bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prehospital Triage Tools across the World: A Scoping Review of the Published Literature
Authors: Bhaumik Smitha , Hannun Merhej , Dymond Chelsea , DeSanto Kristen , Barrett Whitney , Wallis Lee A , Mould-Millman Nee-Kofi 
Published: January 2021

Abstract
BackgroundAccurate triage of the undifferentiated patient is a critical task in prehospital emergency care. This scoping review aims to identify published tools used for prehospital triage across the world and describe their performance characteristics.MethodsA comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. ResultsOf 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n=19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies, and resulting articles, were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. The general triage tools aggregated prehospital vital signs, mental status assessments, and sometimes, features of the history, exam, and anticipated resource need, to categorize patients into numerical or color categories to represent level of acuity. The studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. The stroke triage tools were designed to promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Stroke triage literature evaluates tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools sought to identify patients that require immediate transport to trauma centers with emergency surgery capability. The studies on trauma triage evaluate prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge.ConclusionsThe published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools, without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial RegistrationNot applicable.
The Transition From Minimal Change Disease to Focal and Segmental Glomerulosclerosis in a Patient With Nephrotic Syndrome: a Case Report
Authors: Tang Long , Cai Zhen , Meng Yuan , Zhao Wen-jing , Wang Su-Xia 
Published: January 2021

Abstract
Background:Although minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) have been described as two separate forms of nephrotic syndrome(NS), they are not completely independent. We report a patient presenting a transition from MCD to FSGS, review the literature and explore the relationship between the two diseases.Case presentation:A 42-year-old male welder, Asian, presenting lower extremity edema and elevated serum creatinine, had laboratory exams indicating NS and end-stage renal disease(ESRD). The patient had a kidney biopsy 20 years earlier for NS, which indicated MCD, and this repeated kidney biopsy suggested FSGS. After treatment follow-up, the patient was eventually admitted to renal replacement therapy. Conclusions:MCD and FSGS may be different stages of the same disease. The transition from MCD to FSGS in this case indicates the progression of the disease, which may be related to the excessive metal caused by occupation.
Soluble CD14 and Th 17-Related Interleukins in Bronchoalveolar Lavage Fluid are Potential Triage Biomarkers for Pulmonary Tuberculosis
Authors: Liu Jian , Li Ling Ling , Dong Wen Xiao , Liu Qiao Dan , Hong Zhong Si , Peng Xiao Mou 
Published: January 2021

Abstract
Background: Soluble CD14 (sCD14) and T helper 17-related interleukins (IL-17 and IL-22) in bronchoalveolar lavage fluid (BALF) are preliminarily reported to be increased in pulmonary tuberculosis (PTB). Their significances to the bacteriological confirmation and activity differentiation of PTB, however, are not completely clarified. Methods: A observational study was conducted in 154 consecutive adult patients who were primarily diagnosed with PTB based on radiographic abnormalities. Bacteriological confirmation was made using sputum/BALF smearing, TB-DNA, Xpert test and Mycobacterium tuberculosis (Mtb) culture. BALF and serum sCD14, IL-17 and IL-22 were measured using ELISA assays. Their associations with clinical/bacteriological characteristics were analyzed. Results: Finally, 103, 16, 7 and 28 patients were diagnosed with active, inactive, gray zone and non-PTB, respectively. Among active PTB patients, 82 (79.6%) cases, 33 (32.0%) based on sputum and additional 49 (47.6%) depended on BALF were bacteriologically confirmed. BALF levels of sCD14, IL-17 and IL-22 were similar between patients with PTB and non-PTB, but significantly higher in active PTB and bacteriologically-confirmed patients. The BALF levels of these biomarkers to some extent predicted bacteriological confirmation failure (AUC of IL-22 = 0.866), nonresponders to empiric antibacterial therapy, Xpert test (AUC of IL-22 = 0.760) and Mtb cultures. When the sensitivities were set at ³ 90% (WHO's minimal requirement for a triage test), the specificities of bacteriological confirmation failure prediction and empiric antibacterial therapy nonresponder prediction in interferon-g release assay-positive patients were about 67%, very close to the WHO's minimal requirement (³ 70%) for a triage test. In addition, serum levels of sCD14, IL-17 and IL-22 were relatively lower and had no predictive values. Conclusions: BALF levels of sCD14, IL-17 and IL-22, superior to their serum levels, are potential triage biomarkers and may be used to replace the expensive Xpert test in particular occasions or refer proper patients to conduct lung biopsy and expensive molecular tests in the first week or to start nondelayed anti-TB therapy bypassing empiric antibacterial therapy and time-consuming Mtb culture.
Incidence and Prognostic Significance of Liver Metastases for Newly Diagnosed Ovarian Cancer in Relation to Subtypes
Authors: Zhu Ying , Zhang Yifang , Zhai Lingyun , Zhang Zhigang , Zhou Jianwei 
Published: January 2021

Abstract
Background: Ovarian cancer is a heterogeneous and aggressive malignant tumor, and the liver is one of the most common metastases target visceral organs of ovarian cancer. We aim to analysis the incidence and prognostic relevance of histological subtypes for patients with liver metastases in newly diagnosed ovarian cancer.
Methods: In the Surveillance, Epidemiology, and End Results (SEER) database, we identified the ovarian cancer patients from 2010 to 2016. Multivariable logistic regression was used to determine whether histological types were associated with the presence of liver metastases at diagnosis. The Kaplan-Meier method and multivariable Cox regression was performed to identify covariates associated with survival using the histological types.
Results: Among 25293 ovarian cancer patients, 1749 cases presented with liver metastases. The incidence proportions were highest among ovarian carcinosarcoma patients (OR=17.76, 95% CI=9.26-34.09), and liver metastasis specificity was the highest in the clear cell type (70.69% of the metastatic subset). The median cancer-specific survival (CSS) for non-metastatic ovarian cancer patients was 77 months, but the ovarian cancer with only liver metastasis was 21 months. The mucinous (5 months; vs nonepithelial subtype, HR=0.26; 95% CI, 0.14-0.49) subtype experienced the shortest median survival among all histologic types.
Conclusion: This population-based study provides that liver was one of the most common distant visceral organs for ovarian cancer metastasis, and the incidence proportions of liver metastasis were highest for carcinosarcomas subtype, and the mucinous ovarian cancer with liver metastasis being associated with the poorest survival.
“A Modified Anterolateral Swashbuckler Approach for Distal Femoral Fractures: Description and Outcomes”
Authors: Ghirardelli Stefano , TOULOUPAKIS GEORGIOS , THEODORAKIS EMMANOUIL , Antonini Guido , Violante Bruno , Indelli Pier Francesco 
Published: January 2021

Abstract
Background: The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety a new surgical technique to address distal femoral fractures. Methods: The original "swashbuckler" surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with a Müller AO 33 distal femur or periprosthetic fracture of the knee. The final outcome was recorded according to a functional evaluation scoring system.Results: Twelve patients (2 males and 10 females) with a mean age of 67,8 years (min. 18; max 90 years) were included in this series. The same, modified "swashbuckler" surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients regained their level of activities of daily living. No major intraoperative or postoperative complications were recorded. Conclusions: The modified swashbuckler approach allows anatomical reduction and appropriate fixation with minimal severance of the blood supply to the patella and ensures rapid weight bearing resumption thanks to an intact extensor mechanism.
Up-regulated Vitamin D Receptor by Pelargonium Sidoides Extract EPs® 7630 Contributes to Rhinovirus Defence in Bronchial Epithelial Cells
Authors: Roth Michael , Sun Qingzhu , Tamm Michael 
Published: January 2021

Abstract
Background: The Pelargonium sidoides herbal drug preparation EPs®7630 reduces the severity of viral upper respiratory tract infections. Vitamin D a secosteroid also improves anti-viral host defence. The anti-viral effect of both compounds was linked to similar signalling pathways in immune and epithelial cells. This study assessed if EPs®7630 modifies vitamin D receptor (VDR) expression by human bronchial epithelial cells. Methods: Bronchial epithelial cells were incubated with EPs®7630 over 48 hours before calcitriol stimulation and/or infection with Rhinovirus (RV)-16. The VDR expression and regulation was determined by Western-blotting. Intracellular signalling was studied by inhibition of mitogen activated protein kinases; Erk1/2, p38, and JNK. The anti-viral effect was assessed by immunofluorescence for RV-16 protein.Results: Treatment with EPs®7630 up-regulated the expression of the VDR through activation of Erk1/2 and thereby increased the cells sensitivity to calcitriol, reflected as the increased shift of the VDR from the cytosol into the nucleus. Compared to cells not pre-treated with EPs®7630 this VDR shift occurred at a 5.3 times lower calcitriol concentration. EPs®7630 increased Erk1/2 MAPK dependent signalling, but reduced the phosphorylation of p38. It had not effect on the activation and expression of JNK. EPs®7630 pre-treatment improved the anti-viral effect of vitamin D on RV-16 infection by 2.1 folds compared to vitamin D alone or to untreated cells. Furthermore, EPs®7630 improved the differentiation of epithelial cells by upregulating E-cadherin expression through Erk1/2.Conclusions: The results suggest that EPs®7630 increases host defence against rhinovirus infection by upregulating the VDR and thus increasing the response of epithelial cells to vitamin D.
Unilateral Transforaminal Approach (UTFA) in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Novel Puncture Technique
Authors: yefeng wang , suoyuan Li , xiaoqiang Cai , jun Shen , tianming Zou 
Published: January 2021

Abstract
Background: Percutaneous vertebroplasty (PVP) via various puncture approaches was an effective minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). In recent years, unilateral puncture techniques had been increasingly used with advantages of shorter operation time, lower X-ray exposure. The aim of this study was to explore the safety and efficacy of the unilateral transforaminal approach (UTFA) in PVP for the treatment of OVCFs. Methods: A retrospective study was designed to review 155 cases of single-level OVCFs from July 2018 to December 2019. We treated 77 patients with PVP via the UTFA and 78 via the bilateral transpedicular approach (BTPA). Operation time, number of intraoperative fluoroscopic X-rays, volume of bone cement injection and distribution of bone cement were recorded. We used Visual Analog Scale (VAS) score and Oswestry disability index (ODI) presurgery and at 1 day, 3 months and last follow-up after surgery to assess clinical outcomes. Results: The operation was successfully completed in both groups, with no complications of neurovascular injuries or bone cement embolism. UTFA group had significantly shorter operation time and less-frequent fluoroscopy than BTPA group (P < 0.05). There were no significant differences between the two groups in volume or distribution of injected bone cement (P > 0.05). Postoperative VAS scores and ODI of the two groups were significantly improved over their presurgical values (P < 0.05), but there were no significant differences in VAS or ODI at each time point between the two groups (P > 0.05). Conclusions: Both unilateral transforaminal PVP and bilateral transpedicular PVP were safe and effective treatments for OVCFs, but the former approach had the advantages of shorter operation time and less X-ray radiation exposure and therefore is worthy of greater clinical application.
More Metalwork Removals of Olecranon Fractures After Tension Banding Wiring than Plate Fixation-A Propensity Score Matching Analysis
Authors: Li Yi , Qiu Longhai , Wu Hongbo , Chen Ruixiong , Zhang Zhiwen , Wang Xiaofeng , Huang Yuliang 
Published: January 2021

Abstract
Background: Traditional tension band wiring and plate fixation represent the most common methods for treating olecranon fractures. However, there is no agreement as to which method provides the best outcome. The aim of this retrospective study was to compare the outcomes of tension band wiring (TBW) and plate fixation (PF) for treating displaced olecranon fractures. This is the first study to use propensity score matching analysis to compare treatment methods for olecranon fracture.Method: A total of 107 patients aged between 18 and 85 years old had acute isolated and displaced olecranon fractures. The patients were divided into either TBW (n=49) or PF (n=58) groups. To conduct propensity score matching for the treatment method (TBW versus PF), 58 patients were analyzed by logistic regression (29 patients in each group). Various demographic and treatment-related variables were examined and analyzed to determine their correlation. Results: Functional effects between two groups are similar( in terms of Mayo Elbow Performance Score (MEPS), the patients’ range of elbow motion (ROM) and forearm rotation (RFR), the time return to work (RTW)). The total adverse events rate and metalwork removal events rate are higher in TBW than that in PF. After propensity score matching analysis, the similar primary treatment efficacy (indicated by excellent MEPS) and higher primary adverse events rate ( indicated by metalwork removal) were perceived in TBW than that in PF. Logistic regression analysis revealed that fracture type was an independent factor that affected the efficacy of a treatment (regression coefficient=-1.24<0, P=0.03), indicating that fracture severity was inversely proportional to the efficacy of a treatment for olecranon fracture. Furthermore, logistic regression analysis demonstrated that the treatment method was an independent factor that affected metalwork removal of olecranon fracture (regression coefficient 2.38 > 0, OR = 10.77, P < 0.01), indicating that the risk of metalwork removal in the TBW Group was 10.77 times that in the PF Group.Conclusion: The results indicated that plate fixation should be the first choice of treatment method for olecranon fractures, especially in younger patients with higher quality of life requirements.Trial regislation: The study was not registered in the clinical trial registration center, because it was a retrospective case-control study, which was an observational study with no intervention measures.Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study
CardiOvaScular Mechanisms In Covid-19: Methodology of a prospective observational multimodality imaging study (COSMIC-19 study)
Authors: Alam Shirjel , Shah Anoop , Onyinkwa Kevin , Nganga Edward , Gitau Samuel , Makhdomi Khalid , Chung Michael , Vinayak Sudhir 
Published: January 2021

Abstract
Background: 8-28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections.Methods: This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA & 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels. Discussion: The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic. TRIAL REGISTRATION: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at www.isrctn.com/ISRCTN12154994
Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis
Authors: Long Di , Mackenbach Johan , Martikainen Pekka , Lundberg Olle , Brønnum-Hansen Henrik , Bopp Matthias , Costa Giuseppe , Kovács Katalin , Leinsalu Mall , Rodríguez-Sanz Maica , Menvielle Gwenn , Nusselder Wilma 
Published: January 2021

Abstract
Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.
The derepression of transposable elements in lung cells is associated with the inflammatory response and gene activation in idiopathic pulmonary fibrosis
Authors: Rostami Mahboubeh R , Bradic Martina 
Published: January 2021

Abstract
BackgroundTransposable elements (TEs) are repetitive sequences of viral origin that compose almost half of the human genome. These elements are tightly controlled within cells, and if activated, they can cause changes in both gene regulation and immune viral responses that have been associated with several chronic inflammatory diseases in humans. As oxidants are potent activators of TEs, and because oxidative injury is a major risk factor in relation to idiopathic pulmonary fibrosis (IPF), we hypothesized that TEs might be involved in the regulation of gene expression and so contribute to inflammation in cases of IPF. IPF is a fatal lung disease that involves the gradual replacement of the alveolar tissue with fibrotic scars as well as the accumulation of inflammatory cells in the lower respiratory tract. Although IPF is known to occur as a result of the complex interaction between age, environmental risk factors (i.e., oxidative stress) and genetics, the relative contributions of these factors to the disease remain unclear. To determine whether TEs are associated with IPF, we compared the transcriptional profiles of the genes and TEs of lung cells obtained from both healthy donors and IPF patients. ResultsWe quantified the TEs and gene expression levels using a published bulk RNA-seq dataset concerning 24 subjects (16 donors and eight IPF patients), including three lung-cell types per subject, as well as a scRNA-seq dataset concerning 16 subjects (eight donors and eight IPF patients). We found evidence of TE dysregulation in the alveolar type II lung cells and alveolar macrophages of the IPF patients. In addition, the activation of the LINE1 family of elements in IPF is associated with the increased expression of TE cellular regulators (MOV10, IFI16, SAMHD1, and APOBECG3), interferon-stimulating genes (ISG15, IFI6, IFI27, IFI44, and OAS1), chemokines (CX3CL1 and CXCL9), and interleukins (IL15RA). We also propose that TE derepression might be involved in the regulation of previously reported IPF candidate genes (MUC5B, CHL1, SPP1, and MMP7). ConclusionBased on our findings, we propose that TEs derepression play an important role in the regulation of gene expression and can also prompt both the recruitment of inflammatory processes and the disruption of the immunological balance, which can lead to chronic inflammation in IPF.