bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of PKM2 Expression With HER2/neu and Additional Breast Cancer Biomarkers and its Prognostic Significance
Authors: Al-Qudah Mohammad A. , Al-Keilani Maha S. , Obeidat Marya , Haddad Husam K. , Bdeir Roba , Samman Lina M. 
Published: May 2023

Background:
Pyruvate kinase M2 (PKM2) has a central role in both tumor development and metastasis, and it has increasingly become a valuable subject for many cancer studies due to its important prognostic value in various tumor types. In this study, we aimed to elucidate the impact of PKM2 expression level on breast cancer prognosis and survival rates and its association with various clinicopathologic characteristics and tumor markers in breast cancer patients.

Materials and Methods:
This retrospective study included sample tissues from patients with breast cancer who did not receive chemotherapy or radiotherapy before surgery. Expression levels of PKM2, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), and Ki-67 were analyzed using tissue microarray and immunohistochemistry.

Results:
A total of 164 patients were included with an age range from 28 to 82 years. High PKM2 was observed in 48.8% of cases (80/164). A significant association was found between PKM2 expression and breast cancer molecular subtype and HER2 status (P<0.001). In HER2-negative tumors, there was a significant association between PKM2 expression and tumor grade, TNM stage, pN stage, lymphovascular invasion, and estrogen receptor/progesterone receptor status. Survival analysis revealed that high PKM2 expression levels were associated with decreased overall survival rate in HER2-positive cases with high Ki-67 index. Moreover, in the HER2-positive group, low PKM2 expression level impacted the survival outcome of metastasis (P=0.002).

Conclusions:
PKM2 is a valuable prognostic and a potential diagnostic and predictive marker in breast cancer. Moreover, the combination of PKM2 with Ki-67 provides excellent prognostic accuracy in HER2-positive tumors.
Ten-Year Analysis of Complications Related to Simple Basilar Skull Fractures in Children Presenting to a Trauma Center
Authors: Ryan Sydney , Hewes Hilary , Fenton Stephen F. , Russell Katie , Hansen Kris , Brockmeyer Douglas L. , Robison Jeff 
Published: May 2023

Objectives
Head trauma is a common presenting complaint among children requiring urgent medical attention, accounting for more than 600,000 emergency department (ED) visits annually, 4% to 30% of which identify skull fractures among the patient's injuries. Previous literature shows that children with basilar skull fractures (BSFs) are usually admitted for observation. We studied whether children with an isolated BSF have complications precluding them from safe discharge home from the ED.

Methods
We performed a retrospective review of ED patients aged 0 to 18 years given a simple BSF diagnosis (defined by nondisplaced fracture, with normal neurologic examination, Glasgow Coma Score of 15, no intracranial hemorrhage, no pneumocephalus) during a 10-year period to identify complications associated with their injury. Complications were defined as death, vascular injury, delayed intracranial hemorrhage, sinus thrombosis, or meningitis. We also considered hospital length of stay (LOS) longer than 24 hours or any return visit within 3 weeks of the original injury.

Results
Of the 174 patients included in the analysis, there were no deaths, cases of meningitis, vascular injury, nor delayed bleeding events. Thirty (17.2%) patients required a hospital LOS longer than 24 hours and 9 (5.2%) returned to the hospital within 3 weeks of discharge. Of those with LOS longer than 24 hours, 22 (12.6%) patients needed subspecialty consultation or intravenous fluids, 3 (1.7%) had cerebrospinal fluid leak, and 2 (1.2%) had a concern for facial nerve abnormality. On the return visits, only 1 (0.6%) patient required readmission for intravenous fluids because of nausea and vomiting.

Conclusions
Our findings suggest that patients with uncomplicated BSFs can be safely discharged from the ED if the patient has reliable follow-up, is tolerating oral fluids, has no evidence of cerebrospinal fluid leak, and has been evaluated by appropriate subspecialists before discharge.
Utilizing Clinical Decision Support in the Treatment of Urinary Tract Infection across a Large Pediatric Primary Care Network
Authors: Karas David R. , Upadhyayula Shankar , Love April , Bigham Michael T. 
Published: May 2023

Introduction:
Cystitis and pyelonephritis are common bacterial infections in infants and children, and initial treatment is usually empirical. Antimicrobial stewardship advocates using narrow-spectrum antibiotics with consideration for local resistance patterns. Narrow-spectrum antibiotic use is critical in addressing the global issue of bacterial antimicrobial resistance, associated with approximately 5 million annual deaths.

Methods:
The antimicrobial stewardship committee developed a guideline for diagnosing and managing urinary tract infections and distributed it to all primary care providers. A standardized order set provided clinical decision support regarding appropriate first-line antibiotic therapy. A chief complaint of dysuria prompted the use of the order set. Prescription rates for the most common antimicrobials were tracked on a control chart.

Results:
From March 2018 through March 2020, there were 4,506 antibiotic prescriptions for urinary tract infections. Utilization of the recommended first-line therapy, cephalexin, increased from 27.5% to 74.8%. Over the same period, trimethoprim-sulfamethoxazole, no longer recommended due to high local resistance, decreased from 31.8% to 8.1%. Providers have maintained these prescribing patterns since the conclusion of the project.

Conclusion:
Using clinical decision support as a standardized order set can sustainably improve the use of first-line antimicrobials for treating pediatric urinary tract infections.
The Conditional Effects of Multimorbidity on Operative Versus Nonoperative Management of Emergency General Surgery Conditions
Authors: Rosen Claire B. , Roberts Sanford E. , Wirtalla Chris J. , Keele Luke J. , Kaufman Elinore J. , Halpern Scott D. , Reilly Patrick M. , Neuman Mark D. , Kelz Rachel R. 
Published: May 2023

Objective:
To understand how multimorbidity impacts operative versus nonoperative management of emergency general surgery (EGS) conditions.

Background:
EGS is a heterogenous field, encompassing operative and nonoperative treatment options. Decision-making is particularly complex for older patients with multimorbidity.

Methods:
Using an instrumental variable approach with near-far matching, this national, retrospective observational cohort study of Medicare beneficiaries examines the conditional effects of multimorbidity, defined using qualifying comorbidity sets, on operative versus nonoperative management of EGS conditions.

Results:
Of 507,667 patients with EGS conditions, 155,493 (30.6%) received an operation. Overall, 278,836 (54.9%) were multimorbid. After adjustment, multimorbidity significantly increased the risk of in-hospital mortality associated with operative management for general abdominal patients (+9.8%; P = 0.002) and upper gastrointestinal patients (+19.9%, P < 0.001) and the risk of 30-day mortality (+27.7%, P < 0.001) and nonroutine discharge (+21.8%, P = 0.007) associated with operative management for upper gastrointestinal patients. Regardless of multimorbidity status, operative management was associated with a higher risk of in-hospital mortality among colorectal patients (multimorbid: + 12%, P < 0.001; nonmultimorbid: +4%, P = 0.003), higher risk of nonroutine discharge among colorectal (multimorbid: +42.3%, P < 0.001; nonmultimorbid: +55.1%, P < 0.001) and intestinal obstruction patients (multimorbid: +14.6%, P = 0.001; nonmultimorbid: +14.8%, P = 0.001), and lower risk of nonroutine discharge (multimorbid: −11.5%, P < 0.001; nonmultimorbid: −11.9%, P < 0.001) and 30-day readmissions (multimorbid: −8.2%, P = 0.002; nonmultimorbid: −9.7%, P < 0.001) among hepatobiliary patients.

Conclusions:
The effects of multimorbidity on operative versus nonoperative management varied by EGS condition category. Physicians and patients should have honest conversations about the expected risks and benefits of treatment options, and future investigations should aim to understand the optimal management of multimorbid EGS patients.
Short-term Outcomes After Laparoscopic IPOM vs. Robot-assisted Retromuscular Repair of Small to Medium Ventral Hernias
Authors: Jensen Kristian K. , Helgstrand Frederik , Henriksen Nadia A. 
Published: May 2023

Objective:
To examine the short-term outcomes after laparoscopic intraperitoneal onlay mesh (IPOM) compared to robot-assisted retromuscular repair of small to medium sized ventral hernia.

Summary background information:
With the introduction of a robot-assisted approach, retromuscular mesh placement is technically more feasible compared to laparoscopic IPOM, with potential gains for the patient, including avoidance of painful mesh fixation and intraperitoneal mesh placement.

Methods:
This was a nationwide cohort study of patients undergoing either laparoscopic IPOM or robot-assisted retromuscular repair of a ventral hernia with a horizontal fascial defect <7 cm in the period 2017 to 2022, matched in a 1:2 ratio using propensity scores. Outcomes included postoperative hospital length of stay, 90-day readmission, and 90-day operative reintervention, and multivariable logistic regression analysis was performed to adjust for the relevant confounder.

Results:
A total of 1,136 patients were included for analysis. The rate of IPOM repaired patients hospitalized > 2 days was more than 3 times higher than after robotic retromuscular repair (17.3% vs. 4.5%, P < 0.001). The incidence of readmission within 90 days postoperatively was significantly higher after laparoscopic IPOM repair (11.6% vs. 6.7%, P=0.011). There was no difference in the incidence of patients undergoing operative intervention within the first 90 days postoperatively (laparoscopic IPOM 1.9% vs. robot-assisted retromuscular 1.3%, P=0.624).

Conclusions:
For patients undergoing first-time repair of a ventral hernia, robot-assisted retromuscular repair was associated with a significantly reduced incidence of prolonged length of postoperative hospital stay and risk of 90-day compared to laparoscopic IPOM.
Early lyophilized cryoprecipitate enhances the ADAMTS13/VWF ratio to reduce systemic endotheliopathy and lessen lung injury in a mouse multiple-trauma hemorrhage model
Authors: Zeineddin Ahmad , Wu Feng , Dong Jing-Fei , Vesselinov Roumen , Neal Matthew D. , Corash Laurence , Pati Shibani , Kozar Rosemary A. 
Published: May 2023

BACKGROUND
Recent studies in severely injured patients suggest an important role of von Willebrand Factor (VWF) and ADAMTS13 in the endotheliopathy of trauma (EoT). We hypothesized that the early use of cryoprecipitate would be effective as an endothelial protector by supplementing physiologic VWF and ADAMTS13 to reverse the EoT. We tested a pathogen-reduced lyophilized cryoprecipitate (LPRC) that could expedite the early administration of cryoprecipitate in the battlefield.

METHODS
A mouse multiple-trauma model with uncontrolled hemorrhage (UCH) from liver injury was utilized followed by hypotensive resuscitation (mean arterial pressure, 55–60) × 3 hours with lactated Ringer's (LR), fresh frozen plasma (FFP), conventional pathogen-reduced cryoprecipitate (CC), and LPRC. Blood was collected for measurement of syndecan-1, VWF, and ADAMTS13 by ELISA. Lungs were stained for histopathologic injury and syndecan-1 and bronchial alveolar lavage (BAL) fluid harvested for protein as an indicator of permeability. Statistical analysis was by ANOVA followed by Bonferroni correction.

RESULTS
Following multiple trauma and UCH, blood loss was similar across groups. Mean volume of resuscitation was higher in the LR group compared with the other resuscitation groups. Lung histopathologic injury, syndecan-1 immunostaining and BAL protein were higher with LR compared with resuscitation with FFP and CC, while LPRC further reduced BAL compared with FFP and CC. The ADAMTS13/VWF ratio was significantly lower in LR but improved with FFP and CC, comparable to shams while LPRC further increased this ratio.

CONCLUSION
The protective effects of CC and LPRC were comparable to FFP in ameliorating the EoT in our murine multiple trauma and UCH model. Lyophilized cryoprecipitate may also provide additional benefit by enhancing the ADAMTS13/VWF ratio. These data provide evidence of the safety and efficacy of LPRC and warrants further investigation for its potential application in military settings once approved for human administration.
Feasibility of conducting a military-relevant multicenter cohort study to assess outcomes of early trauma resuscitative interventions in a prolonged care civilian setting
Authors: Mould-Millman Nee-Kofi , Dixon Julia M. , Lategan Hendrick J. , Beaty Brenda , Fosdick Bailey , Fleischer Chelsie , de Vries Shaheem , Schauer Steven G. , Steyn Elmin , Verster Janette , Hodsdon Lesley , Mukonkole Suzan , Doubell Karlien , Stassen Willem , Keenan Sean , Cunningham Cord , Moore Ernest E. , Ginde Adit A. , Bebarta Vikhyat S. 
Published: May 2023

BACKGROUND
The Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study is a 4-year, prospective, observational, large-scale epidemiologic study in South Africa. It will provide novel evidence on how early resuscitation impacts postinjury mortality and morbidity in patients experiencing prolonged care. A pilot study was performed to inform the main EpiC study. We assess outcomes and experiences from the pilot to evaluate overall feasibility of conducting the main EpiC study.

METHODS
The pilot was a prospective, multicenter, cohort study at four ambulance bases, four hospitals, and two mortuaries from March 25 to August 27, 2021. Trauma patients 18 years or older were included. Data were manually collected via chart review and abstraction from clinical records at all research sites and inputted into Research Electronic Data Capture. Feasibility metrics calculated were as follows: screening efficiency, adequate enrollment, availability of key exposure and outcome data, and availability of injury event date/time.

RESULTS
A total of 2,303 patients were screened. Of the 981 included, 70% were male, and the median age was 31.4 years. Six percent had one or more trauma relevant comorbidity. Fifty-five percent arrived by ambulance. Forty percent had penetrating injuries. Fifty-three percent were critically injured. Thirty-three percent had one or more critical interventions performed. Mortality was 5%. Four of the eight feasibility metrics exceed the predetermined threshold: screening ratio, monthly enrollment, percentage with significant organ failure, and missing injury date/time for emergency medical services patients. Two feasibility metrics were borderline: key exposure and primary outcome. Two feasibility metrics fell below the feasibility threshold, which necessitate changes to the main EpiC study: percentage with infections and missing injury date/time for walk-in patients.

CONCLUSION
The EpiC pilot study suggests that the main EpiC study is overall feasible. Improved data collection for infections and methods for missing data will be developed for the main study.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level V.
Characteristics and Treatments of Coronavirus Disease 2019 Patients Presenting With Persistent Hiccups: A Scoping Review
Authors: Boulis Michael , Boulis Mary , Cosgrove Marianne , He Ken 
Published: May 2023

Objectives
Over the time of the pandemic, coronavirus disease 2019 (COVID-19) has surprised us with a growing list of atypical presentations, one of which is persistent hiccups that last more than 48 hours. The aim of this review is to investigate the characteristics of COVID-19 patients presenting with persistent hiccups and explore treatments used to control persistent hiccups in such cases.

Methods
This scoping review was performed utilizing the methodological approach proposed by Arksey and O'Malley.

Results
Fifteen relevant cases were identified. All reported cases were males, aged between 29 and 72 years. More than one-third of the cases did not have symptoms of infection. All cases had a positive severe acute respiratory syndrome coronavirus reverse transcriptase–polymerase chain reaction, as well as lung involvement evident on chest imaging. The medications most frequently used for hiccups in the reported cases were chlorpromazine (6 cases, 83% success), metoclopramide (5 cases, 0% success), and baclofen (3 cases, 100% success).

Conclusions
In patients presenting with persistent hiccups during this pandemic, even in those lacking systemic or other manifestations of COVID-19 or pneumonia, clinicians are encouraged to consider COVID-19 as one of the differential diagnoses. In light of the findings of this review, it is recommended to include a severe acute respiratory syndrome coronavirus reverse transcriptase–polymerase chain reaction test and a chest imaging as part of the workup for these patients. When considering treatment options, this scoping review shows that chlorpromazine has more favorable outcomes compared with metoclopramide for controlling persistent hiccups in COVID-19 patients.
From voice to ink (VINK): Development and assessment of an automated, free-of-charge transcription tool
Authors: Tolle Hannah , Castro Maria del Mar , Wachinger Jonas , Putri Agrin Zauyani , Kempf Dominic , Denkinger Claudia M. , McMahon Shannon A. 
Published: May 2023

AbstractVerbatim transcription of qualitative data is a cornerstone of analytic quality and rigor, yet the time and energy required for such transcription can drain resources, delay analysis and hinder the timely dissemination of qualitative insights. In recent years, software programs have presented a promising mechanism to accelerate transcription, but the broad application of such programs has been constrained due to expensive licensing or “per-minute” fees, data protection concerns, and limited availability of such programs in many languages. In this article, we outline our process of developing and adapting a free, open-source, speech-to-text algorithm (Whisper by OpenAI) into a usable and accessible tool for qualitative transcription. Our program, which we have dubbed “Vink” for voice to ink, is available under a permissive open-source license (and thus free of cost). We assessed Vink’s reliability in transcribing authentic interview audio data in 14 languages, and identified high accuracy and limited correction times in most languages. A majority (9 out of 12) of reviewers evaluated the software performance positively, and all reviewers whose transcript had a word-error-rate below 20% (n=9) indicated that they were likely or very likely to use the tool in their future research. Our usability assessment indicates that Vink is easy-to-use, and we are continuing further refinements based on reviewer feedback to increase user-friendliness. With Vink, we hope to contribute to facilitating rigorous qualitative research processes globally by reducing time and costs associated with transcription, and expanding the availability of this transcription software into several global languages. With Vink running on the researcher’s computers, data privacy issues arising within many other solutions do not apply.Summary boxWhat is already known on this topic:Transcription is a key element to ensure quality and rigor of qualitative data for analysis. Current practices, however, often entail high costs, variable quality, data privacy concerns, stress for human transcribers, or long delays of analysis.What this study adds:We present the development and assessment of a transcription tool (Vink) for qualitative research drawing upon an open-source automatic speech recognition system developed by OpenAI and trained on multilingual audio data (Whisper). Initial validation in real-life data from 14 languages shows high accuracy in several languages, and an easy-to-use interface.How this study might affect research, practice or policy:Vink overcomes limitations of transcription by providing a ready to use, open source and free-of-cost tool, with minimal data privacy concerns, as no data is uploaded to the web during transcription.
Scale-up costs and societal benefits of psychological interventions for alcohol use and depressive disorders in India
Authors: Zadey Siddhesh 
Published: May 2023

AbstractThere is growing evidence for cost-effective psychological interventions by lay health workers for managing mental health problems. In India, Counseling for Alcohol Problems (CAP) and Healthy Activity Program (HAP) have been shown to have sustained cost-effectiveness for improving harmful alcohol use among males and depression remission among both sexes, respectively. We conducted a retrospective analysis of annual costs and economic benefits of CAP and HAP national scale-up with 2019 as the baseline. The CAP and HAP per capita integration costs were obtained from original studies, prevalence and disability-adjusted life-years for alcohol use disorders (AUD) and depressive disorders for 20-64 years old males and females from Global Burden of Disease study, and treatment gaps from National Mental Health Survey. Scale-up costs were calculated for meeting total or unmet needs Societal benefit estimates based on averted disease burden were calculated using human capital and value of life-year approaches. Net benefits were calculated from combinations of differences between societal benefits and scale-up costs. Values were transformed to 2019 international dollars. CAP scale-up costs ranged from Int$ 2.03 (95%UI: 1.67, 2.44) billion to Int$ 6.34 (5.21, 7.61) billion while HAP ones ranged from Int$ 6.85 (5.61, 8.12) billion to Int$ 23.21 (19.03, 27.52) billion. Societal benefits due to averted AUD burden ranged from Int$ 11.51 (8.75, 14.90) billion to Int$ 38.73 (29.43, 50.11) billion and those due to averted depression burden ranged from Int$ 30.89 (20.77, 43.32) billion to Int$ 105.27 (70.78, 147.61) billion. All scenarios showed net positive benefits for CAP (Int$ 6.05-36.38 billion) and HAP (Int$ 11.12-93.50 billion) scale-up. The novel national-level scale-up estimates have actionable implications for mental health financing in India.