bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Urgency, Patient Comorbidities, and Socioeconomic Factors in Surgical Site Infections in Pediatric Surgery
Authors: Quintero Luis Alejandro , Hernandez Jennifer , Orduno Villa Nancy , Romero Dino , Spector Chelsea , Ngo Lisa , Shatawi Zaineb , Levene Tamar , Lao Oliver , Parreco Joshua P. 
Published: June 2024

Background The rise of value-based purchasing has led to decreased compensation for hospital-acquired conditions, including surgical site infections (SSI). This study aims to assess the risk factors for SSI in children and teenagers undergoing gastrointestinal surgery across US hospitals. Methods The 2018-2020 Nationwide Readmissions Database was queried for patients undergoing gastrointestinal surgery under the age of 18. The primary outcome was SSI during index admission or readmission within a year. Comparison groups were elective, trauma, and emergent surgery based on anatomic location and urgency. Univariable comparison used chi-squared tests for relevant variables. Confounders were addressed through multivariable logistic regression with significant variables from univariable analysis. Results 113 108 total patients met the study criteria. The SSI rate during admission or readmission was 2.9% (n = 3254). Infections during admission and readmission were 1.4% (n = 1560) and 1.5% (n = 1694), respectively. The most common site was organ space (48.6%, n = 1657). Increased infection risk was associated with trauma (OR 1.80 [1.51-2.16] P < .001), emergency surgery (OR 1.31 [1.17-1.47] P < .001), large bowel surgery (OR 2.78 [2.26-3.43] P < .001), and those with three or more comorbidities (OR 2.03 [1.69-2.45] P < .001). Investor-owned hospitals (OR .65 [.56-.76] P < .001) and highest quartile income (OR .80 [.73-.88] P < .001) were associated with decreased infection risk. Conclusions Pediatric patients undergoing gastrointestinal surgery face an elevated risk of SSI, especially in trauma and emergency surgeries, particularly with multiple comorbidities. Meanwhile, a reduced risk is observed in high-income and investor-owned hospital settings. Hospitals and surgeons caring for high risk patients should advocate for risk adjustment in value-based payment systems.
The Long-Term Results of Proximal Gastrectomy for Proximal Gastric Cancer: A Propensity Score Matching Analysis Based on SEER Database
Authors: Dai Wei , Wen Feng , Li Xiang , Fu Zhongxue 
Published: June 2024

Background Proximal gastrectomy (PG) is one of function‐preserving gastrectomy (FPG). In this study, we compared the long-term results of proximal gastric cancer (PGC) patients undergoing proximal gastrectomy and total gastrectomy (TG). Method Patients diagnosed with PGC and receiving PG or TG between 2004 and 2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was applied to minimize confounding factors. Kaplan-Meier analysis and log-rank test were used to compare overall survival (OS) and cancer-specific survival (CSS) between the PG and TG groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS. Result A total of 3916 patients were recruited according to the inclusion and exclusion criteria, with 2614 undergoing PG and 1302 undergoing TG. After 1:1 PSM matching, 912 pairs of data were included for analysis. Before PSM matching, PG group tended to have better OS and CSS outcomes. However, after PSM matching, both surgical approaches showed similar long-term results. Conclusion PG for PGC yields comparable long-term outcomes to TG and demonstrates safety in terms of oncologic outcomes.
Needs assessment and patient-guided development of a video-based diabetic retinopathy patient education tool
Authors: Ahmed Osama M , Applebaum Serina S , Ahmad Maham , Ahmed Danya M , Juthani Prerak , Nwanyanwu Kristen 
Published: June 2024

Objective: To gain retina physicians’ and diabetic retinopathy (DR) patients’ perspectives on needs and opportunities in DR education, and then develop and pilot test an educational video. Design: This study utilised qualitative interview data for video creation, and interview and survey data for assessment. Setting: This study was conducted in a single large academic medical centre. Method: We conducted semi-structured interviews with attending retina physicians and DR patients (Cohort A) which were coded for themes about needs in DR patient education. Using these interviews, we designed and piloted a 6-minute user-centred animated video among a second patient cohort (Cohort B), who completed post-intervention interviews. Results: Four physicians and 14 DR patients participated in the study. Themes from Cohort A included accessible information, early management, lifestyle factors and emotional context. Physician themes included effective communication, visual information delivery and individual-level diabetes management. Cohort B commented on the subsequently created video’s improved accessibility, engagement and supplementation of their existing DR knowledge. Conclusion: Physicians and patients showed an interest in video education and identified unique educational needs. We used these insights to create a video that demonstrated positive patient uptake. Close attention to retina physicians’ and DR patients’ perspectives can offer a valuable approach in developing materials to increase patients’ health knowledge. Within the context studied, videos may be more accessible and engaging than the use of traditional print-based education materials.
Comparing the accuracy of four machine learning models in predicting type 2 diabetes onset within the Chinese population: a retrospective study
Authors: Liu Hongzhou , Dong Song , Yang Hua , Wang Linlin , Liu Jia , Du Yangfan , Liu Jing , Lyu Zhaohui , Wang Yuhan , Jiang Li , Yu Shasha , Fu Xiaomin 
Published: June 2024

Objective To evaluate the effectiveness of machine learning (ML) models in predicting 5-year type 2 diabetes mellitus (T2DM) risk within the Chinese population by retrospectively analyzing annual health checkup records. Methods We included 46,247 patients (32,372 and 13,875 in training and validation sets, respectively) from a national health checkup center database. Univariate and multivariate Cox analyses were performed to identify factors influencing T2DM risk. Extreme Gradient Boosting (XGBoost), support vector machine (SVM), logistic regression (LR), and random forest (RF) models were trained to predict 5-year T2DM risk. Model performances were analyzed using receiver operating characteristic (ROC) curves for discrimination and calibration plots for prediction accuracy. Results Key variables included fasting plasma glucose, age, and sedentary time. The LR model showed good accuracy with respective areas under the ROC (AUCs) of 0.914 and 0.913 in training and validation sets; the RF model exhibited favorable AUCs of 0.998 and 0.838. In calibration analysis, the LR model displayed good fit for low-risk patients; the RF model exhibited satisfactory fit for low- and high-risk patients. Conclusions LR and RF models can effectively predict T2DM risk in the Chinese population. These models may help identify high-risk patients and guide interventions to prevent complications and disabilities.
Procalcitonin and C-reactive protein as early predictors in patients at high risk of colorectal anastomotic leakage
Authors: Hu Yilong , Ren Junjie , Lv Zhixin , Liu He , Qiu Xiewu 
Published: June 2024

Objective To assess the diagnostic value of C-reactive protein (CRP) and procalcitonin (PCT) for anastomotic leakage (AL) following colorectal surgery. Methods We retrospectively analyzed data for patients who underwent colorectal surgery at our hospital between November 2019 and December 2023. CRP and PCT were measured postoperatively to compare patients with/without AL, and changes were compared between low- and high-risk groups. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic accuracy of CRP and PCT to identify AL in high-risk patients. Results Mean CRP was 142.53 mg/L and 189.57 mg/L in the low- and high-risk groups, respectively, on postoperative day (POD)3. On POD2, mean PCT was 2.75 ng/mL and 8.16 ng/mL in low- and high-risk patients, respectively; values on POD3 were 3.53 ng/mL and 14.86 ng/mL, respectively. The areas under the curve (AUC) for CRP and PCT on POD3 were 0.71 and 0.78, respectively (CRP cut-off: 235.64 mg/L; sensitivity: 96%; specificity: 89.42% vs PCT cut-off: 3.94 ng/mL; sensitivity: 86%; specificity: 93.56%; AUC: 0.78). The AUC, sensitivity, and specificity for the combined diagnostic ability of CRP and PCT on POD3 were 0.92, 90%, and 100%, respectively (cut-off: 0.44). Conclusions Combining PCT and CRP on POD3 enhances the diagnostic accuracy for AL.
Association of physical performance with cognitive impairment in middle-aged to older haemodialysis patients: a multicentre cross-sectional observational study
Authors: Xu Jia , Zhao Xinhui , Guo Qi , Yu Cheng , Ding Wei , Niu Jianying , Zhao Junli , Zhang Liming , Zhang Suhua , Qi Hualin , Xi Minhui 
Published: June 2024

Objective To determine the prevalence of cognitive impairment (CI) among middle-aged to older patients receiving maintenance haemodialysis (MHD) and to investigate the potential association between CI and physical performance. Methods This cross-sectional observational study enrolled participants aged 55–85 years who received MHD. Cognitive status was assessed using the Mini Mental State Examination (MMSE). Physical performance was measured by hand grip strength, the Timed Up and Go Test (TUGT) and the 4-m walking speed. Sociodemographic, clinical and laboratory parameters were recorded for each patient. Results The study included 592 patients (363 males); and of these, 126 (21.3%) were diagnosed with CI. Compared with patients with normal cognitive function, those with CI were significantly older and had significantly longer dialysis duration, lower educational level, higher Malnutrition Inflammation Score, higher depression and higher Charlson Comorbidity Index score. After adjustment for covariates, multiple regression analysis suggested that grip strength (odds ratio [OR] = 0.959, 95% confidence interval [CI] = 0.924, 0.996) and 4-m walking speed (OR = 0.161, 95% CI = 0.070, 0.368) were protective factors. TUGT (OR = 1.037, 95%CI = 1.003, 1.071) was a risk factor. Conclusion Physical performance was correlated with CI and might be a significant indicator for the early identification of CI in middle-aged to older MHD patients.
The Phenytoin Ataxia Enigma Unveiled “A Case Report’’
Authors: Khadela Avinash , Dave Bhavarth , Premal Yatvi , Patel Nishi , Sadhwani Devang 
Published: June 2024

Background: Phenytoin (PHT) has been approved for the treatment of epilepsy. It belongs to the category of medications with a limited therapeutic window and requires therapeutic drug monitoring (TDM). PTH has been observed to induce a variety of Adverse drug reactions (ADRs) including ataxia, dystonia, nystagmus, dyskinesia, etc. Phenytoin-induced ataxia is an uncommonly observed ADR of Phenytoin whose reports are extremely limited. Case: Herein, we present a case report of a 16-year-old Asian patient with a past history of epilepsy that was admitted to a tertiary care hospital due to the development of ataxia, giddiness, and vomiting when taking Phenytoin in addition to Oxcarbazepine, Clobazam, and Levetiracetam to treat seizures. On admission, Magnetic resonance imaging (MRI) findings revealed bilateral variable cerebrospinal fluid (CSF) lesions in the parieto-occipital region of the periventricular area (periventricular leukomalacia). Additionally, serum Phenytoin levels were observed to be in the toxic range (40 μg/mL) due to which physicians confirmed the ADR to be due to Phenytoin toxicity. Thus, the Phenytoin drug was discontinued in the patient gradually and he was continued on clobazam, oxcarbazepine, and brivaracetam which led to reversal of the ADR in the patient. Conclusion: In this case, ataxia resulted from Phenytoin overdose, as confirmed by MRI and serum tests suggesting that TDM of Phenytoin is essential to prevent ADRs. Given the scarcity of ataxia cases caused by Phenytoin, awareness is lacking within the scientific community. Our aim is to provide insights to promote better monitoring and patient-centered treatment outcomes for epileptic patients.
Cleft lip Sidedness and the Association with Additional Congenital Malformations
Authors: Fell Matthew , Fitzsimons Kate J. , Hamilton Mark J. , Medina Jibby , Butterworth Sophie , Park Min Hae , Van der Meulen Jan , Lewis Sarah , Chong David , Russell Craig JH 
Published: June 2024

Objective To investigate the association between the sidedness of orofacial clefts and additional congenital malformations. Design Linkage of a national registry of cleft births to national administrative data of hospital admissions Setting National Health Service, England Participants 2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012. Main outcome measure The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts. Results For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; P = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; P = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; P < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; P < .001). Conclusions The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.
Understanding the Quality of Life Among Patients With Cancer in Saudi Arabia: Insights From a Cross-Sectional Study
Authors: Aljawadi Mohammad H. , Alkhudair Nora , Alrasheed Marwan , Alsuhaibani Abdulaziz S. , Alotaibi Basil J. , Almuqbil Mansour , Alhammad Abdullah M. , Arafah Azhar , AlGahtani Farjah H. , Rehman Muneeb U. 
Published: June 2024

Introduction Cancer patients’ quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients’ experience. This study measures the OoL among patients with cancer and influencing factors. Methods A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported. Results Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning ( P = .016 and .03) and experienced more significant financial impact ( P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others ( P = .0127). Patients traveling long distances were more likely to face adverse financial consequences ( P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05). Conclusion Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.
Efficacy and Safety of Rivaroxaban Versus Enoxaparin in Prevention of Recurrence of Venous Thrombo-Embolism Events in Cancer Patients: A Meta-Analysis
Authors: Awan Abdul Rafeh , Ahmad Abdullah , Daniyal Muhammad , Khan Malik Muhammad Hamza , Saeed Shaikh Jehanzaib , Siddiqui Muhammad Bilal , Hakeem Sheraz , Shahab Azka , Ali Syed Hasham , Siddiqi Ahmed Kamal 
Published: June 2024

Objective To examine the effectiveness of rivaroxaban compared to enoxaparin in patients diagnosed with cancer and venous thromboembolism. Methods A search of Pub Med, Scopus, and Google Scholar, from inception through April 2023 was conducted. Articles comparing rivaroxaban with enoxaparin in patients with cancer and VTE/PE/DVT were included. Review Manager Version 5.2 was utilised for the analysis of the following outcomes; VTE, PE, DVT, major bleeding, and mortality. Results A total of 8 articles and 2276 patients were included in the final analysis. Pooled analysis showed that rivaroxaban had a statistically insignificant reduced association with VTE occurrence (RR:0.83, 95% CI:0.58–1.18, P:0.3) as well as a statically insignificant reduction in major bleeding (RR:0.79, 95% CI:0.53–1.18, P:0.25). Analysis showcased that there was an insignificant reduction of mortality rivaroxaban as compared to enoxaparin (RR:0.74, 95% CI: 0.46–1.20, P:0.23). Conclusion Rivaroxaban can serve as a viable alternative to enoxaparin, with no appreciable drawbacks, for preventing and managing VTE in patients with malignancy.
A Practical Nomogram for Predicting the Bleeding Risk in Patients with a History of Myocardial Infarction Treating with Aspirin
Authors: Jing Jin , Wanling Lei , Maofeng Wang 
Published: June 2024

Background Aspirin is a widely used antiplatelet medication to prevent blood clots, reducing the risk of cardiovascular event. Healthcare providers need to be mindful of the risk of aspirin-induced bleeding and carefully balancing its benefits against potential risks. The objective of this study was to create a practical nomogram for predicting bleeding risk in patients with a history of myocardial infarction treating with aspirin. Methods A total of 2099 myocardial infarction patients with aspirin were enrolled. The patients were randomly divided into two groups, with a 7:3 ratio, for model development and internal validation. Boruta analysis was utilized to identify clinically significant features associated with bleeding. Logistic regression model based on independent bleeding risk factors was constructed and presented as a nomogram. Model performance was assessed from three aspects: identiﬁcation, calibration, and clinical utility. Results Boruta analysis identified eight clinical features from 25, and further multivariate logistic regression analysis selected four independent risk factors: hemoglobin, platelet count, previous bleeding, and sex. A visual nomogram was created based on these variables. The model achieved an area under the curve of 0.888 (95% CI: 0.845-0.931) in the training dataset and 0.888 (95% CI: 0.808-0.968) in the test dataset. Calibration curve analysis showed close approximation to the ideal curve. Decision curve analysis demonstrated favorable clinical net benefit for the model. Conclusions Our study focused on creating and validating a model to evaluate bleeding risk in patients with a history of myocardial infarction treated with aspirin, which demonstrated outstanding performance in discrimination, calibration, and net clinical benefit.
Semi-active yaw dampers in locomotive running gear: New control algorithms and verification of their stabilising effect
Authors: Jeniš Filip , Michálek Tomáš , Kubík Michal , Hába Aleš , Strecker Zbyněk , Žáček Jiří , Mazůrek Ivan 
Published: June 2024

It is generally accepted that semi-actively (S/A) controlled dampers can significantly improve the behaviour of a road or rail vehicle. In the case of a railway vehicle, it is possible to increase comfort using S/A control of vertical or lateral secondary dampers. On another way, S/A control offers the possibility of solving a contradiction in the damping requirements for different driving modes, in the case of control of bogie yaw dampers. However, this case has not yet been sufficiently investigated. This paper deals with applying magnetorheological dampers with semi-active control in the locomotive bogie to reduce hunting oscillation. The magnetorheological bogie yaw damper design, new algorithms for its control and application on a complex multi-body locomotive model that simulates fast running on a real straight track are shown. An essential part of the paper focuses on the effect of the damping force level and damper force transient response time. The results have shown that using the semi-active control of the yaw dampers makes it possible to reduce vehicle body lateral oscillation by 60% and improve running stability for higher equivalent conicity and subcritical speed. The critical speed can be increased by more than 250 km/h. The efficiency of the proposed semi-active control increases with increasing damping force level and decreasing transient response time. The control is most effective under conditions of low equivalent conicity.
Outcome and safety of mechanical thrombectomy in patients with acute ischemic stroke due to internal carotid artery dissection
Authors: Puggaard Rikke , Laugesen Nicolaj Grønbæk , Hansen Klaus , Brandt Andreas H. , Stavngaard Trine , Truelsen Thomas C. 
Published: June 2024

Background Mechanical thrombectomy (MT) in patients with symptoms of acute ischemic stroke (AIS) due to internal carotid artery dissection (ICAD) remains controversial. In this study, we present clinical outcome and safety of MT in acute ICAD compared to other acute carotid artery pathology. Methods Patients with symptoms of AIS due to internal carotid artery pathology, treated with MT from 2017–2021, were categorized as ICAD or non-ICAD. Baseline and procedural characteristics, complications, and functional outcome at 90 days were compared between the two groups. Factors associated with a favorable outcome (modified Rankin Scale 0–2) were analyzed using multivariate logistic regression. Safety analyses included in-stent thrombosis, perforation, intracranial hemorrhage, and mortality. Results Sixty-seven ICAD patients (14.8%) and 387 non-ICAD patients (85.2%) were enrolled. ICAD patients were younger, median age 53 years (interquartile range (IQR) 47–61) vs. non-ICAD 72 years (IQR 64–79), p < 0.001. Favorable outcome was more common in ICAD patients, 49 ICAD patients (76.6%) vs. 158 non-ICAD patients (42.4%), p < 0.001. Post-procedural symptomatic intracranial hemorrhage occurred in 41 patients, 5 (7.5%) ICAD patients vs. 36 (9.3%) non-ICAD patients, p = 0.6. Mortality differed significantly, 6 (9%) ICAD patients vs. 94 (24.3%) non-ICAD patients, p = 0.01. ICAD was not associated with functional outcome in multivariate analysis, OR = 1.25 [95%confidence interval:0.55–2.86]. Conclusion ICAD patients achieved a better 90-day functional outcome compared with non-ICAD patients. ICAD patients did not perform worse in safety measures than non-ICAD patients. Our data provide indirect evidence that MT is of clinical benefit in ICAD patients with symptoms of AIS.