bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Obesity on Systemic Complications After Operative Pelvic Ring Fractures
Authors: Patel Mihir , Fairburn Stevan , McGwin Gerald , Spitler Clay 
Published: June 2024

OBJECTIVES:
To determine the effect of obesity on systemic complications after operative pelvic ring injuries.

METHODS:

Design:
Retrospective cohort study.

Setting:
Single level 1 trauma center.

Patient Selection Criteria:
All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015 to 2022 were included. Patients were grouped based on body mass index (BMI) into 4 categories (normal = BMI <25, overweight = BMI 25–30, obese = BMI 30–40, and morbidly obese BMI >40).

Outcome Measures and Comparisons:
Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared with those who did not regarding demographic and clinical parameters to determine risk factors for each complication.

RESULTS:
A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI was also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI >40).

CONCLUSIONS:
This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication, specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain postoperative complications during the initial trauma admission.

LEVEL OF EVIDENCE:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Lower Extremity Amputation in Fracture-Related Infection
Authors: Carter Karen J. , Yeager Matthew T. , Rutz Robert W. , Benson Elizabeth Marks , Gross Evan G. , Campbell Collier , Johnson Joseph P. , Spitler Clay A. 
Published: June 2024

OBJECTIVES:
To analyze demographics, comorbidities, fracture characteristics, presenting characteristics, microbiology, and treatment course of patients with fracture-related infections (FRIs) to determine risk factors leading to amputation.

METHODS:

Design:
Retrospective cohort.

Setting:
Single Level I Trauma Center (2013–2020).

Patient Selection Criteria:
Adults with lower extremity (femur and tibia) FRIs were identified through a review of an institutional database. Inclusion criteria were operatively managed fracture of the femur or tibia with an FRI and adequate documentation present in the electronic medical record. This included patients whose primary injury was managed at this institution and who were referred to this institution after the onset of FRI as long as all characteristics and risk factors assessed in the analysis were documented. Exclusion criteria were infected chronic osteomyelitis from a non-fracture-related pathology and a follow-up of less than 6 months.

Outcome Measures and Comparisons:
Risk factors (demographics, comorbidities, and surgical, injury, and perioperative characteristics) leading to amputation in patients with FRIs were evaluated.

RESULTS:
A total of 196 patients were included in this study. The average age of the study group was 44±16 years. Most patients were men (63%) and White (71%). The overall amputation rate was 9.2%. There were significantly higher rates of chronic kidney disease (CKD; P = 0.039), open fractures (P = 0.034), transfusion required during open reduction internal fixation (P = 0.033), Gram-negative infections (P = 0.048), and FRI-related operations (P = 0.001) in the amputation cohort. On multivariate, patients with CKD were 28.8 times more likely to undergo amputation (aOR = 28.8 [2.27 to 366, P = 0.010). A subanalysis of 79 patients with either a methicillin-sensitive Staphylococcus aureus or methicillin-resistant S. aureus (MRSA) infection showed that patients with MRSA were significantly more likely to undergo amputation compared with patients with methicillin-sensitive Staphylococcus aureus (P = 0.031). MRSA was present in all cases of amputation in the Staphylococcal subanalysis.

CONCLUSIONS:
Findings from this study highlight CKD as a risk factor of amputation in the tibia and femur with fracture-related infection. In addition, MRSA was present in all cases of Staphylococcal amputation. Identifying patients and infection patterns that carry a higher risk of amputation can assist surgeons in minimizing the burden on these individuals.

LEVEL OF EVIDENCE:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Machine-learning-based models assist the prediction of pulmonary embolism in autoimmune diseases: A retrospective, multicenter study
Authors: Hu Ziwei , Hu Yangyang , Zhang Shuoqi , Dong Li , Chen Xiaoqi , Yang Huiqin , Su Linchong , Hou Xiaoqiang , Huang Xia , Shen Xiaolan , Ye Cong , Tu Wei , Chen Yu , Chen Yuxue , Cai Shaozhe , Zhong Jixin , Dong Lingli 
Published: June 2024

Abstract

Background:
Pulmonary embolism (PE) is a severe and acute cardiovascular syndrome with high mortality among patients with autoimmune inflammatory rheumatic diseases (AIIRDs). Accurate prediction and timely intervention play a pivotal role in enhancing survival rates. However, there is a notable scarcity of practical early prediction and risk assessment systems of PE in patients with AIIRD.

Methods:
In the training cohort, 60 AIIRD with PE cases and 180 age-, gender-, and disease-matched AIIRD non-PE cases were identified from 7254 AIIRD cases in Tongji Hospital from 2014 to 2022. Univariable logistic regression (LR) and least absolute shrinkage and selection operator (LASSO) were used to select the clinical features for further training with machine learning (ML) methods, including random forest (RF), support vector machines (SVM), neural network (NN), logistic regression (LR), gradient boosted decision tree (GBDT), classification and regression trees (CART), and C5.0 models. The performances of these models were subsequently validated using a multicenter validation cohort.

Results:
In the training cohort, 24 and 13 clinical features were selected by univariable LR and LASSO strategies, respectively. The five ML models (RF, SVM, NN, LR, and GBDT) showed promising performances, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.962–1.000 in the training cohort and 0.969–0.999 in the validation cohort. CART and C5.0 models achieved AUCs of 0.850 and 0.932, respectively, in the training cohort. Using D-dimer as a pre-screening index, the refined C5.0 model achieved an AUC exceeding 0.948 in the training cohort and an AUC above 0.925 in the validation cohort. These results markedly outperformed the use of D-dimer levels alone.

Conclusion:
ML-based models are proven to be precise for predicting the onset of PE in patients with AIIRD exhibiting clinical suspicion of PE.

Trial Registration:

Chictr.org.cn: ChiCTR2200059599.
Clinical research report on traditional Chinese patent medicines and traditional Chinese classic famous prescriptions (2022)
Authors: Wang Danlei , Shi Menglong , Hu Haiyin , Ma Yucong , Peng Dehui , Zhang Junhua , Fauci Alice Josephine , Ji Zhaochen 
Published: June 2024

Objective:
The paper is to comprehensively summarize and analyze the basic situation and methodological quality of clinical randomized controlled trials (RCTs) of traditional Chinese patent medicines and traditional Chinese classic famous prescriptions published in 2022, to provide evidence and reasonable suggestions for the advancement of clinical research and the formulation of policies and guidelines.

Methods:
The Evidence Database System of clinical evidence-based evaluation of traditional Chinese medicine was searched, and data from China National Knowledge Infrastructure (CNKI), PubMed, and other databases were supplemented. The search duration was from January 1, 2022, to December 31, 2022. RCTs of traditional Chinese patent medicines and traditional Chinese classic famous prescriptions were included as the source of clinical evidence, and published information, sample size, intervention, control measures, treatment course, methodological quality, and key link report were analyzed and evaluated.

Results:
A total of 1,464 RCTs of traditional Chinese patent medicines were included, which comprised 667 types of traditional Chinese patent medicines; “traditional Chinese patent medicines + Western medicine vs. Western medicine” was the most widely used intervention and control setting, involving 417 RCTs (28.48%). A total of 245 RCTs of traditional Chinese classic famous prescriptions were included, comprising 55 types of traditional Chinese classic famous prescriptions. “Decoction + conventional treatment vs. conventional treatment” was the most widely used intervention and control setting, with 87 RCTs (35.51%). Published RCTs on traditional Chinese patent medicines and traditional Chinese classic famous prescriptions were limited by the study design and implementation. Most “allocation concealment” and “blinding of patients and personnel” were rated as medium to high risk. There are insufficient reports on key research links such as experimental registration and ethical approval.

Conclusions:
The number of RCTs on traditional Chinese patent medicines has decreased in 2022, but there has been a slight improvement in the research quality and impact. There are relatively few studies on traditional Chinese classic famous prescriptions. Measures must be taken to improve clinical trial design, implementation, and reporting. Methodological experts should be invited to provide professional technical guidance on the trial design. In the research implementation process, attention should be paid to quality control, particularly the standardization of the randomized execution.
Application of radiomics for preoperative prediction of lymph node metastasis in colorectal cancer: a systematic review and meta-analysis
Authors: Abbaspour Elahe , Karimzadhagh Sahand , Monsef Abbas , Joukar Farahnaz , Mansour-Ghanaei Fariborz , Hassanipour Soheil 
Published: June 2024

Background:
Colorectal cancer (CRC) stands as the third most prevalent cancer globally, projecting 3.2 million new cases and 1.6 million deaths by 2040. Accurate lymph node metastasis (LNM) detection is critical for determining optimal surgical approaches, including preoperative neoadjuvant chemoradiotherapy and surgery, which significantly influence CRC prognosis. However, conventional imaging lacks adequate precision, prompting exploration into radiomics, which addresses this shortfall by converting medical images into reproducible, quantitative data.

Methods:
Following PRISMA, Supplemental Digital Content 1 (http://links.lww.com/JS9/C77) and Supplemental Digital Content 2 (http://links.lww.com/JS9/C78), and AMSTAR-2 guidelines, Supplemental Digital Content 3 (http://links.lww.com/JS9/C79), we systematically searched PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar databases until 11 January 2024, to evaluate radiomics models’ diagnostic precision in predicting preoperative LNM in CRC patients. The quality and bias risk of the included studies were assessed using the Radiomics Quality Score (RQS) and the modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Subsequently, statistical analyses were conducted.

Results:
Thirty-six studies encompassing 8039 patients were included, with a significant concentration in 2022–2023 (20/36). Radiomics models predicting LNM demonstrated a pooled area under the curve (AUC) of 0.814 (95% CI: 0.78–0.85), featuring sensitivity and specificity of 0.77 (95% CI: 0.69, 0.84) and 0.73 (95% CI: 0.67, 0.78), respectively. Subgroup analyses revealed similar AUCs for CT and MRI-based models, and rectal cancer models outperformed colon and colorectal cancers. Additionally, studies utilizing cross-validation, 2D segmentation, internal validation, manual segmentation, prospective design, and single-center populations tended to have higher AUCs. However, these differences were not statistically significant. Radiologists collectively achieved a pooled AUC of 0.659 (95% CI: 0.627, 0.691), significantly differing from the performance of radiomics models (P<0.001).

Conclusion:
Artificial intelligence-based radiomics shows promise in preoperative lymph node staging for CRC, exhibiting significant predictive performance. These findings support the integration of radiomics into clinical practice to enhance preoperative strategies in CRC management.
Comparing upfront surgery with neoadjuvant treatments in patients with resectable, borderline resectable or locally advanced pancreatic cancer: a systematic review and network meta-analysis of randomized clinical trials
Authors: He Jiaxin , Lv Na , Yang Zhenyi , Luo Yixuan , Zhong Wen , Wu Chunli 
Published: June 2024

Background:
The aim was to explore the optimal neoadjuvant therapy strategy for resectable, borderline resectable, and locally advanced pancreatic cancer, in order to provide a theoretical basis for the development of new neoadjuvant treatment protocols for clinical use.

Patients and methods:
The authors reviewed literature titles and abstracts comparing three treatment strategies (neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy, and upfront surgery) in PubMed, Embase, The Cochrane Library, Web of Science from 2009 to 2023 to estimate relative odds ratios for resection rate and hazard ratios (HRs) for overall survival (OS) in all include trials.

Results:
A total of nine studies involving 889 patients were included in the analysis. The treatment methods included upfront surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy followed by surgery. The network meta-analysis results demonstrated that neoadjuvant chemoradiotherapy followed by surgery was an effective approach in improving OS for resectable and borderline resectable pancreatic cancer (RPC) patients compared to upfront surgery (HR: 0.79, 95% CI: 0.64–0.98) and neoadjuvant chemotherapy (HR: 0.79, 95% CI: 0.64–0.98). Additionally, neoadjuvant chemoradiotherapy significantly increased the margin negative resection (R0) rate and pathological negative lymph node (pN0) rate in patients with resectable and borderline RPC. However, it is worth noting that neoadjuvant chemoradiotherapy increased the risk of grade 3 or higher treatment-related adverse events, including in patients with locally advanced pancreatic cancer.

Conclusions:
The current evidence suggests that neoadjuvant chemoradiotherapy followed by surgery is the optimal choice for treating patients with resectable and borderline RPC. Future research should focus on optimizing neoadjuvant chemoradiotherapy regimens to effectively improve OS while reducing the occurrence of adverse events.
Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System
Authors: Mani Vivitha , Banaag Amanda , Miura Sarah Selica T. , Munigala Satish , Coles Christian L. , Schoenfeld Andrew J. , Koehlmoos Tracey Pèrez 
Published: June 2024

Purpose:
PSA testing is the primary method of screening for prostate cancer, although recommendations are varied. The COVID-19 pandemic diverted resources away from preventive screenings. We sought to examine alterations in PSA screening among TRICARE beneficiaries in the Military Health System (MHS) over the course of the pandemic.

Materials and Methods:
Using data from the MHS Data Repository, we executed a retrospective open cohort study of male TRICARE Prime beneficiaries aged 40 to 64 years during fiscal years 2018 to 2022. The study period was separated into 3 subperiods: prepandemic (October 1, 2017-February 28, 2020), early pandemic (March 1, 2020-September 30, 2020), and late pandemic (October 1, 2020-September 30, 2022).

Results:
We found a 73% reduction in PSA screenings in the early pandemic and 14% decrease in the late pandemic compared with prepandemic rates. Compared with White men aged 50 to 54 years, men younger than 50 years in all racial groups were less likely to receive screening. In both pandemic periods, all racial groups, except for Black men, were overall more likely than White men to receive screening. Men were more likely to seek PSA screening in the private sector during the pandemic compared with prepandemic times (early pandemic: 1.21 RR, 1.20-1.22 95% confidence interval [CI]; late pandemic: 1.20 RR, 1.19-1.20 95% CI).

Conclusions:
We found significant reductions in PSA screening over the course of the COVID-19 pandemic among TRICARE beneficiaries. While disparities appear less pronounced when compared with other preventive testing, targeted outreach is still necessary for certain sociodemographic groups.
Impact of Androgen Deprivation Therapy on Lumbar Spine Bone Health Using Quantitative Computed Tomography in a Propensity-Matched Cohort of Patients With Prostate Cancer
Authors: Sato Mototaka , Kashii Masafumi , Maekawa Takahiro , Mori Shunsuke , Umeda Shun , Kujime Yuma , Matsushita Makoto , Kamido Satoshi , Ueda Norichika , Nakayama Jiro , Tei Norihide , Miyake Osamu 
Published: June 2024

Purpose:
Fragility fracture risk in patients with prostate cancer is an important issue. The purpose of this study was to accurately assess the impact of androgen deprivation therapy on lumbar spine bone loss using quantitative computed tomography in a propensity-matched cohort of patients with prostate cancer.

Materials and Methods:
Eighty-one patients with prostate cancer who underwent androgen deprivation therapy for 1 year were included. Thirty-nine of these patients were successfully propensity-matched with 39 of 68 patients from a control group who underwent robot-assisted radical prostatectomy without androgen deprivation therapy. Volumetric bone mineral density of trabecular bone in each vertebral body (L1-L4) was measured using quantitative computed tomography during staging and at 1 year after commencing treatment. The change in mean lumbar volumetric bone mineral density (L1-L4) was then calculated.

Results:
Propensity score matching successfully achieved comparable baseline patient characteristics and radiological parameters between the androgen deprivation therapy and control groups. In the androgen deprivation therapy group, the decrease in lumbar volumetric bone mineral density (L1-L4) was significantly greater with confirmed testosterone deficiency (−17.9 ± 12.0%) compared with the control group (−8.5 ± 10.8%, P < .001).

Conclusions:
This study observed a 17.9% reduction in volumetric lumbar bone mineral density (g/cm3) after 1 year of androgen deprivation therapy, exceeding previously reported values (g/cm2) obtained using dual-energy X-ray absorptiometry. The potential overestimation of lumbar spine bone mineral density measured by dual-energy X-ray absorptiometry in older patients with prostate cancer because of concomitant lumbar degenerative disease is a possible reason for this discrepancy. Androgen deprivation therapy may decrease vertebral bone mass and increase the risk of vertebral fractures more than urologists realize.
Speech Perception and Quality-of-Life Outcomes in Mandarin-Speaking Postlingual Deaf Adults With Cochlear Implant: Any Difference With the Intonation Language Users?
Authors: Ho Pei-Hsuan , Huang Po-Kai , Chen Pey-Yu , Chu Chia-Huei , Hsu Hsiao-Man , Chen Xiang-Xiang , Lin Hung-Ching 
Published: June 2024

Objective
To evaluate the effects of related factors on long-term speech perception and quality-of-life (QoL) outcomes in postlingual deaf Mandarin-speaking adult cochlear implant (CI) recipients and to assess any differences between tone language and other intonation language CI adult users.

Study Design
Retrospective cases review

Setting
Tertiary referral center

Patients
Forty-five adult CI recipients (48 implanted ears).

Main Outcome Measures
Post-CI outcomes were evaluated after follow-ups of more than 24 months using speech perception tests and QoL questionnaires. We analyzed the related factors affecting CI outcomes.

Results
A shorter duration of profound deafness was predictive factors for better post-CI speech perception. Earlier implantation and better performance of vowel scores were predictive of better subjective improvements in social and emotional life. Post-CI vowel scores of over 56% indicated promising improvements in QoL.

Conclusion
Shorter duration of deafness could have better post-CI speech perception. Post-CI vowel scores instead of monosyllable words have the more potential to predict the QoL in Mandarin-speaking adult CI recipients.
Remote Delivery of Vestibular Rehabilitation for Vestibular Dysfunction: A Systematic Review
Authors: Perez-Heydrich Carlos A. , Creary-Miller Ilahi , Spann Marcus , Agrawal Yuri 
Published: June 2024

Background
People with vestibular dysfunction encounter many obstacles when seeking vestibular rehabilitation treatment. Remote delivery of vestibular rehabilitation may offer a promising avenue for overcoming these barriers, ensuring uninterrupted and cost-effective care.

Objective
To evaluate clinical trials studying telerehabilitation and virtual reality devices as therapeutic interventions for individuals with vestibular dysfunction.

Methods
A PRISMA systematic review of PubMed, EMBASE, Cochrane, Web of Science, and SCOPUS was conducted for randomized controlled trials describing the use of remote care delivery for vestibular rehabilitation. Bias of studies was assessed with the revised Cochrane risk-of-bias tool (RoB2).

Results
The search identified 1,358 unique articles and 14 articles matched the search criteria. Study samples size ranged from 20 to 337, with mean ages ranging from 29.3 to 77.7 years. Interventions included telephone and online communication, exergaming devices, web-based applications, and head-mounted devices to deliver vestibular rehabilitation. Outcomes included validated questionnaires, objective clinical tests, and physical examinations.

Conclusions
The studies reviewed in this article reported greater or equivalent outcomes when incorporating remote care options as supplements or alternatives to standard care for patients with vestibular dysfunction. Further research is required to address limitations in these studies such as heterogeneity of control groups and cost-effectiveness of these interventions.