bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient Changes in Preexposure Prophylaxis Use and Daily Sexual Behavior After the Implementation of COVID-19 Restrictions Among Men Who Have Sex With Men
Authors: Jongen Vita W. , Zimmermann Hanne M. L. , Boyd Anders , Hoornenborg Elske , van den Elshout Mark A. M. , Davidovich Udi , van Duijnhoven Yvonne T. H. P. , de Vries Henry J C. , Prins Maria , Schim van der Loeff Maarten F. , Coyer Liza ,   on behalf of the Amsterdam PrEP Project team in the HIV Transmission Elimination Amsterdam Initiative
Published: July 2021

Background:
We assessed how the Dutch restrictions imposed on March 15, 2020, affected sexual behavior, preexposure prophylaxis (PrEP), and condom use among PrEP users in Amsterdam.

Methods:
We used data on (1) PrEP use, (2) anal sex acts, and (3) condom use, per partner type [steady partners (SPs), known casual partners (KCPs), and unknown casual partners (UCPs)], collected daily through a mobile application used between December 1, 2019, and June 30, 2020. We compared the period before versus after March 15, 2020, regarding average proportion of days per week at which each end point was reported and average proportion of anal sex acts covered by PrEP and/or condoms.

Results:
We included data from 136 men who have sex with men. After March 15, 2020, the proportion of days with anal sex increased with SPs [odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.10 to 1.44) and decreased with KCPs (OR = 0.73; 95% CI = 0.64 to 0.82) and UCPs (OR = 0.54; 95% CI = 0.48 to 0.61). Shifts in partner types were most profound immediately after March 15, 2020, whereas returning to prerestriction levels mid-May 2020. The proportion of days with PrEP use decreased from 74% before to 58% after March 15, 2020 (P < 0.001). After March 15, 2020, PrEP use during sex decreased with UCPs (β = −0.36; 95% CI = −0.72 to 0.00) but not with SPs and KCPs. Condom use during sex decreased with KCPs (β = −0.36; 95% CI = −0.67 to 0.04) and UCPs (β = −0.24; 95% CI = −0.46 to 0.03) but not with SPs.

Conclusions:
MSM decreased sex with casual partners and increased sex with SP, but changes were transient. Decreases in sex acts with casual partners paralleled decreases in PrEP use. However, condom use during sex with casual partners decreased, indicating the importance of continued sexual health services, including sexually transmitted infections screening and PrEP care, during COVID-19 restrictions.
A Systematic Review Comparing Outcomes of Local Flap Options for Reconstruction of Pressure Sores
Authors: Vathulya Madhubari , Praveen A.J. , Barik Sitanshu , Jagtap Manish Pradip , Kandwal Pankaj 
Published: July 2021

Introduction
Pressure sores are agonizing complications of chronically bedridden patients. The management of these lesions particularly with respect to grades III and IV lesions are chiefly surgical and involves a multidisciplinary approach. Although there are a variety of local flap options, like fasciocutaneous flaps, musculocutaneous flaps, perforator flaps, and combinations of these to choose from, there is a paucity of literature regarding which flap is better among these in terms of complication and recurrence rates.

Methods
The databases searched were as follows: Cochrane Central Register of Controlled trials (January 2000 to July 2020), MEDLINE (January 2000 to July 2020), and EMBASE (January 2000 to August of 2020). Key words used were “pressure ulcer,” “flaps,” “surgery,” “pressure sore” with limits, “human,” and “English.” Primary outcomes were “overall complication rates” and “recurrence rates.” Overall complication was further categorized as flap necrosis, flap dehiscence, infection, and others.

Results
Thirty-nine articles were included in the final analysis. There was a statistically significant difference among the various types of flaps for overall complication, flap dehiscence, infection, flap necrosis, and recurrence rates.

Conclusions
Our study indicates that musculocutaneous flaps have lower recurrence rates, and combined flaps have lower complication rates. However, various other factors, like donor site morbidity, initial defect size, operating time, intraoperative blood loss, salvage options in case of recurrence, should also be considered while choosing a flap to reconstruct a defect.
Chemoradiation and Local Excision Versus Total Mesorectal Excision for T2N0 Rectal Cancer
Authors: Lynn Patricio B. , Van der Valk Maxime J.M. , Claassen Yvette H.M. , Shi Qian , Widmar Maria , Bastiaannet Ester , Van de Velde Cornelis J.H. , Garcia-Aguilar Julio 
Published: July 2021

Objective:
Compare oncological long-term and short-term outcomes between patients with distal cT2NO rectal cancer treated with chemoradio-therapy and local excision (CRT + LE) and patients treated with total mesorectal excision (TME).

Summary Background Data:
Previous studies showed that CRT + LE is equivalent to TME in local tumor control and survival for T2N0 rectal cancer.

Methods:
Seventy-nine patients with cT2N0 rectal adenocarcinoma treated with CRT + LE in the ACOSOG Z6041 trial were compared to a cohort of 79 patients with pT2N0 tumors treated with upfront TME in the Dutch TME trial. Survival, short-term outcomes, and health-related quality of life (HRQOL) were compared between groups.

Results:
Three patients (4%) in the CRT + LE group required abdominoperineal resection, compared with 31 (40%) in the TME group. Forty TME patients (51%) required a permanent stoma. CRT-related toxicity occurred in 43% of the CRT + LE patients; however, TME patients had a higher rate of complications requiring reoperation (1 vs 9%; P = 0.03). Five-year disease-free survival {88.2% [confidence interval (CI), 77.7%–93.9%] vs 88.3% [CI, 78.7%–93.7%]; P = 0.88} and overall survival [90.3% (CI, 80.8%–95.3%) vs 88.4% (CI, 78.9%–93.8%); P = 0.82] were similar in the 2 groups. Compared to baseline, overall HRQOL decreased in the CRT + LE group and improved in the TME group. In both groups, patients with sphincter preservation had worse HRQOL scores 1 year after surgery. Conclusions: In patients who underwent CRT + LE, oncological outcomes were similar to those of patients who underwent TME, with fewer complications requiring reoperation but significant CRT toxicity. Although overall HRQOL decreased in the CRT + LE group and improved in TME patients, when considering anorectal function, results were worse in both groups.
Developing a measure of overall intensity of injury care: A latent class analysis
Authors: Zebrowski Alexis M. , Hsu Jesse Y. , Holena Daniel N. , Wiebe Douglas J. , Carr Brendan G. 
Published: July 2021

BACKGROUND
While injury is a leading cause of death and debility in older adults, the relationship between intensity of care and trauma remains unknown. The focus of this analysis is to measure the overall intensity of care delivered to injured older adults during hospitalization.

METHODS
We used Centers for Medicare and Medicaid Services Medicare fee-for-service claims data (2013–2014), to identify emergency department–based claims for moderate and severe blunt trauma in age-eligible beneficiaries. Medical procedures associated with care intensity were identified using a modified Delphi method. A latent class model was estimated using the identified procedures, intensive care unit length of stay, demographics, and injury characteristics. Clinical phenotypes for each class were explored.

RESULTS
A total of 683,398 cases were classified as low- (73%), moderate- (23%), and high-intensity care (4%). Greater age and reduced injury severity were indicators of lower intensity, while males, non-Whites, and nonfall mechanisms were more common with high intensity. Intubation/mechanical ventilation was an indicator of high intensity and often occurred with at least one other procedure or an extended intensive care unit stay.

CONCLUSION
This work demonstrates that, although heterogeneous, care for blunt trauma can be evaluated using a single novel measure.

LEVEL OF EVIDENCE
For prognostic/epidemiological studies, level III.
Evaluation of hemostatic capacities among commando candidates: Would their blood suit a hemorrhagic war-injured patient in case of blood donation on the battlefield?
Authors: Daniel Yann , Conort Sébastien , Foricher Rachel , Hejl Carine , Travers Stéphane , Foissaud Vincent , Martinaud Christophe 
Published: July 2021

BACKGROUND
In case of a warm fresh whole blood transfusion on the battlefield, the blood donation usually occurs just after a combat phase and often after several days on the fields. To explore the hemostatic capacity of such blood, we analyzed the blood of volunteers attending the commando course of the French Navy, considering this course as an experimental model, placing them into the same physiological conditions as those faced by deployed fighters.

METHODS
Venous blood was collected at the beginning of the course, mimicking their baseline status, and a second time 6 weeks later, from the remaining candidates, during the actual commando training, mimicking the stress conditions. For each candidate, we observed the differences between the two blood samples.

RESULTS
Of the 112 men that attended the first day of the course, only 17 remained 6 weeks later. In the second blood samples, we noted significant increased leucocytes and platelets counts and significant decreased hematocrit and hemoglobin levels. Thrombin generation assays showed significantly lower normalized peak heights (−31%), lower normalized endogenous thrombin potential values (−29%), and lower velocity index (−35%). Normalized lag time and time to peak did not differ. Viscoelastometric testing revealed a significant increasing in clot firmness as assessed by maximum amplitude and amplitude at 6 minutes. The clot speed was significantly increased.

CONCLUSION
This work brings new data on coagulation during prolonged and considerable physical exercise. No obvious deleterious modification of hemostatic properties was observed. The decrease of the endogenous thrombin potentials may reflect a better ability to control the thrombin generation once started. Altogether, these results suggest that this blood could suit well a hemorrhagic war-injured patient.

LEVEL OF EVIDENCE
Prospective observational cohort study, Level III.
Novel Trauma Composite Score is superior to Injury Severity Score in predicting mortality across all ages
Authors: Keskey Robert C. , Slidell Mark B. , Bohr Nicole L. , Biermann Henry , Cirone Justin , Zakrison Tanya , Cone Jennifer , Wilson Kenneth , Hampton David 
Published: July 2021

BACKGROUND
Injury Severity Score (ISS) is a widely used metric for trauma research and center verification; however, it does not account for age-related physiologic parameters. We hypothesized that a novel age-based injury severity metric would better predict mortality.

METHODS
Adult patients (≥18 years) sustaining blunt trauma (BT) or penetrating trauma (PT) were abstracted from the 2010 to 2016 National Trauma Data Bank. Admission vitals, Glasgow Coma Scale, ISS, mechanism, and outcomes were analyzed. Patients with incomplete/non-physiologic vital signs were excluded. For each age: (1) a cut point analysis was used to determine the ISS with the highest specificity and sensitivity for predicting mortality and (2) a linear discriminant analysis was performed using ISS, ISS greater than 16, Trauma and Injury Severity Score, and Revised Trauma Scale to compare each scoring system’s mortality prediction. A novel injury severity metric, the trauma component score (TCS), was developed for each age using significant (p < 0.05) variables selected from Abbreviated Injury Scale scores, Glasgow Coma Scale, vital signs, and gender. Receiver operator curves were developed and the areas under the curve were compared between the TCS and other systems.

RESULTS
There 777,794 patients studied (BT, 91.1%; PT, 8.9%). Blunt trauma patients were older (53.6 ± 21.3 years vs. 34.4 ± 13.8 years), had higher ISS scores (11.1 ± 8.5 vs. 8.5 ± 8.9), and lower mortality (2.9% vs. 3.4%) than PT patients (p < 0.05). When assessing the entire PT and BT cohort the optimal ISS cut point was 16. The optimal ISS was between 20 and 25 for BT younger than 70 years. For those older than 70 years, the optimal BT ISS steadily declined as age increased PT’s cut point was 16 or less for all ages assessed. When the injury metrics were compared by area under the curve, our novel TCS more accurately predicted mortality across all ages in both BT and PT (p < 0.001).

CONCLUSION
Injury Severity Score is a poor mortality predictor in older patients and those sustaining penetrating trauma. The age-based TCS is a superior metric for mortality prediction across all ages.

LEVEL OF EVIDENCE
Clinical outcomes, Level IV.
Firearm violence against children in the United States: Trends in the wake of the COVID-19 pandemic
Authors: Donnelly Megan R. , Grigorian Areg , Swentek Lourdes , Arora Jagmeet , Kuza Catherine M. , Inaba Kenji , Kim Dennis , Lekawa Michael , Nahmias Jeffry 
Published: July 2021

BACKGROUND
This study aimed to evaluate the patterns of firearm violence against children before and after the COVID-19 pandemic, as well as the patterns of specific types of firearm violence against children over time (2016–2020).

METHODS
Retrospective firearm violence data were obtained from the Gun Violence Archive. The rate of firearm violence was weighted per 100,000 children. A scatterplot was created to depict the rate of total annual child-involved shooting incidents over time; with a linear trendline fit to 2016 to 2019 data to show projected versus actual 2020 firearm violence. All 50 states were categorized into either “strong gun law” (n = 25) or “weak gun law” (n = 25) cohorts. Multivariate linear regressions were performed for number of child-involved shootings over time.

RESULTS
There were a total of 1,076 child-involved shootings in 2020, 811 in 2019, and 803 in 2018. The median total child-involved shooting incidents per month per 100,000 children increased from 2018 to 2020 (0.095 vs. 0.124, p = 0.003) and from 2019 to 2020 (0.097 vs. 0.124, p = 0.010). Child killed by adult incidents also increased in 2020 compared with 2018 (p = 0.024) and 2019 (p = 0.049). The scatterplot demonstrates that total child-involved shootings in addition to both fatal and nonfatal firearm violence incidents exceeded the projected number of incidents extrapolated from 2016 to 2019 data. Multivariate linear regression demonstrated that, compared with weak gun law states, strong gun law states were associated with decreased monthly total child-involved shooting incidents between 2018 and 2020 (p < 0.001), as well as between 2019 and 2020 (p < 0.001).

CONCLUSION
Child-involved shooting incidents increased significantly in 2020 surrounding the COVID-19 pandemic. Given that gun law strength was associated with a decreased rate of monthly child-involved firearm violence, public health and legislative efforts should be made to protect this vulnerable population from exposure to firearms.

LEVEL OF EVIDENCE
Epidemiological, level III.
Quantifying contribution of Lipoprotein (a) to atherogenic lipoprotein burden – a novel particle-based approach
Authors: Chilazi Michael , Zheng Weili , Park Jihwan , Marvel Francoise A. , Khoury Shireen , Jones Steven R. , Martin Seth S. 
Published: July 2021

AbstractBackgroundElevated lipoprotein (a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). As clinical LDL cholesterol [LDL-C] incorporates cholesterol from Lp(a) [Lp(a)-C], there is interest in quantifying the contribution of Lp(a)-C to LDL-C given implications for risk assessment, diagnosis, and treatment. Estimating Lp(a)-C is subject to inaccuracies; measuring Lp(a) particle number [Lp(a)-P] is more accurate.ObjectiveTo capture how Lp(a) contributes to the atherogenic lipoprotein burden, we demonstrate a particle-based approach using readily available measures of Lp(a)-P and apolipoprotein B (apoB).MethodsUsing the Very Large Database of Lipids (VLDbL), we compared Lp(a)-P (nmol/L) with all atherogenic particles (“non-HDL-P”). Non-HDL-P was calculated by converting apoB mass to molar concentration using the preserved molecular weight of apoB100 (512 kg/mol). We calculated the percentage of Lp(a)-P relative to non-HDL-P by Lp(a)-P deciles and stratified across sex, age, triglycerides, LDL-C, and non-HDL-C.Results158,260 patients from the VLDbL were included. The fraction Lp(a)-P/non-HDL-P increased with rising Lp(a)-P. Lp(a)-P comprised on average 3% of atherogenic particles among the study population and 15% at the highest Lp(a)-P decile. Findings were similar when stratified by sex. When stratified by age, Lp(a)-P/non-HDL-P was highest among the youngest and oldest patients. Lp(a)-P/non-HDL-P decreased at higher levels of triglycerides and LDL-C owing to larger contributions from VLDL and LDL.ConclusionsWe demonstrate a particle-based approach to quantify the contribution of Lp(a) to total atherogenic particle burden using validated and widely available laboratory assays. Future research applying this method could define clinically meaningful thresholds and inform use in risk assessment and management.
COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis
Authors: Golinelli Davide , Lenzi Jacopo , Adorno Emanuele , Gianino Maria Michela , Fantini Maria Pia 
Published: July 2021

AbstractBackgroundIt is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID-19 pandemic on the quality of care provided by healthcare systems to non-COVID-19 patients. The aim of this study is to assess the impact of the COVID-19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, 2 large regions of northern Italy severely hit by the pandemic.MethodsWe calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (≈6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no “intervention” (lockdown) in the middle of the observation period.ResultsBefore the lockdown, 2-day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (−0.1%) and 69.3% (− 9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significantly decline at a weekly rate of –1.29% (95% CI = –1.71 to –0.88).Divergent trend patterns in the 2 study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness.
Justification, safety, and efficacy of a third dose of mRNA vaccine in maintenance hemodialysis patients: a prospective observational study
Authors: Espi Maxime , Charmetant Xavier , Barba Thomas , Pelletier Caroline , Koppe Laetitia , Chalencon Elodie , Kalbacher Emilie , Mathias Virginie , Ovize Anne , Cart-Tanneur Emmanuelle , Bouz Christine , Pellegrina Laurence , Morelon Emmanuel , Juillard Laurent , Fouque Denis , Couchoud Cécile , Thaunat Olivier 
Published: July 2021

AbstractBackgroundPatients on maintenance hemodialysis (MHD) are at high risk of infection with SARS-Cov-2 and death due to COVID-19. This vulnerable population has been prioritized for vaccination, but the level of protection achieved in these immunocompromised patients is unclear.ObjectivesTo evaluate the protection of MHD patients against COVID-19 after 2 doses (2D) of BNT162b2, and the safety and impact on immune responses of a 3rddose (3D).DesignProspective observational.Setting, Patients, intervention and measurementsREIN national registry was used to compare the severity of 1474 cases of COVID-19 diagnosed in MHD patients after 0, 1 or 2 doses of mRNA vaccine. Anti-spike receptor binding domain (RBD) IgG and interferon gamma-producing CD4+ and CD8+ specific-T cells were measured after 2D and 3D of BNT162b2 in a monocentric cohort of 75 MHD patients.ResultsVaccination reduced disease severity but 11% of MHD patients infected after 2D still died. Tolerance to 3D of BNT162b2 was excellent. MHD patients with humoral response similar to healthy volunteers after 2D did not generate more immune effectors after 3D and had more side effects. In contrast, 2/3 of MHD patients with suboptimal response after 2D reached optimal titer of anti-RBD IgG and/or developed spike-specific CD8+ T cells after 3D. Presence of spike-specific CD4+ T cells after 2D was associated with response to 3D in multivariate analysis (OR=4.80 [1.23−21.54]; p=0.029).LimitationsLimited number of patients injected with 3D.ConclusionStandard scheme of vaccination provides insufficient protection to some MHD patients. Anti-RBD IgG and specific CD4+ T cells should be measured after 2D. Among patients with suboptimal humoral response, those with specific CD4+ T cells could benefit of a 3rddose of vaccine.RegistrationNCT04881396Funding SourceNone
The accuracy of Japanese administrative data in identifying acute exacerbation of idiopathic pulmonary fibrosis
Authors: Anan Keisuke , Kataoka Yuki , Ichikado Kazuya , Kawamura Kodai , Johkoh Takeshi , Fujimoto Kiminori , Tobino Kazunori , Tachikawa Ryo , Ito Hiroyuki , Nakamura Takahito , Kishaba Tomoo , Inomata Minoru , Yamamoto Yosuke 
Published: July 2021

AbstractBackgroundThis study aimed to develop criteria for identifying patients with acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) from Japanese administrative data and validate the pre-existing criteria.MethodsThis retrospective, multi-center validation study was conducted at eight institutes in Japan to verify the diagnostic accuracy of the disease name for AE-IPF. We used the Japanese Diagnosis Procedure Combination data to identify patients with a disease name that could meet the diagnostic criteria for AE-IPF, who were admitted to the eight institutes from January 2016 to February 2019. As a reference standard, two respiratory physicians performed a chart review to determine whether the patients had a disease that met the diagnostic criteria for AE-IPF. Furthermore, two radiologists interpreted the chest computed tomography findings of cases considered AE-IPF and confirmed the diagnosis. We calculated the positive predictive value (PPV) for each disease name and its combination.ResultsWe included 830 patients; among them, 216 were diagnosed with AE-IPF through the chart review. We combined the groups of disease names and yielded two criteria: the criteria with the highest PPV (0.72 [95% confidence interval 0.62 to 0.81]) and that with a slightly less PPV (0.61 [0.53 to 0.68]) but more true positives. Pre-existing criteria showed a PPV of 0.40 (0.31 to 0.49).ConclusionThe criteria derived in this study for identifying AE-IPF from Japanese administrative data show a fair PPV. Although these criteria should be carefully interpreted according to the target population, our findings could be utilized in future database studies on AE-IPF.