bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of chemotherapy in metastatic prostate cancer
Authors: Riaz Irbaz B. , Sweeney Christopher J. 
Published: May 2022

Purpose of review
To summarize the role of chemotherapy and offer some guidance regarding the selection of chemotherapy in mPC.

Recent findings
Patients with mHSPC have varied prognoses with testosterone suppression alone (androgen deprivation therapy, ADT) and differential responses to docetaxel with ADT. Patients with de novo and metachronous high-volume disease have a robust survival benefit with the addition of docetaxel to hormonal therapies. Patients with synchronous low-volume disease have a more modest survival benefit from docetaxel and there is no evidence of survival benefit with docetaxel in patients with metachronous low-volume disease. Integration of biomarkers may refine treatment selection regardless of volume of disease. Docetaxel and cabazitaxel also impart an OS benefit in patients with metastatic castration-resistant prostate cancer (mCRPC). The choice of chemotherapy in mCRPC depends on treatment received in mHSPC setting. Docetaxel remains the first line chemotherapy in castration-resistant patients who have not received it in mHSPC followed by cabazitaxel, otherwise cabazitaxel can be deployed without docetaxel retreatment.

Summary
Chemotherapy is a key class of therapy for selected patients with mHSPC and mCRPC.
Autopsy-Diagnosed Injury Deaths in Persons With Acute or Chronic Alcohol Use
Authors: Stahl-Herz Jay , Pasquale-Styles Melissa 
Published: May 2022

Abstract
Acute and chronic alcohol use is associated with injury, and autopsies may be performed to ascertain injury deaths in persons with acute or chronic alcohol use. This study sought to determine how many decedents with a history of acute or chronic alcohol use had an internal physical injury diagnosed only at autopsy that caused or contributed to the death. The study reviewed medicolegal investigation and autopsy reports at the New York City Office of Chief Medical Examiner between January 1 and October 11, 2018, to identify 1000 consecutive persons with suspected acute or chronic alcohol use who were autopsied to ascertain whether internal physical injury caused or contributed to the death. Of 1000 persons with known or suspected acute or chronic alcohol use, 390 (39.0%) had an external injury. Although 115 (11.5%) had an internal injury at autopsy, only 29 (2.9%) had an injury that caused or contributed to the death. Only 1 decedent had an internal injury that caused the death with no associated external evidence of injury (0.1%). This study demonstrates the rarity of occult lethal injury diagnosed at autopsy in persons with acute or chronic alcohol use.
SARcopenia Assessment in Hypertension: The SARAH Study
Authors: Kara Murat , Kara Özgür , Ceran Yasin , Kaymak Bayram , Kaya Tuğçe Cansu , Çitir Beyza Nur , Durmuş Mahmut Esad , Durmuşoğlu Esra , Razaq Sarah , Doğan Yahya , Shehab Dia , Alkandari Salem A. , Abdulsalam Ahmad J. , Ata Ayşe Merve , Koyuncu Esra Gizem , Coşkun Evrim , Turan Gökhan , Dilek Banu , Culha Mehmet Ali , Yildirim Pelin , Mezian Kamal , Doğu Beril , Kiliç Gamze , Ünlü Zeliha , Barbosa Jorge , Pinho Sérgio , Analay Pelin , Palamar Deniz , Güvener Orhan , Ocak Hasan , Malas Fevziye Ünsal , Baday Murat , Çakir Banu , Özçakar Levent 
Published: May 2022

Abstract

Objective
To investigate the relationship between sarcopenia and RAS-related disorders and to explore the effects of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) on muscle mass/function and physical performance.

Design
This multi-center, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia.

Results
Of the 2613 participants (mean age; 61.0 ± 9.5 years), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters [except chair stand test (CST) in males] were worse in hypertensive group than in normotensive group (all p < 0.05). When clinical/potential confounders were adjusted; HT was found to be an independent predictor of sarcopenia in males [OR = 2.403 (95%CI: 1.514-3.813)] and females [OR = 1.906 (95%CI: 1.328-2.734)] (both p < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and CST in males) were independently/negatively related with HT (all p < 0.05). In females, ACEIs users had higher grip strength and CST performance values but had lower muscle thickness and gait speed values, as compared to those using ARBs (all p < 0.05).

Conclusions
Hypertension was associated with increased risk of sarcopenia at least two times. Among antihypertensives; while ACEIs had higher muscle values, ARBs had higher muscle mass and physical performance values only in females.
“We're playing on the same team”: Communication (dis)connections between trauma patients and surgical residents
Authors: Huang Anna K. , Campbell Paige-Ashley , Chaudhary Mihir J. , Soklaridis Sophie , Miller Doriane , Dinizulu Sonya , Stolbach Bradley , Cosey Gay Franklin , Washington Stephanie , Olivera Perez Henry , Chalmers Kristen , Tessema Frazer , Henry Marion , Slidell Mark , Richardson Joseph , Bailey Zinzi , Owens Tyra , Wilkins Eric , Burgest Valerie , Hardaway Cragg , Francis Myles X. , Asom Anase , Lopez Hinojosa Itzel , Roggin Jake , Hamzat Ibraheem , Zakrison Tanya 
Published: May 2022

BACKGROUND
Patient-physician communication is key to better clinical outcomes and patient well-being. Communication between trauma patients and their physicians remains relatively unexplored. We aimed to identify and characterize the range of strengths and challenges in patient-physician communication in the setting of trauma care.

METHODS
A qualitative, grounded theory approach was used to explore communication strengths and challenges for patients and residents. Patients previously admitted to the trauma service for violent injuries were recruited and interviewed in-person during their trauma clinic appointments. Surgical residents were recruited via email and interviewed virtually via Zoom. Anonymous, semistructured interviews were conducted until thematic saturation was reached.

RESULTS
Twenty-nine interviews with patients and 14 interviews with residents were conducted. Patients reported feeling ignored and misunderstood and having inadequate communication with physicians. Residents cited lack of time, patients' lack of health literacy, differences in background, and emotional responses to trauma as barriers to effective communication with patients. Patients and residents reported an understanding of each other's stressors, similar emotional experiences regarding traumatic stress, and a desire to communicate with each other in greater depth both inside and outside of the hospital.

CONCLUSION
Trauma patients and residents can feel disconnected due to the lack of time for thorough communication and differences in background; however, they understand each other's stressors and share similar emotional responses regarding trauma and a desire for increased communication, connection, and solidarity. Leveraging these shared values to guide interventions, such as a resident curriculum, may help bridge disconnects and improve their communication.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Developing a National Trauma Research Action Plan: Results from the injury prevention research gap Delphi survey
Authors: Cooper Zara , Herrera-Escobar Juan P. , Phuong Jimmy , Braverman Maxwell A. , Bonne Stephanie , Knudson Mary Margaret , Rivara Frederick P. , Rowhani-Rahbar Ali , Price Michelle A. , Bulger Eileen M. ,   the NTRAP Injury Prevention Panel
Published: May 2022

BACKGROUND
In its 2016 report on trauma care, the National Academies of Sciences, Engineering, and Medicine called for the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. We describe the gap analysis and high priority research questions generated from the National Trauma Research Action Plan panel on injury prevention.

METHODS
Experts in injury prevention research were recruited to identify current gaps in injury prevention research, generate research questions and establish the priority of these questions using a consensus-driven Delphi survey approach from December 2019 through September 2020. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with both military and civilian representatives. Participants were encouraged, but not required, to use a Patient/Population, Intervention, Comparison, and Outcome format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome model. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as 60% or greater of panelists agreeing on the priority category.

RESULTS
Twenty-eight subject matter experts generated 394 questions in 12 topic areas. By round 3 of the Delphi, 367 (93.1%) questions reached consensus, of which 169 (46.1%) were determined to be high priority, 196 (53.4%) medium priority, and 2 (0.5%) low priority. Among the 169 high priority questions, suicide (29.6%), firearm violence (20.1%), and violence prevention (18.3%) were the most prevalent topic areas.

CONCLUSION
This Delphi gap analysis of injury prevention research identified 169 high priority research questions that will help guide investigators in future injury prevention research. Funding agencies and researchers should consider these gaps when they prioritize future research.

LEVEL OF EVIDENCE
Therepeutic/Care Management; Level IV.
The physiology of aortic flow and pressures during partial resuscitative endovascular balloon occlusion of the aorta in a swine model of hemorrhagic shock
Authors: Marble Jacob , Patel Nathan T.P. , Lane Magan R. , Williams Timothy K. , Neff Lucas P. , Johnson M. Austin 
Published: May 2022

BACKGROUND
Partial resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise as a method to extend REBOA, but there lacks a standard definition of the technique. The purpose of this study was to investigate the relationships between distal and proximal mean arterial pressure (MAP) and distal aortic flow past a REBOA catheter. We hypothesize that a relationship between distal aortic flow and distal MAP in Zone 1 partial REBOA (pREBOA) is conserved and that there is no apparent relationship between aortic flow and proximal MAP.

METHODS
A retrospective data analysis of swine was performed. Cohort 1 underwent 20% controlled hemorrhage and then randomized to aortic flow of 400 mL/min or complete occlusion for 20 minutes (n = 11). Cohort 2 underwent 30% controlled hemorrhage followed by complete aortic occlusion for 30 minutes (n = 29). Then, they all underwent REBOA wean in a similar stepwise fashion. Blood pressure was collected from above (proximal) and below (distal) the REBOA balloon. Aortic flow was measured using a surgically implanted supraceliac aortic perivascular flow probe. The time period of balloon wean was taken as the time point of interest.

RESULTS
A linear relationship between distal MAP and aortic flow was observed (R
2 value, 0.80), while no apparent relationship appeared between proximal MAP and aortic flow (R
2 value, 0.29). The repeated-measures correlation coefficient for distal MAP (0.94; 95% confidence interval, 0.94–0.94) was greater than proximal MAP (−0.73; 95% confidence interval, −0.74 to −0.72).

CONCLUSION
The relationship between MAP and flow will be a component of next-generation pREBOA control inputs. This study provides evidence that pREBOA techniques should rely on distal rather than proximal MAP for control of distal aortic flow. These data could inform future inquiry into optimal flow rates and parameters based on distal MAP in both translational and clinical contexts.
Tracheostomy decreases continuous analgesia and sedation requirements
Authors: Wallen Taylor E. , Elson Nora C. , Singer Kathleen E. , Hayes Hannah V. , Salvator Ann , Droege Christopher A. , Nomellini Vanessa , Pritts Timothy A. , Goodman Michael D. 
Published: May 2022

BACKGROUND
The goals of sedation in the critically ill surgical patient are to minimize pain, anxiety, and agitation without hindering cardiopulmonary function. One potential benefit of tracheostomy during endotracheal intubation is the reduction of sedation and analgesia; however, there are little data to support this supposition. We hypothesized that patients undergoing tracheostomy would have a rapid reduction in sedation and analgesia following tracheostomy.

METHODS
A retrospective review of tracheostomies performed at a single Level I trauma center from January 2013 to June 2018 was completed. An evaluation of Glasgow Coma Scale, Richmond Agitation-Sedation Scale, and Confusion Assessment Method for the intensive care unit 72 hours pretracheostomy to 72 hours posttracheostomy was performed. The total daily dose of sedation, anxiolytic, and analgesic medications administered were recorded. Mixed-effects models were used to evaluate longitudinal drug does over time (hours).

RESULTS
Four hundred sixty-eight patients included for analysis with a mean age of 58.8 ± 18.3 years. There was a significant decrease in propofol and fentanyl utilization from 24 hours pretracheostomy to 24 hours posttracheostomy in both dose and number of patients receiving these continuous intravenous medications. Similarly, total morphine milligram equivalents (MME) use and continuous midazolam significantly decreased from 24 hours pretracheostomy to 24 hours posttracheostomy. By contrast, intermittent enteral quetiapine and methadone administration increased after tracheostomy. Importantly, Richmond Agitation-Sedation Scale, Glasgow Coma Scale, and Confusion Assessment Method scoring were also significantly improved as early as 24 hours posttracheostomy. Total MME use was significantly elevated in patients younger than 65 years and in male patients pretracheostomy compared with female patients. Patients admitted to the medical intensive care unit had significantly higher MME use compared with those in the surgical intensive care unit pretracheostomy.

CONCLUSION
Tracheostomy allows for a rapid and significant reduction in intravenous sedation and analgesia medication utilization. Posttracheostomy sedation can transition to intermittent enteral medications, potentially contributing to the observed improvements in postoperative mental status and agitation.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
A combat casualty relevant dismounted complex blast injury model in swine
Authors: Cralley Alexis L. , Moore Ernest E. , Kissau Daniel , Coleman Julia R. , Vigneshwar Navin , DeBot Margot , Schaid Terry R. , Moore Hunter B. , Cohen Mitchell J. , Hansen Kirk , Silliman Christopher C. , Sauaia Angela , Fox Charles J. 
Published: May 2022

BACKGROUND
Improvised explosive devices have resulted in a unique polytrauma injury pattern termed dismounted complex blast injury (DCBI), which is frequent in the modern military theater. Dismounted complex blast injury is characterized by extremity amputations, junctional vascular injury, and blast traumatic brain injury (bTBI). We developed a combat casualty relevant DCBI swine model, which combines hemorrhagic shock (HS) and tissue injury (TI) with a bTBI, to study interventions in this unique and devastating military injury pattern.

METHODS
A 50-kg male Yorkshire swine were randomized to the DCBI or SHAM group (instrumentation only). Those in the DCBI group were subjected to HS, TI, and bTBI. The blast injury was applied using a 55-psi shock tube wave. Tissue injury was created with bilateral open femur fractures. Hemorrhagic shock was induced by bleeding from femoral arteries to target pressure. A resuscitation protocol modified from the Tactical Combat Casualty Care guidelines simulated battlefield resuscitation for 240 minutes.

RESULTS
Eight swine underwent the DCBI model and five were allocated to the SHAM group. In the DCBI model the mean base excess achieved at the end of the HS shock was −8.57 ± 5.13 mmol·L−1. A significant coagulopathy was detected in the DCBI model as measured by prothrombin time (15.8 seconds DCBI vs. 12.86 seconds SHAM; p = 0.02) and thromboelastography maximum amplitude (68.5 mm DCBI vs. 78.3 mm in SHAM; p = 0.0003). For the DCBI models, intracranial pressure (ICP) increased by a mean of 13 mm Hg, reaching a final ICP of 24 ± 7.7 mm Hg.

CONCLUSION
We created a reproducible large animal model to study the combined effects of severe HS, TI, and bTBI on coagulation and ICP in the setting of DCBI, with significant translational applications for the care of military warfighters. Within the 4-hour observational period, the swine developed a consistent coagulopathy with a concurrent brain injury evidenced by increasing ICP.
Reading the signs in penetrating cervical vascular injuries: Analysis of hard/soft signs and initial management from a nationwide vascular trauma database
Authors: Marrotte Alexander , Calvo Richard Y. , Badiee Jayraan , Rooney Alexandra S. , Krzyzaniak Andrea , Sise Michael , Bansal Vishal , DuBose Joseph , Martin Matthew J. ,   the AAST PROOVIT Study Group
Published: May 2022

BACKGROUND
Algorithms for management of penetrating cervical vascular injuries (PCVIs) commonly call for immediate surgery with “hard signs” and imaging before intervention with “soft signs.” We sought to analyze the association between initial examination and subsequent evaluation and management approaches.

METHODS
Analysis of PCVIs from the American Association for the Surgery of Trauma Prospective Observational Vascular Injury Treatment vascular injury registry from 25 US trauma centers was performed. Patients were categorized by initial examination findings of hard signs or soft signs, and subsequent imaging and surgical exploration/repair rates were compared.

RESULTS
Of 232 PCVI patients, 110 (47%) had hard signs (hemorrhage, expanding hematoma, or ischemia) and 122 (53%) had soft signs. With hard signs, 61 (56%) had immediate operative exploration and 44% underwent computed tomography (CT) imaging. After CT, 20 (18%) required open surgical repair, and 7% had endovascular intervention. Of note, 21 (19%) required no operative intervention. A total of 122 patients (53%) had soft signs on initial examination; 37 (30%) had immediate surgery, and 85 (70%) underwent CT imaging. After CT, 9% had endovascular repair, 7% had open surgery, and 65 (53%) were observed. No difference in mortality was observed for hard signs patients undergoing operative management versus observation alone (23% vs. 17%, p = 0.6). Those with hemorrhage as the primary hard signs most often required surgery (76%), but no interventions were required in 19% of hemorrhage, 20% of ischemia, and 24% of expanding hematoma.

CONCLUSION
Although hard signs in PCVIs are associated with the need for operative intervention, initial CT imaging can facilitate endovascular options or nonoperative management in a significant subgroup. Hard signs should not be considered an absolute indication for immediate surgical exploration.

LEVEL OF EVIDENCE
Prognostic/Epidemiological; Level IV.
Prehospital factors predict outcomes in pediatric trauma: A principal component analysis
Authors: Ting Tiffany , Wakeman Derek S. , Arca Marjorie J. , Wilson Nicole A. 
Published: May 2022

BACKGROUND
Trauma team activation leveling decisions are complex and based on many variables. Accurate triage decisions improve patient safety and resource utilization. Our purpose was to establish proof-of-concept for using principal component analysis (PCA) to identify multivariate predictors of injury severity and to assess their ability to predict outcomes in pediatric trauma patients. We hypothesized that we could identify significant principal components (PCs) among variables used for decisions regarding trauma team activation and that PC scores would be predictive of outcomes in pediatric trauma.

METHODS
We conducted a retrospective review of the trauma registry (January 2014 to December 2020) at our pediatric trauma center, including all pediatric patients (age <18 years) who triggered a trauma team activation. Data included patient demographics, prehospital report, Injury Severity Score, and outcomes. Four significant principal components were identified using PCA. Differences in outcome variables between the highest and lowest quartile for PC score were examined.

RESULTS
There were 1,090 pediatric patients included. The four significant PCs accounted for greater than 96% of the overall data variance. The first PC was a composite of prehospital Glasgow Coma Scale and Revised Trauma Score and was predictive of outcomes, including injury severity, length of stay, and mortality. The second PC was characterized primarily by prehospital systolic blood pressure and high PC scores were associated with increased length of stay. The third and fourth PCs were characterized by patient age and by prehospital Revised Trauma Score and systolic blood pressure, respectively.

CONCLUSION
We demonstrate that, using information available at the time of trauma team activation, PCA can be used to identify key predictors of patient outcome. While the ultimate goal is to create a machine learning-based predictive tool to support and improve clinical decision making, this study serves as a crucial step toward developing a deep understanding of the features of the model and their behavior with actual clinical data.

LEVEL OF EVIDENCE
Diagnostic Test or Criteria; Level III.