bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viral DNAemia and Immune Suppression in Pediatric Sepsis
Authors: Davila Sam , Halstead E. Scott , Hall Mark W. , Doctor Allan , Telford Russell , Holubkov Richard , Carcillo Joseph A. , Storch Gregory A. 
Published: November 2017

Objectives:
Demonstrate that DNA viremia is common in pediatric sepsis and quantitate its associations with host immune function and secondary infection risk.

Design:
Retrospective analysis of a prospective cohort study.

Patients:
Seventy-three children admitted with sepsis-induced organ failure.

Interventions:
None.

Measurements and Main results:
This study was performed as an ancillary investigation to a single-center prospective study of children with severe sepsis. Longitudinally collected, batched, frozen plasma was examined using real time–polymerase chain reaction for the presence of cytomegalovirus, Epstein-Barr virus, herpes simplex virus, human herpes virus-6, torque teno virus, and adenovirus DNA. Innate immune function was also measured longitudinally via quantification of ex vivo lipopolysaccharide -induced tumor necrosis factor-α production capacity. Viral DNAemia with a virus other than torque teno virus was detected in 28 of 73 subjects (38%) and included cytomegalovirus 5%, Epstein-Barr virus 11%, herpes simplex virus 4%, human herpes virus-6 8%, and adenovirus 26%. In addition, torque teno virus was detected in 89%. Epstein-Barr virus DNAemia was associated with preexisting immune suppression (p = 0.007) Viral DNAemia was associated with preexisting immune suppression and high risk for the subsequent development of secondary infection (p < 0.05 for both). Subjects with viral DNAemia had lower innate immune function over time compared with those who were virus negative (p < 0.05).

Conclusions:
DNAemia from multiple viruses can be detected in septic children and is strongly associated with preexisting immune suppression and secondary infection risk. The role of DNA viruses in the perpetuation of impaired host defense in this setting should be the subject of prospective study.
Strategies for Prevention and Management of Bleeding Following Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Scoping Review
Authors: Siemens Kristina , Sangaran Dilanee P. , Hunt Beverley J. , Murdoch Ian A. , Tibby Shane M. 
Published: November 2017

Objective:We aimed to systematically describe, via a scoping review, the literature reporting strategies for prevention and management of mediastinal bleeding post pediatric cardiopulmonary bypass surgery.Data Sources:MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL Register.Study Selection:Two authors independently screened publications from 1980 to 2016 reporting the effect of therapeutic interventions on bleeding-related postoperative outcomes, including mediastinal drain loss, transfusion, chest re-exploration rate, and coagulation variables. Inclusions: less than 18 years, cardiac surgery on cardiopulmonary bypass.Data Extraction:Data from eligible studies were extracted using a standard data collection sheet.Data Synthesis:Overall, 299 of 7,434 screened articles were included, with observational studies being almost twice as common (n= 187, 63%) than controlled trials (n= 112, 38%). The most frequently evaluated interventions were antifibrinolytic drugs (75 studies, 25%), blood products (59 studies, 20%), point-of-care testing (47 studies, 16%), and cardiopulmonary bypass circuit modifications (46 studies, 15%). The publication rate for controlled trials remained constant over time (4–6/yr); however, trials were small (median participants, 51; interquartile range, 57) and overwhelmingly single center (98%). Controlled trials originated from 22 countries, with the United States, India, and Germany accounting for 50%. The commonest outcomes were mediastinal blood loss and transfusion requirements; however, these were defined inconsistently (blood loss being reported over nine different time periods). The majority of trials were aimed at bleeding prevention (98%) rather than treatment (10%), nine studies assessed both.Conclusions:Overall, this review demonstrates small trial sizes, low level of evidence, and marked heterogeneity of reported endpoints in the included studies. The need for more, higher quality studies reporting clinically relevant, comparable outcomes is highlighted. Emerging fields such as the use of coagulation factor concentrates, goal-directed guidelines, and anti-inflammatory therapies appear to be of particular interest. This scoping review can potentially guide future trial design and form the basis for therapy-specific systematic reviews.
Advances in the Genetics and Biology of Pancreatic Cancer
Authors: Aguirre Andrew J. , Collisson Eric A. 
Published: November 2017

Abstract
Pancreatic ductal adenocarcinoma (PDA) remains one of the most devastating diagnoses in modern medicine. While the clinical management of the disease has improved, the complex biologic underpinnings of PDA enable both its aggressive nature and slow clinical translational progress. In this review, we provide an overview of the key features of PDA genetics and biology, highlighting translational challenges and providing a framework for improved diagnostic and therapeutic approaches.
Symptom Management and Palliative Care in Pancreatic Cancer
Authors: Rabow Michael W. , Petzel Maria Q.B. , Adkins Sarah H. 
Published: November 2017

Abstract
Evidence documents the benefits of palliative care to ameliorate the symptoms of pancreatic cancer as well as those from its treatment. Professional organizations now recommend palliative care for all patients with pancreatic cancer early in the course of illness and concurrently with active treatment. Scrupulous symptom management as well as sensitive communication and advance care planning allow oncologists to provide “primary palliative care” and to care well for patients with pancreatic cancer throughout the course of their illness.
The Treatment Cascade in Children With Unsuppressed Viral Load—A Reality Check in Rural Lesotho, Southern Africa
Authors: Lejone Thabo Ishmael , Ringera Isaac , Cheleboi Molisana , Wagner Sarah , Muhairwe Josephine , Klimkait Thomas , Labhardt Niklaus D. 
Published: November 2017

Background:
As per the guidelines of the World Health Organization, HIV-infected children who do not achieve viral suppression while under antiretroviral therapy (ART) receive enhanced adherence counseling (EAC) with follow-up viral load (VL). A persisting unsuppressed VL after EAC triggers switch to a second-line regimen. We describe the care cascade of children with unsuppressed VL while taking ART.

Methods:
Children, aged <16 years, on first-line ART for ≥6 months with unsuppressed VL (≥80 copies/mL) at first measurement were enrolled. As per guidelines, children/caregivers received EAC and a follow-up VL after 3 months, whereas those with persisting viremia despite good adherence were eligible for switching to second-line. Eighteen months after the first unsuppressed VL, outcomes were assessed.

Results:
Of 191 children receiving a first-time VL in May/June 2014, 53 (28%) had unsuppressed viremia. The care cascade of these 53 children was as follows: 49 (92%) received EAC and a follow-up VL in October 2014 (1 died, 3 lost to follow-up). 36/49 (73%) stayed unsuppressed, but only 24 were switched to second-line. At 18-months follow-up, 10 (19%) were retained in care with suppressed VL, 26 were retained with ongoing viremia (49%), 2 (4%) had died, and 15 (28%) had no VL documentation.

Conclusions:
Only 1 of 5 children with unsuppressed initial VL under ART was retained in care and virally suppressed at 18 months of follow-up. ART programs must increase the focus onto the extremely vulnerable care cascade in children with unsuppressed VL.
Patterns of Coronary Calcification and Their Impact on the Diagnostic Accuracy of Computed Tomography Coronary Angiography
Authors: Noll Dariusz , Kruk Mariusz , Demkow Marcin , Pręgowski Jerzy , Kaczmarska Edyta , Kryczka Karolina , Pracoń Radosław , Dzielińska Zofia , Śleszycka Justyna , Witkowski Adam , Rużyłło Witold , Kępka Cezary 
Published: November 2017

Objective
Despite coronary calcifications being a major factor affecting the diagnostic accuracy of coronary computed tomography angiography (CTA), there is a lack of established criteria for categorizing calcifications. We aimed to evaluate patterns of coronary calcification based on quantitative radiodensity and size parameters to provide coronary calcium categories and assess their impact on the accuracy of coronary CTA.

Methods and Results
We analyzed length, maximum thickness, volume, mean density, and maximum density of coronary calcium and divided each of these parameters into tertiles. Subsequently, we summarized the tertiles for each individual calcification and divided them into 3 equal groups of: mild, moderate, and severe calcification. The accuracy of coronary CTA was defined as the difference between the measurements obtained on coronary CTA versus the reference of intravascular ultrasound (IVUS). We evaluated 252 coronary calcifications within 97 arteries of 60 patients. There was an expected increase in size and density values for mild versus moderate versus severe calcifications, but there was no difference in IVUS measured minimum lumen area among the 3 groups. Of note, coronary CTA significantly underestimated IVUS minimum lumen area measurement by 1.2 ± 1.6 mm2 (14.6 ± 23.1%, P < 0.001) for severe calcifications and by 0.5 ± 2.0 mm2 (3.7 ± 32.1%, P = 0.021) for moderate calcifications. Within mild calcifications, the difference was not significant.

Conclusion
Based on their dimensional and radiodensity characteristics, our analysis revealed patterns of individual coronary artery calcifications that affected the accuracy of coronary CTA measurements; coronary CTA inaccuracy was associated with the presence of moderate or severe calcifications, but not mild calcifications.
Multifunctional Assessment of Non–Small Cell Lung Cancer
Authors: Calandriello Lucio , Larici Anna Rita , Leccisotti Lucia , del Ciello Annemilia , Sica Giuliano , Infante Amato , Congedo Maria Teresa , Poscia Andrea , Giordano Alessandro , Bonomo Lorenzo 
Published: November 2017

Purpose
The aim of this study was to investigate the relationship between whole-tumor CT perfusion and FDG PET/CT parameters in non–small cell lung cancer (NSCLC).

Methods
Twenty-five patients with NSCLC were prospectively included. CT perfusion parameters calculated were blood flow (BF), blood volume (BV), mean transit time, and peak enhancement intensity. SUVmax, SUVpeak, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated for PET/CT. Tumor diameter and volume were measured, and lesions were divided according to maximum axial diameter in more than 3 cm and 3 cm or less. The correlations between CT perfusion and PET/CT parameters were assessed in all tumors, as well as according to tumor diameter and volume.

Results
Lesion diameter and volume showed a negative correlation with BF and BV (r = −0.78, −0.78, −0.57, −0.48, respectively) and a positive correlation with mean transit time (r = 0.55, 0.65, respectively). The negative correlation between BF and lesion diameter and volume was confirmed in the subgroup of lesions of more than 3 cm (r = −0.68, −0.68, respectively). A positive correlation between SUVmax, SUVpeak, SUVmean, and lesion volume was observed (r = 0.50, 0.50, 0.46, respectively) and confirmed in lesions 3 cm or less (r = 0.81, 0.79, 0.78, respectively). Metabolic tumor volume and TLG showed a positive correlation with lesion diameter and volume in the overall population (r = 0.93, 0.87, 0.88, 0.90, respectively) and in lesions of more than 3 cm (r = 0.89, 0.84, 0.84, 0.79, respectively). Blood flow and BV showed a negative correlation with MTV and TLG (r = −0.77, −0.74, and −0.58, −0.48, respectively) in the overall population and with MTV in lesions of more than 3 cm (r = −0.69, −0.62, respectively).

Conclusions
Perfusion and metabolic parameters seem to depend on tumor size. The bigger the tumor, the lower the BF and the BV and, conversely, the higher the SUVpeak, MTV, and TLG. This information would be useful in the clinical setting when diagnosing or treating NSCLC, especially with novel therapies and/or for radiation treatment modulation.
Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases
Authors: Margonis Georgios A. , Sergentanis Theodoros N. , Ntanasis-Stathopoulos Ioannis , Andreatos Nikolaos , Tzanninis Ioannis-Georgios , Sasaki Kazunari , Psaltopoulou Theodora , Wang Jaeyun , Buettner Stefan , Papalois Αpostolos E. , He Jin , Wolfgang Christopher L. , Pawlik Timothy M. , Weiss Matthew J. 
Published: November 2017

Objective:
To examine the impact of surgical margin width on survival following R0 hepatic resection for colorectal metastases (CRLM).

Summary of Background Data:
Although negative resection margin is considered of paramount importance for the prognosis of patients with colorectal liver metastases, optimal resection margin width remains controversial.

Methods:
Eligible studies examining the association between margin status after R0 hepatic resection for CRLM and survival, including overall survival (OS) and disease-free survival (DFS) were sought using the Medline, Cochrane, and EMBASE databases. Random-effects models were used for the calculation of pooled relative risks (RRs) with their 95% confidence intervals (95% CIs).

Results:
Thirty-four studies were deemed eligible for inclusion representing a cohort of 11,147 hepatic resections. Wider resection margin (>1 vs <1 cm) was significantly associated with improved OS at 3 years (pooled RR = 0.86, 95% CI: 0.79–0.95), 5 years (pooled RR = 0.91, 95% CI: 0.85–0.97), and 10 years (pooled RR = 0.94, 95% CI: 0.88–1.00). Similarly, DFS was positively associated with >1 cm resection margin at 3, 5, and 10 years. Interestingly, >1 mm (vs <1 mm) resection margin was significantly associated with improved OS at all-time points. Meta-regression analyses did not reveal any significant modifying role of the study features under investigation, such as the administration of neoadjuvant/adjuvant therapy.

Conclusions:
Importantly, our findings suggest that while a >1 mm margin is associated with better prognosis than a submillimeter margin, achieving a margin >1 cm may result in even better oncologic outcomes and should be considered if possible.
The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs)
Authors: Landoni Luca , Marchegiani Giovanni , Pollini Tommaso , Cingarlini Sara , D’Onofrio Mirko , Capelli Paola , De Robertis Riccardo , Davì Maria V. , Amodio Antonio , Impellizzeri Harmony , Malpaga Anna , Miotto Marco , Boninsegna Letizia , Crepaz Lorenzo , Nessi Chiara , Zingaretti Caterina C. , Paiella Salvatore , Esposito Alessandro , Casetti Luca , Malleo Giuseppe , Tuveri Massimiliano , Butturini Giovanni , Salvia Roberto , Scarpa Aldo , Falconi Massimo , Bassi Claudio 
Published: November 2017

Objective:
The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome.

Background:
Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection.

Methods:
From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses.

Results:
Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years.

Conclusions:
Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.
Sex Differences in Neuropsychological Test Performance in Alzheimer’s Disease and the Influence of the ApoE Genotype
Authors: Tensil Maria , Hessler Johannes B. , Gutsmiedl Maria , Riedl Lina , Grimmer Timo , Diehl-Schmid Janine 
Published: November 2017

Background:
Only few studies exist reporting sex differences in the Alzheimer disease (AD) patients regarding cognitive profile, brain damage, and risk factors. The present study investigated the influence of sex in combination with the Alzheimer risk allele, ε4-allele of apolipoprotein E, on cognitive performance.

Materials and Methods:
We examined the effect of sex and ApoE genotype on a range of neuropsychological markers from the German version of the Consortium to Establish a Registry in Alzheimer’s Disease Neuropsychological Battery in a monocentric study of 399 AD patients.

Results:
Male patients had significantly more years of school and occupational education compared with women. Male AD patients outperformed female patients in tasks of object naming, constructional praxis, and constructional praxis recall. There was no statistically significant interaction effect between sex and ε4-allele of apolipoprotein E for any of the examined variables.

Conclusions:
The superiority of healthy men compared with women in tasks of object naming, constructional praxis, and visual memory seems to remain stable when people develop AD, indicating larger cognitive reserves in men. In contrast, findings that cognitively healthy women outperform men in tests of verbal memory and verbal fluency are not stable in AD. Further studies are needed to gain insight in the reasons for sex differences.
Quality management in universities: towards an integrated approach?
Authors: Manatos Maria J. , Rosa Maria J. , Sarrico Cláudia S. 
Published: November 2017

Purpose
The purpose of this paper is to empirically test the thesis that universities are developing their different quality management (QM) systems comprehensively and integrating them in their broader management and governance systems, covering different processes, organisational levels and the principles of QM.

Design/methodology/approach
The empirical work is based on a country case study which embeds three paradigmatic university case studies. Data are obtained from institutional documents, as well as from individual and panel interviews. A content analysis using N-Vivo was undertaken.

Findings
Universities show signs of integrating QM in their overall management and governance framework. They develop their QM systems with a focus on teaching and learning, but they are increasingly trying to integrate their other processes. They seek to involve their different organisational levels, from the programme to the institutional level. Universities cover most QM principles, but show deficiencies regarding customer focus, mutually beneficial supplier relationships, involvement of people and process and system approach.

Research limitations/implications
The research shows the results of three paradigmatic cases regarding QM implementation, since these were the first to have their QM systems certified by the Agency for Assessment and Accreditation of Higher Education. In future work, it would be interesting to understand how other universities are developing their QM systems and whether implementation occurs in an integrated way.

Practical implications
The authors expect that the results will add to the discussion on the implementation of QM in universities, further contributing to the development of truly integrated approaches to QM in higher education.

Originality/value
The paper discusses the QM systems which are being developed and implemented in universities and analyses how integrated they are, as only those that are fully integrated will contribute to improve the overall quality of universities.
Assessing Lean adoption in food SMEs: Evidence from Greece
Authors: Psomas Evangelos , Antony Jiju , Bouranta Nancy 
Published: November 2017

Purpose
The purpose of this paper is to determine the current state of the Lean principles adopted by food small and medium-sized enterprises (SMEs).

Design/methodology/approach
The case study approach was undertaken in order to gain insights into Lean adoption. Nine Greek food SMEs certified according to the ISO 9001 quality management system (QMS) and the ISO 22000 food safety management system (FSMS) were approached. Interviews were conducted with the chief executive officers and the company managers in charge of the QMS or FSMS, based on a structured questionnaire.

Findings
The food SMEs participating in the present study adopt Lean principles to a high extent. However, there is room for further improvement.

Research limitations/implications
The fact that the data collected suggests subjective business evidence and not objective as well as the fact that only two representatives of each of the nine food SMEs were conducted, comprise the main limitations of the present study. So, the results should be considered with caution, as far as the Lean adoption in the Greek food sector is concerned. Based on these limitations, future research suggestions can be made.

Practical implications
Based on the present study, suggestions can be made regarding the successful adoption of Lean principles, not only for the sample SMEs but also for the whole of the food sector. More specifically, by determining the strengths and weaknesses of the food SMEs’ efforts to adopt Lean, suitable managerial initiatives can be undertaken by these companies as well as the whole sector to fully adopt Lean and derive the respective benefits.

Originality/value
The paper provides insights into the adoption of Lean principles in the Greek food sector. This is the first study in the field of Lean that has been carried out in the Greek food SMEs.