bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood Acute Urticaria and Seasonal Patterns Presenting in the Emergency Department of a Teaching Hospital in London, United Kingdom
Authors: Koumaki Dimitra , Koumaki Vasiliki , Boumpoucheropoulos Sotirios , Katoulis Alexander , Laguda Bisola 
Published: January 2021

Objectives
To characterize the clinical presentation, possible trigger factors and seasonality of acute urticaria (AU) in children referred to the emergency department in a teaching hospital in London, United Kingdom.

Methods
This was a retrospective descriptive study. One hundred and sixty-three consecutive patients younger than 18 years with the diagnosis of AU who attended accident and emergency department from January 2018 until January 2020 at Chelsea and Westminster Hospital in London, United Kingdom, were included in the study. Descriptive statistics were performed using IBM SPSS 25.

Results
In total, 163 patients younger than 18 years, 82 (50.3%) boys and 81 (49.7%) girls. The median age of patients with AU was 4 years (interquartile range, 6 years). In 120 of (73.6%) 163 patients, there was no clear trigger of AU, in 17 (10.4%) of 163 patients, upper respiratory infection was considered as a potential trigger of AU, followed by food in 14 (8.6%) cases, medications in 9 (5.5%) cases, hymenoptera sting in 1 (0.6%) case, and contact urticaria 2 (1.2%) cases. Seventeen (10.4%) of the patients were admitted into the hospital as a result of their urticaria. The majority of AU urticaria cases were reported in autumn with 76 (46.6%) cases with most of AU cases occurring in November (34/163, 20.9%).

Conclusions
A total of 163 cases of AU were identified between January 2018 and January 2020. A seasonal trend of AU in autumn was observed. Respiratory infections were found to be the most commonly associated potential trigger of AU cases.
Implementing Paper Documentation During an Influenza Surge in a Pediatric Emergency Department
Authors: Berkowitz Deena , Simpson Joelle , Cohen Joanna S. , Kadakia Ashaini , Badolato Gia , Breslin Kristen A. 
Published: January 2021

Objective
We hypothesized that a paper documentation and discharge bundle can expedite patient care during an influenza-related surge.

Methods
Retrospective cohort study of low-acuity patients younger than 21 years surging into a pediatric emergency department between January and March 2018 with influenza-like illness. Patient visits documented using a paper bundle were compared with those documented in the electronic medical record on the same date of visit. The primary outcome of interest was time from physician evaluation to discharge for patient visits documented using the paper bundle compared with those documented in the electronic medical record. Secondary outcome was difference in return visits within 72 hours. We identified patient and visit level factors associated with emergency department length of stay.

Results
A total of 1591 patient visits were included, 1187 documented in the electronic health record and 404 documented using the paper bundle. Patient visits documented using the paper bundle had a 21% shortened median time from physician evaluation to discharge (41 minutes; interquartile range, 27–62.8 minutes) as compared with patient visits documented in the electronic health record (52 minutes; interquartile range, 35–61 minutes; P < 0.001). There was no difference in return visits (odds ratio, 0.7; 95% confidence interval, 0.2, 2.2).

Conclusions
Implementation of paper charting during an influenza-related surge was associated with shorter physician to discharge times when compared with patient visits documented in the electronic health record. A paper bundle may improve patient throughput and decrease emergency department overcrowding during influenza or coronavirus disease–related surge.
Acute Appendicitis in Children During the COVID-19 Pandemic
Authors: Gaitero Tristán Jara , Souto Romero Henar , Escalada Pellitero Silvia , Espiñera Clara Rico , Andina Martín David , Espinosa Góngora Rocío , Martín Diaz María José , Leónidas Espinoza Manuel 
Published: January 2021

Aim
The aim of this study was to describe the incidence of complicated appendicitis during the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic lockdown.

Methods
This was a retrospective study of pediatric patients diagnosed with acute appendicitis in a single pediatric institution that assumed care responsibility for most of the pediatric emergencies during the lockdown period in Madrid (Spain). A control group was made up of the same number of patients diagnosed the previous year.

Results
One hundred fifty-one patients diagnosed with acute appendicitis were included (77 during self-quarantine and 74 during the previous year). The incidence of complicated appendicitis was 38.9% versus 28.3%, showing no significant differences. The 2 groups were homogeneous, with no differences in time elapsed between symptom onset and first emergency department visit, laboratory test results, median length of stay, intensive care admissions, or patients correctly diagnosed on their first visit.

Conclusions
COVID-19 (coronavirus disease 2019) self-quarantine has not increased the incidence of complicated appendicitis, and children who developed complicated appendicitis did not have worse clinical outcomes. Parents did not delay presenting for medical attention, and emergency department pediatricians did not fail to diagnose this condition. Reorganization of hospital resources, fast-track treatment protocols for noncomplicated appendicitis, and extended use of home-stay hospitalization for complicated appendicitis could have contributed to these favorable outcomes.
Triple-Negative Breast Cancer
Authors: Nunnery Sara E. , Mayer Ingrid A. , Balko Justin M. 
Published: January 2021

Abstract
Triple-negative breast cancer (TNBC) is pathologically defined by lack of expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 amplification and portends an aggressive clinical course with worse outcomes compared with other breast cancers. Until recently, standard treatment options consisted of sequential cytotoxic chemotherapies for both early and metastatic disease. Advances in sequencing technology have led to the identification of 4 main subtypes of TNBC based on recurrent genetic alterations, transcriptional patterns, and molecular features: basal-like 1 (BL1), basal-like 2 (BL2), mesenchymal (M), and luminal androgen receptor (LAR). Frequent alterations found in DNA damage response pathways, germline and somatic BRCA1/2 genes, PI3K signaling pathways, and the presence of androgen receptors and infiltrating immune cells could serve as actionable targets to optimize treatments and improve outcomes for patients with TNBC. Recent approvals for immune checkpoint inhibitors and the antibody-drug conjugate, sacituzumab govitecan-hziy, for advanced TNBC illustrate the advances in treatment that can result from these molecular discoveries. This review will explore the molecular subtypes of TNBC and their distinct characteristics, as well as highlight the molecular features and potential “drivers” that have been identified as promising targets for new treatment strategies.
Adjuvant and Neoadjuvant Treatment of Triple-Negative Breast Cancer With Chemotherapy
Authors: Marra Antonio , Curigliano Giuseppe 
Published: January 2021

Abstract
Triple-negative breast cancer (TNBC) accounts for 15% to 20% of all invasive breast carcinomas and is defined by the lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. Although TNBC is characterized by high rates of disease recurrence and worse survival, it is significantly more sensitive to chemotherapy as compared with other breast cancer subtypes. Accordingly, despite great efforts in the genomic characterization of TNBC, chemotherapy still represents the cornerstone of treatment. For the majority of patients with early-stage TNBC, sequential anthracycline- and taxane-based neoadjuvant chemotherapy (NACT) represents the standard therapeutic approach, with pathological complete response that strongly correlates with long-term survival outcomes. However, some issues about the optimal neoadjuvant regimen, as well as the effective role of chemotherapy in patients with residual disease after NACT, are still debated. Herein, we will review the current evidences that guide the use of (neo)adjuvant chemotherapy in patients with early-stage TNBC. Furthermore, we will discuss current controversies, including the incorporation of platinum compounds to the neoadjuvant backbone and the optimal treatment for patients with residual disease after NACT. Lastly, we will outline potential future directions that can guide treatment escalation and de-escalation, as well as the development of new therapies. In our view, the application of multi-omics technologies, liquid biopsy assays, and machine learning algorithms are strongly warranted to pave the way toward personalized anticancer treatment for early-stage TNBC.
PARP Inhibitors in Triple-Negative Breast Cancer Including Those With BRCA Mutations
Authors: Layman Rachel M. , Arun Banu 
Published: January 2021

Abstract
Poly(ADP-ribose) polymerase (PARP) is involved in single-strand DNA break base excision repair. PARP inhibition causes synthetic lethality in breast cancers associated with germline BRCA1 and BRCA2 mutations and is routinely used in clinical practice for metastatic breast cancer. Breast cancers with homologous recombination deficiency or BRCAness, most commonly triple-negative breast cancers, may also benefit. Currently, PARP inhibitor use for triple-negative breast cancer with wild-type BRCA does not have definitive efficacy; however, this is an area of active research. Further clinical and translational data may identify additional patient populations that will benefit from PARP inhibitor therapy.
“Triple-Negative Breast Cancer Central Nervous System Metastases From the Laboratory to the Clinic”
Authors: Zimmer Alexandra S. 
Published: January 2021

Abstract
Triple-negative breast cancer (TNBC) accounts for 15% to 20% of breast cancers and has an incidence as high as 50% of brain metastases once patients develop advanced disease. The lack of targeted and effective therapies, characteristic of this subtype of breast cancer, is especially evident once central nervous system (CNS) metastases occur. Compared with other subtypes of breast cancer, TNBC patients have the shorter interval from diagnosis to development of brain metastases and the shorter overall survival once they occur, a median of 4 to 6 months. Preclinical studies of TNBC and CNS microenvironment are actively ongoing, clarifying mechanisms and orienting more effective approaches to therapy. While the first drugs have been specifically approved for use in metastatic TNBC, data on their CNS effect are still awaited.
Development and Validation of a Diagnostic Nomogram for the Preoperative Differentiation Between Follicular Thyroid Carcinoma and Follicular Thyroid Adenomas
Authors: Tang Pengzhou , Ren Caiyue , Shen Lijuan , Zhou Zhengrong 
Published: January 2021

Objective
The aim of the study was to construct and validate a nomogram for differentiating follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA).

Methods
Two hundred patients with pathologically confirmed thyroid follicular neoplasms were retrospectively analyzed. The patients were randomly divided into a training set (n = 140) and validation set (n = 60). Baseline data including demographics, CT (computed tomography) signs, and radiomic features were analyzed. Predictive models were developed and compared to build a nomogram. The predictive effectiveness of it was evaluated by the area under receiver operating characteristic curve (AUC).

Results
The CT model, radiomic model and combination model showed excellent discrimination (AUCs [95% confidence interval] = 0.847 [0.766–0.928], 0.863 [0.746–0.932], 0.913 [0.850–0.975]). The nomogram based on the combination model showed remarkable discrimination in the training and validation sets. The calibration curves suggested good consistency between actual observation and prediction.

Conclusions
This study proposed a nomogram that can accurately and intuitively predict the malignancy potential of follicular thyroid neoplasms.
Repair, Reconstruct, or Divert
Authors: Tang Andrew , Ahmad Usman , Raja Siva , Siddiqui Hafiz U. , Sinopoli Jillian N. , O’Dell Alexander , Pande Amol , Blackstone Eugene H. , Murthy Sudish C. 
Published: January 2021

Objectives:
The aim of this study was to determine differences in esophageal perforation populations undergoing different advanced interventions for perforated esophagus and identify predictors of treatment outcomes.

Summary Background Data:
Contained esophageal perforation can often be managed expectantly, but uncontained perforation is uniformly fatal without invasive intervention. Treatment options for the latter range from simple endoscopic control through advanced intervention. Clinical presentation varies greatly and directs which intervention is most appropriate.

Methods:
From 1996 to 2017, 335 patients were treated for esophageal perforation, and 166 for advanced interventions: 74 primary repair with tissue flap (repair), 26 esophagectomy and gastric pull-up (resection), and 66 esophagectomy and immediate diversion with planned delayed reconstruction (resection-diversion). Patient characteristics, clinical presentation, operative outcomes, and survival were abstracted. Pittsburgh Severity Scores (PSS) were retrospectively calculated. Random survival forest analysis was performed for 90-day mortality and competing risks for reconstruction after resection-diversion.

Results:
Repair and resection patients had lower PSS than resection-diversion patients (3 vs 3 vs 6, respectively). Ninety-day mortality for repair, resection, and resection-diversion was 11% vs 7.7% vs 23%, and 5-year survival was 71% vs 63% vs 47%. Risk of death after resection-diversion was highest within 1 year, but 52% of patients had reconstruction of the upper alimentary tract within 2 years.

Conclusions:
Several advanced interventions exist for critically ill patients with uncontained esophageal perforation. Repair and organ preservation are always preferred; however, patients at extremes of illness might best be treated with resection-diversion, with the understanding that the competing risk of death may preclude eventual reconstruction.
Methods for frailty screening and geriatric assessment in older adults with cancer
Authors: Puts Martine , Soo Wee Kheng , Szumacher Ewa , Decoster Lore 
Published: January 2021

Purpose of review
This review highlights the latest development in the use of geriatric assessment(GA) and frailty assessment for older adults with cancer.

Recent findings
From 2019, there were six large randomized controlled trials (RCTs) completed of GA for older adults with cancer, as well as several studies of frailty screening tools.

Summary
The findings in this review highlight the benefits of implementing GA, followed by interventions to address the identified issues (GA -guided interventions). Four of six RCTs that implemented GA for older adults with cancer showed positive impact on various outcomes, including treatment toxicity and quality of life. GA implementation varied significantly between studies, from oncologist acting on GA summary, geriatrician comanagement, to full GA by a multidisciplinary team. However, there were several barriers reported to implementing GA for all older adults with cancer, such as access to geriatrics and resource issues. Future research needs to elucidate how to best operationalize GA in various cancer settings. The authors also reviewed frailty screening tools and latest evidence on their use and impact.
A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma
Authors: Manzano-Nunez Ramiro , Gomez Alexandra , Espitia David , Sierra-Ruiz Melibea , Gonzalez Jessica , Rodriguez-Narvaez Jose G. , Castillo Andrea C. , Gonzalez Alejandro , Orjuela Jose , Orozco-Martin Viviana , Bernal Felipe , Giron Felipe , Rios Angela C. , Carranza Paola , Gonzalez-Hadad Adolfo , García-Perdomo Herney A. , García Alberto F. 
Published: January 2021

BACKGROUND
We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma.

METHODS
A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework.

RESULTS
We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results.

CONCLUSION
This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed.

LEVEL OF EVIDENCE
Systematic Review and Meta-analysis, level II.
Increasing BMI is associated with higher mortality, worsening outcomes and highly specific injury patterns following trauma: A multi-institutional analysis of 191,274 patients
Authors: Fakhry Samir M. , Morse Jennifer L. , Garland Jeneva M. , Wilson Nina Y. , Shen Yan , Wyse Ransom J. , Watts Dorraine D. 
Published: January 2021

BACKGROUND
As the prevalence of obesity has increased, trauma centers are faced with managing this expanding demographics’ unique care requirements. Research on the effects of body mass index (BMI) in trauma patients remains conflicting. This study aims to evaluate the impact of BMI on patterns of injury and patient outcomes following trauma.

METHODS
Patients from 87 hospitals’ trauma registries were selected. Those missing height, weight, disposition, or who died in the emergency department were excluded. The BMI categories were calculated from admission height and weight and verified against the electronic medical records. Patients were grouped by the National Institutes of Health–defined obesity class and compared by rate of mortality and in-hospital complications. Logistic regression was used to estimate associations, adjusting for age, gender, race, Injury Severity Score, and number of comorbidities.

RESULTS
There were 191,274 patients, 53% male; mean age was 60.4 years, mean Glasgow Coma Scale score 14.4, mean Injury Severity Score of 8.8, and 40.4% normal weight. Increased BMI was associated with an injury pattern of increased rates of extremity fractures (humerus, femur, tibia/fibula) and decreased rates of hip fractures and head injuries. Compared with the normal weight group, patients were more likely to die if they were Underweight (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.01–1.38), obese class II (AOR, 1.24; 95% CI, 1.07–1.45), or obese class III (AOR, 1.55; 95% CI, 1.29–1.87). Obese class III was associated with higher odds of a National Trauma Data Standard complication (AOR, 1.20; 95% CI, 1.11–1.30).

CONCLUSION
In this large multicenter study, increasing BMI and lower than normal BMI were strongly associated with higher mortality. Increasing BMI was also associated with longer length of stay, increased complications, and unique injury patterns. These untoward outcomes, coupled with a distinct injury pattern, warrant care guidelines specific to trauma patients with higher BMI, as well as those with BMI lower than normal.

LEVEL OF EVIDENCE
Epidemiological, Level III.
A clinical practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients
Authors: Billings Joshua D. , Khan Abid D. , Clement L. Paige , Douville Alyssa A. , Brown Eric W. , Schroeppel Thomas J. 
Published: January 2021

BACKGROUND
Predicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. This study compares the outcomes of patients before and after the CPG change.

METHODS
A review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS.

RESULTS
There were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = −1.44; p < 0.001) with R2 = 0.198.

CONCLUSION
Percentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period.

LEVEL OF EVIDENCE
Therapeutic/Care Management. Trauma, Rib, Triage, level IV.
Prevalence of and Factors Associated With Sarcopenia Among Older Adults With Knee Osteoarthritis
Authors: Thaweechotiphat Chanthanee , Kuptniratsaikul Vilai , Boonjareonbuathong Suroj , Akkathep Piyapong , Suesuwan Oiythip 
Published: January 2021

Objective:
To determine the prevalence of sarcopenia in knee osteoarthritis (SKOA) and associated factors among age, gender, body mass index (BMI), nutritional status, knee pain score, knee pain duration, physical activity, and exercise frequency.

Methods:
Knee osteoarthritis (OA) and sarcopenia were diagnosed using American College of Rheumatology and Asian Working Group for Sarcopenia criteria, respectively.

Results:
Prevalence of SKOA using grip strength and quadriceps strength was 2.2% and 9.4%, respectively. There was no significant association between sarcopenia and knee OA. Low BMI and poor nutritional status were significantly associated with SKOA.

Conclusions:
No association between sarcopenia and knee OA was found in this study.