bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consensus on resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian (pre-hospital) trauma care: a Delphi study
Authors: van de Voort Jan C. , Kessel Boris , Borger van der Burg Boudewijn L.S. , DuBose Joseph J. , Hörer Tal M. , Hoencamp Rigo 
Published: January 2024

ABSTRACT

Background
REBOA could prevent lethal exsanguination and support cardiopulmonary resuscitation. In pre-hospital trauma and medical emergency settings, a small population with high mortality rates could potentially benefit from early REBOA deployment. However, its use in these situations remains highly disputed. Since publication of the first Delphi study on REBOA, in which consensus was not reached on all addressed topics, new literature has emerged. Aim of this study was to establish consensus on the use and implementation of REBOA in civilian pre-hospital settings for non-compressible truncal hemorrhage and out-of-hospital cardiac arrest as well as for various in-hospital settings.

Methods
A Delphi study consisting of three rounds of questionnaires was conducted based on a review of recent literature. REBOA-experts with different medical specialties, backgrounds and work environments were invited for the international panel. Consensus was reached when a minimum of 75% of panelists responded to a question and at least 75% (positive) or less than 25% (negative) of these respondents agreed on the questioned subject.

Results
Panel members reached consensus on potential (contra-)indications, physiological thresholds for patient selection, the use of ultrasound and practical, and technical aspects for early femoral artery access and pre-hospital REBOA.

Conclusion
The international expert panel agreed that REBOA can be used in civilian pre-hospital settings for temporary control of non-compressible truncal hemorrhage, provided that personnel are properly trained and protocols are established. For pre-hospital REBOA and early femoral artery access, consensus was reached on (contra-) indications, physiological thresholds and practical aspects. The panel recommends the initiation of a randomized clinical trial investigating the use of pre-hospital REBOA for non-compressible truncal hemorrhage.

Level of evidence
Delphi study (original research, care management), level 5
Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients
Authors: Smida Tanner , Bonasso Patrick , Bardes James , Price Bradley S. , Seifarth Federico , Gurien Lori , Maxson Robert , Letton Robert 
Published: January 2024

BACKGROUND
Timely identification of high-risk pediatric trauma patients and appropriate resource mobilization may lead to improved outcomes. We hypothesized that reverse shock index times the motor component of the Glasgow Coma Scale (GCS) (rSIM) would perform equivalently to reverse shock index times the total GCS (rSIG) in the prediction of mortality and the need for intervention following pediatric trauma.

METHODS
The 2017–2020 National Trauma Data Bank data sets were used. We included all patients 16 years or younger who had a documented prehospital and trauma bay systolic blood pressure, heart rate, and total GCS. We excluded all patients who arrived at the trauma center without vital signs and interfacility transport patients. Receiver operating characteristic curves were used to model the performance of each metric as a classifier with respect to our primary and secondary outcomes, and the area under the receiver operating characteristic curve (AUROC) was used for comparison. Our primary outcome was mortality before hospital discharge. Secondary outcomes included blood product administration or hemorrhage control intervention (surgery or angiography) <4 hours following hospital arrival and intensive care unit admission.

RESULTS
After application of exclusion criteria, 77,996 patients were included in our analysis. Reverse shock index times GCS-motor and rSIG performed equivalently as predictors of mortality in the 1- to 2- (p = 0.05) and 3- to 5-year-old categories (p = 0.28), but rSIM was statistically outperformed by rSIG in the 6- to 12- (AUROC, 0.96 vs. 0.95; p = 0.04) and 13- to 16-year-old age categories (AUROC, 0.96 vs. 0.95; p < 0.01). Reverse shock index times GCS-motor and rSIG also performed similarly with respect to prediction of secondary outcomes.

CONCLUSION
Reverse shock index times GCS-total and rSIM are both outstanding predictors of mortality following pediatric trauma. Statistically significant differences in favor of rSIG were noted in some age groups. Because of the simplicity of calculation, rSIM may be a useful tool for pediatric trauma triage.

LEVEL OF EVIDENCE
Diagnostic Tests or Criteria; Level III.
Pediatric thoracic cage fractures—Mind the sternum: A retrospective analysis of the ACS-TQIP database
Authors: di Natale Anthony , Mak Allison L. , Hwang Rosa , Allukian Myron , Nace Gary W. , Nance Michael L. 
Published: January 2024

BACKGROUND
The thoracic cage is an anatomical entity formed by the thoracic spine, ribs, and sternum. As part of this osteoligamentous complex, the sternum contributes substantially to the stability of the thoracic spine. This study investigates the influence of a concomitant sternal fracture (SF) on the treatment and hospital course of pediatric patients with a thoracic vertebral fracture (TVF).

METHODS
The Trauma Quality Improvement Program data sets from 2016 to 2020 were reviewed. Patients aged 0 year to 19 years with TVF with or without SF following blunt trauma were identified using the Abbreviated Injury Scale codes and selected for further data collection. Patients with transverse or spinous process fractures or incomplete data were excluded. Data collected included demographics, mechanisms of injury, clinical variables, procedures, intensive care unit admission and length of stay, total length of stay and in-hospital mortality. Continuous variables were analyzed with Wilcoxon rank sum test, categorical variables with χ2 test.

RESULTS
A total of 13,434 patients were identified, of which 10,292 had isolated TVF (TVF), 788 TVF and concomitant SF (TVF + SF), 2,225 isolated SF (excluded), and 126 incomplete data (excluded). Motor vehicle collisions were the most common mechanism of injury in both groups (TVF, 75%; TVF + SF, 88%), followed by falls (TVF: 23%, TVF + SF: 12%). Spinal cord injuries were more common among TVF + SF patients (6.4% vs. 4%). Median injury severity score (17 vs. 12), age (17 vs. 15 years), LOS (5 vs. 3 days), and mortality (5.6% vs. 2.3%) were significantly higher and the need for operative treatment (69% vs. 56%) and ICU admission (53% vs. 36%) significantly more frequent in patients with TVF + SF.

CONCLUSION
Concomitant SF occur in 7% of all pediatric patients with TVF and are associated with increased morbidity and mortality. This combination of injuries is likely the result of greater energy transmission and injury potential.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Use of a statewide solid organ injury procotcol to optimize triage, treatment, and transfer for pediatric abdominal trauma
Authors: Swendiman Robert A. , Russell Katie W. , Larsen Kezlyn , Eyre Matthew , Fenton Stephen J. 
Published: January 2024

BACKGROUND
The Utah Pediatric Trauma Network (UPTN) is a non-competitive collaboration of all 51 hospitals in the state of Utah with the purpose of improving pediatric trauma care. Created in 2019, UPTN has implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. A blunt solid organ injury (SOI) protocol was developed to optimize treatment of these injuries statewide. The purpose of this study was to review the effectiveness of the SOI guideline.

METHODS
The UPTN REDCap® database was retrospectively reviewed from 2021 through 2022. We compared admissions from the Level 1 pediatric trauma center (PED1) to non-pediatric hospitals (non-PED1) of children with low-grade (I-II) and high-grade (III-V) SOIs.

RESULTS
In 2 years, 172 patients were treated for blunt SOI, with or without concomitant injuries. There were 48 (28%) low-grade and 124 (72%) high-grade SOIs. 33 (69%) patients were triaged with low-grade SOI injuries at a non-PED1 center, and 17 (35%) were transferred to the PED1 hospital. Most had multiple injuries, but 7 (44%) were isolated, and none required a transfusion or any procedure/operation at either hospital. Of the 124 patients with high-grade injuries, 41 (33%) primarily presented to the PED1 center, and 44 (35%) were transferred there. Of these, 2 required a splenectomy and none required angiography. Thirty-nine children were treated at non-PED1 centers without transfer, and 4 required splenectomy and 6 underwent angiography/embolization procedures. No patient with an isolated SOI died.

CONCLUSION
Implementation of SOI guidelines across UPTN successfully allowed non-pediatric hospitals to safely admit children with low-grade isolated SOI, keeping families closer to home, while standardizing pediatric triage for blunt abdominal trauma in the state.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Brain death/death by neurologic criteria: What you need to know
Authors: Larson Nicholas J. , Dries David J. , Blondeau Benoit , Rogers Frederick B. 
Published: January 2024

ABSTRACT
Since the beginning of time, man has been intrigued with the question of when a person is considered dead. Traditionally, death has been considered the cessation of all cardiorespiratory function. At the end of the last century a new definition was introduced into the lexicon surrounding death in addition to cessation of cardiac and respiratory function: Brain Death/Death by Neurologic Criteria (BD/DNC). There are medical, legal, ethical, and even theological controversies that surround this diagnosis. In addition, there is no small amount of confusion among medical practitioners regarding the diagnosis of BD/DNC. For families enduring the devastating development of BD/DNC in their loved one, it is the duty of the principal caregiver to provide a transparent presentation of the clinical situation and clear definitive explanation of what constitutes BD/DNC. In this report, we present a historical outline of the development of BD/DNC as a clinical entity, specifically how one goes about making a determination of BD/DNC, what steps are taken once a diagnosis of BD/DNC is made, a brief discussion of some of the ethical/moral issues surrounding this diagnosis, and finally the caregiver approach to the family of a patient who had been declared with BD/DNC. It is our humble hope that with a greater understanding of the myriad of complicated issues surrounding the diagnosis of BD/DNC that the bedside caregiver can provide needed closure for both the patient and the family enduring this critical time in their life.
The Impact of the Donor Card Holder Prioritization Program on Kidney Allocation in Israel
Authors: Mor Eytan , Bloom Meitar , Ghinea Ronen , Anteby Roi , Pasvolsky-Gutman Ronit , Loewenthal Ron , Nachmani Ido , Hod Tammy 
Published: January 2024

Background.
Since 2014, as part of a priority program within the Israeli Transplant Law, additional points were given to waitlisted candidates with donor cards. We assessed the impact on deceased donor kidney allocation.

Methods.
This study enrolled all patients older than 18 y who underwent deceased donor kidney transplantation (January 2016–December 2019). Data were obtained from the National HLA Tissue Laboratory registry at the Sheba Medical Center. Patients were grouped by donor card status (ADI group) (not signed, 0 points; relative signed, 0.1 points; patient signed, 2 points; and relative donated, 9 points). The primary outcome was waiting time until kidney transplantation with and without the additional score.

Results.
Four hundred forty-four patients underwent kidney transplantation during the study period: 281 (63%) were donor card holders (DCH) and 163 (37%) were not DCH. DCH with extra points waited 68.0 (±47.0) mo on average, compared with 94.6 (±47.3) mo for not DCH (P < 0.001). Donor card signers had a shorter time until transplant in a multivariable model. Without extra points, 145 recipients (32.6%) would have missed organs allocated to higher-scored candidates. Allocation changes occurred in 1 patient because of an additional 0.1 points, in 103 candidates because of an additional 2 points, and in 41 candidates because of an additional 9 points.

Conclusions.
Additional DCH scores improved allocation and reduced waiting time for donor card signers and those with donating relatives. To enhance fairness, consideration should be given to reducing the score weight of this social criterion and raising scores for other factors, especially dialysis duration.
Tumor Agnostic Drug Delivery with Self-Agglomerating Nanohydrogels (SANGs)
Authors: Housley Stephen N. , Lee Sebinne , Matyunina Lilya V. , Herrmann Olivia A. , Satpathy Minati , Arboleda Johana C. , McDonald John F. , Finn M.G. 
Published: January 2024

AbstractRNA interference (RNAi) holds unique potential as a clinically viable modality to pharmacologically regulate oncogenes in sequence-specific manner. Despite its potential, systemic delivery of RNAi to tumors encounters myriad obstructions and strategies to overcome barriers have largely consisted of academic demonstrations, with few approaches reaching patients. Here, we report the development of a self-agglomerating nanohydrogel (SANGs) platform that is efficiently internalized by cancer cells, is agnostic to RNAi payload, and achieves functional suppression of multiple oncogene targets. After intravenous injection, SANGs preferentially accumulated and were retained ubiquitously in primary and metastatic loci in three aggressive cancer models in a species-agnostic manner. SANGs efficiently delivered multiple RNAi payloads that significantly suppressed oncogene expression and sensitized previously resistance tumorsin vivo. SANGs were found to be safe and well tolerated in simulated clinical applications across three species. We then propose and verify a novel emergent mechanism by which SANGs achieve durable solid-tumor delivery without direct functionalization. Overall, our SANGs platform is an enabling technology for RNAi-based cancer therapeutics and is poised for advanced pharmaceutical development with multiple solid-tumor indications.One-Sentence SummaryOur nanostructure achieves safe and durable tumor-agnostic delivery through a newly described environmentally-responsive mechanism.
Activity-driven chromatin organization during interphase: compaction, segregation, and entanglement suppression
Authors: Chan Brian , Rubinstein Michael 
Published: January 2024

ABSTRACTIn mammalian cells, the cohesin protein complex is believed to translocate along chromatin during interphase to form dynamic loops through a process called active loop extrusion. Chromosome conformation capture and imaging experiments have suggested that chromatin adopts a compact structure with limited interpenetration between chromosomes and between chromosomal sections. We developed a theory demonstrating that active loop extrusion causes the apparent fractal dimension of chromatin to cross over between two and four at contour lengths on the order of 30 kilo-base pairs (kbp). The anomalously high fractal dimensionD= 4 is due to the inability of extruded loops to fully relax during active extrusion. Compaction on longer contour length scales extends within topologically associated domains (TADs), facilitating gene regulation by distal elements. Extrusion-induced compaction segregates TADs such that overlaps between TADs are reduced to less than 35% and increases the entanglement strand of chromatin by up to a factor of 50 to several Mega-base pairs. Furthermore, active loop extrusion couples cohesin motion to chromatin conformations formed by previously extruding cohesins and causes the mean square displacement of chromatin loci during lag times (Δt) longer than tens of minutes to be proportional to Δt1/3. We validate our results with hybrid molecular dynamics – Monte Carlo simulations and show that our theory is consistent with experimental data. This work provides a theoretical basis for the compact organization of interphase chromatin, explaining the physical reason for TAD segregation and suppression of chromatin entanglements which contribute to efficient gene regulation.SIGNIFICANCE STATEMENTDuring interphase, cells must compact chromatin such that gene promoters and their regulatory elements frequently contact each other in space. However, cells also need to insulate promoters from regulatory elements in other genomic sections. Using polymer physics theory and computer simulations, we propose that the cohesin protein complex actively extrudes chromatin into topologically associated domains (TADs) with an anomalously high fractal dimension ofD≈ 4 while suppressing spatial overlap between different TADs. Our model suggests that the fast kinetics of active loop extrusion compared to the slow relaxation of chromatin loops maintains a dense chromatin organization. This work presents a physical framework explaining how cohesin contributes to effective transcriptional regulation.
LeucaenaandAcaialeaf litter negatively affect the survivorship of tadpoles of the South Asian frogMicrohyla ornata
Authors: Pathak-Broome Aranya , Gour-Broome Vivek , Mukherjee Shomen 
Published: January 2024

ABSTRACTLeaf litter from terrestrial plants forms an essential source of organic food matter for many freshwater aquatic organisms. However, leaves of some species are known to alter water quality, affecting the development and survivorship of amphibians. While amphibians from North and South America are affected by terrestrial leaf litter, similar studies are missing from Asia, a region with high amphibian diversity (mainly from the south and south-east Asia). At different tadpole densities, we tested the effect of different leaf litter (two non-native trees and a grass species) on the survivorship of ornate narrow-mouthed frog tadpoles (Microhyla ornata), a common frog in South Asia. We found the tadpole probability of survival extremely low inLeucaenabut high inThemeda. While the odds of survivorship were nearly twelvefold higher inAcaciathanLeucaena, it was not as high as inThemeda. A tadpole also had a lower odds of survival if raised in a high-density environment. In addition,Leucaenalitter water had significantly higher pH levels than other litter types. Since bothLeucaenaandAcaciaare non-native trees actively grown for agroforestry in South Asia, our results highlight another potential threat to amphibians in this region. Given the high amphibian diversity in this region, there is an urgent need for similar studies on other anurans and aquatic organisms.
Experts fail to reliably detect AI-generated histological data
Authors: Hartung Jan , Reuter Stefanie , Kulow Vera Anna , Fähling Michael , Spreckelsen Cord , Mrowka Ralf 
Published: January 2024

AbstractAI-based methods to generate images have seen unprecedented advances in recent years challenging both image forensic and human perceptual capabilities. Accordingly, they are expected to play an increasingly important role in the fraudulent fabrication of data. This includes images with complicated intrinsic structures like histological tissue samples, which are harder to forge manually. We use stable diffusion, one of the most recent generative algorithms, to create such a set of artificial histological samples and in a large study with over 800 participants, we study the ability of human subjects to discriminate between such artificial and genuine histological images. Although they perform better than naive participants, we find that even experts fail to reliably identify fabricated data. While participant performance depends on the amount of training data used, even low quantities result in convincing images, necessitating methods to detect fabricated data and technical standards such as C2PA to secure data integrity.
XKidneyOnco: An Explainable Framework to Classify Renal Oncocytoma and Chromophobe Renal Cell Carcinoma with a Small Sample Size
Authors: Javaheri Tahereh , Heidari Samar , Yang Xu , Yerra Sandeep , Seidi Khaled , Gharib Mohammad Hadi , Setayesh Tahereh , Zhang Guanglan , Chitkushev Lou , Castro Patricia , Salar Sayeeduddin Shahida , Sayeeduddin Zahida , Zarrin-Khameh Neda , Haeri Mohammad , Rawassizadeh Reza 
Published: January 2024

AbstractRenal oncocytoma and chromophobe renal cell carcinoma are two kidney cancer types that present a diagnostic challenge to pathologists and other clinicians due to their microscopic similarities. While RO is a benign renal neoplasm, ChRCC is considered malignant. Therefore, the differentiation between the two is crucial. In this study, we introduce an explainable framework to accurately differentiate ChRCC from RO, histologically. Our approach examined H&E-stained images of 656 ChRCC and 720 RO, and achieved a diagnostic accuracy of 88.2%, the sensitivity of 87%, and 100% specificity for explainable AI, which either outperforms or operate on par with convolutional neural network (CNN) models.Besides, we enrolled 44 pathology experts (including pathologists and pathology trainees) to differentiate the two tumors. The average accuracy of pathologists was 73%, which is 15.2% lower than our framework.These results indicate that the combination of human expert along with explainable AI achieve higher accuracy in differentiating the two tumors, while it reduces the workload of experts and offers the desired explainability for the medical experts.
Prognostic Significance of preoperative serum CA125, CA19-9, CA72-4, CEA, and AFP in Patients with Endometrial cancer
Authors: Wang Zi-hao , Zhang Yun-zheng , Ge Shu-wen , Luhe-Shan  , Wang Bo , Zhang Zi-yu , Wu Qi-jun , Ma Xiao-xin 
Published: January 2024

AbstractObjectiveTo determine preoperative serum CA125, CA19-9, CA72-4, CEA, and AFP with prognostic value, and to establish a risk score based on CA125, CEA, AFP levels for predicting the overall survival (OS) and progression-free survival (PFS) of endometrial cancer (EC) patients.MethodsA retrospective cohort study with 2081 EC patients was conducted at Shengjing Hospital of China Medical University. Patient baseline information, tumor characteristics, and data on five serum biomarkers (CA125, CA19-9, CA72-4, CEA, and AFP) were collected. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using univariate or multivariate Cox proportional hazard models. log-rank test and Kaplan-Meier analysis were used to compared survival, Data were randomly divided into a training cohort (50%, N = 1041) and an external validation cohort (50%, n = 1040). the least absolute shrinkage and selection operator (Lasso)-Cox regression model was used to screen the independent factors for establishing risk score. And develop nomograms for survival rate prediction.ResultsMultivariate analysis showed Elevated CA125 (P<0.0001) AFP (P <0.0001) and CEA(P=0.037) were identified as independent biomarkers for PFS. Increased CA125 (P = 0.003) AFP (P <0.0001) and CEA(P=0.014) were independent factors associated with OS. CA125, AFP and CEA were thus incorporated in an innovative Risk score (RS) by Lasso-Cox regression model, The RS was also an independent indicator for PFS (P<0.0001) and OS (P<0.0001). Furthermore, we developed and validated nomogram based on Cox regression models. The discriminative ability and calibration of the nomograms revealed good predictive ability, as indicated by the calibration plots.ConclusionThis study suggests that the risk score based on preoperative serum levels of CA125, CEA, and AFP was prognostic biomarkers for predicting progression-free survival and overall survival for EC patients. Nomograms based on the RS and clinicopathological features accurately predict Prognosis of EC patients.