bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burnout in anaesthesiology residents
Authors: Chong Margaret Y.F. , Lin Sarah H.X. , Lim Wan Yen , Ong John , Kam Peter C.A. , Ong Sharon G.K. 
Published: August 2021

BACKGROUND
Burnout is an occupational hazard precipitated by chronic exposure to excessive work-related stress. It can have negative impacts on the health and safety of patients and clinicians. Anaesthesiologists are at a high risk of burnout; anaesthetic residents especially may experience higher levels of stress as a result of training requirements and postgraduate examinations. However, the scale of burnout among anaesthesiology residents is not well evaluated.

OBJECTIVES
To determine the prevalence of burnout and identify risk factors contributing to it among anaesthesiology residents worldwide and evaluate preventive strategies at institutional and departmental levels.

DESIGN
A systematic review without meta-analysis.

DATA SOURCES
We searched PubMed, Embase, Scopus and PsycInfo for English language articles published up to 24 May 2021.

ELIGIBILITY CRITERIA
The inclusion criteria for qualitative analysis were a reported burnout prevalence in anaesthesiology residents and the use of an assessment tool. Exclusion criteria were reviews/meta-analyses/correspondence, non-English articles, articles without anaesthesiology residents and lacking information on burnout prevalence and metrics for assessment.

RESULTS
Twelve studies met the inclusion criteria; seven studies utilised the 22-item Maslach Burnout Inventory Human Services Survey (MBI-HSS) and five utilised the abbreviated Maslach Burnout Inventory (aMBI). The reported burnout prevalence among anaesthesiology residents varied between 2.7 and 67.0% (median = 24.7%). Differences in burnout criteria contributed significantly to methodological heterogeneity. Factors predisposing to burnout included long working hours, poor workplace relationships, professional examinations and adverse clinical events. Protected rest time and restricted work hours were identified as effective strategies to prevent burnout. Other preventive strategies include mindfulness and resilience courses, as well as departmental initiatives such as exercise.

CONCLUSION
Burnout is common amongst anaesthesiology residents. Standardised tools and diagnostic criteria are needed to distinguish methodological heterogeneity from true heterogeneity in study populations. Interventions have been proposed to improve management strategies to minimise burnout anaesthesiology residents.

PROSPERO REFERENCE
CRD42019140472.
Evaluation of Ocular Surface and Dry Eye Symptoms in Face Mask Users
Authors: Aksoy Mustafa , Simsek Mert 
Published: August 2021

Objective:
This study aimed to investigate the ocular surface and symptoms of dry eye in individuals who wear face masks on a daily basis.

Methods:
This prospective study evaluated 52 right eyes of 52 subjects (26 men, 26 women) who routinely wore face masks for at least 8 hrs a day. Mean age was 30.48±6.01 years. All patients were assessed with Schirmer-1 test, Tear Break-up Time (TBUT), Oxford staining grade, and Ocular Surface Disease Index (OSDI) at initial clinical admission (T1), after 8 hrs of face mask use (T2), and after 15 days of greater than 8 hrs daily wear of face masks with the open portions of the mask taped down (T3).

Results:
Mean TBUT was 13.03±2.18 seconds(s) at T1, 9.12±1.85 sec at T2, and 12.78±2.05 sec at T3. Mean Schirmer-1 test results were 16.87±3.01 mm at T1, 12.97±2.74 mm at T2, and 17.01±2.95 mm at T3. There was a significant difference between T1 and T2, and between T2 and T3 in TBUT (P<0.001), Schirmer-1 results (P<0.001), and Oxford staining grade (P=0.030, P=0.003, respectively). There was a significant difference between all examination times in OSDI score (P<0.001).

Conclusion:
Improper use of face masks may cause increased ocular irritation and dry eye symptoms. Taping down the upper portion of the face mask blocks exhaled air from directly entering the eyes, preventing potential symptoms of dry eye.
Recent SARS-CoV-2 Outlook and Implications in a COVID-19 Vaccination Era
Authors: Ehianeta Teddy , Mzee Said Abdulrahman Salim , Adebisi Muslimat Kehinde , Ehianeta Oluwayemisi 
Published: August 2021

Abstract
While repurposed drugs came in handy earlier in the wake of the coronavirus disease 2019 (COVID-19) pandemic, vaccination has been considered a more sustainable approach. The recent spikes have been linked to “double,” “triple,” and even multi-mutant variants, thus renewing calls for deeper structural and functional insights of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a lead to rationale design of therapeutics, vaccines, and point-of-care diagnostics. There is a repertoire of findings from the earliest SARS-CoV-2 molecular mimicry to evade host immunity cum host immune responses to the role of the viral glycocalyx in modulating the susceptibility and severity of infection through attraction and repulsive interactions. Recently, molecular studies of some viral components that aid infection in the face of vaccination seem unending. In addition, the wave of infections and the attendant case fatality ratios have necessitated the need for emergency use authorizations for COVID-19 vaccines and in vitro diagnostics. This review provides key updates of SARS-CoV-2, current antigenic and formulation strategies, with emergency use authorizations considerations for future vaccine candidates and diagnostics. We also premise that despite the difficulty in modeling and analyzing glycans, understanding and exploiting their roles in the SARS-CoV-2 architecture is fundamental to glycan-based COVID-19 vaccines devoid of inconsistent clinical outcomes.
Prevalence of tear film hyperosmolarity in 1150 patients presenting for refractive surgery assessment
Authors: Xuan Rachel , Lawless Michael , Sutton Gerard , Hodge Chris 
Published: August 2021

Purpose:
To present an analysis of tear film hyperosmolarity in a large, consecutive population and evaluate the correlation of ocular and systemic conditions with tear film osmolarity (TFO).

Setting:
Private practice, Sydney, Australia.

Design:
Single-center, retrospective, consecutive cohort.

Method:
Patients undergoing screening for laser refractive surgery from October 2017 to October 2020 were retrospectively reviewed. 1404 patients (n = 1357 standard, n = 47 postrefractive) undergoing screening for laser refractive surgery from October 2017 to October 2020 were reviewed. Routine examination included TFO and Ocular Surface Disease Index (OSDI) questionnaire. TFO was conducted prior to further tests, and patients refrained from topical eyedrops minimum 2 hours before the appointment.

Results:
1404 patients (n = 1357 standards, n = 47 postrefractive) patients were reviewed. Mean highest TFO in the standard population was 299.12 ± 11.94 mOsm/L, with 82.3% of eyes <308 mOsm/L indicating normal tear film homeostasis. The mean intereye TFO difference was 8.17 ± 8.60 mOsm/L, with 65.2% of eyes ≤8 mOsm/L. Mean highest TFO in the postrefractive subgroup was 299.72 ± 11.00 mOsm/L, with a mean intereye difference of 9.02 ± 6.92 mOsm/L. Postrefractive surgery patients indicated higher mean OSDI values of 15.28 ± 14.46 compared with the remainder of the population 9.69 ± 10.56 (P = .012). Significant correlation was demonstrated between TFO scores and OSDI normal classification in the standard population only (P = .005, r = 0.077). The use of contact lens correlated inversely with TFO and OSDI scores (P = .000, r = −0.136, and P = .000, r = −0.152, respectively).

Conclusions:
To the authors' knowledge, this study represents the largest available cohort of TFO scores in a standard population presenting for refractive surgery. Although most patients were found to fall within normal ranges, a reasonable percentage were diagnosed with tear hyperosmolarity and therefore at risk for dry eye disease.
Visceral sensitivity modulation by faecal microbiota transplantation: the active role of gut bacteria in pain persistence
Authors: Lucarini Elena , Di Pilato Vincenzo , Parisio Carmen , Micheli Laura , Toti Alessandra , Pacini Alessandra , Bartolucci Gianluca , Baldi Simone , Niccolai Elena , Amedei Amedeo , Rossolini Gian Maria , Nicoletti Claudio , Cryan John F. , O'Mahony Siobhain M. , Ghelardini Carla , Di Cesare Mannelli Lorenzo 
Published: August 2021

Abstract
Recent findings linked gastrointestinal disorders characterized by abdominal pain to gut microbiota composition. The present work aimed to evaluate the power of gut microbiota as a visceral pain modulator and, consequently, the relevance of its manipulation as a therapeutic option in reversing postinflammatory visceral pain persistence. Colitis was induced in mice by intrarectally injecting 2,4-dinitrobenzenesulfonic acid (DNBS). The effect of faecal microbiota transplantation from viscerally hypersensitive DNBS-treated and naive donors was evaluated in control rats after an antibiotic-mediated microbiota depletion. Faecal microbiota transplantation from DNBS donors induced a long-lasting visceral hypersensitivity in control rats. Pain threshold trend correlated with major modifications in the composition of gut microbiota and short chain fatty acids. By contrast, no significant alterations of colon histology, permeability, and monoamines levels were detected. Finally, by manipulating the gut microbiota of DNBS-treated animals, a counteraction of persistent visceral pain was achieved. The present results provide novel insights into the relationship between intestinal microbiota and visceral hypersensitivity, highlighting the therapeutic potential of microbiota-targeted interventions.
Response to immunotherapy in a patient with anaplastic thyroid cancer
Authors: Zheng Luming , Li Ling , He Qingqing , Wang Meng , Ma Yunhan , Zhu Jian , Li Yanchen , Fu Xiaokang , Zhang Yaxuan 
Published: August 2021

Abstract

Rationale:
Anaplastic thyroid carcinoma (ATC) is an aggressive malignancy that is almost always fatal and lacks effective systemic treatment options. Current treatments of ATC include surgery, radiation, and chemotherapy, used in combination when possible. In the aspect of immunotherapy, the biomarker of TMB-H and MSI-H may suggest that patients benefit from pembrolizumab. Programmed cell death-ligand 1 (PD-L1) is highly expressed in ATC but has not been written into the guidelines or approved by the FDA as a biomarker for thyroid cancer immunotherapy.

Patient concerns:
A 55-year-old woman was admitted to our hospital because of a slight right-sided neck enlargement in November 2019.

Diagnoses:
The clinical diagnosis was ATC, pT3bN0M0, and stage IVB.

Interventions:
Oral administration of apatinib (250 mg 3 times daily) was initiated after surgery, but some unpleasant side effects emerged after 1 month of treatment. Next-generation sequencing revealed that the tumor harbored 2 mutations, HRAS p.Q61R and TP53 p.P278S, and PD-L1 staining was positive with a high expression. Thus, camrelizumab (programmed cell death protein 1 inhibitor) was combined with apatinib, and apatinib was changed to 250 mg once a day from March 2020.

Outcomes:
No adverse reactions were observed after the treatment immunotherapy combined with antiangiogenic drugs. Currently, the survival time of patients is more than 11 months, and the quality of life is not affected.

Conclusion:
This case suggests that immunotherapy in patients with ATC based upon PD-L1 evaluation provides a therapeutic option. Targeting programmed cell death protein 1/PD-L1 may provide a much-needed treatment option for patients with advanced ATC.
Clinical therapeutic effects of platelet-rich plasma in patients with burn wound healing
Authors: Li Jie , Hu Wang-Ping , Zhong Guo 
Published: August 2021

Abstract

Background:
In clinical settings, burn wounds are frequently encountered. Since burn wounds are a form of physical injury, they can have long-term adverse effects on the human body. It has been a significant challenge to treat burn wounds completely. Since traditional treatment strategies have been unable to heal burn wounds completely, they lack the efficacy to cure the wounds without long-term effects, such as heavy scarring. Reportedly, platelet-rich plasma (PRP) has shown potential to accelerate wound healing. Yet, there are no conclusive reports on a methodological comparative study of research that has assessed the medical benefits of PRP for treating individuals carrying burn wounds. Thus, the present meta-analysis and systematic study aims to assess the medical benefits of PRP for treating patients carrying burn wounds.

Methods:
The authors will conduct a comprehensive search for randomized controlled trials that evaluate the safeness and efficiency of PRP to treat burn wounds. The search includes 3 Chinese language databases (WanFang database, Chinese BioMedical Literature database, and China National Knowledge Infrastructure) and 4 English language databases (Cochrane Library, EMBASE, Web of Science, and MEDLINE). These electronic databases will be searched from their establishment till May 2021. A pair of independent authors will be selecting eligible studies for extracting data. The same authors will employ the Cochrane risk of bias tool to evaluate the bias risk. We will make use of RevMan (version: 5.3) software to complete data synthesis.

Results:
The present protocol will establish practical and targeted results evaluating the efficacy and safeness of using PRP to treat burn wounds. The current study also provides a reference for clinical use of PRP.

Conclusion:
Stronger evidence about the effectiveness and safety of using PRP to treat and heal burn wounds will be provided for clinicians to refer.

Ethics and dissemination:
Ethics approval is unrequired.

Registration number:
March 31, 2021.osf.io/whauj. (https://osf.io/whauj/).
Effect of aspirin on coronavirus disease 2019
Authors: Son Minkook , Noh Myung-giun , Lee Jeong Hoon , Seo Jeongkuk , Park Hansoo , Yang Sung 
Published: August 2021

Abstract
Several studies reported that aspirin can potentially help prevent infection and serious complications of coronavirus disease (COVID-19), but no study has elucidated a definitive association between aspirin and COVID-19. This study aims to investigate the association between aspirin and COVID-19.
This case-control study used demographic, clinical, and health screening laboratory test data collected from the National Health Insurance Service database. Patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until June 4, 2020, were matched with control patients using propensity score matching according to their SARS-CoV-2 status, the composite of complications, and death. The composite of complications included intensive care unit admission, use of vasopressors, high-flow oxygen therapy, renal replacement therapy, extracorporeal membrane oxygenation, and death. Exposure to aspirin was defined as having a prescription for aspirin for more than 14 days, including the index date. After matching, multivariable-adjusted conditional logistic regression analysis was performed. To confirm the robustness of this study, we used 2 study groups, 3 propensity score matching methods, and 3 models for conditional logistic regression analyses.
The crude odds ratio and 95% confidence interval for SARS-CoV-2 infection between the groups without and with exposure to aspirin were 1.21 (1.04–1.41), but the adjusted odds ratios (95% confidence interval) were not significant. There was no association between aspirin exposure and COVID-19 status. Multiple statistical analyses, including subgroup analysis, revealed consistent results. Furthermore, the results of analysis for complications and death were not significant. Aspirin exposure was not associated with COVID-19-related complications and mortality in COVID-19 patients.
In this nationwide population-based case-control study, aspirin use was not associated with SARS-CoV-2 infection or related complications. With several ongoing randomized controlled trials of aspirin in COVID-19 patients, more studies would be able to confirm the effectiveness of aspirin in COVID-19.
Successful treatment of 2 patients with brain metastases from non-small cell lung cancer with epidermal growth factor receptor mutation receiving dacomitinib
Authors: Zhao Songchen , Cong Xiaofeng , Liu Ziling 
Published: August 2021

Abstract

Rationale:
Approximately 20% of patients with non-small cell lung cancer (NSCLC) are diagnosed with brain metastasis, which is related to poor survival outcomes. The ability of tyrosine kinase inhibitor drugs to penetrate the blood–brain barrier makes them a potential option for intracranial metastases. Dacomitinib, an irreversible second-generation pan-HER tyrosine kinase inhibitor, has become a standard therapy for patients with epidermal growth factor receptor mutations. However, its efficacy in patients with brain metastases (BMs) is not yet established. Here, we present 2 patients with epidermal growth factor receptor-mutant NSCLC with brain metastasis. After initiation of dacomitinib as first-line treatment, a significant clinical response was achieved, and a long-lasting complete remission was achieved in 1 patient up to this date.

Patient concern:
Case 1 was a 47-year-old man who was admittedtothe hospital because of recurrent cough and expectoration for >1 year. Chest computed tomography scans revealed a high-density shadow in the left upper lobe. Cranial magnetic resonance imaging indicated an abnormal nodular enhancement in the right cerebellar hemisphere. Case 2 was a 55-year-old man with a chief complaint of intermittent cough and expectoration for >1 month. Chest computed tomography revealed a high-density mass in the left superior lobe. Magnetic resonance imaging of the central nervous system revealed 2 abnormal nodular enhancements in the left frontal lobe.

Diagnosis:
Both patients were diagnosed with lung adenocarcinoma by bronchoscopy and lymph node biopsy.

Interventions:
Both patients received dacomitinib 30 mg once daily as first-line therapy for 8 and 11 months, respectively until disease progression.

Outcome:
After treatment with dacomitinib, both patients achieved complete response in BMs. Progression-free survival was 11 and 8 months, respectively.

Lessons:
Dacomitinib strongly controlled BMs in patients with advanced NSCLC, and the adverse reactions were tolerable. Dacomitinib may be considered a new treatment option for these patients. Further prospective studies are recommended to confirm this conclusion.
The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension
Authors: Liu Hui , Ding Congcong , Hu Lihua , Li Minghui , Zhou Wei , Wang Tao , Zhu Lingjuan , Bao Huihui , Cheng Xiaoshu 
Published: August 2021

Abstract
Previous studies had shown that an increased aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) was associated with cardiovascular disease. This study aimed to assess the relationship between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension.
By March 31, 2020, a cohort of 14,220 Chinese hypertensive patients was followed up. The end point was all-cause and cardiovascular death. Hazard ratios (HRs) and 95% CIs were calculated for mortality associated with AST/ALT ratio, using Cox proportional hazards models and competing risk model.
In an average of 1.7 years of follow-up, 1.39% (n = 198) of patients died, 55.5% (n = 110) of whom from cardiovascular disease. AST/ALT ratio was associated with increased risk of all-cause death (HR:1.37, 95% CI:1.15–1.63) and cardiovascular death (HR:1.32, 95% CI:1.03–1.68) after adjustment for other potential confounders. Compared with low AST/ALT ratio (Tertile 1), high AST/ALT ratio was associated with high cause mortality (Tertile 2: HR:1.35, 95% CI:0.86–2.10; Tertile 3: HR:2.10, 95% CI:1.37–3.21; P for trend <.001). Compared with low AST/ALT ratio (Tertile 1), a statistically significant increased risk of cardiovascular mortality was also observed (Tertile 2: HR:1.27, 95% CI:0.70–2.29; Tertile 3: HR:1.92, 95% CI:1.09–3.37; P for trend <.001). High AST/ALT ratio was also associated with high cardiovascular mortality (Tertile 2: HR:1.27, 95% CI:0.70–2.29; Tertile 3: HR:1.92, 95% CI:1.09–3.37; P for trend <.001).
Present study indicated that increased AST/ALT ratio levels were predictive of all-cause and cardiovascular mortality among Chinese hypertensive patients.
Trial registration: CHICTR, CHiCTR1800017274. Registered 20 July 2018.
Prognostic factors of patients after liver cancer surgery
Authors: Liang Fangfang , Ma Fuchao , Zhong Jincai 
Published: August 2021

Abstract
This study aimed to investigate the prognostic factors of patients after liver cancer surgery and evaluate the predictive power of nomogram. Liver cancer patients with the history of surgery in the Surveillance, Epidemiology, and End Results database between 2000 and 2016 were preliminary retrieved. Patients were divided into the survival group (n = 2120, survival ≥5 years) and the death group (n = 2615, survival < 5 years). Single-factor and multi-factor Cox regression were used for analyzing the risk factors of death in patients with liver cancer after surgery. Compared with single patients, married status was the protective factor for death in patients undergoing liver cancer surgery (HR = 0.757, 95%CI: 0.685–0.837, P < .001); the risk of death in Afro-Americans (HR = 1.300, 95%CI: 1.166–1.449, P < .001) was higher than that in Caucasians, while the occurrence of death in Asians (HR = 0.821, 95%CI: 0.1754–0.895, P < .0012) was lower; female patients had a lower incidence of death (HR = 0.875, 95%CI: 0.809–0.947, P < .001); grade II (HR = 1.167, 95%CI: 1.080–1.262, P < .001), III (HR = 1.580, 95%CI: 1.433–1.744, P < .001), and IV (HR = 1.419, 95%CI: 1.145–1.758, P = 0.001) were the risk factors for death in patients with liver cancer. The prognostic factors of liver cancer patients after surgery include the marital status, race, gender, age, grade of cancer and tumor size. The nomogram with good predictive ability can provide the prediction of 5-year survival for clinical development.