bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Endoscopic Retrograde CholangioPancreatography (ERCP) and Intraductal Secretin Test (IDST) in the Diagnosis of Chronic Pancreatitis (CP)
Authors: Osuji Vitalis C. , McNulty, RN, BSN, CCRC Gail , Fogel, MD, MSc, FRCP(C) Evan 
Published: January 2019

Background:
CP may be difficult to diagnose in the early stages when imaging may be normal. An IDST performed at ERCP may further evaluate for CP, with determination of pure pancreatic juice (PPJ) volume and bicarbonate concentration (BC). The optimal collection time for IDST is unknown. We report our experience with the IDST in 447 patients with suspected CP.
Experimental Design:
IDSTs performed from 2006-2018 were reviewed, with fluid collected at 5-min intervals for 20-60 minutes. Parameters evaluated were PPJ volume, Secretory Flow Rate (SFR), time of peak SFR, maximum BC and time to maximum BC.
Results:
Maximum BC was reached by 10-min in 59 patients (13.2%); 15-min: 207 patients (46.3%); 20 min: 340 patients (76.1%); 25-min: 384 patients (85.9%); 30-min: 421 patients (94.1%). Peak SFR was reached by 10-min in 92 patients (20.6%); 15-min: 177 patients (39.6%); 20-min: 240 patients (53.7%); 25-min: 284 patients (63.5%); 30-min: 323 patients (72.3%). Final diagnosis (normal vs. CP) for both SFR and BC was determined by 20-min (i.e. in CP pts, either the SFR or BC was low (SFR <3ml/min, BC <105mEq/L) and remained low throughout collection, or normal (>3ml/min and >105mEq/L) within the first 20-min. Further collection did not change the diagnosis.
Conclusion:
At IDST, a 20-minute collection period is necessary to categorize patients into normal or suspected CP groups. A study in control patients (no suspicion of CP) to validate these data is currently underway.
Fecal Bile Acids and Fecal Short Chain Fatty Acids in Patients with Irritable Bowel Syndrome and Control Volunteers
Authors: Patel Chirag , Lockett Carolyn , Xu Huiping , Shin Andrea 
Published: January 2019

Background and Aims: Fecal bile acids (BAs), short chain fatty acids (SCFAs), and gut microbiome may be implicated in irritable bowel syndrome (IBS) pathophysiology. Our aim was to compare fecal organic acids between IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and controls.
Methods: Stool samples were collected from 17 controls, 5 IBS-C, and 5 IBS-D volunteers during a 4-day high fat diet. Aliquots were stored for future analysis of the fecal microbiota. Fecal SCFA and BA analyses were conducted at the Metabolite Profiling Facility at Purdue University and Laboratory Medicine and Pathology at Mayo Clinic. We compared SCFA and BA levels among groups using the Wilcoxon rank sum test. Gamma and linear regression were used to compare SCFAs and BAs adjusting for age and body mass index (BMI).
Results: Fecal acetate levels (mean+SD, µg/mg) were higher in IBS-C (11.3±7) than in controls (6.1±3.3) or IBS-D (7.7±2), although not statistically significant (p=0.19). Total fecal BAs (median [IQR], %) were higher in IBS-D (675 [484-778]) than in controls (342 [130-640]) or IBS-C (321.5 (34.5-718); however, differences were not significant. No significant differences were observed in BAs or SCFAs between groups in multivariate analyses.
Conclusion: We are unable to show significant differences in organic acid levels in IBS and controls. Lack of association may be due to small sample size. Future investigation of larger patient numbers with incorporation of transit and microbiome analyses may shed further light on the role of organic acids in IBS to identify new biomarkers and treatment targets.
Surveying ADR knowledge and practices among US gastroenterologists
Authors: Peng Michael , Rex, MD, MACG Douglas 
Published: January 2019

Background:
The adenoma detection rate (ADR) is of primary importance to the quality of screening colonoscopy. An online survey was conducted to assess knowledge and practices on ADR.
Methods:
Paid questionnaire distributed by email. Eligible respondents were board certified gastroenterologists who perform >80 colonoscopies per month with 3 to 35 years after fellowship.
Results:
39% were unaware that ADR applies only to screening colonoscopies and 76% incorrectly answered that ADR includes sessile serrated polyps/adenomas. 51% of respondents incorrectly believe the threshold is set at 25% because 25% is a national ADR average. Many also believe the threshold depends on the patient population (current evidence suggests adjusting ADR for factors other than age and sex is unnecessary). 75% ranked ADR as highly important. 80% reported tracking ADR. A busy practice was the most common reason for not tracking ADR. Caps, chromoendoscopy, and good bowel preparation were viewed as valuable for improving ADR (this is true except for caps). HD colonoscopes and education were considered less valuable (although evidence suggests HD and education are associated with improved ADR). 57% reported not sharing ADR information with their patients, and 59% reported no patients in the past 6 months asking for their ADR.
Conclusion:
The importance of ADR as a validated quality measure is well understood, but there are misconceptions among gastroenterologists regarding the definition and measurement of ADR and which methods are proven to increase ADR. Patients are having very little impact on ADR measurement.
Outcome of Pediatric Emergency Point-of-Care Ultrasound (POCUS) for Management of Skin and Soft Tissue Infection Prior to Ultrasound Program Implementation
Authors: Phillips, BS Whitney , Nti, MD, MSc Benjamin 
Published: January 2019

Background and Hypothesis: Point-of-care ultrasound (POCUS) is underutilized for evaluation of skin and soft tissue infections (SSTI) in the pediatric emergency department (ED). This study seeks to determine the utilization of POCUS compared to formal radiology ultrasound for SSTI in the pediatric ED prior to an ultrasound program implementation. We hypothesize that POCUS utilization will be low but can lead to a decreased length of stay (LOS) and cost for patients with SSTI.
Experimental Design or Project Methods: This is a retrospective EMR chart review covering pre-implementation (July 2016-June 2017) and post-implementation (July 2018-June 2019) of a POCUS program curriculum. Patients (<18 years old) were included based on screening for diagnoses via the international classification of diseases 9th and 10th revision codes for abscesses and cellulitis. We excluded patients who required admission and subspecialty consult or had other non-SSTI evaluation.
Results: Pre-Implementation period included 160 patients who met inclusion and exclusion criteria. Of these, 16 (10%) received POCUS evaluation and 8 (5%) received a radiology image evaluation. The majority of patients had cellulitis (80%) when compared to abscess (20%). The average LOS for POCUS ultrasound was 173 minutes compared to 304 minutes for radiology evaluation. The total cost for visit was $3,503 for patients evaluated by POCUS compared to $8,875.56 for patients who received radiology imaging.
Conclusion and Potential Impact: Taken together, the pre-implementation assessment of POCUS utilization in the pediatric emergency department was low but associated with decreased LOS and lower total ED cost when applied to SSTI management.
Early Pain, Narcotic Use, and Functional Recovery in Aseptic Revision Total Knee Arthroplasty Performed with Morphine Spinal Analgesia versus Fentanyl Spinal Analgesia with Adductor Canal Block
Authors: Rice, BA Justin , Mohiuddin, BS Amer , Nielson Trent , Ziemba-Davis, BA Mary , Meneghini, MD R. Michael 
Published: January 2019

Background and Hypothesis: There has been a trend away from intrathecal morphine for perioperative pain control during and after total knee arthroplasty (TKA) and it has been replaced by shorter-acting non-morphine spinals combined with adductor canal block (ACB) regional analgesia. The purpose of this study is to compare pain control and side-effects between morphine intrathecal alone and fentanyl spinal with ACB in revision TKA.
Project Methods: Prospectively collected data on 167 consecutive aseptic revision TKAs performed by a single surgeon between 2010 and 2017 were retrospectively reviewed.  Inpatient pain, narcotic use, functional milestones, complications, and four-month patient reported outcomes were compiled for the two cohorts (110 fentanyl/ACB and 57 morphine cases).
Results: Average age (p=0.66) and BMI (p=0.542) were equivalent in the two cohorts (p=0.542). Fentanyl/ACB patients gained more range-of-motion (ROM) by 4-month follow-up (p=0.051) than morphine patients. However, fentanyl/ACB patients had higher average pain scores (p=0.006), consumed opioids earlier (p<0.001), and consumed more opioids (p<0.001) on postoperative day one. Morphine analgesia was associated with more nausea/vomiting (p=0.001) and pruritus (p=0.00001).
Conclusion and Potential Impact: Morphine intrathecal patients reported less inpatient pain and consumed less opioid, which most likely reflects morphine’s longer half-life. Improved 4-month ROM in the fentanyl/ACB group may reflect the quadriceps-sparing nature of ACBs. It is also possible that the operative field in revision TKA extends beyond the sensory protection of ACB. Further research is required to elucidate the relative impact of ACBs on primary vs. revision procedures.
Comparison of two techniques using EUS guided liver biopsies via 19g core biopsy needle to obtain optimal core specimen in benign disease
Authors: Rumancik Brad , Kota Sharwani , Irvin Judy , Zelt Christina , Mirro Michael , Sharma Neil 
Published: January 2019

Background and Hypothesis:
Endoscopic ultrasound (EUS) guided fine-needle biopsy (FNB) to obtain core liver specimen is shown to be effective and safe. However, prospective data is limited regarding EUS-FNB in non-malignant liver disease. This study evaluates two EUS-FNB techniques with the hypothesis that the modified wet suction (MWS) technique will produce greater pathological yield than the slow pull (SP) technique in patients with non-malignant liver disease.
Experimental Design or Project Methods:
In this prospective, randomized controlled trial we are evaluating efficacy and safety of EUS-FNB techniques (MWS versus SP) in patients with initial indication for an upper endoscopy plus need for a liver biopsy to assess non-malignant disease. The primary outcome is pathological yield defined as number of complete portal tracts (CPTs), specimen length, and fragmentation. Secondary outcomes include pathological yield between two specimen processing techniques, pathological yield between left versus right liver lobe biopsy, time for biopsy technique, and complications.
Results:
For this interim analysis, 8 patients (5 received MWS and 3 received SP) out of a projected total of 360 patients are enrolled. Independent t-test analysis reveals no statistical difference between CPTs (P=0.56), specimen length (P=0.12), and fragmentation (P=0.16). No differences are found between any secondary outcomes, and there have been no biopsy-related complications.
Conclusion and Potential Impact:
This underpowered interim analysis reveals no statistical difference in primary or secondary outcomes between MWS versus SP technique. The current results for both groups are consistent with specimen adequacy criteria determined by American Association for the Study of Liver Disease.
Increasing Adolescents’ Access to the HIV Continuum of Care: Development of a Screening Tool for Medical Legal Partnerships
Authors: Scalzo Anna C. , Gilbert, JD, MPH Amy L. 
Published: January 2019

Background: Research has shown that at-risk youth are not being reached by HIV testing efforts and are encountering barriers at other points along the HIV Continuum of Care (CoC). Legal remedies often exist for youth and their families in addressing barriers to the HIV CoC. The purpose of this study was to develop a targeted screening tool for identifying unmet health-harming legal needs that create barriers to the HIV CoC at the level of individual youth, to be used in clinics with Medical Legal Partnerships (MLPs) designed to address such barriers through legal intervention.
Project Methods: A literature search was completed to investigate if validated screening questions already existed for the 10 areas of adolescent health-harming legal needs previously identified from qualitative interviews with at-risk youth and care providers. A focus group of legal professionals was conducted to better understand the range of legal solutions that exist and identify critical concepts and language for screening questions.
Results: The study team developed a brief survey that can be used in clinic to screen individual adolescents for potential, actionable legal needs. Some questions were adapted from existing resources, while others were newly synthesized.
Conclusion and Potential Impact: The screening tool will be piloted with a representative sample of at-risk youth and eventually implemented in adolescent-focused FQHC sites with active MLPs. This tool will be used to identify actionable legal needs and prompt referrals to legal professionals who can help adolescents resolve health-harming legal needs that may prevent access to the HIV CoC.
Predictors of Patient Function, Pain, and Satisfaction after Reimplantation for Infected Hip and Knee Arthroplasty
Authors: Sikoski Christian , Ziemba-Davis, BA Mary , Meneghini, MD R. Michael 
Published: January 2019

Background/Hypothesis: Prevalence of periprosthetic joint infection (PJI) is expected to rise as hip and knee arthroplasty procedures increase. This study purpose was to evaluate factors affecting patient-reported outcomes after resection and reimplantation procedures.
Project Methods: 38 hips and 35 knees consecutively treated by a single surgeon were retrospectively reviewed. Prospectively collected preoperative and minimum one and two-year postoperative Knee Injury and Osteoarthritis Outcome Score/KOOS Jr., Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., UCLA Activity Level, and satisfaction were compiled. Fifteen demographic variables and covariates of outcomes (sex, age, etc.) were accounted for in analysis.
Results: 47% of hip and 71% of knee patients were chronically infected poor hosts (McPherson stage III-B/C). In hips, worse McPherson stage was associated with lower activity levels at latest follow-up (p=0.007). Activity was higher in hip patients with constrained liners compared to dual mobility implants at one (p=0.009) and two-year (p=0.001) follow-up. The same result was observed in knees with varus-valgus constrained liners vs. hinged implants (p=0.005, p=0.029). However, varus-valgus constrained articulations were associated with more stair pain at one (p=0.003) and two (p=0.012) years. 83% of hip and knee patients were satisfied or very satisfied with their outcome at latest follow-up.
Conclusion/Potential Impact: Positive outcomes observed following reimplantation procedures will help establish patient expectations. It appears the increased joint stability imparted by hinged TKA and constrained liners in THA may offer advantage in stair pain and clinical function, respectively, in reimplantation arthroplasty after PJI.
Senescent T cell population in Glioblastoma
Authors: Song Leo , Henriquez Mario , Chintala, PhD Sreenivasulu , Dey, MD Mahua 
Published: January 2019

Background and Hypothesis: Glioblastoma (GBM) is the most common primary brain tumor in adults and has a median overall survival of 20.6 months. Intracranial location, infiltrative growth with near 100% recurrence and the blood brain barrier are challenges which make treating GBM difficult. CD8+ T cells (CTLs) are largely responsible for mediating anti-tumor responses and thus, are an endpoint to most immunotherapies. However, the immunosuppressive tumor microenvironment (TME) hampers T cell effectiveness and causes exhaustion and senescence. Senescent CTLs (CD28-CD57+) can result from DNA damage which causes loss of CD28. Lack of CD28 renders CTLs insensitive to immune signals and result in loss of cytotoxic functions. Thus, we hypothesize that CTLs have lost CD28 expression and are becoming senescent in the TME of GBM patients.
Experimental Design or Project Methods: CD8 and CD28 RNA expression data was pulled from TCGA in glioma and normal brain patients and a Pearson’s correlation was conducted. Lymphocytes were isolated from patient tumor brain and blood and using flow cytometry, CD3+ CD8+ T cells were identified and stained for CD28, CD57, PD-1, and TIM-3.
Results: RNA sequencing data from TCGA database on CD8 and CD28 expression showed a negative correlation in GBM patients compared to normal patients. Majority of CD8+ lymphocytes from patient brain had lost CD28+ expression compared to blood.
Conclusion and Potential Impact: The increased senescent T cell population in GBM suggests that the TME has a mechanism for cytotoxic T cell immunosuppression. Preventing CD8+ T cell senescence in GBM can improve current immunotherapies by promoting activation of tumor infiltrating lymphocytes.
Investigating the role of COQ8B in aortic smooth muscle cells.
Authors: Stadler Henry , Ware Stephanie , Landis Benjamin 
Published: January 2019

Background and Hypothesis:
Thoracic aortic aneurysm (TAA) is an aortopathy characterized by aortic enlargement and life-threatening complications such as aortic dissection and sudden cardiac death. Previous studies identified COQ8B as a candidate genetic modifier of TAA severity. COQ8B is important for mitochondrial biosynthesis of coenzyme Q, but its precise functions are not defined. We hypothesize that alteration of COQ8B influences TAA pathogenesis via energy and oxidant metabolism pathways.
Experimental Design:
Smooth muscle cells (SMCs) were cultured directly from leftover healthy aortic tissues acquired during cardiac transplant operations. At confluence of 50-70%, cells were transfected with siRNA targeting COQ8B or a non-targeting negative control siRNA. Gene expression was measured using real-time quantitative polymerase chain reaction (RT-qPCR). Production of the reactive oxygen species hydrogen peroxide (H2O2) was measured using the fluorescence-based Amplex Red Hydrogen Peroxide Assay (Invitrogen) in basal growth medium.
Results:
Expression of COQ8B decreased by approximately 75% to 85% at 48 hours following siRNA transfection compared with negative control. This was associated with approximately 1.5 fold upregulation of the SMC contractile gene CNN1 (p<0.05). Knockdown of COQ8B did not appear to alter H2O2 production measured at timepoints of 48 or 72 hours.
Conclusion and Impact:
Based on these preliminary data, decreased COQ8B expression appears to alter the contractile phenotype of SMCs but may not significantly influence extracellular levels of H2O2 under basal conditions. Exogenous activation of pathways important for TAA pathogenesis may be required to elucidate the role of COQ8B. Ultimately, this work may lead to improved clinical approaches.
Determining if Double Gene Knockdown of P65 and PDK2 Increases Cytotoxicity and Radiation Sensitivity of Pancreatic Cancer Cells
Authors: Tenbarge Madison , Townsend Devyn , Erdwin Ryan , Chin-Sinex Helen , Mendonca Marc 
Published: January 2019

Background: Pancreatic ductal adenocarcinoma (PDA) is currently the 4th leading cause of cancer death in the US because of late detection and resistance to chemotherapy and radiation. This tumor resistance is partially due to high activity of the transcription factor, NF-[Symbol]B which promotes cell survival and pyruvate dehydrogenase kinase 2 (PDK2) which regulates aerobic glycolysis (Warburg Metabolism), cell proliferation, and inhibition of apoptosis. We have shown that simultaneous treatment with the chemical NF-B inhibitor DMAPT and the Warburg inhibitor DCA is cytotoxic and enhances radiation-induced cell death in human PDA cells.
Experimental Design: We hypothesize that double gene knockdown of the P65 subunit of NF-[Symbol]B and PDK2 by siRNA will lead to increased cytotoxicity and radiation sensitivity. The PDA cell line (Mia PaCa-2) was utilized and was transfected with appropriate siRNAs. The cells were plated and followed by irradiation with either 0, 2, 4, or 6 Gy of 160 kVp X-rays.
Results: Analysis of Western blots shows the successful silencing of P65, but the knockdown of PDK2 are pending. The differences in plating efficiency were not found to be statistically significant between the treatment groups. The differences in survival fraction were not found to be statistically significant at 2, 4, or 6 Gy, but there is a trend for enhancement at 6 Gy.
Conclusion: Preliminary data indicate there was no increase in cytotoxicity or radiation-induced cell killing after treatment with SiP65, SiPDK2, or both. However, to date we have no evidence that siPDK2 is working and further experiments are underway.
Effectiveness of Quinn's Early Educational Program on Attention and Memory of Preschool Children in Isfahan
Authors: Abadeh Sayehnaz Saniei , Abedi Ahmad 
Published: January 2019

Background: Early intervention at preschool age can resolve many cognitive and metacognitive problems of children. Accordingly the present study aimed to investigate the effectiveness of Quinn's early educational program, on attention and memory of pre-school children in Isfahan city.
Methods: The study design was Randomized controlled trial. The study population included parents of all pre-school children in Isfahan city during school year 2016 - 2017. Thirty persons were selected through convenience sampling and then randomly divided into experimental and control groups (15 in each group). The research tool that was used in this study is Conner’s Neuropsychological Testing 2004. First, the pretest was conducted for both groups; then the experimental group was exposed to eight 90-minute sessions of Quinn's early educational program; but there was no interference for the control group. At the end of the intervention, the posttest was conducted for both groups. The data of the study was analyzed through covariance analysis test.
Results: The findings showed that Quinn's early educational program has impacts on the attention and memory of pre-school children (P-value < 0.0005). The average of children's memory and attention were 18.7 ± 7.12 and 11.73 ± 5.68 in order to 11.45 ± 11.4 and 4.93 ± 2.45, respectively.
Conclusion: Given the impact of Quinn's program on the memory and attention of pre-school children, this training can be used to improve the attention and memory of preschool children.

Keywords: Quinn's Early Educational Program, Attention, Memory, Preschool