bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of glioblastoma surgery and patient outcomes: a multicenter cohort study
Authors: Müller Domenique M J , De Swart Merijn E , Ardon Hilko , Barkhof Frederik , Bello Lorenzo , Berger Mitchel S , Bouwknegt Wim , Van den Brink Wimar A , Conti Nibali Marco , Eijgelaar Roelant S , Furtner Julia , Han Seunggu J , Hervey-Jumper Shawn , Idema Albert J S , Kiesel Barbara , Kloet Alfred , Mandonnet Emmanuel , Robe Pierre A J T , Rossi Marco , Sciortino Tommaso , Vandertop W Peter , Visser Martin , Wagemakers Michiel , Widhalm Georg , Witte Marnix G , De Witt Hamer Philip C 
Published: April 2021

AbstractBackgroundThe impact of time-to-surgery on clinical outcome for patients with glioblastoma has not been determined. Any delay in treatment is perceived as detrimental, but guidelines do not specify acceptable timings. In this study, we relate the time to glioblastoma surgery with the extent of resection and residual tumor volume, performance change, and survival, and we explore the identification of patients for urgent surgery.MethodsAdults with first-time surgery in 2012–2013 treated by 12 neuro-oncological teams were included in this study. We defined time-to-surgery as the number of days between the diagnostic MR scan and surgery. The relation between time-to-surgery and patient and tumor characteristics was explored in time-to-event analysis and proportional hazard models. Outcome according to time-to-surgery was analyzed by volumetric measurements, changes in performance status, and survival analysis with patient and tumor characteristics as modifiers.ResultsIncluded were 1033 patients of whom 729 had a resection and 304 a biopsy. The overall median time-to-surgery was 13 days. Surgery was within 3 days for 235 (23%) patients, and within a month for 889 (86%). The median volumetric doubling time was 22 days. Lower performance status (hazard ratio [HR] 0.942, 95% confidence interval [CI] 0.893–0.994) and larger tumor volume (HR 1.012, 95% CI 1.010–1.014) were independently associated with a shorter time-to-surgery. Extent of resection, residual tumor volume, postoperative performance change, and overall survival were not associated with time-to-surgery.ConclusionsWith current decision-making for urgent surgery in selected patients with glioblastoma and surgery typically within 1 month, we found equal extent of resection, residual tumor volume, performance status, and survival after longer times-to-surgery.
Are Monthly Market Returns Predictable?
Authors: Keppo Jussi , Shumway Tyler , Weagley Daniel 
Published: April 2021

Abstract
We document significant persistence in the market timing performance of active individual investors, suggesting that some investors are skilled at timing. Using data on all trades by active Finnish individual investors over almost 15 years, we also show that the net purchases of skilled versus unskilled investors predict monthly market returns. Our results lend credibility to the view that market returns are predictable, without having to specify which variables active investors use to successfully time the market. (JEL G10, G11, G12, G14, G15).
Goal-directed Fluid Therapy Versus Conventional Fluid Therapy During Craniotomy and Clipping of Cerebral Aneurysm: A Prospective Randomized Controlled Trial
Authors: Bloria Summit D. , Panda Nidhi B. , Jangra Kiran , Bhagat Hemant , Mandal Banashree , Kataria Ketan , Chauhan Rajeev , Luthra Ankur , Soni Shiv Lal , Kaloria Narender , Mahajan Shalvi , Paul Shamik Kr , Gupta Shailesh , Agrawal Sanket , Singla Navneet 
Published: April 2021

Background:
Fluid imbalance is common after aneurysmal subarachnoid hemorrhage and negatively impacts clinical outcomes. We compared intraoperative goal-directed fluid therapy (GDFT) using left ventricular outflow tract velocity time integral (LVOT-VTI) measured by transesophageal echocardiography with central venous pressure (CVP)-guided fluid therapy during aneurysm clipping in aneurysmal subarachnoid hemorrhage patients.

Methods:
Fifty adults scheduled for urgent craniotomy for aneurysm clipping were randomly allocated to 2 groups: group G (n=25) received GDFT guided by LVOT-VTI and group C (n=25) received CVP-guided fluid management. The primary outcome was intraoperative mean arterial pressure (MAP). Secondary outcomes included volume of fluid administered and several other intraoperative and postoperative variables, including neurological outcome at hospital discharge and at 30 and 90 days.

Results:
There was no difference in MAP between the 2 groups despite patients in group G receiving lower volumes of fluid compared with patients in group C (2503.6±534.3 vs. 3732.8±676.5 mL, respectively; P<0.0001). Heart rate and diastolic blood pressure were also comparable between groups, whereas systolic blood pressure was higher in group G than in group C at several intraoperative time points. Other intraoperative variables, including blood loss, urine output, and lactate levels were not different between the 2 groups. Postoperative variables, including creatinine, duration of postoperative mechanical ventilation, length of intensive care unit and hospital stay, and incidence of acute kidney injury, pneumonitis, and vasospasm were also comparable between groups. There was no difference in neurological outcome at hospital discharge (modified Rankin scale) and at 30 and 90 days (Extended Glasgow Outcome Scale) between the 2 groups.

Conclusion:
Compared with CVP-guided fluid therapy, transesophageal echocardiography–guided GDFT maintains MAP with lower volumes of intravenous fluid in patients undergoing clipping of intracranial aneurysms with no adverse impact on postoperative complications.
Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States
Authors: Fortin Chelsea N. , Jiang Charley , Caldwell Martina T. , As-Sanie Sawsan , Dalton Vanessa , Marsh Erica E. 
Published: April 2021

OBJECTIVE:
To describe trends in emergency department (ED) visits in the United States with a primary diagnosis of leiomyomas, subsequent admissions, and associated charges.

METHODS:
The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database was used to retrospectively identify all ED visits from 2006 to 2017 among women aged 18–55 years with a primary diagnosis of leiomyomas as indicated by International Classification of Diseases (ICD) diagnosis codes. Trends in ED visits and subsequent admissions were analyzed and stratified by patient and hospital characteristics. Secondary ICD codes, Current Procedural Terminology codes, and hospital charges were analyzed. A multivariate regression model was used to identify predictors of admission.

RESULTS:
Although the number of ED visits for leiomyomas increased from 28,732 in 2006 to 65,685 in 2017, the admission rate decreased, from 23.9% in 2006 to 11.1% in 2017. Emergency department visits for leiomyomas were highest among women who were aged 36–45 years (44.5%), in the lowest income quartile (36.1%), privately insured (38.3%), and living in the South (46.2%). Admission was more likely at nonteaching hospitals (odds ratio [OR] 1.23, 95% CI 1.08–1.39) or those located in the Northeast (OR 1.39, 95% CI 1.15–1.68). Patient characteristics associated with admission included older age (26–35 years: OR 1.42, 95% CI 1.21–1.66; 36–45 years: OR 2.01, 95% CI 1.72–2.34; 46–55 years: OR 2.60, 95% CI 2.23–3.03) and bleeding-related complaints (OR 14.92, 95% CI 14.00–15.90). Admission was least likely in uninsured patients (Medicare: OR 1.37, 95% CI 1.21–1.54; Medicaid: OR 1.26, 95% CI 1.16–1.36; private: OR 1.44, 95% CI 1.32–1.56).

CONCLUSION:
Although ED visits for leiomyomas are increasing, admission rates for these visits are decreasing. The substantial decline in admissions suggests many of these visits could potentially be addressed in a non–acute-care setting. However, when women with leiomyomas present with a bleeding-related complaint, the odds of admission increase 15-fold. There is an apparent disparity in likelihood of admission based on insurance type.
Malnourishment-Associated Acetaminophen Toxicity in Pregnancy
Authors: Dom Aaron M. , Royzer Rebecca , Olson-Chen Courtney 
Published: April 2021

BACKGROUND:
Although acetaminophen is commonly used in pregnancy, it can deplete glutathione concentrations and cause accumulation of 5-oxoproline, with subsequent metabolic acidosis.

CASE:
A malnourished 25-year-old woman, G2P1001, with chronic acetaminophen use presented with abdominal pain and high anion gap metabolic acidosis. After ruling out other potential causes, her urine 5-oxoproline level was found to be elevated. She received N-acetylcysteine, with resolution of the acidosis.

CONCLUSION:
Those who care for pregnant patients should remain alert to 5-oxoprolinemia as a cause of metabolic acidosis during pregnancy. Care must be taken when using acetaminophen in states of malnutrition. N-acetylcysteine seems to be an effective antidote.
Health Care Use by Commercially Insured Postpartum and Nonpostpartum Women in the United States
Authors: Steenland Maria W. , Kozhimannil Katy B. , Werner Erika F. , Daw Jamie R. 
Published: April 2021

OBJECTIVE:
To compare the type, frequency, and timing of health care use among commercially insured postpartum and nonpostpartum women.

METHODS:
This retrospective cohort study used data from a large national commercial claims database. Women between 18 and 44 years of age who gave birth in 2016 (n=149,563) and women who were neither pregnant nor postpartum between 2015 and 2017 (n=2,048,831) (nonpostpartum) were included. We examined hospitalization, and preventive visits, problem visits, and emergency department (ED) visits among postpartum women during the early postpartum period (less than 21 days after childbirth), the postpartum period (21–60 days postpartum), and extended postpartum period (61–365 days after childbirth). Visits among nonpostpartum women were assessed during time periods of equivalent duration.

RESULTS:
Almost 24% of postpartum women had a problem visit in the early postpartum period, compared with 19.7% of nonpostpartum women (adjusted difference 4.8 percentage points [95% CI 4.6–5.0]). Approximately 3% of postpartum women had an early ED visit, more than double the percentage among nonpostpartum women (adjusted difference 2.3 percentage points [95% CI 2.2–2.4]). Both problem visits and ED visits among postpartum women remained elevated relative to nonpostpartum women during the postpartum and extended postpartum periods. Although postpartum women were more likely than nonpostpartum women to receive preventive care during the early and postpartum periods, only 43% of postpartum women had a preventive visit during the extended postpartum period, a rate 1.8 (95% CI −2.1 to −1.5) percentage points lower than that of nonpostpartum women. Adjusted hospitalization rates among postpartum women in the early (0.8%), postpartum (0.3%), and extended postpartum (1.4%) periods were higher than those of nonpostpartum women (0.1%, 0.2%, and 1.6%, respectively).

CONCLUSIONS:
Commercially insured postpartum women use more health care than nonpostpartum women, including inpatient care. Differences are largest in the early postpartum period and persist beyond 60 days postpartum.
Barriers to Exercise in Postpartum Women: A Mixed-Methods Systematic Review
Authors: Edie Rebekah , Lacewell Alexis , Streisel Christine , Wheeler Lauren , George Ellie , Wrigley Jordan , Pietrosimone Laura , Figuers Carol 
Published: April 2021

Background:
Exercise is a safe and beneficial way of improving physical and psychological well-being in postpartum people; yet, postpartum people are less likely to meet the recommended guidelines for physical activity. Identifying the barriers to exercise in the postpartum period may assist health care professionals to better understand how to counsel this population on strategies for exercise.

Objective:
To synthesize the current literature on barriers to exercise in postpartum people.

Study Design:
A mixed-methods systematic review.

Methods:
A systematic literature search was conducted in MEDLINE/PubMed, EMBASE, Scopus, and CINAHL databases of both qualitative and quantitative studies that examined the barriers to exercise among postpartum people. The articles were selected on the basis of predetermined inclusion and exclusion criteria. The Downs and Black Checklist of Methodological Quality was used to assess study quality.

Results:
Ten studies met the inclusion criteria (7 qualitative and 3 quantitative). Barriers were categorized into the following categories: intrapersonal, interpersonal, sociocultural/demographic, physical environment, and health care environment. The most reported barriers in each category were tiredness and/or lack of sleep (7 out of 10 mentioned), time and/or unpredictable routines/schedule and busy with domestic chores/care/responsibilities (both 8 out of 10 mentioned), lack of support from family, friends, and other mothers (9 out of 10 mentioned), weather (7 out of 10 mentioned), and breastfeeding (3 out of 10 mentioned), respectively.

Conclusion:
Physical therapists and other health care professionals should be aware of the major reported barriers to exercise among postpartum people, as this will help guide them in providing meaningful education and counseling strategies to increase exercise in this unique population. Further research is needed to capture a more diverse group of postpartum people, as well as considering how policy may affect exercise postpartum.
Effectiveness and Safety of EUS Rendezvous After Failed Biliary Cannulation With ERCP
Authors: Klair Jagpal S. , Zafar Yousaf , Ashat Munish , Bomman Shivanand , Murali Arvind R. , Jayaraj Mahendran , Law Joanna , Larsen Michael , Singh Dhruv P. , Rustagi Tarun , Irani Shayan , Ross Andrew , Kozarek Richard , Krishnamoorthi Rajesh 
Published: April 2021

Background:
Endoscopic ultrasound–guided rendezvous (EUS-RV) endoscopic retrograde cholangiopancreatography (ERCP) is an alternative to interventional radiology–guided rendezvous ERCP in patients who failed biliary cannulation with conventional ERCP. However, there is significant variation in reported rates of success and adverse events associated with EUS-RV-assisted ERCP. We performed a systematic review and a proportion meta-analysis to reliably assess the effectiveness and safety of the EUS-RV-assisted ERCP.

Materials and Methods:
We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through August 2020) to identify studies reporting EUS-RV-assisted ERCP in patients who failed biliary cannulation with conventional ERCP techniques. Using the random-effects model described by DerSimonian and Laird, we calculated the pooled rates of technical success, clinical success, and adverse events of EUS-RV-assisted ERCP.

Results:
Twelve studies reporting a total of 342 patients were included in the meta-analysis. The pooled rate of technical success (12 studies reporting a total of 342 patients) was 86.1% [95% confidence interval (CI): 78.4-91.3]. The pooled rate of clinical success (4 studies reporting a total of 94 patients) was 80.8% (95% CI: 64.1-90.8). The pooled rate of overall adverse events (12 studies; 42 events in 342 patients) was 14% (95% CI: 10.5-18.4). Low to moderate heterogeneity was noted in the analyses.

Conclusions:
EUS-RV-assisted ERCP appears to be effective and safe in patients who failed biliary cannulation with conventional ERCP. Given the risk of adverse events, it should be performed in centers with expertise in therapeutic endoscopic ultrasound.
The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty
Authors: Lee Yan Ho , Lee Jonathan Y. , Luo Jiajun , Lawson William , Westreich Richard 
Published: April 2021

Background:
A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors’ objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty.

Methods:
A retrospective case series was performed on patients who had undergone rhinoplasty performed by the senior author (R.W.) from September of 2008 to July of 2015. Patients with at least 3 months of follow-up and adequate photographs were included. The mean follow-up period was 11.0 months (range, 3 to 72 months). A total of 68 patients were included. Preoperative and postoperative photographs were analyzed to measure changes in nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view, and nostril show bilaterally.

Results:
Of the 68 patients, statistically significant improvement of nasal axis deviation of 4.32 degrees toward the midline was observed. Alar facial angle on base view was improved 1.01 degrees toward the horizontal. Nostril symmetry also improved based on the ratio between the shorter side and the longer side. The mean change in nostril show ratio was 0.19 toward a 1:1 ratio.

Conclusions:
Previous studies have shown that the subalar grafting technique is an important adjunctive technique in rhinoplasty for patients with midfacial asymmetries. This case series demonstrates that this technique can provide sustained results in the correction of the nasal foundation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Rhinosurgery during and after the COVID-19 Pandemic: International Consensus Conference Statement on Preliminary Perioperative Safety Measures
Authors: Haug Martin D. , Lekakis Garyfalia , Bussi Mario , Cerkes Nazim , Calvert Jay , East Charles , Gerbault Olivier , Gubisch Wolfgang , Heppt Werner , Kamburoglu Haldun , Most Sam , Oranges Carlo M. , Vavrina Josef , Rohrich Rod J. , Robotti Enrico 
Published: April 2021

Background:The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society.Methods:A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel’s recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained.Results:Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures.Conclusion:The implementation of the panel’s recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.
Is It Worth the Risk? Contralateral Prophylactic Mastectomy With Immediate Bilateral Breast Reconstruction
Authors: Chadab Tara M. , Bernstein Jaime L. , Lifrieri Andrea , Ascherman Jeffrey A. , Grant Robert T. , Rohde Christine H. 
Published: April 2021

Background
An increasing number of women are choosing to undergo contralateral prophylactic mastectomy with immediate bilateral breast reconstruction. Operating on the contralateral noncancer side is not without its own set of risks. We sought to compare complication rates between the cancerous and contralateral prophylactic breasts.

Methods
A retrospective review was conducted of all patients undergoing immediate postmastectomy bilateral breast reconstruction for unilateral breast cancer between January 2008 and January 2019 at a single institution. Data were collected on patient demographics, cancer and adjuvant/neoadjuvant treatments, tumor, reconstruction, hospital stay, and complications. Complications were compared between the cancerous and the noncancerous breasts.

Results
One hundred sixty patients met the inclusion criteria of this study. Of these 160 patients, 33 (20.6%) had complications (major and minor) only to the cancerous breast, 7 (4.4%) had complications only to the noncancerous breast, and 7 (4.4%) had bilateral complications. Most patients underwent tissue expander/implant reconstruction (93.8%) with the rest (6.2%) undergoing abdominally based flap or latissimus dorsi flap reconstruction. Patients with complications were more likely to have hypertension, diabetes, exposure to radiation, and neoadjuvant chemotherapy. Complications included wound dehiscence, hematoma, cellulitis, seroma, capsular contracture, infected implant, and skin necrosis. Overall, there were significantly more complications to the cancerous breasts than the noncancerous breasts (P < 0.001). In addition, although exposure to radiation to the affected side significantly increased the likelihood of complications to that side (P < 0.0001), patients who were not exposed to any radiation were also more likely to have complications to the cancer side than to the noncancer side (P = 0.00065). However, after controlling for the effects of radiation, there was no significant difference in complications between the cancer side and the prophylactic side when stratifying by specific complications.

Conclusions
Although contralateral prophylactic mastectomy with immediate bilateral reconstruction is not without added risk when compared with a unilateral procedure, this study shows that the incidence of complications to the noncancerous breast is less than that to the cancerous breast. This information can be used to help counsel patients with unilateral breast cancer on their treatment options and associated risks.