bluuebunny/crossref_metadata_2025_split huggingface dataset:
A266 IS A MULTIVITAMIN SUFFICIENT TO MEET NUTRITIOAL REQUIREMENTS IN CANADIAN ADULTS FOLLOWING A GLUTEN-FREE DIET?
Authors: Chibbar R , Weiten D , Green K H , Rigaux L , Bernstein C N , Graff L A , Duerksen D , Silvester J 
Published: February 2020

Abstract

Background
Concerns exist regarding nutritional deficiencies and risk of metabolic syndrome in patients with celiac disease (CD) on a gluten-free diet (GFD).

Aims
This study assessed if patients with CD trying to follow a GFD meet Recommended Dietary Allowance (RDA) targets for macro- and micronutrients and the effect of supplement use in reaching RDA targets.

Methods
Adults (&gt;16 years) with biopsy confirmed CD (Marsh 3) were recruited within 6 weeks of starting a GFD. Participants prospectively completed a 3-day food record, including dietary supplement use, at 6, 12, and 24 months after study entry. Macro- and micronutrient consumption was determined using the Nutrition Coordinating Center Food & Nutrient Database (NCCDB), USDA National Nutrient Database for Standard Reference (USDA SR28), and CRON-O-Meter Community Database (CCDB). RDA targets were analyzed using a paired t-test and logistic regression, adjusted for age and sex.

Results
Forty-nine participants (71% female; mean age 49 years) completed interpretable food records at all time points. Most (59%) used supplements and supplement use was highest at 6 months (51%). Considering macronutrients, ≥88% met the RDA for carbohydrates and protein at each time point; however, only 44% met the target for fibre. Participants who took a supplement plus a multivitamin were significantly more likely than those who took only a multivitamin to meet the RDA for vitamins B12 and D. Fewer than 20% of those who took neither a multivitamin nor an iron supplement met the RDA, whereas ≥70% of those taking a multivitamin had adequate iron intake. Participants were significantly more likely to meet RDA targets for calcium with a supplement than with a multivitamin only. Even with supplementation, ≤55% met the RDA for folate.

Conclusions
There is a need for ongoing monitoring and dietician support for GFD treatment in CD. Adults with celiac disease met RDA targets for protein and carbohydrate, but not fibre. While specific calcium supplementation was required to meet RDA targets for calcium, a multivitamin was generally sufficient to meet RDA targets for iron, Vitamin B12 and D. Folate was below target at all time points even with supplementation.

Funding Agencies
CAG, CIHRNIH
A267 ROLE OF INTESTINAL EPITHELIAL NUCLEAR RECEPTOR HNF4A DURING METABOLIC DISORDERS
Authors: Tremblay S , Girard R , Noll C , Carpentier A , Boudreau F 
Published: February 2020

Abstract

Background
HNF4α belongs to the hormone nuclear receptor family and is expressed in liver, intestinal epithelium and pancreas where it regulates genes involved in the control of metabolism. Inactivating mutations in the HNF4A gene cause several forms of maturity-onset diabetes of the young (MODY). However, the specific deletion of Hnf4a in mouse pancreatic beta cells does not lead to diabetes, suggesting the contribution of other tissues, such as the intestine, are necessary for the progression of the disease.

Aims
Our main hypothesis was that intestinal epithelial HNF4α regulates gene products that act through a paracrine mode of communication in the context of glucose metabolism. The aims of this study were to investigate the impact of deleting Hnf4a in the mouse intestinal epithelium during glucose homeostasis and to identify molecular mechanisms involved during glucose-induced obesity resistance.

Methods
The Villin-Cre recombinase transgenic mouse model was used to conditionally delete Hnf4a in the intestinal epithelium (Hnf4adeltaIEC). Hnf4adeltaIEC mice were put on a high sugar diet for 8 to 12 weeks, using a 30% sucrose supplemented ab lithium water. Blood glucose values in controls and mutants were measured from whole venous blood from fasted mice or during glucose and insulin tolerance tests. Mouse serum hormone levels (Ghrelin, Fibroblast-growth factor-15 (Fgf15), Insulin, Cholecystokinin (CCK), etc.) were measured using mouse ELISA kits. The Promethion High-Definition Room Calorimetry System was used for indirect calorimetry and metabolic studies.

Results
Both male and female Hnf4adeltaIEC mice displayed a metabolic resistance to develop obesity under sucrose supplementation when compared to control mice. While male mutant mice showed a resistance to obesity after only 2 weeks of treatment, female mutant mice took at least 6 weeks to display some resistance. The gut hormones ghrelin and Fgf15 were also found modified in fasted mutant mice. Female mutant mice presented a significant increase of 1.8 fold in circulating Fgf15 and an increase of 1.4 fold in circulating ghrelin. Similar changes were observed in male mutant mice. However, only male mutant mice presented an insulin resistance and an oral glucose tolerance after between 6 and 8 weeks. Brown adipose tissue (BAT) whitening was observed after 8 weeks of sucrose treatment in control obese animals, a condition that was prevented in Hnf4adeltaIEC mice.

Conclusions
The identification of paracrine intestinal targets for HNF4α in association with glucose metabolism will provide a better understanding of the molecular nature of tissues crosstalk in energy balance and in metabolism disorders including diabetes and obesity.

Funding Agencies
CIHR
A269 EUS-GUIDED ROSE FNA AND CNB FOR THE DIAGNOSIS OF PANCREATIC CANCER: A COMPARATIVE ANALYSIS
Authors: Almudaires A , Williams G , Gruchy S E , Morgenthau A 
Published: February 2020

Abstract

Background
Endoscopic ultrasound-guided fine-needle aspiration with Rapid On Site Evaluation (ROSE EUS-FNA) and endoscopic ultrasound-guided core-needle biopsy (EUS-CNB) are widely used for the diagnosis of pancreatic tumors. There is no known published randomized control trial that compares between the two modalities. Given the aggressive nature of pancreatic cancer, it is crucial to make a prompt diagnosis in order to initiate treatment in a timely fashion.

Aims
This study compares the diagnostic performance of ROSE EUS-FNA and EUS-CNB for diagnosis of pancreatic cancer.

Methods
A retrospective review was performed for patients who underwent ROSE EUS-FNA and/ or EUS-CNB for solid pancreatic lesion. Diagnostic yield (defined as percentage of diagnostic samples), diagnostic accuracy (defined as percentage of correct diagnosis), sensitivity and specificity for malignancy were compared between ROSE EUS- FNA and EUS- CNB. Baseline characteristics for both patients and lesions were also obtained.

Results
A total of 82 patients with solid pancreatic lesions were reviewed. 84 EUS with 61 FNA and 74 CNB were performed. The diagnostic yield was 42/61 (69%) and 59/74 (79.7%) for FNA and CNB respectively (P 0.166). The diagnostic accuracy was 33/61 (54%) and 53/74 (71%) for FNA and CNB respectively (P 0.0326).
50 patients underwent both FNA and CNB during the same EUS. The calculated diagnostic yield among this subgroup was 33/50 (66%) and 39/50 (78%) for FNA and CNB respectively (P 0.265); with diagnostic accuracy of 26/50 (52%) for FNA and 34/50 (68%) for CNB (P 0.152). The diagnostic accuracy after combining both techniques was 40/50 (80%).
The incremental increase in diagnostic yield by combining both methods was 12/50 (24%) and 6/50 (12%) relative to FNA and CNB respectively.
The sensitivity for the diagnosis of malignancy for FNA and CNB was 60.8% and 92.7%, respectively. The specificity was 100% for both methods.

Conclusions
EUS-guided CNB is a superior method of assessing solid pancreatic lesion and pancreatic malignancy with better diagnostic yield and accuracy and higher sensitivity than ROSE EUS-FNA.

Funding Agencies
None
A272 THE CANADIAN DIRECT OBSERVATION OF PROCEDURAL SKILLS (CANDOPS) TOOL FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A MULTI-CENTRE PROSPECTIVE STUDY
Authors: Khan U , Barkun A N , Benchimol E I , Salim M , Telford J J , Enns R A , Mohamed R , Forbes N , Sandha G S , Mosko J , May G , Kortan P , Chatterjee A , James P 
Published: February 2020

Abstract

Background
Previous studies have demonstrated that many graduating trainees may not have all of the skills needed to independently practice endoscopic retrograde cholangiopancreatography (ERCP) safely and effectively. As a part of competency-based learning curriculum development, it is essential to provide formative feedback to trainees and ensure they acquire the knowledge and skills for independent practice.

Aims
To assess the performance of advanced endoscopy trainees across Canada using the Canadian Direct Observation of Procedural Skills (CanDOPS) ERCP assessment tool. Procedural items evaluated include both technical (cannulation, sphincterotomy, stone extraction, tissue sampling, and stent placement) and non-technical (leadership, communication and teamwork, judgment and decision making) skills.

Methods
We conducted a prospective national multi-centre prospective study. Advanced endoscopy trainees with at least two years of gastroenterology training or five years of general surgery in North America and minimal experience performing ERCPs (less than 100 ERCP procedures) were invited to participate. The CanDOPS tool was used to measure every fifth ERCP performed by trainees over a 12-month fellowship training period. ERCPs were evaluated by experienced staff endoscopists at each study site under standard clinical protocol. Cumulative sum (CUSUM) analyses were used to generate learning curves.

Results
The data from five Canadian sites and 11 trainees participated in the study. A total of 261ERCP evaluations were completed. Median number of evaluations by site and trainee was 49 (IQR 31–76) and 15 (IQR 11–45). Median number of cases trainees performed prior to their ERCP training was 50 (IQR 25–400). There was a significant improvement in almost all scores over time, including selective cannulation, sphincterotomy, biliary stenting and all non-technical skills (P&lt;0.01). CUSUM analyses using acceptable and unacceptable failure rates of 20% and 50% demonstrated trainees achieved competency for most measures in their final month of their training. Competency in tissue sampling was not achieved within a one-year training period.

Conclusions
This is the first ERCP performance evaluation tool that examines multiple technical and non-technical aspects of the procedure. Although trainee ERCP skills do improve during their training period, there exists a notable variability in time to competency for the different skills measured using the CanDOPS tool. Large prospective research is required to determine if competency is achieved using more stringent definitions of ERCP competency and to determine factors associated with reaching competency.

Funding Agencies
None
A273 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN A TERTIARY CANADIAN HOSPITAL: OPTIMIZING TISSUE SAMPLING TECHNIQUES
Authors: Taylor S A , Bak A W , Lin T , Jowhari F , Savard M , Parker B , Dick J , Perini R 
Published: February 2020

Abstract

Background
Pancreatic and biliary cancer can be difficult to definitively diagnose, and tissue diagnosis defines clinical management in both early and late disease. The majority of patients with pancreaticobiliary malignancy present with late disease and only 30% have resectable tumours, contributing to poor prognosis and outcome. Endoscopic retrograde cholangiopancreatography (ERCP) is a mainstay for diagnosing and treating conditions of the bile and pancreatic duct.

Aims
This study aimed to provide data on the diagnostic performance of ERCP utilizing conventional methods for tissue acquisition particularly in the setting of an indeterminate stricture. In particular, this was a quality assurance review to determine our centre’s baseline performance as a reference so new methods of tissue acquisition such as SpyglassTM can be benchmarked against.

Methods
In a tertiary care hospital, 3723 ERCP procedures were performed between 2013 and 2017. Demographic and clinical information was retrospectively collected. Demographic and clinical information was collected. Three ERCP techniques of tissue sampling were analyzed: brushing alone (BiA), biopsy alone (BrA), and brushing and biopsy dual-modality approach (BrBi). The diagnostic performances (sensitivity, specificity, and accuracy) were calculated with data from post-sampling clinical reports, surgical pathological reports, and diagnostic imaging reports.

Results
222 patients (285 ERCP procedure) met the study criteria and received fluoroscopy-guided ERCP sampling with cytology brushing and/or tissue biopsies. 36 (13%) patients had BiA, 85 (29%) patients had BrA, and 164 (58%) patients had BrBi. The sensitivities, specificities, and accuracies of the three sampling techniques respectively were: 56%, 93%, and 85% for BiA; 73%, 96%, and 83% for BrA; and 79%, 94%, and 86% for BrBi.

Conclusions
Our retrospective analysis of fluoroscopic-guided tissue acquisition shows accuracy as high as current published data on direct visualization cholangiosopy guided techniques. A prospective study looking not only at clinical yield but a cost analysis should be put in place prior to a commitment to purchase new equipment such as the SpyglassTM.

Funding Agencies
None
John Trevisa
Authors: Twomey Michael 
Published: February 2020

The English translator John Trevisa (b. c. 1342–d. 1402) was an exact contemporary of the poet Geoffrey Chaucer. As is the case with Chaucer, very little of Trevisa’s life can be reconstructed from extant documents. Like Chaucer, Trevisa observed social and political events but referred only obliquely to them, and like Chaucer he staked his legacy to a body of work in English only. If Chaucer’s achievement was to elevate English poetry to a status rivaling that of poetry in Latin, Italian, and French, Trevisa’s was to prove English prose capable of conveying nuanced theological, political, and historical arguments. Trevisa’s known translations are of the apocryphal Gospel of Nicodemus; the Dialogus inter militem et clericum (“Dialogue between a knight and a cleric”), a defense of temporal power; Archbishop Richard FitzRalph’s antifraternal sermon, Defensio curatorum (“Defense of secular priests”); Aegidius Romanus’s De regimine principum (“On the rule of princes”); Ranulph Higden’s universal history, Polychronicon; and Bartholomaeus Anglicus’s encyclopedia, De proprietatibus rerum (“On the properties of things”). Early modern antiquarians believed that Trevisa translated the Bible into English, but hard evidence is lacking (see under Trevisa, the Bible, and the Wycliffite Movement). Under his own name, Trevisa wrote a Dialogue between a Lord and a Clerk on Translation and an Epistle to Lord Berkeley upon Translation as prefaces to his translation of the Polychronicon. He also composed one original poem, with which he prefaced his translation of Bartholomaeus Anglicus. No longer attributed to Trevisa are the Middle English version of the Revelationes of Pseudo-Methodius, a translation of Vegetius’s De re militari that accompanies De regimine principum in its sole manuscript witness, and Apocalypse texts in Anglo-Norman French painted on the ceiling and walls of Berkeley Chapel, Gloucestershire, England.
Debbie Friedman
Authors: Cohen Judah M. 
Published: February 2020

Song leader, composer, and liturgist Debbie Friedman (also Deborah Lynn Friedman, b. 1951–d. 2011) played a significant role in liberal American Jewish music circles over a career that began in the late 1960s, and ended with her premature death from pneumonia on 9 January 2011. Born in Utica, New York, Friedman grew up in St. Paul, Minnesota, where she premiered her service Sing Unto God in 1972 with the choir from her alma mater, Highland Park High School. In the era just before American Jewish seminaries accepted women into cantorial training programs, Friedman parlayed her work with youth groups and summer camps into broader professional opportunities. A season at the Olin-Sang-Ruby Union Institute, a Reform Jewish summer camp in Wisconsin, led to an artist-in-residence position at Chicago Sinai congregation (1972–1977). From there she moved on to positions as a youth group leader at Houston’s Congregation Beth Israel (1978–1984); cantor/soloist at The New Reform Congregation in southern California’s San Fernando Valley (1984–1987); and co-leader of monthly healing services on New York City’s Upper West Side in the 1990s and 2000s. In addition to an active concertizing career, Friedman recorded twenty-two albums, many of which comprised complete, multipart, religious rituals created in collaboration with progressive religious organizations. Although Friedman’s music has become ubiquitous in liberal Jewish settings around the world, scholarship has proceeded slowly due to ambivalence about Friedman’s lack of formal Jewish music training, perceptions of her “outsider” status related to Jewish institutional life, and concerns that the more popular style of her music symbolized spiritual shallowness—matters made more complicated by Friedman’s own repeated claims that she could not read sheet music. Even when New York’s Hebrew Union College School of Sacred Music hired Friedman to instruct its cantorial students in 2007, and when the school itself officially took Friedman’s name just after her death, due to a sizeable anonymous donation in her memory, concerns about her role as a representative of Jewish musical tradition persisted. Thus, most research on Friedman tends to focus on historical and social issues, while struggling to address her music on its own terms. The entries in this article consequently include a significant number of primary and journalistic sources useful for future scholarship.
An Evaluation of the Defined Observer Role in Simulation With Baccalaureate Nursing Students
Authors: Howard Sheri 
Published: February 2020

Abstract
The purpose of this study was to compare satisfaction, self-confidence, and engagement of baccalaureate nursing students using defined observer roles versus traditional observer role and to evaluate student perceptions of these constructs. A quasi-experimental comparative mixed-method design was utilized for the study with a convenience sample of 132 students. Data analysis indicates a statistically significant difference between overall scores for satisfaction, self-confidence, and engagement for defined observer roles (n = 67) versus traditional observer roles (n = 65). Students’ perceptions of satisfaction, self-confidence, and engagement were increased with the use of defined observer roles.
Reconstituted High-density Lipoprotein Therapy Improves Survival in Mouse Models of Sepsis
Authors: Tanaka Sébastien , Genève Claire , Zappella Nathalie , Yong-Sang Jennyfer , Planesse Cynthia , Louedec Liliane , Viranaïcken Wildriss , Bringart Matthieu , Montravers Philippe , Denamur Erick , Duranteau Jacques , Couret David , Meilhac Olivier 
Published: February 2020

Abstract

Background
High-density lipoproteins exert pleiotropic effects including antiinflammatory, antiapoptotic, and lipopolysaccharide-neutralizing properties. The authors assessed the effects of reconstituted high-density lipoproteins (CSL-111) intravenous injection in different models of sepsis.

Methods
Ten-week-old C57BL/6 mice were subjected to sepsis by cecal ligation and puncture or intraperitoneal injection of Escherichia coli or Pseudomonas aeruginosa pneumonia. CSL-111 or saline solution was administrated 2 h after the sepsis. Primary outcome was survival. Secondary outcomes were plasma cell-free DNA and cytokine concentrations, histology, bacterial count, and biodistribution.

Results
Compared with saline, CSL-111 improved survival in cecal ligation and puncture and intraperitoneal models (13 of 16 [81%] survival rate vs. 6 of 16 [38%] in the cecal ligation and puncture model; P = 0.011; 4 of 10 [40%] vs. 0 of 10 [0%] in the intraperitoneal model; P = 0.011). Cell-free DNA concentration was lower in CSL-111 relative to saline groups (68 [24 to 123] pg/ml vs. 351 [333 to 683] pg/ml; P < 0.001). Mice injected with CSL-111 presented a decreased bacterial count at 24 h after the cecal ligation and puncture model both in plasma (200 [28 to 2,302] vs. 2,500 [953 to 3,636] colony-forming unit/ml; P = 0.021) and in the liver (1,359 [360 to 1,648] vs. 1,808 [1,464 to 2,720] colony-forming unit/ml; P = 0.031). In the pneumonia model, fewer bacteria accumulated in liver and lung of the CSL-111 group. CSL-111–injected mice had also less lung inflammation versus saline mice (CD68+ to total cells ratio: saline, 0.24 [0.22 to 0.27]; CSL-111, 0.07 [0.01 to 0.09]; P < 0.01). In all models, no difference was found for cytokine concentration. 111Indium bacterial labeling underlined a potential hepatic bacterial clearance possibly promoted by high-density lipoprotein uptake.

Conclusions
CSL-111 infusion improved survival in different experimental mouse models of sepsis. It reduced inflammation in both plasma and organs and decreased bacterial count. These results emphasized the key role for high-density lipoproteins in endothelial and organ protection, but also in lipopolysaccharide/bacteria clearance. This suggests an opportunity to explore the therapeutic potential of high-density lipoproteins in septic conditions.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Desflurane Anesthesia Alters Cortical Layer–specific Hierarchical Interactions in Rat Cerebral Cortex
Authors: Hudetz Anthony G. , Pillay Siveshigan , Wang Shiyong , Lee Heonsoo 
Published: February 2020

Abstract

Background
Neurocognitive investigations suggest that conscious sensory perception depends on recurrent neuronal interactions among sensory, parietal, and frontal cortical regions, which are suppressed by general anesthetics. The purpose of this work was to investigate if local interactions in sensory cortex are also altered by anesthetics. The authors hypothesized that desflurane would reduce recurrent neuronal interactions in cortical layer–specific manner consistent with the anatomical disposition of feedforward and feedback pathways.

Methods
Single-unit neuronal activity was measured in freely moving adult male rats (268 units; 10 animals) using microelectrode arrays chronically implanted in primary and secondary visual cortex. Layer-specific directional interactions were estimated by mutual information and transfer entropy of multineuron spike patterns within and between cortical layers three and five. The effect of incrementally increasing and decreasing steady-state concentrations of desflurane (0 to 8% to 0%) was tested for statistically significant quadratic trend across the successive anesthetic states.

Results
Desflurane produced robust, state-dependent reduction (P = 0.001) of neuronal interactions between primary and secondary visual areas and between layers three and five, as indicated by mutual information (37 and 41% decrease at 8% desflurane from wakeful baseline at [mean ± SD] 0.52 ± 0.51 and 0.53 ± 0.51 a.u., respectively) and transfer entropy (77 and 78% decrease at 8% desflurane from wakeful baseline at 1.86 ± 1.56 a.u. and 1.87 ± 1.67 a.u., respectively). In addition, a preferential suppression of feedback between secondary and primary visual cortex was suggested by the reduction of directional index of transfer entropy overall (P = 0.001; 89% decrease at 8% desflurane from 0.11 ± 0.18 a.u. at baseline) and specifically, in layer five (P = 0.001; 108% decrease at 8% desflurane from 0.12 ± 0.19 a.u. at baseline).

Conclusions
Desflurane anesthesia reduces neuronal interactions in visual cortex with a preferential effect on feedback. The findings suggest that neuronal disconnection occurs locally, among hierarchical sensory regions, which may contribute to global functional disconnection underlying anesthetic-induced unconsciousness.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New