bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current status of medical oncology in Japan and changes over the most recent 7-year period: results of a questionnaire sent to designated cancer care hospitals
Authors: Arai Makoto , Ohno Izumi , Takahashi Koji , Fan Meng Meng , Tawada Akinobu , Ishioka Chikashi , Takiguchi Yuichi 
Published: August 2021

Abstract

Background
According to a questionnaire sent to Designated Cancer Care Hospitals in Japan in 2013, only 39.4% of the institutes had medical oncology departments. Furthermore, most of these medical oncology departments were primarily responsible for the treatment of limited disease categories and the administration of newly developed therapeutic modalities, including molecular-targeted therapy. The aim of the present study was to update these previous findings and to clarify the changes over the intervening 7-year period.

Methods
The questionnaire was sent to all 393 Designated Cancer Care Hospitals on 13 March 2020. Similar to the previous questionnaires, questions were asked regarding the presence of a medical oncology department, the number of physicians in the department and the degrees of responsibility for drug therapies provided by medical oncologists to adult patients with solid cancers.

Results
In total, 270 institutions (68.7%) responded. Overall, 145 of these 270 institutions (53.7%) had medical oncology departments, representing a significant increase compared with the results of the previous study (P &lt; 0.01). Among the institutions with a medical oncology department, these departments were responsible for the administration of over 30% of all cytotoxic and molecular-targeted drug therapies for extragonadal germ cell tumors, cancers of unknown primary site, soft tissues, head and neck, esophagus, stomach, colon and rectum, and pancreas as well as the administration of immune checkpoint inhibitors (ICI) for microsatellite instability-high tumors, cancers of the stomach, esophagus and head and neck, and melanoma.

Conclusion
The proportion of institutes with medical oncology departments in Japan has increased. In addition, the responsibility of medical oncology departments has expanded to include newly emerging drugs, such as ICIs.
Frameless immobilization system with roll correction for stereotactic radiosurgery of intracranial brain metastases
Authors: Park So-Yeon , Choi Noorie , Jang Na Young 
Published: August 2021

Abstract
The objectives of this study were to develop a frameless immobilization system that allows roll rotation corrections and to investigate the performance of this system for stereotactic radiosurgery (SRS) treatment. We designed the support frame of a frameless immobilization system based on the commercial Brainlab immobilization system. The support frame consisted of a fixed component and a rotating component. With rack and pinion gears and guide holes installed in the system, the rotating component was configured to be rotated along the longitudinal axis of the patient with respect to the fixed component. To evaluate the performance of the system, the six degree-of-freedom (6D) positioning corrections (translational and rotational corrections) were assessed by image verification between planning computed tomography (CT) and cone-beam computed tomography (CBCT) images. The commercial immobilization system was evaluated in the same manner for comparison. The mean translational shifts for the commercial system were 0.68 ± 0.19 mm, 0.73 ± 0.24 mm and 0.78 ± 0.19 mm, while those for the developed system were 0.44 ± 0.31 mm, 0.43 ± 0.25 mm and 0.60 ± 0.14 mm in the lateral, longitudinal and vertical directions, respectively. The mean rotational shifts for the commercial system were 0.37° ± 0.12°, 0.32° ± 0.16° and 0.38° ± 0.14°, while those for the developed system were 0.04° ± 0.04°, 0.11° ± 0.06° and 0.15° ± 0.12° along the lateral, vertical and longitudinal axes of the patient, respectively. For institutions that do not have 6D robotic couches installed, the use of the developed immobilization system can provide 6D corrections, resulting in shorter treatment times and higher patient positioning accuracy.
Relationships of pelagic ciliates with the microbial food web components at a coastal station in the oligotrophic Eastern Mediterranean Sea: temporal and vertical variability
Authors: Romano Filomena , Pitta Paraskevi 
Published: August 2021

Abstract
The annual/temporal and vertical dynamics of the microbial food web (MFW) was studied in a coastal station of the oligotrophic Eastern Mediterranean Sea. The present study analyzed the changes of all components of the MFW with a specific focus on the relationships between different size classes of heterotrophic and mixotrophic ciliates with their potential prey. The MFW was dominated by heterotrophic picoplankton in all months and depths analyzed, whereas autotrophic nanoplankton took advantage in cold months with higher nutrient availability. On the other hand, mixotrophic microplankton biomass was higher in summer when nutrients and chlorophyll-a were scarce.
As part of the mixotrophic biomass, mixotrophic ciliates were correlated with their “potential” prey at the surface and deep chlorophyll maximum. Large mixotrophic ciliates (L. strobila) were more selective in terms of potential prey, showing a correlation with Synechococcus. On the other hand, mixotrophic nanociliates (Strombidium dalum) were correlated differently with different potential prey according to depth, supporting the idea that nanociliates could be more generalists in terms of prey selection. Because the relationships between mixotrophic ciliates and their potential prey are still poorly studied, this work represents the start for further investigation.
Determinants of Global Value Chain Participation: Cross-Country Evidence
Authors: Fernandes Ana Margarida , Kee Hiau Looi , Winkler Deborah 
Published: August 2021

AbstractThe past decades have witnessed big changes in international trade with the rise of global value chains (GVCs). Some countries, such as China, Poland, and Vietnam rode the tide, while other countries, many in the Africa region, faltered. This paper studies the determinants of countries’ GVC participation, based on a panel database of more than 100 countries from 1990 to 2015. Results from a three-pronged empirical approach show that factor endowments, geography, political stability, liberal trade policies, foreign direct investment and domestic industrial capacity are very important in determining GVC participation. These factors matter more for GVC trade than traditional trade.
Peripheral Arterial Lines in Extremely Preterm Neonates
Authors: Mense Lars , Rose Stephanie , Bruck Antje , Rüdiger Mario , Kaufmann Maxi , Seipolt Barbara 
Published: August 2021

Background:
Arterial catheterization is a routine procedure in extremely preterm neonates. Umbilical arterial catheters (UACs) are typically used for this purpose, but life-threatening complications have been described. Peripheral arterial lines (PALs) might offer a valuable alternative, but their feasibility in extremely preterm newborns is unclear.

Purpose:
To investigate efficacy and complications of PALs in extremely preterm neonates.

Methods:
Retrospective analysis of patients born below 26 weeks of gestation in 2011-2014 (cohort 1, UAC as primary arterial access) and 2015-2019 (cohort 2, PAL as primary arterial access). Arterial line placement during their first 14 days of life, duration of arterial access, reasons for discontinuation, and long-term complications were recorded from health records.

Results:
In total, 161 of 202 newborns had an arterial line during their first 14 days of life. In cohort 2, the life span of a PAL was significantly longer than that in cohort 1. Signs of dysfunction were the primary reason to discontinue a PAL. Signs of peripheral ischemia were present in 36 of 105 cases (34%) when the PAL was removed but persisted in only 2 patients. UAC-associated persistent ischemic damage occurred in 2 of 97 patients.

Implications for Practice and Research:
PALs are a valuable alternative to UACs even in preterm newborns below 26 weeks of gestational age. A special focus on ischemic complications is warranted. Prospective, multicenter studies to verify safety and efficacy of arterial line management and complications in extremely preterm infants are warranted.
Performing Multiple Posterior Spinal Fusions in 1 Day: A Comparison of Perioperative Outcomes Between Morning and Afternoon Cases
Authors: O’Neill Nora P. , Hedequist Daniel J. , Glotzbecker Michael , Cook Danielle , Yang Troy , McCann Mary E. , Chacko Sabeena , Cravero Joseph , Hresko Michael Timothy 
Published: August 2021

Background:
High-volume centers for idiopathic scoliosis (IS) have difficulty in scheduling posterior spinal fusions (PSFs) due to operating room availability, particularly during school vacation. A solution is for 1 surgeon to perform 2 PSF cases back-to-back. This study aims to compare morning and afternoon PSF cases performed by the same surgeon for perioperative outcomes.

Methods:
A retrospective review of PSF cases for IS that occurred on the same day as another PSF by the same surgeon between January 2013 and December 2019 was conducted. Perioperative outcomes included surgical time, estimated blood loss, length of stay, and inpatient opioid consumption normalized by the patient’s weight. Postoperative outcomes included complications, revision rate, curve correction, and patient-reported outcomes using the Scoliosis Research Society-30.

Results:
A total of 95 patients (87% female), mean age 15.6 years, were analyzed, with 48 morning cases and 47 afternoon cases. The median follow-up was 1.9 years (range: 0.3 to 6.1 y). Tests for equivalency determined equivalence in median anesthesia and mean surgical duration (P=0.05). The groups had similar initial curve correction (P=0.43) and rate of complications at 90 days postoperative (2 in each group for a total of 4 complications). No significant differences were seen between Scoliosis Research Society-30 scores at 6 months or in those who have reached 2 years postoperative.

Conclusions:
Little literature exists on the safety of a surgeon performing 2 PSF cases in 1 day, particularly in regard to pain outcomes, 30- and 90-day complication rates, and quality of life measures. This study indicates that few differences in safety, pain, and quality of life outcomes may appear between morning and afternoon PSF cases.

Level of Evidence:
Level II.
Time-Dissociated Pharmacokinetic Pharmacodynamic Model of Cyclosporine Among Malaysian Renal Transplant Recipients
Authors: Albitar Orwa , Harun Sabariah Noor , Ballouze Rama , Mohamed Noor Dzul Azri , Sheikh Ghadzi Siti Maisharah 
Published: August 2021

Background:
Cyclosporine is an essential component of many immunosuppressive regimens. However, its pharmacokinetic and pharmacodynamic (PKPD) modeling has not been widely investigated. This study aims to develop a time-dissociated PKPD model of cyclosporine in renal transplant patients.

Methods:
Medical records of renal transplant patients at Penang General Hospital were retrospectively analyzed. A time-dissociated PKPD model with covariate effects was developed using NONMEM to evaluate renal graft function response, quantified as estimated glomerular filtration rate (eGFR), toward the cyclosporine cumulative exposure (area under the concentration–time curve). The final model was integrated into a tool to predict the potential outcome. Individual eGFR predictions were evaluated based on the clinical response recorded as acute rejection/nephrotoxicity events.

Results:
A total of 1256 eGFR readings with 2473 drug concentrations were obtained from 107 renal transplant patients receiving cyclosporine. An Emax drug effect with a linear drug toxicity model best described the data. The baseline renal graft level (E0), maximum effect (Emax), area under the concentration–time curve achieving 50% of the maximum effect, and nephrotoxicity slope were estimated as 12.9 mL·min−1·1.73 m−2, 50.7 mL·min−1·1.73 m−2, 1740 ng·h·mL−1, and 0.00033, respectively. The hemoglobin level was identified as a significant covariate affecting the E0. The model discerned acute rejection from nephrotoxicity in 19/24 cases.

Conclusions:
A time-dissociated PKPD model successfully described a large number of observations and was used to develop an online tool to predict renal graft response. This may help discern early rejection from nephrotoxicity, especially for patients unwilling to undergo a biopsy or those waiting for biopsy results.
Toward Standardization of the Placement Process Used in Full-Time Clinical Education Experiences: Findings and Recommendations of the Placement Process Task Force
Authors: Rindflesch Aaron , Flom-Meland Cindy , McCallum Christine , Prescher Kelly , Reynolds Emily , Scardillo Janette , Gusman Lori Nolan , Maes Kristel , Cohoon Christie , Cookinham Brittani , Ellerbe Redd Terri 
Published: August 2021

Background and Purpose.
The Placement Process Task Force (PPTF), a combined effort of the Clinical Education Special Interest Group and the National Consortium of Clinical Educators, has developed recommendations for the placement process of students in full-time clinical education experiences following data collection from stakeholders. The PPTF submitted a report to both boards and highlights its methods and rationale for the recommendations here.

Position and Rationale.
To reduce variability and administrative burden shared among stakeholders, there should be a common definition of the process. Additionally, a common clinical calendar should be developed and adopted with accepted deadlines for placement requests, offer acceptance, offer release, student assignment, and onboarding requirements. Training should be required for new directors of clinical education (DCEs) and site coordinators of clinical education (SCCEs) to initiate them to the common calendar. Only the DCE/ACCE or employed members of the DCE/ACCE team should be responsible for securing clinical education placement offers. Adoption of these recommendations will allow progress toward the goal of reducing administrative burden with the potential of creating opportunities for DCEs and SCCEs to participate in the advancement of clinical education development and scholarship.

Discussion and Conclusion.
The current variability of placement processes commonly used in full-time clinical education has negative effects on SCCEs and clinics, DCEs and academic programs, and students. Reducing variability and administrative burden can result in additional productivity of stakeholders for tasks, such as clinical instructor development, student development, and clinical education research.
Association of dispatcher-assisted cardiopulmonary resuscitation with initial shockable rhythm and survival after out-of-hospital cardiac arrest
Authors: Goto Yoshikazu , Funada Akira , Maeda Tetsuo , Goto Yumiko 
Published: August 2021

Background and importance
Bystander cardiopulmonary resuscitation (CPR) and initial shockable rhythm are crucial predictors of survival after out-of-hospital cardiac arrest (OHCA). However, the relationship between dispatcher-assisted CPR (DA-CPR) and initial shockable rhythm is not completely elucidated.

Objective
To examine the association of DA-CPR with initial shockable rhythm and outcomes.

Design, setting and participants
This nationwide population-based observational study conducted in Japan included 59 688 patients with witnessed OHCA of cardiac origin after excluding those without bystander CPR. Patients were divided into DA-CPR (n = 42 709) and CPR without dispatcher assistance (unassisted CPR, n = 16 979) groups.

Outcome measures and analysis
The primary outcome measure was initial shockable rhythm, and secondary outcome measures were 1-month survival and neurologically intact survival. A Cox proportional hazards model adjusted for collapse-to-first-rhythm-analysis time and multivariable logistic regression models were used after propensity score (PS) matching to compare the incidence of initial shockable rhythm and outcomes, respectively.

Main results
Among all patients (mean age 76.7 years), the rates of initial shockable rhythm, 1-month survival and neurologically intact survival were 20.8, 10.7 and 7.0%, respectively. The incidence of initial shockable rhythm in the DA-CPR group (20.4%, 3462/16 979) was significantly higher than that in the unassisted CPR group (18.5%, 3133/16 979) after PS matching (P < 0.0001). However, no significant differences were found between the two groups with respect to the incidence of initial shockable rhythm in the Cox proportional hazards model [adjusted hazard ratio of DA-CPR for initial shockable rhythm compared with unassisted CPR, 0.99; 95% confidence interval (CI), 0.97–1.02, P = 0.56]. No significant differences were observed in the survival rates in the two groups after PS matching [10.8% (1833/16 979) vs. 10.3% (1752/16 979), P = 0.16] and neurologically intact survival rates [7.3% (1233/16 979) vs. 6.8% (1161/16 979), P = 0.13]. The multivariable logistic regression model showed no significant differences between the groups with regard to survival (adjusted odds ratio of DA-CPR compared with unassisted CPR: 1.00; 95% CI, 0.89–1.13, P = 0.97) and neurologically intact survival (adjusted odds ratio: 1.12; 95% CI, 0.98–1.29, P = 0.14).

Conclusion
DA-CPR after OHCA had the same independent association with the likelihood of initial shockable rhythm and 1-month meaningful outcome as unassisted CPR.
Metabolic regulation of macrophage proliferation and function in atherosclerosis
Authors: Patterson Michael T. , Williams Jesse W. 
Published: August 2021

Purpose of review
Macrophage accumulation within atherosclerotic plaque is a primary driver of disease progression. However, recent advances in both phenotypic and functional heterogeneity of these cells have allowed for improved insight into potential regulation of macrophage function within lesions. In this review, we will discuss recent insights on macrophage heterogeneity, lipid processing, metabolism, and proliferation in atherosclerosis. Furthermore, we will identify outstanding questions in the field that are pertinent to future studies.

Recent findings
With the recent development of single-cell RNA sequencing, several studies have highlighted the diverse macrophage populations within plaques, including pro-inflammatory, anti-inflammatory, lipid loaded and tissue resident macrophages. Furthermore, new data has suggested that differential activation of metabolic pathways, including glycolysis and fatty acid oxidation, may play a key role in determining function. Recent works have highlighted that different populations retain varying capacity to undergo proliferation; regulating the proliferation pathway may be highly effective in reducing plaque in advanced lesions.

Summary
Macrophage populations within atherosclerosis are highly heterogeneous; differences in cytokine production, lipid handling, metabolism, and proliferation are seen between subpopulations. Understanding the basic cellular mechanisms that drive this heterogeneity will allow for the development of highly specific disease modulating agents to combat atherosclerosis.
Systematic Review and Meta‐analysis of Histological Gastric Biopsy Aspects According to the Updated Sydney System in Children
Authors: Kalach Nicolas , Zrinjka Misak , Bontems Patrick , Kori Michal , Homan Matjaz , Cabral José , Casswall Thomas , Chong Sonny , Cilleruelo Maria Luz , Faraci Simona , Megraud Francis , Papadopoulou Alexandra , Pehlivanoglu Ender , Raymond Josette , Rea Francesca , Maria Rogalidou , Roma Eleftheria , Tavares Marta , Ugras Meltem , Urbonas Vaidotas , Urruzuno Pedro , Gosset Pierre , Creusy Colette , Delebarre Mathilde , Verdun Stephane ,   ESPGHAN‐Helicobacter pylori Special Interest Group (ESPGHAN‐ H. pylori‐SIG)
Published: August 2021

ABSTRACTObjectives:A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori‐positive versus H pylori‐negative children referred for upper gastrointestinal endoscopy.Methods:The Prisma method was used to perform a systematic review and meta‐analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle‐Ottawa Scale, and a meta‐regression analysis was done. The study was registered on the PROSPERO platform.Results:Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta‐analysis concerning 5990 H pylori‐infected and 17,782 uninfected children.H pylori‐positive versus H pylori‐negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta‐regression analysis showed that H pylori‐positive versus H pylori‐negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence.Conclusions:H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.
Local Anesthetic Systemic Toxicity during Labor, Birth, and Immediate Postpartum
Authors: Mock Nicole D. , Griggs Kellie M. , Mileto Lisa A. 
Published: August 2021

Abstract
Local anesthetic systemic toxicity (LAST) is a life-threatening event caused by elevated local anesthetic plasma concentration. It is often unrecognized or misdiagnosed. Peripartum women are at increased risk for toxicity due to pregnancy-related physiological changes. Rising serum drug levels can cause cellular level impairment of mitochondria and voltage-gated ion channels leading to a cascade of symptoms that can end in cardiac arrest. Local anesthetic systemic toxicity can mimic other maternal pathologies but may be considered if local anesthetics have been used. Published treatment guidelines for this event include lipid emulsion which is approved for use in pregnant women. We review LAST in the maternity care setting, published treatment protocols, management of maternity patients with toxicity, and recommendations to increase awareness among maternity care clinicians for this medical emergency.
Histopathological Findings in a Fatal Case of Paraquat Poisoning
Authors: Moar Jacob Joseph , Hill Lawrence 
Published: August 2021

Abstract
Fatal paraquat ingestion presents many interesting pathological findings for the forensic pathologist. The majority of prior research regarding paraquat poisoning has focused on the lung and liver, this article is further directed to and presents some of the histopathological findings present in the brain. Typical macroscopic and histopathological findings of paraquat poisoning were identified in the liver and lungs. The brain was found to be edematous with widening of the centrum semiovale, whereas histologically, it was found that there was extravasation of erythrocytes into the surrounding Virchow-Robin spaces, a finding normally associated with blunt force head injury and, therefore, commonly interpreted by forensic pathologists as a cortical contusion hemorrhage.