bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Enhanced Recovery Protocol on Opioid Use in Pelvic Organ Prolapse Surgery
Authors: Mehr Allen A. , Elmer-Lyon Caroline , Maetzold Erin , Bradley Catherine S. , Kowalski Joseph T. 
Published: September 2021

Objectives
Our primary objective was to compare the total opioid use by patients undergoing apical pelvic organ prolapse surgery before and after implementation of an enhanced recovery protocol (ERP).

Methods
Participants of this ambispective cohort study included a “pre-ERP” retrospective cohort and an “ERP” cohort of patients prospectively enrolled after the full implementation of the ERP in January 2019. Demographic and clinical data were collected from the electronic record. Descriptive statistics were used for demographic variables. Total opioid use was calculated for each participant using morphine milligram equivalents (MMEs) and compared between cohorts using the Student t test.

Results
Study participants (n = 65) were similar between cohorts and had a mean (SD) age of 62.4 (9.7) years and body mass index of 28.9 (4.8), and had a median parity of 3 (interquartile range, 2–4). Comorbid conditions, assessed with the Charlson Comorbidity Index, were also similar, with a mean (SD) of 2 (2.9). Hysterectomy approach and apical procedures did not differ between groups. After ERP implementation, mean (SD) intraoperative and postoperative MMEs decreased significantly (59.4 [31.6] vs 36.9 [20.5], P < 0.01). Total MMEs prescribed at discharge also decreased (392.3 [88.4] vs 94.6 [61.3], P < 0.01). Total anesthesia time and surgical time were similar, whereas mean total admission time decreased (27.3 [10.8] vs 18 [8.6] hours, P < 0.01). Telephone calls within 30 days increased from mean 1 (1.0) to 2.2 (1.9) (P < 0.01), whereas clinic visits and 30-day readmissions did not differ.

Conclusions
Women undergoing apical pelvic organ prolapse surgery at an academic medical center received significantly fewer opioids after implementation of an ERP without a change in postoperative pain scores.
Value in acute care surgery, Part 1: Methods of quantifying cost
Authors: Martin R. Shayn , Lester Erica L.W. , Ross Samuel W. , Davis Kimberly A. , Tres Scherer L.R. , Minei Joseph P. , Staudenmayer Kristan L. 
Published: September 2021

BACKGROUND
With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions. Different approaches to quantifying cost exist depending on the purpose of the analysis and available resources. Cost analysis methods range from detailed microcosting and time-driven activity-based costing to less complex gross and expenditure-based approaches. An overview of these methods and a practical approach to costing based on the needs of the acute care surgeon leader is presented.
Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients
Authors: Yorkgitis Brian K. , Tatum Danielle M. , Taghavi Sharven , Schroeppel Thomas J. , Noorbakhsh Matthew R. , Philps Frances Hite , Bugaev Nikolay , Mukherjee Kaushik , Bellora Mellody , Ong Adrian W. , Ratnasekera Asanthi , Nordham Kristen D. , Carrick Matthew M. , Haan James M. , Lightwine Kelly L. , Lottenberg Lawrence , Borrego Robert , Cullinane Daniel C. , Berne John D. , Rodriguez Mederos Dalier , Hayward Thomas Z. , Kerwin Andy J. , Crandall Marie 
Published: September 2021

BACKGROUND
Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would not improve mortality in severe traumatic brain injury (TBI) patients.

METHODS
An Eastern Association for the Surgery of Trauma–sponsored prospective, multicentered, observational study of 15 trauma centers was performed. Patient demographics, injury burden, comorbidities, AT agents, and reversal attempts were collected. Outcomes of interest were head injury severity and in-hospital mortality.

RESULTS
Analysis was performed on 2,793 patients. The majority of patients were on aspirin (acetylsalicylic acid [ASA], 46.1%). Patients on a platelet chemoreceptor blocker (P2Y12) had the highest mean Injury Severity Score (9.1 ± 8.1). Patients taking P2Y12 inhibitors ± ASA, and ASA-warfarin had the highest head Abbreviated Injury Scale (AIS) mean (1.2 ± 1.6). On risk-adjusted analysis, warfarin-ASA was associated with a higher head AIS (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.34–4.42) after controlling for Injury Severity Score, Charlson Comorbidity Index, initial Glasgow Coma Scale score, and initial systolic blood pressure. Among patients with severe TBI (head AIS score, ≥3) on antiplatelet therapy, reversal with desmopressin (DDAVP) and/or platelet transfusion did not improve survival (82.9% reversal vs. 90.4% none, p = 0.30). In severe TBI patients taking Xa inhibitors who received prothrombin complex concentrate, survival was not improved (84.6% reversal vs. 84.6% none, p = 0.68). With risk adjustment as described previously, mortality was not improved with reversal attempts (antiplatelet agents: OR 0.83; 85% CI, 0.12–5.9 [p = 0.85]; Xa inhibitors: OR, 0.76; 95% CI, 0.12–4.64; p = 0.77).

CONCLUSION
Reversal attempts appear to confer no mortality benefit in severe TBI patients on antiplatelet agents or Xa inhibitors. Combination therapy was associated with severity of head injury among patients taking preinjury AT therapy, with ASA-warfarin possessing the greatest risk.

LEVEL OF EVIDENCE
Prognostic, level II.
Spike-independent infection of human coronavirus 229E in bat cells
Authors: Mah Marcus G , Linster Martin , Low Dolyce HW , Yan Zhuang , Jayakumar Jayanthi , Samsudin Firdaus , Wong Foong Ying , Bond Peter J , Mendenhall Ian H , Su Yvonne CF , Smith Gavin JD 
Published: September 2021

AbstractBats are the reservoir for numerous human pathogens including coronaviruses. The factors leading to the emergence and sustained transmission of coronaviruses in humans are poorly understood. An outstanding question is how coronaviruses can accomplish a host switch with a likely mismatch between the surface protein spike of a bat virus and the human cellular receptor at the time of zoonotic virus transmission. To identify potential novel evolutionary pathways for zoonotic virus emergence, we serially passaged six human 229E isolates in a newly establishedRhinolophus lepidus(horseshoe bat) kidney cells and analyzed viral genetic changes. Here we observed extensive deletions within the spike and ORF4 genes of five 229E viruses after passaging in bat cells. As a result, spike protein expression and infectivity of human cells was lost in 5 of 6 viruses but the capability to infect bat cells was maintained. Only viruses that expressed the spike protein could be neutralized by 229E spike-specific antibodies in human cells, whereas there was no neutralizing effect on viruses that do not express the spike protein inoculated on bat cells. However, one isolate acquired an early stop codon abrogating spike expression but maintaining infection in bat cells. Upon passaging this isolate in human cells, spike expression was restored due to acquisition of nucleotide insertions amongst virus subpopulations. Spike-independent infection of coronaviruses provides an alternative mechanism for viral maintenance in bats that does not rely on the compatibility of viral surface proteins and cellular entry receptors.
COVID-19 L·OVE REPOSITORY IS HIGHLY COMPREHENSIVE AND CAN BE USED AS A SINGLE SOURCE FOR COVID-19 STUDIES
Authors: Verdugo-Paiva F , Vergara C , Ávila C , Castro J , Cid J , Contreras V , Jara I , Jiménez V , Lee MH , Muñoz M , Rojas Gómez AM , Rosón-Rodríguez P , Serrano-Arévalo K , Silva-Ruz I , Vásquez-Laval J , Zambrano-Achig P , Zavadzki G , Rada G 
Published: September 2021

ABSTRACTObjectiveCOVID-19 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains over 430,000 articles as of 20 September 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews.MethodsOur sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that were available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search.ResultsWe identified 83 eligible systematic reviews that included 2132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2125/2132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2057/2132). Both the comprehensiveness and the currency were 100% for randomised trials (82/82).ConclusionThe COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes
Lower probability and shorter duration of infections after Covid-19 vaccine correlate with anti-SARS-CoV-2 circulating IgGs
Authors: Ronchini Chiara , Gandini Sara , Pasqualato Sebastiano , Mazzarella Luca , Facciotti Federica , Mapelli Marina ,   IEO Covid Team, Frige’ Gianmaria , Passerini Rita , Pase Luca , Capizzi Silvio , Mastrilli Fabrizio , Orecchia Roberto , Natoli Gioacchino , Pelicci Pier Giuseppe 
Published: September 2021

AbstractThe correlation between immune responses and protection from SARS-CoV-2 infections and its duration remains unclear. We performed a sanitary surveillance at the European Institute of Oncology (IEO) in Milan over a 17 months period. Pre-vaccination, in 1,493 participants, we scored 266 infections (17.8%) and 8 possible reinfections (3%). Post-vaccination, we identified 30 infections in 2,029 vaccinated individuals (1.5%). We report that the probability of infection post-vaccination is i) significantly lower compared to natural infection, ii) associated with a significantly shorter median duration of infection than that of first infection and reinfection, iii) anticorrelated with circulating antibody levels.
A novel echo-parameter supersedes the Society of Thoracic Surgeons risk score in predicting post transcatheter aortic valve replacement mortality
Authors: Chao Chieh-Ju , Agasthi Pradyumma , Seri Amith R , Barry Timothy , Shanbhag Anusha , Wang Yuxiang , Eleid Mackram , Fortuin David , Sweeney John P. , Pollak Peter , El Sabbagh Abdallah , Lester Steven J. , Freeman William K , Naqvi Tasneem Z. , Holmes David R , Appleton Christopher P. , Arsanjani Reza 
Published: September 2021

AbstractObjectiveTo accurately predict post-TAVR mortality, we proposed a family of new echo-parameters (augmented blood pressure) derived from blood pressure and aortic valve gradient measurements and examined them in this study.Patients and MethodsPatients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between January 1, 2012, and June 30, 2017, were identified to retrieve baseline demographics, echocardiographic and mortality data. Augmented blood pressure parameters and valvulo-arterial impedance were evaluated by univariate and multivariate Cox regression. Receiver operating characteristic curve analysis was used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score.ResultsThe final cohort contained 974 patients with a mean age of 81.4±8.3 years old, and 56.6% were male. The mean STS risk score was 8.2±5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that augmented systolic blood pressure and augmented mean arterial pressure (AugMAP) parameters were independent predictors for 1-year post-TAVR mortality (all p<0.0001). A univariate model of AugMAP1 supersedes the STS score model in predicting 1-year post-TAVR mortality (area under curve: 0.700 vs. 0.587, p=0.0051).ConclusionAugmented mean arterial pressure provides a simple but effective approach for clinicians to quickly estimate the clinical outcome of TAVR patients. It can be incorporated in the assessment of TAVR candidacy.
Oral Pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations
Authors: Murchu Eamon O , Marshall Liam , Hayes Catherine , Harrington Patricia , Moran Patrick , Teljeur Conor , Ryan Máirín 
Published: September 2021

AbstractBackgroundThe objective of this study was to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) of the effectiveness and safety of oral Pre-Exposure Prophylaxis (PrEP) to prevent HIV.MethodsDatabases (PubMed, Embase and the Cochrane Register of Controlled Trials) were searched up to 5/7/2020. RCTs were included that compared oral tenofovir-containing PrEP to placebo, no treatment or alternative medication/dosing schedule. The primary outcome was the rate ratio (RR) of HIV infection using a modified intention-to-treat analysis. All analyses were stratified a priori by population: men who have sex with men (MSM), serodiscordant couples, heterosexuals and people who inject drugs (PWID).The quality of individual studies was assessed using the Cochrane Risk-of-Bias tool and the certainty of evidence was assessed using GRADE.ResultsOf 2,803 unique records, 15 RCTs met our inclusion criteria. Over 25,000 participants were included, encompassing 38,289 person-years of follow-up data.PrEP was found to be effective in MSM (Rate Ratio [RR] 0.25, 95% CI: 0.1-0.61; Absolute Rate Difference [ARD] -0.03, 95% CI: -0.01 to -0.05), serodiscordant couples (RR 0.25, 95% CI: 0.14-0.46; ARD -0.01, 95% CI: -0.01 to -0.02) and PWID (RR 0.51, 95% CI: 0.29-0.92; ARD - 0.00, 95% CI: -0.00 to -0.01), but not in heterosexuals (RR 0.77, 95% CI: 0.46-1.29).Efficacy was strongly associated with adherence (p<0.01). PrEP was found to be safe, however unrecognised HIV at enrolment increased the risk of viral drug mutations. Evidence for risk compensation or an increase in STIs was not found.DiscussionPrEP is safe and effective in MSM, serodiscordant couples and PWID. Additional research is needed prior to recommending PrEP in heterosexuals. Data were limited by poor adherence in several studies. No RCTs were identified for other high-risk groups, such as trangender women and sex workers.PROSPERO IDCRD42017065937Article SummaryStrengths and limitations of this studyA systematic review and meta-analysis of RCTs was conducted of the efficacy and safety of oral PrEP to prevent HIV following best practice guidelines (PRISMA guidelines and GRADE framework)Observational studies were excluded from this review, and as such, PrEP effectiveness may be lower in real-world settingsChange in sexual behaviour, or ‘risk compensation’, is difficult to ascertain based on RCT evidence aloneDue to substantial variation in adherence across studies, findings should be interpreted with caution.
A Novel Penalized Inverse-Variance Weighted Estimator for Mendelian Randomization with Applications to COVID-19 Outcomes
Authors: Xu Siqi , Wang Peng , Fung Wing Kam , Liu Zhonghua 
Published: September 2021

SummaryMendelian randomization (MR) utilizes genetic variants as instrumental variables (IVs) to estimate the causal effect of an exposure variable on an outcome of interest even in the presence of unmeasured confounders. However, the popular inverse-variance weighted (IVW) estimator could be biased in the presence of weak IVs, a common challenge in MR studies. In this article, we develop a novel penalized inverse-variance weighted (pIVW) estimator, which adjusts the original IVW estimator to account for the weak IV issue by using a penalization approach to prevent the denominator of the pIVW estimator from being close to zero. Moreover, we adjust the variance estimation of the pIVW estimator to account for the presence of balanced horizontal pleiotropy. We show that the recently proposed debiased IVW (dIVW) estimator is a special case of our proposed pIVW estimator. We further prove that the pIVW estimator has smaller bias and variance than the dIVW estimator under some regularity conditions. We also conduct extensive simulation studies to demonstrate the performance of the proposed pIVW estimator. Furthermore, we apply the pIVW estimator to estimate the causal effects of five obesity-related exposures on three coronavirus disease 2019 (COVID-19) outcomes. Notably, we find that hypertensive disease is associated with an increased risk of hospitalized COVID-19; and peripheral vascular disease and higher body mass index are associated with increased risks of COVID-19 infection, hospitalized COVID-19 and critically ill COVID-19.
Distinct brainstem to spinal cord noradrenergic pathways differentially regulate spinal neuronal activity
Authors: Kucharczyk Mateusz Wojciech , Di Domenico Francesca , Bannister Kirsty 
Published: September 2021

AbstractBrainstem to spinal cord pathways modulate spinal neuronal activity. We implemented locus coeruleus (LC) targeting strategies by microinjecting CAV-PRS-ChR2 virus in the spinal cord (LC:SC module) or LC (LC:LC module). While activation of both modules inhibited evoked spinal neuronal firing via α1-adrenoceptor-mediated actions, LC:SC opto-activation abolished diffuse noxious inhibitory controls. The LC as a pain generator is likely mechanistically underpinned by maladaptive communication with discrete descending modulatory pathways.
Electrodeformation of White Blood Cells Enriched with Gold Nanoparticles
Authors: Hallfors N. G. , Teo J. M. , Bertone P. , Joshi C. , Orozaliev A. , Martin M. N. , Isakovic A. F. 
Published: September 2021

AbstractThe elasticity of white blood cells (WBCs) provides valuable insight into the condition of the cells themselves, the presence of some diseases, as well as immune system activity. In this work, we describe a novel process of refined control of WBCs’ elasticity through a combined use of gold nanoparticles (AuNPs) and the microelectrode array device. The capture and controlled deformation of gold nanoparticles enriched white blood cells in vitro are demonstrated and quantified. Gold nanoparticles enhance the effect of electrically induced deformation and make the DEP related processes more controllable.
Computing personalized brain functional networks from fMRI using self-supervised deep learning
Authors: Li Hongming , Dhivya Srinivasan , Cui Zaixu , Zhuo Chuanjun , Gur Raquel E. , Gur Ruben C. , Oathes Desmond J. , Davatzikos Christos , Satterthwaite Theodore D. , Fan Yong 
Published: September 2021

ABSTRACTA novel self-supervised deep learning (DL) method is developed for computing bias-free, personalized brain functional networks (FNs) that provide unique opportunities to better understand brain function, behavior, and disease. Specifically, convolutional neural networks with an encoder-decoder architecture are employed to compute personalized FNs from resting-state fMRI data without utilizing any external supervision by optimizing functional homogeneity of personalized FNs in a self-supervised setting. We demonstrate that a DL model trained on fMRI scans from the Human Connectome Project can identify canonical FNs and generalizes well across four different datasets. We further demonstrate that the identified personalized FNs are informative for predicting individual differences in behavior, brain development, and schizophrenia status. Taken together, self-supervised DL allows for rapid, generalizable computation of personalized FNs.
Effect of different disease-modifying therapies on humoral response to BNT162b2 vaccine in Sardinian multiple sclerosis patients
Authors: Pitzalis Maristella , Idda Maria Laura , Lodde Valeria , Loizedda Annalisa , Lobina Monia , Zoledzwieska Magdalena , Virdis Francesca , Delogu Giuseppe , Pirinu Federica , Marini Maria Giuseppina , Mingoia Maura , Frau Jessica , Lorefice Lorena , Fronza Maria , Carmagini Daniele , Carta Elisa , Orrù Valeria , Uzzau Sergio , Solla Paolo , Loi Federica , Devoto Marcella , Steri Maristella , Fiorillo Edoardo , Floris Matteo , Zarbo Ignazio Roberto , Cocco Eleonora , Cucca Francesco 
Published: September 2021

AbstractObjectivesVaccination against COVID-19 is highly recommended to patients affected by multiple sclerosis (MS); however, the impact of MS disease-modifying therapies (DMTs) on the immune response following vaccination has been only partially investigated. Here, we aimed to elucidate the effect of DMTs on the humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines in MS patients.MethodsWe obtained sera from 912 Sardinian MS patients and 63 healthy controls 30 days after the second dose of BNT162b2 vaccine and tested them for SARS-CoV-2 response using anti-Spike (S) protein-based serology. Previous SARS-CoV-2 infection was assessed by anti-Nucleocapsid (N) serology. Patients were either untreated or undergoing treatment with a total of 13 different DMTs. Differences between treatment groups comprised of at least 10 patients were assessed by generalized linear mixed-effects model. Demographic and clinical data and smoking status were analyzed as additional factors potentially influencing humoral immunity from COVID-19 vaccine.ResultsMS patients treated with natalizumab, teriflunomide, azathioprine, fingolimod, ocrelizumab, and rituximab showed significantly lower humoral responses compared to untreated patients. We did not observe a statistically significant difference in response between patients treated with the other drugs (dimethyl fumarate, interferon, alemtuzumab and glatiramer acetate) and untreated patients. In addition, older age, male, sex and active smoking were significantly associated with lower antibody titers against SARS-CoV-2. MS patients previously infected with SARS-CoV-2 had significantly higher humoral responses to vaccine than uninfected patients.ConclusionHumoral response to BNT162b2 is significantly influenced by the specific DMTs followed by patients, as well as by other factors such as previous SARS-CoV-2 infection, age, sex, and smoking status. These results are important to inform targeted strategies to prevent clinically relevant COVID-19 in MS patients.