bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Impact of Surgeon Self-awareness by Comparing Self Versus Peer Ratings of Surgical Skill and Outcomes for Bariatric Surgery
Authors: Varban Oliver A. , Thumma Jyothi R. , Carlin Arthur M. , Ghaferi Amir A. , Dimick Justin B. , Finks Jonathan F. 
Published: November 2020

Objective:
To evaluate variation in self versus peer-assessments of surgical skill using surgical videos and compare surgeon-specific outcomes with bariatric surgery.

Summary Background Data:
Prior studies have demonstrated that surgeons with lower peer-reviewed ratings of surgical skill had higher complication rates after bariatric surgery.

Methods:
This is a retrospective cohort study of 25 surgeons who voluntarily submitted a video of a typical laparoscopic sleeve gastrectomy (SG) between 2015 and 2016. Videos were self and peer-rated using a validated instrument based on a 5-point Likert scale (5= “master surgeon” and 1= “surgeon-in-training”). Risk adjusted 30-day complication rates were compared between surgeons who over-rated and under-rated their skill based on data from 24,186 SG cases and 12,888 gastric bypass (GBP) cases.

Results:
individual overall self-rating of surgical skill varied between 2.5 and 5. Surgeons in the top quartile for self:peer ratings (n = 6, ratio 1.58) had lower overall mean peer-scores (2.98 vs 3.79, P = 0.0150) than surgeons in the lowest quartile (n = 6, ratio 0.94). Complication rates between top and bottom quartiles were similar after SG, however leak rates were higher with gastric bypass among surgeons who over-rated their skill with SG (0.65 vs 0.27, P = 0.0181). Surgeon experience was similar between comparison groups.

Conclusions and Relevance:
Self-perceptions of surgical skill varied widely. Surgeons who over-rated their skill had higher leak rates for more complex procedures. Video assessments can help identify surgeons with poor self-awareness who may benefit from a surgical coaching program.
Pancreatobiliary Maljunction-associated Gallbladder Cancer Is as Common in the West, Shows Distinct Clinicopathologic Characteristics and Offers an Invaluable Model for Anatomy-induced Reflux-associated Physio-chemical Carcinogenesis
Authors: Muraki Takashi , Pehlivanoglu Burcin , Memis Bahar , Reid Michelle D. , Uehara Takeshi , Basturk Olca , Pernicka Jennifer Golia , Klimstra David S. , Jarnagin William R. , Ito Tetsuya , Hasebe Osamu , Okaniwa Shinji , Horigome Naoto , Hisa Takeshi , Mittal Pardeep , Sarmiento Juan M. , Maithel Shishir K. , Koshiol Jill , Tsai Susan , Evans Douglas , Erkan Mert , Adsay Volkan 
Published: November 2020

Objective:
To determine the associations of pancreatobiliary maljunction (PBM) in the West.

Background:
PBM (anomalous union of common bile duct and pancreatic duct) is mostly regarded as an Asian-only disorder, with 200X risk of gallbladder cancer (GBc), attributed to reflux of pancreatic enzymes. Methods: Radiologic images of 840 patients in the US who underwent pancreatobiliary resections were reviewed for PBM and contrasted with 171 GBC cases from Japan.

Results:
Eight % of the US GBCs (24/300) had PBM (similar to Japan; 15/ 171, 8.8%), in addition to 1/42 bile duct carcinomas and 5/33 choledochal cysts. None of the 30 PBM cases from the US had been diagnosed as PBM in the original work-up. PBM was not found in other pancreatobiliary disorders. Clinicopathologic features of the 39 PBM-associated GBCs (US:24, Japan:15) were similar; however, comparison with non-PBM GBCs revealed that they occurred predominantly in females (F/M = 3); at younger (<50-year-old) age (21% vs 6.5% in non-PBM GBCs; P = 0.01); were uncommonly associated with gallstones (14% vs 58%; P < 0.001); had higher rate of tumor-infiltrating lymphocytes (69% vs 44%; P = 0.04); arose more often through adenoma-carcinoma sequence (31% vs 12%; P = 0.02); and had a higher proportion of nonconventional carcinomas (21% vs 7%; P = 0.03). Conclusions: PBM accounts for 8% of GBCs also in the West but is typically undiagnosed. PBM-GBCs tend to manifest in younger age and often through adenoma-carcinoma sequence, leading to unusual carcinoma types. If PBM is encountered, cholecystectomy and surveillance of bile ducts is warranted. PBM-associated GBCs offer an invaluable model for variant anatomy-induced chemical (reflux-related) carcinogenesis.
Invasive and Noninvasive Progression After Resection of Noninvasive Intraductal Papillary Mucinous Neoplasms
Authors: Amini Neda , Habib Joseph R. , Blair Alex , Rezaee Neda , Kinny-Köster Benedict , Cameron John L. , Hruban Ralph H. , Weiss Matthew J. , Fishman Elliot K. , Lafaro Kelly J. , Zaheer Atif , Manos Lindsey , Burns William R. , Burkhart Richard , He Jin , Yu Jun , Wolfgang Christopher L. 
Published: November 2020

Objective:
To define frequencies, pattern of progression (invasive vs noninvasive), and risk factors of progression of resected noninvasive intraductal papillary mucinous neoplasms (IPMNs).

Background:
There is a risk of progression in the remnant pancreas after resection of IPMNs.

Methods:
Four hundred forty-nine consecutive patients with resected IPMNs from 1995 to 2018 were included to the study. Patients with invasive carcinoma or with follow-up <6 months were excluded. Noninvasive progression was defined as a new IPMN, increased main pancreatic duct size, and increased size of an existing lesion (5 mm compared with preoperative imaging). Invasive progression was defined as development of invasive cancer in the remnant pancreas or metastatic disease.

Results:
With a median follow-up of 48.9 months, progression was identified in 124 patients (27.6%); 108(24.1%) with noninvasive and 16(3.6%) with invasive progression. Median progression follow-up was longer for invasive progression (85.4 vs 55.9 months; P = 0.001). Five-and 10-year estimates for a cumulative incidence of invasive progression were 6.4% and 12.9% versus 26.9% and 41.5% for noninvasive progression. After risk adjustment, multifocality (HR 4.53, 95% CI 1.34–15.26; P = 0.02) and high-grade dysplasia (HGD) in the original resection (HR 3.60, 95% CI 1.13–11.48; P = 0.03) were associated with invasive progression.

Conclusions:
Progression to invasive carcinoma can occur years after the surgical resection of a noninvasive IPMN. HGD in the original resection is a risk factor for invasive progression but some cases of low-grade dysplasia also progressed to cancer. Patients with high-risk features such as HGD and multifocal cysts should be considered for more intensive surveillance and represent an important cohort for future trials such as anti-inflammatory or prophylactic immunotherapy.
The Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal, and Upper Gastrointestinal Cancer Surgery
Authors: Lambert Joel E. , Hayes Lawrence D. , Keegan Thomas J. , Subar Daren A. , Gaffney Christopher J. 
Published: November 2020

Objective:
To determine the impact of prehabilitation on hospital length of stay, functional capacity, complications, and mortality after surgery in patients with hepatobiliary, colorectal, and upper gastrointestinal cancer.

Background:
“Prehabilitation” encompasses exercise, nutrition, and psychosocial interventions to optimize health before surgery. The benefits of prehabilitation are ill-defined.

Methods:
Medline, Embase and Cochrane Databases were searched systematically for the terms “prehabilitation AND exercise,” “perioperative care AND cancer surgery,” and “colorectal AND hepatobiliary AND hepatopancreatobiliary AND esophagogastric AND recovery AND outcomes.” Primary outcomes analyzed were hospital length of stay, functional capacity, significant postoperative complications (Clavien Dindo ≥ III), and mortality. A meta-analysis was conducted on the effect of all-modality prehabilitation for patients with colorectal, hepatopancreatobiliary and upper gastrointestinal cancer surgery using the raw mean difference, risk difference, and a random-effects model.

Results:
Three hundred and seventy seven original titles were identified. Fifteen studies (randomized controlled trials; n = 9 and uncontrolled trials; n = 6) were included in the meta-analysis. Prehabilitation reduced hospital length of stay by 1.78 days versus standard care (95% CI: −3.36, −0.20, P < 0.05). There was no significant difference in functional capacity with prehabilitation determined using the 6-minute walk test (P = 0.816) and no significant reduction in postoperative complications (P = 0.378) or mortality rates (P = 0.114).

Conclusions:
Prehabilitation was associated with reduced hospital length of stay but had no effect on functional capacity, postoperative complications, or mortality rates. Thus, prehabilitation should be recommended to accelerate recovery from cancer surgery, demonstrated by reduced hospital length of stay.
Immediate Oral Refeeding in Patients With Mild and Moderate Acute Pancreatitis
Authors: Ramírez-Maldonado Elena , López Gordo Sandra , Pueyo Eva M. , Sánchez-García Ariadna , Mayol Susana , González Sergio , Elvira Jordi , Memba Robert , Fondevila Constantino , Jorba Rosa 
Published: November 2020

Objective:
To establish the optimal time to start oral refeeding in mild and moderate acute pancreatitis (AP) to reduce hospital length-of-stay (LOS) and complications.

Summary Background Data:
Oral diet is essential in mild and moderate AP. The greatest benefits are obtained if refeeding starts early; however, the definition of “early” remains controversial.

Methods:
This multicenter, randomized, controlled trial (NCT03829085) included patients with a diagnosis of mild or moderate AP admitted consecutively to 4 hospitals from 2017 to 2019. Patients were randomized into 2 treatment groups: immediate oral refeeding (IORF) and conventional oral refeeding (CORF). The IORF group (low-fat-solid diet initiated immediately after hospital admission) was compared to CORF group (progressive oral diet was restarted when clinical and laboratory parameters had improved) in terms of LOS (primary endpoint), pain relapse, diet intolerance, complications, and, hospital costs.

Results:
One hundred and thirty one patients were included for randomization. The mean LOS for the IORF and CORF groups was 3.4 (SD ± 1.7) and 8.8 (SD ± 7.9) days, respectively (P < 0.001). In the CORF group alone, pain relapse rate was 16%. There were fewer complications (8% vs 26%) and health costs were twice as low, with a savings of 1325.7€/patient in the IORF than CORF group.

Conclusions:
IORF is safe and feasible in mild and moderate AP, resulting in significantly shorter LOS and cost savings, without causing adverse effects or complications.
Acute Kidney Injury in Deceased Organ Donors and Kidney Transplant Outcomes
Authors: Sonnenberg Elizabeth M. , Hsu Jesse Y. , Cohen Jordana B. , Potluri Vishnu S. , Geng Zhi , Levine Matthew H. , Abt Peter L. , Reese Peter P. 
Published: November 2020

Objective:
The aim of this study was to determine graft function and survival for kidney transplants from deceased donors with acute kidney injury (AKI) that persists at the time of organ procurement.

Background:
Kidneys from donors with AKI are often discarded and may provide an opportunity to selectively expand the donor pool.

Methods:
Using Organ Procurement and Transplantation Network and DonorNet data, we studied adult kidney-only recipients between May 1, 2007 and December 31, 2016. DonorNet was used to characterize longitudinal creatinine trends and urine output. Donor AKI was defined using KDIGO guidelines and terminal creatinine ≥1.5 mg/dL. We compared outcomes between AKI kidneys versus “ideal comparator” kidneys from donors with no or resolved AKI stage 1 plus terminal creatinine <1.5mg/dL. We fit proportional hazards models and hierarchical linear regression models for the primary outcomes of all-cause graft failure (ACGF) and 12-month estimated glomerular filtration rate (eGFR), respectively.

Results:
We identified 7660 donors with persistent AKI (33.2% with AKI stage 3) from whom ≥1 kidney was transplanted. Observed rates of ACGF within 3 years were similar between recipient groups (15.5% in AKI vs 15.1% ideal comparator allografts, P = 0.2). After risk adjustment, ACGF was slightly higher among recipients of AKI kidneys (adjusted hazard ratio 1.05, 95% confidence interval: 1.01–1.09). The mean 12-month eGFR for AKI kidney recipients was lower, but differences were not clinically important (56.6 vs 57.5 mL/min/1.73m2 for ideal comparator kidneys; P < 0.001). There were 2888 kidneys discarded from donors with AKI, age ≤65 years, without hypertension or diabetes, and terminal creatinine ≤4 mg/dL.

Conclusion:
Kidney allografts from donors with persistent AKI are often discarded, yet those that were transplanted did not have clinically meaningful differences in graft survival and function.
Sex-Based Role Misidentification and Burnout of Resident Physicians
Authors: Jain Nina , Rome Benjamin N. , Foote Michael B. , DeFilippis Ersilia M. , Powe Camille E. , Yialamas Maria A. 
Published: November 2020

Objective:
This cross-sectional study characterized associations between sex, role misidentification, and burnout among surgical and nonsurgical residents.

Summary Background Data:
Limited evidence suggests that female resident physicians are more likely to be misidentified as nonphysician team members, with potential negative implications for wellbeing. The prevalence and impact of role misidentification on the trainee experience in surgical as compared to nonsurgical specialties is unknown.

Methods:
An anonymous electronic survey was distributed to fourteen different residency programs at 2 academic medical centers in August 2018. The survey included questions about demographics, symptoms of burnout, the frequency of misidentification as another member of the care team, and the effect of misidentification on respondents’ well-being. Results: Two-hundred sixty out of 419 (62.1% response rate) resident physicians completed the survey, of whom 184 (77.3%) reported being misidentified as a nonphysician at least weekly. Female sex was associated with a significantly increased odds of being misidentified at least weekly (adjusted OR 23.7, 95% CI 10.9–51.5; P < 0.001), as was training in a surgical program (adjusted OR 3.7, 95% CI 1.7–8.0; P = 0.001). Frequent role misidentification was associated with burnout (OR 2.6, 95% CI 1.2–5.5; P = 0.01). In free-text responses, residents reported that being misidentified invoked a sense of not belonging, caused emotional exhaustion, and interfered with patient communication.

Conclusions:
Role misidentification is more prevalent among female residents and surgical residents, compared to male residents and nonsurgical residents, respectively. Physician role misidentification is associated with burnout and has negative implications for resident wellbeing; interventions to reduce role misidentification are needed.
Electrocardiographic Abnormalities and Troponin Elevation in COVID-19
Authors: Chorin Ehud , Dai Matthew , Kogan Edward , Wadhwani Lalit , Shulman Eric , Nadeau-Routhier Charles , Knotts Robert , Bar-Cohen Roi , Barbhaiya Chirag , Aizer Anthony , Holmes Douglas , Bernstein Scott , Spinelli Michael , Park David , Chinitz Larry , Jankelson Lior 
Published: November 2020

AbstractBackgroundthe COVID19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality.MethodsWe retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion.ResultsMortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05 – 1.00 ng/ml) the presence of ECG abnormality resulted in significantly greater mortality.ConclusionECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID19.
Survival prediction for bladder cancer using machine learning: development of BlaCaSurv online survival prediction application
Authors: Das Ashis Kumar , Mishra Shiba , Mishra Devi Kalyan , Gopalan Saji Saraswathy 
Published: November 2020

AbstractBackgroundBladder cancer is the most common cancer of the urinary system among the American population and it is the fourth most common cause of cancer morbidity and the eight most common cause of cancer mortality among men. Using machine learning algorithms, we predict the five-year survival among bladder cancer patients and deploy the best performing algorithm as a web application for survival prediction.MethodsMicroscopically confirmed adult bladder cancer patients were included from the Surveillance Epidemiology and End Results (SEER) database (2000-2017) and randomly split into training and test datasets (70/30 ratio). Five machine learning algorithms (logistic regression, support vector machine, gradient boosting, random forest, and K nearest neighbor) were trained on features to predict five-year survival. The algorithms were compared with performance metrics and the best performing algorithm was deployed as a web application.ResultsA total of 52,529 patients were included in our study. The gradient boosting algorithm was the best performer in terms of predictive ability and discrimination. It was deployed as the survival prediction web application named BlaCaSurv (https://blacasurv.herokuapp.com/).ConclusionsWe tested several machine learning algorithms and developed a web application for predicting five-year survival for bladder cancer patients. This application can be used as a supplementary prognostic tool to clinical decision making.
Antiretroviral treatment-induced decrease in immune activation contributes to reduced susceptibility to tuberculosis in HIV-1-TB co-infected persons
Authors: Wilkinson Katalin A. , Schneider-Luftman Deborah , Lai Rachel , Barrington Christopher , Jhilmeet Nishtha , Lowe David M , Kelly Gavin , Wilkinson Robert J 
Published: November 2020

AbstractAntiretroviral treatment (ART) reduces the risk of developing active tuberculosis (TB) in HIV-1 co-infected persons. In order to understand host immune responses during ART in the context of Mycobacterium tuberculosis (Mtb) sensitization, we performed RNAseq analysis of whole blood-derived RNA from HIV-1 infected patients during the first 6 months of ART. A significant fall in RNA sequence abundance of the Hallmark IFN-alpha, IFN-gamma, IL- 6/JAK/STAT3 signaling, and inflammatory response pathway genes indicated reduced immune activation and inflammation at 6 months of ART compared to day 0. Further exploratory evaluation of 65 soluble analytes in plasma confirmed the significant decrease of inflammatory markers after 6 months of ART. Next, we evaluated 30 soluble analytes in QuantiFERON Gold in-tube (QFT) samples from the Ag stimulated and Nil tubes, during the first 6 months of ART in 30 patients. There was a significant decrease in IL-1alpha and IL-1beta (Ag-Nil) concentrations as well as MCP-1 (Nil), supporting decreased immune activation and inflammation. At the same time, IP-10 (Ag-nil) concentrations significantly increased, together with chemokine receptor-expressing CD4 T cell numbers. Our data indicate that ART-induced decrease in immune activation combined with improved antigen responsiveness may contribute to reduced susceptibility to tuberculosis in HIV-1-TB co-infected persons.
Wastewater-based Epidemiology for Averting COVID-19 Outbreaks on The University of Arizona Campus
Authors: Betancourt Walter W. , Schmitz Bradley W. , Innes Gabriel K. , Pogreba Brown Kristen M. , Prasek Sarah M. , Stark Erika R. , Foster Aidan R. , Sprissler Ryan S. , Harris David T. , Sherchan Samendra P. , Gerba Charles P. , Pepper Ian L. 
Published: November 2020

AbstractThe University of Arizona utilized wastewater-based epidemiology paired with clinical testing as a surveillance strategy to monitor COVID-19 prevalence in a dormitory community. Positive SARS-CoV-2 RNA detection in wastewater led to prompt testing of all residents and the identification and isolation of three infected individuals which averted potential disease transmission.TextWastewater-based epidemiology (WBE) utilizes concentrations of SARS-CoV-2 in sewage to monitor population-level COVID-19 infections(1–3). Currently, WBE is a promising indicator to support public health decisions(3,4). In this case study, WBE was used to detect a COVID-19 outbreak in a student dormitory (henceforth Dorm A) at the University of Arizona (UArizona).The StudyUArizona incorporated wastewater surveillance as a potential early-warning tool for COVID-19 outbreaks on campus. Grab samples (1L) were collected from a sewer manhole specific to Dorm A, between August 18-31 to monitor SARS-CoV-2 RNA in wastewater. Upon positive detection of viral RNA in wastewater samples, clinical testing was conducted on every individual living in the dorm. UArizona performed two clinical testing modalities, antigen (1 hour turnaround) test via anterior nasal swab and RT-PCR (48-72 hour turnaround) via nasopharyngeal swab samples. Individuals were subject to clinical testing via two routes: Campus Health Services (CHS) if experiencing symptoms or Test All Test Smart (TATS) regardless of symptoms. Refer to Appendix for method details.Article Summary LineWastewater-based epidemiology with subsequent clinical testing identified individuals infected with COVID-19 living in a dormitory and further spread of disease was prevented with public health action.
What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review
Authors: Cosco Theodore D. , Best John , Davis Daniel , Bryden Daniele , Arkill Suzanne , Oppen James van , Riadi Indira , Conroy Simon 
Published: November 2020

AbstractBackground & aimThe aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients.MethodsMedline, Embase, Web of Science and the grey literature were searched for papers from inception to 10th September 2020; the search was re-run in Medline up until the 9th December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively.Results2286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association.ConclusionsWhilst the majority of studies have shown a positive association between COVID-19 related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness.Key pointsFrailty is being used to assess the risk of dying from COVID-19Emerging studies demonstrate a complex relationship between frailty and COVID-19 related deathsClinicians should exert caution in placing too much emphasis on the influence of frailty in older people with COVID-19Researchers should ensure that frailty scales are used as designed when planning and reporting future research.