bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multicenter Retrospective Study of Gemcitabine Plus Nab-Paclitaxel for Elderly Patients With Advanced Pancreatic Cancer
Authors: Kobayashi Satoshi , Ueno Makoto , Ikeda Masafumi , Ozaka Masato , Sano Yusuke , Hirotani Akane , Tozuka Yuichiro , Fukushima Taito , Tezuka Shun , Moriya Satoshi , Umemoto Kumiko , Watanabe Kazuo , Sasaki Mitsuhito , Hashimoto Yusuke , Imaoka Hiroshi , Ohno Izumi , Mitsunaga Shuichi , Yamada Ikuhiro , Sasaki Takashi , Sasahira Naoki , Morimoto Manabu 
Published: February 2020

Objectives
This study aimed to assess the lesser known therapeutic benefit, particularly safety and effectiveness of gemcitabine plus nab-paclitaxel (GnP) treatment in elderly patients with advanced pancreatic cancer.

Methods
We retrospectively enrolled advanced pancreatic cancer patients aged ≥75 years who received GnP as first-line treatment between December 2014 and December 2016. We assessed survival, adverse events, and early treatment discontinuation.

Results
The cohort comprised 116 patients (median age, 77 [range, 75–84] years). The overall survival and progression-free survival were 21.8 and 12.1 months in patients with locally advanced cancer and 13.3 and 5.9 months, in patients with metastasis, respectively. The response and disease control rates were 31% and 81%, respectively. Within the first 2 months of treatment, grade 4 hematological and grade 3–4 nonhematological toxicities occurred in 10 and 23 patients, respectively. Early discontinuation due to adverse events occurred in 12 patients; the associated risk factors were age ≥80 years (odds ratio, 9.43) and serum albumin level <3.5 g/dL (odds ratio, 5.12).

Conclusions
In selected patients aged ≥75 years, GnP showed acceptable toxicities and effectiveness. However, patients aged ≥80 years and those with serum albumin levels <3.5 g/dL should be carefully assessed for treatment eligibility.
The Influence of Patients' Age on the Outcome of Treatment for Pancreatic Ductal Adenocarcinoma
Authors: Malik Abdullah K. , Lamarca Angela , Siriwardena Ajith Kumar , O'Reilly Derek , Deshpande Rahul , Satyadas Thomas , Jamdar Saurabh , Sheen Aali , McNamara Mairead , Hubner Richard , Valle Juan , De Liguori Carino Nicola 
Published: February 2020

Objective
The aim of the study was to determine the impact of age on curative management and outcomes of patients with pancreatic ductal adenocarcinoma.

Methods
Patients who underwent resection for pancreatic ductal adenocarcinoma at 2 units were retrospectively reviewed (between 2005 and 2017) and stratified by age (older patients ≥70 years). Regression analysis was used to explore factors impacting administration of adjuvant chemotherapy and survival. The Kaplan-Meier method was used to estimate overall survival (time from surgery to death). Statistical significance was set at P < 0.05.

Results
From 2005 to 2014, 222 patients were identified (<70 years, n = 128; ≥70 years, n = 94). Elderly patients were less likely to receive adjuvant chemotherapy compared with younger patients (odds ratio, 0.57, P = 0.041). Tumor stage, margin, and year of surgery (post-2011 vs pre-2011) were not predictors for chemotherapy receipt (P > 0.05). Frailty was the commonest reason (36.8%) to decline chemotherapy in elderly patients. In patients receiving adjuvant chemotherapy, completion rates (P = 0.32) and overall survival (24 months vs 30 months, P = 0.50) were no different.

Conclusions
Elderly patients demonstrate similar outcomes to younger yet are less likely to commence chemotherapy because of frailty. Holistic preoperative assessment may improve selection for curative treatment.
Eupatilin Ameliorates Cerulein-Induced Pancreatitis Via Inhibition of the Protein Kinase D1 Signaling Pathway In Vitro
Authors: Park Won Suk , Paik Kyuhyun , Yang Keum Jin , Kim Jong Ok 
Published: February 2020

Objective
The aim of this study was to investigate the effects of eupatilin on protein kinase D1 (PKD1) and nuclear factor kappa B (NF-κB) signaling pathways in cerulein-induced in vitro pancreatitis.

Methods
We used collagenase digestion to isolate pancreatic acinar cells from male C57BL/6 mice. In vitro acute pancreatitis was induced by treatment with a supramaximal dose of cerulein. Eupatilin was pretreated before stimulation with cerulein.

Results
Eupatilin significantly reduced cerulein-induced amylase release in pancreatic acini. Eupatilin treatment downregulated cerulein-induced expression of interleukin (IL)-1β, IL-6, and CC chemokine ligands 2 and 5, but it upregulated expression of IL-4 and IL-10. We demonstrated that eupatilin pretreatment attenuated cerulein-induced necrosis in isolated pancreatic acinar cells. This effect of eupatilin was confirmed by lactic dehydrogenase assay, fluorescence-activated cell sorting analysis, and cytopathologic analysis. Eupatilin inhibited cerulein-induced activation of PKD1/NF-κB and the nuclear translocation of NF-κB.

Conclusions
Our data demonstrated that eupatilin is a potential therapeutic candidate for the treatment of pancreatitis through its ability to reduce cellular necrosis and inflammatory responses by inhibition of the PKD1/NF-κB signaling pathway.
Using Point-of-Care Ultrasound to Characterize Acute Inguinal Swelling of Young Children in the Pediatric Emergency Department
Authors: Friedman Nir , Lee Michelle S. , Mclean Lianne , Tessaro Mark O. 
Published: February 2020

Abstract
Acute inguinal swelling in young children is frequently assumed to be an inguinal hernia, often prompting a bedside reduction attempt. We report 3 cases of inguinal swelling where the use of point-of-care ultrasound changed the patients' management by identifying an alternate diagnosis, thus avoiding unnecessary and painful procedures as well as their associated sedation risks.
Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes
Authors: Lockhart Elizabeth , Turner DeAnne , Martinez-Tyson Dinorah , Baldwin Julie A. , Marhefka Stephanie L. 
Published: February 2020

Context:
The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)—virtual health care networks—to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team.

Objective:
To understand the perceptions of MHH administrators regarding CHW engagement in MHHs, as well as the facilitators and barriers to adoption in MHHs that are unknown.

Design, Setting, and Participants:
Semistructured qualitative interviews (n = 18) were conducted with MHH administrators throughout New York State guided by the Diffusion of Innovations (DOI) framework. Qualitative thematic analysis was used to explore the domains and themes.

Results:
Most MHH administrators believed that CHWs fit within MHHs. The DOI constructs of compatibility and complexity and the Consolidated Framework for Implementation Research construct of external policies helped explain CHW integration. CHWs were compatible with MHHs by enrolling patients, helping coordinate patient care, and providing social support. The complexities of CHW integration into MHHs included barriers to CHW integration, no direct reimbursement for their services, lack of clarity for CHW roles and responsibilities, and no explicit external policy for their use in MHHs.

Conclusions:
CHWs can, and have, been integrated into the relatively novel Health Home system. While some barriers have prevented their integration into all MHHs, lessons learned could provide guidance for CHW integration into other health care systems in the United States.
Measuring retention in HIV care: the impact of data sources and definitions using routine data
Authors: Phillips Tamsin K. , Orrell Catherine , Brittain Kirsty , Zerbe Allison , Abrams Elaine J. , Myer Landon 
Published: February 2020

Objectives:
Measuring retention is critical for antiretroviral therapy (ART) management and program monitoring; however, many definitions and data sources, usually from single health facilities, are used. We used routine electronic data, linked across facilities, to examine the impact of definitions and data sources on retention estimates among women in Cape Town, South Africa.

Design:
Retrospective cohort study.

Methods:
We compiled routine electronic laboratory, pharmacy and clinic visit data for 617 women who started ART during pregnancy (2013–2014) and estimated 24-month retention using different definitions and data sources. We used logistic regression to assess consistency of associations between risk factors and retention, and receiver operating characteristics analyses to describe how different retention estimates predict viremia at 12 months on ART.

Results:
Using all available data sources, retention ranged from 41% (no gap >180 days) to 72% (100% 12-month visit constancy). Laboratory data (expected infrequently) underestimated retention compared with clinic visit data that identified more than 80% of women considered retained in all definitions. In all estimates, associations with known risk factors for nonretention remained consistent and retention declined over time: 77, 65 and 58% retained using all data sources in months 6–12, 12–18 and 18–24, respectively (P < 0.001). The 180-day gap definition was most strongly associated with viremia (odds ratio 24.3 95% confidence interval 12.0–48.9, all data sources).

Conclusion:
Researchers must carefully consider the most appropriate retention definition and data source depending on available data. Presenting more than one approach may be warranted to obtain estimates that are context-appropriate and comparable across settings.
Ventilator-associated pneumonia: new principles guiding empiric antibiotic therapy
Authors: Dominedò Cristina , Ceccato Adrian , Torres Antoni 
Published: February 2020

Purpose of review
Ventilator-associated pneumonia (VAP) is a serious event in critically ill patients. We aim to review the most recent evidences about VAP, including its cause, the main differences between the American and European guidelines in the definition of risk factors for multidrug-resistant pathogens, the main principles guiding empirical antibiotic treatment, and the potential role of molecular diagnostic tests.

Recent findings
The 2016 ATS/IDSA and the 2017 ERS/ESICM/ESCMID/ALAT guidelines provide different approaches for the management of VAP. Both guidelines highlight the need to use local epidemiological data for antibiotic choice; however, they identify different risk factors that can assist with decision making when local data are not available. Nevertheless, validation studies of the American guidelines suggest that empiric antibiotic therapy based on risk factors may lead to an overuse of broad-spectrum antibiotics. Rapid diagnostic tests may allow a faster identification of VAP cause, resulting in more adequate antimicrobial therapy and reduced exposition to broad-spectrum antibiotics.

Summary
Clinical studies should be conducted to evaluate the benefits of implementing guidelines and new approaches such as combinations of clinical data with rapid diagnostic tests; meantime adaptations of guidelines to local settings should be carried out by a local multidisciplinary expert team.
Reducing Opioid Prescribing After Ambulatory Plastic Surgery With an Opioid-Restrictive Pain Protocol
Authors: Johnson Shepard P. , Wormer Blair A. , Silvestrini Rachel , Perdikis Galen , Drolet Brian C. 
Published: February 2020

Background
Opioids are often prescribed in excess, or unnecessarily, after ambulatory surgery. Perioperative opioid stewardships should be a priority with an emphasis on multimodal pain control.

Methods
In this prospective cohort study, prescribing patterns after implementation of an opioid-restrictive pain protocol, Plastic Surgery Initiative to provide Controlled Analgesia and Safe Surgical Outcomes (PICASSO), were compared with historical controls in an academic plastic surgery department. The protocol was initiated on July 1, 2018, and applied to all adult patients undergoing outpatient plastic surgery. Plastic Surgery Initiative to provide Controlled Analgesia and Safe Surgical Outcomes provides an algorithm for analgesic prescribing based on type of surgery and patient factors. A hospital-based pharmaceutical database was used to identify prescriptions, and univariate analyses were used to compare cohorts.

Results
The preprotocol and postprotocol cohorts consisted of 539 and 632 patients, respectively. There was no difference in age (48.2 years vs 48.3 years) or sex (72.2% vs 67.8% female). The proportion of patients filling opioid prescriptions went down from 95% to 76% after PICASSO. The total oral morphine equivalent per opioid prescription (217.5 ± 109.5 vs 87.2 ± 43.4) was significantly less in the PICASSO cohort. Additionally, the proportion of patients receiving nonopioid prescriptions, acetaminophen (60.7% vs 86.9%), ibuprofen (8.7% vs 74.2%), and gabapentin (23.6% vs 57.9%), increased significantly. Opioid refill rates were not increased after implementation (9.1% vs 7.3%, P = 0.35).

Conclusions
The PICASSO pain protocol resulted in a 20% decrease in opioid prescriptions and a 2.5-fold decrease in the oral morphine equivalent per prescription, equivalent to eighteen 5-mg oxycodone pills. This opioid-restrictive protocol can improve the analgesic prescribing culture in a plastic surgery department.
Microsurgical Breast Reconstruction in the Obese Patient Using Abdominal Flaps
Authors: Boczar Daniel , Huayllani Maria T. , Forte Antonio J. , Rinker Brian 
Published: February 2020

Background
The obesity epidemic has led to larger numbers of obese patients seeking breast reconstruction. The aim of this study was to compare complication rates and patient satisfaction between obese and nonobese women undergoing autologous breast reconstruction using abdominal free flaps.

Methods
The records of all patients who underwent microsurgical breast reconstruction by one surgeon for 15 years were reviewed. Patients were divided into obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese groups. Demographic data, medical and smoking history, cancer type and treatments, surgical details, and complications were recorded. Breast-Q surveys were mailed to all patients, and satisfaction ratings were compared between obese and nonobese patients.

Results
There were 109 patients and 149 breast reconstructions, with a mean age of 49 years. Follow-up ranged from 6 to 112 months (median = 19 months). There were 59 patients in the obese group and 52 in the nonobese group. The 2 groups did not differ significantly in median age, follow-up, pathology type, presence of chemotherapy or radiation, or smoking history. Obese group had a higher incidence of mastectomy flap necrosis (19.3% vs 7.7%, P < 0.01) and a higher rate of unplanned reoperations (38.6% vs 21.1%, P < 0.01). Obesity was not associated with a higher risk of microsurgical complications or flap loss (7.0% vs 3.8%, P = 0.21). Overall wound complications did not differ between the groups, but the obese group had a higher rate of severe wound complications requiring operative intervention (15.8% vs 3.8%, P < 0.01). The obese group had a higher incidence of hernia or bulge (10.5% vs 0%, P = 0.03). Thirty-three patients returned completed surveys (response rate of 30%). There was no statistically significant difference in any Breast-Q category associated with BMI.

Conclusions
Obesity was associated with higher rates of wound complications, reoperation, and abdominal bulge after microsurgical breast reconstruction. However, patient satisfaction remained high. Patients should be counseled regarding their relative risks, but high BMI should not be considered an absolute contraindication for microsurgical breast reconstruction.
Experience With LDLT in Patients With Hepatocellular Carcinoma and Portal Vein Tumor Thrombosis Postdownstaging
Authors: Soin Arvinder S. , Bhangui Prashant , Kataria Tejinder , Baijal Sanjay S. , Piplani Tarun , Gautam Dheeraj , Choudhary Narendra S. , Thiagarajan Srinivasan , Rastogi Amit , Saraf Neeraj , Saigal Sanjiv 
Published: February 2020

Background.
Median survival in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) is 2–6 months; conventionally liver transplantation is contraindicated.

Methods.
We studied outcomes following living donor liver transplantation (LDLT) post-PVTT downstaging (DS) with stereotactic body radiotherapy (SBRT), and tumor ablation (with transarterial chemo- or radio-embolization).

Results.
Of 2348 consecutive LDLTs, 451 were for HCC, including 25 with PVTT (mainly Vp1-3) after successful DS and 20 with Vp1/2 PVTT without previous treatment. DS was attempted in 43, was successful in 27 (63%), and 25 underwent LDLT. Median alpha fetoprotein (AFP) at diagnosis and pre-LDLT were 78.1 ng/mL (3-58 200) and 55 ng/mL (2-7320), respectively. Mean DS to LDLT time was 10.2 weeks (5–16). Excluding 2 postoperative deaths, 1- and 5-year overall survival (OS) and recurrence-free survival (RFS) were 82%, 57%, and 77%, 51%, respectively, comparable to survival in 382 HCC patients without PVTT undergoing upfront LDLT (5-y OS 65%, P = 0.06; RFS 66%, P = 0.33, respectively). There was a trend toward better OS in DS+LDLT versus non-DS LDLT group (5-y OS/RFS—48%/40%). OS was significantly better than in HCC-PVTT patients receiving no intervention or palliative Sorafenib alone (1-y OS of 0%) or Sorafenib with TARE/SBRT (2-y OS of 17%) at our center during the study period. Initial AFP <400 ng/mL and AFP fall (initial minus pre-LDLT) >2000 ng/mL predicted better RFS; Grade III/IV predicted worse OS in DS patients.

Conclusions.
HCC patients with PVTT can achieve acceptable survival with LDLT after successful DS. Low initial AFP level, a significant drop in AFP with DS and low tumor grade, favorably influence survival in these patients.
Consequences of single-locus and tightly linked genomic architectures for evolutionary responses to environmental change
Authors: Oomen Rebekah A. , Kuparinen Anna , Hutchings Jeffrey A. 
Published: February 2020

AbstractGenetic and genomic architectures of traits under selection are key factors influencing evolutionary responses. Yet, knowledge of their impacts has been limited by a widespread assumption that most traits are controlled by unlinked polygenic architectures. Recent advances in genome sequencing and eco-evolutionary modelling are unlocking the potential for integrating genomic information into predictions of population responses to environmental change. Using eco-evolutionary simulations, we demonstrate that hypothetical single-locus control of a life history trait produces highly variable and unpredictable harvesting-induced evolution relative to the classically applied multi-locus model. Single-locus control of complex traits is thought to be uncommon, yet blocks of linked genes, such as those associated with some types of structural genomic variation, have emerged as taxonomically widespread phenomena. Inheritance of linked architectures resembles that of single loci, thus enabling single-locus-like modeling of polygenic adaptation. Yet, the number of loci, their effect sizes, and the degree of linkage among them all occur along a continuum. We review how linked architectures are often associated, directly or indirectly, with traits expected to be under selection from anthropogenic stressors and are likely to play a large role in adaptation to environmental disturbance. We suggest using single-locus models to explore evolutionary extremes and uncertainties when the trait architecture is unknown, refining parameters as genomic information becomes available, and explicitly incorporating linkage among loci when possible. By overestimating the complexity (e.g., number of independent loci) of the genomic architecture of traits under selection, we risk underestimating the complexity (e.g., nonlinearity) of their evolutionary dynamics.
Evidence and characteristics of human-to-human transmission of SARS-CoV-2
Authors: Kang Min , Wu Jie , Ma Wenjun , He Jianfeng , Lu Jing , Liu Tao , Li Baisheng , Mei Shujiang , Ruan Feng , Lin Lifeng , Zou Lirong , Ke Changwen , Zhong Haojie , Zhang Yingtao , Chen Xuguang , Liu Zhe , Zhu Qi , Xiao Jianpeng , Yu Jianxiang , Hu Jianxiong , Zeng Weilin , Li Xing , Liao Yuhuang , Tang Xiujuan , Xiao Songjian , Wang Ying , Song Yingchao , Zhuang Xue , Liang Lijun , Zeng Siqing , He Guanhao , Lin Peng , Deng Huihong , Song Tie 
Published: February 2020

AbstractBackgroundOn December 31, 2019, an outbreak of COVID-19 in humans was reported in Wuhan, and then spread fast to other provinces, China. We analyzed data from field investigations and genetic sequencing to describe the evidence and characteristics of human-to-human transmission in Guangdong Province.MethodsA confirmed COVID-19 case was defined if a suspected case was verified with positive of SARS-CoV-2 in throat swabs, nasal swabs, bronchoalveolar lavage fluid (BALF), or endotracheal aspirates by real-time reverse transcriptase polymerase chain reaction assay (RT-PCR) or genetic sequencing. Field investigations were conducted for each confirmed case. Clinical and demographic data of confirmed cases were collected from medical records. Exposure and travel history were obtained by interview.ResultsA total of 1,151 confirmed cases were identified as of February 10, 2020 in Guangdong Province, China. Of them, 697 (60.1%) cases were from 234 cluster infections. Two hundred and fourteen (18.6%) were secondary cases, in which 144 cases were from family cluster infections. With the epidemic continuing, although familial cluster events were dominated, community cluster events increased with a nosocomial event. The whole genomes within the same family cluster infections were identical, and presented a few unique single nucleotide variants (SNVs) compared with SARS-CoV-2 identified on December 2019 in Wuhan.ConclusionsWe observed evident human-to-human transmissions of SARS-CoV-2 in Guangdong, China. Although most of them were from family cluster infections, community and nosocomial infections were increasing. Our findings indicate that human-to-human transmission risks are transferring from family to community in Guangdong Province.