bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of simulation training on decision to delivery interval in cord prolapse
Authors: Gallagher Gillian , Griffin Alison , Clipperton Sharon , Janssens Sarah 
Published: June 2021

BackgroundUmbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance.AimTo assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia.MethodA retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours).ResultsAfter the introduction of simulation training, mean DDI decreased by 4.1 min (difference −4.1, 95% CI −6.2 to −1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH.ConclusionsThe introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.
EULAR portfolio for Rheumatology training: a EULAR School of Rheumatology initiative
Authors: van Onna Marloes , Ramiro Sofia , Haines Catherine , Holland-Fischer Mette , da Silva Jose Antonio Pereira , Dudler Jean , Edwards Chris , Alunno Alessia , Nikiphorou Elena , Falzon Louise , Sivera Francisca 
Published: June 2021

ObjectiveAbout half of the rheumatology trainees do not use a portfolio. This project was established to reach consensus about the content of a EULAR portfolio for Rheumatology training and subsequently develop portfolio assessment forms.MethodsAfter establishing a portfolio working group (WG), including nine rheumatologists and one educationalist, a systematic literature review (SLR) on the content and structure of portfolios for postgraduate learning was conducted (November 2018). This was followed by a survey among WG members and members of the EMerging EUlar NETwork, inquiring about the content and structure of existing national portfolios. The portfolio WG selected the key components of the portfolio, taking previous experience and feasibility into account. Assessment forms (eg, case-based discussion) were developed and pilot-tested.Results13/2034 articles were included in the SLR (12 high/1 moderate risk of bias). Information on procedural skills, personal reflections, learning goals and multisource feedback was most often included a portfolio. Twenty-five respondents completed the survey (response≈50%). Feedback from assessors, reflective writing and formulation of learning goals were considered important dimensions to be covered in a portfolio. Six key components of the portfolio were established: curriculum vitae, personal development plan, clinical work, professional behaviours, education and research activities. Suggested minimal content for each component was formulated. Four assessment forms were successfully pilot-tested by 11 rheumatologists and their trainees.ConclusionA EULAR portfolio for Rheumatology training and assessment forms were developed. Portfolio implementation, particularly in countries without an existing portfolio, may promote a higher standard of rheumatology training across Europe.
Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities
Authors: Abdolrahimzadeh Fard Hossein , Borazjani Roham , Sabetian Golnar , Shayan Zahra , Boland Parvaz Shahram , Abbassi Hamid Reza , Aminnia Shiva , Salimi Maryam , Paydar Shahram , Taheri Akerdi Ali , Zare Masome , Shayan Leila , Mahmudi-Azer Salahaddin 
Published: June 2021

ObjectivesThe triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the specificity and sensitivity of available triage systems for COVID-19 among trauma patients. Furthermore, it aimed to develop a novel triage system for SARS-CoV-2 detection among trauma patients in centers with limited resources.MethodsAll patients referred to our center from February to May 2020 were enrolled in this prospective study. We evaluated the SARS-CoV-2 triage protocols from the WHO, the Iranian Ministry of Health and Medical Education (MOHME), and the European Centre for Disease Control and Prevention (ECDC) for their effectiveness in finding COVID-19 infected individuals among trauma patients. We then used these data to design a stepwise triage protocol to detect COVID-19 positive patients among trauma patients.ResultsAccording to our findings, the WHO protocol showed 100% specificity and 13.3% sensitivity. The MOHME protocol had 99% specificity and 23.3% sensitivity. While the ECDC protocol showed 93.3% sensitivity and 89.5% specificity, it did not prioritize patients based on traumatic injuries and unstable conditions. Our stepwise triage protocol, which prioritizes traumatic injuries, had 93.3% sensitivity and 90.3% specificity.ConclusionOur study shows that the triage protocols from the WHO, MOHME and ECDC are not best equipped to diagnose SARS-CoV-2 infected individuals among trauma patients. In our proposed stepwise triage system, patients are triaged according to their hemodynamic conditions, COVID-19 related clinical states, and COVID-19 related laboratory findings. Our triage model can lead to more accurate and resource-effective management of trauma patients with potential COVID-19 infection.Level of evidenceLevel Ⅲ.
Unmasking New Promises: Expanding the Antigen Landscape For Antibody–Drug Conjugates
Authors: Oberoi Honey K. , Garralda Elena 
Published: June 2021

Abstract
Cross-reactivity with normal tissues is one of the key concerns for target selection for antibody–drug conjugates. Probody therapeutics are masked antibodies that can selectively be activated by proteases in the tumor. CX-2029, is a first-in-class Probody targeting CD71 with preliminary efficacy and a tolerable safety profile.
See related article by Johnson et al., p. 4521
Extracorporeal Membrane Oxygenation May Improve Outcomes After Resuscitative Thoracotomy: A National Trauma Data Bank Analysis
Authors: Owattanapanich Natthida , Inaba Kenji , Allen Brad , Lewis Meghan , Henry Reynold , Clark Damon , Matsushima Kazuhide , Strumwasser Aaron 
Published: June 2021

Background Albeit low survival rates, resuscitative thoracotomy (RT) is considered standard for selected trauma patients. Because it has potential for rapid cardiopulmonary rescue, extracorporeal membrane oxygenation (ECMO) may augment RT. The aim of this study was to identify the impact of ECMO on trauma patients that recently underwent RT after injury. Study Design All patients who underwent RT were identified from the National Trauma Data Bank (2007-2017). Patients were excluded if they died within 60 minutes, underwent delayed ECMO, and/or had missing data. Delayed ECMO group was defined as those patients undergoing ECMO after 1 hour following RT. Results Out of 8 694 272 injured patients, 10 106 (.1%) underwent RT. Median age was 31 years [23-45], 86% male. Penetrating injury was the dominant mechanism (62%). Of these, .6% (23) underwent immediate ECMO. Extracorporeal membrane oxygenation patients were significantly younger (23[17-33] vs. 31[23-46], p .003) and had significantly higher chest abbreviated injury scale scores (5[4-5] vs. 3[3-4], P < .001). Extracorporeal membrane oxygenation patients achieved significantly higher rate of return of spontaneous circulation (96% vs. 70%, p .007) and had nonsignificant trend of improved mortality (52% vs. 63%, p .260). Conclusion Immediate ECMO may be a useful therapeutic modality after RT. It achieves higher ROSC rates with opportunity for improved survival. Future prospective study is warranted.
Factors Affecting One-Year Outcomes After Major Lower Extremity Amputation in the Vascular Quality Initiative Amputation Registry
Authors: Andersen James C. , Mannoia Kristyn A. , Patel Sheela T. , Leong Beatriz V. , Murga Allen G. , Teruya Theodore H. , Kiang Sharon C. , Abou-Zamzam Ahmed M. 
Published: June 2021

Introduction Major lower extremity amputation (LEA) results in significant morbidity and mortality. This study identifies factors contributing to adverse long-term outcomes after major LEA. Study Design Amputations in the Vascular Quality Initiative (VQI) long-term follow-up database from 2012 to 2017 were included. Multivariable logistic regression determined which significant patient factors were associated with 1-year mortality, long-term functional status, and progression to higher level amputation within 1 year. Results 3440 major LEAs were performed and a mortality rate of 19.9% was seen at 1 year. Logistic regression demonstrated that 1-year mortality was associated with post-op myocardial infarction (MI) (odds ratio (OR) 1.7, CI 1.02-2.97, P = .04), congestive heart failure (CHF) (OR 1.9, confidence interval (CI) 1.56-2.38, P < .001), hypertension (HTN) (OR 1.31, CI 1.00-1.72, P = .05), chronic obstructive pulmonary disease (COPD) (OR 1.36, CI 1.13-1.63, P < .001), and dependent functional status (OR 2.01, CI 1.67-2.41, P < .001). A decline in ambulatory status was associated with COPD (OR 1.36, CI 1.09-1.68, P = .006). Dependent functional status was protective against revision to higher level amputation (OR .18, CI .07-.45, P < .001). Conclusion In the VQI, 1-year mortality after major LEA is nearly 20% and associated with HTN, CHF, COPD, dependent functional status, and post-op MI. Decreased functional status at 1 year was associated with COPD, and progression to higher level amputation was less likely in patients with dependent functional status.
Association of Body Mass Index on Injuries and Outcomes After Ground-Level Falls
Authors: Owattanapanich Natthida , Schellenberg Morgan , Switzer Emily , Clark Damon H. , Matsushima Kazuhide , Inaba Kenji 
Published: June 2021

Background The impact of body mass index (BMI) on trauma severity after ground-level falls (GLF) is currently unclear. This study aimed to examine the associations between BMI, injuries, and outcomes after GLF. Study Design All patients ≥16 years of age injured by GLF were queried from the TQIP database (2013-2017). Exclusions were transfers, emergency department death, AIS 6 in any region, and missing data. Body mass index defined study groups: Underweight (BMI<18.5), Normal (BMI 18.5-24.9), Overweight (25.0-29.9), and Obese (≥30). Results After exclusions, 131 570 patients remained for analysis. Most patients had a normal BMI (n = 58 503, 44%). Median ISS was 9 [IQR 9-10] in all groups. The Obese group had significantly lower rates of fractures than the Normal group, particularly femur fractures (53% vs. 64%, P < .001), but required orthopedic surgical intervention more frequently (45% vs. 41%, P < .001). On multivariate analysis, being overweight was protective against mortality (OR .881, P = .005), while obesity was not associated with mortality (OR 1.012, P = .821). Conclusion Increasing BMI may be protective against both fracture risk and mortality after GLF. However, obese patients require operative fixation more frequently. Particularly as fracture diagnosis may be more challenging in the obese, special care should be taken during their tertiary surveys after GLF to ensure injuries are not missed.
The Utility of Extended Criteria Donor Livers in High Acuity Liver Transplant Recipients
Authors: Guorgui Jacob , Ito Takahiro , Younan Stephanie , Agopian Vatche G. , Dinorcia Joseph , Farmer Douglas G. , Busuttil Ronald W. , Kaldas Fady M. 
Published: June 2021

Background Although the use of extended criteria donor (ECD) liver allografts has gained momentum as a potential method by which to expand the donor pool, their use largely remains relegated to low acuity liver transplant (LT) recipients. Thus, we sought to examine whether such grafts also have utility in high acuity (Model for End-Stage Liver Disease [MELD] ≥ 35) recipients. Study Design Extended criteria donors were defined as donor age > 60 years, hepatitis C virus positive donor, split livers, livers with cold ischemia time > 12 h, donor after cardiac death livers, or having macrosteatosis > 30%. Outcomes were compared between standard liver (SL) and ECD grafts in recipients with MELD ≥ 35. Results Of 225 patients, 46 (20.4%) received an ECD liver and 179 (79.6%) received a SL. Extended criteria donor graft recipients had significantly higher levels of post-LT maximal transaminases and rate of early allograft dysfunction. Nonetheless, high acuity ECD graft recipients had similar short- and long-term patient survival compared to SL recipients, with 1-,3-, and 5-year survivals of 86.9%, 82.3%, 79.3% and 86.9%, 80.5%, and 75.4%, respectively ( P = .674). There were also no significant differences in graft survival or rejection-free survival between the 2 groups. Conclusion The lack of inferior patient/graft survival among high acuity ECD graft recipients suggests that ECD livers present a viable method by which to expand the donor pool for this group of patients.
Factors Associated With Retained Foreign Bodies Following Major Operations
Authors: Verma Arjun , Tran Zachary , Hadaya Joseph , Williamson Catherine G. , Rahimtoola Rhea , Benharash Peyman 
Published: June 2021

Background Retained surgical foreign bodies (RFB) are associated with inferior clinical and financial outcomes. The present work examined a nationally representative sample of all major operations to identify factors associated with RFB. Study Design The 2005-2017 National Inpatient Sample was used to identify adults undergoing cardiac, neurosurgical, orthopedic, genitourinary, gastrointestinal, vascular, and thoracic operations. International Classifications of Diseases 9th-10th Revisions diagnosis codes were used to identify instances of RFB. Results Of an estimated 71,445,042 hospitalizations, .02% had a diagnosis of RFB, with decreasing incidence from .03 to .02% over the study period (NPtrend < .001). Relative to vascular operations, gastrointestinal (adjusted odds ratio [AOR] 2.12), thoracic (AOR 1.80), and multi-cavity (AOR 2.17) were associated with greater odds of RFB. Laparoscopic approach (AOR .33) and trauma-associated admission (AOR .52, all P < .001) were associated with reduced odds of RFB. Despite similar mortality, RFB was associated with increased odds of pulmonary infection (AOR 1.62), sepsis (AOR 1.26), and wound infection (AOR 5.15), as well as a 2.3-day increment in length of stay and $7700 in hospitalization costs (all P < .001). Conclusion The development of novel mitigation strategies may reduce the incidence of RFB in high-risk populations, such as those undergoing gastrointestinal, thoracic, and multi-cavity operations.
Common mental disorders among women and its social correlates in an urban marginalized populace in South India
Authors: Nair Aiswarya R , Shivanna Yeshvanth Kumar Gubbi , Illimoottil Jesson Paulson , Rachana Arun , Mahasampath Gowri S , Abraham Sunil , Kurian Suja 
Published: June 2021

Background: Common mental disorders (CMD) cause a range of health, social and economic burden, and disorders like depression and anxiety are more prevalent among women. Prevalence and factors contributing to increased vulnerability for CMDs have regional variation. Identification of factors contributing to the vulnerability is essential to both psychiatric epidemiology and in addressing mental health challenges in the community. Methods: This cross-sectional study aimed at understanding the burden of CMD and its association with social determinants of mental health. Women hailing from urban slum attending the outpatient family care facility for their medical problems constituted the sample. Data was collected using a clinical research form with variables such as sociodemographic profile, health profile, and psychosocial profile. The questionnaire had specific questions on indicators of poverty, certain stressors, and support system. Presence of CMD was assessed using Clinical Interview Schedule-Revised (CIS-R), a standard tool for CMD research in primary care settings. A cut off score of 12 and above was considered for detecting CMD. Research ethical principles were adhered to and data was analyzed using SPSS 21.0. Results: Among 172 women, 77 (44.8%) were diagnosed to have CMDs. Univariate analysis revealed a significant association between age, marital status, living arrangement, educational level, difficulty with buying food, presence of debt, chronic medical illness, husband’s alcohol use, marital satisfaction, experiencing abuse, family support, religious participation, and a diagnosis of CMD. Multivariate analysis showed high burden with nuclear family arrangement, difficulty to buy food, experiencing abuse and, low burden with higher educational level, family support, and religious participation. Conclusion: Considering the high prevalence and the treatment gap of CMDs in primary setting, family-physician should be sensitized for detection and management of CMDs. Social interventions targeting poverty, women’s education and empowerment, and support system are likely to decrease the burden of CMDs in this population.
Objectively-assessed physical activity and self-reported activity pacing in adults with multiple sclerosis: A pilot study
Authors: Abonie Ulric S , Saxton John , Baker Katherine , Hettinga Florentina J 
Published: June 2021

Objective: To examine the association between self-reported activity pacing (a strategy to manage fatigue symptoms) and objectively-measured physical activity behaviours in adults with multiple sclerosis. Design: Single cross-sectional study Setting: Multiple sclerosis rehabilitation centre in Colchester, United Kingdom. Subjects: Twenty-one adults (59 ± 9 years) with multiple sclerosis. Main measures: Physical activity behaviours (activity level: activity counts per minute; activity variability: highest activity counts per minute each day divided by activity counts per minute on that day) were measured with accelerometers. Self-reported activity pacing (Activity Pacing and Risk of Overactivity Questionnaire), fatigue severity (Fatigue Severity Scale) and health-related quality of life (RAND-12-Item Short-Form Health Survey) were measured. Scatter plots were used to explore associations between measures. Results: Activity level was 258 ± 133 counts per minutes, activity variability was 4 ± 1, self-reported activity pacing was 3 ± 1, fatigue severity was 5 ± 2 and health-related quality of life was 43 ± 8. Increased self-reported activity pacing was associated with lower activity levels and less variability in daily activities. Conclusion: This investigation suggests that people with multiple sclerosis who have low physical activity levels could be inappropriately using activity pacing as a reactionary response to their multiple sclerosis symptoms.
INHBA promotes the proliferation, migration and invasion of colon cancer cells through the upregulation of VCAN
Authors: Guo Jia , Liu Yuan 
Published: June 2021

Objective Colon cancer has high morbidity and mortality rates, and proliferation, invasion and migration play an important role in colon cancer progression. Here, the effects of inhibin subunit beta A (INHBA) on cell proliferation, invasion and migration were investigated. Methods The UALCAN database was used to assess INHBA expression in colon cancer tissues and predict the survival of patients with high and low INHBA expression. The relevant proteins were detected by RT-qPCR and western blot. Cell transfection was performed to overexpress or inhibit INHBA and versican (VCAN). The high correlation between INHBA and VCAN found through LinkedOmics and StarBase databases was verified by immunoprecipitation assays. Cell proliferation was detected by cell counting kit-8 and colony formation assays. Wound healing and Transwell assays were used to assess migration and invasion. Results INHBA expression was upregulated in colon cancer tissues and cells. INHBA inhibition impaired the proliferation, migration and invasion of these cells. In addition, we confirmed the correlation between INHBA and VCAN in colon cancer cells. Finally, we found that INHBA interference inhibited the aggressive behavior of colon cancer cells by downregulating VCAN. Conclusion INHBA promotes the proliferation, migration and invasion of colon cancer cells through the upregulation of VCAN.
Effect of Modified Lemaire Anterolateral Extra-articular Tenodesis on the Magnetic Resonance Imaging Maturity Signal of Anterior Cruciate Ligament Hamstring Graft
Authors: Rojas Gonzalo , Perelli Simone , Ibanez Maximiliano , Formagnana Mario , Ormazabal Inmaculada , Monllau Juan Carlos 
Published: June 2021

Background: Lateral extra-articular tenodesis (LET) is one of the most widely used procedures to restore anterolateral stability. Clinical outcomes after the addition of LET to anterior cruciate ligament (ACL) reconstruction (ACLR) have been widely investigated; however, the potential influence of LET on the ACL ligamentization process has not been examined. Purpose/Hypothesis: The purpose was to use 10-month postoperative magnetic resonance imaging (MRI) scans to determine whether the maturity of grafts after hamstring autograft ACLR was affected by concomitant LET. The hypothesis was that when modified Lemaire lateral extra-articular tenodesis (MLLET) was performed, the MRI parameters of ACL graft maturity would be modified. Study Design: Cohort study; Level of evidence, 3. Methods: The study included patients treated between December 2017 and December 2018 who had undergone anatomic 3-strand hamstring tendon autograft ACLR, with or without concomitant MLLET, and had undergone MRI 10 months postoperatively. Thus, the study included 30 patients who had isolated ACLR and 22 patients who had ACLR plus MLLET. The 2 groups were comparable based on all criteria analyzed. To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in 3 regions of interest of the proximal, midsubstance, and distal ACL graft. Lower SNQ ratios indicate less water content and, theoretically, better maturity and healing of the graft. Results: The mean ± SD for SNQ was 4.62 ± 4.29 (range, 3.12-6.19) in the isolated ACLR group and 7.59 ± 4.68 (range, 4.38-8.04) in the ACLR plus MLLET group ( P = .012). Upon comparing the mean values of the 3 portions between the 2 groups, we found a significant difference between the 2 groups for the proximal and middle portions ( P = .007 and P = .049, respectively) but no difference in the distal portion ( P = .369). Conclusion: At the 10-month follow-up, hamstring tendon autografts for anatomic ACLR with MLLET did not show the same MRI signal intensity compared with isolated hamstring anatomic ACLR.