bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adhesive small bowel obstruction: Single band or matted adhesions? A predictive model based on computed tomography scan
Authors: Guerrini Jacopo , Zugna Daniela , Poretti Dario , Samà Laura , Costa Guido , Mei Simona , Ceolin Martina , Biloslavo Alan , Zago Mauro , Viganò Luca , Kurihara Hayato 
Published: April 2021

BACKGROUND
Preoperative identification of the cause of adhesive small bowel obstruction (ASBO) is crucial for decision making. Some computed tomography (CT) findings can be indicative of single adhesive bands or matted adhesions. Our aim was to build a predictive model based on CT data to discriminate ASBO due to single adhesive band or matted adhesions.

METHODS
A retrospective single center study was conducted, covering all consecutive patients with a preoperative CT scan, undergoing urgent surgery for ASBO between January 1, 2005, and December 31, 2017. Preoperative CT scans were blindly reviewed, and all the CT findings indicative of single adhesive band or matted adhesions described in literature were recorded. According to intraoperative findings, ASBOs were retrospectively classified into single band and matted ASBO. All observed CT findings were compared between the two groups. A predictive model based on logistic regression was developed, and its ability was quantified by discrimination and calibration. Internal cross-validation was conducted by bootstrap resampling.

RESULTS
A total of 116 patients were analyzed (males, 53.5%; median age, 68 years; single band ASBO in 65.5% of cases). The odds of single band ASBO were increased four times in presence of complete obstruction (odds ratios, 4.19; 95% confidence interval, 1.49–12.56) and seven times in presence of fat notch sign (odds ratios, 7.37; 95% confidence interval, 1.83–40.03). The predictive model combining all CT findings had an accuracy of 86% in single band ASBO prediction. Accuracy decreased to 79% in the internal validation. Sensitivity, specificity, and positive and negative predictive values were calculated at different cut-points of the predicted risk: using a 0.70 cut-point, the specificity is 80%, the sensitivity is 68%, and the positive and negative predictive values are 87% and 57%, respectively.

CONCLUSION
The proposed predictive model based on combination of specific CT findings may elucidate whether ASBO is caused by single bands or matted adhesions and, consequently, influence the clinical pathway.

LEVEL OF EVIDENCE
Prognostic study, level IV
The effect of sexual dysfunction on health-related quality of life in men following traumatic pelvic fractures
Authors: Wang Alice Y. , Vavilala Monica S. , Rivara Frederick P. , Johnsen Niels V. 
Published: April 2021

BACKGROUND
Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life (HrQOL) in men.

METHODS
A total of 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated postinjury HrQOL and sexual function. Inverse probability weighting was used to adjust for survey nonresponse. Pelvic fracture characteristics were classified based on the Orthopedic Trauma Association classification system. Sexual function was evaluated using the International Index of Erectile Function, and HrQOL was evaluated using the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL.

RESULTS
After inverse probability weighting and adjustment for potential confounders, a decrease in International Index of Erectile Function was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (β = 0.28, p = 0.02). No association was identified between Orthopedic Trauma Association pelvic fracture configuration and risk of postinjury erectile dysfunction (ED) (p = 0.99). Furthermore, 53.3% of men reported persistent ED at a median of 42.6 months (interquartile range, 28.0–63.3 months) following injury. The presence of ED was independently associated with a decrease in HrQOL (β = 10.92, p < 0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10 years for men with ED following pelvic fracture relative to those without.

CONCLUSION
Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation.

LEVEL OF EVIDENCE
Prognostic, level IV.
Is resuscitative endovascular balloon occlusion of the aorta for computed tomography diagnosis feasible or not? A Japanese single-center, retrospective, observational study
Authors: Otsuka Hiroyuki , Takeda Michihiro , Sai Kisei , Sakoda Naoki , Uehata Atsushi , Sato Toshiki , Sakurai Keiji , Aoki Hiromichi , Yamagiwa Takeshi , Iizuka Shinichi , Inokuchi Sadaki 
Published: April 2021

BACKGROUND
Advances in medical equipment have resulted in changes in the management of severe trauma. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) in this scenario is still unclear. This study aimed to evaluate the usage of REBOA and utility of computed tomography (CT) in the setting of aortic occlusion in our current trauma management.

METHODS
This Japanese single-tertiary center, retrospective, and observational study analyzed 77 patients who experienced severe trauma and persistent hypotension between October 2014 and March 2020.

RESULTS
All patients required urgent hemostasis. Twenty patients underwent REBOA, 11 underwent open aortic cross-clamping, and 46 did not undergo aortic occlusion. Among patients who underwent aortic occlusion, 19 patients underwent prehemostasis CT, and 7 patients underwent operative exploration without prehemostasis CT for identifying active bleeding sites. The 24-hour and 28-day survival rates in patients who underwent CT were not inferior to those in patients who did not undergo CT (24-hour survival rate, 84.2% vs. 57.1%; 28-day survival rate, 47.4% vs. 28.6%). Moreover, the patients who underwent CT had less discordance between primary hemostasis site and main bleeding site compared with patients who did not undergo CT (5% vs. 71.4%, p = 0.001). In the patients who underwent prehemostasis CT, REBOA was the most common approach of aortic occlusion. Most of the bleeding control sites were located in the retroperitoneal space. There were many patients who underwent interventional radiology for hemostasis.

CONCLUSION
In a limited number of patients whose cardiac arrests were imminent and in whom no active bleeding sites could be clearly identified without CT findings, REBOA for CT diagnosis may be effective; however, further investigations are needed.

LEVEL OF EVIDENCE
Therapeutic/care management study, level V.
Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary trauma center, systematic review, and meta-analysis
Authors: Ku Jerry C. , Priola Stefano M. , Mathieu Francois , Taslimi Shervin , Pasarikovski Christopher R. , Zeiler Frederick A. , Machnowska Matylda , Nathens Avery , Yang Victor X.D. , da Costa Leodante 
Published: April 2021

BACKGROUND
Blunt cerebrovascular injuries (BCVIs) may occur following trauma and lead to ischemic stroke if untreated. Antithrombotic therapy decreases this risk; however, the optimal agent has yet to be determined in this population. The aim of this study was to compare the risk-benefit profile of antiplatelet (AP) versus anticoagulant (AC) therapy in rates of ischemic stroke and hemorrhagic complications in BCVI patients.

METHODS
We performed a retrospective review of BCVI patients at our tertiary care Trauma hospital from 2010 to 2015, and a systematic review and meta-analysis of the literature. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to September 16, 2019. References of included publications were searched manually for other relevant articles. The search was limited to articles in humans, in patients 18 years or older, and in English. Studies that reported treatment-stratified clinical outcomes following AP or AC treatment in BCVI patients were included. Exclusion criteria included case reports, case series with n < 5, review articles, conference abstracts, animal studies, and non–peer-reviewed publications. Data were extracted from each study independently by two reviewers, including study design, country of origin, sex and age of patients, Injury Severity Score, Biffl grade, type of treatment, ischemic stroke rate, and hemorrhage rate. Pooled estimates using odds ratio (OR) were combined using a random-effects model using a Mantel-Hanzel weighting. The main outcome of interest was rate of ischemic stroke due to BCVI, and the secondary outcome was hemorrhage rate based on AC or AP treatment.

RESULTS
In total, there were 2044 BCVI patients, as reported in the 22 studies in combination with our institutional data. The stroke rate was not significantly different between the two treatment groups (OR, 1.27; 95% confidence interval, 0.40–3.99); however, the hemorrhage rate was decreased in AP versus AC treated groups (OR, 0.38; 95% confidence interval, 0.15–1.00).

CONCLUSION
Based on this meta-analysis, both AC and AP seem similarly effective in preventing ischemic stroke, but AP is better tolerated in the trauma population. This suggests that AP therapy may be preferred, but this should be further assessed with prospective randomized trials.

LEVEL OF EVIDENCE
Review article, level II.
Between the devil and the deep blue sea: A review of 25 modern naval mass casualty incidents with implications for future Distributed Maritime Operations
Authors: Tadlock Matthew D. , Gurney Jennifer , Tripp Michael S. , Cancio Leopoldo C. , Sise Michael J. , Bandle Jesse , Cubano Miguel , Lee Joseph , Vasquez Matthew , Acosta José A. 
Published: April 2021

ABSTRACT
In the future, United States Navy Role 1 and Role 2 shipboard medical departments will be caring for patients during Distributed Maritime Operations in both contested and noncontested austere environments; likely for prolonged periods of time. This literature review examines 25 modern naval mass casualty incidents over a 40-year period representative of naval warfare, routine naval operations, and ship-based health service support of air and land operations. Challenges, lessons learned, and injury patterns are identified to prepare afloat medical departments for the future fight.

LEVEL OF EVIDENCE
Literature Review, level V.
Efficacy of past, present, and future fluid strategies in an improved large animal model of non-compressible intra-abdominal hemorrhage
Authors: Donaldson Ross I. , Graham Todd L. , Fisher Timothy C. , Armstrong Jonathan , Buchanan Oliver J. , Cambridge John , Ross James D. 
Published: April 2021

BACKGROUND
Noncompressible hemorrhage is a leading cause of potentially survivable combat death, with the vast majority of such deaths occurring in the out-of-hospital environment. While large animal models of this process are important for device and therapeutic development, clinical practice has changed over time and past models must follow suit. Developed in conjunction with regulatory feedback, this study presents a modernized, out-of-hospital, noncompressible hemorrhage model, in conjunction with a randomized study of past, present, and future fluid options following a hypotensive resuscitation protocol consistent with current clinical practice.

METHODS
We performed a randomized controlled experiment comparing three fluid resuscitation options in Yorkshire swine. Baseline data from animals of same size from previous experiments were analyzed (n = 70), and mean systolic blood pressure was determined, with a permissive hypotension resuscitation target defined as a 25% decrease from normal (67 mm Hg). After animal preparation, a grade IV to V liver laceration was induced. Animals bled freely for a 10-minute “time-to-responder” period, after which resuscitation occurred with randomized fluid in boluses to the goal target: 6% hetastarch in lactated electrolyte injection (HEX), normal saline (NS), or fresh whole blood (FWB). Animals were monitored for a total simulated “delay to definitive care” period of 2 hours postinjury.

RESULTS
At the end of the 2-hour study period, 8.3% (1 of 12 swine) of the HEX group, 50% (6 of 12 swine) of the NS group, and 75% (9 of 12 swine) of the FWB had survived (p = 0.006), with Holm-Sidak pairwise comparisons showing a significant difference between HEX and FWB and (p = 0.005). Fresh whole blood had significantly higher systemic vascular resistance and hemoglobin levels compared with other groups (p = 0.003 and p = 0.001, respectively).

CONCLUSION
Survival data support the movement away from HEX toward NS and, preferably, FWB in clinical practice and translational animal modeling. The presented model allows for future research including basic science, as well as translational studies of novel diagnostics, therapeutics, and devices.
Do surgical emergencies stay at home? Observations from the first United States Coronavirus epicenter
Authors: Dong Caroline T. , Liveris Anna , Lewis Erin R. , Mascharak Smita , Chao Edward , Reddy Srinivas H. , Teperman Sheldon H. , McNelis John , Stone Melvin E. 
Published: April 2021

BACKGROUND
During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase.

METHODS
A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality.

RESULTS
A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045).

CONCLUSION
Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population.

LEVEL OF EVIDENCE
Epidemiological, level IV.
Fragmentation of care in the blunt abdominal trauma patient: Capturing our true outcomes and impact on care
Authors: Carr Matthew J. , Badiee Jayraan , Benham Derek A. , Diaz Joseph A. , Calvo Richard Y. , Sise C. Beth , Sise Michael J. , Bansal Vishal , Martin Matthew J. 
Published: April 2021

BACKGROUND
Trauma care is associated with unplanned readmissions, which may occur at facilities other than the index treatment facility. This “fragmentation of care” may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC.

METHODS
The California Office of Statewide Health Planning and Development patient discharge data set was evaluated for calendar years 2016 to 2018. Patients 15 years or older diagnosed with blunt abdominal solid organ injury during the index admission were identified. Readmissions were evaluated postdischarge at 1, 3, and 6 months. Patients readmitted within 6 months to a facility other than the index admission facility (fragmented care [FC]) were compared with those readmitted to their index admission facility (non-FC). Logistic regression modeling was used to evaluate risk of FC.

RESULTS
Of the total 1,580 patients, there were 752 FC (47.6%) and 828 (52.4%) non-FC. Readmissions representing FC at months 1, 3, and 6 were 40.3%, 49.3%, and 53.4%, respectively. At index admission, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (5.8% non-FC vs. 2.9% FC, p = 0.006). In an adjusted model, multiple readmissions (odds ratio [OR] 1.11, p = 0.014), readmission >30 days after index facility discharge (OR, 1.98; p < 0.001), and discharge to a nonmedical facility (OR, 2.46; p < 0.0001) were associated with increased odds of FC. Operative intervention at index admission was associated with lower odds of FC (OR, 0.77; p = 0.039). However, FC was not independently associated with demographic or insurance characteristics.

CONCLUSION
The rate of FC among patients with blunt abdominal injury is high. The risk of FC is mitigated when patients are managed operatively during the index admission. Trauma systems should implement measures to ensure that these patients are followed postdischarge.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III; Care management, level IV.
Neutralizing activity of Sputnik V vaccine sera against SARS-CoV-2 variants
Authors: Ikegame Satoshi , Siddiquey Mohammed N. A. , Hung Chuan-Tien , Haas Griffin , Brambilla Luca , Oguntuyo Kasopefoluwa Y. , Kowdle Shreyas , Vilardo Ariel Esteban , Edelstein Alexis , Perandones Claudia , Kamil Jeremy P. , Lee Benhur 
Published: April 2021

ABSTRACTThe novel pandemic betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected at least 120 million people since its identification as the cause of a December 2019 viral pneumonia outbreak in Wuhan, China. Despite the unprecedented pace of vaccine development, with six vaccines already in use worldwide, the emergence of SARS-CoV-2 ‘variants of concern’ (VOC) across diverse geographic locales suggests herd immunity may fail to eliminate the virus. All three officially designated VOC carry Spike (S) polymorphisms thought to enable escape from neutralizing antibodies elicited during initial waves of the pandemic. Here, we characterize the biological consequences of the ensemble of S mutations present in VOC lineages B.1.1.7 (501Y.V1) and B.1.351 (501Y.V2). Using a replication-competent EGFP-reporter vesicular stomatitis virus (VSV) system, rcVSV-CoV2-S, which encodes S from SARS coronavirus 2 in place of VSV-G, and coupled with a clonal HEK-293T ACE2 TMPRSS2 cell line optimized for highly efficient S-mediated infection, we determined that only 1 out of 12 serum samples from a cohort of recipients of the Gamaleya Sputnik V Ad26 / Ad5 vaccine showed effective neutralization (IC90) of rcVSV-CoV2-S: B.1.351 at full serum strength. The same set of sera efficiently neutralized S from B.1.1.7 and showed only moderately reduced activity against S carrying the E484K substitution alone. Taken together, our data suggest that control of some emergent SARS-CoV-2 variants may benefit from updated vaccines.
CliP: subclonal architecture reconstruction of cancer cells in DNA sequencing data using a penalized likelihood model
Authors: Jiang Yujie , Yu Kaixian , Ji Shuangxi , Shin Seung Jun , Cao Shaolong , Montierth Matthew D , Huang Licai , Kopetz Scott , Msaouel Pavlos , Wang Jennifer Rui , Kimmel Marek , Zhu Hongtu , Wang Wenyi 
Published: April 2021

AbstractSubpopulations of tumor cells characterized by mutation profiles may confer differential fitness and consequently influence prognosis of cancers. Understanding subclonal architecture has the potential to provide biological insight in tumor evolution and advance precision cancer treatment. Recent methods comprehensively integrate single nucleotide variants (SNVs) and copy number aberrations (CNAs) to reconstruct subclonal architecture using whole-genome or whole-exome sequencing (WGS, WES) data from bulk tumor samples. However, the commonly used Bayesian methods require a large amount of computational resources, a prior knowledge of the number of subclones, and extensive post-processing. Regularized likelihood modeling approach, never explored for subclonal reconstruction, can inherently address these drawbacks. We therefore propose a model-based method,Clonal structureidentification through pair-wisePenalization, or CliP, for clustering subclonal mutations without prior knowledge or post-processing. The CliP model is applicable to genomic regions with or without CNAs. CliP demonstrates high accuracy in subclonal reconstruction through extensive simulation studies. Utilizing the well-established regularized likelihood framework, CliP takes only 16 hours to process WGS data from 2,778 tumor samples in the ICGC-PCAWG study, and 38 hours to process WES data from 9,564 tumor samples in the TCGA study. In summary, a penalized likelihood framework for subclonal reconstruction will help address intrinsic drawbacks of existing methods and expand the scope of computational analysis for cancer evolution in large cancer genomic studies. The associated software tool is freely available at:https://github.com/wwylab/CliP.