bluuebunny/crossref_metadata_2025_split huggingface dataset:
Totally laparoscopic versus laparoscopy-assisted distal gastrectomy: the KLASS-07: a randomized controlled trial
Authors: Park Shin-Hoo , Lee Chang-Min , Hur Hoon , Min Jae-Seok , Ryu Seung Wan , Son Young-Gil , Chae Hyun Dong , Jeong Oh , Jung Mi Ran , Choi Chang In , Song Kyo Young , Lee Han Hong , Kim Ho Goon , Jee Ye Seob , Hwang Sun-Hwi , Lee Moon-Soo , Kim Kwang Hee , Seo Sang Hyuk , Jeong In Ho , Son Myoung Won , Kim Chang Hyun , Yoo Moon-Won , Oh Sung Jin , Kim Jeong Goo , Hwang Seong Ho , Choi Sung IL , Yang Kyung Sook , Huang Hua , Park Sungsoo 
Published: May 2024

JOURNAL/ijos/04.03/01279778-202408000-00031/figure1/v/2024-08-13T152924Z/r/image-jpeg

Backgrounds:
Strong evidence is lacking as no confirmatory randomized controlled trials (RCTs) have compared the efficacy of totally laparoscopic distal gastrectomy (TLDG) with laparoscopy-assisted distal gastrectomy (LADG). The authors performed an RCT to confirm if TLDG is different from LADG.

Methods:
The KLASS-07 trial is a multi-centre, open-label, parallel-group, phase III, RCT of 442 patients with clinical stage I gastric cancer. Patients were enroled from 21 cancer care centres in South Korea between January 2018 and September 2020 and randomized to undergo TLDG or LADG using blocked randomization with a 1:1 allocation ratio, stratified by the participating investigators. Patients were treated through R0 resections by TLDG or LADG as the full analysis set of the KLASS-07 trial. The primary endpoint was morbidity within postoperative day 30, and the secondary endpoint was quality of life (QoL) for 1 year. This trial is registered at ClinicalTrials.gov (NCT 03393182).

Results:
Four hundred forty-two patients were randomized (222 to TLDG, 220 to LADG), and 422 patients were included in the pure analysis (213 and 209, respectively). The overall complication rate did not differ between the two groups (TLDG vs. LADG: 12.2% vs. 17.2%). However, TLDG provided less postoperative ileus and pulmonary complications than LADG (0.9% vs. 5.7%, P=0.006; and 0.5% vs. 4.3%, P=0.035, respectively). The QoL was better after TLDG than after LADG regarding emotional functioning at 6 months, pain at 3 months, anxiety at 3 and 6 months, and body image at 3 and 6 months (all P<0.05). However, these QoL differences were resolved at 1 year.

Conclusions:
The KLASS-07 trial confirmed that TLDG is not different from LADG in terms of postoperative complications but has the advantages to reduce ileus and pulmonary complications. TLDG can be a good option to offer better QoL in terms of pain, body image, emotion, and anxiety at 3–6 months.
Association between postoperative radiotherapy for young-onset nonsmall cell lung cancer and risk of second primary malignancies: comparative study
Authors: Li Zuwei , Guo Minzhang , Liu Lunxu , Deng Senyi 
Published: May 2024

Background:
The most common form of therapy for nonsmall cell lung cancer (NSCLC) in early stage is surgery-based combination therapy, including radiotherapy and immunotherapy. However, postoperative radiotherapy (PORT) of cancer is correlated with increasing risk of second primary malignancy (SPM), especially young-onset cancer cases. The authors aimed to quantify the risks of SPM associated with PORT treatment for young‑onset NSCLC in early stage.

Methods:
The authors screened for SPM that developed over 5 years since the diagnosis of NSCLC. Using the data from the Surveillance, Epidemiology, and End Results database, PORT-correlated risks were estimated with multivariate Logistic regression analysis. Moreover, Fine-Gray’s competing risk regression analysis was used to calculate the cumulative incidence of SPMs.

Results:
Among the 30 308 young-onset NSCLC patients in early stage undergoing surgery, a total of 3728 patients have received PORT. Logistic regression analyses showed that PORT showed substantial correlation with elevated risks of second solid malignancies [relative risks (RR)=1.31; 95% CI: 1.17–1.46], lung cancer (RR=1.23; 95% CI: 1.07–1.42), breast cancer (RR=1.74; 95% CI: 1.16–2.74), and colon and rectum cancers (RR=1.37; 95% CI: 1.07–2.06) as well as a negligible risk of second hematologic malignancies (RR=1.15; 95% CI: 0.82–1.67). The cumulative incidence of SPMs revealed similar findings. Higher RR was obtained in NSCLC patients aged 60–69 years (RR=1.33), in white race (RR=1.36), diagnosed in 1975–2000 (RR=1.23) and 2001–2015 (RR=1.40), or diagnosed with lung adenocarcinoma (RR=1.55).

Conclusion:
PORT for young-onset NSCLC in early stage was correlated with elevated risks of SPMs (lung cancer, breast cancer, as well as colon and rectum cancers), supporting the need for long-term surveillance of these patients.
The Current State of Advanced Pediatric Emergency Medicine Point-of-Care Ultrasound (POCUS) Training
Authors: Moake Matthew M. , Klekowski Nicole , Kusulas Matthew P. , Kharasch Sigmund J. , Teng David , Constantine Erika ,   on behalf of the P2Network
Published: May 2024

Objectives
This study aims to assess the current state of advanced pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) training in North America, including trends in dedicated PEM POCUS fellowships and alternative advanced POCUS training pathways, to better guide future educational efforts within the field.

Methods
We identified and surveyed 22 PEM POCUS fellowship directors across the United States and Canada regarding PEM POCUS fellowship application trends, potential barriers to pursuing additional POCUS training, and novel training models that meet the needs of the PEM POCUS workforce.

Results
The past 5 years have seen a growth in both PEM POCUS fellowship program number and trainee positions available, with a general impression by fellowship directors of a high demand for faculty who have these training credentials. However, there was a discordant drop in fellowship applicants and corresponding match rate in 2022, the cause of which is not clear. A number of programs are offering alternative advanced training options including combined PEM/POCUS fellowships and POCUS tracks within PEM fellowship.

Conclusion
As POCUS use within PEM evolves, a growing number of advanced training options are being developed. Understanding the motivations and barriers for pursuing advanced POCUS training can help to shape these options going forward, to ensure the experience incorporated within each model meets the needs of trainees, the needs of PEM divisions, and the future needs of our field.
Urinalysis in Suspected Child Abuse Evaluation in the Emergency Department
Authors: Singh Nidhi V. , Lichtsinn Katrin , Ray Molly , Lawson Karla A. , Piper Karen , Wilkinson Matthew H. 
Published: May 2024

Background
Intra-abdominal injury (IAI) is the second leading cause of mortality in abused children. It is challenging to identify in young patients due to their limited verbal skills, delayed symptoms, less muscular abdominal wall, and limited bruising.

Methods
We conducted a retrospective cohort study of children aged 0 to 12 months who were evaluated in the emergency department for suspected child abuse with a skeletal survey and urinalysis between January 1, 2015, and December 31, 2017. Our primary objective was to identify the proportion of IAI cases identified by urinalysis alone (>10 RBC/HPF) and not by examination findings or other laboratory results. A secondary objective was to quantify potential delay in disposition while waiting for urinalysis results, calculated as the length of time between receiving skeletal survey and laboratory results and receiving urinalysis results.

Results
Six hundred thirteen subjects met our inclusion criteria; two subjects had hematuria, one of whom had a urinary tract infection. The other was determined to have blood from a catheterized urine specimen. One subject was found to have an IAI. We further found that urinalysis was delayed for 78% of subjects and took a median of 93 [interquartile range, 46–153] minutes longer than imaging and/or laboratories.

Conclusions
No subjects were diagnosed with abdominal trauma based on urinalysis during evaluation in the emergency department who would not have been identified by other standard testing. In addition, patients' disposition was delayed while waiting for urinalysis.
Catching Suicide Before It Harms
Authors: Wadih Esper G. , Caperell Kerry 
Published: May 2024

Objectives
Suicide is the second leading cause of death in people aged 10 to 24 years. We aim to assess the effectiveness of universal suicide screening in a pediatric ED.

Methods
Since April 7, 2019, all patients 10 years and older who presented to the pediatric ED of our freestanding children's hospital were screened with the validated Columbia Suicide Severity Rating Scale and categorized as mild, moderate, or severe risk for suicide. Screenings from 2019 were reviewed by investigators. All children aged 10 to 18 years who were screened were included. Data collected included demographic information, previous ED visits, past chief complaints), suicidal ideation, suicide attempt, and disposition.

Results
A total of 11,469 subjects were screened for suicide risk. Of those screened, 340 were positive on Columbia Suicide Severity Rating Scale, and 5 were excluded for being outside of the age range. Of the remaining 335 subjects who screened positive, 116 (34.5%) of them presented with a primarily medical chief complaint. A total of 120 subjects screened mild risk (35.8%), 46 were moderate (13.7%), and 169 were severe (50.4%). Overall, 141 positive subjects were admitted for mental health concerns.

Conclusions
Several patients who screened positive for suicide risk did not present with a mental health concern. Nearly half of screen-positive children who were admitted for mental health concerns had been seen in the ED in the year before their visit. Initiation of universal suicide screening in the pediatric ED identified a significant number of children with unrecognized suicide risk.
Obesity as a Risk Factor for Adverse Outcomes After Pedestrian Trauma Accidents in the Pediatric Population
Authors: Mulvihill Hannah , Roster Katie , Lakhi Nisha 
Published: May 2024

Objective
The aim of the study is to determine whether overweight or obese children are at an increased risk for injury and adverse outcomes following pedestrian motor vehicle accidents.

Methods
We performed a retrospective study of patients between the ages of 2 and 17 who were pedestrians injured in a collision with a motorized vehicle, presenting to a level 1 trauma center, between January 1, 2010, to December 31, 2021. Patients with admission weights falling above the 90th percentile of the Centers for Disease Control and Prevention's sex-specific growth charts were identified as overweight/obese, those below the cutoff were categorized as nonobese. Groups were compared regarding demographics, mechanism of injury, Injury Severity Score, and Abbreviated Injury Scale by body region of injury. Outcome measures included hospital admission, length of hospital stay, intensive care unit (ICU) admission, ICU length of stay, and mortality.

Results
Of the 306 patients included, 72 (23.5%) were overweight/obese and 234 (76.5%) were nonobese. The mean Injury Severity Score scores were higher among overweight/obese patients (5.37 vs 8.74, P = 0.008). Overweight/obese children were more likely to sustain severe abdominal injuries (Abbreviated Injury Scale ≥ 3) (12.2% vs 5.1%; odds ratio [OR], 2.64; 95% CI, 1.07–6.56; P = 0.030), be admitted to the hospital (94.5% vs 74.3%; OR, 12.07; 95% CI, 2.87–50.72; P < 0.001), require ICU admission (31.0% vs 20.0%, OR, 1.87; 95% CI, 1.03–3.36; P = 0.036), and require a longer ICU stay (0.9 vs 0.4 days, P = 0.014) compared with nonobese patients.

Conclusions
Obese and overweight children are at increased risk for higher injury severity scores, severe abdominal injuries, and ICU admission after pedestrian motor vehicle accidents.
Impact of a Mental Health Screening Process in a Pediatric Emergency Department
Authors: Stocker Bryan , Jain Shobhit , Patel Lina , Tarantino Celeste , Sullivant Shayla , Worland Kathryn 
Published: May 2024

Objective
The aim of this study was to describe how specific mental health–trained social workers can assist in the evaluations and follow-up of patients presenting with mental health concerns in the pediatric emergency department (ED).

Methods
Work was performed at a quaternary children's hospital ED with 95,000 annual ED visits across 2 locations. Patients requiring mental health services identified based on presenting complaint or from universal suicide screen were included. Emergency department team first evaluates the patients for medical screening and then consults a team of social workers specialized in acute mental health screening (AMHS). The team evaluates and provides recommendation for disposition and assists in plan completion. For patients not admitted, AMHS team makes 24- and 48-hour calls to ensure safety. We collected and analyzed the data on all eligible patients from September 2015 through June 2019 for (1) demographic information, (2) trends in number of consults to AMHS, (3) disposition plans and trends by year, and (4) frequency of follow-up phone calls.

Results
A total of 5950 patient visits were reviewed, for 4454 distinct patients. Most patients were 12 to 17 years of age, female, and White, with Medicaid being the predominant insurance. The most common chief complaint was suicidal ideation/plan/attempt. Self-referrals were the majority of assessments, and 59% of patients were already receiving mental health services. Median team response time was 19 minutes. There was an upward trend in consults. Psychiatric hospitalization was the most common disposition; more than 95% of the other visits had timely follow-up phone calls.

Conclusion
Despite an increasing number of patients presenting to the ED with mental health crisis, safe and efficient management is possible with ED staff–social worker partnership. This approach can ensure that eligible patients receive consistent and evidence-based evaluations and can allow ED clinicians to respond to medical emergencies that require their attention.
Nondiagnostic 99mTc-MAG3 Diuresis Renography Studies Caused by Propofol Sedation
Authors: Singh Karan Bir , Daley Kurt , Christian Caryl , Wegner Eva A. , Rossleigh Monica A. 
Published: May 2024

Abstract

99mTc-MAG3 diuresis renography is a noninvasive functional imaging technique used to assess clearance of radiotracer in a dilated urinary tract under high diuresis. It is commonly performed in patients to diagnose functionally significant urinary tract obstruction. In some pediatric patients, sedation is required to enable imaging. However, propofol, a commonly used IV sedative agent, is associated with altered renal hemodynamics. We report a case series of 3 pediatric patients at our institution who received propofol sedation to enable 99mTc-MAG3 diuresis renography using a F+0 protocol, outlining that some “abnormal” studies were in fact assessed to be nondiagnostic.
The Application of “Table Tennis Racquet” Random Skin Flap in the Treatment of Facial Skin Carcinoma
Authors: Tian Kai , Jia Zou , Xu Wushuang , Wang Xiaoyun , Xie Xiaoming , Gu Yifei , Cao Shikun , Gao Suyue , Li Ke , Wu Lijun 
Published: May 2024

Background
The repair of facial skin and soft tissue defects remains a clinical challenge. The author introduced a novel “table tennis racquet” random skin flap for wound repair after facial skin cancer excision and discussed its survival mechanisms.

Methods
A lateral mandibular neck skin flap shaped like a table tennis racquet with no well-known blood vessels at the narrow pedicle was designed in 31 cases to repair tissue defects. Among them, there were 8 cases of skin carcinoma in the frontotemporal area and 23 cases of skin carcinoma in the cheek. The flap area was 8.0 × 7.0 cm at maximum and 3.0 × 2.5 cm at minimum, with a pedicle width of 1.0–2.0 cm and a pedicle length of 2.0–6.0 cm.

Results
All 31 “table tennis racquet” random skin flaps survived, although there were 3 cases with delayed healing of distal flap bruising. All of them had an ideal local shape after repair with a concealed donor area and inconspicuous scars.

Conclusions
This flap has a “table tennis racquet” shape with a pedicle without well-known blood vessels and has a length-to-width ratio that exceeds that of conventional random flaps, making it unconventional. Because of its long and narrow pedicle, it not only has a large rotation and coverage area but also can be designed away from the defect area, avoiding the defect of no donor tissue being localized near the defect. Overall, this approach is an ideal option for repairing tissue defects after enlarged excision of facial skin carcinoma.
A 10-Year Review of Collagenase Versus Fasciectomy in the Treatment of Dupuytren Contracture
Authors: Steppe Cyrus , Cinclair Richard , Lies Shelby 
Published: May 2024

BackgroundDupuytren disease (DD) is one of the most common disorders of the hand, affecting 5.7% to 11.7% of the global population. This study seeks to evaluate the 10-year efficacy of the 2 most prominent treatment modalities for DD in Veterans Affairs hospitals, injectable collagenaseClostridium histolyticumversus open fasciectomy.MethodsA retrospective review was conducted of all electronic medical records of patients who underwent open fasciectomy or collagenase injection to treat their persistent Dupuytren contracture between April 2011 and April 2021. All procedures were performed by 1 of 5 senior surgeons at the same Veterans Affairs Hospital.ResultsA total of 232 patients were treated for DD, with 247 collagenase injections and 44 open fasciectomies performed in this sample. Collagenase patients were, on average, 6.51 years after intervention at the time of review. Open fasciectomy patients were, on average, 4.56 years after operation at the time of review. Collagenase decreased contractures, on average, by 29.40 degrees, whereas open fasciectomy decreased contractures, on average, by 38.59 degrees. Of the contractures that were initially classified as resolved, 50 of 155 (32.2%) treated with collagenase and 6 of 56 (10.7%) treated with open fasciectomy recurred. The use of open fasciectomy compared with collagenase injections to treat contracture was associated with a 74.2% decrease in the likelihood of recurrence.ConclusionsThis study found that treatment of DD with collagenase injection is associated with a significantly lower degree of deformity correction, lower rate of resolution, and increased rate of recurrence when compared with open fasciectomy.
Thirty- and 90-Day Morbidity and Mortality by Clavien-Dindo after Surgery for Antireflux and Hiatal Hernia
Authors: Ivy Megan L , Baison George , Griffin Cassandra , Welch Allison C , White Peter T , Farivar Alexander S , Bograd Adam J , Aye Ralph W , Louie Brian E 
Published: May 2024

BACKGROUND:
The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset.

STUDY DESIGN:
We retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days. All complications were graded using the Clavien-Dindo (CD) grading system. The highest grade of complication was used per patient during 30- and 31- to 90-day intervals.

RESULTS:
Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were CD less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338).

CONCLUSIONS:
Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent.
A novel genetic mouse model of fatal aortic dissection reveals massive inflammatory cell infiltration in the thoracic aorta
Authors: Kimura Kenichi , Motoyama Eri , Kanki Sachiko , Asano Keiichi , Sheikh Md Al Amin , Clarin Maria Thea Rane Dela Cruz , Raja Erna , Takeda Mariko , Ishii Ryutaro , Murata Kazuya , Deleeuw Violette , Sips Patrick , Mosquera Laura Muiño , De Backer Julie , Mizuno Seiya , Sakai Lynn Y , Nakamura Tomoyuki , Yanagisawa Hiromi 
Published: May 2024

AbstractBackgroundAortic dissection (AD) is the separation of medial layers of the aorta and is a major cause of death in patients with connective tissue disorders such as Marfan syndrome. However, molecular triggers instigating AD, its temporospatial progression, and how vascular cells in each vessel layer interact and participate in the pathological process remain incompletely understood. To unravel the underlying molecular mechanism of AD, we generated a spontaneous AD mouse model.MethodsWe incorporated a novel missense variant (p.G234D) inFBN1, the gene for fibrillin-1, identified in a non-syndromic familial AD patient into mice using CRISPR/Cas9 system. We performed histopathological analyses of the aortic lesions by histology, immunofluorescence staining, electron microscopy, synchrotron-based imaging and single-cell (sc)RNA-sequencing. Biochemical analysis was performed to examine the binding capacity of mutant human FBN1G234D protein to latent Tgfβ binding proteins (LTBPs), and signaling pathways in the mutant aortic wall were examined by western blot analysis.Results50% of theFbn1G234D/G234Dmutant mice died within 5 weeks of age from multiple intimomedial tears that expanded longitudinally and progressed to aortic rupture accompanied by massive immune cell infiltration. scRNA-sequencing, validated by immunostaining, revealed a significant increase in MHC class II-positive pro-inflammatory macrophages and monocytes at the site of intima tears with upregulation of MMP2/9 and marked disruption of elastic lamina. Subendothelial matrices, such as type IV collagen and laminin, expanded into the medial layer, where fibronectin expression was highly upregulated.Fbn1G234D/G234Dendothelial cells exhibited altered mechanosensing with loss of parallel alignment to blood flow and upregulation of VCAM-1 and ICAM-1, all of which likely contributed to the infiltration of immune cells. Biochemically, FBN1G234D lost the ability to bind to latent TGFβ binding protein (LTBP)-1, -2, and -4, resulting in the downregulation of TGFβ signaling in the aortic wall.ConclusionsWe show that dynamic interactions involving endothelial cells (ECs) and macrophages/monocytes in the intima, where the ECM microenvironment is altered with the reduced TGFβ signaling, contributes to the initiation of AD. Our novel AD mouse model provides a unique opportunity to identify target molecules involved in the intimomedial tears that can be utilized for development of therapeutic strategies.