bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes mellitus promoted lymph node metastasis in gastric cancer: a 15–year single-institution experience
Authors: Chen Xinhua , Chen Yuehong , Li Tao , Liang Weiqi , Huang Huilin , Su Hongtao , Sui Chuyang , Hu Yanfeng , Chen Hao , Lin Tian , Chen Tao , Zhao Liying , Liu Hao , Li Guoxin , Yu Jiang 
Published: October 2021

Abstract

Background:
Previous studies have revealed that diabetes mellitus (DM) promotes disease progress of gastric cancer (GC). This study aimed to further investigating whether DM advanced lymph nodes (LNs) metastasis in GC.

Methods:
The clinicopathologic data of GC patients with >15 examined LN (ELN) between October 2004 and December 2019 from a prospectively maintained database were included. The observational outcomes included the number (N3b status) and anatomical distribution (N3 stations) of metastatic LN (MLN).

Results:
A total of 2142 eligible patients were included in the study between October 2004 and December 2019. N3 stations metastasis (26.8% in DM vs. 19.3% in non-DM, P
= 0.026) and N3b status (18.8% in DM vs. 12.8% in non-DM, P
= 0.039) were more advanced in the DM group, and multivariate logistic regression analyses confirmed that DM was an independent factor of developing N3 stations metastasis (odds ratio [OR] = 1.771, P
= 0.011) and N3b status (OR = 1.752, P
= 0.028). Also, multivariate analyses determined DM was independently associated with more MLN (β = 1.424, P
= 0.047). The preponderance of N3 stations metastasis (DM vs. non-DM, T1–2: 2.2% vs. 4.9%, T3: 29.0% vs. 20.3%, T4a: 38.9% vs. 25.8%, T4b: 50.0% vs. 36.6%; ELN16–29: 8.6% vs. 10.4%, ELN30–44: 27.9% vs. 20.5%, ELN ≥ 45: 37.7% vs. 25.3%), N3b status (DM vs. non-DM, T1–2: 0% vs. 1.7%, T3: 16.1% vs. 5.1%, T4a: 27.8% vs. 19.1%, T4b: 44.0% vs. 28.0%; ELN16–29: 8.6% vs. 7.9%, ELN30–44: 18.0% vs. 11.8%, ELN ≥ 45: 26.4% vs. 17.3%), and the number of MLN (DM vs. non-DM, T1–2: 0.4 vs. 1.1, T3: 8.6 vs. 5.2, T4a: 9.7 vs. 8.6, T4b: 17.0 vs. 12.8; ELN16–29: 3.6 vs. 4.6, ELN30–44: 5.8 vs. 5.5, ELN ≥ 45: 12.0 vs. 7.7) of DM group increased with the advancement of primary tumor depth stage and raising of ELN.

Conclusions:
DM was an independent risk factor for promoting LN metastasis. The preponderance of LN involvement in the DM group was aggravated with the advancement of tumor depth.
Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes
Authors: Bengelloun Adrián K. , Ortega Guillermo J. , Ancochea Julio , Sanz-Garcia Ancor , Rodríguez-Serrano Diego A. , Fernández-Jiménez Guillermo , Girón Rosa , Ávalos Elena , Soriano Joan B. , de Ulíbarri J. Ignacio 
Published: October 2021

Abstract

Background:
In-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is high. Simple prognostic indices are needed to identify patients at high-risk of COVID-19 health outcomes. We aimed to determine the usefulness of the CONtrolling NUTritional status (CONUT) index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital admission.

Methods:
Our study design is of a retrospective observational study in a large cohort of COVID-19 patients. In addition to descriptive statistics, a Kaplan–Meier mortality analysis and a Cox regression were performed, as well as receiver operating curve (ROC).

Results:
From February 5, 2020 to January 21, 2021, there was a total of 2969 admissions for COVID-19 at our hospital, corresponding to 2844 patients. Overall, baseline (within 4 days of admission) CONUT index could be scored for 1627 (57.2%) patients. Patients’ age was 67.3 ± 16.5 years and 44.9% were women. The CONUT severity distribution was: 194 (11.9%) normal (0–1); 769 (47.2%) light (2–4); 585 (35.9%) moderate (5–8); and 79 (4.9%) severe (9–12). Mortality of 30 days after admission was 3.1% in patients with normal risk CONUT, 9.0% light, 22.7% moderate, and 40.5% in those with severe CONUT (P < 0.05). An increased risk of death associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model (P < 0.05). An increasing baseline CONUT stage was associated with a longer duration of admission, a greater requirement for the use of non-invasive and invasive mechanical ventilation, and other clinical outcomes (all P < 0.05). The ROC of CONUT for mortality had an area under the curve (AUC) and 95% confidence interval of 0.711 (0.676–0746).

Conclusion:
The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patients.
Short-term Exposure to Air Pollution and Attributable Risk of Kidney Diseases
Authors: Lee Whanhee , Prifti Kristi , Kim Ho , Kim Ejin , Yang Juyeon , Min Jieun , Park Jae Yoon , Kim Yong Chul , Lee Jung Pyo , Bell Michelle L. 
Published: October 2021

Background:
Several studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency room (ER) burden. This study aimed to estimate excess ER visits attributable to short-term air pollution and to provide evidence relevant to air pollution standards to protect kidney patients.

Methods:
We conducted time-series analysis using National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter ≤10 µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney and urinary system disease, acute kidney injury (AKI), and chronic kidney disease (CKD). We performed a two-stage time-series analysis to estimate excess ER visits attributable to air pollution by first calculating estimates for each of 16 regions, and then generating an overall estimate.

Results:
For all kidney and urinary disease (902,043 cases), excess ER visits attributable to air pollution existed for all pollutants studied. For AKI (76,330 cases), we estimated the highest impact on excess ER visits from O3, while for CKD (210,929 cases), the impacts of CO and SO2 were the highest. The associations between air pollution and kidney ER visits existed for days with air pollution concentrations below current World Health Organization guidelines.

Conclusion:
This study provides quantitative estimates of ER burdens attributable to air pollution. Results are consistent with the hypothesis that stricter air quality standards benefit kidney patients.
Can Ensemble Machine Learning Improve the Accuracy of Severe Maternal Morbidity Screening in a Perinatal Database?
Authors: Cartus Abigail R. , Naimi Ashley I. , Himes Katherine P. , Jarlenski Marian , Parisi Sara M. , Bodnar Lisa M. 
Published: October 2021

Background:
Severe maternal morbidity (SMM) is an important maternal health indicator, but existing tools to identify SMM have substantial limitations. Our objective was to retrospectively identify true SMM status using ensemble machine learning in a hospital database and to compare machine learning algorithm performance with existing tools for SMM identification.

Methods:
We screened all deliveries occurring at Magee-Womens Hospital, Pittsburgh, PA (2010–2011 and 2013–2017) using the Centers for Disease Control and Prevention list of diagnoses and procedures for SMM, intensive care unit admission, and/or prolonged postpartum length of stay. We performed a detailed medical record review to confirm case status. We trained ensemble machine learning (SuperLearner) algorithms, which “stack” predictions from multiple algorithms to obtain optimal predictions, on 171 SMM cases and 506 non-cases from 2010 to 2011, then evaluated the performance of these algorithms on 160 SMM cases and 337 non-cases from 2013 to 2017.

Results:
Some SuperLearner algorithms performed better than existing screening criteria in terms of positive predictive value (0.77 vs. 0.64, respectively) and balanced accuracy (0.99 vs. 0.86, respectively). However, they did not perform as well as the screening criteria in terms of true-positive detection rate (0.008 vs. 0.32, respectively) and performed similarly in terms of negative predictive value. The most important predictor variables were intensive care unit admission and prolonged postpartum length of stay.

Conclusions:
Ensemble machine learning did not globally improve the ascertainment of true SMM cases. Our results suggest that accurate identification of SMM likely will remain a challenge in the absence of a universal definition of SMM or national obstetric surveillance systems.
LENS CAPSULAR FLAP TRANSPLANTATION AS PRIMARY TREATMENT FOR CLOSURE OF LARGE MACULAR HOLES
Authors: Peng Jie , Chen Chunli , Zhang Lihua , Huang Yue , Zhang Hongtao , Zheng Yan , Ren Jianing , Zou Yihua , Zhang Xuerui , Zhao Peiquan 
Published: October 2021

Purpose:
To report the long-term outcomes of lens capsular flap transplantation (LCFT) as initial treatment for large macular holes (MHs).

Methods:
Thirteen consecutive eyes with large MHs who received LCFT as primary treatment were reviewed retrospectively. All enrolled eyes underwent standard 23-gauge vitrectomy, internal limiting membrane peeling, LCFT, and 15% perfluoropropane tamponade. Autologous whole blood was applied in selected eyes to make the LCT intact. A face-down position maintained for 2 weeks postoperatively. Data including demographic information, medical history, anatomical and functional outcomes, and complications were recorded.

Results:
The mean preoperative MHs diameter was 979.42 ± 388.28 µm. Eight eyes received autologous LCFT, and the other five eyes received allogenic LCFT. Whole blood was applied in seven eyes. The mean follow-up duration was 19.57 ± 6.24 months (range: 12.0–32.2 months). The macular hole was successfully closed in all cases (13/13). The median best-corrected visual acuity improved from 1.76 (interquartile range, 1.23–1.91) logarithm of the minimum angle of resolution (median Snellen acuity: 20/1,150) preoperatively to 1.16 ± 0.47 logarithm of the minimum angle of resolution (mean Snellen acuity: 20/290) (P < 0.01) at the last visit. No severe complications were noted.

Conclusion:
Lens capsular flap transplantation may help to improve the closure rate and visual outcomes in large MHs, which could be an alternative method as primary treatment for large MHs.
Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children
Authors: Quinn Helen E. , Comeau Jeannette L. , Marshall Helen S. , Elliott Elizabeth J. , Crawford Nigel W. , Blyth Christopher C. , Kynaston Jennifer A. , Snelling Tom L. , Richmond Peter C. , Francis Joshua R. , Macartney Kristine K. , McIntyre Peter B. , Wood Nicholas J. 
Published: October 2021

Background:
Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization.

Methods:
Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group.

Results:
Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1–96.7). Across all years (2012–2019), of 55 cases 4–11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities.

Conclusions:
Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.
Surfing Performance in Para Surfers with Lower-Limb Amputations: A Cross-Sectional Study
Authors: Johnson Maureen E. , David Heather M. , Ganesan Mohan 
Published: October 2021

ABSTRACT

Introduction
This study investigated surfing performance in surfers with transfemoral amputations (TFAs) and transtibial amputations (TTAs) who participated in international para surfing competitions. The purpose of this research was to compare surfers with lower-limb amputations with judged wave scores and surfing experience for para surfing classification efficacy.

Materials and Methods
Collected archived data (n = 20) from classification records included demographics, residual limb lengths, surfing experiences, and judged wave scores. Continuous variables age (years), residual leg length (cm), remaining leg length (%), prior surfing experience (years), and duration of competing experience (years) were analyzed using independent sample t-test. Ordinal variables surfing performance scores of 2019 and 2020 between the groups were compared using Mann-Whitney U test. Spearman ρ correlation coefficient was used to determine the association between the duration of prior surfing experience and duration of competition experience with the surfing score in both groups.

Results
Surfers with TFA with longer residual limb lengths (n = 3) and surfers with TTA (n = 14) surfed with a prosthetic leg standing. Surfers with TFA with shorter residual limb lengths (n = 3) surfed without a prosthesis kneeling. We found that para surfers who stood or kneeled with TFA performed significantly better than para surfers with TTA, reflected through judged wave scores in 2019 (P = 0.028) and 2020 (P = 0.019). No statistically significant relationship existed between para surfers with TFA who kneeled or stood. No statistically significant relationship existed between years of para surfing and judged wave scores.

Conclusions
Surfers with TFA who stood or kneeled received higher judged wave scores than surfers with TTA; however, no other significant significance was found for TFA intragroup comparisons or prior surf experience. The data size was too small for confirmatory analysis. Results appeal to a new need for inquiry on para surfers with TFA and TTA, specifically biomechanical performance surfing differences.

Clinical Relevance
Individuals with transfemoral and/or transtibial amputations can participate competitively in para surfing contests. Surfers with TFAs can successfully compete either standing with a prosthesis or kneeling without a prosthesis.
Endoscopic Transcanal and Transmastoid Laser-Assisted Resection of Middle Ear Capillary Hemangioma
Authors: Patel Evan J. , Deep Nicholas L. , Liu Cheng Z. , Jethanamest Daniel 
Published: October 2021

Objective:
To present a rare case of a middle ear capillary hemangioma in an adult.

Patient:
A 31-year-old woman with a 6-month history of left ear fullness, pressure, tinnitus, and progressive hearing loss.

Intervention:
Endoscopic laser-assisted resection.

Main Outcome Measures:
Clinical, radiographic, and histopathological findings of a capillary hemangioma.

Results:
Otoscopy revealed an erythematous and slightly pulsating multilobulated middle ear retrotympanic mass. Her audiogram demonstrated a left-sided mixed hearing loss with air-conduction thresholds in the severe-to-profound range. Computed tomography (CT) imaging was significant for total opacification of the left middle ear and mastoid air cells. She underwent a combined endoscopic transcanal and transmastoid excision of the mass with ossicular chain reconstruction. A KTP laser was used to ablate and shrink down the periphery of the lesion. Pathology of the specimen was consistent with a capillary hemangioma. The patient's pulsatile tinnitus and spontaneous vertigo resolved postoperatively.

Conclusions:
Capillary hemangiomas are an uncommon cause of vascular middle ear lesions in adults and typically present with symptoms of aural fullness, pulsatile tinnitus, conductive hearing loss, otalgia, and vertigo. Surgery resection provides definitive treatment and the use of laser ablation techniques can allow for hemostasis and excellent visualization.
Associations of CB1 cannabinoid receptor (CNR1) gene polymorphisms with risk for alcohol dependence
Authors: Pabalan Noel , Chaweeborisuit Phanthip , Tharabenjasin Phuntila , Tasanarong Adis , Jarjanazi Hamdi , Eiamsitrakoon Thanee , Tapanadechopone Pairath 
Published: October 2021

Abstract

Objectives:
Reported associations of the cannabinoid receptor 1 (CNR1) single nucleotide polymorphisms (SNPs) with alcohol dependence (AD) have been inconsistent, prompting a meta-analysis to obtain more precise estimates.

Methods:
A Boolean search of 4 databases (PubMed, Scopus, Google Scholar, and Mednar) sought articles that evaluated the association between CNR1 polymorphisms and risk of AD. We selected the articles with sufficient genotype frequency data to enable calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Using the Population Intervention Comparators Outcome elements, AD patients (P) were compared by genotype data between AD-participants (I) and non-AD-participants (C) in order to determine the risk of AD (O) attributed to the CNR1 SNPs. Analyzing 4 SNPs (rs1049353, rs1535255, rs2023239, and rs806379) using standard genetic models, we examined associations where multiple comparisons were Holm–Bonferroni corrected. The pooled ORs were assessed for aggregate statistical power and robustness (sensitivity analysis). Subgroups were Caucasians and African-Americans.

Results:
From 32 comparisons, 14 were significant indicating increased risk, from which 5 outcomes (P-value for association [P
a] = .003 to <.001) survived the Holm–Bonferroni-correction, which were deemed robust. In the rs1535255 outcomes, the codominant effect (OR = 1.43, 95% CIs = 1.24–1.65, P
a < .001) had greater statistical power than the dominant effect (OR = 1.30, 95% CI = 1.08–1.57, P
a = .006). In contrast, the rs2023239 codominant outcome was underpowered. Significance of both rs806379 Caucasian outcomes (ORs = 1.20–1.43, 95% CIs = 1.07–1.57, P
a = .003) contrasted with the null effects in African-Americans (ORs = 0.98–1.08, 95% CIs = 0.70–1.53).

Conclusions:
Three CNR1 SNPs (rs1535255, rs2023239, and rs806379) were implicated in their associations with development of AD: based on aggregate statistical power, rs1535255 presented greater evidence for associations than rs2023239; rs806379 implicated the Caucasian subgroup. Multiple statistical and meta-analytical features (consistency, robustness, and high significance) underpinned the strengths of these outcomes. Our findings could render the CNR1 polymorphisms useful in the clinical genetics of AD.
Ginseng adjuvant therapy on COVID-19
Authors: Shi Hang , Xia Yawen , Gu Renjun , Yu Shuang 
Published: October 2021

Abstract

Background:
Corona virus disease 2019 (COVID-19) is spreading fast and it brings great pressure to the social economy. Many reports revealed that ginseng can develop immunity for respiratory disease, but there is no evidence to prove its effects on COVID-19. This protocol of systematic review and meta-analysis will clarify the safety and effectiveness of ginseng adjuvant therapy on COVID-19 patients.

Methods:
Different databases (Web of Science, Cochrane Library, PubMed, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, Wan fang Database, ClinicalTrials, World Health Organization Trials, and Chinese Clinical Trial Registry) will be retrieved to search related articles according to pre-defined inclusion and exclusion criteria. Clinical recovery time and effective rates will be assessed as the primary outcomes and any changes of patient's condition will be considered as the secondary outcomes. Subgroup analysis and sensitivity analysis will be conducted to explore sources of heterogeneity. Endnote X9.3 will be used to manage data screening. The statistical analysis will be completed by RevMan5.3 and Stata/SE 15.1 software.

Results:
This study will assess the effects and safety for ginseng adjuvant therapy on COVID-19 patients.

Conclusion:
The discussion will be considered to determine whether sufficient evidence exists to prove the effects of ginseng adjuvant therapy for COVID-19 patients.

Systematic review registration:
PROSPERO (ID: CRD42021277843)
Spinal cord ischemia following open surgery of a ruptured isolated internal iliac artery aneurysm
Authors: Akabane Kentaro , Uchida Tetsuro , Umetsu Rieko , Hirooka Shuto , Kim Cholus , Uchino Hideaki , Shimanuki Takao 
Published: October 2021

Abstract

Introduction:
Isolated internal iliac artery (IIA) aneurysms (IIIAAs) rarely occur. However, they may enlarge asymptomatically and rupture, causing fatality. Even after successful surgery of ruptured IIIAAs, there might be a potential risk of postoperative spinal cord ischemia (SCI)-related paraplegia, which is extremely rare. However, this paraplegia significantly impacts patients’ activities of daily living.

Patient concerns:
A 71-year-old man who had no remarkable medical history was referred to our hospital with sudden lower abdominal pain.

Diagnosis:
Computed tomography (CT) revealed right IIIAA with small volumes of contrast medium extravasation and hematoma. He presented with cyanosis in the bilateral lower limbs. Moreover, blood gas analysis showed lactic acidosis. Therefore, he was diagnosed with ruptured IIIAA complicated by peripheral circulatory failure.

Interventions:
Considering his pre-shock status, an emergency operation comprising ligation of the proximal neck and suture closure of the distal IIA orifice was successfully performed.

Outcomes:
Immediately after surgery, motor and sensory dysfunction in the bilateral lower limbs occurred. Magnetic resonance imaging confirmed the presence of SCI. The patient could not stand independently and had neurogenic bladder and rectal disorder.

Conclusion:
Postoperative SCI is a serious complication with no definitive predictors, preventive methods, or highly efficacious treatments. Therefore, vascular surgeons should preempt its occurrence and focus on preventing hemodynamic instability and maintain collateral extra-segmental arterial blood flow, especially in ruptured cases.