bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Injured Patients Before and After the Institution of a Third-Tier Activation at a Level 1 Trauma Center
Authors: Young Andrew M. , Young Brian R. , Young Steven D. , Brundage Alexander , Koyada Prajeeth , Cramer Christopher , Young Jeffrey S. 
Published: September 2023

Background We hypothesized that the addition of a third-level trauma activation would improve outcomes by formalizing an evaluation process for patients in need of urgent evaluation who did not meet the criteria for full or partial trauma alert activation. Methods Admission records for all trauma patients admitted between 2000 and 2021 were obtained. The gamma alert trauma activation was implemented in 2011. A washout period of 6 months was used to account for adjustment to the new protocol. Propensity score matching was performed based on ISS scores, age, injury mechanism, and best-validated comorbidities to create a balanced patient distribution. Patients with missing data were excluded from this study. The association between era and outcomes was determined using logistic and linear regression analyses. Results The matched cohort was well balanced (SMD <.1, all balanced covariates) and included 18,572 patients. Patients in the gamma alert era had decreased ED dwell time, hospital length of stay, and intensive care unit (ICU) length of stay. Readmission rates and rates of upgrade to ICU status were reduced in the gamma alert era. This era was also associated with lower rates of renal failure, UTI, and pneumonia. There was no significant difference in mortality following implementation of the gamma alert. Discussion Implementation of the gamma alert was associated with an improvement in ED dwell times, fewer unplanned admissions to the ICU, decreased readmissions, and a reduction in other in-hospital events. We believe that this reflects improved triage of patients to the ICU and more effective care of trauma patients.
Comparison Between Continuous and Separate Grafts for ALL Reconstruction When Combined With ACL Reconstruction: A Retrospective Cohort Study From the SANTI Study Group
Authors: Ripoll Thomas , Moreira da Silva Andre Giardino , Saoudi Samy , Noguero Antoine , Nicolle Romain , Maris Victor , Helito Camillo , Cavaignac Etienne 
Published: September 2023

Background: While various techniques have been described to augment the anterolateral side of the knee, such as lateral extra-articular tenodesis and anterolateral ligament (ALL) reconstruction (ALLR), it is unclear how they affect clinical outcomes. The aim of this study was to compare the results of 2 ALLR techniques for combined anterior cruciate ligament (ACL)/ALL reconstruction. Hypothesis: The graft rupture rate, complications, and patient-reported outcomes are similar between a reconstruction technique using a continuous gracilis graft (CG) and single femoral tunnel for ACL/ALL reconstruction, and one using a separate gracilis graft (SG) and independent femoral tunnels. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of data collected prospectively at 2 hospitals was conducted: one in which a CG is preferred when performing combined ACL/ALL reconstruction and the other in which an SG is preferred. The medical records at these 2 hospitals were searched to identify ACL-deficient patients who had undergone ACL/ALL reconstruction between 2015 and 2020. Eligible patients were between 18 and 60 years of age, had the reconstruction surgery done within 24 months of the injury, and had ≥2 years of follow-up. The eligible patients were contacted to gather outcomes, or their outcomes were collected in person during their last follow-up visit. Outcomes evaluated included graft rupture rate, complication rate, and Lysholm and International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores. Preoperative and intraoperative data were also evaluated. Results: A total of 237 patients were available for analysis in the GC group and 178 in the SG group with a mean follow-up of 3 years (CG: SD, 9.6 months; SG: SD, 8.1 months). The authors found a low rate of graft rupture (CG: 3.4%; SG: 2.8%; P = .785) and no difference between techniques. The complication rate was 6% in the CG group, while it was 10% in the SG group ( P = .112). The mean value of the IKDC-SKF was similar between techniques (CG: 88.1; SG: 87.9; P = .267), and the mean Lysholm score was excellent in both sets of patients (CG: 90.0; SG: 92.4; P < .001). Conclusion: This study found little to no difference in the graft rupture rate, complication rate, and functional knee scores when using a CG or SG for ALLR during combined ACL/ALL reconstruction. Both techniques are equivalent and can be used for an anterolateral augmentation procedure in combination with ACL reconstruction.
Food Insecurity and Perceived Effects of COVID-19 on Livelihoods in Rural Sri Lanka
Authors: Singh Nishmeet , Scott Samuel , Kumar Neha , Ramani Gayathri , Marshall Quinn , Sinclair Kate , Kalupahana Saman , Fernando Malika , Silva Renuka , Perera Amila , Jayatissa Renuka , Olney Deanna 
Published: September 2023

Background: Little is known about how the COVID-19 pandemic has affected food security and livelihoods in Sri Lanka. Objective: This article aims to assess food insecurity, perceived effects of COVID-19, and coping mechanisms among agriculture-based households in rural Sri Lanka. Methods: We used 2 rounds of panel data from phone surveys (n = 1057 households) conducted in 5 districts. Food insecurity (30-day recall), perceived impacts of COVID-19 (6-month recall), and coping mechanisms (6-month recall) were assessed using a household questionnaire. To assess food insecurity, we used the 8-item Food Insecurity Experience Scale. We tested for differences between T1 (baseline: December 2020-February 2021) and T2 (follow-up: July 2021-September 2021) and explored the association between food insecurity and the perceived effect of COVID-19 on income using a logistic regression model. Results: Food insecurity was highly prevalent (T1: 75%, T2: 80%) but varied across districts. Most respondents were affected by COVID-19 and/or COVID-19-associated mitigation measures (T1: 84%, T2: 89%). Among affected households, commonly reported impacts included those on income (T1: 77%, T2: 76%), food costs (T1: 84%, T2: 83%), and travel (∼90% in both rounds). Agricultural activities were also adversely affected (T1: 64%, T2: 69%). About half of COVID-19-affected households reported selling livestock or assets to meet basic needs. Households whose income was impacted by COVID-19 were more likely to be food insecure (adjusted odds ratio: 2.56, P < .001). Conclusions: Households in rural Sri Lanka experienced food insecurity and livelihood disturbances during the COVID-19 pandemic. Additional surveys are needed to assess recovery post-COVID-19 and to understand if programs that support livelihoods have been protective.
The Stresses of Surrogate Decision-Making: Contributing Factors and Clinicians’ Role in Mitigation
Authors: Mishkin Adrienne D. , Allen Nicole C. , Cheung Stephanie G. , Faccini Maria Carla , Flicker Lauren S. , Shalev Daniel 
Published: September 2023

Background Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation. Methods An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience. Results 108 respondents were included; 91 completed all items. Most respondents ranked their experience as a surrogate as one of the most stressful experiences of their lives; this was associated with whether it was an end-of-life decision ( P = .003), Respondent Religion ( P = .015), or religious or spiritual beliefs ( P = .024), and having their own health problems (P = .008). On individual Likert responses, surrogates reported significant stress mitigation when they felt they had been helpful ( P < .001), knew the patient’s wishes ( P = .0011), specifically discussed patient wishes ( P < .001), or patient’s wishes were documented ( P < .001). Items about surrogate-team interaction also met significance, including the physician being communicative and available (P < .001), respectful ( P = .007), honest ( P < .001), and validating ( P = .001). Conclusions Surrogate stress is an evolving area for research. Significant factors included relationship with the medical team, making this an important area for HPM to play a key role in mitigating surrogate stress.
Determining the Mental Status, Sleep Quality, and Eating Behaviors of University Students During the COVID-19 Pandemic: A Cross-Sectional Study
Authors: Şahin Hilal , Çebi Kadir , Yıldırım Arzu , Hacıhasanoğlu Aşılar Rabia 
Published: September 2023

BACKGROUND: The COVID-19 pandemic has resulted in adverse effects on individuals’ physical and mental health worldwide, with university students also being adversely affected by this process. OBJECTIVES: This research aimed to determine the mental condition, sleep quality, and eating behaviors of university students during the COVID-19 process. METHOD: This cross-sectional study was conducted with 1,065 university students. Study data were collected with an online questionnaire including a personal information form, the Depression Anxiety Stress Scale, the Pittsburgh Sleep Quality Index, and the Dutch Eating Behavior Scale. RESULTS: Students’ poor sleep quality was determined to be 69.5%. It was also determined that students’ depression and stress levels were moderate that their anxiety levels were low, their eating behaviors were generally problematic, and more than half had poor sleep quality. In addition, eating disorders and poor sleep quality increased as depression, anxiety, and stress levels increased, and eating disorders increased as poor sleep quality increased ( p < .05). CONCLUSIONS: The results emphasize the importance of the strengthening of students’ mental health, particularly by improving their sleep quality and eating habits. Evidence-based interventions regarding the effects of the pandemic should be made for students under the leadership of a psychiatric nurse, and effective strategies must be developed accordingly.
Analysis of Serum VEGF, IGF-1, and HIF-1α Levels in ADHD
Authors: Ertürk Emre , Işık Ümit , Şirin Fevziye Burcu 
Published: September 2023

Objective: In recent years, it has been emphasized that various growth factors that affect neurogenesis may lead to ADHD. In this study, we aimed to investigate the role of VEGF, IGF-1, and HIF-1α growth factors in the etiopathogenesis of ADHD. Method: Levels of VEGF, IGF-1, and HIF-1α were compared between 40 ADHD children and 40 healthy children, aged 7 to 13 years. Result: VEGF, IGF-1, and HIF-1α levels did not significantly differ between the groups. There was a negative correlation between serum VEGF levels and the parent-rated T-DSM-IV-S (AD) subscale. There was a positive correlation between serum IGF-1 levels and the parent-rated T-DSM-IV-S (AD) subscale, and SDQ (ES) subscale. Conclusion: Given our limitations and the fact that some of our findings differ from those of other studies, it is evident that this area requires additional research with larger samples.
Relaxing radial retinal incisions for the treatment of persistent macular holes
Authors: Camenzind-Zuche Hanna , Janeschitz-Kriegl Lucas , Hasler Pascal , Prünte Christian 
Published: September 2023

Purpose Various surgical techniques have been described for managing persistent macular holes after an unsuccessful vitrectomy with internal limiting membrane (ILM) peeling. However, the closure and functional improvement rates after these procedures are limited. Therefore, the aim of this study was to evaluate the usefulness of radial retinal incisions (retinotomies) in eyes with persistent large macula holes despite previous vitrectomy with ILM peeling. Design In a retrospective case series, closure rate and best-corrected visual acuity (BCVA) were evaluated in eyes with persistent macular holes after an unsuccessful vitrectomy that included posterior vitreous detachment and ILM peeling. Subjects 22 eyes of 22 patients (10 men and 12 women) underwent re-vitrectomy with radial retinal incisions. All the patients had undergone an unsuccessful surgery before. Methods Small-incision re-vitrectomy with radial retinal incisions (retinotomies) and air tamponade was performed. Main Outcome Measurements For all eyes, high-definition SD-OCT scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery; 1 week and 1 month after surgery; and at final follow-up. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) in logMAR and Snellen at baseline, 1 and 4 months after operation, and at the final follow-up visit were analyzed. Results The mean baseline macular hole diameter was 668.5 ± 226.8 μm. At the final examination, 16 (72.72%) of the 22 macula holes were closed. Visual acuity increased in 17 eyes, was stable in 3 eyes, and decreased in 2 eyes owing to central retinal atrophy in both. The mean BCVA increased from logMAR 1.04 ± 0.29 at baseline to 0.57 ± 0.31 (Snellen 0.11 ± 0.05 to 0.33 ± 0.18). In all successful cases, macula hole closure was attained after 3 days, and none of the eyes showed macula hole recurrence. Conclusion The results of this limited case series suggest that radial retinal incisions of the rim in persistent macula holes after initial surgery with ILM peeling increase the success rate of macula hole closure and results in a relevant increase in BCVA. However, as the number of eyes included in this series is limited, the results must be confirmed in a study with a larger sample size.
Conventional anatomical landmark versus preprocedural ultrasound for thoracic epidural analgesia: A systematic review and meta-analysis
Authors: Sharapi Mahfouz , Mahfouz Amany , Philip Kerollos , Mektebi Ammar , Albakri Khaled 
Published: September 2023

Background: Thoracic epidural analgesia is the gold standard for major thoracic and abdominal surgeries. Aim: Ultrasound-guided and landmark-based thoracic epidural insertion are compared in this systematic review. Methods: Randomised controlled trials were sought in six databases for a systematic review and meta-analysis. With a 95% confidence interval, a fixed-effects model calculated risk ratio or mean difference. Cochrane risk of bias assessed bias. Four randomised controlled trials were examined. Findings: Preprocedural ultrasound increased thoracic epidural placement first-puncture success rate (risk ratio = 1.28, 95% confidence interval (1.05 to 1.56), p value = 0.02) and decreased the need for two or more skin punctures (mean difference = −2.41, 95% confidence interval (−3.34 to −1.47), p value = 0.00001). The ultrasound group reduced needle redirections (risk ratio = 0.6, 95% confidence interval (0.38 to 0.94), p value = 0.02). The epidural block success rate was equal in both groups (risk ratio = 1.02, 95% confidence interval (0.96 to 1.07), p value = 0.6). Conclusion: Thoracic epidural insertion is improved by ultrasound but not the success rate. Quality research with larger samples is needed to emphasise these conclusions.
Pursuit or discontinuation of anti-PD1 after 2 years of treatment in long-term responder patients with non-small cell lung cancer
Authors: Ardin Camille , Humez Sarah , Leroy Vincent , Ampere Alexandre , Bordier Soraya , Escande Fabienne , Turlotte Amélie , Stoven Luc , Nunes David , Cortot Alexis , Gauvain Clément 
Published: September 2023

Background: The optimal duration of immune checkpoint inhibitor (ICI) treatment for patients with advanced non-small cell lung cancer (NSCLC) remains to be determined. Treatment durations in cornerstone phase 3 clinical trials vary between a fixed 2-year duration and pursuit until disease progression. Clinical practices may thus differ according to the attending physician. Objectives: Here we provide real-world data about treatment decisions at 2 years, with subsequent clinical outcomes. Design and Methods: This multicentric observational study included patients with advanced NSCLC whose disease was controlled after 2 years of pembrolizumab or nivolumab. The primary outcome was the decision to discontinue ICI treatment or not, along with factors motivating this decision. Secondary outcomes included progression-free survival (PFS) (according to treatment continuation or not) and adverse events. Results: A total of 91 patients were included, of which 60 (66%) had been pre-treated. The programmed death-ligand 1 expression level was ⩾50% in 43 patients (47%). In 61 patients (67%), ICI was continued after 2 years of treatment. This decision was significantly associated with the care center ( p < 0.001) but neither with the tumor response at 2 years, as evaluated by CT scan or PET scan, nor with clinical status, immune-related adverse events, or previous locally treated oligo-progressive disease under ICI. Two years after the 2-year decision, PFS was 68.5%, [95% confidence interval (CI) (53.3–88.0)] in the ‘ICI discontinuation’ group and 64.1% [95% CI (51.9–79.2)] in the ‘ICI pursuit’ group; hazard ratio for relapse was 1.14 [95% CI (0.54–2.30), p = 0.77]. The overall survival rate at 24 months after discontinuation was 89.2% [95% CI (78.4–100)] for the ‘discontinuation’ group and 93.1% [95% CI (85.8–100)] for the ‘pursuit’ group. Given insufficient power, overall survival could not be compared. Conclusion: The decision to continue ICI or not after 2 years of treatment depends mainly on the care center and does not seem to impact survival. Larger, randomized data sets are required to confirm this result.
Adverse events induced by durvalumab and tremelimumab combination regimens: a systematic review and meta-analysis
Authors: Matsumoto Hiromi , Somekawa Kohei , Horita Nobuyuki , Ueda Suguru , Kaneko Megumi , Kaneko Ayami , Fukuda Nobuhiko , Izawa Ami , Kamimaki Chisato , Tanaka Katsushi , Murohashi Kota , Fuji Hiroaki , Tagami Yoichi , Aoki Ayako , Watanabe Keisuke , Hara Yu , Kobayashi Nobuaki , Kaneko Takeshi 
Published: September 2023

Background: Immune checkpoint inhibitors (ICIs) have shown remarkable therapeutic outcomes among cancer patients. Durvalumab plus tremelimumab (DT) is under investigation as a new ICI combination therapy, and its efficacy has been reported in various types of cancer. However, the safety profile of DT remains unclear, especially considering rare adverse events (AEs). Objective: We aimed to assess the frequency of AEs associated with DT. Design: This study type is a systematic review and meta-analysis. Data Sources and Methods: Four databases were searched for articles. Randomized trials, single-arm trials, and prospective and retrospective observational studies were included. The type of cancer, previous treatment, and performance status were not questioned. Major AE indicators such as any AE and the pooled frequency of each specific AE were used as outcomes. As a subgroup analysis, we also compared cases in which DT was performed as first-line treatment with those in which it was performed as second-line or later treatment. The protocol for this systematic review was registered on the University Hospital Medical Information Network (UMIN) Center website (ID: UMIN000046751). Results: Forty-one populations including 3099 patients were selected from 30 articles. Pooled frequencies of key AE indicators are shown below: any AEs, 77.8% [95% confidence interval (CI): 67.9–87.6]; grade ⩾ 3 AEs, 29.3% (95% CI: 24.2–34.4); serious AEs, 34.9% (95% CI: 28.1–41.7); AE leading to discontinuation, 13.3% (95% CI: 9.3–17.4); treatment-related deaths, 0.98% (95% CI: 0.5–1.5). AEs with a frequency exceeding 15% are shown below: fatigue, 30.1% (95% CI: 23.8–36.3); diarrhea, 21.7% (95% CI: 17.8–25.6); pruritus 17.9% (95% CI: 14.4–21.3); decreased appetite, 17.7% (95% CI: 13.7–22.0); nausea, 15.6% (95% CI: 12.1–19.6). There were no significant differences in these pooled frequencies between subgroups. Conclusions: The incidence of any AE in DT therapy was approximately 78%, and the incidence of grade 3 or higher AEs was approximately 30%, which was independent of prior therapy.
Third-line treatment patterns and clinical outcomes for metastatic colorectal cancer: a retrospective real-world study
Authors: Deng Ting , Duan Jingjing , Bai Ming , Zhang Le , Li Hongli , Liu Rui , Ning Tao , Ge Shaohua , Wang Xia , Yang Yuchong , Ji Zhi , Wang Feixue , Ba Yi 
Published: September 2023

Background: There are multiple recommendations on the third-line therapy of metastatic colorectal cancer (mCRC); however, no consensus has been reached. Objectives: This study aimed to explore the patient demographics and the real-world third-line treatment landscape of mCRC. Design: A retrospective real-world cohort study. Methods: Electronic medical records of mCRC patients from Tianjin Medical University Cancer Institute and Hospital between 2013 and 2020 were collected. Upon descriptive, comparative, and survival analyses, a retrospective study was conducted to describe demographics and clinical outcomes of mCRC patients receiving third-line treatment. Results: Among 218 mCRC patients receiving third-line therapy, 65.5% received chemotherapy combined with or without targeted drugs, followed by anti-angiogenic monotherapy (18.4%), anti-epidermal growth factor receptor drugs (6.9%) and immunotherapy (6.4%). The overall response rate and disease control rate reached 10.2% and 59.2%, respectively; and median progression-free survival (PFS) and overall survival were 4.0 m and 10.7 m, respectively. After Cox multivariate analysis, we found that therapeutic regime was an independent prognostic factor. Compared to patients receiving anti-angiogenic monotherapy, those receiving chemotherapy combined with or without targeted drugs exhibited better prognosis. For patients whose PFS were longer in the front-line treatment, the PFS of third-line therapy was also relatively longer ( p = 0.023). Multiple types of therapies (>3, p = 0.002) or multiple drugs (>5, p = 0.024) in the whole-course management of mCRC are indicators of longer survival. Conclusion: Chemotherapy combined with or without targeted therapy remained dominated third-line choice and showed favorable efficacy compared with anti-angiogenic monotherapy. With the application of more types and quantities of effective drugs, patients would achieve better survival.