bluuebunny/crossref_metadata_2025_split huggingface dataset:
Generation of citric acid-hyperproducers independent of methanol effect by high-level expression of cexA encoding citrate exporter in Aspergillus tubingensis
Authors: Yoshioka Isato , Kirimura Kohtaro 
Published: August 2024

ABSTRACT
Methanol reportedly stimulates citric acid (CA) production by Aspergillus niger and A. tubingensis; however, the underlying mechanisms remain unclear. Here, we elucidated the molecular functions of the citrate exporter gene cexA in relation to CA production by A. tubingensis WU-2223L. Methanol addition to the medium containing glucose as a carbon source markedly increased CA production by strain WU-2223L by 3.38-fold, resulting in a maximum yield of 65.5 g/L, with enhanced cexA expression. Conversely, the cexA-complementing strain with the constitutive expression promoter Ptef1 (strain LhC-1) produced 68.3 or 66.7 g/L of CA when cultivated without or with methanol, respectively. Additionally, strain LhC-2 harboring two copies of the cexA expression cassette produced 80.7 g/L of CA without methanol addition. Overall, we showed that cexA is a target gene for methanol in CA hyperproduction by A. tubingensis WU-2223L. Based on these findings, methanol-independent CA-hyperproducing strains, LhC-1 and LhC-2, were successfully generated.
Flamingos as ecosystem engineers: flock size and foraging behaviors linked to nutrient availability
Authors: Delfino Henrique Cardoso , Carlos Caio José 
Published: August 2024

Abstract
In wetland ecosystems, birds play a crucial role in nutrient cycling through various activities such as excrement deposition, sediment disturbance during foraging, and utilization of mud and vegetation for nesting. Particularly noteworthy are species exhibiting colonial breeding or high sociability, as they can significantly influence waterbody communities and act as ecosystem engineers in these habitats. Flamingos (Phoenicopteridae) possess all these characteristics, making them potential ecosystem engineers. In this study, we aim to test the hypothesis that Chilean Flamingos (Phoenicopterus chilensis) exert such effects on an important non-breeding wetland. Moreover, we seek to elucidate the underlaying reasons for these effects and their relationship with flock size and foraging behavior. To accomplish this, we conducted a year-long study on the flock of Chilean Flamingos at Lagoa do Peixe National Park in southern Brazil. We collected environmental and behavioral data, including nitrogen, phosphorus, and dissolved oxygen levels, water turbidity, salinity, and temperature, from areas both with and without flamingos. Our findings suggest a significant role of Chilean Flamingos in maintaining the nutrient cycle within wetland ecosystems. This is attributed not only to the high levels of guano deposition but also to the bioturbation caused by their foraging behaviors. Furthermore, we observed a significant correlation between flock size, the mean duration of foraging behaviors, and the magnitude of these effects. This study points to the likely effects of flamingos on wetlands ecosystems, emphasizing the intricate interplay between these birds and their habitats and highlighting the importance of conserving both the species and their ecosystems.
72277 - Multidisciplinary treatment decision associated with improved survival in gastric cancer patients; a nationwide cohort study in 7818 patients
Authors: Engborg Jonathan , Hedberg Jakob , Lindblad Mats , Linder Gustav 
Published: August 2024

Abstract

Introduction
Gastric cancer has an age-standardized annual incidence rate of 8-9 cases per 100,000 population in Sweden, often diagnosed in a late stage requiring complex treatment strategies. The aim was to study and evaluate the effect of multidisciplinary conferences (MDC) on survival in Swedish gastric cancer patients from 2006-2021.

Method
A retrospective cohort study of 7818 patients identified in the national registry for esophageal- and gastric cancer (NREV) was performed. Survival outcomes were compared using Kaplan-Meier method and Cox proportional hazards models adjusted for clinical and demographic variables identified with a directed acyclic graph.

Result
In 5282 (68%) patients treatment recommendation was made at an MDC, rising from 20% in 2006 to 90% in 2021. Median follow-up was 9.5 months. 6510 patients were included in multivariate analysis. MDC patients had improved survival (hazard ratio (HR) = 0.89, 95% CI 0.83-0.95, p=0.001), similarly found in subgroup analysis of patients older than 80 years (HR = 0.82, 95% CI 0.73-0.92, p=0.001), low performance status (ECOG 3-4, HR = 0.63, 95% CI 0.54-0.74, p&lt;0.001) and late-stage disease (stage IV, HR = 0.91, 95% CI 0.84-0.98, p=0.012), Figure 1.

Discussion
MDC-guided treatment decisions is positively associated with increased survival in gastric cancer patients. This effect persists when looking at characteristics traditionally excluding patients from MDC (i.e. age &gt;80, low performance status and advanced disease). The results suggest that more patients might benefit from insights at MDCs.
70571 - Evaluating the 10% tracer signal cutoff for defining a lymph node being an additional sentinel lymph node in breast cancer surgery
Authors: AbuOddos Nizar , Christenhusz Anke , Alice Lejla , Mirzaei Nushin , Karakatsanis Andreas , Eriksson Staffan , Bagge Roger Olofsson , Wärnberg Fredrik 
Published: August 2024

Abstract

Introduction
Superparamagnetic iron oxide nanoparticles (SPIO) is an effective tracer for sentinel lymph node (SLN) identification. A common definition of an additional SLN is a node with ≥10% of the signal produced by the highest signaling SLN. This study aimed to investigate the risk of additional SLNs being metastatic based on percentage of the maximum magnetic signal.

Method
Individual SLN data from five Swedish and three Dutch studies (n=908) using SPIO in breast cancer patients were extracted from patients with SLN metastases. Additional SLNs were grouped based on the percentage of their magnetic signal compared to the highest signaling SLN (SLN1=100%). The risk of additional SLNs being metastatic by signal percentage was calculated. Chi-square-test was used to compare proportions.

Result
Of 156 patients with SLN metastases, 78 had only one SLN. Among 78 patients with ≥2 SLNs, a total of 204 SLNs were retrieved, 115 with metastases and 89 without. The risk of metastasis in SLN1 was 75.6% (59/78 nodes), in SLNs with 99-80% of SLN1 signal risk was 65.4% (17/26), 79-60%; 36.8% (7/19), 59-40%; 41.7% (10/24), 39-20%; 43.2% (16/37), and 19-10%; 37.5% (6/16)(p=0.25).
Removal of only the highest signaling SLN, would correctly stage 59/78 (75.6%) patients; the two highest signaling SLNs correctly staged 74/78 (94.9%); the three highest, 78/78(100%), respectively. The difference between 1 vs. 2 SLNs removed was 19% (p&lt;0.001) and 2 vs. 3 SLNs: 5%(n.s.).

Discussion
In this exploratory analysis, removal of &gt;3 SLNs following the 10% cutoff or adjustment of the cutoff did not result in a meaningful clinical benefit.
71514 - Phyllodes Tumours: Interdisciplinary Management Recommendations from the Stockholm Region
Authors: Lindqvist Ebba , Fahlén Mia , Fredholm Hanna , Hartman Johan , Karlsson Fredrik , Papakonstantinou Andri , Sackey Helena , Zouzos Athanasios 
Published: August 2024

Abstract

Introduction
Phyllodes tumours (PT) are fibroepithelial breast tumours divided into benign, borderline, and malignant PT.

Method
We here present the first Swedish practice guidelines for the clinical management of PT, from an interdisciplinary working group in the Stockholm region.

Result
PT should be suspected in patients over ≥ 30 years of age presenting with a fast-growing lump and/or a lump of ≥ 5 cm size. There are diagnostic challenges specific to PT, which are difficult to separate from fibroadenoma and other lesions on radiology. The preoperative work-up of breast lumps of ≥ 2 cm should involve a core needle biopsy, however, the sensitivity for PT is low with core needle biopsy and fine needle aspiration alike.
Suspected borderline and malignant PT should be managed at a sarcoma centre, in collaboration between sarcoma surgeons and breast surgeons. All suspected PT should be discussed preoperatively at a multidisciplinary team meeting. For recommended excisional margins, see Table 1. Positive margins can be accepted for benign PT, which have a low risk of recurrence and no metastatic potential.
Sentinel node biopsy is not indicated in surgery for PT. Immediate breast reconstruction is not advisable in cases of malignant PT, but may otherwise be offered. Post-operative follow-up is tailored to the subtype of PT, and for borderline and malignant PT involves both clinical and radiological surveillance. For malignant PT, adjuvant radiotherapy can sometimes be indicated and may prevent recurrence.

Discussion
We believe that these guidelines will be of clinical use in the work-up, management and follow-up of PT.
71691 - Long-term overall survival after isolated liver perfusion with melphalan in patients with isolated liver metastases of uveal melanoma (SCANDIUM trial)
Authors: Nelson Axel , Shafazand Amir , All-Ericsson Charlotta , Cahlin Christian , Elander Nils , Helgadottir Hildur , Kiilgaard Jens Folke , Kinhult Sara , Ljuslinder Ingrid , Rizell Magnus , Eilard Malin Sternby , Ullenhag Gustav , Nilsson Jonas A , Ny Lars , Lindnér Per , Bagge Roger Olofsson 
Published: August 2024

Abstract

Introduction
Uveal melanoma, a rare subtype of melanoma, often spreads to the liver, resulting in poor prognosis with limited treatment options. The SCANDIUM trial investigated the efficacy of isolated hepatic perfusion (IHP) with high-dose melphalan compared to investigators choice of treatment for patients with liver metastases from uveal melanoma. We have previously reported superior response rates and progression-free survival with IHP, although overall survival (OS) at 24 months did not reach statistical significance. Here we present extended OS follow-up data.

Method
In this phase III trial, treatment-naïve nordic patients with isolated liver metastases from uveal melanoma were randomized between 2013 and 2021 to receive either IHP or best alternative care in a 1:1 ratio, with no crossover allowed. All IHP treatments were performed at Sahlgrenska University hospital.

Result
Patients were randomized to IHP (n=43) or control (n=44). In the IHP group, 89% underwent the procedure. The control group received chemotherapy (49%), immunotherapy (39%) or localized treatment interventions (9%). The overall response rate in the IHP group was 40%, with a median response duration of 13.7 months. At a minimum 36-month follow-up, the 3-year OS rate was 18.6% in the IHP group compared to 9.1% in the control group (p=0.23). The 5-year OS rate was 16.3% versus 6.8%, respectively. Median OS was 21.4 months in the IHP group and 17.3 months in the control group (p=0.11, log-rank test).

Discussion
Extended analysis of the SCANDIUM trial confirms the long-term efficacy of one-time IHP treatment compared to best alternative care for isolated liver metastases from uveal melanoma.
71793 - Infectious complications after immediate versus delayed implant-based reconstruction in women with breast cancer – a retrospective cohort study
Authors: Franzén Sofie , Lothigius Karin , Landerholm Kalle 
Published: August 2024

Abstract

Introduction
Immediate breast reconstruction (IBR) has come to increase in Sweden. In Jönköping, an implant is used for all reconstructions. The study aimed to investigate postoperative infections and compare implant-based IBR with implant-based delayed breast reconstruction (DBR).

Method
This retrospective study included all women who had undergone IBR or DBR between 2016 and 2022 in Region Jönköpings län. Data was collected from medical charts. The main endpoint was surgical site infection within three months. The secondary endpoint was time to oncological treatment.

Result
130 breasts were included, 96 in the group IBR and 34 in the group DBR, distribution per year is shown in Figure 1. Malignancy was the most common indication (78%) and 38% of the included breasts were previously operated with breast conserving surgery. Infection within three months occurred in 15 breasts, 14 of these among IBR (p=0,11), none of them had received radiation therapy. Implant removal within three months occurred in three of the 11 reoperated breasts, only one of them due to infection. Implant volume was associated with infection in IBR (p=0,014). Time to oncological treatment was 39 days among IBR and 38 among DBR (p=0,44). No patient was excluded from adjuvant treatment because of infection.

Discussion
Infection was found almost exclusively among IBR. Few patients had a known risk factor, unexpectedly none of them were affected by infection. The chance of receiving timely adjuvant therapy did not differ between the groups.
72197 - Evaluating MRI artefacts and skin discoloration using an intradermal ultra-low dose of superparamagnetic iron oxide for sentinel lymph node detection
Authors: Mirzaei Nushin , Wärnberg Fredrik , Zaar Pontus , Diniz Micael Oliveira , Karakatsanis Andreas , Leonhard Henrik , Bagge Roger Olofsson 
Published: August 2024

Abstract

Introduction
Superparamagnetic iron oxide (SPIO) nanoparticles is non-inferior as a tracer for sentinel lymph node detection in patients with breast cancer compared to the standard radioactive tracer with or without blue dye. Sentinel lymph node biopsy has been successful using an ultra-low dose of 0.1 mL SPIO injected intradermally in patients with breast cancer, and this study aims to assess the potential reduction of SPIO-related skin discoloration and breast magnetic resonance imaging (MRI) artefacts at 6 and 12 months after breast conserving surgery using an ultra-low dose of SPIO.

Method
Skin discoloration and MRI artefact were pre-planned endpoints in the prospective MAGSNOW feasibility study. MRI follow-ups were scheduled 6 and 12 months after surgery, and MRI artefacts were classified in six grades. SPIO-induced skin discoloration was assessed at baseline, 1, 6 and 12 months by photography.

Result
Thirty-seven out of fifty patients underwent 6 and 12 months MRI follow-ups, revealing no MRI artefacts impairing breast assessment. At 12 months, twenty-seven (73.0%) patients had minimal MRI artefacts, primarily in the subcutaneous tissue, or less than 5 mm in the fibroglandular tissue. Additionaly, at 12 months, twenty-seven out of fifty (54%) patients had a skin discoloration with a median area of 0.79 cm2 (IQR 0.14-1.41).

Discussion
An ultra-low dose of SPIO may offer a solution to the concerns of MRI artefacts and skin discoloration associated with the present recommended dose of 1-2 mL of SPIO. However, these findings have to be confirmed in a larger trial.
70926 - Early discharge from Paediatric day surgery unit
Authors: Heina Elisabet 
Published: August 2024

Abstract

Introduction
Day surgery units are characterized by a rapid patient flow. In the pediatric setting there is often a delay in discharge due to micturition problem for the child postoperatively.
This might lead to a long day, waiting for the child to pee after minor surgery. Some children have difficulties urinating due to anaesthetic causes, others for surgical reasons. Furthermore, the environment at a hospital can be stressful for children and have a negative impact on the ability to urinate.
The aim for this study was to see if it’s safe for children to be discharged without having peed after day surgery procedures.

Method
A routine was developed for early discharge, which meant children were discharged prior to micturition if the child’s general condition was good. Excluded procedures were bilateral undescended testis, Fowler Stephens 2 and hypospadias. Thorough oral and written information was given regarding when/where to seek healthcare if the child didn´t urinate the same evening. Written consent was obtained by caregivers.

Result
Out of 1000 children where 122* patients selected for early discharge, 119 of these were eligible for inclusion according to protocol. 2 out of 119 patients had to attend healthcare. 1 patient urinated upon arrival at the ward, 1 needed enema to urinate.
*The 3 excluded patients had hypospadia operation, all 3 needed to attend healthcare to urinate.

Discussion
With appropriate information and instructions, discharge prior to urination is safe and can be offered to children after daycare surgery if the caregiver and patient prefer early discharge.
71821 - Comparisons of serum and urine concentrations of leucine-rich alpha-2 glycoprotein 1 (LRG1) in children with and without appendicitis
Authors: Gudjonsdottir Johanna , Roth Bodil , Ohlsson Bodil , Hagander Lars , Salö Martin 
Published: August 2024

Abstract

Introduction
Leucine rich alpha-2 glycoprotein 1 (LRG1) has emerged as a promising biomarker for appendicitis, especially in pediatric patients. However, the currently available data are sparse. We aimed to compare serum and urine leucine rich alpha-2 glycoprotein 1 (LRG1) concentrations in children with no appendicitis (NA), uncomplicated appendicitis (UA) and complicated appendicitis (CA).

Method
A prospective study including children &lt;15 years with suspected appendicitis (pain in the right lower quadrant). Blood and urine samples were collected during clinical evaluation at the Pediatric ED and analyzed for LRG1 concentrations. Group comparisons were made using Kruskal-Wallis test with post hoc Dunn-Bonferroni tests for pairwise comparisons. Appendicitis diagnosis and severity were determined through histopathological examination. The study was approved by the regional ethics committee (Regionala Etikprövningsmyndigheten, Lund, Sweden, DNR 2013/614).

Result
173 children were included. 133 (77%) had appendicitis and 57 (43%) of these had complicated appendicitis. The median age was 10 (IQR 8-12) years and 99 (57%) were boys. The groups differed in distribution of sex, age and symptom duration. Median serum LRG1 for patients with NA, UA, and CA were 27.6 (19.7-36.6) μg/mL, 24.8 (18.7-30.1) μg/mL, and 23.5 (18.9-31.5) μg/mL, respectively (p=0.16). Median urine LRG1 were 0.33 (0.10-0.72) μg/mL, 0.1 (0.02-0.29) μg/mL, and 0.3 (0.12-1.07) μg/mL, respectively (p&lt;0.001, significant when comparing NA with UA, and UA with CA).

Discussion
There were no differences in serum LRG1 in our groups. Children with UA had lower urine LRG1 compared to children with NA and CA. These analyses, however, do not take into consideration potential confounding.
72322 - Centralization of the surgical care of patients born with anorectal malformations does not reduce short-term complications
Authors: Petersens Malin af , Stenström Pernilla , Borg Helena , Danielson Johan , Gunnarsdottir Anna , Oddsberg Jenny , Gustafson Elisabet , Graneli Christina , Hagelsteen Kristine , Tofft Louise , Wester Tomas 
Published: August 2024

Abstract

Introduction
The Swedish National Board of Health and Welfare centralized the surgical care of patients with anorectal malformations from four to two centers in 2018. The aim of this study was to compare short term complications after anorectal reconstruction before and after centralization.

Method
This was a retrospective review of hospital records, including all children in Sweden who underwent reconstruction of an anorectal malformation 1st of July 2013 to 30th of June 2023, divided into two 5-year periods, before and after centralization. The main outcomes were unplanned readmissions and procedures requiring general anesthesia up to 90 days after the reconstruction, as well as complications classified according to Clavien-Madadi up to 30 days after the procedure.

Result
Before centralization 173 children underwent anorectal reconstruction compared with 176 children after centralization. Patient groups were comparable with respect to associated malformations and type of anorectal malformation. Eighty (46%) children had a stoma before the anorectal reconstruction prior to centralization and 89 (51%) after (p=0.454). The anorectal reconstruction was performed at median age 61 and 47 days of age, respectively. Unplanned readmissions after anorectal reconstruction were needed in 12 (6%) children before centralization compared with 24 (14%) after (p=0.0520). Unplanned procedures under general anesthesia were required in 21 (12%) children before centralization compared with 24 (14%) after (p=0.294). There were 16 (9%) complications (Clavien-Madadi III-V) within 30 days after anorectal reconstruction before centralization and 12 (7%) after (p=0.856).

Discussion
Centralization of the surgical care of patients with anorectal malformations in Sweden does not seem to reduce short-term complications.
71223 - Risk factors for severe complications and mortality in elderly undergoing colon surgery – a retrospective cohort study from the ERAS-registry
Authors: Bjerregaard Felix , Baloch Naseer , Asklid Daniel , Ljungqvist Olle , Pekkari Klas , Elliot Anders H , Gustafsson Ulf O 
Published: August 2024

Abstract

Introduction
The rising global population of older adults is expected to lead to more elderly individuals needing surgery for colon cancer. It's crucial to study risk factors for mortality and complications following colon surgery in this demographic.

Method
The Swedish part of the ERAS-database (EIAS) from 2009 and 2022 was used. Patients aged ≥ 75 years undergoing colon surgery were compared with younger patients regarding basic characteristics and type of surgery. Possible risk factors for mortality and complications in the elderly group were analyzed using multivariate regression.

Result
11 767 patients were included. After adjusting for available confounders, male gender, OR: 1.62; 95% CI: (1.23-2.14), ASA ≥ 3, OR: 1.59; 95% CI: (1.19-2.12), severe pulmonary disease, OR: 1.74; 95% CI: (1.03-2.95), recent immunosuppressive treatment, OR: 3.23; 95% CI: (1.61-6.47), diverticular disease as indication for surgery, OR: 2.78; 95% CI: (1.53-5.07) and open surgery, OR: 1.40; 95% CI (1.05-1.85) were significantly associated with severe complications in patients ≥ 75 years. Likewise, smoking, OR: 2.59; 95% CI (1.04-6.50), ASA ≥ 3, OR: 2.38; 95% CI (1.15-4.92), severe pulmonary disease, OR: 2.98; 95% CI (1.21-7.33), and open surgery, OR: 2.07; 95% CI (1.09-3.91) were significantly associated with mortality within 30 days in the elderly group.

Discussion
Several risk factors for severe complications and mortality within 30 days of colon surgery in the elderly population were identified. Among these, severe pulmonary disease, an ASA score of ≥ 3, and undergoing open surgery were all significantly associated with both severe complications and mortality.