bluuebunny/crossref_metadata_2025_split huggingface dataset:
MICROGLIA AND INFILTRATING T-CELLS ADOPT LONG-TERM, AGE-SPECIFIC, TRANSCRIPTIONAL CHANGES AFTER TRAUMATIC BRAIN INJURY IN MICE
Authors: Chen Zhangying , Islam Mecca B.A.R. , Ford Kacie P. , Zhao Guangyuan , Chen Shang-Yang , Wang Yidan , Davis Booker T. , Mentis Alexios-Fotios A. , Schwulst Steven J. 
Published: February 2023

ABSTRACT
Aged traumatic brain injury (TBI) patients suffer increased mortality and long-term neurocognitive and neuropsychiatric morbidity compared with younger patients. Microglia, the resident innate immune cells of the brain, are complicit in both. We hypothesized that aged microglia would fail to return to a homeostatic state after TBI and adopt a long-term injury-associated state within aged brains compared with young brains after TBI. Young and aged male C57BL/6 mice underwent TBI via controlled cortical impact versus sham injury and were sacrificed 4 months post-TBI. We used single-cell RNA sequencing to examine age-associated cellular responses after TBI. Brains were harvested, and CD45+ cells were isolated via fluorescence-activated cell sorting. cDNA libraries were prepared using the 10x Genomics Chromium Single Cell 3′ Reagent Kit, followed by sequencing on a HiSeq 4,000 instrument and computational analyses. Post-injury, aged mice demonstrated a disparate microglial gene signature and an increase in infiltrating T cells compared with young adult mice. Notably, aged mice post-injury had a subpopulation of age-specific, immune-inflammatory microglia resembling the gene profile of neurodegenerative disease-associated microglia with enriched pathways involved in leukocyte recruitment and brain-derived neurotrophic factor signaling. Meanwhile, post-injury, aged mice demonstrated heterogeneous T-cell infiltration with gene profiles corresponding to CD8 effector memory, CD8 naive-like, CD8 early active T cells, and Th1 cells with enriched pathways, such as macromolecule synthesis. Taken together, our data showed that the aged brain had an age-specific gene signature change in both T-cell infiltrates and microglia, which may contribute to its increased vulnerability to TBI and the long-term sequelae of TBI.
Variables Influencing the Differential Host Response to Burns in Pediatric and Adult Patients
Authors: Barrios Evan L. , Polcz Valerie E. , Moldawer Lyle L. , Rincon Jaimar C. , Efron Philip A. , Larson Shawn D. 
Published: February 2023

ABSTRACT
Burn injury is a significant source of morbidity and mortality in the pediatric population. Although 40,000 pediatric patients in the United States are admitted to the hospital with burn wounds annually, significant differences exist in the management and treatment of these patients, even among highly specialized burn centers. Some aspects of pediatric burn research, such as metabolic changes and nutritional support following burn injury have been studied extensively; however, in many aspects of burn care, pediatric research lags behind the study of adult populations. This review compares and contrasts a wide array of physiologic and immune responses between children and adults after burn injury. Such a review elucidates where robust research has been conducted, where adult research is applicable to pediatric patients, and where additional pediatric burn research needs to be conducted.
Automated Video Debriefing Using Computer Vision Techniques
Authors: VanVoorst Brian R. , Walczak Nicholas R. , Hackett Matthew G. , Norfleet Jack E. , Schewe Jon P. , Fasching Joshua S. 
Published: February 2023

Introduction
Within any training event, debriefing is a vital component that highlights areas of proficiency and deficiency, enables reflection, and ultimately provides opportunity for remediation. Video-based debriefing is desirable to capture performance and replay events, but the reality is rife with challenges, principally lengthy video and occlusions that block line of sight from camera equipment to participants.

Methods
To address this issue, researchers automated the editing of a video debrief, using a system of person-worn cameras and computer vision techniques. The cameras record a simulation event, and the video is processed using computer vision. Researchers investigated a variety of computer vision techniques, ultimately focusing on the scale invariant feature transform detection method and a convolutional neural network. The system was trained to detect and tag medically relevant segments of video and assess a single exemplar medical intervention, in this case the application of a tourniquet.

Results
The system tagged medically relevant video segments with 92% recall and 66% precision, resulting in an F1 (harmonic mean of precision and recall) of 72% (N = 23). The exemplar medical intervention was successfully assessed in 39.5% of videos (N = 39).

Conclusion
The system showed suitable accuracy tagging medically relevant video segments, but requires additional research to improve medical intervention assessment accuracy. Computer vision has the potential to automate video debrief creation to augment existing debriefing strategies.
Association Between Distress at Diagnosis and Disease-free Survival Among Patients With Resectable Colon Cancer: A Large Cohort Study
Authors: Shin Jung Kyong , Kang Danbee , Kim Soohyun , Choi Youngeun , Lee Woo Yong , Yun Seong Hyeon , Cho Yong Beom , Huh Jung Wook , Park Yoon Ah , Cho Juhee , Kim Hee Cheol 
Published: February 2023

Objective:
This study aimed to evaluate the association between distress at initial diagnosis and disease-free survival in patients with resectable colon cancer.

Summary Background Data:
Considerable research has examined the psychological impact of having a confirmed diagnosis of cancer, but relatively limited research has examined the impact of distress during the diagnostic phase on oncological outcomes.

Methods:
This is a retrospective cohort study. We included newly diagnosed colon cancer patients who had resectable surgery and underwent distress screening between July 2014 and July 2021 (N=1,362). The Korean versions of the Distress Thermometer were used to assess distress and related problems. Patients were categorized into 3 groups based on distress score: low (<4), moderate (4–7), and severe (≥8). The primary outcome was disease-free survival.

Results:
The mean distress was 5.1 (SD=2.4) and 61%, and 15% of patients had moderate and severe distress at diagnosis, respectively. The severe distress group was more likely to report fear, sadness, and concerns regarding insurance/finance, work, and childcare than the low distress group. Compared with the low distress group, the severe distress group had worse disease-free survival (Hazard Ratio=1.84, 95% CI=1.03, 3.29). The association was more evident in patients with stage IV disease (Hazard Ratio=2.53, 95% CI=1.02, 6.25).

Conclusions:
A substantial number of patients with colon cancer experience distress at diagnosis, and severe distress has a negative impact on oncologic outcomes. Active monitoring and appropriate management of distress at diagnosis should be adopted at clinical settings.
Comparative Outcomes of Groin Hernia Repair by Sex Among Medicare Beneficiaries
Authors: Ehlers Anne P. , Rob Farizah , Thumma Jyothi , Howard Ryan , Davidson Giana H. , Waljee Jennifer F. , Dimick Justin B. , Telem Dana A. 
Published: February 2023

Objective:
To compare the rates of operative recurrence between male and female patients undergoing groin hernia repair.

Background Data:
Groin hernia repair is common but understudied in females. Limited prior work demonstrates worse outcomes among females.

Methods:
Using Medicare claims, we performed a retrospective cohort study of adult patients who underwent elective groin hernia repair between January 1, 2010 and December 31, 2017. We used a Cox proportional hazards model to evaluate the risk of operative recurrence up to 5 years following the index operation. Secondary outcomes included 30-day complications following surgery.

Results:
Among 118,119 patients, females comprised the minority of patients (n=16,056, 13.6%). Compared with males, female patients were older (74.8 vs. 71.9 y, P<0.01), more often white (89.5% vs. 86.7%, P<0.01), and had a higher prevalence of nearly all measured comorbidities. In the multivariable Cox proportional hazards model, we found that female patients had a significantly lower risk of operative recurrence at 5-year follow-up compared with males (aHR 0.70, 95% CI 0.60–0.82). The estimated cumulative incidence of recurrence was lower among females at all time points: 1 year [0.68% (0.67–0.68) vs. 0.88% (0.88–0.89)], 3 years [1.91% (1.89–1.92) vs. 2.49% (2.47–2.5)], and 5 years [2.85% (2.82–2.88) vs. 3.7% (3.68–3.75)]. We found no significant difference in the 30-day risk of complications.

Conclusions:
We found that female patients experienced a lower risk of operative hernia recurrence following elective groin hernia repair, which is contrary to what is often reported in the literature. However, the risk of operative recurrence was low overall, indicating excellent surgical outcomes among older adults for this common surgical condition.
Waiting to Operate
Authors: Boerner Thomas , Harrington Caitlin , Tan Kay See , Adusumilli Prasad S. , Bains Manjit S. , Bott Matthew J. , Downey Robert J. , Huang James , Ilson David H. , Isbell James M. , Janjigian Yelena Y. , Park Bernard J. , Rocco Gaetano , Rusch Valerie W. , Sihag Smita , Wu Abraham J. , Jones David R. , Molena Daniela 
Published: February 2023

Objective:
To assess postoperative morbidity, disease-free survival (DFS), and overall survival (OS) in patients treated with salvage esophagectomy (SE).

Background Data:
A shift toward a “surgery as needed” approach for esophageal cancer has emerged, potentially resulting in delayed esophagectomy.

Methods:
We identified patients with clinical stage I-III esophageal adenocarcinoma or squamous cell carcinoma who underwent chemoradiation followed by esophagectomy from 2001 to 2019. SE was defined as esophagectomy performed >90 days after chemoradiation (“for time”) and esophagectomy performed for recurrence after curative-intent chemoradiation (“for recurrence”). The odds of postoperative serious complications were assessed by multivariable logistic regression. The relationship between SE and OS and DFS were quantified using Cox regression models.

Results:
Of 1137 patients identified, 173 (15%) underwent SE. Of those, 61 (35%) underwent SE for recurrence, and 112 (65%) underwent SE for time. The odds of experiencing any serious complication [odds ratio, 2.10 (95% CI, 1.37–3.20); P=0.001] or serious pulmonary complication [odds ratio, 2.11 (95% CI, 1.31–3.42); P=0.002] were 2-fold higher for SE patients; SE patients had a 1.5-fold higher hazard of death [hazard ratio, 1.56 (95% CI, 1.25–1.94); P<0.0001] and postoperative recurrence [hazard ratio, 1.43 (95% CI, 1.16–1.77); P=0.001]. Five-year OS for nonsalvage esophagectomy was 45% [(95% CI, 41.6%-48.6%) versus 26.5% (95% CI, 20.2%–34.8%) for SE (log-rank P<0.001)]. Five-year OS for SE for time was 27.1% [(95% CI, 19.5%–37.5%) versus 25.2% (95% CI, 15.3%–41.5%) for SE for recurrence (P=0.611)].

Conclusions:
SE is associated with a higher risk of serious postoperative complications and shorter DFS and OS.
Long-term Outcomes of Ultrasound-guided Thermal Ablation for the Treatment of Solitary Low-risk Papillary Thyroid Microcarcinoma
Authors: Yan Lin , Liu Ying , Li WenHui , Zhu YaLin , Wang Jinling , Zhang Mingbo , Tang Jie , Che Ying , Wang Hui , Wang Shurong , Luo Yukun 
Published: February 2023

Objective:
To report more than 5-year outcomes of ultrasound-guided thermal ablation (TA) for patients with solitary low-risk papillary thyroid microcarcinoma (PTMC) in a large multicenter cohort.

Background:
TA, including radiofrequency ablation (RFA) and microwave ablation (MWA) have been used in patients with low-risk PTMC who refuse surgery or active surveillance. However, its clinical value remains controversial.

Materials and Methods:
This retrospective multicenter study included 474 patients with solitary low-risk PTMC treated with TA (357 for RFA; 117 for MWA) from 4 centers and followed up for at least 5 years. Disease progression including lymph node metastasis and recurrent tumors, volume reduction rate (VRR), tumor disappearance rate, complications, and delayed surgery were assessed. RFA and MWA outcomes were compared using propensity score matching.

Results:
During the median follow-up period of 77.2 months, disease progression incidence, lymph node metastasis, and recurrent tumors rates were 3.6%, 1.1%, and 2.5%, respectively. Age below 40 years old, male sex, Hashimoto thyroiditis, and tumor size were not independent factors associated with disease progression by Cox analysis. The median VRR was 100% and 471 tumors disappeared radiographically. Eight patients experienced transient voice change (1.7%) which recovered within 3 months. None of the patients underwent delayed surgery because of anxiety. After 1:1 matching, no significant differences were found in the disease progression, VRR, tumor disappearance rate, or complications between RFA and MWA subgroups.

Conclusion:
This multicenter study revealed that TA was an effective and safe treatment for patients with solitary low-risk PTMC, which could be offered as a treatment option for the management for low-risk PTMC.
Variation in Anesthesiology Provider–Volume for Complex Gastrointestinal Cancer Surgery
Authors: Hallet Julie , Sutradhar Rinku , Eskander Antoine , Carrier François M. , McIsaac Daniel , Turgeon Alexis F. , d’Empaire Pablo Perez , Idestrup Chris , Flexman Alana , Lorello Gianni , Darling Gail , Kidane Biniam , Chan Wing C , Kaliwal Yosuf , Barabash Victoria , Coburn Natalie , Jerath Angela 
Published: February 2023

Objective:
Examine between-hospital and between-anesthesiologist variation in anesthesiology provider–volume (PV) and delivery of high-volume anesthesiology care.

Background:
Better outcomes for anesthesiologists with higher PV of complex gastrointestinal cancer surgery have been reported. The factors linking anesthesiology practice and organization to volume are unknown.

Methods:
We identified patients undergoing elective esophagectomy, hepatectomy, and pancreatectomy using linked administrative health data sets (2007–2018). Anesthesiology PV was the annual number of procedures done by the primary anesthesiologist in the 2 years before the index surgery. High-volume anesthesiology was PV>6 procedures/year. Funnel plots to described variation in anesthesiology PV and delivery of high-volume care. Hierarchical regression models examined between-anesthesiologist and between-hospital variation in delivery of high-volume care use with variance partition coefficients (VPCs) and median odds ratios (MORs).

Results:
Among 7893 patients cared for at 17 hospitals, funnel plots showed variation in anesthesiology PV (median ranging from 1.5, interquartile range: 1–2 to 11.5, interquartile range: 8–16) and delivery of HV care (ranging from 0% to 87%) across hospitals. After adjustment, 32% (VPC 0.32) and 16% (VPC: 0.16) of the variation were attributable to between-anesthesiologist and between-hospital differences, respectively. This translated to an anesthesiologist MOR of 4.81 (95% CI, 3.27–10.3) and hospital MOR of 3.04 (95% CI, 2.14–7.77).

Conclusions:
Substantial variation in anesthesiology PV and delivery of high-volume anesthesiology care existed across hospitals. The anesthesiologist and the hospital were key determinants of the variation in high-volume anesthesiology care delivery. This suggests that targeting anesthesiology structures of care could reduce variation and improve delivery of high-volume anesthesiology care.
Use of Critical View of Safety and Proctored Preceptorship in Preventing Bile Duct Injury During Laparoscopic Cholecystectomy—Experience of 3726 Cases From a Tertiary Care Teaching Institute
Authors: Bansal Virinder K. , Asuri Krishna , Jain Mayank , Prakash Om , Bhattacharjee Hemanga K. , Isukapati Samrajya , Dey Souvik , Baksi Aditya , Khan Washim Firoz , Subramaniam Rajeshwari , Ramachandran Rashmi , Garg Pramod , Kumar Subodh , Mishra Mahesh C. 
Published: February 2023

Introduction:
Bile duct injury (BDI) continues to occur despite technological advances and improvements in surgical training over the past 2 decades. This study was conducted to audit our data on laparoscopic cholecystectomies performed over the past 2 decades to determine the role of Critical View of Safety (CVS) and proctored preceptorship in preventing BDI and postoperative complications.

Materials and Methods:
All patients undergoing elective laparoscopic cholecystectomy were analyzed retrospectively. The data were obtained from a prospectively maintained database from January 2004 to December 2019. Proctored preceptorship was used in all cases. Intraoperative details included the number of patients where CVS was defined, number of BDI and conversions. Postoperative outcomes, including hospital stay, morbidity, and bile duct stricture, were noted.

Results:
Three thousand seven hundred twenty-six patients were included in the final analysis. Trainee surgeons performed 31.6% of surgeries and 9.5% of these surgeries were taken over by the senior surgeon. A CVS could be delineated in 96.6% of patients. The major BDI rate was only 0.05%.

Conclusion:
This study reiterates the fact that following the basic tenets of safe laparoscopic cholecystectomy, defining and confirming CVS, and following proctored preceptorship are critical in preventing major BDI.
Is Cystogastrostomy a Definitive Operation for Pancreatitis Associated Pancreatic Fluid Collections?
Authors: Darwish Muhammad Bassel , Logarajah Shankar , McLaren Patrick James , Campilan Beatrice , Benzie Annie Laurie , Cho Edward , Osman Houssam , Jeyarajah D. Rohan 
Published: February 2023

Background:
Pancreatic-enteric drainage procedures have become standard therapy for symptomatic pancreatic pseudocysts and walled-off pancreatic necrosis. The need for pancreatic resection after cyst-enteric drainage procedure in the event of recurrence is not well studied. This study aimed to quantify the percentage of patients requiring resection due to recurrence after surgical cystogastrostomy and identify predictors of drainage failure.

Methods:
A single-institution retrospective review was conducted to identify all patients undergoing surgical cystogastrostomy between 2012 and 2020. Demographic, disease, and treatment characteristics were identified. Failure of surgical drainage was defined as the need for subsequent pancreatic resection due to recurrence. Characteristics between failure and nonfailure groups were compared with identifying predictors of treatment failure.

Results:
Twenty-four cystogastrostomies were performed during the study period. Three patients (12.5%) required a subsequent distal pancreatectomy after surgical drainage. There was no difference in comorbidities between drainage alone and failure of drainage groups. Mean cyst size seemed to be larger in patients that underwent drainage alone versus those that needed subsequent resection (15.2 vs 10.3 cm, P=0.05). Estimated blood loss at initial operation was similar between groups (126 vs 166 mL, P=0.36).

Conclusion:
Surgical pancreatic drainage was successful in the initial management of pancreatic fluid collections. We did not identify any predictors of failure of initial drainage. There was a trend suggesting smaller cyst size may be associated with cystgastrostomy failure. Resection with distal pancreatectomy for walled-off pancreatic necrosis and pancreatic pseudocysts can be reserved for cases of failure of drainage.
Timing of Colonoscopy for Hemodynamically Stable Patients With Acute Lower Gastrointestinal Bleeding
Authors: Özkan Atakan 
Published: February 2023

Introduction:
The detection rate of the etiology of the lower gastrointestinal system (GIS) hemorrhage has been low, although urgent colonoscopy has been performed. Even if the etiology has been specified, the possibility of rebleeding is uncertain. Furthermore, adequate bowel cleansing required for colonoscopy cannot be achieved in emergency situations, so the procedure may fail. The aim of this study is to compare the etiological diagnoses of patients with lower GIS bleeding after bowel preparation at their first hospitalization and after discharge.

Material and Method:
Patients who were hemodynamically stable after upper GIS bleeding were identified and divided into 2 groups. Colonoscopy was performed in the first group of patients at their first hospitalization. The second group of patients was called again for colonoscopy within 2 weeks after discharge. Patients were classified according to their age, gender, bleeding etiology, whether complete colonoscopy procedure was possible (The cecum was intubated, and the bowel cleansing was sufficient to evaluate the intestinal mucosa), and whether the colonoscopic intervention was performed.

Results:
The rate of patients who are hemodynamically stable and require emergency intervention at their first hospitalization is 5%. The colonoscopy repeat rate is 70% for the first hospitalization group, and the patients with no findings despite the second colonoscopy at a rate of 50% are re-evaluated electively.

Discussion:
Our study suggests that colonoscopy should be performed in elective conditions after a complete bowel cleansing in hemodynamically stable patients.
Diagnostic Accuracy of Imaging Modalities on Occult Groin Hernias According to Hernia type and a Surgeon-centered Individualized Groin Hernia Management Algorithm
Authors: Akgul Nedim , Turan Mehmet Ilker 
Published: February 2023

Background:
The purpose of this study is to evaluate the diagnostic performance of imaging techniques for the identification of groin hernias based on the type of hernia and to demonstrate the efficacy of an algorithm based on the surgeon and surgical technique.

Materials and Methods:
Medical records of 561 patients who were operated on for groin hernia were retrospectively analyzed. A total of 102 patients who had both pelvic computed tomography (CT) and ultrasonography (USG) recordings preoperatively and underwent transabdominal preperitoneal repair were included in the study.

Results:
A contralateral asymptomatic occult groin hernia was detected in 25.5% of all patients. The overall sensitivity of USG and CT on contralateral asymptomatic occult hernia was 42.3% and 65.4%, respectively. The sensitivity of USG according to the contralateral occult hernia type was 66.7%, 35.7%, 33.3%, and 50% for direct, indirect, femoral, and pantaloon hernias, respectively. The sensitivity of CT according to the contralateral occult hernia type was 0%, 57.1%, 100%, and 100% for direct, indirect, femoral, and pantaloon hernias, respectively.

Conclusions:
The handicap created by the variability in the diagnostic sensitivity of imaging modalities can be overcome with the choice of transabdominal preperitoneal repair in the surgical technique.