bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Margins Melanoma: How Deep Is Deep Enough?
Authors: Burger Megan L. , Haggerty James M. , Wang Shengxuan , Oxenberg Jacqueline C. 
Published: December 2022

Background Wide excision (WE) to muscular fascia for invasive melanoma is common practice but excision to subcutaneous tissue may be adequate. We evaluated practice patterns regarding depth of biopsy and excision as well as risks for recurrence. Methods Retrospective review of patients with pT1-4 melanoma (cN0) treated with WE at a single institution was performed. Patient factors were evaluated. Biopsy and excision techniques were compared to pathology and reviewed for recurrence. Results 385 patients from 2006 to 2020 were included. Lesions were on the extremity (n = 189), head/neck (n = 48), trunk (n = 148). Biopsy techniques included shave (n = 330), excisional (n = 36), punch (n = 10), incisional (n = 9). Deep biopsy margins were positive for IM/melanoma in situ in 139 patients. WE specimens were taken to muscular fascia (n = 218) or mid/deep fat (n = 144). 51 patients had recurrent disease or a new primary lesion: locoregional (n = 31), distant (3), or new lesions (n = 17). Discussion Patient characteristics associated with recurrence include older age and female gender. Tumor characteristics associated with recurrence include lesions located on the trunk, superficial spreading melanoma, ulceration, perineural invasion, and clinical T and P stage. Patients that recurred were more likely to have WE taken to or including muscular fascia. Biopsy type, deep margin on biopsy, and depth of dissection was not associated with recurrence.
Should I Stay or Should I Go? Cognitive Modeling of Left-Turn Gap Acceptance Decisions in Human Drivers
Authors: Zgonnikov Arkady , Abbink David , Markkula Gustav 
Published: December 2022

Objective We aim to bridge the gap between naturalistic studies of driver behavior and modern cognitive and neuroscientific accounts of decision making by modeling the cognitive processes underlying left-turn gap acceptance by human drivers. Background Understanding decisions of human drivers is essential for the development of safe and efficient transportation systems. Current models of decision making in drivers provide little insight into the underlying cognitive processes. On the other hand, laboratory studies of abstract, highly controlled tasks point towards noisy evidence accumulation as a key mechanism governing decision making. However, it is unclear whether the cognitive processes implicated in these tasks are as paramount to decisions that are ingrained in more complex behaviors, such as driving. Results The drivers’ probability of accepting the available gap increased with the size of the gap; importantly, response time increased with time gap but not distance gap. The generalized drift-diffusion model explained the observed decision outcomes and response time distributions, as well as substantial individual differences in those. Through cross-validation, we demonstrate that the model not only explains the data, but also generalizes to out-of-sample conditions. Conclusion Our results suggest that dynamic evidence accumulation is an essential mechanism underlying left-turn gap acceptance decisions in human drivers, and exemplify how simple cognitive process models can help to understand human behavior in complex real-world tasks. Application Potential applications of our results include real-time prediction of human behavior by automated vehicles and simulating realistic human-like behaviors in virtual environments for automated vehicles.
Outcomes of coronary artery bypass grafting with coronary endarterectomy: A systematic review and meta-analysis of recent studies
Authors: Zhang Wei , Wu Haibo 
Published: December 2022

Objective: The aim of this systematic review and meta-analysis was to evaluate the short-term and long-term outcomes of coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) versus isolated CABG. Methods: Studies evaluating outcomes of CABG with CE (CE-CABG) were searched from 1 January 2000 to 30 September 2022, on PubMed, Embase, and Cochrane databases. The primary outcome was 30 -days mortality. Secondary outcomes were postoperative myocardial infraction, low output syndrome, cardiac arrhythmia, renal dysfunction, and 5 years survival. Results: A total of 12 observational studies including 114,319 patients assessing CE-CABG ( n = 35,174) versus isolated CABG ( n = 79,145) were included. Compared to isolated CABG alone, CE-CABG was significantly associated with increased incidences of 30-days mortality (RR, 1.87; 95% CI, 1.73–2.07; p < 0.01), postoperative myocardial infraction (RR, 1.61; 95% CI, 1.26–2.05; p < 0.01), low output syndrome (RR, 1.54; 95% CI, 1.17–2.02; p < 0.01), and renal dysfunction (RR, 1.56; 95% CI, 1.44–1.69; p < 0.01). However, there was no difference in either rate of cardiac arrhythmia (RR, 1.06; 95% CI, 0.97–1.15; p = 0.20) or 5 years survival (RR, 1.05; 95% CI, 0.95–1.16; p = 0.34) between the CE-CABG group and the control group. Subgroup analysis on CE technique showed that CE-CABG was also associated with 30 days mortality in patients undergoing closed CE (RR, 1.49; 95% CI, 1.09–2.03), whereas this association between CE and 30 days mortality was not observed in patients undergoing open CE (RR, 1.76; 95% CI, 0.58–5.32). Conclusions: Despite poor short-term outcomes, CE-CABG appeared to offer satisfactory long-term survival in patients with diffuse coronary artery disease.
The impact of comprehensive blood conservation program on major complications after total aortic arch replacement
Authors: Yan Weidong , Zhang Qiaoni , Gao Sizhe , Liu Gang , Teng Yuan , Wang Jing , Wang Jian , Zhou Boyi , Yan Shujie , Ji Bingyang 
Published: December 2022

Introduction Patients undergoing total aortic arch replacement (TAAR) usually require blood products perioperatively. This cohort study aimed to investigate the impact of a comprehensive blood conservation program on the major complications in these patients. Methods Patients with traditional or comprehensive blood management intraoperatively from January 2017 to December 2018 were included. We compared the rates of major complications (cerebral vascular accident, acute kidney injury, or mortality) between the two groups after propensity score matching (PSM). The association between blood management and outcomes was assessed by logistic regression. Restricted cubic splines (RCS) were built to evaluate the impact of fresh frozen plasma (FFP) on complications. Patients were stratified by the ratio of FFP/RBC (red blood cell) to investigate the effect of the ratio on complications. Results After 1:1 PSM, 200 patients were selected. 35% (35/100) of patients suffered major complications in the traditional group, while it decreased to 22% (22/100) in the comprehensive management group (OR = 0.524, p = 0.043). Multivariable logistic regression showed that FFP was a risk factor (OR = 1.186, p = 0.014). RCS results indicated that with the increase of FFP, the risk of complications gradually increases. The cut-off value was 402 mL. Patients in the group of ratio = 0 ∼ 0.5 had a higher chance than those without transfusion (OR = 7.487, p < 0.001). Conclusions Comprehensive blood conservation program in patients undergoing TAAR is safe and can reduce the incidence of major complications, which are associated with FFP volume and the ratio of FFP/RBC.
Medication errors in an oncology inpatient setting in India—Audit by clinical pharmacists
Authors: Chaudhari Akshay , Mule Akshay , Dhande Priti 
Published: December 2022

Background Good clinical practices and strict vigilance are needed, especially for patients receiving chemotherapy. Regular audits using a specially developed tool need to be conducted in the oncology wards to identify lapses in the use of chemotherapy drugs. Methodology Observational study was conducted in the adult and paediatric oncology inpatient settings in an Indian tertiary care hospital for a period of 2.5 years. It was an audit of case files of chemotherapy patients for their drug prescriptions, medication reconciliation records and adverse drug reports. Data was presented as frequencies and percentages. Results 1.3% medication errors and 0.23% adverse drug reactions were reported during the study period. Majority were transcription (38%) and drug reconstitution errors (29%) and were either in the near-miss or no-harm category. Conclusion Medication errors were found in the oncology wards, but due to the vigilance of clinical pharmacists, none of the patients were harmed as a consequence of these errors.
Prevalence of Respiratory Symptoms and Risk Factors Among Street Sweepers in Gondar City Northwest, Ethiopia, 2021: A Cross-Sectional Study
Authors: Worede Eshetu Abera , Brhan Alemaw Helen , Feleke Hailemariam , Engdaw Garedew Tadege 
Published: December 2022

Background: Street sweepers are exposed to a variety of risk factors such as dust, bioaerosols, and volatile organic matter, which are responsible for the development of various respiratory symptoms and lung function impairments. However, there is a limited data on the prevalence of respiratory symptoms and associated factors among street sweepers in Ethiopia, especially in the study area. Objective: This study aimed to assess the prevalence of respiratory symptoms and associated factors among street sweepers in Gondar town, northwest Ethiopia, in 2021. Methods: Using simple random sampling technique, a total of 391 workers were selected between August 10 and September 15, 2021. The data was entered and analyzed using the Epi Info Version 7 and Statistical Package for Social Science (SPSS) 22 software, respectively. Descriptive statistics, bivariable, and multivariable logistic regression model were used. P ⩽ .05 and adjusted odds ratios (AOR) with 95% confidence interval (CI) were used to declare the statistical significance. Result: A total of 391 respondents, with a response rate of 99.2% participated. The prevalence of respiratory symptoms among street sweepers was 35.3% (95% CI: 30.2, 40.5). History of respiratory illness (AOR = 7.75, (95% CI: 3.45, 17.45), washing personal protective equipments (PPE) after use (AOR = 4.77; 95% CI: 2.02, 11.28), previous work in cement (AOR = 3.10, 95% CI: 1.32, 7.34), and flour factories (AOR = 2.13, 95% CI: 2.02, 4.43), and alcohol drinking (AOR = 3.77, 95% CI: 1.94, 7.29) were associated with respiratory symptom among street sweepers. Conclusion: The overall prevalence of respiratory symptoms among street sweepers was 35.3%. Previous respiratory illness, washing personal protective equipment after use, previous work in a cement and flour factory, and drinking alcohol were independently associated with respiratory symptoms. To reduce the respiratory symptoms among street sweeper, it is advisable implementing safe work practice measures and behavioral changes among workers.
Parents’ perspectives of factors affecting parent–adolescent communication about type 1 diabetes and negotiation of self-management responsibilities
Authors: Rawdon Caroline , Kilcullen Sophia M , Murphy Nuala , Swallow Veronica , Gallagher Pamela , Lambert Veronica 
Published: December 2022

Adolescence is an important time in which young people take on type 1 diabetes (T1D) self-management responsibility. Parents are key facilitators of this process. Little is known about parents’ experiences of communicating with their children about T1D during adolescence. Semi-structured interviews were conducted with 32 parents (24 mothers and 8 fathers) of adolescents (11–17 years) living with T1D to explore how parents communicate about T1D and self-management with their adolescent children. Parents were recruited through two national child and adolescent diabetes and endocrine clinics and online advertisement through a national diabetes advocacy organisation. Interviews were transcribed verbatim and thematically analysed. Six themes were identified: parent factors, quality of the parent–adolescent relationship, communication strategies, adolescent factors, communication triggers and family/system factors. Understanding factors that impact communication about self-management between parents and adolescents will enable healthcare professionals to provide support and targeted interventions as parent and adolescent roles change over time.
Hybrid Coronary Revascularization: Early Outcomes and Midterm Follow-Up in Patients Undergoing Single or Multivessel Robotic TECAB and PCI
Authors: Nisivaco Sarah M. , Kitahara Hiroto , Abutaleb Abdul Rahman , Nathan Sandeep , Balkhy Husam H. 
Published: December 2022

Objective: Hybrid coronary revascularization (HCR) is the integration of sternal-sparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD). It is traditionally performed with single-vessel bypass (left internal mammary artery [LIMA] to left anterior descending artery [LAD]) and PCI but can also be accomplished with multiple arterial grafts using bilateral IMA conduits. We sought to review our HCR experience over an 8-year period with robotic totally endoscopic coronary artery bypass (TECAB) and PCI. Methods: Of 694 patients undergoing beating-heart TECAB from August 2013 to June 2022, 306 patients were designated as intention-to-treat HCR candidates. Patients underwent PCI prior to, the same day as, or following TECAB, performed using single or bilateral IMA grafts. We retrospectively reviewed early and midterm outcomes up to 8 years in this cohort of patients. Results: The mean Society of Thoracic Surgeons predicted risk of mortality was 1.5% ± 2.5%. There were 44 patients (14%) who had ≥70% left main disease and 218 patients (71%) who had triple-vessel disease. A total of 193 patients (63%) underwent multivessel grafting (advanced HCR), with 83% bilateral IMA use. Mean operative time was 263 ± 80 min, and mean length of stay was 2.6 days. The mean number of vessels bypassed per patient was 1.7 ± 0.6. The mean number of vessels stented was 1.2 ± 0.5. Of the patients, 84% underwent TECAB first, 14% PCI first, and 2% same-day TECAB/PCI. Mortality was 0.6% (observed to expected ratio: 0.42). Early graft patency was 97% (328 of 339 grafts); LIMA-LAD patency was 98%. At 8-year follow-up (mean 37 ± 26 months), all-cause and cardiac-related mortality were 13% and 2.6%, respectively. Freedom from major adverse cardiac and cerebrovascular events was 92%. Conclusions: In patients with multivessel CAD, integrating robotic single and multivessel TECAB with PCI resulted in excellent early and midterm outcomes. In experienced hands, the robotic endoscopic approach allows the routine use of multiple arterial grafting during HCR.
A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair
Authors: Fatehi Hassanabad Ali , Nagase Fernanda N. I. , Basha Ameen M. , Hammal Fadi , Menon Devidas , Kent William D. T. , Ali Imtiaz S. , Nagendran Jeevan , Stafinski Tania 
Published: December 2022

Objective: Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy. Methods: A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible. Results: The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches. Conclusions: Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.
Menopause knowledge and education in women under 40: Results from an online survey
Authors: Munn Carly , Vaughan Leigh , Talaulikar Vikram , Davies Melanie C , Harper Joyce C 
Published: December 2022

Background: All women experience the menopause, yet education around the topic is limited. Studies conducted in women aged over 40 show that women have limited knowledge about the menopause. Objectives: This study aims to understand what women under 40 know about the menopause, how they have acquired this knowledge and where they think menopause education should be taught. This data will help to determine how to effectively deliver menopause education. Design: A survey was designed that asked women under 40 what they know of, and their attitudes to, the menopause, using Qualtrics XM software. Methods: The survey was advertised for 5 weeks on social media. Six questions related to menopause education were analysed. Responses between age groups under 20, 21–30 and over 30 were compared using a chi-square test. A thematic-style analysis was also conducted on a free-text question where answers referred to education. Results: A total of 738 women’s responses were included in the analysis; over 80% had no knowledge or just some knowledge of the menopause. Women over 30 used official websites (p = 0.017) and scientific literature (p = 0.047) significantly more than other age groups to learn about the menopause, while women under 20 were more likely to learn from family members (p = 0.002). These women felt education should start in schools. Conclusion: Many women under 40 have limited education of the menopause. Women under 20 are more passive in their approach to learning about the menopause compared with those over 30, who are more proactive. Menopause education strategies must start at school and extend beyond schools adopting a multifaceted approach; it is recommended that the workplace, social media and public health campaigns are used to deliver menopause education moving forward.
Cardiovascular and cerebrovascular–associated mortality in patients with preceding bronchiectasis exacerbation
Authors: Lee Sang Chul , Son Kang Ju , Hoon Han Chang , Park Seon Cheol , Jung Ji Ye 
Published: December 2022

Background: Bronchiectasis is associated with an increased incidence of atherosclerotic cardiovascular disease (ASCaVD) and atherosclerotic cerebrovascular disease (ASCeVD). Its effect on associated mortality is unclear. Objectives: This study investigated the effects of bronchiectasis exacerbation prior to ASCaVD or ASCeVD events on mortality in patients with bronchiectasis using a large population–based database. Methods: A retrospective cohort of patients with bronchiectasis who experienced ASCaVD ( n = 1066) or ASCeVD ( n = 825) was studied for the first time using a nationwide population–based database (National Health Insurance Service-National Sample Cohort, Korea, 2002–2015). We classified each cohort according to the presence of moderate bronchiectasis exacerbation within 1 year before the ASCaVD or ASCeVD event. We evaluated 90-day, 1-year, and all-cause mortalities risk. Results: Within 1 year before the index ASCaVD or ASCeVD event, 149 (13.9%) and 112 (13.6%) patients with bronchiectasis experienced moderate exacerbation(s), respectively. Mild exacerbations did not different in frequency between the survivors and nonsurvivors. In both cohorts, more nonsurvivors experienced moderate exacerbations than survivors. The odds ratios of 90-day and 1-year mortalities and hazard ratios of all-cause mortalities on experiencing moderate exacerbations were 2.27 [95% confidence interval (CI) = 1.26–4.10], 3.30 (95% CI = 2.03–5.38), and 1.78 (95% CI = 1.35–2.34) in the bronchiectasis-ASCaVD cohort and 1.73 (95% CI = 0.94–3.19), 1.79 (95% CI = 1.07–3.00), and 1.47 (95% CI = 1.10–1.95), in the bronchiectasis-ASCeVD cohort. Conclusion: Hospitalization or emergency room visit for bronchiectasis exacerbation within 1 year before ASCaVD or ASCeVD is associated with an increased ASCaVD- or ASCeVD-associated mortality.
A phase II study of S-1 and cisplatin with concurrent thoracic radiotherapy followed by durvalumab for unresectable, locally advanced non-small-cell lung cancer in Japan (SAMURAI study): primary analysis
Authors: Tanaka Hisashi , Tanzawa Shigeru , Misumi Toshihiro , Makiguchi Tomonori , Inaba Megumi , Honda Takeshi , Nakamura Junya , Inoue Koji , Kishikawa Takayuki , Nakashima Masanao , Fujiwara Keiichi , Kohyama Tadashi , Ishida Hiroo , Kuyama Shoichi , Miyazawa Naoki , Nakamura Tomomi , Miyawaki Hiroshi , Oda Naohiro , Ishikawa Nobuhisa , Morinaga Ryotaro , Kusaka Kei , Fujimoto Nobukazu , Fukuda Yasushi , Yasugi Masayuki , Tsuda Takeshi , Ushijima Sunao , Shibata Kazuhiko , Shibayama Takuo , Bessho Akihiro , Kaira Kyoichi , Shiraishi Kenshiro , Matsutani Noriyuki , Seki Nobuhiko 
Published: December 2022

Background: The standard of care for unresectable, locally advanced non-small-cell lung cancer (LA-NSCLC) is chemoradiotherapy (CRT) followed by durvalumab, based on the PACIFIC study. Although multiple Japanese phase II studies have shown high efficacy and tolerability of CRT with cisplatin plus S-1 (SP), no prospective study using durvalumab after SP-based CRT has been reported. Objectives: We conducted a multicenter phase II study of this approach, the interim analysis of which showed a high transition rate to durvalumab consolidation therapy. Here, we report the primary analysis results. Design: In treatment-naïve LA-NSCLC, cisplatin (60 mg/m2, day 1) and S-1 (80–120 mg/body, days 1–14) were administered with two 4-week cycles with concurrent thoracic radiotherapy (60 Gy) followed by durvalumab (10 mg/kg) every 2 weeks for up to 1 year. Methods: The primary endpoint was 1-year progression-free survival (PFS). The expected 1-year PFS and its lower limit of the 80% confidence interval (CI) were set as 63% and 47%, respectively, based on the results of TORG1018 study. Results: In all, 59 patients were enrolled, with 51 (86.4%) proceeding to durvalumab. The objective response rate throughout the study was 72.9% (95% CI: 59.7–83.6%). After median follow-up of 21.9 months, neither median PFS nor OS was reached. The 1-year PFS was 72.5% (80% CI: 64.2–79.2%, 95% CI: 59.1–82.2%), while the 1-year overall survival was 91.5% (95% CI: 80.8–96.4%). No grade 5 adverse events were observed throughout the study. The most common adverse event during the consolidation phase was pneumonitis (any grade, 78.4%; grade ⩾3, 2.0%). Eventually, 52.5% of patients completed 1-year durvalumab consolidation therapy from CRT initiation. Conclusion: This study of durvalumab after SP-based CRT met its primary endpoint and found a 1-year PFS of 73% from CRT initiation. This study provides the first prospective data on the prognosis and tolerability of durvalumab consolidation from the initiation of CRT. Trial registration: Japan Registry of Clinical Trials, jRCTs031190127, registered 1 November, 2019, https://jrct.niph.go.jp/latest-detail/jRCTs031190127