bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distinctions Between Self-Report and Performance-Based Measures of Physical Function in Older Patients Prior to Chemotherapy
Authors: Torstveit Ann Helen , Løyland Borghild , Grov Ellen Karine , Guren Marianne , Paul Steven M. , Ritchie Christine , Vistad Ingvild , Miaskowski Christine , Utne Inger 
Published: June 2021

Background
The maintenance of physical function (PF) is an extremely important outcome for elderly people.

Objective
The aims of this study were to identify differences in the subjective and objective measures of PF between younger older adults (YOAs, 60-69 years of age) and older adults (OA, ≥70 years of age), to compare the PF scores with age-matched samples from the general population, and to evaluate for associations between the subjective and objective measures of PF.

Methods
Patients (n = 139) were assessed using subjective (ie, European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire) and objective (ie, Short Physical Performance Battery [SPPB]) measures prior to chemotherapy (CTX). Data were analyzed using parametric and nonparametric tests.

Results
No differences were found between the 2 age groups in any of the subjective or objective measures of PF. Compared with the age-matched general population, both YOAs and OAs had significantly lower scores in both measures of PF. Large effect sizes were found for differences in European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire role function, SPPB balance, and SPPB total scores between the YOA group and the age-matched general population samples. Correlations between the subjective and objective measures were low.

Conclusions
Older patients with cancer have lower PF than their age-matched general population prior to CTX. Longitudinal studies are warranted to evaluate for changes in PF during and following CTX.

Implications for Practice
Nurses need to perform routine assessments of PF in older oncology patients prior to CTX. Our findings suggest that SPPB gait speed may be a useful screening measure for PF in older patients.
MIBG Uptake in Pancreas as a Normal Variant
Authors: Wang Yu , Yang Xu , Wang Wei , Yang Jigang 
Published: June 2021

Abstract
A 5-year-old girl with high-risk neuroblastoma underwent 123I-MIBG scintigraphy for disease restaging. The whole-body images showed a faint MIBG uptake in the midabdomen. Abdominal SPECT/CT demonstrated the focus locating in the pancreatic head. However, this activity disappeared on delayed acquisition at 6-hour later. Follow-up MIBG scan after 6 months did not show the abnormal MIBG uptake in the pancreatic head. Delayed scan could be helpful for differential diagnosis.
Transoral Endoscopic Plating for Orbital Blowout Fractures
Authors: Abba Michael , Abramson Alex , Nahlieli Oded 
Published: June 2021

Abstract
Orbital fractures account for up to 40% of craniofacial injuries. In this article, the authors present the transoral endoscopy-assisted plating technique for treating orbital blowout fractures (OBF). A retrospective analysis of 56 cases treated with transoral endoscopy-assisted approach was performed. Immediate versus delayed surgery decision-making was performed by using our 2-week algorithm. The surgical technique included only transoral incisions, forced duction and “pulse” tests, osteotomy, endoscopic inspections, the reduction with a curved elevator and an indwelling balloon, the retrieval of prolapsed fatty tissue back into the orbit, removal of sharp bony fragments, adaptation of the titanium mesh to the orbital floor and its fixation with screws to stable bony structures, reattachment of the osteotomized lateral wall, and postoperative computed tomography (CT) scan with 3D CT reconstruction. The overall success rate of surgeries was 96%. The resolution of comorbidities resulted in a normal globe position, normal eye movement, and the resolution of diplopia. Postoperative complications were insignificant with one case of surgical edema and one case of infection and sequestration that appeared six months after surgery. These results remained unchanged after 20 to 24 months of follow-up. The suggested minimally invasive transoral technique can be effectively implemented in cases of OBF as well as in cases when the medial wall of the orbit is involved. Our results presented a high success rate with minimal rate of complications, thus our technique is a safe way with minimal morbidity for treating OBF.
Paradoxical Temporal Enlargement: An Expansion of Superficial Temporal Fat Pad Following Interfacial Technique for Pterional Craniotomy
Authors: Krug Randall G. , Kuruoglu Doga , Yan Maria , Van Gompel Jamie J. , Morris Jonathan M. , Kamath Marielle J. , Graffeo Christopher S. , Sharaf Basel 
Published: June 2021

Objective:
Contour irregularities in the temporal region have been reported previously after procedures involving temporal dissection. In this study, we report paradoxical temporal enlargement (PTE) following interfascial pterional craniotomy.

Methods:
A retrospective review of patients who underwent a unilateral transcranial procedure with frontotemporal approach at our institution between September 2013 and December 2017 was performed. Patients with a previous craniotomy or bilateral craniotomy were excluded. Radiological imaging series including computed tomography and magnetic resonance imaging were utilized to calculate temporal soft tissue volumes both preoperatively and postoperatively by using advanced software technology. Relative soft tissue volume differences between the operative side and the contralateral side were calculated at different time-points including preoperative, 3-months follow-up (3M), 12-months (12M) follow-up, and the last follow-up (LFU, over 1-year).

Results:
Forty-three patients were included. Mean age was 52.7 ± 4.5 years. Mean follow-up was 27.9 ± 15.8 months. Significant changes of temporal fat pad relative-volume difference were observed between the preoperative and the corresponding 3M (t [82] = −2.8865, P = 0.0050); 12M (t [77] = −4.4321, P < 0.0001), and LFU (t [74] = −4.9862, P < 0.0001) postoperative time points. No significant change of the temporalis muscle was observed between the preoperative and the corresponding 3M (P = 0.3629), 12M (P = 0.1553), or LFU (P = 0.0715). Soft tissue volume showed a significant increase on the operative side between the preoperative and the corresponding LFU (t [74] = −2.5866, P =  0.0117).

Conclusions:
Paradoxical temporal enlargement with more than 10% volumetric change was observed in 24% of the patients at their LFU (>1-year). This change was not due to temporalis muscle changes. Paradoxical temporal enlargement was due to hypertrophy of the superficial temporal fat pad. Before surgical correction of postoperative temporal contour changes, it is important to obtain imaging and characterize the etiology of the deformity.
Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery
Authors: Chen Herbert , Tseng Jennifer F. , Chaer Rabih , Spain David A. , Stewart John H. , Dent Daniel , Ibáñez Beatriz , Barry Carol L. , Jones Andrew T. , Buyske Jo 
Published: June 2021

Objective:
To Study the Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery.

Summary of Background Data:
The ABS General Surgery CE is normally an in-person oral examination. Due to the COVID-19 outbreak, the ABS was required to reschedule these. After 2 small pilots, the CE's October administration represented the first large-scale remote virtual exam. The purpose of this report is to compare the outcomes of this virtual and the previous in-person CEs.

Methods:
CE candidates were asked to provide feedback on their experience via a survey. The passing rate was compared to the 1025 candidates who took the 2019–2020 in-person CEs.

Results:
Of the 308 candidates who registered for the virtual CE, 306 completed the exam (99.4%) and 188 completed the survey (61.4%). The majority had a very positive experience. They rated the virtual CE as very good/excellent in security (90%), ease of exam platform (77%), audio quality (71%), video quality (69%), and overall satisfaction (86%). Notably, when asked their preference, 78% preferred the virtual exam. There were no differences in the passing rates between the virtual or in-person exams.

Conclusions:
The first virtual CE by the ABS was completed using available internet technology. There was high satisfaction, with the majority preferring the virtual platform. Compared to past in-person CEs, there was no difference in outcomes as measured by passing rates. These data suggest that expansion of the virtual CE may be desirable.
Liver Transplantation in the Time of a Pandemic
Authors: MacConmara Malcolm , Wang Benjamin , Patel Madhukar S. , Hwang Christine S. , DeGregorio Lucia , Shah Jigesh , Hanish Steven I. , Desai Dev , Lynch Raymond , Tanriover Bekir , Zeh Herbert , Vagefi Parsia A. 
Published: June 2021

Objective:
During the initial wave of the COVID-19 pandemic, organ transplantation was classified a CMS Tier 3b procedure which should not be postponed. The differential impact of the pandemic on access to liver transplantation was assessed.

Summary Background Data:
Disparities in organ access and transplant outcomes among vulnerable populations have served as obstacles in liver transplantation.

Methods:
Using UNOS STARfile data, adult waitlisted candidates were identified from March 1, 2020 to November 30, 2020 (n = 21,702 pandemic) and March 1, 2019 to November 30, 2019 (n = 22,797 pre-pandemic), and further categorized and analyzed by time periods: March to May (Period 1), June to August (Period 2), and September to November (Period 3). Comparisons between pandemic and pre-pandemic groups included: Minority status, demographics, diagnosis, MELD, insurance type, and transplant center characteristics. Liver transplant centers (n = 113) were divided into tertiles by volume (small, medium, large) for further analyses. Multivariable logistic regression was fitted to assess odds of transplant. Competing risk regression was used to predict probability of removal from the waitlist due to transplantation or death and sickness. Additional temporal analyses were performed to assess changes in outcomes over the course of the pandemic.

Results:
During Period 1 of the pandemic, Minorities showed greater reduction in both listing (−14% vs −12% Whites), and transplant (−15% vs −7% Whites), despite a higher median MELD at transplant (23 vs 20 Whites, P < 0.001). Of candidates with public insurance, Minorities demonstrated an 18.5% decrease in transplants during Period 1 (vs −8% Whites). Although large programs increased transplants during Period 1, accounting for 61.5% of liver transplants versus 53.4% pre-pandemic (P < 0.001), Minorities constituted significantly fewer transplants at these programs during this time period (27.7% pandemic vs 31.7% pre-pandemic, P = 0.04). Although improvements in disparities in candidate listings, removals, and transplants were observed during Periods 2 and 3, the adjusted odds ratio of transplant for Minorities was 0.89 (95% CI 0.83–0.96, P = 0.001) over the entire pandemic period.

Conclusions:
COVID-19's effect on access to liver transplantation has been ubiquitous. However, Minorities, especially those with public insurance, have been disproportionately affected. Importantly, despite the uncertainty and challenges, our systems have remarkable resiliency, as demonstrated by the temporal improvements observed during Periods 2 and 3. As the pandemic persists, and the aftermath ensues, health care systems must consciously strive to identify and equitably serve vulnerable populations.
Molecular Genomic Assessment Using a Blood-based mRNA Signature (NETest) is Cost-effective and Predicts Neuroendocrine Tumor Recurrence With 94% Accuracy
Authors: Modlin Irvin M. , Kidd Mark , Frilling Andrea , Falconi Massimo , Filosso Pier Luigi , Malczewska Anna , Kitz Alexandra 
Published: June 2021

Introduction:
Identification of residual disease after neuroendocrine tumor (NET) resection is critical for management. Post-surgery imaging is insensitive, expensive, and current biomarkers ineffective. We evaluated whether the NETest, a multigene liquid biopsy blood biomarker, correlated with surgical resection and could predict recurrence.

Methods:
Multicenter evaluation of NET resections over 24 months (n = 103): 47 pancreas, 26 small bowel, 26 lung, 2 appendix, 1 duodenum, 1 stomach. Surgery: R0 (83), R1/R2 (20). One millilitre of blood was collected at D0 and posroperative day (POD) 30. Transcript quantification by polymerase chain reaction (normal: ≤20), CgA by NEOLISA (normal ≤108 ng/mL). Standard-of-care (SoC) follow-up costs were calculated and compared to POD30 NETest-stratification approach. Analyses: Wilcoxon-paired test, Chi-square test.

Results:

D0 biomarkers:
NETest: 103 of 103 (100%)-positive, whereas 23 of 103 (22%) were CgA-positive (Chi-square = 78, P < 0.0001).
In the R0 group, the NETest decreased 59 ± 28 to 26 ± 23 (P < 0.0001); 36% (30/83) remained elevated. No significant decrease was evident for CgA. In the R1/R2 group the NETest decreased but 100% remained elevated. CgA levels did not decrease.
An elevated POD30 NETest was present in R0 and 25 (83%) developed radiological recurrences. Normal score R0 s (n = 53) did not develop recurrence (Chi-square = 56, P < 0.0001). Recurrence prediction was 94% accurate with the NETest.

Cost evaluation:
Using the NETest to stratify postoperative imaging resulted in a cost-savings of 42%.

Conclusion:
NETest diagnosis is more accurate than CgA (100% vs 22%). Surgery significantly decreased NETest. An elevated POD30 NETest predicted recurrence with 94% accuracy and post-surgical POD30 NETest follow-up stratification decreased costs by 42%. CgA had no surgical utility. Further studies would define the accuracy and cost-effectiveness of the NETest in the detection of postoperative recurrent disease.
Extent of Lymphadenectomy and Long-term Survival in Esophageal Cancer
Authors: Gottlieb-Vedi Eivind , Kauppila Joonas H. , Mattsson Fredrik , Hedberg Jakob , Johansson Jan , Edholm David , Lagergren Pernilla , Nilsson Magnus ,   FINEGO group, Lagergren Jesper 
Published: June 2021

Objective:
To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenec-tomy.

Summary of Background Data:
There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.

Methods:
This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.

Results:
Among 2306 patients, the second (4–8 nodes), seventh (21–24 nodes) and eighth decile (25–30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the first decile [hazard ratio (HR) = 0.77, 95% CI 0.61–0.97, HR = 0.76, 95% CI 0.59–0.99, and HR = 0.73, 95% CI 0.57–0.93, respectively]. In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI0.40–0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41–0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.

Conclusion:
Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20–30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
COVID-19 in Solid Organ Transplant Recipients in Spain Throughout 2020: Catching the Wave?
Authors: Coll Elisabeth , Fernández-Ruiz Mario , Padilla María , Moreso Francesc , Hernández-Vicente Ana , Yañez Iñigo , Molina María , Vázquez-Sánchez Teresa , Crespo Marta , Facundo Carme , Rodríguez-Ferrero María Luisa , Ruiz Fuentes María Carmen , Loinaz Carmelo , Bernal Gabriel , Melilli Edoardo , Bravo Carlos , Diekmann Fritz , Lladó Laura , García-Álvarez Teresa M. , Salcedo Magdalena , Beneyto Isabel , Castells Lluis , Alonso Rodrigo , Rodríguez-Benot Alberto , Díaz-Corte Carmen , Graus Javier , Ortiz-Bautista Carlos , García-Cosío María Dolores , Hinojal Rosa , Peña Lucía , Domínguez-Gil Beatriz 
Published: June 2021

Background.
Few studies have analyzed differences in clinical presentation and outcomes in solid organ transplant (SOT) recipients with coronavirus disease 2019 (COVID-19) across different pandemic waves.

Methods.
In this multicenter, nationwide, prospective study, we compared demographics and clinical features, therapeutic management, and outcomes in SOT recipients diagnosed with COVID-19 in Spain before (first wave) or after (second wave) 13 July 2020.

Results.
Of 1634 SOT recipients, 690 (42.2%) and 944 (57.8%) were diagnosed during the first and second periods, respectively. Compared with the first wave, recipients in the second were younger (median: 63 y [interquartile range, IQR: 53–71] versus 59 y [IQR: 49–68]; P < 0.001) and less likely to receive anti-severe acute respiratory syndrome coronavirus 2 drugs (81.8% versus 8.1%; P < 0.001), with no differences in immunomodulatory therapies (46.8% versus 47.0%; P = 0.931). Adjustment of immunosuppression was less common during the second period (76.4% versus 53.6%; P < 0.001). Hospital admission (86.7% versus 58.1%; P < 0.001), occurrence of acute respiratory distress syndrome (34.1% versus 21.0%; P < 0.001), and case-fatality rate (25.8% versus 16.7%; P < 0.001) were lower in the second period. In multivariate analysis, acquiring COVID-19 during the first wave was associated with an increased risk of death (OR: 1.47; 95% confidence interval [CI], 1.12-1.93; P = 0.005), although this impact was lost in the subgroup of patients requiring hospital (OR: 0.97; 95% CI, 0.73-1.29; P = 0.873) or intensive care unit admission (OR: 0.65; 95% CI, 0.35-1.18; P = 0.157).

Conclusions.
We observed meaningful changes in demographics, therapeutic approaches, level of care, and outcomes between the first and second pandemic waves. However, outcomes have not improved in the more severe cases of posttransplant COVID-19.
Does Social Support Moderate Wound Pain and Health-Related Quality of Life in Patients With Chronic Wounds? A Multicenter Descriptive Cross-sectional Study
Authors: Ren Hui , Wang Daguang , Ding Yanming , Hu Haiyan , Qin Zeying , Fu Xiaojin , Hu Yueyang , Cao Ruilin , Liang Leilei , Li Chuanen , Mei Songli 
Published: June 2021

PURPOSE:
We sought to explore the relationships among social support, health-related quality of life (HRQOL), and wound pain, and to examine whether social support would moderate the relationship between wound pain and HRQOL.

DESIGN:
A multicenter descriptive cross-sectional study.

SUBJECTS AND SETTINGS:
Individuals with chronic wounds attending wound clinics affiliated with 3 public hospitals in Beijing, China.

METHODS:
Sociodemographic and wound characteristics of 162 participants were retrieved from medical records. Participants completed questionnaires for wound-related pain intensity (Numerical Rating Scale), social support (Social Support Rating Scale), and HRQOL (Medical Outcome Study Short Form-36). The moderating effect analysis was examined using the PROCESS analytic tool developed by Hayes, based on the bias-corrected bootstrapping method.

RESULTS:
Results revealed that higher pain intensity was significantly related to lower HRQOL (P < .01), and higher social support was associated with better HRQOL (P < .01). However, there was no significant correlation between social support and wound pain (P = .55). Importantly, the moderating effect of social support on the relationship between wound pain and HRQOL was statistically significant (P = .008).

CONCLUSIONS:
We found that social support moderated the impact of wound pain on HRQOL in patients with chronic wounds. This finding suggests that support obtained from social networks may be a beneficial intervention to improve the HRQOL of patients with chronic wounds, especially those suffering from high-intensity wound pain.
An Autologous Protein-Based Topical Ointment for Hard-to-Heal Skin Wounds
Authors: Muñoz Victoria , Pino Ander , Martinez Carmen , Echevarria Begoña , Lacramioara Varlan , Anitua Eduardo 
Published: June 2021

BACKGROUND:
There is increasing evidence regarding the wound healing potential of platelet-derived autologous by-products. We provide preliminary data regarding the use of a new plasma rich in growth factors–derived autologous topical ointment for the management of hard-to-heal wounds.

CASES:
Four patients suffering from difficult-to-heal wounds were treated with the autologous ointment. Within 2 to 8 weeks, all wounds healed completely with no signs of infection or functional impairment of the affected limbs. No adverse events were reported.

CONCLUSION:
Randomized and controlled trials are needed to determine the clinical efficacy of the autologous ointment. Nevertheless, results from this multiple case series indicate that this approach may be useful for accelerating the re-epithelization of difficult-to-heal wounds.
Biomarker Prediction of Postoperative Healing of Diabetic Foot Ulcers
Authors: Cheng Pu , Dong Yunxian , Hu Zhicheng , Huang Shaobin , Cao Xiaoling , Wang Peng , Xu Hailin , Zhu Jiayuan , Tang Bing 
Published: June 2021

PURPOSE:
The purpose of this study was to investigate the relationship and to determine potential usefulness of serum albumin as a biomarker for predicting postoperative diabetic foot ulcer (DFU) healing.

DESIGN:
A retrospective study.

SUBJECTS AND SETTING:
The sample comprised 266 inpatients with type 2 diabetes receiving care in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Among them, 174 had DFUs and underwent surgery for foot DFUs including amputation, skin grafting, and flap procedures. A comparison group consisted of 92 inpatients without a DFU or surgery.

METHODS:
The association between healing and preoperative albumin levels was analyzed via a logistic regression model and receiver operating characteristic (ROC) curve.

RESULTS:
The albumin value of patients with DFU grade 3 or more (3.23 ± 0.58 g/dL) was lower than that of patients with DFU grade 1-2 (3.58 ± 0.5 g/dL), and both were lower than that of the comparison group (3.89 ± 0.3 g/dL). Patients with a DFU with hypoalbuminemia (<3.5 g/dL) had a 2.5-fold higher risk of nonhealing at postoperative 28 days than patients with normal levels (odds ratio = 3.51; 95% confidence interval, 1.75-7.06; P < .001). For patients with a DFU overall, the ROC curve showed a preoperative albumin cutoff of 3.44 g/dL for DFU wound healing.

CONCLUSIONS:
For patients with a DFU undergoing surgery, preoperative serum albumin may be used as a biomarker for predicting postoperative healing.