bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geographic Proximity of Family Members and Healthcare Utilization After Complex Surgical Procedures
Authors: Bucher Brian T. , Yang Meng , Richards Steed Rebecca , Fraser Alison , Finlayson Samuel R.G. , Hanson Heidi A. 
Published: July 2022

Objective:
We sought to determine the relationship between a patient’s proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures.

Background:
Social support mechanisms are increasingly identified as modifiable risk factors for healthcare utilization.

Methods:
We performed a retrospective cohort study of 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. We defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. For each patient, we aggregated the number of first-degree relatives (FDR) living within 30 miles of the patient’s home address at the time of the surgical procedure into the following categories: 0 to 1, 2 to 3, 4 to 5, 6+ FDRs. We developed hierarchical multivariable regression models to determine the relationship between the number of FDR living within 30 miles of the patient and the healthcare utilization outcomes.

Results:
Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%, P<0.001), unplanned readmission (10.9% vs 12.0%, P=0.001), nonindex readmission (2.6% vs 3.2%, P=0.003); higher rates of home discharge (88.0% vs 85.3%, P<0.001); and shorter length of stay (7.3 vs 7.5 days, P=0.02). After multivariable adjustment, a larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission (P<0.001 for trend), 30-day unplanned readmission (P<0.001), nonindex readmission (P<0.001); higher likelihood of home discharge (P<0.001); and shorter index length of stay (P<0.001).

Conclusions:
The geographic proximity of family members is significantly associated with decreased healthcare utilization after complex cardiovascular and oncologic surgical procedures.
Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq
Authors: Gurney Jennifer M. , Graf Victoria , Staudt Amanda M. , Trevino Jennifer D. , VanFosson Christopher A. , Wild Hannah , Wren Sherry M. 
Published: July 2022

Objective:
To characterize humanitarian trauma care delivered by US military treatment facilities (MTFs) in Afghanistan and Iraq during combat operations.

Background:
International Humanitarian Law, which includes the Geneva Conventions, defines protections and standards of treatment to victims of armed conflicts. In 1949, these standards expanded to include injured civilians. In 2001, the Global War on Terror began in Afghanistan and expanded to Iraq in 2003. US MTFs provided care to all military forces, civilians, and enemy prisoners. A thorough understanding of the scope, epidemiology, resource requirements, and outcomes of civilian trauma in combat zones has not been previously characterized.

Methods:
Retrospective cohort analysis of the Department of Defense Trauma Registry from 2005 to 2019. Inclusion criteria were civilians and Non–North Atlantic Treaty Organization (NATO) Coalition Personnel (NNCP) with traumatic injuries treated at MTFs in Afghanistan and Iraq. Patient demographics, mechanism of injury, resource requirements, procedures, and outcomes were categorized.

Results:
A total of 29,963 casualties were eligible from the Registry. There were 16,749 (55.9%) civilians and 13,214 (44.1%) NNCP. The majority of patients were age above 13 years [26,853 (89.6%)] and male [28,000 (93.4%)]. Most injuries were battle-related: 12,740 (76.1%) civilians and 11,099 (84.0%) NNCP. Penetrating trauma was the most common cause of both battle and nonbattle injuries: 12,293 (73.4%) civilian and 10,029 (75.9%) NNCP. Median Injury Severity Score (ISS) was 9 in each cohort with ISS≥25 in 2236 (13.4%) civilians and 1398 (10.6%) NNCP. Blood products were transfused to 35% of each cohort: 5850 civilians received a transfusion with 2118 (12.6%) of them receiving ≥10 units; 4590 NNCPs received a transfusion with 1669 (12.6%) receiving ≥10 units. MTF mortality rates were civilians 1263 (7.5%) and NNCP 776 (5.9%). Interventions, both operative and nonoperative, were similar between both groups.

Conclusions:
In accordance with International Humanitarian Law, as well as the US military’s medical rules of eligibility, civilians injured in combat zones were provided the same level of care as NNCP. Injured civilians and NNCP had similar mechanisms of injury, injury patterns, transfusion needs, and ISS. This analysis demonstrates resource equipoise in trauma care delivered to civilians and NNCP. Hospitals in combat zones must be prepared to manage large numbers of civilian casualties with significant human and material resources allocated to optimize survival. The provision of humanitarian trauma care is resource-intensive, and these data can be used to inform planning factors for current or future humanitarian care in combat zones.
Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds
Authors: Lian Tiffany , Ashbrook Matthew , Myers Lee , Chiba Hiroto , Ghafil Cameron , Silverstein Madeleine , Lee Eugenia , Inaba Kenji , Matsushima Kazuhide 
Published: July 2022

BACKGROUND
Selective nonoperative management (SNOM) of abdominal gunshot wounds (GSWs) is increasingly used as computed tomography (CT) has become a diagnostic adjunct for the evaluation of intraabdominal injuries including hollow viscus injuries (HVIs). Currently, there is scarce data on the diagnostic accuracy of CT for identifying HVI. The purpose of this study was to determine the diagnostic accuracy of different CT findings in the diagnosis of HVI following abdominal GSW.

METHODS
This retrospective single-center cohort study was performed from January 2015 to April 2019. We included consecutive patients (≥18 years) with abdominal GSW for whom SNOM was attempted and an abdominal CT was obtained as a part of SNOM. Computed tomography findings including abdominal free fluid, diffuse abdominal free air, focal gastrointestinal wall thickness, wall irregularity, abnormal wall enhancement, fat stranding, and mural defect were used as our index tests. Outcomes were determined by the presence of HVI during laparotomy and test performance characteristics were analyzed.

RESULTS
Among the 212 patients included for final analysis (median age: 28 years), 43 patients (20.3%) underwent a laparotomy with HVI confirmed intraoperatively whereas 169 patients (79.7%) were characterized as not having HVI. The sensitivity of abdominal free fluid was 100% (95% confidence interval [CI]: 92–100). The finding of a mural defect had a high specificity (99%, 95% CI: 97–100). Other findings with high specificity were abnormal wall enhancement (97%, 95% CI: 93–99) and wall irregularity (96%, 95% CI: 92–99).

CONCLUSION
While there was no singular CT finding that confirmed the diagnosis of HVI following abdominal GSW, the absence of intraabdominal free fluid could be used to rule out HVI. In addition, the presence of a mural defect, abnormal wall enhancement, or wall irregularity is considered as a strong predictor of HVI.

LEVEL OF EVIDENCE
Diagnostic Test or Criteria; Level II.
Recombinant human MG53 protein attenuates brain lesion size in a large animal model of traumatic brain injury
Authors: Jin Guang , Ho Jessie W. , Keeney-Bonthrone Toby Philip , Ober Rebecca Ariel , Liu Baoling , Chtraklin Kiril , Wang Xiao-Liang , Zhou Xinyu , Cai Chuanxi , Li Yongqing , Tan Tao , Ma Jianjie , Alam Hasan B. 
Published: July 2022

BACKGROUND
MG53, a member of the tripartite motif (TRIM) protein family, plays an essential role in cell membrane repair and promotes cell survival. Recent studies show that systemic delivery of recombinant human MG53 (rhMG53) protein markedly attenuates tissue injury/inflammation, and facilitates healing. This study was performed to test whether intravenous administration of rhMG53 protein would decrease the lesion size in a clinically relevant large animal model of traumatic brain injury (TBI).

METHOD
Yorkshire swine (40–45 kg; n = 5/group) were subjected to controlled cortical impact TBI and randomized to either: (1) rhMG53 protein (2 mg/kg, intravenous) or (2) normal saline control. Hemodynamics, intracranial pressure, and brain oxygenation were monitored for 7 hours. Brains were then harvested and sectioned into 5-mm slices and stained with 2,3,5-triphenyltetrazolium chloride to quantify the lesion size. Blood-brain barrier permeability of MG53 in the brain was determined by Western blot and immunohistochemistry. Bcl-2 and phospho-GSK β levels were measured as makers of prosurvival pathway activation.

RESULTS
Hemodynamic parameters were similar in both groups, but the lesion size in the rhMG53-treated group (2,517 ± 525.4 mm3) was significantly (p < 0.05) smaller than the control group (3,646 ± 740.1 mm3). In the treated animals, rhMG53 was detected in the regions surrounding the TBI, but it was absent in the saline-treated control animals. Bcl-2 and phospho-GSK β levels in the brains were upregulated in the rhMG53-treated animals.

CONCLUSION
Intravenously administered rhMG53 localizes to the injured areas of the brain, with the treated animals demonstrating a significant attenuation in the brain lesion size following TBI.
Detecting Traumatic Brain Injury-Induced Coagulopathy: What We Are Testing and What We Are Not
Authors: Dong Jing-fei , Zhang Fangyi , Zhang Jianning 
Published: July 2022

ABSTRACT
Coagulopathy after traumatic brain injury (TBI) is common and has been closely associated with poor clinical outcomes for the affected patients. TBI-induced coagulopathy (TBI-IC) is consumptive in nature and evolves rapidly from an injury-induced hypercoagulable state. TBI-IC defined by laboratory tests is significantly more frequent than clinical coagulopathy, which often manifests as secondary, recurrent, or delayed intracranial or intracerebral hemorrhage. This disparity between laboratory and clinical coagulopathies has hindered progress in understanding the pathogenesis of TBI-IC and developing more accurate and predictive tests for this severe TBI complication. In this review, we discuss laboratory tests used in clinical and research studies to define TBI-IC, with specific emphasis on what the tests detect and what they do not. We also offer perspective on developing more accurate and predictive tests for this severe TBI complication.

Level of evidence
published reports
The Hidden Epidemic: The Prevalence and Impact of Concurrent Liver Diseases in Patients Undergoing Liver Transplantation in Australia and New Zealand
Authors: Howell Jess , Majumdar Avik , Fink Michael , Byrne Mandy , McCaughan Geoff , Strasser Simone I. , Crawford Michael , Hodgkinson Peter , Stuart Katherine A. , Tallis Caroline , Chen John , Wigg Alan , Jones Robert , Jaques Bryon , Jeffrey Gary , Adams Leon , Wallace Michael C. , Gane Ed , Thompson Alex , Gow Paul 
Published: July 2022

Background.
Prevalence of concurrent liver diseases among liver transplant recipients and impact on posttransplant outcomes are unknown.

Methods.
This retrospective study included adult liver transplants between January 1‚ 1985‚ and December 31‚ 2019‚ from the Australian and New Zealand Liver and Intestinal Transplant Registry. Up to 4 liver disease causes were recorded for each transplant; concurrent liver diseases were defined as >1 liver disease indication for transplantation, excluding hepatocellular carcinoma. Impact on posttransplant survival was determined using Cox regression.

Results.
A total of 840 (15%) of 5101 adult liver transplant recipients had concurrent liver diseases. Recipients with concurrent liver diseases were more likely male (78% versus 64%) and older (mean age 52 versus 50 y). A higher proportion of liver transplants for hepatitis B (12% versus 6%), hepatitis C (33% versus 20%), alcohol liver disease (23% versus 13%), and metabolic-associated fatty liver disease (11% versus 8%, all P < 0.001) were identified when all indications were included than with primary diagnosis only. The number and proportion of liver transplants performed for concurrent liver diseases have increased from 8 (6%) during Era 1 (1985–1989) to 302 (20%) during Era 7 (2015–2019; P < 0.001). Concurrent liver diseases were not associated with increased posttransplant mortality (adjusted hazard ratio, 0.98, 95% confidence interval, 0.84-1.14).

Conclusions.
Concurrent liver diseases are increasing among adult liver transplant recipients in Australia and New Zealand; however, they do not appear to impact posttransplant survival. Reporting all liver disease causes in the transplant registry reports provides more accurate estimates of liver disease burden.
Retrospective Review of Trauma ICU Patients With and Without Palliative Care Intervention
Authors: Rotundo Erica , Braunreuther Elizabeth , Dale Miles , Vancheswaran Aparna , Sub Lee Joon , Hossain Raeesa H , Butler Jonathan , Lugassy Mara , Latifi Rifat , Finbarr Blood Vincent 
Published: July 2022

BACKGROUND:
Older trauma patients present with poor preinjury functional status and more comorbidities. Advances in care have increased the chance of survival from previously fatal injuries with many left debilitated with chronic critical illness and severe disability. Palliative care (PC) is ideally suited to address the goals of care and symptom management in this critically ill population. A retrospective chart review was done to identify the impact of PC consults on hospital length of stay (LOS), ICU LOS, and surgical decisions.

STUDY DESIGN:
A Level 1 Trauma Center Registry was used to identify adult patients who were provided PC consultation in a selected 3-year time period. These PC patients were matched with non-PC trauma patients on the basis of age, sex, race, Glasgow Coma Scale, and Injury Severity Score. Chi-square tests and Student’s t-tests were used to analyze categorical and continuous variables, respectively. Any p value >0.05 was considered statistically significant.

RESULTS:
PC patients were less likely to receive a percutaneous endoscopic gastric tube or tracheostomy. PC patients spent less time on ventilator support, spent less time in the ICU, and had a shorter hospital stay. PC consultation was requested 16.48 days into the patient’s hospital stay. Approximately 82% of consults were to assist with goals of care.

CONCLUSION:
Specialist PC team involvement in the care of the trauma ICU patients may have a beneficial impact on hospital LOS, ICU LOS, and surgical care rendered. Earlier consultation during hospitalization may lead to higher rates of goal-directed care and improved patient satisfaction.
Validation of the Memorial Sloan Kettering Gastric Cancer Post-Resection Survival Nomogram: Does It Stand the Test of Time?
Authors: Nakauchi Masaya , Court Colin M , Tang Laura H , Gönen Mithat , Janjigian Yelena Y , Maron Steven B , Molena Daniela , Coit Daniel G , Brennan Murray F , Strong Vivian E 
Published: July 2022

BACKGROUND:
The Memorial Sloan Kettering Cancer Center (MSK) nomogram combined both gastroesophageal junction (GEJ) and gastric cancer patients and was created in an era from patients who generally did not receive neoadjuvant chemotherapy. We sought to reevaluate the MSK nomogram in the era of multidisciplinary treatment for GEJ and gastric cancer.

STUDY DESIGN:
Using data on patients who underwent R0 resection for GEJ or gastric cancer between 2002 and 2016, the C-index of prediction for disease-specific survival (DSS) was compared between the MSK nomogram and the American Joint Committee on Cancer (AJCC) 8th edition staging system after segregating patients by tumor location (GEJ or gastric cancer) and neoadjuvant treatment. A new nomogram was created for the group for which both systems poorly predicted prognosis.

RESULTS:
During the study period, 886 patients (645 gastric and 241 GEJ cancer) underwent up-front surgery, and 999 patients (323 gastric and 676 GEJ) received neoadjuvant treatment. Compared with the AJCC staging system, the MSK nomogram demonstrated a comparable C-index in gastric cancer patients undergoing up-front surgery (0.786 vs 0.753) and a better C-index in gastric cancer patients receiving neoadjuvant treatment (0.796 vs 0.698). In GEJ cancer patients receiving neoadjuvant chemotherapy, neither the MSK nomogram nor the AJCC staging system performed well (C-indices 0.647 and 0.646). A new GEJ nomogram was created based on multivariable Cox regression analysis and was validated with a C-index of 0.718.

CONCLUSIONS:
The MSK gastric cancer nomogram’s predictive accuracy remains high. We developed a new GEJ nomogram that can effectively predict DSS in patients receiving neoadjuvant treatment.
Simultaneous Spectral Differentiation of Multiple Fluorophores in Super-resolution Imaging Using a Glass Phase Plate
Authors: Fernando Sanduni I. , Martineau Jason T. , Hobson Robert J. , Vu Thien N. , Baker Brian , Mueller Brian D. , Menon Rajesh , Jorgensen Erik M. , Gerton Jordan M. 
Published: July 2022

AbstractMulticolor localization microscopy typically relies on sequential imaging and bandpass filters to distinguish fluorescent tags, which introduces temporal delays during live imaging, and decreases photon yield. By engineering the point-spread function (PSF), different fluors can be imaged simultaneously and distinguished by their unique patterns, without discarding photons. Here, we insert a silicon-dioxide phase plate at the Fourier plane of the detection path of a wide-field fluorescence microscope to produce distinguishable PSFs (X-PSFs) at different wavelengths. We demonstrate that the resulting PSFs can be localized spatially and spectrally using a statistics-based computational algorithm and can be utilized for hyper-spectral super-resolution microscopy of biological samples. Single PSFs in fixed U2OS cells were acquired using dSTORM with simultaneous illumination of fluors without emission filters. The modified PSF achieves ∼21 nm lateral localization precision (FWHM), ∼17 nm axial precision (FWHM) with an average of 1,800 - 3,500 photons per PSF and a background as high as 130 - 400 photons per pixel. The modified PSF can distinguish up to three fluorescent probes with ∼80 nm peak-to-peak separation between consecutive spectra.
Fully Quantitative Measurements of the Antibody Levels for SARS-CoV-2 Infections and Vaccinations calibrated against the NISTmAb Standard IgG Antibody
Authors: James-Pemberton Philip H. , Helliwell Mark W. , Olkhov Rouslan V. , Kohli Shivali , Westlake Aaron C. , Farrar Benjamin M. , Shaw Andrew M. 
Published: July 2022

AbstractHumanised recombinant antibodies specific to the SARS-CoV-2 Spike protein were calibrated against the NISTmAb standard human antibody to produce a fully quantitative antibody assay. The assay allows comparative studies between patient cohorts to be performed from which common properties may be derived. Two cohorts comparing patient vaccine response to AstraZeneca ChAdOx1-S (AZ, 35 patients) and Pfizer/BioNTech BNT162b2 (Pfizer, 25 patients) shows close association of the 31st percentile of the AZ distribution (2.90 ± 1.10 mg/L) and the 7th percentile of the Pfizer distribution (1.11 ± 1.10 mg/L) corresponding to the efficacy of the vaccines at preventing infection. The AZ IgG response distribution varies from 0.6 mg/L–25.4 mg/L with an average (mode) of 3.3 ± 1.0 mg/L; the Pfizer response distribution varies from 0.6 mg/L to 33.1 mg/L with a mode of 3.7 ± 1.0 mg/L. A third patient cohort looked at the recovery of 195 SARS-CoV-2 RT-PCR-positive patient samples and 200 pre-pandemic patient samples. A fourth patient cohort reviewed the NIBSC Anti-SARS-CoV-2 Verification Panel. The diagnostic cut-off for RT-PCR-positive patient samples was 1.34 ± 1.10 mg/L and the NIBSC panel separated seropositive and seronegative samples at 1.90 ± 1.10 mg/L. The mean value of the two prevention and two recovery thresholds is 1.8 mg/L with 95% confidence limits of 0.2–3.4 mg/L. In recovery and, critically, infection prevention, an antibody concentration threshold estimate of 3.4 mg/L appears mechanistically important. An antibody immunity threshold predicting a mucosal concentration preventing SARS-CoV-2 colonisation of the nasopharyngeal cavity is discussed.
Prospective Observational Cohort Study Of Tenecteplase Versus Alteplase In Routine Clinical Practice
Authors: Warach Steven J , Dula Adrienne N , Milling Truman J , Miller Samantha , Allen Leigh , Zuck Nathan D , Miller Collin , Jesser Christine A , Misra Lotika R , Miley Jefferson T , Mawla Manzure , Ding Ming-Chieh , Bertelson John A , Tsui Annie Y , Jefferson John R , Davison Holly M , Shah Darshan N , Padrick Matthew M , Nova Alan S. , Ellington Kent T , Krishna Vivek R , Davis Lisa A , Paydarfar David 
Published: July 2022

ABSTRACTBackground and PurposeA 10-hospital regional network transitioned to tenecteplase as the standard of care stroke thrombolytic in September 2019 because of its workflow advantages and reported non-inferior clinical outcomes relative to alteplase in meta-analyses of randomized trials. We assessed whether tenecteplase use in routine clinical practice reduces thrombolytic workflow times with non-inferior clinical outcomes.MethodsWe designed a prospective registry-based observational, sequential cohort comparison tenecteplase (n=234) to alteplase (n=354) treated stroke patients. We hypothesized: (1) an increase in the proportion of patients meeting target times for target door to needle (DTN) and transfer door-in-door-out (DIDO), and (2) non-inferior favorable (discharge to home with independent ambulation) and unfavorable (symptomatic intracranial hemorrhage, in-hospital mortality or discharge to hospice) in the tenecteplase group. Total hospital cost associated with each treatment was also compared.ResultsTarget DTN within 45 minutes was superior for tenecteplase, 41% versus 29%; aOR 1.76 (95% CI 1.24, 2.52), P = 0.002. Target DIDO within 90 minutes was superior for tenecteplase 37% (15/43) versus 14% (9/65); OR 3.69 (95% CI 1.47, 9.7), P =0.006, overall, and 67% (12/18) versus 14% (2/14) for those transferred for thrombectomy after thrombolytic treatment (P =0.009). Favorable outcome for tenecteplase fell within the 6.5% non-inferiority margin; aOR 1.28 (95% CI 0.92, 1.77). Unfavorable outcome was less for tenecteplase 7.7% versus 11.9%, aOR 0.79 (95% CI 0.46, 1.32), but did not fall within the pre-specified 1% non-inferior boundary. Net benefit (%favorable – %unfavorable) was greater for the tenecteplase sample: 36% v 27%. P =0.022. Median cost per hospital encounter was less for tenecteplase cases ($13,382 vs $15,841; P <0.001).ConclusionsSwitching to tenecteplase in routine clinical practice in a 10-hospital network was associated with shorter DTN and DIDO times, non-inferior favorable clinical outcomes at discharge, and reduced hospital costs. Evaluation in larger, multicenter cohorts is recommended to determine if these observations generalize.