bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 5-Year Retrospective Cohort Study
Authors: Pu Wenjing , Luo Gang , Chen Tao , Jing Lihua , Hu Qing , Li Xiaoyun , Xia Hongfen , Deng Mingming , Lü Muhan , Chen Xia 
Published: September 2020

Objective
The aim of this study was to evaluate the epidemiology, etiology, severity, and outcomes of acute pancreatitis (AP) in the southern Sichuan region of China.

Methods
All patients with first-attack AP between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University were retrospectively identified. The etiology tendency was analyzed, and the relationship was defined with sex, aging, severity, length of stay, and mortality.

Results
Three thousand twenty-eight patients were enrolled for analysis. Acute biliary pancreatitis had the highest incidence rate; the second and third most common causes were hypertriglyceridemic (14.4%) and alcoholic (14.2%), followed by idiopathic (13.6%), mixed etiology (12.9%), and miscellaneous (2.31%). Patients with alcoholic AP were more likely to be middle-aged males, whereas patients with acute biliary pancreatitis were more likely to be elderly females (P < 0.05). The overall mortality in the hospital was 1%, and there was no difference in each etiological groups (P > 0.05).

Conclusions
Biliary disease was the predominant etiology of AP in southern Sichuan of China, and hypertriglyceridemia ranked second. The proportion of hypertriglyceridemic AP and mixed etiology AP gradually increased, whereas idiopathic AP decreased. There were different etiology proportion of AP according age, sex, and severity.
Syndecan-1 and KRAS Gene Expression Signature Associates With Patient Survival in Pancreatic Cancer
Authors: Wu Yixing , Huang Huatian , Fervers Beatrice , Lu Lingeng 
Published: September 2020

Objectives
The purpose of this study was to investigate the association of syndecan-1 (SDC1) and KRAS molecular characteristics with patient survival in pancreatic cancer.

Methods
Both SDC1 mRNA and methylation and KRAS mRNA and somatic mutations, as well as clinical data were retrieved from The Cancer Genome Alta pancreatic cancer data set for survival analyses. Kyoto Encyclopedia of Gene and Genomes pathway analysis for coexpressed genes for either SDC1 or KRAS was performed, respectively.

Results
A significantly negative correlation existed between SDC1 mRNA and DNA methylation. Patients with KRAS somatic mutations had a significantly higher SDC1 mRNA but lower methylation than those without the mutations. Compared with patients with KRAS
low
SDC1
low signature, those with a high level of KRAS and SDC1 alone or both had a significantly elevated mortality. The adjusted hazard ratios (95% confidence interval) were 2.30 (1.16–4.54, P = 0.017) for KRAS
low
SDC1
high, 2.85 (1.48–5.49, P = 0.002) for KRAS
high
SDC1
low, and 2.48 (1.31–4.70, P = 0.005) for KRAS
high
SDC1
high, respectively. Several Kyoto Encyclopedia of Gene and Genomes pathways were shared, whereas there were distinct pathways between KRAS and SDC1 coexpressed genes.

Conclusions

SDC1 interplays with KRAS, and targeting both KRAS and SDC1 in combination may be more beneficial to pancreatic cancer patients.
Impact of the Human Immunodeficiency Viruses Status on Outcomes in Patients Hospitalized With Acute Pancreatitis
Authors: Jiang Yi , Rodgers Brandon , Chowdhury Salil , Ali Hasan , Ahlawat Sushil 
Published: September 2020

Objectives
We aimed to examine the clinical characteristics and outcomes of patients admitted for acute pancreatitis (AP) in the population with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

Methods
The National Inpatient Sample from 2010 to 2014 was used to identify adult patients admitted with AP. Patients were grouped based on the HIV status. Primary outcomes were mortality, length of stay (LOS), disposition and total hospitalization charges. Secondary outcomes included acute kidney injury, septic shock, respiratory failure and pancreatic procedures.

Results
After matching and weighting, a total of 14,152 HIV-positive patients (6904 with AIDS and 7248 with asymptomatic HIV [aHIV]) with AP were identified. Acute pancreatitis with AIDS were associated with a higher rate of acute kidney injury, longer LOS, higher hospitalization charges, and less routine disposition compared with HIV-negative AP. Patients with aHIV had less septic shock, shorter LOS, and less hospitalization charges compared with HIV-negative patients and less respiratory failure, shorter LOS, and less hospitalization charges compared with AIDS patients.

Conclusions
Patients admitted for AP with AIDS have worse outcomes. On the contrary, aHIV status was not only associated with better outcomes when compared with AIDS, but to HIV-negative status as well.
Acute Pancreatitis in Celiac Disease
Authors: Osagiede Osayande , Lukens Frank J. , Wijarnpreecha Karn , Corral Juan E. , Raimondo Massimo , Kröner Paul T. 
Published: September 2020

ObjectivesStudies suggest that adults diagnosed with celiac disease (CD) are at higher risk of developing acute pancreatitis (AP). The aim of this study is to explore the relationship between CD and AP in terms of inpatient prevalence, mortality, morbidity, and resource utilization in the past decade.MethodsRetrospective cohort study using the Nationwide Inpatient Sample (2007–2016). The primary outcome was the occurrence of AP in CD patients. Secondary outcomes were the trend in AP cases in CD patients, and mortality, morbidity, length of stay, and total hospital charges and costs.ResultsOf 337,201 CD patients identified, 7372 also had AP. The mean age was 53 years, 71% were women. The inpatient prevalence of AP in CD was 2.2% versus 1.2% in non-CD cohort (P< 0.01). Patients with CD displayed increased odds of having AP (adjusted odds ratio, 1.92;P< 0.01). Patients with AP and CD displayed lower odds of morbidity and mortality than non-CD patients with AP.ConclusionsThe inpatient prevalence of AP is higher in CD patients, and increased from 2007 to 2016. Patients with CD and AP displayed lower morbidity and mortality, which may suggest that they have a less severe form of AP or lower baseline comorbidity.
The Epidemiology of Pancreatic Cancer and the Association With Acetylsalicylic Acid in the United States
Authors: Khoudari George , Alkhayyat Motasem , Abou Saleh Mohannad , Mansoor Emad , Sarmini Muhammad Talal , Baidoun Firas , Vega Kenneth J. , Sanaka Madhusudhan R. 
Published: September 2020

ObjectivesPancreatic cancer (PaC) is the third leading cause of cancer-related death in the United States. Multiple studies have investigated the epidemiology and the association between PaC and acetylsalicylic acid (ASA) use, revealing mixed results. Using a large database, we sought to investigate the epidemiology of PaC.MethodsUsing a commercial database (Explorys Inc, Cleveland, Ohio), which includes electronic health record data from 26 major integrated US health care systems, all patients 18 years and older diagnosed with PaC for 5 years were identified based on Systematized Nomenclature Of Medicine—Clinical Terms. We determined the prevalence of PaC and the potential associated factors using univariable and multivariable analysis.ResultsOf the 32,970,850 individuals, we identified 30,250 individuals with PaC with an overall prevalence of 0.08%. Individuals with PaC were more likely to be males, seniors (age, >65 years), and White, compared with patients without PaC. In subgroup analysis of chronic pancreatitis, individuals on ASA, individuals >65 years, White, and White males were less likely to have PaC, and non-White females were more likely to have PaC.ConclusionsThis is the largest population-based study evaluating the epidemiology of PaC. We observed a protective association of ASA on a subgroup of patients with PaC and chronic pancreatitis.
Serum Exo-EphA2 as a Potential Diagnostic Biomarker for Pancreatic Cancer
Authors: Wei Qian , Zhang Jingya , Li Ze , Wei Lijuan , Ren Li 
Published: September 2020

Objectives
Pancreatic cancer (PC) is a highly malignant tumor with poor detection sensitivity and specificity in biomarkers and diagnosis. Previous research indicated that serum Ephrin type-A receptor 2 in exosomes (Exo-EphA2) was highly expressed and might have facilitated cell migration in PC cells. However, the dynamics of clinical performance of serum Exo-EphA2 in PC patients are unknown. Thus, this study evaluated serum Exo-EphA2 as a potential diagnostic biomarker in PC.

Methods
The expressions of serum Exo-EphA2 were assessed by enzyme-linked immunosorbent assay for N = 353 serum samples, including from 204 PC patients, 75 patients with benign pancreatic disease, and 74 healthy control patients. Carbohydrate antigen 19-9 (CA 19-9) and carbohydrate antigen 242 (CA 242) were measured by automated immunoassay.

Results
Serum Exo-EphA2 levels were significantly higher in PC patients than in benign pancreatic disease and healthy control patients. Receiver operating characteristic curve analysis suggested that using combined diagnoses of Exo-EphA2 with CA 19-9 and CA 242 was more effective to discriminate early stage (stage I and II) in PC than in healthy controls and benign disease patients.

Conclusions
Novel findings suggest that serum Exo-EphA2 is a potential early diagnostic biomarker complementing CA 19-9 and CA 242 in PC.
Immunological Gene Signature Associated With the Tumor Microenvironment of Pancreatic Cancer After Neoadjuvant Chemotherapy
Authors: Hane Yuma , Tsuchikawa Takahiro , Nakamura Toru , Hatanaka Kanako C. , Saito Tatsuro , Tanaka Kimitaka , Nakanishi Yoshitsugu , Asano Toshimichi , Noji Takehiro , Okamura Keisuke , Shichinohe Toshiaki , Yokota Isao , Hatanaka Yutaka , Hirano Satoshi 
Published: September 2020

Objectives
Neoadjuvant chemotherapy (NAC) has improved overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but its effects on immune gene signatures are unknown. Here, we examined the immune transcriptome after NAC for PDAC.

Methods
Resected tumor specimens were obtained from 140 patients with PDAC who received surgery first (n = 93) or NAC (n = 47). Six patients were randomly selected from each group, and RNA was extracted from tumor tissues. We compared 770 immune-related genes among the 2 groups using nCounterPanCancer Immune Profiling (NanoString Technologies, Seattle, Wash). Gene clusters were classified into 14 immune function groups based on gene ontology argolism by nSolver 4.0 software (NanoString Technologies), and corresponding immune cell function scores were compared.

Results
Eleven genes (LY86, SH2D1A, CD247, TIGIT, CR2, CD83, LAMP3, CXCR4, DUSP4, SELL, and IL2RA) were significantly downregulated in the NAC group. Gene expression analysis showed that the functions of regulatory T cells, B cells, and natural killer CD56 dim cells were significantly decreased in the NAC group.

Conclusions
Neoadjuvant chemotherapy may suppress regulatory T cells and B-cell function in the PDAC microenvironment. The 11 identified genes could be useful for predicting the efficacy of NAC and could be therapeutic targets for PDAC.
Critical Analysis of Laboratory Testing Methodologies When Interpreting Conflicting Results at Autopsy
Authors: Johnson Kimberly Margaret , Gunsolus Ian L. , Tlomak Wieslawa 
Published: September 2020

Abstract
Toxicological analysis is an important diagnostic component of a postmortem examination and may involve both antemortem and postmortem specimens. Here, we present a case in which an antemortem specimen, when reanalyzed in the forensic toxicology laboratory, resulted in values that contradicted the reported values from the medical record and required further investigation. This case involves a 51-year-old man decedent with a medical history of chronic alcohol abuse. His antemortem urine drug screen, performed upon admission to an emergency department, was negative. His serum blood alcohol level at presentation was reported as 0.960 g/dL and, repeated 4 hours later, was 0.500 g/dL with a comment indicating that there was significant lipemia interfering with the results. At autopsy, the antemortem blood sample collected from the hospital, postmortem blood, and vitreous humor samples were analyzed and all 3 samples were found to be negative for ethanol. The hospital laboratory used an enzymatic assay for ethanol detection, which is known to be impacted by lipemia, and the forensic laboratory used head-space gas chromatography, which is not impacted by lipemia. This highlights the need to critically analyze laboratory testing methodologies when interpreting conflicting results at autopsy.
Safety and Oncologic Outcomes of Magnetic Resonance Imaging–Guided Cryoablation of Renal Cell Carcinoma
Authors: Cazzato Roberto Luigi , De Marini Pierre , Leonard-Lorant Ian , Leclerc Loïc , Auloge Pierre , Tricard Thibault , Dalili Danoob , Garnon Julien , Lang Hervé , Gangi Afshin 
Published: September 2020

Objectives
Magnetic resonance imaging guidance has been sporadically reported for renal tumor cryoablation (CA); therefore, clinical experience with this modality is still limited.
The aim of this study is to retrospectively analyze our 10-year experience with renal tumor CA performed on a 1.5 T magnetic resonance imaging unit with the intent of reporting procedural safety and oncologic outcomes.

Materials and Methods
We included 143 patients (102 men; 41 women; median age, 73 years; range, 34–91 years) with 149 tumors (median size, 2.6 cm; range, 0.6–6.0 cm), treated between 2009 and 2019. Patient, tumor, procedure, and follow-up data were collected and analyzed. The Kaplan-Meier method was used to estimate local recurrence–free (LRFS), metastasis-free (MFS), disease-free (DFS), cancer-specific, and overall (OS) survival. Univariate and multivariate models were used to identify factors associated with complications, LRFS, MFS, DFS, and OS.

Results
The overall complication rate was 10.7% (16/149 tumors), with 1 major (1/149 [0.7%]; 95% confidence interval, 0.0%–3.7%) hemorrhagic complication. Other minor complications (15/149 [10.1%]; 95% confidence interval, 0.6%–16.1%) did not include any cases of injury to nearby organs. There were no factors associated with complications.
Five-year estimates of LRFS (primary/secondary), MFS, DFS, cancer-specific survival, and OS were 82.8%/91.5%, 91.1%, 75.1%, 98.2%, and 89.6%, respectively. Increasing tumor size (hazard radio [HR], 1.8; P = 0.02) and intraparenchymal tumor location (HR, 5.6; P < 0.01) were associated with lower LRFS; increasing patient's age (HR, 0.5; P = 0.01), high tumor grade (HR, 23.3; P < 0.01) and non–clear-cell/nonpapillary histology (HR, 20.1; P < 0.01) with metastatic disease; and high tumor grade (HR, 3.2; P = 0.04) with lower DFS.

Conclusion
Magnetic resonance imaging–guided CA of renal tumors is associated with acceptable morbidity and high survival estimates at 5-year follow-up. Given the absence of complications resulting from injuries to nearby organs, further studies are required to evaluate whether the potential reduced incidence of these adverse events justifies large-scale implementation of this interventional modality.
Analogous telomeres shortening and different metabolic profile: hypertension versus hypertension/type 2 diabetes mellitus comorbidity
Authors: AlDehaini Dhuha M.B. , Al-Bustan Suzanne A. , Malalla Zainab Hasan Abdulla , Ali Muhalab E. , Sater Mai , Giha Hayder A. 
Published: September 2020

Background
Eukaryotes chromosomal ends are capped and protected by telomeres, which are noncoding DNA repeats synthesized by telomerase enzyme. The telomerase enzyme is a nucleoprotein encoded by TERC and TERT genes. Naturally, the length of the telomeres shortens with each cell cycle but the shortening is fastened in certain age-related diseases like hypertension (HTN) and type 2 diabetes mellitus (T2DM).

Materials and methods
Blood samples (n = 171) were obtained from Kuwaiti subjects with HTN, and HTN/T2DM comorbidity (HTN-DM) and healthy subjects. The leukocyte telomere length (LTL) was measured by SYBR green quantitative rtPCR, and plasma telomerase enzyme was measured by ELISA, in addition, three single nucleotide polymorphisms (SNPs) in telomere-related genes; TERC rs12696304GC, TERT rs2736100CA, and ACYP2 rs6713088GC were genotyped by real-time PCR.

Results
Marked LTL shortening in subjects with HTN and HTN-DM compared to healthy subjects, P = 0.043 and P < 0.001, respectively, was noticed. On the contrary, the plasma telomerase enzyme levels and minor allele frequencies and genotypes of the tested SNPs were comparable between the study groups, except for TERT (CA) genotype which was over-represented in HTN (P = 0.037). Furthermore, the comparisons between HTN and HTN-DM revealed significantly higher total cholesterol (P = 0.015) and LDL-C (P = 0.008) in HTN, while higher insulin levels (P < 001), HOMA-IR (P < 001), and BMI (P = 0.004) were observed in HTN-DM.

Conclusion
This study showed comparable LTL shortening in HTN and HTN-DM, irrespective of plasma telomerase enzyme levels or tested TERC, TERT, and ACYP2 gene polymorphisms, although HTN and HTN-DM differed in several metabolic markers. More studies are required to affirm these observations.
Facilitation of evidence implementation within a clinical fellowship program: a mixed methods study
Authors: Lizarondo Lucylynn , McArthur Alexa , Lockwood Craig , Munn Zachary 
Published: September 2020

ABSTRACT

Background and aim:
Facilitation is a multifaceted process for supporting and enabling individual or group of health practitioners to implement positive changes in clinical practice. Facilitation has never been explored within the context of an educational program that integrates a practical, evidence-based implementation component, such as a clinical fellowship program (CFP). The aim of this research was to identify features of facilitation as it occurs in the JBI (formerly known as Joanna Briggs Institute) CFP that promotes the use of evidence into clinical practice.

Methods:
We used a mixed methods study design to address the objective of this study. An electronic survey was administered to clinicians of different clinical backgrounds who completed the CFP (i.e. clinical fellows). Purposively selected clinical fellows and assigned internal or external facilitators were interviewed.

Results:
Forty-three clinical fellows completed the survey and 16 individual interviews and two focus groups were conducted. Findings from the survey and interviews demonstrated that facilitation within the context of a CFP is a collaborative effort between assigned facilitators and clinical fellows. Our study showed that both assigned facilitators and clinical fellows perform facilitation activities, with assigned internal and external facilitators providing support and assistance to clinical fellows, who in turn, support the evidence implementation project within their local organization. The study also suggests that external facilitation should be tailored to the individual clinical fellow's characteristics and their previous experiences.

Conclusion:
Facilitation in an evidence-based CFP involves a partnership between clinical fellows and assigned facilitators, indicating a collaborative effort that involves a set of internal and external facilitation activities. Our study findings can guide the delivery of CFPs, particularly in identifying suitable people for the facilitator's role, which can have important implications for evidence implementation. Future research should focus on evaluating the effectiveness of these programs in improving practice and health outcomes.
Impacts of extreme summers on European ecosystems: a comparative analysis of 2003, 2010 and 2018
Authors: Bastos A. , Fu Z. , Ciais P. , Friedlingstein P. , Sitch S. , Pongratz J. , Weber U. , Reichstein M. , Anthoni P. , Arneth A. , Haverd V. , Jain A. , Joetzjer E. , Knauer J. , Lienert S. , Loughran T. , McGuire P. C. , Obermeier W. , Padrón R. S. , Shi H. , Tian H. , Viovy N. , Zaehle S. 
Published: September 2020

In Europe, three widespread extreme summer drought and heat (DH) events have occurred in 2003, 2010 and 2018. These events were comparable in magnitude but varied in their geographical distribution and biomes affected. In this study, we perform a comparative analysis of the impact of the DH events on ecosystem CO2fluxes over Europe based on an ensemble of 11 dynamic global vegetation models (DGVMs), and the observation-based FLUXCOM product. We find that all DH events were associated with decreases in net ecosystem productivity (NEP), but the gross summer flux anomalies differ between DGVMs and FLUXCOM. At the annual scale, FLUXCOM and DGVMs indicate close to neutral or above-average land CO2uptake in DH2003 and DH2018, due to increased productivity in spring and reduced respiration in autumn and winter compensating for less photosynthetic uptake in summer. Most DGVMs estimate lower gross primary production (GPP) sensitivity to soil moisture during extreme summers than FLUXCOM. Finally, we show that the different impacts of the DH events at continental-scale GPP are in part related to differences in vegetation composition of the regions affected and to regional compensating or offsetting effects from climate anomalies beyond the DH centres.This article is part of the theme issue ‘Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale’.
Spring enhancement and summer reduction in carbon uptake during the 2018 drought in northwestern Europe
Authors: Smith Naomi E. , Kooijmans Linda M. J. , Koren Gerbrand , van Schaik Erik , van der Woude Auke M. , Wanders Niko , Ramonet Michel , Xueref-Remy Irène , Siebicke Lukas , Manca Giovanni , Brümmer Christian , Baker Ian T. , Haynes Katherine D. , Luijkx Ingrid T. , Peters Wouter 
Published: September 2020

We analysed gross primary productivity (GPP), total ecosystem respiration (TER) and the resulting net ecosystem exchange (NEE) of carbon dioxide (CO2) by the terrestrial biosphere during the summer of 2018 through observed changes across the Integrated Carbon Observation System (ICOS) network, through biosphere and inverse modelling, and through remote sensing. Highly correlated yet independently-derived reductions in productivity from sun-induced fluorescence, vegetative near-infrared reflectance, and GPP simulated by the Simple Biosphere model version 4 (SiB4) suggest a 130–340 TgC GPP reduction in July–August–September (JAS) of 2018. This occurs over an area of 1.6 × 106km2with anomalously low precipitation in northwestern and central Europe. In this drought-affected area, reduced GPP, TER, NEE and soil moisture at ICOS ecosystem sites are reproduced satisfactorily by the SiB4 model. We found that, in contrast to the preceding 5 years, low soil moisture is the main stress factor across the affected area. SiB4’s NEE reduction by 57 TgC for JAS coincides with anomalously high atmospheric CO2observations in 2018, and this is closely matched by the NEE anomaly derived by CarbonTracker Europe (52 to 83 TgC). Increased NEE during the spring (May–June) of 2018 (SiB4 −52 TgC; CTE −46 to −55 TgC) largely offset this loss, as ecosystems took advantage of favourable growth conditions.This article is part of the theme issue ‘Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale’.