bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Metformin Use on Survival in Patients Undergoing Liver Resection for Colorectal Cancer Metastases
Authors: Kaltenmeier Christof , Morocco Brittany , Yazdani Hamza , Reitz Katherine , Meyer Kelley , Molinari Michele , Geller David , Tohme Samer 
Published: November 2021

Introduction Resection of colorectal liver metastases provides the best chance for survival in patients with Stage IV colorectal cancer; however, hepatic recurrence is frequent and the main cause of death. Multiple epidemiological studies have documented an association between metformin and anti-neoplastic effects in a variety of cancers. Given the vast literature, we evaluated the incidence on recurrence and survival of patients on metformin who undergo surgery for colorectal liver metastasis (CRLM). Methods We selected 270 consecutive patients with known CRLM who underwent hepatic metastases resection at our institution between January 1st 2012 and December 31st 2019. Patients were divided based on their use of metformin (n = 62) or no metformin (n = 208). Adjusted analysis of recurrence-free (RFS) and overall survival (OS) was performed. Results Patients on metformin had significantly longer RFS (HR: .44, 95% CI: .26-.75, P < .002; Median RFS: 49 months vs 33 months) and OS (HR .60, 95% CI .31-.97, P < .048, Median OS: 72 months vs 60 months). Additional factors associated with shorter RFS on univariate analysis included the following: CEA > 200 ng/ml (HR: 2.23, 95% CI 1.21-4.03, P < .010), positive liver margin (HR: 3.70, 95% CI 2.27-6.03, P < .001), and >1 tumor (HR: 1.98, 95% CI 1.26-3.09, P < .003). Liver margin remained a significant factor for predicting shorter OS (HR: 4.99, 95% CI 2.49-10.0, P < .001). Conclusion In this study, we found that patients with CRLM on metformin have prolonged RFS and OS postliver resection. Further prospective randomized trials need to be carried out to evaluate the anti-neoplastic effect of metformin in diabetic and non-diabetic cancer patients.
Mode-I and mode-II interlaminar fracture properties of high modulus pitch-based carbon fiber reinforced polymers containing different nanostructures
Authors: Naito Kimiyoshi , Nagai Chiemi 
Published: November 2021

The mode-I and mode-II interlaminar fracture properties of high modulus pitch-based carbon fiber reinforced polymers (CFRPs) (fiber: K13C; resin: EX-1515 cyanate ester) modified with 20–30 nm β-SiC nanoparticles or multiwalled-carbon nanotubes (MWCNTs) were investigated. Different volume fractions of both the β-SiC nanoparticles (1, 2, 5, and 10 vol%) and MWCNTs (1, 3, 5, and 7 vol%) were tested. The values of the mode-I and mode-II interlaminar fracture toughness of the CFRPs containing the lowest volume fractions of these nanostructures were larger compared with the unfilled composite but decreased with increasing the volume fraction of the inclusions. No differences in mechanical properties were observed among the different nanostructure types.
Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients
Authors: Szmygin Maciej , Sojka Michał , Tarkowski Piotr , Pyra Krzysztof , Luchowski Piotr , Wojczal Joanna , Ficek Remigiusz , Drelich-Zbroja Anna , Jargiełło Tomasz 
Published: November 2021

Background Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. Purpose To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. Material and Methods This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. Results The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0–2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. Conclusion In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.
Feasibility of self-administered acupressure for allergic rhinitis: a pilot randomized controlled trial and lessons learnt for future studies
Authors: Liang Yaqun , Lenon George Binh , Li Mingdi , Yang Angela Wei Hong 
Published: November 2021

Objectives: Allergic rhinitis (AR) is an immunoglobulin (Ig)E-mediated inflammatory condition that is highly prevalent worldwide. The aim of this pilot trial was to evaluate the feasibility and safety of self-administered acupressure for AR. Methods: A randomized, single-blind, non-specific controlled clinical trial was conducted at Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia. Fifteen AR patients were randomized into two groups: self-administered acupressure at five specific acupressure (SA) points or five non-specific acupressure (NSA) points (1 min/point, twice a day), and treated for 4 weeks with an 8-week follow-up period. The primary outcome was the change in 7-point scale symptom severity. Secondary outcomes included the rhinoconjunctivitis quality of life questionnaire and standardized activities (RQLQs), medication usage, adverse events and participants’ opinions of the blinding method. The Statistical Package for the Social Science (SPSS) version 26 was used for data analyses. Results: Fourteen participants completed the study and no major adverse events were reported. No statistically significant differences between SA and NSA groups were identified in 7-point scale symptom severity scores, RQLQs or medication usage. However, participants in the SA group believed that SA was useful for AR and recommended it for self-care. The credibility of the blinding method was successful. No adverse effects were considered to be related to the intervention. Conclusion: Acupressure is feasible and appears to be safe for self-administration by AR sufferers. Experience from this pilot study has guided minor amendments to the protocol. A large-scale randomized controlled trial is warranted to further investigate the efficacy and safety of self-administered acupressure for the management of AR.
Revision Rates After Total Ankle Replacement: A Comparison of Clinical Studies and Arthroplasty Registers
Authors: Hauer Georg , Hofer Reinhard , Kessler Markus , Lewis Jan , Leitner Lukas , Radl Roman , Leithner Andreas , Sadoghi Patrick 
Published: November 2021

Background: The aim of this study was to assess the outcome of total ankle replacement (TAR) regarding revision rates by comparing clinical studies of the last decade to data displayed in arthroplasty registers. The secondary aim was to evaluate whether dependent clinical studies show a superior outcome to independent publications. Additionally, revision rates of mobile bearing implants (MB-TARs) were compared to those of fixed bearing implants (FB-TARs). Methods: Clinical studies on TARs between 2010 and 2020 were systematically reviewed, with the endpoint being a revision for any reason. The parameter “revision rate per 100 observed component years (CYs)” was calculated for each publication. The pooled revision rate for clinical studies was compared to the data reported in arthroplasty registers. In a second step, revision rates were subdivided and analyzed for independent and dependent publications and for FB-TARs and MB-TARs. Results: A total of 43 publications met the inclusion criteria comprising 5806 TARs. A revision rate of 1.8 per 100 observed CYs was calculated, corresponding to a 7-year revision rate of 12.6%. The 3 arthroplasty registers included showed revision rates ranging from 8.2% to 12.3% after 7 years. No significant difference between dependent and independent publications nor between FB-TARs and MB-TARs was detected. Conclusion: Revision rates of clinical studies and arthroplasty registers are comparable. Surgeons can compare their own revision rates with those from this study. Dependent studies do not seem to be biased, and no superiority for one bearing type can be described. Level of Evidence: Level III, systematic review of level III studies
Human performance and system safety: Alternative perspectives on safety assessment
Authors: Mumaw Randall J. , Roth Emilie M. , Bier Vicki , Bley Dennis , Boring Ronald , Hettinger Larry 
Published: November 2021

Discussion Panel Abstract: The recent Boeing 737MAX accidents crystalized for the public the complexity of anticipating system and operator performance and developing a system design that prevents catastrophic outcomes. The operational situations, progression of flightcrew actions, and system behaviors that led to the two accidents had not been anticipated by the manufacturer or the regulator. These accidents were only the most recent examples of our failure to anticipate and manage operational complexities and operator performance. The art and science of human factors has yet to perfect risk assessment (or safety assessment) for complex systems. In the not-so-distant past, system risk assessment made estimates of human error probabilities (HEPs) for specific operational tasks, which were combined with estimated equipment failure rates to produce an overall risk estimate. Indeed, these Human Reliability Analysis (HRA) techniques have evolved over decades and are still being developed (e.g., IDHEAS-ECA, Xing et al., 2020), partly because they satisfy the need for a simple quantitative threshold that can be used by industry and regulators: if risk probability is too high, change the design or some other aspect of operations. Through the years, there have been critiques of the HRA approach (e.g., Hollnagel, 1998) that led to revisions, such as focusing on cognitive functions instead of operator tasks, but not to the basic quantitative risk-estimation approach. Other approaches to assessing risk/safety have wandered down other paths: attempting to capture system complexity from an operator’s perspective (Roth, Mumaw, Lewis, 1994; Nuclear Regulatory Commission, 2000), or better documenting the many ways in which system operators manage complexity daily to find ways to improve their capacity (Hollnagel, Woods, & Leveson, 2006). These approaches have used different measures than HEPs; e.g., measures of operator performance, measures of interface usability/design, measures of task complexity, and the analysis of system constraints. In this panel, we offer different perspectives on risk/safety assessment as it relates to operator performance in complex systems. Foundational to assessment is deciding the nature of safety and the role of operator performance. Another important question is, as you move away from simple quantitative measures, how do you establish safety thresholds? That is, what guidance can we give to industry and regulators regarding how to measure safety and how to decide that action is required on the basis of safety.
Muscular loads associated with floor vacuuming with cordless stick cleaners
Authors: Kwon Yujin , Shin Gwanseob 
Published: November 2021

The muscular loads of the upper extremity and chest muscles were assessed during floor vacuuming with stick vacuum cleaners. Ten participants conducted vacuuming with two stick cleaners (weight: 3.03 kg, 3.56 kg) on tiled and carpeted floors while the myoelectric activity of the upper extremity and chest muscles were collected. The mean muscle activation levels ranged from 15.5% to 45.7% of the maximum voluntary capacity. Greater muscular loads were observed on the forearm and shoulder muscles when vacuuming with repeated curved strokes (vs. straight storkes), and on the chest muscle when vacuuming the carpeted floor. The range of muscular loads were higher than that of occupational tasks such as house painting and dental drilling, which have been known as intensive activities for upper extremities. The results suggest that floor vacuuming with stick vacuum cleaners is physically demanding for household consumers. Ergonomic interventions such as more user-friendly design should be considered.
Macular and peripapillary microvasculature after dexamethasone injection in diabetic macular edema
Authors: Ozcalıskan Sehnaz , Pehlıvanoglu Seren , Huseyınhan Zahid , Alagoz Cengiz , Erdogan Gurkan , Artunay Ozgur 
Published: November 2021

Purpose To evaluate the microvascular changes in the macular and peripapillary area after intravitreal dexamethasone implant in diabetic macular edema (DME) Material and Methods We included 31 eyes of 31 patients treated with a single dose dexamethasone implant for DME. All subjects underwent swept-source optical coherence tomography (OCT) and OCT angiography imaging before (T0), and one month (T1), two months (T2), and four months (T4) after dexamethasone injection. The foveal avascular zone (FAZ) area of superficial and deep capillary plexus (SCP and DCP) was calculated by delineating the FAZ border using the measurement tool of the device. The vessel density (VD) of SCP and DCP and choriocapillaris (CC) in the macular and peripapillary area were automatically calculated. Results There was an insignificant reduction in FAZ area measurements of SCP after dexamethasone injection in DME patients (p = 0.846). The FAZ area of DCP were significantly smaller compared to T0 measurements at T1, T2, and T4 (p = 0.013, p = 0.031, and p = 0.029, respectively). The mean average parafoveal VD measurements were significantly decreased after dexamethasone injection in SCP and DCP (p = 0.004, p = 0.005). The peripapillary VD in retinal capillary plexuses and choriocapillaris showed no significant difference after dexamethasone injection. Conclusion Intravitreal dexamethasone leads to a significant FAZ area decrease in DCP with a reduction in parafoveal VD measurements. In addition, no significant VD changes were observed in the peripapillary area after dexamethasone. These findings indicate that dexamethasone may improve macular ischemia with no significant effects on peripapillary microvasculature in DME patients.
Effectiveness and safety of intravenous dexmedetomidine sedation for ophthalmic surgery under regional anesthesia
Authors: De Nucci Annalisa , Scialdone Antonio , Lando Gabriele , Monaco Gaspare , Cacioppo Viviana , Campbell Davies Sophia , Casalino Giuseppe , Gemma Marco 
Published: November 2021

Purpose To assess the effectiveness and safety of intravenous (IV) dexmedetomidine for sedation in ophthalmic surgery. Methods Prospective, observational, uncontrolled, single-center study. Patients were sedated with a continuous dexmedetomidine IV infusion started 15 min before regional anesthesia administration and maintained up to the end of surgery. Effectiveness of dexmedetomidine was assessed by the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) targeted at 5. Safety was assessed by the incidence of patients’ movements/snoring and by the incidence of respiratory and haemodynamic complications. An eleven-point numerical rating scale (NRS) was used to assess the level of satisfaction of both the surgeon and the patient. Results 123 patients (73 males, mean age: 63 ± 13) were included; 81 (81/123; 65.8%) patients reached the requested MOAA/S score of 5. Any intraoperative movement – mostly voluntary – occurred in 34 (34/123; 27.6%) cases with no need for a switch to general anaesthesia; no ocular complications related to the intraoperative movements occurred. Intraoperative snoring occurred in 30 (30/123; 24.4%) patients and it did not affect the surgical manoeuvres. Respiratory drive depression requiring manual or mechanical ventilation never occurred. Bradycardia occurred in 14 (14/123; 11.3%), cases but only 4 (4/123; 3.2%) patients required atropine administration, which was always effective. Intraoperative analgesia was consistently obtained and both the surgeons and the patients reported a high NRS satisfaction score. Conclusion Dexmedetomidine provided adequate sedation in patients undergoing ocular surgery under local anaesthesia and showed a good effectiveness and safety profile. Upper airway obstruction, apnoea and snoring can occur.
Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters
Authors: Ablordeppey Enyo A , Keating Shannon M , Brown Katherine M , Theodoro Daniel L , Griffey Richard T , James Aimee S 
Published: November 2021

Background: The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR. Methods: We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation. Results: The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators. Conclusion: Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.
Vessel diameter and close surveillance helps predict early patency in native arteriovenous fistulas
Authors: Kirkham Emily N , Fallon John , Foy Chris , Harris Sophie , Birch Gemma , Bullingham Julie , Pickett Thomas M , Kulkarni Sachin R , Paravastu Sharath CV , Cooper David G 
Published: November 2021

Introduction: Arteriovenous fistulas are the preferred method of vascular access for haemodialysis. Data suggests patency rates can be low and may be related to vessel diameters prior to creation. We use specific size criteria for fistula selection. We aimed to establish patency rates in relation to vessel size and whether other factors affect fistula patency. Methods: Consecutive patients undergoing radiocephalic (RCF) or brachiocephalic (BCF) creation between 2016 and 2018 were analysed. Preoperative arterial and venous diameters were collected. Six-week and six-month primary and secondary patency rates were analysed to establish any impact of vessel size on patency and re-intervention rates between groups. A univariate analysis was performed. Results: Ninety four RCFs and 101 BCFs were created. Median artery and vein size for RCF were 2.7 and 3.0 mm respectively. For BCF, they were 4.6 and 4.3 mm respectively. At 6-weeks, overall satisfactory patency for RCF and BCF combined was 91.8%. 89.7% demonstrated primary patency; 2.1% secondary patency. At 6-months, overall patency was 78.7%; 58.5% demonstrated primary patency, 20.2% secondary patency. A univariate analysis, for both groups, revealed vein size was a significant predictor of overall satisfactory patency at 6-weeks, with larger veins more likely to remain patent ( p = 0.025 RCF, p = 0.007 BCF). However, artery size was not predictive ( p = 0.1 RCF, p = 0.5 BCF). At 6-months, neither artery nor vein diameter were predictive in either group. When comparing size of vessel based on fistula type, vessels used to create RCFs were smaller than those for BCFs ( p < 0.001). RCFs were more likely to receive endovascular intervention or occlude when compared to BCFs ( p = 0.014). Discussion: Excellent patency and maturation rates can be achieved using fairly strict vessel size criteria. Vein size might be the more important predictor of early success. RCFs can be challenging due to smaller vessels, but maturation rates can be optimised by close surveillance and aggressive re-intervention.
The power struggle: exploring the reality of clinical reasoning
Authors: Pillay Thiani , Pillay Mershen 
Published: November 2021

Purpose: Historically, clinical reasoning has largely been considered from an empirical, biomedical standpoint. This epistemology, rooted in imperial rule, is influential in how healthcare practitioners practice. An empirical approach to healthcare often oversimplifies the complex nature of clinical reasoning by obscuring the influence of imperial ideologies on decision-making. This can perpetuate inequitable approaches to healthcare delivery which deepen social, political and economic divides globally. This paper aims to explore and challenge this standpoint by exploring how power, imperialism and performativity influences healthcare provision and decision-making amongst healthcare practitioners in dysphagia rehabilitation. Methods: Qualitative exploratory interviews were undertaken with seven South African trained SLPs with experience working in dysphagia. To allow for participation and collaboration from participants, three data collection tools were employed within the interviews: oral histories, cognitive mapping and arts-based tasks. An initial modified thematic analysis followed by a further ideological analysis were undertaken to analyse the data collected. Results: The results suggest that the participants felt influenced by several manifestations of power within healthcare. We argue that this demonstrates that imperial practices can influence knowledge, interaction and context and therefore affect how healthcare practitioners make decisions. Conclusion: By acknowledging the impact of imperialism and power dynamics on healthcare provision and clinical reasoning we can potentially begin to transform the epistemology from which we approach healthcare provision in favour of one which is better suited to the current realities of healthcare to allow for equitable service provision.