bluuebunny/crossref_metadata_2025 huggingface dataset:
A Great late Ediacaran ice age
Authors: Wang Ruimin , Shen Bing , Lang Xianguo , Wen Bin , Mitchell Ross N , Ma Haoran , Yin Zongjun , Peng Yongbo , Liu Yonggang , Zhou Chuanming
Published: April 2023

The emergence of the Ediacara biota soon after the Gaskiers glaciation ca. 580 million years ago (Ma) implies a possible glacial fuse for the evolution of animals. However, the timing of Ediacaran glaciation remains controversial because of poor age constraints on the ∼30 Ediacaran glacial deposits known worldwide. In addition, paleomagnetic constraints and a lack of convincing Snowball-like cap carbonates indicate that Ediacaran glaciations likely did not occur at low latitudes. Thus, reconciling the global occurrences without global glaciation remains a paradox. Here, we report that the large amplitude, globally synchronous ca. 571–562 Ma Shuram carbon isotope excursion occurs below the Ediacaran Hankalchough glacial deposit in Tarim, confirming a post-Shuram glaciation. Leveraging paleomagnetic evidence for a ∼90° reorientation of all continents due to true polar wander, and a non-Snowball condition that rules out low-latitude glaciations, we use paleogeographic reconstructions to further constrain glacial ages. Our results depict a ‘Great Ediacaran Glaciation’ occurring diachronously but continuously from ca. 580–560 Ma as different continents migrated through polar–temperate latitudes. The succession of radiation, turnover and extinction of the Ediacara biota strongly reflects glacial–deglacial dynamics.
Selecting Sunak: Conservative MPs’ Nomination Preferences in the (Second) British Conservative Party Leadership Election
Authors: Booth Oliver , Butler Chris , Jeffery David , Roe-Crines Andrew
Published: April 2023

This article utilises an original dataset covering all members of the Parliamentary Conservative Party (PCP) to analyse the basis of support for Rishi Sunak, Boris Johnson and Penny Mordaunt in the October 2022 British Conservative Party leadership election. The significance of our findings is that they form the basis for a new understanding of how conservatism in the UK is changing post-Brexit. Our political variables include constituency majority size, red wall status, constituency support for leave, an MP’s position in the June 2022 vote of confidence in Johnson’s leadership of the Conservative Party, ministerial status and rebellion rates on key legislation. Our ideological variables include EU referendum position and membership of the European Research Group and the Conservative Environment Network, along with whether MPs are classed as socially liberal, socially conservative or pro-levelling up. We find that candidates appealed to different, often rival, sections of the Conservative Party. In line with previous studies of this nature, social liberalism still represents a key dividing line within the party, and the European dimension of intra-party conflict has remained significant in light of the UK’s decision to leave the European Union.
Viral synergism suppresses R gene-mediated resistance by impairing downstream defense mechanisms in soybean
Authors: Alazem Mazen , Bwalya John , Hsuan Pai , Yu Jisuk , Cam Chu Huong , Burch-Smith Tessa , Kim Kook-Hyung
Published: April 2023

Viral synergism occurs when mixed infection of a susceptible plant by 2 or more viruses leads to increased susceptibility to at least 1 of the viruses. However, the ability of 1 virus to suppress R gene-controlled resistance against another virus has never been reported. In soybean (Glycine max), extreme resistance (ER) against soybean mosaic virus (SMV), governed by the Rsv3 R-protein, manifests a swift asymptomatic resistance against the avirulent strain SMV-G5H. Still, the mechanism by which Rsv3 confers ER is not fully understood. Here, we show that viral synergism broke this resistance by impairing downstream defense mechanisms triggered by Rsv3 activation. We found that activation of the antiviral RNA-silencing pathway and the proimmune mitogen-activated protein kinase 3 (MAPK3), along with the suppression of the proviral MAPK6, are hallmarks of Rsv3-mediated ER against SMV-G5H. Surprisingly, infection with bean pod mottle virus (BPMV) disrupted this ER, allowing SMV-G5H to accumulate in Rsv3-containing plants. BPMV subverted downstream defenses by impairing the RNA-silencing pathway and activating MAPK6. Further, BPMV reduced the accumulation of virus-related siRNAs and increased the virus-activated siRNA that targeted several defense-related nucleotide-binding leucine-rich repeat receptor (NLR) genes through the action of the suppression of RNA-silencing activities encoded in its large and small coat protein subunits. These results illustrate that viral synergism can result from abolishing highly specific R gene resistance by impairing active mechanisms downstream of the R gene.
The Virtues of Mediation: Milton’s Ludlow Maske
Authors: Rao Namratha
Published: April 2023

This essay, partly by way of Milton’s Spenserian engagements, argues that A Maske is neither a celebration of resolve, nor a univocal assertion of exceptional virtue that facilitates some fusion of pleasure and virtue, but is instead a risky exploration of the mediacy of virtue and the virtues of mediation, however much they fail to satisfy. Several kinds of mediation texture A Maske: mediation as the middle ground between disparate things, mediation as intervention in conflict, mediation as the making sensuous of ideas or putting into medium, and, above all, mediation as the material and social process that takes place in and through opposites that both require and condition one another. Consequently, Milton exploits rather than forecloses the dialectical promise of the masque form and leaves open, but not unanswered, the difficult questions of immediacy and transcendence. Drawing on the writings of T. W. Adorno, this essay suggests that mediation—and his related concept, ‘constellation’—afford supple and illuminating ways with which to think through the contradictions of Milton’s poetic-philosophical thought. It offers new interpretations of cruxes in A Maske and shows how each of its characters entails others through a combination of fissures and resemblances. In presenting not an isolated form of virtue, but sketching instead a constellation of interrelated forms, A Maske reveals how—in tending to its mediations—the drear woods of the world might be made to disclose the starry threshold with which we begin and from which we are removed.
Cisgendered Workspaces: Outright and Categorical Exclusion in Cisgendered Organizations
Authors: Jones Angela
Published: April 2023

Scholars have only begun exploring how cisgenderism and its byproduct, cissexism, shape organizational processes and how classification systems produce categorical exclusions that harm transgender and non-binary people in cisgendered organizations. Drawing from in-depth interviews with transmasculine and non-binary sex workers, I build on burgeoning research on categorical exclusion in cisgendered organizations, examining how cisgenderism and cissexism, alongside racism, shape what I call cisgendered workspaces. Cisgendered workspaces is a conceptual framework that scholars can use to analyze the complex ways that cisgenderism and cissexism shape the design of workspaces, the administration of gender, workers’ labor experiences, and the adverse effects of cissexist exclusion. I argue that cisgendered workspaces produce two distinct modes of exclusion: outright exclusion and categorical exclusion. I demonstrate how transmasculine and non-binary sex workers experience outright exclusion (e.g., brothels or agencies that refuse to hire them) and categorical exclusions (e.g., escort advertising sites that have options for only cisgender women and men). I explore how cissexist exclusions and racism contribute to workers’ lack of access to critical resources and produce adverse mental health outcomes—all conditions that adversely affect worker job satisfaction and thwart experiences of joy and pleasure.
“The Yo-Yo Effect”: U.S. Department of Veterans Affairs Social Workers’ Experiences with Job Flexibility during the Pandemic
Authors: Kranke Derrick , Gioia Debbie , Alenkin Nikola , Mudoh Yvonne , Solorzano Emily , Dobalian Aram
Published: April 2023

Social work turnover from the emotional overload of providing care during the pandemic has created staff shortages and exposed many gaps in service delivery. Those social workers who sustained employment during this pandemic are asked to take on flexible/additional roles to fill in those gaps in services to their most vulnerable clients. This qualitative study (N = 12) of U.S. Department of Veterans Affairs (VA) inpatient social workers at two sites across the country assesses their experiences of taking on additional roles at their respective VA facility. Three research questions were addressed to the participants: (1) Describe your roles and responsibilities during the COVID-19 pandemic? (2) How did those responsibilities change/evolve over time? and (3) Did you receive training for your new roles or tasks? Thematic analysis revealed six themes that would facilitate effectiveness and continuity of care: (1) recognizing insufficient training to handle a pandemic, (2) meeting the demand for care, (3) responding to unexpected aspects of flexibility, (4) adjusting to new roles over time, (5) adaptation and support, and (6) additional resources to simplify efforts. With COVID rates stabilizing across much of the United States, now is the time to implement trainings and education about job flexibility in the future instance of a pandemic.
First Report of In Vitro Insensitivity to Fluazinam of Clarireedia jacksonii Causing Dollar Spot of Turfgrass on New England Golf Courses
Authors: Shi Xiaojing , Sang Hyunkyu , Yamada Toshihiko , Jung Geunhwa
Published: April 2023

Dollar spot, caused by the newly renamed ascomycete fungus Clarireedia spp., contributes to the aesthetic and functional damage and ultimate death of turfgrass. Fluazinam, a protective fungicide belonging to the 2,6-dinitroaniline chemical group, has proven to be one of the most efficacious fungicide classes of managing a variety of turfgrass diseases, including dollar spot, due to its low risk for fungicide resistance as a broad-spectrum fungicide. Dollar spot isolates collected from six New England golf courses with suspected resistance to multiple fungicide classes had shown reduced sensitivity to fluazinam using a mycelial growth inhibition assay. This is the first report of reduced sensitivity to fluazinam in dollar spot field isolates in the United States. Briefly, in vitro sensitivity assays of 22 isolates collected from 12 golf courses and UMass turf research facilities showed that reduced fluazinam sensitivity of isolates was detected on six golf courses since 2017, demonstrating that fungi with higher exposure to fluazinam tend to develop reduced sensitivity over time. To date, there is no reported field resistance of fluazinam in C. jacksonii. However, the findings highlight the need for ongoing monitoring of in vitro and field sensitivity to fluazinam in C. jacksonii, as well as emphasizing judicious use of fluazinam in managing dollar spot disease to delay the development of fungicide resistance.
Post-transcriptional regulation of erythropoiesis
Authors: Li Yanan , Zhang Haihang , Hu Bin , Wang Pan , Wang Wei , Liu Jing
Published: April 2023

Erythropoiesis is a complex, precise, and lifelong process that is essential for maintaining normal body functions. Its strict regulation is necessary to prevent a variety of blood diseases. Normal erythropoiesis is precisely regulated by an intricate network that involves transcription levels, signal transduction, and various epigenetic modifications. In recent years, research on post-transcriptional levels in erythropoiesis has expanded significantly. The dynamic regulation of splicing transitions is responsible for changes in protein isoform expression that add new functions beneficial for erythropoiesis. RNA-binding proteins adapt the translation of transcripts to the protein requirements of the cell, yielding mRNA with dynamic translation efficiency. Noncoding RNAs, such as microRNAs and lncRNAs, are indispensable for changing the translational efficiency and/or stability of targeted mRNAs to maintain the normal expression of genes related to erythropoiesis. N6-methyladenosine-dependent regulation of mRNA translation plays an important role in maintaining the expression programs of erythroid-related genes and promoting erythroid lineage determination. This review aims to describe our current understanding of the role of post-transcriptional regulation in erythropoiesis and erythroid-associated diseases, and to shed light on the physiological and pathological implications of the post-transcriptional regulation machinery in erythropoiesis. These may help to further enrich our understanding of the regulatory network of erythropoiesis and provide new strategies for the diagnosis and treatment of erythroid-related diseases.
Delineating asthma according to inflammation phenotypes with a focus on paucigranulocytic asthma
Authors: Feng Yinhe , Liu Xiaoyin , Wang Yubin , Du Rao , Mao Hui
Published: April 2023

Asthma is characterized by chronic airway inflammation and airway hyper-responsiveness. However, the differences in pathophysiology and phenotypic symptomology make a diagnosis of “asthma” too broad hindering individualized treatment. Four asthmatic inflammatory phenotypes have been identified based on inflammatory cell profiles in sputum: eosinophilic, neutrophilic, paucigranulocytic, and mixed-granulocytic. Paucigranulocytic asthma may be one of the most common phenotypes in stable asthmatic patients, yet it remains much less studied than the other inflammatory phenotypes. Understanding of paucigranulocytic asthma in terms of phenotypic discrimination, distribution, stability, surrogate biomarkers, underlying pathophysiology, clinical characteristics, and current therapies is fragmented, which impedes clinical management of patients. This review brings together existing knowledge and ongoing research about asthma phenotypes, with a focus on paucigranulocytic asthma, in order to present a comprehensive picture that may clarify specific inflammatory phenotypes and thus improve clinical diagnoses and disease management.
Assessment of Risk Factors Correlated with Outcomes of Traumatic Lower Extremity Soft Tissue Reconstruction
Authors: Levin Scott R. , Burke Peter A. , Brahmbhatt Tejal S. , Siracuse Jeffrey J. , Slama Jaromir , Roh Daniel S.
Published: April 2023

Background:

Identifying risk factors for traumatic lower extremity reconstruction outcomes has been limited by sample size. We evaluated patient and procedural characteristics associated with reconstruction outcomes using data from almost four million patients.

Methods:

The National Trauma Data Bank (2015–2018) was queried for lower extremity reconstructions. Univariable and multivariable analyses determined associations with inpatient outcomes.

Results:

There were 4675 patients with lower extremity reconstructions: local flaps (77%), free flaps (19.2%), or both (3.8%). Flaps were most commonly local fasciocutaneous (55.1%). Major injuries in reconstructed extremities were fractures (56.2%), vascular injuries (11.8%), and mangled limbs (2.9%). Ipsilateral procedures prereconstruction included vascular interventions (6%), amputations (5.6%), and fasciotomies (4.3%). Postoperative surgical site infection and amputation occurred in 2% and 2.6%, respectively. Among survivors (99%), mean total length of stay (LOS) was 23.2 ± 21.1 days and 46.8% were discharged to rehab. On multivariable analysis, vascular interventions prereconstruction were associated with increased infection [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.05–3.79, P = 0.04], amputation (OR 4.38, 95% CI 2.56–7.47, P < 0.001), prolonged LOS (OR 1.59, 95% CI 1.14–2.22, P = 0.01), and discharge to rehab (OR 1.49, 95% CI 1.07–2.07, P = 0.02). Free flaps were associated with prolonged LOS (OR 2.08, 95% CI 1.74–2.49, P < 0.001).

Conclusions:

Prereconstruction vascular interventions were associated with higher incidences of adverse outcomes. Free flaps correlated with longer LOS, but otherwise similar outcomes. Investigating reasons for increased complication and healthcare utilization likelihood among these subgroups is warranted.
Outcomes of abdominal false lumen embolization for chronic aortic dissection after prior proximal repair with stent-graft
Authors: Kuo Ching-Yuan , Huang Chun-Yang , Chen Tai-Wei , Hsu Hung-Lung , Shih Chun-Che , Hsu Chiao-Po
Published: April 2023

Background:

Persistent false lumen (FL) perfusion with aneurysmal formation is common after thoracic endovascular aortic repair (TEVAR) for typical extended aortic dissection and is associated with poor outcomes. Endovascular FL embolization (FLE) has recently been tried for treatment of postdissection aortic aneurysm (PDAA). However, most reports address thoracic rather than abdominal FLE. In this study, we present the results of abdominal FLE in patients with residual patent abdominal FL following stent-graft repair for aortic dissection.

Methods:

Between 2015 and 2019, 24 patients (mean age: 56.7 ± 11.8 years, range: 40-84 years, 18 male) received endovascular abdominal FLE using vascular plugs, coils, or candy plugs as the main surgery (5 patients) or auxiliary procedure (19 patients) after earlier stent-graft repair for aortic dissection (Type A: 9, Type B: 15). The medical records were reviewed and aortic remodeling was examined comparing the preembolization computed tomography (CT) and the most recent CT before reintervention.

Results:

Technical success was achieved without any intraoperative complications, early morbidity, or mortality. Median follow-up was 34.4 months (range: 12-71). Regarding thoracic FL, 15 patients exhibited complete thrombosis before the procedure and did not change status thereafter except for 1 patient with distal stent-graft-induced new entry. In the other 9 patients, 6 exhibited increased thrombosis. With regard to the abdominal aorta, increased FL thrombosis only occurred in 8 patients with 3 (12.5%) achieving complete thrombosis. The maximal thoracic aortic diameter did not change (1.4 ± 5.6 mm) statistically, but the abdominal diameter increased significantly (4.3 ± 3.7 mm, p < 0.005).

Conclusion:

From our results, abdominal FLE is a safe procedure. However, covering all the re-entry tears is complex and the possibility of complete FL thrombosis is low. The abdominal aortic diameter appears to become enlarged in these patients. Continuous follow-up is necessary after FLE.
Link Between the Female Athlete Triad and Gymnastics-Related Injury in Retired Collegiate Gymnasts
Authors: Fryar Caroline , Howell David R. , Seehusen Corrine N. , Tilley David , Casey Ellen , Sweeney Emily A.
Published: April 2023

Objectives:

To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery.

Design:

Retrospective case–control.

Setting:

Online survey.

Patients:

Four hundred seventy former collegiate gymnasts.

Interventions:

Athletes completed online survey distributed through social media.

Main Outcome Measures:

Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2analyses.

Results:

Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%;P=0 .03). A significantly greater proportion of the disordered eating–only group reported a spine injury compared with the menstrual irregularity–only group (P= 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P= 0.006).

Conclusions:

College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries.
Systolic Blood Pressure and Objective Hearing Thresholds Among Japanese Middle-Aged Adults: A Facility-Based Retrospective Cohort Study
Authors: Miyata Jun , Umesawa Mitsumasa , Yoshioka Tetsuya , Iso Hiroyasu
Published: April 2023

Introduction

Very few studies have compared the magnitude of the changes in the hearing thresholds at 1 and 4 kHz according to the systolic blood pressure (SBP). We investigated the effects of SBP on repeated measures of hearing threshold using pure-tone audiometry.

Methods

This retrospective cohort study included 5,479 (for the analysis at 1 kHz) and 2,045 (for 4 kHz) individuals aged 50 to 59 years who underwent facility-based health checkups. A multivariable generalized linear mixed model was constructed for the analysis at 1 and 4 kHz.

Results

The mean follow-up durations were 30,262 and 7,454 person-years, respectively. The interaction of SBP and year was significantly associated with the change in hearing threshold in both analyses at 1 kHz (with estimated slope, 0.00080; 95% confidence interval, 0.00049–0.00110) and 4 kHz (with estimated slope, 0.0042; 95% confidence interval, 0.0028–0.0057). The 10-year changes in hearing threshold with baseline SBP of 110 and 140 mm Hg were 0.4 and 0.6 dB at 1 kHz and 1.0 and 2.3 dB at 4 kHz, respectively.

Conclusions

Higher SBP was associated with an increased hearing threshold at both 1 and 4 kHz among middle-aged individuals.
Molecular Genetic Etiology and Revisiting the Middle Ear Surgery Outcomes of Branchio-Oto-Renal Syndrome: Experience in a Tertiary Referral Center
Authors: Nam Dong Woo , Kang Dae Woong , Lee So Min , Park Moo Kyun , Lee Jun Ho , Oh Seung Ha , Suh Myung-Whan , Lee Sang-Yeon
Published: April 2023

Objectives

To explore the phenotypes and genotypes of patients with branchio-oto-renal (BOR) and branchio-otic (BO) syndrome, and to analyze the middle ear surgery outcomes qualitatively and quantitatively, proposing a factor usefully prognostic of surgical outcomes.

Study design

Retrospective cohort study.

Setting

Tertiary referral center.

Patients

Eighteen patients with BOR/BO syndrome in 12 unrelated Korean families.

Intervention

Middle ear surgery, including either stapes surgery or ossicular reconstruction.

Main Outcome Measure

Clinical phenotypes, genotypes, and middle ear surgery outcomes

Results

Eight probands (66.7%) were confirmed genetically; the condition segregated as a dominant or de novo trait. Six EYA1 heterozygous variants were identified by exome sequencing and multiplex ligation-dependent probe amplification. All variants were pathogenic or likely pathogenic based on the ACMG/AMP guidelines. Two novel EYA1 frameshift variants (p.His373Phefs*4 and p.Gln543Asnfs*90) truncating a highly conserved C-terminal Eya domain were identified, expanding the genotypic spectrum of EYA1 in BOR/BO syndrome. Remarkably, middle ear surgery was individualized to ensure optimal audiological outcomes and afforded significant audiological improvements, especially in BOR/BO patients without enlarged vestibular aqueducts (EVAs). A significant difference in air-bone gap closure after middle ear surgery was noted between the two groups even after adjusting for confounders: −20.5 dB in ears without EVAs (improvement) but 0.8 dB in ears with EVAs (no change or deterioration). Furthermore, the success rate was significantly associated with the absence of EVA.

Conclusions

The results of this study were against the notion that middle ear surgery is always contraindicated in patients with BOR/BO syndrome, and an EVA could be a negative prognostic indicator of middle ear surgery in BOR/BO patients. This may aid to determine the strategy of audiological rehabilitation in patients with BOR/BO syndrome.
Adjunctive Cilostazol in Patients With High Residual Platelet Reactivity After Drug-Eluting Stent Implantation: A Randomized, Open-Label, Single-Center, Prospective Study (ADJUST-HPR)
Authors: Long Zhe Guo , Hau Yu Long , Lee Dong-Hyun , Kim Moo Hyun , Serebruany Victor
Published: April 2023

Background:

Cilostazol as an adjunct to dual antiplatelet therapy (DAPT) postcoronary stenting may further reduce vascular occlusion risks. The aim of this study was to assess the impact of cilostazol on high residual platelet reactivity (HRPR) in patients undergoing drug-eluting coronary stent implantation.

Methods:

In a randomized, open-label, single-center, prospective study, the degree of platelet inhibition by cilostazol 100 mg twice daily was assessed on top of conventional DAPT compared with standard clopidogrel and low-dose aspirin combination in poststent patients with HRPR. HRPR was defined as P2Y12 units (PRU) > 240 as measured by the VerifyNow P2Y12 assay. In addition, the platelet activity was assessed by light transmittance aggregometry (LTA) and Multiplate electrode analyzer (MEA).

Results:

The total of 148 patients were screened, and HRPR was observed in 64 (43.2%). Those were randomized for DAPT versus triple therapy (TAPT). After 30 days, TAPT group exhibited significantly lower rate of HRPR when assessed by all 3 devices (VerifyNow: 40.0 vs. 66.7% P = 0.04, LTA: 6.7 vs. 30.0% P = 0.02, MEA: 10.0 vs. 30.0% P = 0.05 L all vs. DAPT). Also, higher absolute mean difference in TAPT versus DAPT group after 30 days (VerifyNow: 71.3 ± 38.2 vs. 24.6 ± 40.2 P < 0.001, LTA: 23.9 ± 15.1 vs. 9.4 ± 11.8 P < 0.001, MEA: 9.3 ± 12.9 vs. 2.4 ± 17.3 P = 0.08) was observed.

Conclusions:

Cilostazol in addition to standard DAPT reduces the incidence of HRPR and diminishes further platelet activity in poststent patients. Whether this favorable laboratory finding will affect clinical outcomes requires an adequately powered randomized trial.
Histopathological Changes in Liver of Patients With Chronic Pancreatitis Requiring Surgical Intervention and Their Clinical Significance
Authors: Saluja Sundeep Singh , Varshney Vaibhav Kumar , Kumar Ajay , Sugumaran Kandasamy , Aravinda PS , Mishra Pramod Kumar
Published: April 2023

Objectives

The histopathological changes in the liver and their clinical implication in chronic pancreatitis (CP) have not been studied well. We analyzed the incidence, risk factors, and long-term outcomes of these changes in CP.

Methods

Chronic pancreatitis patients who underwent surgery with intraoperative liver biopsy from 2012 to 2018 formed the study group. Based on liver histopathology, 3 groups were formed: normal liver, group NL; fatty liver, group FL; and inflammation/fibrosis, group FS. The risk factors and long-term outcomes, including mortality, were evaluated.

Results

Among 73 patients, 39 (53.4%) had idiopathic, and 34 (46.6%) had alcoholic CP. The median age was 32 years, 52 (71.2%) were males and comprised NL, n = 40 (55%); FL, n = 22 (30%); and FS, n = 11 (15%). The preoperative risk factors were comparable among NL and FL groups. Overall 14 of 73 patients (19.2%) (NL, 5 of 40; FL, 5 of 22; FS, 4 of 11 [P = 0.82]) had died at median follow-up of 36 months (range, 25–85 months). The main causes of mortality were tuberculosis and severe malnutrition secondary to pancreatic insufficiency.

Conclusions

The mortality is higher in patients with inflammation/fibrosis or steatosis in liver biopsy, and such patients need monitoring for progression of liver disease and pancreatic insufficiency.
Successful Pancreatic Cancer Screening Among Individuals at Elevated Risk Using Endoscopic Ultrasound and Magnetic Resonance Imaging
Authors: Raff Joshua Peter , Cook Brennan , Jafri Farrukh Nadeem , Boxer Nicole , Maldonado Jessica , Hopkins Una , Roayaie Sasan , Noyer Charles
Published: April 2023

Objectives

Guidelines for testing individuals at risk (IAR) for developing pancreatic duct adenocarcinoma (PC) are being advanced from university hospital populations. We implemented a screen-in criteria and protocol for IAR for PC in our community hospital setting.

Methods

Eligibility was based on germline status and/or family history of PC. Longitudinal testing continued, alternating between endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI). The primary objective was to analyze pancreatic conditions and their associations with risk factors. The secondary objective was to evaluate the outcomes and complications resulting from testing.

Results

Over 93 months, 102 individuals completed baseline EUS, and 26 (25%) met defined endpoints of any abnormal findings in the pancreas. Average enrollment was 40 months, and all participants with endpoints continued standard surveillance. Two participants (1.8%) had endpoint findings requiring surgery for premalignant lesions. Increasing age predicted for endpoint findings. Analysis of longitudinal testing suggested reliability between the EUS and MRI results.

Conclusions

In our community hospital population, baseline EUS was effective in identifying the majority of findings; advancing age correlated with a greater chance of abnormalities. No differences were observed between EUS and MRI findings. Screening programs for PC among IAR can be successfully performed in the community setting.
Pancreatic Lineage Cell Differentiation of Bone Marrow Mesenchymal Stromal Cells on Acellular Pancreatic Bioscaffold
Authors: Li Zhao , Du Yue , Wang Xin
Published: April 2023

Objectives

We evaluated the potential differentiation ability of bone mesenchymal stromal cells (BMSCs) into pancreatic lineage cells on a rat acellular pancreatic bioscaffold (APB) and the effect of differentiated BMSCs in vivo.

Methods

The BMSCs were dynamically or statically cultured with or without growth factor in both culture systems. We assessed the cytological behavior and differentiation. We also evaluated the pancreatic fibrosis and pathological scores.

Results

The proliferation rates of BMSCs were significantly higher in the APB groups. The APB induced BMSCs to express mRNA markers at higher levels. All tested pancreatic functional proteins were also expressed at higher levels in the APB group. The secretion of metabolic enzymes was higher in the APB system. The ultrastructure of BMSCs in the APB group further revealed the morphological characteristics of pancreatic-like cells. For the in vivo study, the pancreatic fibrosis and pathological scores were significantly lower in the differentiated BMSCs group. In addition, in both the in vitro and the in vivo study, growth factor significantly improved proliferation, differentiation, and pancreatic cell therapy.

Conclusions

The APB can promote BMSC differentiation toward pancreatic lineage and pancreatic-like phenotypes, giving it the potential for use in pancreatic cell therapies and tissue engineering.
Early Increases in Posttransplant Pancreatic Enzymes Are Associated With Surgical Complications But Not Graft Failure Among Pancreas Transplant Recipients
Authors: Parajuli Sandesh , Leverson Glen E. , Kaufman Dixon B. , Djamali Arjang , Welch Bridget M. , Sollinger Hans W. , Mandelbrot Didier A. , Odorico Jon S.
Published: April 2023

Objectives

This study aimed to find the association between immediate postoperative increases in pancreatic enzymes and posttransplant complications among pancreas transplant recipients (PTRs).

Methods

We analyzed all PTRs transplanted at the University of Wisconsin between June 2009 and September 2018. Enzyme levels were presented as a ratio of absolute numbers to the upper limit of normal value, with value >1 considered as abnormal. We specifically evaluated bleeding, fluid collections, and thrombosis complications based on the amylase or lipase ratios on day 1 (Amylase1, Lipase1) and maximum ratios within 5 days of transplant (Amylasemax, Lipasemax). For early complications, we focused on technical complications that occurred within 90 days of transplant. For long-term outcomes, we assessed patient and graft survival, and rejections.

Results

There were a total of 443 PTRs, 287 were simultaneous pancreas and kidney recipients, and 156 were solitary pancreas recipients. Higher Amylase1, Liplase1, Amylasemax, and Lipasemax were associated with an increase in early complications, mainly need for pancreatectomy, fluid collections, bleeding complications, or graft thrombosis, particularly in the solitary pancreas group.

Conclusions

Our finding suggests that cases of early perioperative enzyme increase merit consideration for early imaging investigation to mitigate detrimental outcomes.
Postoperative Poor Oral Intake After Distal Pancreatectomy
Authors: Park Hyeong Min , Park Sang-Jae , Kang Mee Joo , Han Sung-Sik , Kim Sun-Whe
Published: April 2023

Objectives

Poor oral intake (POI) without an identifiable cause is frequently observed after distal pancreatectomy (DP). This study was designed to investigate the incidence and risk factors of POI after DP, and its impact on the length of hospital stay.

Methods

The prospectively collected data of patients who received DP were retrospectively reviewed. A diet protocol after DP was followed, and POI after DP was defined as the oral intake being less than 50% of the daily requirement and parenteral calorie supply being required on postoperative day 7.

Results

Of the 157 patients, 21.7% (34) experienced POI after DP. The multivariate analysis revealed that the remnant pancreatic margin (head; hazard ratio, 7.837; 95% confidence interval, 2.111–29.087; P = 0.002) and postoperative hyperglycemia >200 mg/dL (hazard ratio, 5.643; 95% confidence interval, 1.482–21.494; P = 0.011) were independent risk factors for POI after DP. The length of hospital stay (median [range]) of the POI group was significantly longer than that of the normal diet group (17 [9–44] vs 10 [5–44] days; P < 0.001).

Conclusions

Patients undergoing pancreatic resection at pancreatic head portion should follow a postoperative diet, and postoperative glucose levels should be strictly regulated.
Regional Growth Velocity and Incidence of Pancreatic Neuroendocrine Neoplasias in Multiple Endocrine Neoplasia Type 1
Authors: Kann Peter Herbert , Scheunemann Adrian , Adelmeyer Jan , Bergmann Simona , Goebel Joachim Nils , Bartsch Detlef K. , Holzer Katharina , Albers Max B. , Manoharan Jerena , Scheunemann Lisann M.
Published: April 2023

Objectives

Pancreatic neuroendocrine neoplasias (pNENs) in multiple endocrine neoplasia type 1 are predominantly found in the dorsal anlage. Whether their growth velocity and incidence might be related to their location in the pancreas has not been investigated yet.

Methods

We studied 117 patients using endoscopic ultrasound.

Results

Growth velocity could be calculated for 389 pNENs. Increase of largest tumor diameter (% per month) was 0.67 (standard deviation [SD], 2.04) in the pancreatic tail (n = 138), 1.12 (SD, 3.00) in the pancreatic body (n = 100), 0.58 (SD, 1.19) in the pancreatic head/uncinate process—dorsal anlage (n = 130), and 0.68 (SD, 0.77) in the pancreatic head/uncinate process—ventral anlage (n = 12). Comparing growth velocity of all pNENs in the dorsal (n = 368, 0.76 [SD, 2.13]) versus ventral anlage, no significant difference was detected. Annual tumor incidence rate was 0.21 in the pancreatic tail, 0.13 in the pancreatic body, 0.17 in the pancreatic head/uncinate process—dorsal anlage, 0.51 dorsal anlage together, and 0.02 in the pancreatic head/uncinate process—ventral anlage.

Conclusions

Multiple endocrine neoplasia type 1 pNENs are unequally distributed between ventral (low prevalence and incidence) and dorsal anlage. However, there are no regional differences in growth behavior.
KRAS Mutation Testing on Endoscopic Ultrasound-Guided Fine-Needle Aspiration Samples Improves the Diagnostic Accuracy of Pancreatic Cancer
Authors: Yeung Maximus C.F. , Shek Tony W.H.
Published: April 2023

Objectives

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology was one of the investigations for pancreatic masses. While the specificity approached 100%, its sensitivity remained low because of high rate of indeterminate and false-negative results. Meanwhile, KRAS gene was frequently mutated in up to 90% of pancreatic ductal adenocarcinoma and its precursor lesions. This study aimed to determine whether KRAS mutation analysis could improve the diagnostic sensitivity in EUS-FNA samples for pancreatic adenocarcinoma.

Methods

The EUS-FNA samples from patients with a pancreatic mass obtained between January 2016 and December 2017 were reviewed retrospectively. The cytology results were classified as malignant, suspicious for malignancy, atypical, negative for malignancy, and nondiagnostic. KRAS mutation testing was performed using polymerase chain reaction followed by Sanger sequencing.

Results

A total of 126 EUS-FNA specimens were reviewed. The overall sensitivity and specificity by cytology alone were 29% and 100%, respectively. When KRAS mutation testing was performed in cases with indeterminate and negative cytology, the sensitivity increased to 74.2%, and the specificity remained at 100%.

Conclusions

KRAS mutation analysis, especially when performed in cytologically indeterminate cases, improves the diagnostic accuracy for pancreatic ductal adenocarcinoma. This may reduce the need to repeat invasive EUS-FNA for diagnosis.
The Impact of Preexisting Psychiatric Disorders on Outcomes After Pancreatic Cancer Surgery
Authors: Perry Lauren M. , Kleber Kara T. , Rajasekar Ganesh , Nuño Miriam , Bold Richard J.
Published: April 2023

Objectives

Comorbid psychiatric illness has been associated with worse outcomes after some major surgical procedures. We hypothesized that patients with preexisting mood disorders would have worse postoperative and oncologic outcomes after pancreatic cancer resection.

Methods

This retrospective cohort study analyzed Surveillance, Epidemiology, and End Results patients with resectable pancreatic adenocarcinoma. A preexisting mood disorder was classified if a patient was diagnosed and/or treated with medication approved for depression/anxiety within 6 months before surgery.

Results

Of 1305 patients, 16% had a preexisting mood disorder. Mood disorders had no impact on hospital length of stay (12.9 vs 13.2 days, P = 0.75), 30-day complications (26% vs 22%, P = 0.31), 30-day readmissions (26% vs 21%, P = 0.1), or mortality (30 days: 3% vs 4%, P = 0.35); only an increased 90-day readmissions rate (42% vs 31%, P = 0.001) was observed. No effect on adjuvant chemotherapy receipt (62.5% vs 69.2%, P = 0.06) or survival (24 months, 43% vs 39%, P = 0.44) was observed.

Conclusions

Preexisting mood disorders influenced 90-day readmissions after pancreatic resection, but not other postoperative or oncologic outcomes. These findings suggest that affected patients should be expected to have outcomes similar to patients without mood disorders.
A Retrospective Real-World Evidence Evaluation of the Characteristics of Exocrine Pancreatic Insufficiency in Patients With Chronic Pancreatitis and Type 2 Diabetes Treated With Pancrelipase in the United States
Authors: Rosenberg Jonathan , Reddy Manchikanti Nagarjuna , Seelam Prafulla , Li Olivia , Twal Janine , Pack Jennifer
Published: April 2023

Objectives

This retrospective real-world data analysis assessed clinical/health care professional characteristics of gastrointestinal symptom profiles in pancrelipase-treated patients with exocrine pancreatic insufficiency symptoms and chronic pancreatitis (CP) or type 2 diabetes (T2D).

Methods

Data were from the Decision Resources Group Real-World Evidence Data Repository US database. Patients 18 years and older receiving pancrelipase (Zenpep) between index dates August 2015 and June 2020 were included. Gastrointestinal symptoms were assessed 6, 12, and 18 months post-index versus baseline.

Results

A total of 10,656 pancrelipase-treated patients with CP (n = 3215) or T2D (n = 7441) were identified. Significant/sustained reductions in gastrointestinal symptoms were observed in both cohorts after pancrelipase treatment (P < 0.001) versus baseline. Significantly fewer patients with CP compliant with treatment for more than 270 days (n = 1553) reported abdominal pain (P < 0.001) and nausea/vomiting (P < 0.05) versus those compliant for less than 90 days (n = 1115). Significantly fewer patients with T2D compliant with treatment for more than 270 days (n = 2964) reported abdominal pain (P < 0.001) and diarrhea/steatorrhea (P < 0.05) versus those compliant for less than 90 days (n = 2959).

Conclusions

Pancrelipase reduced exocrine pancreatic insufficiency symptoms in patients with CP or T2D, with greater treatment compliance associated with improved gastrointestinal symptom profiles.
Circ_0058058 Drives the Malignant Phenotypes and Immune Evasion of Pancreatic Cancer by the MicroRNA-557–Dependent Regulation of PDL1
Authors: Lin Lin , Xiao Liang , Jin Chang'e , Qin Ying , Deng Haoyuan , Li Meixiang , Lin Huan , Gong Xuehao
Published: April 2023

Objectives

Pancreatic cancer (PC) is one of the most deadly malignancies in the world. Recently, circular RNAs play crucial roles in PC progression. However, the functions of circ_0058058 in PC are barely known.

Methods

The expression of circ_0058058, microRNA-557-5p (miR-557), and programmed cell death receptor ligand 1 (PDL1) was detected by quantitative real-time polymerase chain reaction. Functional experiments were implemented to disclose the effect of circ_0058058 deficiency on PC cell proliferation, apoptosis, invasion, angiogenesis, and immune escape. The binding relationship between miR-557 and circ_0058058 or PDL1 was identified by dual-luciferase reporter assay and RNA immunoprecipitation assay. In vivo assay was used to disclose the impact of circ_0058058 silencing on tumor formation in vivo.

Results

Circ_0058058 was highly expressed in PC tissues and cell lines. Knockdown of circ_0058058 repressed cell proliferation, invasion, angiogenesis, and immune escape while contributed to apoptosis in PC cells. Mechanically, circ_0058058 worked as a molecular sponge of miR-557 to regulate PDL1 expression. Moreover, circ_0058058 showed a promotional effect on tumor growth in vivo.

Conclusions

Our findings suggested that circ_0058058 served as miR-557 sponge to upregulate PDL1, thereby triggering PC proliferation, invasion, angiogenesis, and immune escape.
Outbreak of leptospirosis amidst COVID’19 in Tanzania: a new threat? Short communication
Authors: Shaikh Omer A. , Azam Umama , Naseem Muhammad U. , Ochani Sidhant , Hasibuzzaman Md. Al , Ullah Kaleem
Published: April 2023

As the world is still fighting to combat the coronavirus disease 2019 (COVID-19) virus, the United Republic of Tanzania has been confronting yet another bacterial infection called leptospirosis (LS). It is caused by the spirochete bacteria of genus Leptospira, and has been known to infect several people, already claiming a number of lives. It infects 1 million people annually with ~60 000 deaths having a fatality rate of 6.85% worldwide. COVID has profusely burdened the healthcare system worldwide within the past 2 years; it has sabotaged medical management and brought down resources, which has now made it difficult for any country to withstand another pandemic. LS has overburdened the medical care system of Tanzania abjectly; it is now imperative not to overlook environmental factors, like a flood, the presence of rodents, unsatisfactory socioeconomic conditions in areas where dogs reside, substandard wastewater and garbage disposal facilities, or any other factor which might lead to further spread of LS and put Tanzania in jeopardy.
Contemporary Tools for Leadership Growth
Authors: Ferren Melora D.
Published: April 2023

The complex and ever-changing healthcare environment can leave leaders scrambling to find the right tools in their toolbox to lead, and previous tools may no longer be working. In this column, nurse leadership expert Dr Rose Sherman, EdD, RN, NEA-BC, FAAN, shares the best tools that contemporary leaders can learn to use to excel in leading others.
Exploration of Lived Experiences and Measurement of Burnout Among US Clinical Research Nurses
Authors: Johnson Elizabeth , Rainbow Jessica
Published: April 2023

OBJECTIVE

The aims of this study were to explore the experiences of US clinical research nurses supporting the conduct of clinical trials before and during the COVID-19 pandemic and assess dimensions of burnout among these nurses using the Maslach Burnout Inventory-Human Services Survey.

BACKGROUND

Clinical research nurses are a subspecialty of nursing that supports clinical trial conduct. Postpandemic clinical research nurse well-being, including indicators of burnout, has not been established.

METHODS

A cross-sectional descriptive study via online survey was conducted.

RESULTS

A sample of US clinical research nurses scored overall high for the Maslach category of Emotional Exhaustion, moderate for Depersonalization, and moderate for Personal Achievement. Themes included together or apart, rewarding but challenging, and surviving or thriving.

CONCLUSION

Supportive measures such as workplace appreciation and consistent change communication may benefit clinical research nurse well-being and reduce burnout during times of unpredicted crisis and beyond.
The State of Rest Break Practices Among 12-Hour Shift Hospital Nurses in the United States
Authors: Sagherian Knar , Cho Hyeonmi , Steege Linsey M.
Published: April 2023

OBJECTIVE

This cross-sectional study aimed to explore the characteristics, content, and context of rest breaks taken by hospital nurses.

BACKGROUND

Nurses often miss, skip, or take interrupted breaks. To improve the quality of breaks and promote within-shift recovery, it is important to understand current rest break practices including break activities and contextual challenges around them.

METHODS

Survey data from 806 nurses were collected between October and November 2021.

RESULTS

Most nurses did not take regular breaks. Rest breaks were often interrupted, spent being worried about work, and rarely resulted in a relaxed state. Common break activities were having a meal or a snack, and browsing the Internet. Regardless of workload, nurses considered patient acuity, staffing, and unfinished nursing tasks when deciding to take breaks.

CONCLUSION

Rest break practices are of poor quality. Nurses mainly consider workload-related factors when taking breaks, which warrants the attention of nursing administration.
The Impact of a Nursing-Led Intervention Bundle With a Bedside Checklist to Reduce Mortality During the Initial COVID-19 Pandemic and Implications for Future Emergencies
Authors: Pugh Suzanne , Chan Florinda , Han Sarah , Lindo Rosalie , Krzewski Dina Giatis , D'Orazi Mary Ann , Narayanajaya Derrik , Gao Ziqi , Norful Allison A.
Published: April 2023

OBJECTIVE

The study objective was to examine the effectiveness of a bedside checklist enforcing nursing-led interventions in hospitalized COVID-19 patients early in the pandemic.

BACKGROUND

The absence of treatment guidelines for COVID-19 presented challenges to reducing mortality rates early in the pandemic. A bedside checklist and a bundle of nursing-led interventions named “Nursing Back to Basics (NB2B)” were assembled for patient care after a scoping review of evidence.

METHODS

A retrospective analysis was conducted to investigate the impact of the evidence-based interventions randomly implemented based on patient bed assignment. Electronic data (patient demographics, bed assignment and ICU transfers, length of stay, and patient discharge disposition) were extracted and calculated using descriptive statistics, t tests, and linear regression.

RESULTS

Patients receiving the NB2B intervention enforced with a bedside checklist had significantly lower mortality rates (12.3%) compared with those receiving standard nursing care (26.9%).

CONCLUSIONS

Bedside checklists enforcing evidence-based nursing-led interventions may be beneficial as a 1st-line public health emergency response.