bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic and clinical value of circPRKCI expression in diverse human cancers
Authors: Liu Zhongyue , Ren Xiaolei , Yang Zhimin , Mei Lin , Li Wenyi , Tu Chao , Li Zhihong 
Published: September 2023

Abstract

Background:
Highly expressed in various human cancers, circular RNA Protein Kinase C Iota (circPRKCI) has been reported to play an important role in cancer development and progression. Herein, we sought to reveal the prognostic and clinical value of circPRKCI expression in diverse human cancers.

Methods:
We searched the Pubmed, Web of Science, and the Cochrane Library databases from inception until May 16, 2021. The relationship between circPRKCI expression and cancer patients' survival, including overall survival (OS) and disease-free survival (DFS), was assessed by pooled hazard ratios (HR) with corresponding 95% confidence interval (CI). The correlation between circPRKCI expression and clinical outcomes was evaluated using odds ratios (OR) with corresponding 95% CI. The data were analyzed by STATA software (version 12.0) or Review Manager (RevMan 5.3).

Results:
A total of 15 studies with 1109 patients were incorporated into our meta-analysis. The results demonstrated that high circPRKCI expression was significantly related to poor OS (HR = 1.96, 95% CI: 1.61, 2.39, P <0.001) when compared with low circPRKCI expression in diverse human cancers. However, elevated circPRKCI expression was not associated with DFS (HR = 1.34, 95% CI: 0.93, 1.95, P = 0.121). Furthermore, the patient with a higher circPRKCI expression was prone to have a larger tumor size, advanced clinical stage, and lymph node metastasis, but it was not significantly correlated with age, gender, and distant metastasis.

Conclusion:
Elevated circPRKCI expression was correlated with worse OS and unfavorable clinical features, suggesting a novel prognostic and predictive role of circPRKCI in diverse human cancers.
Transoral Septoplasty before Le Fort I Downfracture: A Novel Functional Rhinoplasty Technique
Authors: Godbe Kerilyn N. , DeWitt Jason , Garg Ravi K. 
Published: September 2023

Summary:
Individuals with maxillary dentofacial deformities commonly have preexisting nasal airway obstruction with associated nasal septal deviation. Combination bimaxillary procedures with intraoral septoplasty after maxillary downfracture have been demonstrated to address dentofacial deformities and nasal obstruction simultaneously. Although effective, current transoral septoplasty techniques offer limited visualization of the superior septum and are challenging to perform due to septal mobility after Le Fort I downfracture. Here, we describe a novel approach in which a transoral septoplasty is performed before completion of the Le Fort I maxillary downfracture, improving septal stability during the dissection and affording better visualization of the septal L-strut for precise cartilage resection.
Predictors for postoperative cranial nerve complications in carotid body tumor resection. a retrospective cohort study
Authors: Alimohamad Hoda , Yilmaz Dilek , Marang-van de Mheen Perla J. , Jansen Jeroen , Hamming Jaap F. , Schepers Abbey 
Published: September 2023

Introduction:
Carotid Body Tumors (CBTs) are slow-growing benign tumors. Therefore, surgical resection is considered in case of tumor growth. Timing of surgery is of the utmost importance as the risk of iatrogenic surgical complications increases when resecting larger tumors, whereas on the other hand resections for asymptomatic small CBT should be prevented. The primary aim of this study was to identify which tumor size or dimension is most accurate to predict nerve injury in patients undergoing resection of a CBT.

Material and methods:
This retrospective cohort study included patients who underwent surgical resection of CBT at the university hospital in South-Holland. Baseline patient characteristics and tumor measurements were retrieved from the medical records. We assessed how the different methods of measuring the size of the tumor were interrelated using Pearson correlation. Logistic regression was used to assess which variables were independently associated with nerve injury, including age at surgery, Shamblin classification and those dimensions that captured different aspects of tumor size (rather than measuring the same as shown by high correlations) as possible independent variables.

Results:
In 125 patients, 143 CBT were resected whereof in 35 cases cranial nerve injury occurred, (transient in 16 cases and permanent in 19 cases). The risks for nerve injury increased with larger tumor size and Shamblin classification. Logistic regression analysis showed that the anterior-posterior (AP) diameter significantly increased the odds of a nerve injury, a doubling for every 1 cm increase in AP diameter (odds ratio [95%CI] 2.12[1.29-3.48], P-value=0.003.

Conclusion:
This study shows that measured tumor size in AP plane is a strong predictor for postoperative nerve injury of a CBT resection. This predictor can be used in daily clinic to give insight in operative risks. More research is needed in order to select the most appropriate time window for CBT resection.
Nationwide analysis of pre-hospital tranexamic acid for trauma demonstrates systematic bias in adherence to treatment guidelines: a retrospective cohort study
Authors: Almuwallad Ateeq , Cole Elaine , Rossetto Andrea , Brohi Karim , Perkins Zane , Davenport Ross 
Published: September 2023

Background:
Prehospital (PH) tranexamic acid (TXA) improves survival from trauma haemorrhage. Injury mechanism, physiology and sex demographics vary with patient age. We hypothesised that these factors influence TXA guideline compliance and examined national trends in PH use to identify any systematic biases in bleeding management.

Materials & Methods:
UK Trauma Audit & Research Network data for TXA eligible patients admitted to Major Trauma Centres were divided into cohorts: 2013-2015 (n=32,072) and 2017-2019 (n=14,974). Patients were stratified by PH, Emergency Department (ED) or no TXA use. Logistic regression models explored interaction between PH variables and TXA administration. Results are presented as Odds Ratios (OR) with 95% Confidence Intervals (CI).

Results:
PH TXA use increased from eight percent to 27% over time (P<0.001). Only three percent of eligible patients who fell <2 m received PH TXA vs. 63% with penetrating injuries (P<0.001). Older patients eligible for pre-hospital TXA were less likely to receive it compared to younger patients (≥65 y old: 590 [13%] vs <65 y old: 3361 [33%], P<0.001). There was significant interaction between age and sex with fewer older women receiving PH TXA. In shocked patients, one third of females compared to a fifth of men did not receive TXA (P<0.001). There was a decrease in pre-hospital TXA use as age increased (P<0.001).

Conclusions:
Despite a three-fold increase in use, treatment guidance for PH TXA is not universally applied. Older people, women and patients with low energy injury mechanisms appear to be systematically under-treated. Training and education for pre-hospital providers should address these potential treatment biases.
Hyperglycemia and insulin infusion in pancreatoduodenectomy: A prospective cohort study on feasibility and impact on complications
Authors: Ekström Eva , Fagher Katarina , Tingstedt Bobby , Rystedt Jenny , Nilsson Johan , Löndahl Magnus , Andersson Bodil 
Published: September 2023

Background:
Hyperglycemia is a risk factor for postoperative complications but its impact on outcome after pancreatoduodenectomy (PD) is scarcely studied. This prospective cohort study aimed to assess the effect of continuous insulin infusion on postoperative complications and blood glucose, as well as to evaluate the impact of hyperglycemia on complications, after PD.

Materials and methods:
One hundred patients planned for PD were prospectively included for perioperative continuous insulin infusion and a historic cohort of 100 patients was included retrospectively. Median blood glucose levels were calculated and data on complications were analyzed and compared between the historic cohort and the intervention group as well as between normo- and hyperglycemic patients.

Results:
Median glucose levels were significantly lower in the intervention group compared to the historic cohort up to 30 days postoperatively (median glucose 8.5 mmol/l (IQR 6.4 – 11) vs. 9.1 mmol/l (IQR 6.8 – 17) (P=0.007)). No significant differences in complication rates were recorded between these two groups. The incidence of complications classified as Clavien ≥3 was higher in hyperglycemic patients (100% vs. 27%, P=0.024). Among hyperglycemic patients the prevalence of preoperative diabetes was higher compared to normoglycemic patients (52% vs.12%, P<0.001). In patients with a known diagnosis of diabetes, a trend, although not statistically significant, towards a lower incidence of postoperative pancreatic fistula (POPF) grade B and C, as well as postpancreatectomy hemorrhage (PPH) grade B and C, was seen compared to those without preoperative diabetes (6.8% vs. 14%, P=0.231 and 2.3% vs. 7.0%, P=0.238 respectively).

Conclusion:
Insulin infusion in the early postoperative phase after PD is feasible in a non-ICU setting and significantly decreased blood glucose levels. The influence on complications was limited. Preoperative diabetes was a significant predictor of postoperative hyperglycemia and was associated with a lower incidence of clinically significant POPF.
Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia: A multicenter retrospective cohort study
Authors: Murata Takaaki , Yamaguchi Nobuo , Shimomoto Yutaro , Mikajiri Yumi , Sasaki Yuki , Konagaya Kensuke , Igarashi Yuto , Sawamura Naoki , Yamamoto Kota , Kume Nao , Suno Yuma , Kurata Shuji , Kasetani Tetsuya , Kato Ichiro , Nishida Tomoki , Hirata Hirohisa , Miyake Katsunori , Oonishi Takahisa , Isogai Naoko , Fukai Ryuta , Kanomata Hiroyuki , Shimoyama Rai , Kashiwagi Hiroyuki , Takenoue Tomohiro , Terashima Takahiro , Murayama Hiroyuki , Kohriki Shunsaku , Morita Takeshi , Takaki Mutsuo , Ogino Hidemitsu , Kanemaru Takayuki , Sano Ken , Kurogi Norimitsu , Watanabe Kazunao , Hirata Masahiro , Kawachi Jun 
Published: September 2023

Background:
Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis.

Materials and Methods:
In this multicenter retrospective study, we reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and non-survivor groups, and statistical analysis was performed to determine clinical physiological factors.

Results:
Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75–14.2], and the median SOFA scores were 5 [3–7] in the survivor group and 13 [9–17.5] in the non-survivor group. Univariate analysis revealed a significant difference in body mass index (P<0.001), hypoglycemia (P=0.0012), previous cardiovascular surgery (P=0.0019), catecholamine use (P<0.001), SOFA score (P<0.001), platelet count (P=0.0023), and lactate level (P<0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% confidence interval 1.94–280.00; P=0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score ≥10.

Conclusion:
This study confirmed that a SOFA score of ≥10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches ≥10.
Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: A systematic review and meta-analysis
Authors: Mao Benliang , Zhu Shanfei , Li Dan , Xiao Junhao , Wang Bailin , Yan Yong 
Published: September 2023

Background:
Robotic platform has been increasingly applied in major hepatectomy. However, the role or advantage of robotic approach comparing with laparoscopic approach in major hepatectomy remains controversial. This meta-analysis compares perioperative outcomes of robotic major hepatectomy (RMH) to laparoscopic major hepatectomy (LMH) for hepatic neoplasms.

Methods:
PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify comparative studies compared RMH versus LMH for hepatic neoplasms. The search timeframe was set before May 2023. Main outcomes were mortality, overall morbidities, serious complications, and conversion to open surgery. Secondary outcomes were operative time, intraoperative blood loss, blood transfusion, postoperative length of hospital stay, R0 resection, reoperation, and readmission. Studies were evaluated for quality by Cochrane risk of bias tool or Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD#).

Results:
Twelve retrospective cohort studies concerning total 1657 patients (796 RMH, 861 LMH) were included. Meta-analyses showed no significant differences in mortality (OR=1.23, 95% CI=0.50–2.98, P=0.65), overall postoperative complications (OR=0.83, 95% CI=0.65–1.06, P=0.14), operative time (MD=6.47, 95% CI=−14.72 to 27.65, P=0.55), blood transfusion (OR=0.77, 95% CI=0.55–1.08, P=0.13), R0 resection (OR=1.45, 95% CI=0.91–2.31, P=0.12), reoperation (OR=0.76, 95% CI=0.31–1.88, P=0.56), and readmission (OR=0.63, 95% CI=0.28–1.44, P=0.27) between RMH and LMH. Incidence of serious complications (OR=0.60, 95% CI=0.40–0.90, P=0.01), conversion to open surgery (OR=0.41, 95% CI=0.27–0.63, P<0.0001), blood loss (MD=−91.42, 95% CI=−142.18 to −40.66, P=0.0004), and postoperative hospital stay (MD=−0.64, 95% CI=−0.78 to −0.49, P<0.00001) were reduced for RMH versus LMH.

Conclusions:
RMH is associated with comparable short-term surgical outcomes and oncologic adequacy compared to LMH when performed by experienced surgeons at large centers. RMH may result in reduced major morbidities, conversion rate, blood loss, and hospital stay, but these results were volatile. Further randomized studies should address the potential advantages of RMH over LMH.
Living alone predicts poor prognosis among patients with acute myocardial infarction
Authors: Fukumoto Daichi , Kanda Daisuke , Takumi Takuro , Ikeda Yoshiyuki , Tokushige Akihiro , Ohmure Kenta , Sonoda Takeshi , Arikawa Ryo , Anzaki Kazuhiro , Ohishi Mitsuru 
Published: September 2023

Background
Living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. We thus investigated the impact of living alone on mortality in acute myocardial infarction (AMI) patients.

Methods
Subjects comprised 277 AMI patients who underwent percutaneous coronary intervention (PCI). Associations between all-cause and cardiac deaths after PCI and baseline characteristics including living alone and Global Registry of Acute Coronary Events (GRACE) risk score were assessed.

Results
Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of both all-cause and cardiac deaths compared with patients not living alone (18% vs. 8%, P = 0.019 and 14% vs. 4%, P = 0.004). Multivariate Cox proportional hazards regression analysis models showed living alone [hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20–5.62; P = 0.016 and HR, 4.17; 95% CI, 1.60–10.84; P = 0.003] and GRACE risk score (HR, 1.02; 95% CI, 1.01–1.03; P = 0.003 and HR, 1.03; 95% CI, 1.01–1.04; P < 0.001) correlated significantly with all-cause and cardiac deaths. Cox proportional hazards modeling revealed that patients living alone with GRACE risk score ≥162 derived from the receiver-operating characteristic curve showed a significantly greater risk of all-cause death than patients not living alone with GRACE risk score <162 (HR 16.57; 95% CI 6.67–41.21; P < 0.001).

Conclusion
Among AMI patients, living alone represents an independent risk factor for all-cause and cardiac deaths after PCI, separate from GRACE risk score. Furthermore, AMI patients living alone with high GRACE risk scores may experience an additively increased risk of mortality after PCI.
Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions
Authors: Qin Qing , Chen Lu , Ge Lei , Qian Juying , Ma Jianying , Ge Junbo 
Published: September 2023

Objectives
This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy.

Backgrounds
DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain.

Methods
We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group.

Results
The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR.

Conclusion
DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.
Market Competition and Anemia Management in the United States Following Dialysis Payment Reform
Authors: Bhatnagar Anshul , Parvathareddy Vishnupriyadevi , Winkelmayer Wolfgang C. , Chertow Glenn M. , Erickson Kevin F. 
Published: September 2023

Background:
Whether market competition influences health care provider responses to national reimbursement reforms is unknown.

Objectives:
We examined whether changes in anemia management after the expansion of Medicare’s dialysis payment bundle varied with market competition.

Research Design:
With data from the US dialysis registry, we used a difference-in-differences (DID) design to estimate the independent associations of market competition with changes in anemia management after dialysis reimbursement reform.

Subjects:
A total of 326,150 patients underwent in-center hemodialysis in 2009 and 2012, representing periods before and after reimbursement reform.

Measures:
Outcomes were erythropoiesis-stimulating agent (ESA) and intravenous iron dosage, the probability of hemoglobin <9 g/dL, hospitalizations, and mortality. We also examined serum ferritin concentration, an indicator of body iron stores. We used a dichotomous market competition index, with less competitive areas defined as effectively having <2 competing dialysis providers.

Results:
Compared with areas with more competition, patients in less competitive areas had slightly more pronounced declines in ESA dose (60% vs. 57%) following reimbursement reform (DID estimate: −3%; 95% CI, −5% to −1%) and less pronounced declines in intravenous iron dose (−14% vs. −19%; DID estimate: 5%; 95% CI, 1%–9%). The likelihoods of hemoglobin <9 g/dL, hospitalization, and mortality did not vary with market competition. Serum ferritin concentrations in 2012 were 4% (95% CI, 3%–6%) higher in less competitive areas.

Conclusions:
After the expansion of Medicare’s dialysis payment bundle, ESA use declined by more, and intravenous iron use declined by less in concentrated markets. More aggressive cost-reduction strategies may be implemented in less competitive markets.
Understanding constraints to adaptation using a community-centred toolkit
Authors: Buffa Danielle C. , Thompson Katharine E. T. , Reijerkerk Dana , Brittain Stephanie , Manahira George , Samba Roger , Lahiniriko Francois , Brenah Marius Clovis Jean , Augustin Jean Yves , Tsitohery Justome Ricky Francois , Razafy Roi Magnefa , Leonce Harison , Rasolondrainy Tanambelo , Douglass Kristina 
Published: September 2023

Worldwide, marginalized and low-income communities will disproportionately suffer climate change impacts while also retaining the least political power to mitigate their consequences. To adapt to environmental shocks, communities must balance intensifying natural resource consumption with the need to ensure the sustainability of ecosystem provisioning services. Thus, scientists have long been providing policy recommendations that seek to balance humanitarian needs with the best outcomes for the conservation of ecosystems and wildlife. However, many conservation and development practitioners from biological backgrounds receive minimal training in either social research methods or participatory project design. Without a clear understanding of the sociocultural factors shaping decision-making, their initiatives may fail to meet their goals, even when communities support proposed initiatives. This paper explores the underlying assumptions of a community's agency, or its ability to develop and enact preferred resilience-enhancing adaptations. We present a context-adaptable toolkit to assess community agency, identify barriers to adaptation, and survey perceptions of behaviour change around natural resource conservation and alternative food acquisition strategies. This tool draws on public health and ecology methods to facilitate conversations between community members, practitioners and scientists. We then provide insights from the toolkit's collaborative development and pilot testing with Vezo fishing communities in southwestern Madagascar.This article is part of the theme issue ‘Climate change adaptation needs a science of culture’.