bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model
Authors: Steer Kieran JD , Sun Zhuolu , Sadowski Daniel C , Yong Jean H E , Coldman Andrew , Nemecek Nicole , Yang Huiming 
Published: September 2023

Objective To estimate the impact on clinical outcomes and healthcare resource use from recommending that patients with 1–2 low-risk adenomas (LRAs) return to routine fecal immunochemical test (FIT) screening instead of surveillance colonoscopy, from a Canadian provincial healthcare system perspective. Methods The OncoSim-Colorectal microsimulation model simulated average-risk individuals eligible for FIT-based colorectal cancer (CRC) screening in Alberta, Canada. We simulated two surveillance strategies that applied to individuals with 1–2 LRAs (<10 mm) removed as part of the average risk CRC screening program: (a) Surveillance colonoscopy (status quo) and (b) return to FIT screening (new strategy); both at 5 years after polypectomy. A 75 ng/mL FIT positivity threshold was used in the base case. The simulations projected average annual CRC outcomes and healthcare resource use from 2023 to 2042. We conducted alternative scenarios and sensitivity analyses on key variables. Results Returning to FIT screening (versus surveillance colonoscopy) after polypectomy was projected to have minimal impact on long-term CRC incidence and deaths (not statistically significant). There was a projected decrease of one (4%) major bleeding event and seven (5%) perforation events per year. There was a projected increase of 4800 (1.5%) FIT screens, decrease of 3900 (5.1%) colonoscopies, and a decrease of $3.4 million (1.2%) in total healthcare costs per year, on average. The annual colonoscopies averted and healthcare cost savings increased over time. Results were similar in the alternative scenarios and sensitivity analyses. Conclusions Returning to FIT screening would have similar clinical outcomes as surveillance colonoscopy but could reduce colonoscopy demand and healthcare costs.
A Study to Assess the Knowledge Regarding Cardiopulmonary Resuscitation Among Staff of Ambulance, Equipped Status of Ambulances, and their Utilization
Authors: Kumar Ashok , Agnihotri Meenakshi , Verma Subhash , Rathore Gayatri , Ram Kheta , Saini Sandeepna , VM Dr Karthik , Kumar Pramod , Nagi Manisha , Kaur Maninder Deep , Nagar Pramod Kumar , Aggarwal Achala , Gairolla Jitender 
Published: September 2023

Introduction Most patients are quickly transferred to the hospitals by ambulances worldwide. Hence, it is imperative that ambulance should be well equipped with all emergency equipment and well-trained staff to provide cardiopulmonary resuscitation (CPR) or basic life support (BLS) to victim in pre-hospital environment, if required. Purpose To assess knowledge regarding CPR of ambulance staff, equipped status of ambulances, and their utilization during CPR or first aid. Methods Total 400 ambulance staff were purposively recruited after obtaining informed written consent. They were interviewed as per validated interview schedule regarding CPR knowledge and utilization of equipment during CPR or first aid. Using an observation checklist for assessment of available equipment for CPR and first aid in the ambulance was checked. Results Mean age of participants was 35.57 ± 7.63 years. All were males. Among them 63.75% were posted in private ambulance, and 73.50% ambulances had solo staff. Most (98.25%) ambulances were equipped with oxygen cylinder and only 3.5% had portable ventilator. Majority (75%) lacked the essential equipment as per AHA/national guidelines. Mean knowledge score of participants was 2.85 ± 4.10 and 62.25% and they had poor knowledge regarding CPR and only 12.25% had good/very good knowledge. Conclusion There is a lack of knowledge regarding CPR among ambulance staff and there is lack of equipped status of ambulances. They were not fully aware regarding the use of equipment, which were available in the ambulance in emergency. So, there is a need to train them about CPR as well utilization of ambulance equipment.
Heat treatment for giant cell tumors of bone: A systematic review
Authors: Schoutens Carlijn , Verspoor Floortje GM 
Published: September 2023

This systematic review evaluates the effects of heat treatments in de novo, residual and recurrent giant cell tumors of bone (GCTB). Studies were eligible for inclusion if one of the following treatments was administered: radiofrequency ablation (RFA), microwave ablation, argon cauterization, electrocauterization and hot liquid treatment. The primary outcome was recurrence. Secondary outcomes were complications, pain, function, and quality of life. Recurrence rates for microwave ablation as an adjuvant to intralesional curettage were 0%, 4% and 10% (3 retrospective single-group studies); for argon cauterization 4%, 8% and 26% (3 cohort studies); electrocauterization 0% to 33% (8 cohort studies); and hot liquid 9.5% and 24% (2 cohort studies). Follow-up was generally ≥24 months. Data on pain, function and quality of life were scarce. Complications included infection and secondary osteoarthritis. Current evidence does not demonstrate or exclude an effect of heat treatments on recurrence in GCTB. Further research should objectify if (subgroups of) patients benefit from these treatments.
Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study
Authors: van der Plas Pleun P.J.M. , van Heesch Gwen G.M. , Koudstaal Maarten J. , Pullens Bas , Mathijssen Irene M.J. , Bernard Simone E. , Wolvius Eppo B. , Joosten Koen F.M. 
Published: September 2023

ObjectiveTo reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence.DesignProspective study.SettingSophia Children's Hospital, Rotterdam, the Netherlands.Patients/ Participants36 patients with Robin Sequence who were treated between 2011 and 2021.InterventionsPositional therapy and respiratory support.Main Outcome Measure(s)Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA).ResultsTwenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from −0.40 to −0.33 to −1.03, respectively.ConclusionsNon-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.
Impact of pegaspargase dose capping on incidence of pegaspargase-related adverse events in adults
Authors: Tiao Emily , Bernhardi Ciera L , Trovato James A , Lawson Justin , Seung Hyunuk , Emadi Ashkan , Duffy Alison P 
Published: September 2023

Introduction Asparaginase derivatives are essential components of the treatment of acute lymphoblastic leukemia in adolescent and young adult patients. However, their associated toxicities limit wider use in older populations. This study seeks to determine if the practice of capping the pegaspargase dose at 3750 units reduces the risk of related adverse events in adults. Methods Adverse event data were retrospectively collected 28 days following each administration of pegaspargase in a single center. Doses were categorized as either capped (≤3750 units) ( n = 57, 47.5%) or non-capped (>3750 units) ( n = 63, 52.5%). The primary endpoint of this study was the composite incidence of serious pegaspargase-related adverse events, defined as grade 3 or higher. Results Of the 120 doses administered, 47 (39.2%) were administered to patients  > 39 years. For the primary endpoint, 26 doses (45.6%) in the dose capped group versus 22 doses (34.9%) in the non-dose capped group were associated with serious pegaspargase-related adverse events ( p = 0.23). Isolated laboratory abnormalities accounted for all hepatotoxicity and pancreatic toxicity events, while venous thromboembolism and bleeding occurred after 8.3% and 13.3% of doses, respectively. Multivariate analysis of the primary outcome to adjust for differences in baseline characteristics found no difference between groups (OR 2.56 (0.84, 7.77, p = 0.098)). Conclusions The incidence of serious clinical toxicities was low in this study, particularly pegaspargase-related venous thromboembolism. This suggests that the practice of capping pegaspargase doses at 3750 units, coupled with vigilant monitoring and prophylaxis for pegaspargase-related adverse events, can allow for the inclusion of this drug in the treatment of older individuals.
Retrolental cohesive ophthalmic viscoelastic injection in severely subluxated cataracts: The “Viscolift technique”
Authors: Iannetta D. , Romano V. , Valsecchi N. , Mesiani M. , Moramarco A. , Fontana L. 
Published: September 2023

Introduction To describe a novel surgical approach in the management of subluxated cataracts. Methods A 70-year-old Caucasian male with a subluxated cataract in the left eye was referred to our clinic at the Azienda Ospedaliero-Universitaria di Bologna- Ophthalmology Unit. The ophthalmic examination revealed a best-corrected visual acuity (BCVA) of 20/200 in the left eye with monocular diplopia and a severely subluxated NO6/NC6 cataract and the fundus examination did not reveal any vitreoretinal abnormalities. The right eye had 20/20 BCVA and was pseudophakic. After a 300° conjunctival peritomy, a single 25-gauge valved trocar 4 mm was inserted from the limbus in the inferotemporal quadrant, where the cataract was mainly dislocated and a corneal paracentesis to reduce the anterior chamber intraocular pressure was performed. Subsequently cohesive viscoelastic was progressively injected in the retrolental space through the trocar, to recenter and elevate the subluxated cataract. Thereafter, a complete centered capsulorhexis was performed, four capsular hooks were inserted to stabilize the bag, and complete phacoemulsification was performed with intact posterior capsular support. In the end, given the lack of capsular support elements such as the Cionni ring or Ahmed segment, a sutureless scleral fixated intraocular lens was implanted. Results One week after surgery, the BCVA was 20/25, and the final BCVA at 6 months was 20/20, without any complications. Conclusions Retrolental cohesive ophthalmic viscoelastic injection could represent a novel effective surgical approach in recentering and elevating subluxated cataracts, facilitating the capsulorhexis, and reducing the risk of a pars plana approach.
Efficacy and safety of low dose, weight-based subcutaneous enoxaparin protocol in recurrent arteriovenous access thrombosis
Authors: Gan Chye Chung , Tan Ru Yu , Cheong May Anne , Pang Suh Chien , Tng Ren Kwang Alvin , Tan Chee Wooi , Lee Lai Heng , Ng Heng Joo , Tay Kiang Hiong , Chong Tze Tec , Tan Chieh Suai 
Published: September 2023

Background: This study aims to evaluate the safety and efficacy of a short-term, low dose, weight-based subcutaneous enoxaparin protocol (SEP) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis. Methods: Prospective follow-up of 25 patients who presented to a tertiary institution with recurrent AV access thrombosis and treated with anticoagulation according to SEP following successful thrombectomy. Patency and safety outcomes of SEP were studied. Results: The participants were 66.4 ± 10.2 years old and predominantly male (60%) and of Chinese ethnicity (72%). The AV accesses had a median age of 1.4 (0.6, 5.6) years with 60% being non-autogenous arteriovenous access while 40% were autogenous arteriovenous access. Thrombolytic agents (urokinase (72%) or alteplase (28%)) were used in all procedures while adjunct thrombectomy device was used in only four procedures. The mean dose of enoxaparin was 36.0 ± 8.2 mg or 0.64 ± 0.1 mg/kg/day for a mean duration 30.0 days (Interquartile range: 27.5, 31.0). One patient developed minor bleeding episode. Kaplan-Meier analysis demonstrated that the mean thrombosis-free survival pre- versus post-SEP adoption was 27.3 (95% CI 17.9–36.7) versus 183.5 (95% CI 100.1–266.9) days ( p < 0.001). After adjusting for the type of thrombolytic agent, use of adjunct thrombectomy device, cutting balloon, drug-coated balloon, and stent graft, SEP remained a significant factor associated with longer thrombosis-free patency (HR 0.166: 95% CI 0.070–0.392, p < 0.001). Discussion: SEP appears to be a feasible and safe thromboprophylaxis method to improve thrombosis-free patency for AV access with recurrent thrombosis.
Implementation of an integrated community approach in deprived neighbourhoods: a theory-based process evaluation using the Consolidated Framework for Implementation Research (CFIR)
Authors: Grootjans Sanneke J.M. , Stijnen M.M.N. , Hesdahl-De Jong I. , Kroese M.E.A.L. , Ruwaard D. , Jansen M.W.J. 
Published: September 2023

Background: We investigated the implementation process of an Integrated Community Approach (ICA) applied in four low socio-economic status neighbourhoods in Maastricht, the Netherlands. The ICA is a Population Health Management initiative and aims to improve population health, quality of care, professional’s satisfaction and decrease costs of care. This study addresses the facilitators and barriers for implementing the ICA from a stakeholder perspective, including steering group members, professionals and citizens. Methods: We conducted a mixed-methods study using a triangulation of methods to investigate the implementation from 1 December 2016 to 31 December 2020. The Consolidated Framework for Implementation Research guided data collection and data-analysis for evaluating the implementation process. In total, 77 interviews, 97 observations, seven focus groups, 65 collected documents and two surveys with open-ended questions were conducted. Results: Facilitators for implementation were the use of citizen science to bring residents’ needs into sharp focus, the integration of the ideology of Positive Health into the working routines of the professionals and leadership at the steering group level to overcome barriers in the ICA. The existing accounting and financial infrastructure obstructed combining budgets at neighbourhood level. Conclusions: Engaging citizens and professionals at an early stage is an important facilitator for implementation. The use of a shared vision on health also worked as a facilitator since it created a shared language among professionals, which is important in Population Health Management initiatives where multiple professionals are expected to collaborate. Trial Registration: NTR 6543; registration date, 25 July 2017.
Bilateral lower extremity injuries in pedestrian versus motor vehicle collisions
Authors: Marvin David T , Seilern und Aspang Jesse , Webb Alexander , Shah Jason , Cantu Nicholas , Hernandez-Irizarry Roberto C , Moore Thomas J 
Published: September 2023

Background Lower extremity (LE) injuries following pedestrian versus motor vehicle collision (PMVC) are a common cause of morbidity and mortality in orthopedic trauma. There is currently no evidence illustrating the presentation of orthopedic bilateral LE injuries (BLEI). This study aimed to evaluate the patterns of BLEI on postoperative outcomes and hospital utilization following PMVC. Methods This retrospective cohort analysis included 532 consecutive patients presenting to a single level I trauma center with LE injuries following PMVC from January 1, 2017 to May 31, 2021. Injury location was categorized by extremity region (hip/femur, knee, leg, ankle, midfoot). Outcome measures included 30-day postoperative complications (infection, compartment syndrome, myocardial infarction, pneumonia, pulmonary embolism, sepsis, stroke) and hospital utilization (length of stay, ICU admission, prolonged ventilation [≥48 h], readmission). Mann–Whitney U, chi-square, and logistic regressions were performed calculating odds ratio (OR) with 95% confidence intervals. Results A total of 142 (26.7%) patients sustained BLEI. The most common BLEI complexes (212 total) were bilateral leg (25.0%), hip/femur and leg (17.0%), leg and knee (12.3%), and hip/femur and knee (8.0%). Bilateral and unilateral injuries showed no difference for postoperative complications (11.3% vs. 6.2%; p = 0.062). However, BLEI had higher odds of ICU admission (OR:2.97, CI:1.68–5.26), prolonged ventilation (OR:2.38, CI:1.24–4.59), and patients remained hospitalized 10.87 days longer (p < 0.001). Conclusion Our findings indicate that more than a quarter of PMVCs with LE injuries present with BLEI and require significantly more hospital resources. This is the first study to characterize BLEI in PMVCs, highlighting associated patterns to encourage heightened awareness in trauma evaluation. Level of Evidence: III
Analysis of the ion current in misfiring and firing cycles during the cold starting of a compression ignition engine
Authors: Trivedi Manan J , Raut Prasad D , Alkhayat Samy , Henein Naeim A 
Published: September 2023

Compression ignition engines will continue to power heavy-duty, long-haul vehicles, and heavy machinery in the future, while batteries become more prevalent in powering light-duty vehicles. However, compression ignition engines face problems when started under severe cold conditions. These problems include combustion instability, misfiring, and higher emissions of unburnt hydrocarbons. Feedback of an engine’s performance to its control unit can be used to improve the fuel injection strategy in real time and mitigate these problems. The ion current signal, being reflective of the combustion and emissions characteristics, has already been proven as a reliable feedback signal under warmed-up conditions. This paper investigates the ion current signal as potential feedback during the cold starting and the warm-up period. Cold starting experiments were conducted in a VW’s 2.0-L, direct injection, four-cylinder compression ignition engine at ambient temperatures of −10°C, 0°C, 10°C, and 20°C. The engine experienced misfiring cycles at the ambient temperatures of −10°C and 0°C. In some misfiring cycles, the ion current was detected even though the pressure trace did not show a distinct combustion event, indicating that the autoignition occurred but the combustion failed to sustain. This means the ion current can identify un-sustained combustion events in misfiring cycles. In firing cycles, an ion current characteristic could well predict the combustion phasing at ambient temperatures of 10°C and 20°C. The real-time feedback of (1) un-sustained combustion events in misfiring cycles and (2) combustion phasing in firing cycles at various ambient temperatures can be utilized to mitigate cold starting problems in compression ignition engines.
Comparative Evaluation of Two Paclitaxel-Coated Stents in an Experimental Setting
Authors: Pouhin Alexandre , Coscas Raphaël , Crespy Valentin , Poupardin Olivia , Pais-De-Barros Jean-Paul , Bouchot Olivier , Bernard Alain , Steinmetz Eric 
Published: September 2023

Introduction: Unlike paclitaxel-coated balloons, pre-clinical data comparing different paclitaxel-coated stents (PCSs) are weak. The study objective was to compare the features of the 2 main PCSs: Eluvia® (Boston Scientific, Marlborough, MA) versus ZilverPTX® (Cook Medical, Bloomington, IN). Method: Analysis was carried out on 12 pigs divided into 2 groups: Eluvia® (n=6) and ZilverPTX® (n=6). The pigs received the PCS corresponding to their group in each external iliac artery and were paired one by one, to examine 6 different post-implantation timepoints: after 30 minutes, 6 hours, 24 hours, 3 days, 7 days, and 14 days. The paclitaxel concentration measurements and the histological analysis were carried out under blind testing on the plasma, arterial, lymph node, and muscle samples. A linear regression model and Wilcoxon Mann-Whitney test were used to study the variables. Results: The plasma paclitaxel rate decrease over 24 hours after PCS implantation was significantly different between the two groups, expressed by the correlation coefficient 0.19 (0.14–0.23; p<0.001) with an undetectable concentration at the 10th hour for Eluvia® versus 3 days for ZilverPTX®. Significantly higher paclitaxel concentrations with ZilverPTX® PCS were observed in muscle samples at each timepoint: extensor digitorum brevis 3.2 (1.17–5.23; p=0.005), biceps femoris 4.27 (2.27–6.26; p<0.001), semi-tendinosus 3.79 (1.85–5.73; p=0.001), tibialis anterior 3.0 (1.37–4.64; p=0.001), and in the femoral nodes 2.27±1.74 ng/g versus 0.14±0.13 ng/g (p<0.001). Histological analysis revealed a trend for more marked intimal inflammation in the arteries stented with ZilverPTX® (p=0.063), especially after the 7th and 14th days. Conclusion: Such a difference in the concentration of paclitaxel in the plasma, muscles, and lymph nodes between the two stents was higher than expected based on differences in device design. The clinical consequences of these results remain to be elucidated, particularly regarding the concerning presence of paclitaxel in muscles and adjacent lymph nodes. Clinical Impact This experimental study compares 2 paclitaxel-coated stents. It demonstrates that differences in stent designs and drug features (coatings and concentrations) translate into differences in terms of concentrations of paclitaxel in the plasma, muscles, and lymph nodes. Our results favor the Eluvia® stent over the ZilverPTX® stent, although more studies are required to confirm this conclusion.
Mechanical properties of flexible composites reinforced with high-performance glass fiber multi-axial warp-knitted fabrics
Authors: Li Bing , Zhao Ziyu , Ma Pibo 
Published: September 2023

This paper investigates the quasi-static mechanical properties and damage behavior of flexible composites prepared from high-performance glass fiber-based multi-axial warp knitted fabrics as reinforcement and high tenacity environmentally friendly thermoplastic polyurethane as a matrix. The composites were produced by attaching thermoplastic polyurethane (TPU) to the top and bottom of the fabric using a vulcanization machine, followed by hot-pressing for different temperatures and time settings. Moreover, the effects of different preparation processes on the tensile strength, static puncture resistance, and tear strength of flexible composites were investigated in this paper. The results indicated that both hot-pressing temperature and vulcanization time had a significant impact on the mechanical properties of the composites. With an optimum vulcanization temperature of 185°C and a vulcanization time of 10 min, the composite provides optimum tensile strength and puncture resistance. Tear strength is the worst and is related to the reinforcement’s organisational structure and the interfacial bond’s strength. The results of this study are of theoretical and practical significance for applying high-performance multi-axial warp-knitted flexible composites as raw materials in the construction field.