bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment Modalities and the Role of Endoscopy for Delayed Gastric Emptying After Whipple Operation: Analysis of 53 Patients
Authors: Ozgun Yigit Mehmet , Oter Volkan , Piskin Erol , Colakoglu Muhammet Kadri , Aydin Osman , Aksoy Erol , Dalgic Tahsin , Bostanci Erdal Birol 
Published: January 2021

Background Delayed gastric emptying (DGE) is one of the most common complications after Whipple surgery. This situation delays postoperative oral food intake and prolongs hospitalization. Postoperative DGE often develops due to complications such as intra-abdominal abscess, collections, and anastomosis leaks, and these are called secondary DGE. The pathogenesis of primary DGE is still unknown, and there are insufficient data in the literature about the treatment. In this study, patients undergoing Whipple operation were examined separately as primary and secondary DGE. We discussed the causes and treatments of these patients, and also we aimed to present the therapeutic effect of endoscopy for primary DGE after the Whipple procedure. Methods From March 2014 to March 2018, data of 262 patients who underwent the Whipple procedure were collected prospectively. We observed that postoperative DGE developed in 53 (21.7%) patients. We retrospectively divided the patients by etiology into 2 groups as primary and secondary and graded DGE according to the International Study Group of Pancreatic Surgery. We defined patients who did not have secondary causes such as intra-abdominal abscess as primary DGE. Appropriate interventional procedures were performed for patients with secondary causes. We performed endoscopic intervention with therapeutic intent for patients who had primary DGE. Results The overall rate of DGE was 21.7% (n = 53) among 262 patients undergoing the Whipple procedure. It was observed that in 31 (58.5%) of these 53 patients, DGE was developed due to secondary causes. Interventional procedures were performed to these patients when necessary. A total of 22 (41.5%) patients developed primary DGE. Of these, 9 patients were grade A, 7 were grade B, and 6 were grade C. The mean duration of hospitalization for secondary DGE and primary DGE was 20.36 and 28.7 days, respectively. After endoscopic intervention with therapeutic intent to primary DGE patients, we observed that patients tolerated solid meal after 12 hours in grade B and after 26 hours in grade C patients. Conclusion Delayed gastric emptying, which is a common complication after Whipple operation and which deteriorates the quality of life and prolongs the duration of hospital stay, should be treated according to the cause. In secondary DGE, treatment modalities must be focused on intra-abdominal causes such as hematoma, collection, and abcess. We suggest that the primary DGE which is unresponsive to medical treatments could be treated endoscopically. After endoscopic intervention, patients with primary DGE can be started oral intake on the same day and discharged more quickly.
Chronic Fatigue After Thyroidectomy: A Patient-Centered Survey
Authors: Lumpkin Stephanie T. , Button Julia , Stratton Lee , Strassle Paula D. , Kim Lawrence T. 
Published: January 2021

Background Fatigue after thyroidectomy is common, but there is a paucity of data regarding its prevalence and duration. We hypothesized that total thyroidectomy (TT) patients would have more long-term fatigue than thyroid lobectomy (TL) patients. Methods Statewide survey of thyroidectomy patients (2004-2017) was carried out. Results 281 patients completed the survey. 216 respondents (77%) had TT and 65 (23%) had TL. Within one year of surgery, 172 (61%) respondents recalled being troubled by new fatigue all, most, or some of the time. Total thyroidectomy patients were more likely to report new fatigue (69% vs. 44%, aOR 2.72, 95% CI 1.44 to 5.18). Of patients ( n = 172) reporting new fatigue, 67 (39%) reported at least moderate improvement. Nineteen (28%) saw improvement within 1 year, 35 (52%) saw improvement in 1-2 years, and 11 (16%) saw improvement after 2 years. Conclusion Long-term fatigue after TT can be debilitating, long-lasting, and less prevalent after TL.
Prognostic Factors in Patients With Borderline Resectable Pancreatic Ductal Adenocarcinoma Undergoing Resection
Authors: Ren Weizheng , Xourafas Dimitrios , Ashley Stanley W. , Clancy Thomas E. 
Published: January 2021

Background Neoadjuvant treatment (NT) has become standard in the management of borderline resectable pancreatic cancer (BR-PDAC), improving prognosis. The primary mechanism for this improvement remains unclear. Methods Clinicopathological data of patients with BR-PDAC who underwent resection between January 2008 and December 2018 at a single institution were retrospectively reviewed. Univariable and multivariate analyses were used to compare survival between patients who received NT vs. those who underwent upfront resection (UR). Results A total of 138 patients were included, 64 underwent UR and 74 NT. Neoadjuvant treatment resulted in higher margin-negative (R0) resection rate (68.9%) than UR (43.8%, P = .005). Neoadjuvant treatment was associated with improved overall survival (OS, P = .009) and progression-free survival (PFS, P = .027). R0 resection was also associated with improved OS ( P < .001) and PFS ( P < .001). On multivariable analysis, when adjusting for clinically relevant variables without considering R status, NT was an independent predictor for improved OS ( P = .046) and PFS ( P = .040). When additionally accounting for margin status, R0 was an independent predictor for improved OS ( P < .001) and PFS ( P < .001), while NT was not. Subgroup analysis, stratified by margin status, revealed that NT was not an independent predictor for OS or PFS for either subgroup. Discussion Neoadjuvant treatment is associated with improved OS and PFS in patients with BR-PDAC; however, this effect is outweighed by margin status. These results suggest that the primary benefit of NT was dependent on facilitating R0 resection. Upfront resection might remain a valid treatment option if R0 resection could be accurately predicted.
Examination of the Validity of the Chinese Version of the Children’s Hope Scale Among Chinese Adolescents
Authors: Ling Yu , Yang Qin , Ge Zixuan , Zhong Mingtian , Zeng Yifang , Huebner Scott E. 
Published: January 2021

Given possible developmental and/or cultural differences in the meaning and levels of hope among children, we evaluated the validity, measurement invariance, and latent mean differences for the Chinese version of the Children’s Hope Scale (CHS) across gender. Our sample comprised 2045 Chinese adolescents (46.4% men), with a mean age of 12.94 years. Confirmatory factor analyses (CFAs) supported one-factor and two-factor models. Cronbach’s alphas, mean inter-item correlations, and test–retest coefficients supported their reliability for both models. Also, multigroup CFA for both models indicated measurement invariance across gender. Analyses of latent means revealed no significant gender differences for the CHS total or Agency factor. However, men scored higher than women on the Pathways factor. Such differences suggest consideration of gender when assessing and promoting hope in Chinese adolescents.
Investigation on rail corrugation grinding criterion based on coupled vehicle–track dynamics and rolling contact fatigue model
Authors: Liang Hongqin , Li Wei , Zhou Zhijun , Wen Zefeng , Li Shaoguang , An Dong 
Published: January 2021

Based on the measured spectra of rail roughness and track structures longitudinal roughness, the rail grinding limit is studied with the help of an established coupled dynamic metro vehicle–track model and a rolling contact fatigue model. The results indicate that metro rail grinding control should be regulated according to corrugation wavelength range and operating speed. Based on the rolling contact fatigue model, longer wavelength of rail corrugation has less influence on the wheel rolling contact fatigue. For the metro lines with a maximum operating speed of 80 km/h, the average levels of rail corrugation in the wavelength ranges of 30–65 mm, 65–125 mm, and 125–250 mm should be less than 5.4, 24.8, and 33.8 dB re 1 μm, respectively; for the ones with the operating speed of 80–120 km/h, the corresponding average corrugation levels in the three wavelength ranges should be less than 4.4, 9.8, and 29.8 dB re 1 μm, respectively.
Multimodal imaging of two cases of retinal vein occlusion secondary to Waldenstrom macroglobulinemia
Authors: Remolí Sargues Lidia , Montero Hernández Javier , Navarro Palop Catalina , Monferrer Adsuara Clara , Castro Navarro Verónica , Cervera Taulet Enrique 
Published: February 2021

Purpose: To report multimodal imaging characteristics of two cases of retinal vein occlusion (RVO) secondary to Waldenstrom macroglobulinemia (WM). Case report: Case 1: An 82-year-old woman presented with vision loss. She had a history of WM. Best-corrected visual acuity (BCVA) was 20/100 Snellen equivalent in the right eye (OD) and 20/63 in the left eye (OS). Fundoscopy showed bilateral hemorrhages in posterior pole and along superotemporal arcade. Fluorescein angiography illustrated no macular leakage. Optical coherence tomography (OCT) revealed macular edema (ME). Optical coherence tomography angiography (OCTA) demonstrated abnormalities in choriocapillaris. A diagnosis of bilateral branch RVO was made and ME was treated with intravitreal dexamethasone, achieving stability. Case 2: A 65-year-old man presented with venous dilation, tortuosity, and intraretinal hemorrhages. BCVA was 20/20 in both eyes (OU). OCT showed ME and hyperreflective dots in choroid. A diagnosis of bilateral central RVO was made. Laboratory evaluation and bone narrow biopsy confirmed a diagnosis of WM. After that, our patient consulted because of vision loss. BCVA was 20/400 in OU. Fundoscopy and OCT demonstrated a worsening of the intraretinal hemorrhages and the ME. OCTA showed damage of choriocapillaris. Thus, intravitreal dexamethasone and plasmapheresis was advised. Two months after, BCVA was 20/40 in the OD and 20/32 in the OS. Also, fundoscopy and OCT improved. Conclusion: Early treatment of WM is truly important, with the aim of achieving a decrease in IgM levels in order to avoid toxic effect over the RPE that results in refractory ME.
Dementia stigma reduction (DESeRvE) through education and virtual contact in the general public: A multi-arm factorial randomised controlled trial
Authors: Kim Sarang , Richardson Alice , Werner Perla , Anstey Kaarin J 
Published: January 2021

Objective To examine the efficacy of the Dementia Stigma Reduction (DESeRvE) programme, aimed at reducing the general public dementia-related stigma utilising ‘education’ and ‘contact’ approaches. Methods A total of 1024 Australians aged between 40 and 87 years (M = 60.8, SD = 10.1) participated in a factorial randomised controlled trial. This trial examined four conditions: online education programme (ED), contact through simulated contact with people with dementia and carers (CT), education and contact (ED+CT) and active control. Cognitive, emotional and behavioural aspects of dementia-related stigma were measured with a modified Attribution Questionnaire, and dementia knowledge was measured with the Dementia Knowledge Assessment Scale at the baseline, immediately and 12 weeks after the completion of the intervention. Results All four groups improved (reduction in scores) significantly from baseline to week 12 in dementia-related stigma, and the effects were stronger for those with higher baseline stigma scores. Intervention groups also improved significantly from baseline in dementia knowledge. Especially, the ED (β = .85, SE = .07; p < .001) and ED+CT (β = .78, SE = .08; p < .001) groups at immediate follow-up and CT (β = .21, SE = .09; p < .05) and ED+CT (β = .32, SE = .09; p < .001) at 12-week follow-up showed significant effects. Conclusions Findings suggest that DESeRvE can be a valuable tool to enhance public’s dementia knowledge and reduce dementia-related stigma, especially for those with higher levels of stigma. Reduction in stigma, however, may take a longer time to achieve, whereas improvement in dementia knowledge is instant.
Characterizing dementia caregiver style in managing care challenges: Cognitive and behavioral components
Authors: Leggett Amanda N , Bugajski Benjamin C , Gitlin Laura N , Kales Helen C 
Published: January 2021

Background Caring for a person living with dementia can take a physical and emotional toll, but understudied is the process by which family caregivers actually provide care. Caregiver management styles may vary and affect care decision-making, experiences, receptivity to and participation in interventions, and outcomes for the caregiver and person living with dementia. Methods Participants included 100 primary family caregivers for persons with dementia who were on average 64 years old and had been providing care for 55 months, 74% women, and 18% nonwhite. Participants were interviewed in Michigan and Ohio regarding their cognitive and behavioral management of a recent care challenge and values guiding their decision-making. The rigorous and accelerated data reduction technique was used to analyze qualitative data leading to the identification of caregiving styles. Styles were compared across sample characteristics using chi-square and ANOVA tests. Findings Five distinct styles emerged: “Externalizers” (superficial understanding, self-focused, and frequent expressions of anger or frustration), “Individualists” (provide care by going alone, emotionally removed, and lack management strategies), “Learners” (recognize need to change their approach but are stuck and emotionally turbulent), “Nurturers” (positive affect and empathy toward care and reflect natural mastery), and “Adapters” (arsenal of acquired management strategies and adapt to challenges). Style groups differed significantly in terms of age and use of formal care supports. Discussion We identified five distinct styles by which caregivers addressed care challenges using a robust qualitative methodology. Styles may be important to identify in order to better tailor interventions to needs and abilities.
Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture
Authors: Shimohira Masashi , Nagai Keiichi , Ohta Kengo , Sawada Yusuke , Nakayama Keita , Shibamoto Yuta 
Published: February 2021

Introduction: Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture. Methods: Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization. Results: The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months). Conclusions: Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.
Safety and efficacy of rituximab as first- and second line treatment in multiple sclerosis – A cohort study
Authors: Torgauten Hilde Marie , Myhr Kjell-Morten , Wergeland Stig , Bø Lars , Aarseth Jan H , Torkildsen Øivind 
Published: January 2021

Background Rituximab is increasingly used as off-label therapy in multiple sclerosis (MS). More data are needed on safety and efficacy of rituximab, particularly in cohorts of de novo patients and patients in early therapy escalation. Objective To investigate the safety and efficacy of off-label treatment with rituximab in an MS-cohort of predominantly de novo patients or as therapy escalation. Methods We retrieved safety and efficacy data from the Norwegian MS-registry and biobank for all MS-patients treated with rituximab at Haukeland University Hospital, Bergen, Norway, during a four year period. Results In the 365 MS-patients (320 relapsing-remitting MS (RRMS), 23 secondary progressive MS (SPMS), and 22 primary progressive MS (PPMS)), the overall annualized relapse rate (ARR) was 0.03 and annualized drug discontinuation rate (ADDR) was 0.05. NEDA-3 was achived in 79% of patients with available data (n=351). Sixty-one patients experienced infusion-related adverse events of which two were serious (CTCAE grade 3–4). Eighteen patients experienced serious non-infusion related adverse events, of which 16 were infections. Infections (n = 34; 9.3%, CTCAE grade 2-5), hypogammaglobulinemia (n = 19, 5.2%) and neutropenia (n = 16; 4.4%) were the most common non-infusion-related adverse events. Conclusion Rituximab was a safe and highly efficient disease modifying therapy in this cohort of MS-patients; however, infections and neutropenia need to be monitored.
All Cause Mortality and Causes of Death in People with Hemophilia: A Systematic Review and Meta Analysis
Authors: Alam Arafat Ul , Karkhaneh Mohammad , Wu Cynthia M. , Sun Haowei 
Published: February 2021

Background: There have been many improvements in hemophilia treatment over the last 30 years. Complications and resulting causes of death will be impacted by these changes. We aimed to conduct a systematic review and meta-analysis on all cause mortality and causes of death among people with hemophilia.
Methods: Using a predefined search strategy, we systematically searched EMBASE, MEDLINE, Web of Science, CINAHL, Cochrane central register of controlled trials and Google Scholar from inception through November 6, 2019. Studies that reported standardized mortality ratio (SMR) of hemophilia patients compared with the general population and/or reported causes of death were included. Random-effects meta-analysis with inverse variance method was used to obtain pooled estimates. We further stratified the analysis by the year of cohort entry (before 2000 vs after 2000).
Results: Of the 4072 studies identified , 16 studies from 10 different countries met the eligibility criteria. The pooled SMR for all-cause mortality among people with hemophilia, compared with the general population was 1.93 (95% CI 1.38-2·70; I²=97%) (Figure: 1). The pooled SMR before and after the year 2000 were 2.40 (95% CI 1.92-3·00; I²=87%) and 1.20 (95% CI 1.03-1·40; I²=62%) respectively. Causes of mortality were extracted for 5808 deaths. Before the year 2000, 34% deaths occurred due to AIDS followed by hemorrhage (28%) cardiovascular disease (20%) , liver disease (11%) and cancer (9%) (Table: 1). Fewer (18%) deaths were attributable to AIDS after the year 2000 without any notable difference due to other causes.
Conclusion: : With advancement of treatments, mortality in hemophilia patients have declined over the last few decades. Particularly, effective prevention and treatment of HIV has made an impact. However, hemorrhage and cardiovascular disease still rank as leading causes of death.

Disclosures
Wu: Servier: Other: advisory board; BMS-pfizer: Honoraria, Other: advisory board; leo pharma: Other: advisory board; Pfizer: Honoraria. Sun:Octapharma: Research Funding; Sanofi: Other: Advisory board; Pfizer: Other: Advisory board; Octapharma: Other: Advisory board; Novo Nordisk: Other: Advisory board.
Myeloma Induce Fapα+ Macrophage to Remodel Immune Microenvironment Which Lead to Anti-PD-1 Dilemma
Authors: Gu Huiyao , He Jingsong , Zhang Enfan , Cai Zhen 
Published: February 2021

Background: Multiple myeloma (MM) is a hematologic cancer which is characterized by clonal immune globulin. In recent years, FAPα+ fibroblast has been found in many tumor microenvironments, and play an important role in tumor immune escape. Furthermore, we find monocyte-derived macrophages can also express FAPα+ under existence of MM cell line.
Objective Explore the impact of FAPα+ Macrophage in MM immune microenvironment.
Methods Western blot(WB) and flow cytometry(FCM) was used to detect the expression of FAPα+ on macrophages. WB was used to detect the PDL1 altering. FCM was used to detect FAPα+ PDL1+macrophages in patient with myeloma. FCM was used to detect apoptosis of CD4+/CD8+ T cells and MM cells.
Results: 1.MM cell line can induce FAPα+ expression on Macrophage through TGFβ1 or CSF1. 2.Over-expression FAPα on macrophage can promote the expression of PDL1 and knock-down FAPα can reduce PDL1. 3.FAPα can increases mRNA PDL1 and partially inhibits ubiquitination mediating autophagy of PDL1. 4.Over-expression FAPα on macrophage can induce CD4+/CD8+T cell apoptosis and knock-down FAPα can reduce T cell apoptosis. 5. FAPα inhibitor combined with anti-PDL1 or anti-PD1 monoclonal antibody can promote CD138+MM cell apoptosis.
Conclusions: MM can induce macrophage expressing FAPα to further promote PDL1 expression and mediate MM immune escape. Combination of FAPα inhibitor with anti-PDL1 or anti-PD1 monoclonal antibody may facilitate immunotherapy effect in MM treatment.
Key words: FAPα, Macrophage, PDL1, T cell, Immunotherapy

Disclosures
No relevant conflicts of interest to declare.
Intermittent concurrent use of clopidogrel and proton pump inhibitors did not increase risk of adverse clinical outcomes in Chinese patients with coronary artery disease
Authors: He Wanbing , Shu Xiaorong , Zhu Enyi , Deng Bingqing , Lin Yongqing , Wu Xiaoying , Zhou Zenan , Wang Jingfeng , Nie Ruqiong 
Published: February 2021

Abstract
Background
Proton pump inhibitors (PPIs) are frequently prescribed to patients with coronary heart disease (CHD) under antiplatelet therapy to prevent gastrointestinal (GI) bleeding. However, its clinical impact is still under debate, especially in Asian population. This study was undertaken to explore the effects of concurrent use of clopidogrel and PPIs on the clinical outcomes in Chinese patients with CHD in secondary prevention.

Methods
A single-center retrospective study was conducted in 638 patients with CHD on consecutive clopidogrel therapy for at least 1 year. After 18-month follow-up, adverse clinical events were collected. Cox regression was used to calculate hazard ratios (HR) and 95% confidence interval (CI) for the effect of PPI use on the outcomes. A total of 638 patients were recruited from 2014 to 2015 in this study, among whom 201 were sustained PPI users, 188 were intermittent PPI users and the remaining 249 were non-PPI users.

Results
Compared with sustained PPI users, intermittent use of PPIs was associated with a lower risk of stroke, major adverse cardiac events (MACE) and net adverse clinical event (NACE) (stroke: adjusted HR: 0.109, 95% CI 0.014–0.878, p = 0.037; MACE: adjusted HR: 0.293, 95% CI 0.119–0.722; p = 0.008; NACE: adjusted HR: 0.357, 95% CI 0.162–0.786, p = 0.011). Subgroup analysis further revealed the benefit of intermittent PPI use was significant in male CHD patients over 60 years old, with hypertension or chronic kidney disease, and undergoing percutaneous coronary intervention during hospitalization.

Conclusion
The current findings suggest that the intermittent concurrent use of PPIs and clopidogrel is not associated with an increased risk of 18-month adverse clinical outcomes, and intermittent use of PPIs is associated with a lower rate of MACE and NACE.