bluuebunny/crossref_metadata_2025_split huggingface dataset:
Precision Medicine in Pancreatic Disease—Knowledge Gaps and Research Opportunities
Authors: Lowe Mark E. , Andersen Dana K. , Caprioli Richard M. , Choudhary Jyoti , Cruz-Monserrate Zobeida , Dasyam Anil K. , Forsmark Christopher E. , Gorelick Fred S. , Gray Joe W. , Haupt Mark , Kelly Kimberly A. , Olive Kenneth P. , Plevritis Sylvia K. , Rappaport Noa , Roth Holger R. , Steen Hanno , Swamidass S. Joshua , Tirkes Temel , Uc Aliye , Veselkov Kirill , Whitcomb David C. , Habtezion Aida 
Published: November 2019

Abstract
A workshop on research gaps and opportunities for Precision Medicine in Pancreatic Disease was sponsored by the National Institute of Diabetes and Digestive Kidney Diseases on July 24, 2019, in Pittsburgh. The workshop included an overview lecture on precision medicine in cancer and 4 sessions: (1) general considerations for the application of bioinformatics and artificial intelligence; (2) omics, the combination of risk factors and biomarkers; (3) precision imaging; and (4) gaps, barriers, and needs to move from precision to personalized medicine for pancreatic disease. Current precision medicine approaches and tools were reviewed, and participants identified knowledge gaps and research needs that hinder bringing precision medicine to pancreatic diseases. Most critical were (a) multicenter efforts to collect large-scale patient data sets from multiple data streams in the context of environmental and social factors; (b) new information systems that can collect, annotate, and quantify data to inform disease mechanisms; (c) novel prospective clinical trial designs to test and improve therapies; and (d) a framework for measuring and assessing the value of proposed approaches to the health care system. With these advances, precision medicine can identify patients early in the course of their pancreatic disease and prevent progression to chronic or fatal illness.
FGD4 (Frabin) Overexpression in Pancreatic Neuroendocrine Neoplasms
Authors: Shahid Mohammad , George Tarra B. , Saller James , Haija Mohammad , Sayegh Zena , Boulware David , Strosberg Jonathan , Chakrabarti Ratna , Coppola Domenico 
Published: November 2019

Objective
The pathogenesis of pancreatic neuroendocrine tumors (PNETs) is still unclear. We propose Frabin as a new molecular alteration in PNETs. Frabin is a guanine nucleotide exchange factor playing a role in mediating actin cytoskeleton changes during cell migration, morphogenesis, polarization, and division.

Methods
Patients with PNETs of different grades were assessed for Frabin expression using immunohistochemistry and tissue microarray. The tissue microarray included 12 grade 1 and 3 grade 2 PNETs and 14 grade 3 pancreatic neuroendocrine carcinomas (PECAs). Frabin immunostain was scored with Allred system. Statistical analysis used SAS and R software. Immunohistochemistry scores were correlated with tumor grade and stage. The Spearman correlation coefficient was calculated with P values.

Results
Pancreatic neuroendocrine tumors were graded according to the World Health Organization 2017 guidelines. Frabin was expressed by 24 (82.7%) of the PNET/PECA studied. Only 5 (17.2%) of the 29 PNETs/PECA evaluated were Frabin negative. Frabin expression was cytoplasmic in all cases. We found a significant positive correlation (ρ = 0.47) between Frabin immunohistochemistry score and tumor grade (P = 0.01). No correlation was found between Frabin expression and tumor stage (P = 0.91).

Conclusions
We report Frabin overexpression as a novel molecular alteration occurring in PNETs/PECAs.
Severe Acute Pancreatitis in Autopsies Associated With Surgeries and Severe Inflammatory Diseases
Authors: Matsuda Yoko , Masuda Yoshishige , Shimoji Keigo , Matsukawa Miho , Kinowaki Yuko , Fukumura Yuki , Kikuyama Masataka , Arai Tomio 
Published: November 2019

Objective
We clarified clinicopathological characteristics of acute pancreatitis in terminal patients.

Methods
Pathological changes in the entire pancreas from serial autopsies (N = 183) classified lesions into the following 3 categories: focal neutrophil infiltration, focal necrotizing pancreatitis, and diffuse necrotizing pancreatitis. The former two are possible precursors of diffuse necrotizing pancreatitis. Immunohistochemical staining was performed to analyze pancreatic stellate cells and inflammatory cells.

Results
There were pathologically acute pancreatitis in 45 patients (24.6%), and no patients were diagnosed with it before autopsy. Focal neutrophil infiltration was present in 22 cases, focal necrotizing pancreatitis in 18 cases, and diffuse necrotizing pancreatitis in 5 cases. Severe inflammatory disease and surgery were associated with acute pancreatitis. Sepsis due to viral or bacterial infection was the most common cause of acute pancreatitis. Patients with diffuse necrotizing pancreatitis showed low white blood cell counts, while amylase levels were not increased. Increase in α-smooth muscle actin and nestin-positive stellate cell numbers in acute pancreatitis was correlated to increase in numbers of CD34-positive vascular endothelium, CD68- or CD163-positive macrophages, CD138-positive plasmacytes, CD3-positive T lymphocytes, and myeloperoxidase-positive leucocytes.

Conclusions
Necrotizing pancreatitis without typical clinical signs was frequently detected in autopsy samples. Clinicians must be mindful of necrotizing pancreatitis in terminal patients.
Drug-Induced Acute Pancreatitis in Adults
Authors: Simons-Linares C. Roberto , Elkhouly Mohamed A. , Salazar Miguel J. 
Published: November 2019

Abstract
Drug-induced acute pancreatitis (DIAP) is a rare entity that is often challenging for clinicians. The aim of our study was to provide updated DIAP classes considering the updated definition of acute pancreatitis (AP) and in light of new medications and new case reports. A MEDLINE search (1950–2018) of the English language literature was performed looking for all adult (≥17 years old) human case reports with medication/drug induced as the cause of AP. The included case reports were required to provide the name of the drug, and diagnosis of AP must have been strictly established based on the revised Atlanta Classification criteria. A total of 183 medications were found to be implicated in 577 DIAP cases. A total of 78 cases were excluded because of minimal details or lack of definite diagnosis of AP. Drug-induced AP is rare, and most drugs cause mild DIAP. Only 2 drugs are well described in the literature to explain causation rather than association (azathioprine and didanosine). Larger case-control studies and a formal standardized DIAP reporting system are essential to study the true potential of the DIAP-implicated drugs described in this review.
Performance Characteristics of Magnetic Resonance Imaging in Patients With Pancreas Divisum
Authors: Shah Rushikesh , Mekaroonkamol Parit , Patel Vaishali A. , Raphael Kara , Dacha Sunil , Keilin Steven A. , Cai Qiang , Mittal Pardeep , Willingham Field F. 
Published: November 2019

Objective
This study was designed to assess the diagnostic accuracy of standard nonsecretin-enhanced preprocedural magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) in patients with and without pancreas divisum.

Methods
Patients undergoing MRI/MRCP followed by endoscopic retrograde cholangiopancreatography with between 2009 and 2016 were reviewed. The diagnostic accuracy of the MRI/MRCP was evaluated against the pancreatography. A subsequent independent blinded re-review performed by an expert abdominal radiologist was also evaluated. Multivariate binary logistic regression was performed to assess the impact of clinicopathologic factors on the diagnostic accuracy.

Results
A total of 189 patients were included in analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI/MRCP for pancreas divisum were 63%, 97%, 94%, and 82% initially and 81%, 91%, 91%, and 82% on the expert review. Motion artifact, the presence of pancreatic tumor, and pancreatic necrosis were not found to significantly impact the accuracy. A normal diameter pancreatic duct (P = 0.04) and complete divisum anatomy were correlated with improved accuracy (P = 0.001).

Conclusions
Although expert review, normal duct diameter, and complete divisum are associated with increased sensitivity, pancreas divisum may be uncharacterized by preprocedural MRI in 19% to 37% of patients before the index endoscopic retrograde cholangiopancreatography.
Xenografts Derived From Patients' Ascites Recapitulate the Gemcitabine Resistance Observed in Pancreatic Cancer Patients
Authors: Machinaga Akihito , Hori Yuichi , Shimizu Kazuya , Okahara Kyohei , Yanagita Emmy , Miyoshi Makoto , Itoh Tomoo , Sasai Ken 
Published: November 2019

Objectives
Most patient-derived pancreatic ductal adenocarcinoma (PDAC) xenografts have been established from surgical specimens of patients who have not received chemotherapy. However, xenografts have rarely been established from chemotherapy-resistant, advanced PDACs, because such cases are usually inoperable. The purpose of this study is to establish patient-derived xenografts using PDAC cells refractory to chemotherapy.

Methods
Clinical PDAC cells obtained from ascites of patients who had received continuous chemotherapy were implanted into the flanks of immunocompromised mice. Growth and histological features of the xenografts with and without gemcitabine treatment were then analyzed.

Results
Ascites-derived PDAC cells were successfully expanded through serial xenograft passage without changes in histological appearance. While treatment with gemcitabine substantially inhibited the growth of all PDAC xenografts tested, the tumor volume gradually increased, and the tumors showed marked regrowth even under continued gemcitabine treatment. These findings are consistent with the actual clinical course of the corresponding patients for each xenograft.

Conclusions
Ascites-derived xenograft models represent a valuable experimental system for testing the efficacy of currently available therapeutic compounds on chemotherapy-resistant PDAC cells and for elucidation of the mechanisms underlying chemotherapy resistance.
Inpatient Ordering of Home Hydroxyurea by Residents for Hospitalized Patients With Sickle Cell Disease
Authors: Shaw Rebekah , Kappa Sarah , Nickel Robert S. 
Published: November 2019

Background:Hydroxyurea is a well-established disease-modifying medication for sickle cell disease (SCD). At some institutions, hydroxyurea can only be ordered by “chemotherapy-certified” providers which may not include pediatric resident physicians.Methods:We conducted a survey of 39 American pediatric hospitals regarding their policy on resident hydroxyurea ordering for SCD. Our institution changed its policy in June 2016 to allow residents to order hydroxyurea for hospitalized patients with SCD who were already on hydroxyurea at home. We conducted a retrospective review of the medical records of a random sample of patients with SCD on hydroxyurea admitted the year before and the year after this policy change.Results:In our national survey, 51% of surveyed hospitals allowed residents to order hydroxyurea, 19% required a second signature, and 30% did not allow residents to order hydroxyurea. In our institutional study, patients after the policy change were significantly more likely to have received their home hydroxyurea by hospital day 1: before 62/90 (69%) versus after 105/119 (88%),P=0.0005. The proportion of patients who inappropriately received hydroxyurea was very low in both groups: before 1/91 (1%) versus after 3/126 (2%),P=0.64, with no serious adverse clinical events due to inappropriate hydroxyurea administration.Conclusions:Considerable national variation in practice currently exists in regards to resident hydroxyurea ordering hospital policies. A policy allowing residents to order hydroxyurea significantly increased the likelihood of a patient receiving hydroxyurea while hospitalized with no significant increase in inappropriate hydroxyurea administration. Resident hydroxyurea ordering seems safe and beneficial.
Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion
Authors: Psychogios Klearchos , Kargiotis Odysseas , Safouris Apostolos , Magoufis Georgios , Liakakis Georgios , Stamboulis Eleftherios , Tsivgoulis Georgios 
Published: November 2019

Introduction:
Tenecteplase has recently been studied as an alternative thrombolytic agent in acute stroke, with a possible superior effect in achieving reperfusion of large intracranial vessels.

Case Report:
A 90-year-old female patient was admitted to our stroke unit because of acute onset of dysarthria, left-sided neglect, and hemiparesis. Brain computed tomography (CT) coupled with CT angiography and CT perfusion (postprocessed with the use of RAPID software) demonstrated right proximal middle cerebral artery occlusion with a large penumbra/small ischemic core pattern. The patient was subsequently treated with bolus tenecteplase infusion (0.25 mg/kg). Mechanical thrombectomy was abandoned because the patient has rapidly improved. The patient was discharged to her own home 4 days later with no neurological deficit and functionally independent (modified Rankin scale of 0).

Conclusion:
This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.
Relationship Between Sleep Characteristics and Sudden Unexplained Death Risk in Epilepsy
Authors: Dede Hava Ö. , Bebek Nerses , Oğuz Akarsu Emel , Samanci Bedia , Karbay Merih , Gürses Candan , Baykan-Baykal Betül , Karadeniz Derya , Gökyiğit Ayşen 
Published: November 2019

Background:
Sleep disorders and disturbances are generally underestimated in patients with epilepsy. The aim of this study is to determine the frequency of sleep disturbances and the comorbidity of sleep disorders in people with epilepsy without any complaints about sleep and their relation of sudden unexplained death in epilepsy (SUDEP) risk.

Methods:
Sleep complaints and the presence of sleep disorders were assessed with 4 questionnaires in 139 patients with epilepsy. Subjective sleep features were evaluated with Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire for sleep apnea, and restless legs syndrome with International Restless Legs Syndrome Study Group (IRLSSG) severity scale. The presence of rapid eye movement/nonrapid eye movement parasomnia was asked to the patients and their relatives who share the same house. The patients’ SUDEP-7 scores were also determined and associations with sleep problems were investigated statistically.

Results:
Ninety-two patients with focal and 47 patients with generalized epilepsy were evaluated after their consent. The daily sleep quality was poor in 34 (24.5%) patients with PSQI. Daily sleepiness was present in 7 (5%) patients with ESS. Twenty-five patients (18%) had severe sleep apnea risk with the Berlin Questionnaire. Mild or severe RLS was detected in 24 patients (17.2%). There were no significant differences between focal or generalized epilepsy groups’ scores. No statistically significant relationship was identified between SUDEP-7 scores and sleep quality or sleep-related disorders.

Conclusion:
Our results emphasized a remarkable magnitude of the comorbidity of sleep disorders in patients with epilepsy, even for those who do not have complaints about sleep. As SUDEP cases are frequently seen during sleep, it is important to evaluate sleep in patients with epilepsy.
“I'll Just Pick It Up…”: Women's Acceptability of Self-Sampling Methods for Sexually Transmitted Infection Screening
Authors: Griner Stacey B. , Vamos Cheryl A. , Puccio Joseph A. , Perrin Karen M. , Beckstead Jason W. , Daley Ellen M. 
Published: November 2019

Background
Rates of sexually transmitted infection (STI) screening are suboptimal among college women. Self-sampling methods (SSMs) may improve STI screening rates, but critical gaps remain regarding the influential characteristics of SSM to prioritize in intervention development. The purpose of this study was to explore intervention characteristics influencing the decision to adopt SSM among college women.

Methods
In-depth interviews (n = 24) were conducted with sexually active college women aged 18–24 years to explore preferred intervention characteristics of SSM. Interviews were stratified by screening status (screened or not screened). The instrument was guided by constructs from the Diffusion of Innovation theory and included characteristics of SSM, such as relative advantage, compatibility, complexity, adaptability, and risk and uncertainty.

Results
Overall, women felt that the SSM was not complex and that the instructions were straightforward. Participants discussed their strong preference for receiving their results via text or e-mail rather than via telephone. In addition, women described their concerns about mailing their sample and described their concern about potential contamination and tampering. The most salient advantage to use of SSM was avoiding an interaction with a health care provider.

Conclusions
This study contributes to an understanding of the salient intervention characteristics influencing the use of SSM for STI screening, which can be leveraged to improve the health of students and improve rates of screening. Findings can be used to inform the development of a future innovative, theory-based intervention that promotes the use of SSM to improve STI screening rates, and ultimately decrease the burden of STI-related disease.
Patients Are Willing to Wait for Rapid Sexually Transmitted Infection Results in a University Student Health Clinic
Authors: Gettinger Jesse , Van Wagoner Nicholas , Daniels Brice , Boutwell Alexander , Van Der Pol Barbara 
Published: November 2019

Abstract
We examined the acceptability and feasibility of using a 30-minute chlamydia/gonorrhea test in a student health clinical setting. One hundred eight students were enrolled and 89.4% were willing to wait up to 20 minutes beyond the conclusion of their routine visit. The average amount of time added per clinic visit was less than 11 minutes. Patient and staff satisfaction were high.
Safety and Effectiveness of Same-Day Chlamydia trachomatis and Neisseria gonorrhoeae Screening and Treatment Among Gay, Bisexual, Transgender, and Homeless Youth in Los Angeles, California, and New Orleans, Louisiana
Authors: Keizur Erin M. , Goldbeck Cameron , Vavala Gabriella , Romero-Espinoza Adriana , Ocasio Manuel , Fournier Jasmine , Lee Sung-Jae , Abdalian Sue-Ellen , Rotheram Mary Jane , Klausner Jeffrey D. 
Published: November 2019

Background
Gay, bisexual, transgender, and homeless youth are at risk of sexually transmitted infections. As part of an adolescent human immunodeficiency virus prevention study, we provided same-day Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and treatment. We aimed to evaluate the feasibility and effectiveness of same-day CT and NG treatment on the proportion of participants receiving timely treatment.

Methods
We recruited adolescents with high sexual risk behaviors aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, and community health centers in Los Angeles, California, and New Orleans, Louisiana from May 2017 to June 2019. Initially, participants were offered point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and referral to another clinic for treatment. After March 2018 in Los Angeles and November 2018 in New Orleans, we provided same-day treatment (and partner treatment packs) for study participants. We measured the proportion of participants who received same-day treatment and the median time to treatment. We collected frequency of partner treatment and any reported adverse treatment-related events.

Results
The proportion of participants receiving same-day CT and NG treatment increased from 3.6% (5/140) to 21.1% (20/95; Δ17.5%; 95% confidence interval, 9.2%–26.9%) after implementation of same-day testing and treatment. The median time to treatment decreased from 18.5 to 3 days. Overall, 36 participants took a total of 48 partner treatment packs. There were no reported treatment-related adverse events.

Conclusions
Providing sexually transmitted infection treatment to adolescents at the same visit as testing is feasible and safe, and can increase the proportion of individuals receiving timely treatment.
Religion, Culture, and Autopsy
Authors: Avşar Abdullah , Okdemir Erdem , Keten Alper , Kaya Ömer 
Published: November 2019

Abstract
The autopsy maintains its significance both forensically and medically despite enormous developments in antemortem and postmortem diagnostic methods. The present study probes the knowledge, attitude, and behavior of religious officials in our city toward autopsy and make an evaluation of how religion and culture affect those factors.
The study consists of 219 Imams (male) and 69 Quran instructors (female) who serve in urban and rural regions of Kahramanmaras and approved informed consent forms.
Two hundred thirty (79%) of the participants stated that the autopsy was an appropriate process according to Islam; 1 (0.3%) stated that it was inappropriate, whereas 57 (19.8%) were observed to have no idea regarding its appropriateness.
The mean knowledge score that participants had about autopsy was determined to be 7.45 ± 1.73 (min = 1, max = 10).
On the other hand, 240 participants (83.3%) stated that it was important for the religious officials to inform the society about the autopsy.
The negative attitude toward autopsy stems from the lack of knowledge and traditions. The religious officials could help the doctors to change the negative attitude stemming from tradition toward the autopsy.
A Call to Restore Your Calling
Authors: Miller Elissa G. , Mull Colette C. 
Published: November 2019

Abstract
Many aspects of our health care system in the United States can lead to physicians feeling helpless—an inability to save a dying child, an inability to protect an immunocompromised child from a vaccine-preventable illness because of waning herd immunity, and a burdensome new electronic medical record system that your employer insists you must use. The cumulative effect of these experiences can lead to moral distress and ultimately moral injury. We discuss helplessness, moral distress, and moral injury in the setting of today's practice of emergency medicine and provide concrete recommendations to help providers cope with their own reactions to distressing clinical situations.