bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Intraoperative Molecular Imaging after Fluorescent-Guided Pulmonary Metastasectomy for Sarcoma
Authors: Azari Feredun , Kennedy Gregory T , Zhang Kevin , Bernstein Elizabeth , Maki Robert G , Gaughan Colleen , Jarrar Doraid , Pechet Taine , Kucharczuk John , Singhal Sunil 
Published: April 2022

BACKGROUND:
Intraoperative molecular imaging (IMI) has been shown to improve lesion detection during pulmonary sarcomatous metastasectomy. Our goal in this study was to evaluate whether data garnered from IMI-guided resection of pulmonary sarcoma metastasis translate to improved patient outcomes.

STUDY DESIGN:
Fifty-two of 65 consecutive patients with a previous history of sarcomas found to have pulmonary nodules during screening were enrolled in a nonrandomized clinical trial. Patients underwent TumorGlow the day before surgery. Data on patient demographics, tumor biologic characteristics, preoperative assessment, and survival were included in the study analysis and compared with institutional historical data of patients who underwent metastasectomy without IMI. p values < 0.05 were considered significant.

RESULTS:
IMI detected 42 additional lesions in 31 patients (59%) compared with the non-IMI cohort where 25% percent of patients had additional lesions detected using tactile and visual feedback only (p < 0.05). Median progression-free survival (PFS) for patients with IMI-guided pulmonary sarcoma metastasectomy was 36 months vs 28.6 months in the historical cohort (p < 0.05). IMI-guided pulmonary sarcoma metastasectomy had recurrence in the lung with a median time of 18 months compared with non-IMI group at 13 months (p < 0.05). Patients with synchronous lesions in the IMI group underwent systemic therapy at a statistically higher rate and tended to undergo routine screening at shorter interval.

CONCLUSIONS:
IMI identifies a subset of sarcoma patients during pulmonary metastasectomy who have aggressive disease and informs the medical oncologist to pursue more aggressive systemic therapy. In this setting, IMI can serve both as a diagnostic and prognostic tool without conferring additional risk to the patient.
COVID-19 Vaccination Gap in Admitted Trauma Patients: A Critical Opportunity
Authors: Turer Robert W , Chen Qingxia , Jones Ian D , Gondek Stephen P , Guillamondegui Oscar D , Dennis Bradley M 
Published: April 2022

BACKGROUND:
Coronavirus disease 2019 (COVID-19) vaccination is the core strategy for pandemic management. We hypothesized that a vaccination gap might exist between emergency department (ED) patients admitted for trauma and other ED patients.

STUDY DESIGN:
This was an observational quality improvement study using electronic health record data at an academic level-1 trauma center. Participants were all patients presenting to the adult ED with a Tennessee home address between January 1 and June 1, 2021. We measured the proportional difference in vaccination between admitted trauma patients and other ED patients over time (by week) and association via Spearman’s rank correlation coefficient. Binary logistic regression facilitated covariate analysis to account for age, sex, race, home county, and ethnicity without and then with interaction between trauma admission and time. Geographic visual analysis compared county-level vaccination rates with odds of trauma admission by home county using a bivariate chloropleth map.

RESULTS:
The proportional difference in vaccination between trauma-admitted and other ED patients increased over time (Spearman’s = 0.699). Adjusting for age, sex, race, home county, and ethnicity, there was a statistically significant vaccination difference between trauma-admitted and other ED patients (odds ratio = 0.53, 95% CI 0.43–0.65, p < 0.0001). Geographic analysis revealed increased trauma admission odds and lower vaccination rates in surrounding counties compared with Davidson County.

CONCLUSIONS:
We observed a widening COVID-19 vaccination gap between trauma-admitted and other ED patients. Vaccine outreach during trauma admission may provide a valuable point of contact for unvaccinated patients.
Outcomes in Elderly Patients Undergoing Liver Transplantation Compared with Liver-Directed Ablative Therapy in Early-Stage Hepatocellular Carcinoma
Authors: Shah Malay B , Villagomez Rubio Diego A , Orozco Gabriel , Desai Siddharth , Ancheta Alexandre , Gupta Meera , Mei Xiaonan , Evers B Mark , Gedaly Roberto , Cannon Robert M 
Published: April 2022

BACKGROUND:
Orthotopic liver transplantation (OLT) is the accepted treatment in patients with unresectable, early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. Due to increasing waitlist demand for OLT, determining optimal groups for transplant is critical. Elderly patients are known to have poorer postoperative outcomes. Considering the effectiveness of liver-directed therapies for HCC, we sought to determine whether elderly patients received survival benefit from OLT over liver-directed therapy alone.

STUDY DESIGN:
The National Cancer Database participant use file was used to analyze data between 2004 and 2017. Only patients ≥70 years of age who received OLT or liver-directed therapy alone were included. Patients with alpha-fetoprotein >500 ng/mL or missing alpha-fetoprotein values were excluded. Baseline demographic variables, model for end-stage liver disease score, and overall survival from time of diagnosis were collected. Descriptive statistics, Kaplan-Meier survival, Cox proportional hazards model, and propensity score matching were used.

RESULTS:
A total of 2,377 patients received ablative therapy alone, and 214 patients received OLT. Multivariable analysis and Kaplan-Meier showed that OLT conferred a significant survival benefit compared to liver-directed therapy alone. Age was also associated with a yearly 3% increase in risk of mortality. Propensity-matched analysis adjusting also demonstrated a significant survival benefit for elderly patients receiving OLT compared to liver-directed therapy alone.

CONCLUSION:
Despite increased age and associated comorbidities being factors associated with poor outcomes, OLT confers a survival advantage compared to liver-directed ablative therapies alone in selected elderly patients with HCC. OLT should be offered in medically appropriate elderly patients with HCC.
Resuscitative Endovascular Balloon Occlusion of the Aorta in Penetrating Trauma
Authors: Schellenberg Morgan , Owattanapanich Natthida , DuBose Joseph J , Brenner Megan , Magee Gregory A , Moore Laura J , Scalea Thomas , Inaba Kenji ,   The AAST PROOVIT Study Group
Published: April 2022

BACKGROUND:
Resuscitative endovascular balloon occlusion of the aorta (REBOA) achieves temporary hemorrhage control via aortic occlusion. Existing REBOA literature focuses on blunt trauma without a clearly defined role in penetrating trauma. This study compared clinical/injury data and outcomes after REBOA in penetrating vs blunt trauma.

STUDY DESIGN:
All patients in the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) database, an observational American Association for the Surgery of Trauma dataset of trauma patients requiring aortic occlusion, who underwent REBOA were included (January 2014 through February 2021). Study groups were defined by mechanism: penetrating vs blunt. Subgroup analysis was performed of patients arriving with vital signs. Univariable/multivariable analyses compared injuries and outcomes.

RESULTS:
Seven hundred fifty-nine patients underwent REBOA: 152 (20%) penetrating and 607 (80%) blunt. Patients undergoing penetrating REBOA were less severely injured (injury severity score 25 vs 34; p < 0.001). The most common hemorrhage source was abdominal in penetrating REBOA (79%) and pelvic in blunt REBOA (31%; p = 0.002). Penetrating REBOA was more likely to occur in the operating room (36% vs 17%) and less likely in the emergency department (63% vs 81%; p < 0.001). Penetrating REBOA used more zone I balloon deployment (76% vs 64%) and less zone III (19% vs 34%; p = 0.001). Improved or stabilized hemodynamics were less frequent after penetrating REBOA (41% vs 62%, p < 0.001; 23% vs 41%, p < 0.001). On subgroup analysis of patients arriving alive, improvement or stabilization in hemodynamics was similar between groups (87% vs 86%, p = 0.388; 77% vs 72%, p = 0.273). Penetrating REBOA was not independently associated with mortality (odds ratio 1.253; p = 0.776).

CONCLUSIONS:
Despite lower injury severity, REBOA was significantly less likely to improve or stabilize hemodynamics after penetrating trauma. Among patients arriving alive, however, outcomes were comparable, suggesting that penetrating REBOA may be most beneficial among patients with vital signs. Because hemorrhage source, catheter insertion setting, and deployment zone varied significantly between groups, existing blunt REBOA data may not be appropriately extrapolated to penetrating trauma. Further study of REBOA as a means of aortic occlusion in penetrating trauma is needed.
Novel Machine Learning Approach for the Prediction of Hernia Recurrence, Surgical Complication, and 30-Day Readmission after Abdominal Wall Reconstruction
Authors: Hassan Abbas M , Lu Sheng-Chieh , Asaad Malke , Liu Jun , Offodile Anaeze C , Sidey-Gibbons Chris , Butler Charles E 
Published: April 2022

BACKGROUND:
Despite advancements in abdominal wall reconstruction (AWR) techniques, hernia recurrences (HRs), surgical site occurrences (SSOs), and unplanned hospital readmissions persist. We sought to develop, validate, and evaluate machine learning (ML) algorithms for predicting complications after AWR.

METHODS:
We conducted a comprehensive review of patients who underwent AWR from March 2005 to June 2019. Nine supervised ML algorithms were developed to preoperatively predict HR, SSOs, and 30-day readmission. Patient data were partitioned into training (80%) and testing (20%) sets.

RESULTS:
We identified 725 patients (52% women), with a mean age of 60 ± 11.5 years, mean body mass index of 31 ± 7 kg/m2, and mean follow-up time of 42 ± 29 months. The HR rate was 12.8%, SSO rate was 30%, and 30-day readmission rate was 10.9%. ML models demonstrated good discriminatory performance for predicting HR (area under the receiver operating characteristic curve [AUC] 0.71), SSOs (AUC 0.75), and 30-day readmission (AUC 0.74). ML models achieved mean accuracy rates of 85% (95% CI 80% to 90%), 72% (95% CI 64% to 80%), and 84% (95% CI 77% to 90%) for predicting HR, SSOs, and 30-day readmission, respectively. ML identified and characterized 4 unique significant predictors of HR, 12 of SSOs, and 3 of 30-day readmission. Decision curve analysis demonstrated that ML models have a superior net benefit regardless of the probability threshold.

CONCLUSIONS:
ML algorithms trained on readily available preoperative clinical data accurately predicted complications of AWR. Our findings support incorporating ML models into the preoperative assessment of patients undergoing AWR to provide data-driven, patient-specific risk assessment.
Predictive Role of Gut Microbiota in Weight Loss Achievement after Bariatric Surgery
Authors: Gutiérrez-Repiso Carolina , Garrido-Sánchez Lourdes , Alcaide-Torres Juan , Cornejo-Pareja Isabel , Ocaña-Wilhelmi Luis , García-Fuentes Eduardo , Moreno-Indias Isabel , Tinahones Francisco J 
Published: April 2022

BACKGROUND:
Bariatric surgery induces changes in gut microbiota that have been suggested to contribute to weight loss and metabolic improvement. However, whether preoperative gut microbiota composition could predict response to bariatric surgery has not yet been elucidated.

STUDY DESIGN:
Seventy-six patients who underwent sleeve gastrectomy were classified according to the percentage of excess weight loss (%EWL) 1 year after surgery in the responder group: >50%EWL (n=50) and the nonresponder group: <50%EWL (n=26). Patients were evaluated before surgery, and 3 months and 1 year after surgery. Gut microbiota composition was analyzed before surgery (n=76) and 3 months after bariatric surgery (n=40).

RESULTS:
Diversity analysis did not show differences between groups before surgery or 3 months after surgery. Before surgery, there were differences in the abundance of members belonging to Bacteroidetes and Firmicutes phyla (nonresponder group: enriched in Bacteroidaceae, Bacteroides, Bacteroides uniformis, Alistipes finegoldii, Alistipes alistipes, Dorea formicigenerans, and Ruminococcus gnavus. Responder group: enriched in Peptostreptococcaceae, Gemmiger, Gemiger formicilis, Barnesiella, Prevotellaceae, and Prevotella; linear discriminant analysis >2; p < 0.05). Prevotella-to-Bacteroides ratio was significantly lower in the nonresponder group compared to the responder group (p = 0.048). After surgery, the responder group showed an enrichment in taxa that have been shown to have beneficial effects on host metabolism. Before surgery, PICRUSt analysis showed an enrichment in pathways involved in the biosynthesis components of the O-antigen polysaccharideunits in lipopolysaccharides in the nonresponder group.

CONCLUSIONS:
Preoperative gut microbiota could have an impact on bariatric surgery outcomes. Prevotella-to-Bacteroides ratio could be used as a predictive tool for weight loss trajectory. Early after surgery, patients who experienced successful weight loss showed an enrichment in taxa related to beneficial effects on host metabolism.
Emergency General Surgery Transfer and Effect on Inpatient Mortality and Post-Discharge Emergency Department Visits: A Propensity Score Matched Analysis
Authors: Watson Michael , Zhao Jing , Turk Philip , Hetherington Timothy , Schiffern Lynnette , Ross Samuel W , Matthews Brent D , Reinke Caroline E 
Published: April 2022

BACKGROUND:
Patients undergoing emergency general surgery (EGS) and interhospital transfer (IHT) have increased mortality. Prior analyses of IHT have been limited by the inability to track post-discharge outcomes or have not included nonoperative EGS. We evaluated outcomes for IHT to our tertiary care facility compared with direct admission through the emergency department.

STUDY DESIGN:
Patients admitted directly (2015 to 2017) with a common EGS diagnosis (appendicitis, cholecystitis, choledocholithiasis, small bowel obstruction, and diverticulitis) were propensity score matched to patients transferred from another acute care hospital. Propensity score matching (PSM) was performed using patient characteristics, EGS diagnosis, comorbidities, and surgical critical care consultation. The primary outcome was inpatient mortality, and secondary outcomes were length of stay (LOS) 30-day hospital readmission.

RESULTS:
We identified 3,153 directly admitted patients and 1,272 IHT patients. IHT patients were older (mean 59.4 vs 51.5 years), had a higher Charlson comorbidity index (median 3 vs 1), White race (72% vs 49%), and BMI greater than 40 kg/m2 (11.6% vs 9.8%). After PSM, each group included 1,033 patients. IHT patients had a higher median LOS (5.5 days vs 3.8, p < 0.001), higher inpatient mortality (odds ratio [OR] 1.69, p = 0.03), and more complications (OR 1.57, p < 0.001). The rate of post-discharge 30-day hospital encounters was similar (OR 1.08, p = 0.460). However, IHT patients had more emergency department encounters (OR 1.35, p = 0.04) and fewer observation-status readmissions (OR 0.53, p = 0.01).

CONCLUSIONS:
After PSM to reduce confounding variables, patients with common EGS diagnoses transferred to a tertiary care facility have increased inpatient morbidity and mortality. The increased morbidity and resource utilization for these patients extends beyond the index hospital stay.
Persistent racial disparities in deep brain stimulation for Parkinson’s disease
Authors: Cramer Samuel W. , Do Truong H. , Palzer Elise F. , Naik Anant , Rice Abigail L. , Novy Savannah G. , Hanson Jacob T. , Piazza Amber N. , Howard Madeleine A. , Huling Jared D. , Chen Clark C. , McGovern Robert A. 
Published: April 2022

ABSTRACTWe sought to determine whether racial and socio-economic disparities in the utilization of deep brain stimulation (DBS) for Parkinson’s disease (PD) have improved over time. We examined DBS utilization and analyzed factors associated with placement of DBS. The odds of DBS placement increased across the study period while White PD patients were 5 times more likely than Black patients to undergo DBS. Individuals, regardless of racial background, with two or more comorbidities were 14 times less likely to undergo DBS. Privately insured patients were 1.6 times more likely to undergo DBS. Despite increasing DBS utilization, significant disparities persist in access to DBS.
Semi-automated socio-anthropologic analysis of themedical discourseon rheumatoid arthritis: potential impact in public health
Authors: Nardini Christine , Candelise Lucia , Turrini Mauro , Addimanda Olga 
Published: April 2022

AbstractThe debilitating effects of non-communicable diseases (NCDs) and the accompanying chronic inflammation, represent a significant obstacle for the sustainability of our development, with efforts being spread worldwide to contrast NCDs’ diffusion, as per the United Nations Sustainable Development Goals (SDG 3). In fact, despite efforts of variable intensities in numerous directions (from innovations in biotechnology to lifestyle modifications), NCDs’ incidence remains pandemic.The present work wants to contribute to this major concern with a specific focus on the fragmentation of the medical approaches, via an interdisciplinary analysis of themedical discourse, i.e. the heterogenous reporting that biomedical scientific literature uses to describe the anti-inflammatory therapeutic landscape in NCDs. The aim is to better capture the roots of this compartmentalization and the power relations existing among three segregatedpharmacological, experimentalandunstandardizedbiomedical approaches, to ultimately empower collaboration beyond medical specialties and possibly untap a more ample and effective reservoir of integrated therapeutic opportunities.Using as exemplar disease rheumatoid arthritis (RA), twenty-eight articles were manually translated each into a nine-dimensional categorical variable of medical socio-anthropological relevance, relating in particular (but not only) tolegitimacy, temporalityandspatialization. This digitalized picture (9 × 28 table) of the medical discourse was further analyzed by simple automatic learning approaches to identify differences and highlight commonalities among the biomedical categories.Interpretation of these results gives original insights including the suggestion to: empower scientific communication betweenunstandardizedapproaches and basic biology; promote non-pharmacological therapies repurposing to enhance robustness ofexperimentalapproaches; align the spatial representation of diseases and therapies inpharmacologyto effectively embrace thesystemicapproach promoted by modern personalized and preventive medicines. We hope this original work may expand and foster interdisciplinarity among public health stakeholders, ultimately contributing to the achievement of SGD3.
Privacy Risks of Whole-Slide Image Sharing in Digital Pathology
Authors: Holub Petr , Müller Heimo , Bíl Tomáš , Pireddu Luca , Plass Markus , Prasser Fabian , Schlünder Irene , Zatloukal Kurt , Nenutil Rudolf , Brázdil Tomáš 
Published: April 2022

AbstractAccess to large volumes of so-calledwhole-slide images—high-resolution scans of complete pathological slides—has become a cornerstone of the development of novel artificial intelligence methods in pathology for diagnostic use, education/training of pathologists, and research. Nevertheless, a methodology based on risk analysis for evaluating the privacy risks associated with sharing such imaging data and applying the principle “as open as possible and as closed as necessary” is still lacking. In this article, we develop a model for privacy risk analysis for whole-slide images which focuses primarily on identity disclosure attacks, as these are the most important from a regulatory perspective. We introduce a mathematical model for risk assessment and design a taxonomy of whole-slide images with respect to privacy risks. Based on this risk assessment model and the taxonomy, we conduct a series of experiments to demonstrate the risks using real-world imaging data. Finally, we develop guidelines for risk assessment and recommendations for low-risk sharing of whole-slide image data.
Extracellular vesicle-bound DNA in urine is indicative of kidney allograft injury
Authors: Sedej Ivana , Štalekar Maja , Tušek Žnidarič Magda , Goričar Katja , Kojc Nika , Kogovšek Polona , Dolžan Vita , Arnol Miha , Lenassi Metka 
Published: April 2022

AbstractExtracellular vesicle-bound DNA (evDNA) is an understudied extracellular vesicle (EV) cargo, particularly in cancer-unrelated fundamental and biomarker research. Although evDNA has been detected in urine, little is known about its characteristics, localization, and biomarker potential for kidney pathologies. To address this, we enriched EVs from urine of well-characterized kidney transplant recipients undergoing allograft biopsy, characterized their evDNA and its association to allograft injury. Using DNase treatment and immunogold labelling TEM, we show that DNA is bound to the surface of urinary EVs. Although the urinary evDNA and cell-free DNA correlated in several characteristics, the DNA integrity index showed evDNA was less fragmented (P< 0.001). Urinary EVs from patients with rejection and non-rejection allograft injury were significantly larger (mean:P= 0.045, median:P= 0.031) and have bound more DNA as measured by normalized evDNA yield (P= 0.018) and evDNA copy number (P= 0.007), compared to patients with normal histology. Urinary evDNA characteristics associated with the degree of interstitial inflammation, combined glomerulitis and peritubular capillaritis, and inflammation in areas of fibrosis (allP< 0.050). The normalized dd-evDNA copy numbers differed between the antibody- and T cell-mediated rejection (P= 0.036). Our study supports the importance of DNA as urine EV cargo, especially as potential non-invasive kidney allograft injury biomarker.