability to evacuate casualties from the point of injury for up to 72 hours. We analyzed pulse-oximeter–derived noninvasive SpO2 and assessed the SpO2/FiO2 ratio (SFR) as a surrogate for the PaO2/FiO2 ratio (PFR), an accepted marker of lung function. We hypothesized that SFR is a suitable surrogate for PFR in a data set from animal models of combat-relevant trauma, PFC, and aeromedical evacuation.

METHODS
Data from anesthetized swine (N = 30) subjected to combat relevant trauma, resuscitation, and critical care interventions were analyzed. Pairwise correlations and Bland-Altman and regression analyses were performed to compare PFR and SFR, based on averaged SpO2 values obtained from two monitoring devices.

RESULTS
We performed 683 pairwise correlations. SpO2/FiO2 ratio was numerically higher than PFR with a 313 cutoff values for acute respiratory distress syndrome (ARDS) (PFR ≥300). Sensitivity/specificity for detection of mild ARDS was 75%/73% with a 200 to 300 PFR range corresponding to 252 to 312 SFR range. For moderate ARDS, sensitivity/specificity was 61%/93% with a 100 to 200 PFR range corresponding to 191 to 251 SFR range. For severe ARDS, sensitivity/specificity was 49%/97% with a 0 to 100 PFR range corresponding to 0 to 190 SFR range. For all groups, areas under the receiver operating characteristic curves ranged from 0.76 to 0.98.

CONCLUSION
SpO2/FiO2 ratio is a useful surrogate for PFR when arterial blood gas testing is not available during dynamically changing physiologic conditions, for example, during austere conditions, PFC, or aeromedical evacuation, and may permit early detection of casualties in need of lung-specific life-saving interventions. Studies in critically ill humans are warranted.
Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma
Authors: Hanna Kamil , Bible Letitia , Chehab Mohamad , Asmar Samer , Douglas Molly , Ditillo Michael , Castanon Lourdes , Tang Andrew , Joseph Bellal 
Published: April 2020

INTRODUCTION
Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.

METHODS
We analyzed the (2015–2016) Trauma Quality Improvement Program. We included adult (age, ≥18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.

RESULTS
A total of 8,494 patients were identified, of which 280 received WB-CT (WB, 1 [1–1]; pRBC, 16 [10–23]; FFP, 9 [6–16]; platelets, 3 [2–5]) and 8,214 received CT only (pRBC, 15 [10–24]; FFP, 10 [6–16]; platelets, 2 [1–4]). Mean ± SD age was 34 ± 16 years, 79% were male, Injury Severity Score was 33 (24–43), and 63% had penetrating injuries. Patients who received WB-CT had a lower 24-hour mortality (17% vs. 25%; p = 0.002), in-hospital mortality (29% vs. 40%; p < 0.001), major complications (29% vs. 41%; p < 0.001), and a shorter length of stay (9 [7–12] vs. 15 [10–21]; p = 0.011). On regression analysis, WB was independently associated with reduced 24-hour mortality (odds ratio [OR], 0.78 [0.59–0.89]; p = 0.006), in-hospital mortality (OR, 0.88 [0.81–0.90]; p = 0.011), and major complications (OR, 0.92 [0.87–0.96]; p = 0.013).

CONCLUSION
The use of WB as an adjunct to CT is associated with improved outcomes in resuscitation of severely injured civilian trauma patients. Further studies are required to evaluate the role of adding WB to massive transfusion protocols.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Improved outcomes utilizing a novel pectin-based pleural sealant following acute lung injury
Authors: Kuckelman John , Conner Jeffrey , Zheng Yifan , Pierce Aidan , Jones Ian , Lammers Daniel , Cuadrado Dan , Eckert Matthew , Mentzer Steven 
Published: April 2020

BACKGROUND
Persistent air leaks after thoracic trauma are associated with significant morbidity. To evaluate a novel pectin sealant in a swine model of traumatic air leaks, we compared a pectin biopolymer with standard surgical and fibrin-based interventions.

METHODS
A standardized lung injury was created in male Yorkshire swine. Interventions were randomized to stapled wedge resection (n = 5), topical fibrin glue (n = 5), fibrin patch (n = 5), and a pectin sealant (n = 6). Baseline, preintervention and postintervention tidal volumes (TV) were recorded. Early success was defined as the return to near-normal TV (>95% of baseline). Late success was defined as no detectable air leak in the chest tube after chest closure.

RESULTS
There were no differences in injury severity between groups (mean TV loss, 62 ± 17 mL, p = 0.2). Early success was appreciated in 100% (n = 6) of the pectin interventions which was significantly better than the fibrin sealant (20%, n = 1), fibrin patch (20%, n = 1), and stapled groups (80%, n = 4, p = 0.01). The percent of return to baseline TV after sealant intervention was significantly increased in the pectin (98%) and staple arms (97%) compared with the fibrin sealant (91%) and fibrin patch arms (90%) (p = 0.02; p = 0.03). Late success was also improved with the pectin sealant: no air leak was detected in 83% of the pectin group compared with 40% in the stapled group (p = 0.008)—90% of the fibrin-based interventions resulted in continuous air leaks (p = 0.001).

CONCLUSION
Pectin-based bioadhesives effectively seal traumatic air leaks upon application in a porcine model. Further testing is warranted as they may provide a superior parenchymal-sparing treatment option for traumatic air leaks.
Repeat computed tomography head scan is not indicated in trauma patients taking novel anticoagulation: A multicenter study
Authors: Cohan Caitlin M. , Beattie Genna , Bowman Jessica A. , Galante Joseph M. , Kwok Amy M. , Dirks Rachel C. , Kornblith Lucy Z. , Plevin Rebecca , Browder Timothy D. , Victorino Gregory P. 
Published: April 2020

BACKGROUND
The number of trauma patients on prehospital novel oral anticoagulants (NOACs) is increasing. After an initial negative computed tomography of the head (CTH), practice patterns are variable for obtaining repeat CTH to evaluate for delayed intracranial hemorrhage (ICH-d). However, the risks and outcomes of ICH-d for patients on NOACs are unclear. We hypothesized that, for these patients, the incidence of ICH-d is low, similar to that of warfarin, and when it occurs, it does not result in clinically significant worse outcomes.

METHODS
Five level 1 trauma centers in Northern California participated in a retrospective review of anticoagulated trauma patients. Patients were included if their initial CTH was negative. Primary outcomes were incidence of ICH-d, neurosurgical intervention, and death. Patient factors associated with the outcome of ICH-d were determined by multivariable regression.

RESULTS
From 2016 to 2018, 777 patients met the inclusion criteria (NOAC, n = 346; warfarin, n = 431), 54% of whom received a repeat CTH. Delayed intracranial hemorrhage incidence was 2.3% in the NOAC group and 4% in the warfarin group (p = 0.31). No NOAC patient with ICH-d required neurosurgical intervention or died because of their head injury. Two warfarin patients received neurosurgical intervention, and three died from their head injury. Head Abbreviated Injury Scale ≥3 was associated with increased odds of developing ICH-d (adjusted odds ratio, 32.70; p < 0.01).

CONCLUSION
The incidence of ICH-d in patients taking NOAC is low. In this study, patients on NOACs who developed ICH-d after an initial negative CTH did not need neurosurgical intervention or die from their head injury. Repeat CTH in this patient population does not appear necessary.

LEVEL OF EVIDENCE
Prognostic/epidemiologic study, level III.
Therapeutic, level IV.
Training With Wii Balance Board for Dynamic Balance in Older Adults
Authors: García-Bravo Sara , García-Bravo Cristina , Molina-Rueda Francisco , Cuesta-Gómez Alicia 
Published: April 2020

Background and Purpose:
Age-related muscle strength deterioration and decreased ability to react appropriately and regain balance after unexpected sudden disturbances and deficit they have in the use of responsible mechanisms to control the dynamic stability in response to a disturbance are important intrinsic risk factors for the fall. The main objective of this study is to verify the impact on the dynamic balance, through the Limits of Stability test, of a physical exercise program in older adults using the Nintendo Wii console.

Methods:
The sample consisted of a total of 12 patients. Pre and posttreatment measurements and assessments were carried out at the Laboratory of Motion Analysis, Biomechanics, Ergonomics and Motor Control (LAMBECOM) in the Faculty of Health Sciences of the Rey Juan Carlos University.

Results and Conclusions:
The results of this study show improvements in the scores of all the variables analyzed by Limits of Stability: RT, MVL, EPE, MXE and DCL. The results obtained seem to determine that the protocol used through training with the Nintendo Wii and its Wii Fit video game produced clinical improvements in postural control and dynamic balance and a positive impact on quality of life.
Randomized Controlled Trial of Aquatic Cycling for Treatment of Knee Osteoarthritis in Elderly People
Authors: Rezasoltani Zahra , Sanati Ehsan , Kazempour Mofrad Reza , Azizi Sirous , Dadarkhah Afsaneh , Najafi Sharif 
Published: April 2020

Objective:
To assess the effects of aqua-cycling on pain, physical function, and muscle strength among elderly people with knee osteoarthritis.

Methods:
We performed a randomized controlled trial from November 2016 through July 2017 in an outpatient clinic of the Department of Physical Medicine and Rehabilitation at the University Hospital. Patients were 60 years and older and had knee osteoarthritis. Among 32 patients who were randomly allocated to the groups aqua-cycling and control, 30 completed the study. We used the Knee injury and Osteoarthritis Outcome Score to assess the patients' opinion about their knees and associated problems. The measurements were performed at the baseline, and after 4, 8, and 12 sessions of aqua-cycling. Participants in the intervention group performed aqua-cycling, 3 sessions per week for 4 weeks. Each session lasted 50 minutes including 10 minutes of warm-up, 30 minutes of cycling, and 10 minutes of cool-down exercises. Both groups used acetaminophen, if needed, and followed lifestyle recommendations for 4 weeks.

Results:
There were significant improvements in pain reduction, physical function, and muscle strength in favor of aqua-cycling (all P < .001). Within-group analyses showed that participants in the aqua-cycling group experienced significant pain reduction (P < .001), and improved in physical function (P < .001), quadriceps (P < .001), and hamstring muscle strength (P < .001). Within-group comparisons for the group control were not significant (all P > .05).

Conclusion:
Aqua-cycling is effective, and can be used alone or combined with other treatments in the management of osteoarthritis.
Validation of a Brief Cognitive Screening Examination in an Adult Acute Inpatient Rehabilitation Population
Authors: Parkhurst Drew , Wyatt Rebecca , Andary Michael , Sylvain Jim 
Published: April 2020

Objective:
To establish validity of a Brief Cognitive Screening Examination (BCSE) to identify patients requiring further cognitive testing.

Methods:
A total of 100 adult inpatients at a university acute inpatient rehabilitation facility were given the Mini-Mental State Examination (MMSE), Clock Draw Test (CDT), and BCSE. The BCSE is a 2-minute test to assess registration, concentration, working memory, and calculation.

Results:
Univariate linear regression analysis demonstrated that BCSE scores of 16 predicted the MMSE score of 28 (P < .01) and BCSE of 12 or less predicted the MMSE less than 24 (P < .01).

Conclusion:
The BCSE is a valid, time-efficient, bedside cognitive screen that identifies patients who would benefit from further cognitive evaluation.
Technostress at work and mental health: concepts and research results
Authors: Dragano Nico , Lunau Thorsten 
Published: April 2020

Purpose of review
The ongoing digitalization has profound consequences for work in modern economies. It is, therefore, important to investigate if digital technologies increase stress at work (i.e. ‘technostress’) and lead to impaired mental health. This article describes the concept of technostress and discusses possible risks and opportunities of digital technologies at work and their effect on mental health.

Recent findings
Studies report that the use of digital technologies is associated with specific psychosocial demands (e.g. higher workload, complexity, conflicts between work and other life domains) and resulting psychobiological stress reactions. It is, however, still unclear if this kind of technostress causes mental disorders because epidemiological studies are missing. Yet, an increasing number of studies suggests that well designed digital work may promote good health if it optimizes work organization or enables greater flexibility, and increases control and autonomy at work.

Summary
Digitalization of work seems to have both opportunities and risks for the mental health of employees. The number of studies is currently limited and further research is necessary to describe the advantages and disadvantages more precisely.