bluuebunny/crossref_metadata_2025_split huggingface dataset:
An ‘Omics Approach to Unraveling the Paradoxical Effect of Diet on Perfluorooctanesulfonic Acid (PFOS) and Perfluorononanoic Acid (PFNA)-Induced Hepatic Steatosis
Authors: Pfohl Marisa , Marques Emily , Auclair Adam , Barlock Benjamin , Jamwal Rohitash , Goedken Michael , Akhlaghi Fatemeh , Slitt Angela L 
Published: January 2021

Abstract
Perfluoroalkyl substances (PFAS) are a family of toxicants universally detected in human serum and known to cause dyslipidemia in animals and humans. Hepatic steatosis, which is defined as lipid deposition in the liver, is known to be a consequence of poor diet. Similarly, PFAS are known to induce hepatic steatosis in animals on a low-fat chow. This study explored diet-PFAS interactions in the liver and their potential to modulate hepatic steatosis. Male C57BL/6J mice were fed with either a low-fat diet (10% kcal from fat, LFD) or a moderately high-fat diet (45% kcal from fat, HFD) with or without perfluorooctanesulfonic acid (3 ppm, PFOS) or perfluorononanoic acid (3 ppm, PFNA) in feed for 12 weeks. Livers were excised for histology and quantification of PFAS and lipids. The PFOS and PFNA coadministration with HFD reduced the hepatic accumulation of lipid and PFAS relative to the LFD treatment groups. Furthermore, transcriptomic analysis revealed that PFAS administration in the presence of an HFD significantly reduces expression of known hepatic PFAS uptake transporters, organic anion transporter proteins. Transcriptomics and proteomics further revealed several pathways related to lipid metabolism, synthesis, transport, and storage that were modulated by PFAS exposure and further impacted by the presence of dietary fat. Both dietary fat content and the chemical functional head group exerted significant influence on hepatic PFAS accumulation and the resulting biochemical signature, suggesting that diet and structure should be considered in the design and interpretation of research on PFAS induced hepatic steatosis.
Photoprotective compounds as early markers to predict holm oak crown defoliation in declining Mediterranean savannahs
Authors: Encinas-Valero Manuel , Esteban Raquel , Hereş Ana-Maria , Becerril José María , García-Plazaola José Ignacio , Artexe Unai , Vivas María , Solla Alejandro , Moreno Gerardo , Curiel Yuste Jorge 
Published: January 2021

AbstractDehesas, human-shaped savannah-like ecosystems, where the overstorey is mainly dominated by the evergreen holm oak (Quercus ilex L. subsp. ballota (Desf.) Samp.), are classified as a global conservation priority. Despite being Q. ilex a species adapted to the harsh Mediterranean environmental conditions, recent decades have witnessed worrisome trends of climate-change-induced holm oak mortality. Holm oak decline is evidenced by tree vigour loss, gradual defoliation and ultimately, death. However, before losing leaves, trees undergo leaf-level physiological adjustments in response to stress that may represent a promising field to develop biochemical early markers of holm oak decline. This study explored holm oak photoprotective responses (pigments, tocopherols and photosynthetic performance) in 144 mature holm oak trees with different health statuses (i.e., crown defoliation percentages) from healthy to first-stage declining individuals. Our results indicate differential photochemical performance and photoprotective compounds concentration depending on the trees' health status. Declining trees showed higher energy dissipation yield, lower photochemical efficiency and enhanced photoprotective compounds. In the case of total violaxanthin cycle pigments (VAZ) and tocopherols, shifts in leaf contents were significant at very early stages of crown defoliation, even before visual symptoms of decline were evident, supporting the value of these biochemical compounds as early stress markers. Linear mixed-effects models results showed an acute response, both in the photosynthesis performance index and in the concentration of foliar tocopherols, during the onset of tree decline, whereas VAZ showed a more gradual response along the defoliation gradient of the crown. These results collectively demonstrate that once a certain threshold of leaf physiological damage is surpassed, that leaf cannot counteract oxidative stress and progressive loss of leaves occurs. Therefore, the use of both photosynthesis performance indexes and the leaf tocopherols concentration as early diagnostic tools might predict declining trends, facilitating the implementation of preventive measures to counteract crown defoliation.
Matching the Pieces: The Presence of Idiosyncratic Deals and Their Impact on Retirement Preferences Among Older Workers
Authors: Jonsson Robin , Hasselgren Caroline , Dellve Lotta , Seldén Daniel , Larsson Daniel , Stattin Mikael 
Published: January 2021

AbstractDespite working life prolongation having been at the center of the policy agenda in Europe for the last two decades, organizations’ engagement in formal age-management activities intended to strengthen older workers’ motivation and work ability appears limited. Given policies to extend working lives, negotiated individualized work arrangements—often called idiosyncratic deals (I-deals)—can be an informal and complementary approach to formalized age-management practices, improving the person–job fit and helping older workers extend their working lives. Nevertheless, research on I-deals and retirement preferences remains scarce in the Nordic context, where collective agreements regulate conditions of employment and the employer–employee relationship. Using confirmatory factor analysis and structural equation modeling, this study examines five areas of I-deals (i.e., Task and Work Responsibilities, Workload Reduction, Schedule Flexibility, Location Flexibility, and Financial Incentives) and their relationships with retirement preferences among Swedish public-sector employees aged 55 years or older (n = 4,499). Findings show that I-deals are generally less prevalent among women and older employees, as well as among those with poor health, in lower socioeconomic positions, and with shorter organizational tenure. Regarding retirement preferences, we found Task and Work Responsibilities to be related to later preferred retirement age, while, surprisingly, the opposite was observed for Workload Reduction, probably because individuals who received workload reductions also reported poorer health. Comparatively, factors such as matching employees’ competence, experience, and growth opportunities seem to be the most important for public-sector employees’ retirement preferences.
Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence
Authors: Kanlioz Murat , Ekici Uğur , Tatli Faik , Karatas Turgay 
Published: January 2021

ABSTRACT

OBJECTIVE
To assess the success of treatment methods at reducing recurrence, the most important problem in pilonidal sinus disease (PSD), along with factors affecting the occurrence of PSD and posttreatment recurrence.

METHODS
The researchers retrospectively analyzed files of patients treated for PSD between 2003 and 2018. Three study groups were created: G1, G2, and G3. G1 included all PSDs with recurrence, and a comparable number of cases without recurrence were selected randomly for the G2 group. The control group, G3, included healthy individuals without PSD. In all groups, the following were recorded: body mass index, skin color and oiliness, family history of PSD, hair overgrowth, smoking habit, time spent sitting per day, and number of baths per week. The following were additionally recorded for G1 and G2: treatment methods, follow-up periods, pretreatment abscess(es), and time of onset of complaints before treatment. The number of recurrences and the period between last treatment and recurrence were also recorded for G1.

RESULTS
G1 comprised 234 patients; G2, 247 patients; and G3, 128 healthy individuals. The significant factors causing recurrence included body mass index, family history, bathing habits, hair overgrowth, skin color and oiliness, time spent sitting per day, smoking habit, abscess(es), and duration of symptom(s) (P < .05). Limberg flap repair was the most successful treatment method. Sixty-three (27%), 135 (58%), and 185 (79%) recurrences occurred in the first 6 months, in the first year, and in the first 2 years, respectively.

CONCLUSIONS
The researchers recommend Limberg flap repair for treatment. It is possible to reduce recurrence by taking preventable factors into consideration.
Understanding gastroesophageal reflux disease in children
Authors: Friedman Chloe , Sarantos Gianna , Katz Sarah , Geisler Sheryl 
Published: January 2021

ABSTRACT
Gastroesophageal reflux disease (GERD) is a common disorder with increasing prevalence in children. The diagnosis and management of GERD remains a challenge because of its nonspecific symptomatology from infancy through adolescence. Certain presenting alarm symptoms warrant a further, more extensive workup. Treatment of pediatric GERD begins with lifestyle and nonpharmacologic management, including postural adjustments, dietary changes, and weight loss if indicated. Pharmacologic interventions can be prescribed to relieve symptoms for patients whose disease does not respond to lifestyle management. Patients with refractory symptoms can be managed with surgical intervention. Complications may arise if GERD remains untreated, ranging from worsening oral health to failure to thrive.
Changes in the Frequency of Cesarean Delivery in Nulliparous Women in Labor in a Canadian Population, 1992–2018
Authors: Wood Stephen , Tang Selphee 
Published: January 2021

OBJECTIVE:
To examine the relative contribution of changes in patient demographics and physician management to changes in the cesarean delivery rate in labor among nulliparous women.

METHODS:
We conducted a retrospective cohort study of 485,451 births to nulliparous women who experienced labor at or beyond 35 weeks of gestation in Alberta, Canada, from 1992 to 2018. The data were from a province-wide perinatal database. The primary outcome was cesarean delivery. Multivariate logistic regression and calculation of population attributable risk for identified risk factors were performed.

RESULTS:
The cesarean delivery rate increased from 12.5% in 1992 to 24% in 2018. The prevalence of maternal risk factors for cesarean delivery such as obesity, maternal age 35 years or older at delivery, and comorbidities increased over the study period. However, this did not account for the increase in cesarean delivery, because the frequency of cesarean delivery increased irrespective of risk status. Additionally, the population-attributable risk for each risk factor was stable across the study period. For example, for maternal age 35 years or older at delivery, the number of cesarean deliveries attributable to this factor (the population-attributable risk) was 0.9 per 100 deliveries in 1992–1998 and 1 per 100 in 2014–2018. The proportion of cesarean deliveries in which nonreassuring fetal status was the indication increased from 30.1% in 1992 to 51.1% in 2018. The absolute rate of cesarean delivery in the second stage of labor increased from 3.1% in 1992 to 5.9% in 2018. This was due to a significant increase, among those who entered the second stage, in cesarean delivery without a trial of forceps, from 2.5% in 1992 to 7.0% in 2018.

CONCLUSION:
The observed doubling of the rate of cesarean delivery in labor in first-time mothers was not driven by patient risk factors. Increases in the rate of cesarean delivery for nonreassuring fetal status and decreased operative vaginal deliveries were important factors.
Prophylactic Negative Pressure Wound Therapy After Laparotomy for Gynecologic Surgery
Authors: Leitao Mario M. , Zhou Qin C. , Schiavone Maria B. , Cowan Renee A. , Smith Evan S. , Iasonos Alexia , Veith Mitchell , Rafizadeh Michael , Curran Katherine , Ramesh Bhavani , Chang Kaity , Chi Dennis S. , Sonoda Yukio , Brown Amy K. , Cosin Jonathan A. , Abu-Rustum Nadeem R. , Martino Martin A. , Mueller Jennifer J. , Long Roche Kara , Jewell Elizabeth L. , Broach Vance , Lambrou Nicholas C. , Diaz John P. , Zivanovic Oliver 
Published: January 2021

OBJECTIVE:
To estimate the effectiveness of prophylactic negative pressure wound therapy in patients undergoing laparotomy for gynecologic surgery.

METHODS:
We conducted a randomized controlled trial. Eligible, consenting patients, regardless of body mass index (BMI), who were undergoing laparotomy for presumed gynecologic malignancy were randomly allocated to standard gauze or negative pressure wound therapy. Patients with BMIs of 40 or greater and benign disease also were eligible. Randomization, stratified by BMI, occurred after skin closure. The primary outcome was wound complication within 30 (±5) days of surgery. A sample size of 343 per group (N=686) was planned.

RESULTS:
From March 1, 2016, to August 20, 2019, we identified 663 potential patients; 289 were randomized to negative pressure wound therapy (254 evaluable participants) and 294 to standard gauze (251 evaluable participants), for a total of 505 evaluable patients. The median age of the entire cohort was 61 years (range 20–87). Four hundred ninety-five patients (98%) underwent laparotomy for malignancy. The trial was eventually stopped for futility after an interim analysis of 444 patients. The rate of wound complications was 17.3% in the negative pressure wound therapy (NPWT) group and 16.3% in the gauze group, absolute risk difference 1% (90% CI −4.5 to 6.5%; P=.77). Adjusted odds ratio controlling for estimated blood loss and diabetes was 0.99 (90% CI 0.62–1.60). Skin blistering occurred in 33 patients (13%) in the NPWT group and in three patients (1.2%) in the gauze group (P<.001).

CONCLUSION:
Negative pressure wound therapy after laparotomy for gynecologic surgery did not lower the wound complication rate but did increase skin blistering.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02682316.

FUNDING SOURCE:
The protocol was supported in part by KCI/Acelity.
Congenital Kyphosis: Progressive Correction With an Instrumented Posterior Epiphysiodesis: A Preliminary Report
Authors: Rocos Brett , Lebel David E. , Zeller Reinhard 
Published: January 2021

Purpose:
Congenital kyphosis is a rare condition. In this case series we sought to identify the outcomes and complications of posterior instrumented fusion and the resultant epiphysiodesis effect in uniplanar congenital kyphosis in pediatric patients.

Method:
Pediatric patients were included if treated for a uniplanar congenital kyphotic deformity treated with posterior instrumented spinal fusion between October 2006 and August 2017, with a minimum of 2 years of follow-up. Patients were excluded if a coronal deformity >10 degrees was present.

Results:
Six patients met the inclusion criteria. Mean age at surgery was 3.6 years. The mean kyphotic deformity before surgery was 49.7 degrees. All patients underwent posterior instrumented fusion with autogenous iliac crest graft and a cast or brace postoperatively. One patient showed a loss of motor evoked potential on prone positioning which returned to normal on supine positioning. No patient showed any postoperative neurological deficits. One patient was diagnosed with a wound infection which was successfully treated with oral antibiotics.
By a follow-up of 5.4 years (range, 2.2 to 10.9 y) there was no failure of instrumentation. An epiphysiodesis effect (a difference of ≥5 degrees in the kyphotic deformity measured between the immediate postoperative and final follow-up lateral whole spine XR) of 16.2 degrees (range, 7.2 to 30.9 degrees) was seen in 5 patients. The mean annual epiphysiodesis effect was 2.7 degrees (95% confidence interval, 1.4-4.1 degrees). No kyphosis proximal to the instrumentation was observed for the duration of follow-up.

Conclusion:
Posterior instrumented fusion and epiphysiodesis is safe and effective. The epiphysiodesis effect occurs in 5/6 of cases, and our data suggests that the procedure is associated with an acceptable blood loss and a low incidence of neurological complications.
Risk Factors for Revision Surgery After Primary Adult Thoracolumbar Deformity Surgery
Authors: Varshneya Kunal , Stienen Martin N. , Medress Zachary A. , Fatemi Parastou , Pendharkar Arjun V. , Ratliff John K. , Veeravagu Anand 
Published: January 2021

Study Design:
This is a retrospective cohort study.

Objective:
The aim was to identify the risk factors for revision surgery within 2 years of patients undergoing primary adult spinal deformity (ASD) surgery.

Summary of Background Data:
Previous literature reports estimate 20% of patients undergoing thoracolumbar ASD correction undergo reoperation within 2 years. There is limited published data regarding specific risk factors for reoperation in ASD surgery in the short term and long term.

Methods:
The authors queried the MarketScan database in order to identify patients who were diagnosed with a spinal deformity and underwent ASD surgery from 2007 to 2015. Patient-level factors and revision risk were investigated during 2 years after primary ASD surgery. Patients under the age of 18 years and those with any prior history of trauma or tumor were excluded from this study.

Results:
A total 7422 patients underwent ASD surgery during 2007–2015 in the data set. Revision rates were 13.1% at 90 days, 14.5% at 6 months, 16.7% at 1 year, and 19.3% at 2 years. In multivariate multiple logistic regression analysis, obesity [adjusted odds ratio (OR): 1.58, P<0.001] and tobacco use (adjusted OR: 1.38, P=0.0011) were associated with increased odds of reoperation within 2 years. Patients with a combined anterior-posterior approach had lower odds of reoperation compared with those with posterior only approach (adjusted OR: 0.66, P=0.0117).

Conclusions:
Obesity and tobacco are associated with increased odds of revision surgery within 2 years of index ASD surgery. Male sex and combined surgical approach are associated with decreased odds of revision surgery.
Tocilizumab in Coronavirus Disease 2019-Related Critical Illness: A Propensity Matched Analysis
Authors: Rajendram Prabalini , Sacha Gretchen L. , Mehkri Omar , Wang Xiaofeng , Han Xiaozhen , Vachharajani Vidula , Duggal Abhijit 
Published: January 2021

Objectives:
The primary objective was to evaluate ICU mortality at 28 days in patients with severe hypoxemic respiratory failure due to coronavirus disease 2019 infection who received tocilizumab. The secondary objectives were to evaluate ICU-, hospital-, mechanical ventilation-, and vasopressor-free days at day 28 and development of secondary infections.

Design:
Retrospective, observational, multicenter, cohort study between March 15, 2020, and May 31, 2020. Using propensity score matching based on ICU admission source, C-reactive protein, Sequential Organ Failure Assessment score, vasopressor use, age, race, weight, and mechanical ventilation, patients who received tocilizumab were matched to patients who did not receive tocilizumab.

Setting:
Ten hospitals within the Cleveland Clinic Enterprise.

PATIENTS:
Adult patients admitted to a medical, surgical, neurosciences, or mixed ICU with severe acute respiratory syndrome coronavirus 2 infection.

Interventions:
None.

Measurements and Main Results:
Four-hundred forty-four patients were included: 342 patients (77%) did not receive tocilizumab and 102 patients (23%) received tocilizumab. Of those, 82 patients in each arm were matched. Before matching, patients who received tocilizumab had higher Sequential Organ Failure Assessment scores (6.1 ± 3.4 vs 4.7 ± 3.6), higher C-reactive protein (21.0 ± 10.2 vs 13.7 ± 9.6 mg/dL), higher frequency of intubation, vasopressor requirement, and paralytics. After matching, characteristics were more balanced and over 85% of patients required mechanical ventilation. ICU mortality was lower in tocilizumab group (23.2% vs 37.8%; risk difference, –15%; 95% CI, –29% to –1%), with more ICU-, hospital-, and vasoactive-free days at day 28 compared with those who did not receive tocilizumab. There was no difference in mechanical ventilation-free days at day 28 or development of secondary infections.

Conclusions:
Tocilizumab use was associated with a significant decrease in ICU mortality in critically ill coronavirus disease 2019 patients with severe hypoxemic respiratory failure. Future randomized controlled trials limited to tocilizumab administration in critically ill coronavirus disease 2019 patients, with severe hypoxemic respiratory failure, are needed to support these findings.
Age–period–cohort effects in utilization of diagnostic procedures leading to incidental colorectal cancer detection
Authors: Salvatori Andrea , Andreano Anita , Decarli Adriano , Russo Antonio Giampiero 
Published: January 2021

Background and aim
Despite the overall decrease in colorectal cancer (CRC) incidence, a small but constant rise has been recently observed in people younger than 50 years across several countries. This phenomenon can be explained by environmental or lifestyle factors, but it may also be partially justified by an increasing tendency in younger cohorts to undertake diagnostic procedures that may lead to CRC incidental diagnosis.

Methods
We performed an age–period–cohort analysis on 1 815 694 diagnostic procedures undertook by the population of the City of Milan, served by the Agency for Health Protection of Milan, between 1999 and 2018. We considered all instances of colonoscopy, rectoscopy, fecal occult blood test (FOBT) and ultrasonography. We stratified by gender, nationality and quintile of socioeconomic deprivation.

Results
Incidence of utilization rose with age for all procedures but rectoscopy; there was a marked increase from 2005 to 2010 for FOBT and colonoscopy. A strong all-procedures cohort effect was observed, greater for FOBT and colonoscopy. A steady increase of diagnostic procedures utilization started in cohorts born in the late 1950s, with a relative effect rising from 0.91 [95% confidence interval (CI) 0.90–0.92] for the 1950 cohort to 5.03 (95% CI, 4.58–5.48) for the 1990 one.

Conclusion
We found a growing tendency in younger cohorts to undertake diagnostic procedures, explainable by inappropriate access to endoscopic procedures, that can lead to an incidental diagnosis of CRC. This finding may at least partially explain the observed rising incidence of early-onset CRC.
The role of cardiorespiratory fitness on quality of life in midlife women
Authors: Flesaker Michelle Q. , Serviente Corinna , Troy Lisa M. , Witkowski Sarah 
Published: January 2021

Abstract

Objective:
We aimed to characterize the relationship between cardiorespiratory fitness and quality of life in a sample of healthy midlife women aged 40 to 65 years.

Methods:
Cardiorespiratory fitness was measured with a VO2max test. Quality of life was assessed with the menopause-specific Utian Quality of Life scale (UQOL). The UQOL measures overall quality of life, which comprises health, emotional, occupational, and sexual domains. Simple and multiple linear regression models were built to analyze relationships between cardiorespiratory fitness and overall quality of life as well as the separate UQOL domains.

Results:
Forty-nine women with an average age of 52.5 years were included in the analysis. In simple linear models, cardiorespiratory fitness was related to overall (R

2
= 0.34, P < 0.001), health (R

2
= 0.55, P < 0.001), emotional (R

2
= 0.08, P = 0.05), and occupational (R

2
= 0.09, P = 0.03) quality of life. In multiple regression models, cardiorespiratory fitness was associated with overall (P < 0.01) and health (P < 0.001) quality of life, after controlling for physical activity, age, body mass index, and time sedentary.

Conclusions:
Higher cardiorespiratory fitness is associated with better quality of life during midlife, particularly in the health domain. Increasing cardiorespiratory fitness may be a useful means to promote quality of life in this population.