bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis
Authors: Giglio Mariateresa , Biancofiore Giandomenico , Corriero Alberto , Romagnoli Stefano , Tritapepe Luigi , Brienza Nicola , Puntillo Filomena 
Published: December 2021

AbstractBackgroundGoal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery.ObjectivesThe aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures.Data sourcesRandomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on.Study appraisal and synthesis methodsMeta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsIn 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result.The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87,p= 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80,p= 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78,p= 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group.Conclusions and implications of key findingsThe present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.
Routine drug monitoring of serum concentrations of morphine, morphine-3-glucuronide and morphine-6-glucuronide do not predict clinical observations in cancer patients
Authors: Klepstad Pal , Borchgrevink Petter C , Dale Ola , Zahlsen Kolbjørn , Aamo Trond , Fayers Peter , Fougner Bjørn , Kaasa Stein 
Published: December 2021

The clinical importance of routine drug monitoring of serum concentrations of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) during chronic morphine therapy is not established. We measured morphine, M6G and M3G serum concentrations in cancer pain patients receiving oral ( n = 263, median dose 80 mg/24 hours) or subcutaneous (sc) ( n = 35, median dose 110 mg/24 hours) morphine. Regression analyses were performed to investigate if serum concentrations of morphine, M3G and M6G predicted pain intensity (Brief Pain Inventory), health-related quality-of-life variables (EORTC QLQ-C30) and cognitive function (Mini-Mental Score). Serum concentrations were also compared in patients categorized as morphine ’treatment successesfland ‘treatment failures’. We observed that serum concentrations of morphine, M6G or M3G did not predict pain intensity, cognitive function, nausea or tiredness. ‘Treatment failuresflcaused by nausea, tiredness, cognitive failure or constipation did not have statistically significant different morphine, M6G and M3G serum concentrations than patients classified as ’treatment successes’. In conclusion, this study did not observe any concentration–effect relationships of morphine, M3G or M6G with pain intensity, nausea, constipation, tiredness or cognitive failure in blood samples obtained during routine clinical drug monitoring in cancer patients. This result suggests that therapeutic drug monitoring as a routine tool during chronic morphine treatment has limited value for clinical decision making.
Quality of Life After Endoscopic Surgical Management of Pituitary Adenomas
Authors: Castle-Kirszbaum Mendel , Wang Yi Yuen , King James , Goldschlager Tony 
Published: December 2021

BACKGROUND:
Patient-reported quality of life (QOL) is a vital metric for surgical success.

OBJECTIVE:
To assess the effect of surgery on QOL in the largest prospectively collected, longitudinal cohort of surgically managed pituitary adenomas.

METHODS:
A consecutive surgical adenoma cohort (n = 304) between late 2016 and mid-2020 underwent a scheduled overall (Anterior Skull Base Questionnaire-35) and sinonasal-specific (Sinonasal Outcome Test-22) QOL assessment. Scores were stratified by adenoma subtype and analyzed for clinical predictors of QOL changes.

RESULTS:
The average age was 53.8 ± 16 yr, and 53% of participants were female. 60.9% of adenomas were nonfunctioning while adrenocorticotropic hormone adenomas (16.4%), growth hormone adenomas (14.1%), and prolactinomas (5.9%) were the most prevalent secreting adenomas. Baseline overall QOL differed between tumor types (P = .006), with adrenocorticotropic hormone adenomas worse than growth hormone adenomas (P = .03) and nonfunctioning pituitary adenomas (NFPA) (P < .001). Sinonasal QOL worsened in the 3 wk after surgery but returned to baseline by 6 wk and beyond. Overall QOL worsened at 3 wk after surgery (P < .001) but significantly improved from baseline by 3 mo (P = .009) and beyond (P < .001). Emotional functioning improved soon after surgery, followed by performance and pain, and then, by 6 mo, physical function and vitality. Predictors of improved QOL were sellar/suprasellar lesions (P = .01), prolactinomas (P = .003), and NFPA (P = .04). Conversely, new postoperative hypopituitarism (P = .04) and larger adenoma volume (P = .04) predicted QOL worsening.

CONCLUSION:
QOL is worsened after surgery at early time points. Prolactinomas and NFPA enjoy significant QOL improvements from surgery as early as 3 mo postoperatively. Other functional tumors may experience early benefits in younger patients without hypopituitarism and when isolated to the sellar/suprasellar region. These findings provide valuable information for counseling patients and setting expectations for surgery.
Association of Neurological Impairment on the Relative Benefit of Maximal Extent of Resection in Chemoradiation-Treated Newly Diagnosed Isocitrate Dehydrogenase Wild-Type Glioblastoma
Authors: Aabedi Alexander A. , Young Jacob S. , Zhang Yalan , Ammanuel Simon , Morshed Ramin A. , Dalle Ore Cecilia , Brown Desmond , Phillips Joanna J. , Oberheim Bush Nancy Ann , Taylor Jennie W. , Butowski Nicholas , Clarke Jennifer , Chang Susan M. , Aghi Manish , Molinaro Annette M. , Berger Mitchel S. , Hervey-Jumper Shawn L. 
Published: December 2021

BACKGROUND:
Increases in the extent of resection of both contrast-enhanced (CE) and non–contrast-enhanced (NCE) tissue are associated with substantial survival benefits in patients with isocitrate dehydrogenase wild-type glioblastoma. The fact, however, remains that these lesions exist within the framework of complex neural circuitry subserving cognition, movement, and behavior, all of which affect the ultimate survival outcome. The prognostic significance of the interplay between CE and NCE cytoreduction and neurological morbidity is poorly understood.

OBJECTIVE:
To identify a clinically homogenous population of 228 patients with newly diagnosed isocitrate dehydrogenase wild-type glioblastoma, all of whom underwent maximal safe resection of CE and NCE tissue and adjuvant chemoradiation. We then set out to delineate the competing interactions between resection of CE and NCE tissue and postoperative neurological impairment with respect to overall survival.

METHODS:
Nonparametric multivariate models of survival were generated via recursive partitioning to provide a clinically intuitive framework for the prognostication and surgical management of such patients.

RESULTS:
We demonstrated that the presence of a new postoperative neurological impairment was the key factor in predicting survival outcomes across the entire cohort. Patients older than 60 yr who suffered from at least one new impairment had the worst survival outcome regardless of extent of resection (median of 11.6 mo), whereas those who did not develop a new impairment had the best outcome (median of 28.4 mo) so long as all CE tissue was resected.

CONCLUSION:
Our data provide novel evidence for management strategies that prioritize safe and complete resection of CE tissue.
Sculpting with stem cells: how models of embryo development take shape
Authors: Veenvliet Jesse V. , Lenne Pierre-François , Turner David A. , Nachman Iftach , Trivedi Vikas 
Published: December 2021

ABSTRACTDuring embryogenesis, organisms acquire their shape given boundary conditions that impose geometrical, mechanical and biochemical constraints. A detailed integrative understanding how these morphogenetic information modules pattern and shape the mammalian embryo is still lacking, mostly owing to the inaccessibility of the embryo in vivo for direct observation and manipulation. These impediments are circumvented by the developmental engineering of embryo-like structures (stembryos) from pluripotent stem cells that are easy to access, track, manipulate and scale. Here, we explain how unlocking distinct levels of embryo-like architecture through controlled modulations of the cellular environment enables the identification of minimal sets of mechanical and biochemical inputs necessary to pattern and shape the mammalian embryo. We detail how this can be complemented with precise measurements and manipulations of tissue biochemistry, mechanics and geometry across spatial and temporal scales to provide insights into the mechanochemical feedback loops governing embryo morphogenesis. Finally, we discuss how, even in the absence of active manipulations, stembryos display intrinsic phenotypic variability that can be leveraged to define the constraints that ensure reproducible morphogenesis in vivo.
Colonic healing requires Wnt produced by epithelium as well as Tagln+ and Acta2+ stromal cells
Authors: Das Soumyashree , Feng Qiang , Balasubramanian Iyshwarya , Lin Xiang , Liu Haoran , Pellón-Cardenas Oscar , Yu Shiyan , Zhang Xiao , Liu Yue , Wei Zhi , Bonder Edward M. , Verzi Michael P. , Hsu Wei , Zhang Lanjing , Wang Timothy C. , Gao Nan 
Published: December 2021

ABSTRACT
Although Wnt signaling is clearly important for the intestinal epithelial homeostasis, the relevance of various sources of Wnt ligands themselves remains incompletely understood. Blocking the release of Wnt in distinct stromal cell types suggests obligatory functions of several stromal cell sources and yields different observations. The physiological contribution of epithelial Wnt to tissue homeostasis remains unclear. We show here that blocking epithelial Wnts affects colonic Reg4+ epithelial cell differentiation and impairs colonic epithelial regeneration after injury in mice. Single-cell RNA analysis of intestinal stroma showed that the majority of Wnt-producing cells were contained in transgelin (Tagln+) and smooth muscle actin α2 (Acta2+) expressing populations. We genetically attenuated Wnt production from these stromal cells using Tagln-Cre and Acta2-CreER drivers, and found that blockage of Wnt release from either epithelium or Tagln+ and Acta2+ stromal cells impaired colonic epithelial healing after chemical-induced injury. Aggregated blockage of Wnt release from both epithelium and Tagln+ or Acta2+ stromal cells drastically diminished epithelial repair, increasing morbidity and mortality. These results from two uncharacterized stromal populations suggested that colonic recovery from colitis-like injury depends on multiple Wnt-producing sources.
Computed tomography-based radiomics analysis to predict lymphovascular invasion in esophageal squamous cell carcinoma
Authors: Peng Hui , Yang Qiuxing , Xue Ting , Chen Qiaoling , Li Manman , Duan Shaofeng , Cai Bo , Feng Feng 
Published: December 2021

Objective
The present study explored the value of preoperative CT radiomics in predicting lymphovascular invasion (LVI) in esophageal squamous cell carcinoma (ESCC).

Methods
A retrospective analysis of 294 pathologically confirmed ESCC patients undergoing surgical resection and their preoperative chest-enhanced CT arterial images were used to delineate the target area of the lesion. All patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Radiomics features were extracted from single-slice, three-slice, and full-volume regions of interest (ROIs). The least absolute shrinkage and selection operator (LASSO) regression method was applied to select valuable radiomics features. Radiomics models were constructed using logistic regression method and were validated using leave group out cross-validation (LGOCV) method. The performance of the three models was evaluated using the receiver characteristic curve (ROC) and decision curve analysis (DCA).

Results
A total of 1218 radiomics features were separately extracted from single-slice ROIs, three-slice ROIs, and full-volume ROIs, and 16, 13 and 18 features, respectively, were retained after optimization and screening to construct a radiomics prediction model. The results showed that the AUC of the full-volume model was higher than that of the single-slice and three-slice models. According to LGOCV, the full-volume model showed the highest mean AUC for the training cohort and the validation cohort.

Conclusion
The full-volume radiomics model has the best predictive performance and thus can be used as an auxiliary method for clinical treatment decision making.

Advances in knowledge:
LVI is considered to be an important initial step for tumor dissemination. CT radiomics features correlate with LVI in ESCC and can be used as potential biomarkers for predicting LVI in ESCC.
Ethanol consumption during gestation promotes placental alterations in IGF-1 deficient mice
Authors: Martín-Estal Irene , Fajardo-Ramírez Oscar R , Bermúdez De León Mario , Zertuche-Mery Carolina , Rodríguez-Mendoza Diego , Gómez-Álvarez Patricio , Galindo-Rangel Marcela , Leal López Andrea , Castilla-Cortázar Inma , Castorena-Torres Fabiola 
Published: December 2021

Background: During pregnancy, the placenta is an extremely important organ as it secretes its own hormones, e.g. insulin-like growth factor 1 (IGF-1), to ensure proper intrauterine fetal growth and development. Ethanol, an addictive and widely used drug, has numerous adverse effects during pregnancy, including fetal growth restriction (FGR). To date, the molecular mechanisms by which ethanol triggers its toxic effects during pregnancy, particularly in the placenta, are not entirely known. For this reason, a murine model of partial IGF-1 deficiency was used to determine ethanol alterations in placental morphology and AAH expression. Methods: Heterozygous (HZ, Igf1+/-) female mice were given 10% ethanol during 14 days as an acclimation period and throughout pregnancy. HZ female mice given water were used as controls. At gestational day 19, pregnant dams were sacrificed, placentas were collected and genotyped for subsequent studies. Results: IGF-1 deficiency and ethanol consumption during pregnancy altered placental morphology, and decreased placental efficiency and aspartyl/asparaginyl β-hydroxylase (AAH) expression in placentas from all genotypes. No differences were found in Igf1, Igf2, Igf1r and Igf2r mRNA expression in placentas from all groups. Conclusions: IGF-1 deficiency and ethanol consumption throughout gestation altered placental development, suggesting the crucial role of IGF-1 in the establishment of an adequate intrauterine environment that allows fetal growth. However, more studies are needed to study the precise mechanism to stablish the relation between both insults.
The “Rotten” matter in A Farewell to Arms: An Ecological Gothic reading
Authors: NG LAY SION 
Published: December 2021

This article uncovers the gothic tropes manifest in the “rotten” food, human bodies, landscapes, and rain in Ernest Hemingway’s A Farewell to Arms through an eco-gothic perspective. It demonstrates how the rotten food, the disjointed bodies, the broken landscapes, and the gothic rain can be viewed in the novel as counter-narratives against the narratives of war, the military, and modern medicine. The first part of this article suggests interpreting war as a form of cannibalism by exploring the representations of rotten food and the connection between eating and killing. Next, the author focuses on how the body is fragmented both metaphorically and literally by the discourse of war, the military, and medical science. The third part uncovers the non-anthropocentric consciousness embedded within the protagonist’s narrative, followed by the gothicizing and romanticization of nature in the fourth section. Here, the protagonist’s linking of the human body to the natural landscape, the descriptions of the gothic rain, and the romanticized snow—all these, as the author argues, can be interpreted as a collective resistance against industrial, anthropocentric warfare.
When Reflection Hurts: The Effect of Cognitive Processing Types on Organizational Adaptation to Discontinuous Change
Authors: Alves Marlon Fernandes Rodrigues , Vastola Vincenzo , Vasconcelos Ribeiro Galina Simone , Zollo Maurizio 
Published: December 2021

Technological breakthroughs, institutional disruptions, and natural disasters often alter the course of organizations and entire industries. Such discontinuous changes threaten organizations’ survival by affecting the value of the knowledge accumulated in routines and capabilities. Although it is widely acknowledged that managerial cognition is a critical antecedent of organizational responses to discontinuous change, the role of type 1 (intuitive) and type 2 (reflective) processing in the adaptation of shared patterns of behavior, that is, routines, remains understudied. Drawing on dual-process theory, we propose that particular features of type 1 processing render this approach superior to type 2 processing, especially in highly ambiguous environments in which information is limited and difficult to verify. We tested our hypotheses in a longitudinal experiment linking individual-level factors with organizational-level practices of routine adaptation. Experienced managers, paired in 80 groups, developed routines in a first round of a simulation game; in a second round, we then introduced a discontinuous change making previous routines obsolete in order to observe how they adapted. The data show that priming type 1 processing facilitates organizational adaptation more than type 2 processing by providing faster, more routinized, efficiently coordinated, and optimal responses. In addition, type 1 appears to be more functional in highly ambiguous environments, whereas type 1 and type 2 processes yield similar levels of performance under low levels of ambiguity. Overall, our study advances the understanding of the nondeliberative dimension of organizational adaptation to discontinuous change. History: This paper has been accepted for the Organization Science Special Issue on Experiments in Organizational Theory. Funding: This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001). Supplemental Material: The online appendix is available at https://doi.org/10.1287/orsc.2021.1517 .
O mar é uma pergunta
Authors: Maciel Katia , Cunha Analu , Luz André Sheik , Araujo Inês De , Flores Livia , Braga Nathan 
Published: December 2021

Ao passar por momentos pontuais da trajetória da artista e pesquisadora Katia Maciel, a entrevista aborda temas e processos dos seus vídeos, instalações e performances: a relação amorosa, a cidade, a floresta e o mar são deflagradores de situações e associações entre meios e campos diversos. O interesse da artista por temporalidades simultâneas e situações sensoriais perturbadoras não deixa de reverberar uma indagação sobre o que pode ser o cinema e a poesia, sempre em diálogo com sua reflexão teórica sobre a videoarte e a questão da participação do espectador na arte contemporânea brasileira
Violência armada e qualidade de vida: um estudo seccional na Estratégia Saúde da Família
Authors: Siqueira Janaina Moreno de , Sousa Ana Inês , Souza Norma Valéria Dantas de Oliveira , Carvalho Eloá Carneiro , David Helena Maria Scherlowski Leal , Farias Sheila Nascimento Pereira de 
Published: December 2021

Objetivo: avaliar a qualidade de vida dos usuários da Estratégia Saúde da Família (ESF) no contexto da violência urbana. Método: estudo transversal realizado com 93 usuários da ESF, em 2020, na região metropolitana do Rio de Janeiro. Como limitação apresenta-se impossibilidade de estabelecer uma relação temporal entre a exposição e o desfecho. Pesquisa aprovada pelos Comitês de Ética em Pesquisa (CEP) da Escola Anna Nery e, da Secretaria Municipal de Saúde da Prefeitura do Rio de Janeiro. Resultados: o domínio de relações sociais foi o de maior mediana (75,00), seguido do domínio psicológico (66,67), domínio físico (60,71) e por último o domínio de meio ambiente (56,25), valor de p < 0,001. Conclusão: a menor média no domínio ambiente relaciona-se as piores percepções de qualidade de vida com condições de saúde associadas à violência no território, que traz danos à saúde e a qualidade de vida dos sujeitos.
Screening for hereditary haemochromatosis in patients undergoing knee arthroplasty
Authors: Krasin Elisha , Gold Aviram , Morgan Samuel , Warschawski Yaniv 
Published: December 2021

Aims Hereditary haemochromatosis is a genetic disorder that is caused by several known mutations in the human homeostatic iron regulator protein ( HFE) gene. Abnormal accumulation of iron causes a joint disease that resembles osteoarthritis (OA), but appears at a relatively younger age and is accompanied by cirrhosis, diabetes, and injury to other organs. Increased serum transferrin saturation and ferritin levels are known markers of haemochromatosis with high positive predictive values. Methods We have retrospectively analyzed the iron studies of a cohort of 2,035 patients undergoing knee joint arthroplasty due to OA. Results No patients had HFE gene C282Y, S65C, or H63D mutations testing. In total, 18 patients (2.96%) of the male cohort and 51 (3.58%) of the female cohort had pathologically increased ferritin levels that may be indicative of haemochromatosis. Seven patients (0.34%) had serum transferrin saturation above 45%. Conclusion The awareness for the diagnosis of this disorder in Orthopaedics is low and needs improvement. Osteoarthritic patients undergoing knee arthroplasty should be routinely screened for haemochromatosis by iron studies and referred to genetic testing when needed. Level of evidence: Level III - Retrospective cohort study. Cite this article: Bone Jt Open 2021;2(12):1062–1066.