bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Population-Level Prevalence of Exocrine Pancreas Insufficiency and the Subsequent Risk of Pancreatic Cancer
Authors: Babajide Oyedotun , Desai Aakash , Eruchalu Chinelo , Sedarous Mary , Adekunle Ayooluwatomiwa Deborah , Youssef Michael , Mahmud Muftah , Okafor Philip N. 
Published: May 2024

Objectives
The aim of this study was to study the prevalence of exocrine pancreas insufficiency (EPI) at a population level and the subsequent risk of pancreatic ductal adenocarcinoma (PDAC).

Materials and Methods
Using TriNetX (a database of over 79 million US residents), we included patients ≥18 years with EPI (identified via ICD-10 codes) and continuous follow-up from 2016–2022. Patients with prior pancreas resection and PDAC before an EPI diagnosis were excluded. The primary outcome was EPI prevalence. Secondary outcomes included imaging utilization, PDAC risk, and pancreatic enzyme replacement therapy (PERT) utilization. We performed 1:1 propensity score matching (PSM) of patients with EPI versus patients without an EPI diagnosis.

Results
The population prevalence of EPI was 0.8% (n = 24,080) with a mean age of 55.6 years. After PSM, PDAC risk among patients with EPI was twice as high compared with patients without EPI (aHR, 1.97; 95% CI, 1.66–2.36). This risk persisted even after excluding patients with a history of acute or chronic pancreatitis (adjusted odds ratio, 4.25; 95% CI, 2.99–6.04). Only 58% (n = 13, 390) of patients with EPI received PERT. No difference was observed in PDAC risk between patients with EPI on PERT and those not on PERT (aHR, 1.10; 95% CI, 0.95–1.26; P = 0.17).

Conclusions
Despite a low prevalence, patients with EPI may have a higher risk of PDAC, and majority with EPI were not on PERT. PERT did not impact incident PDAC risk after an EPI diagnosis.
Clinical Full-Time Equivalent in PICUs: Survey of the U.S. Pediatric Critical Care Chiefs Network, 2020–2022
Authors: Ettinger Nicholas A. , Loscalzo Steven , Liu Hongyan , Griffis Heather , Mack Elizabeth H. , Agus Michael S. D. 
Published: May 2024

OBJECTIVES:
To inform workforce planning for pediatric critical care (PCC) physicians, it is important to understand current staffing models and the spectrum of clinical responsibilities of physicians. Our objective was to describe the expected workload associated with a clinical full-time equivalent (cFTE) in PICUs across the U.S. Pediatric Critical Care Chiefs Network (PC3N).

DESIGN:
Cross-sectional survey.

SETTING:
PICUs participating in the PC3N.

SUBJECTS:
PICU division chiefs or designees participating in the PC3N from 2020 to 2022.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A series of three surveys were used to capture unit characteristics and clinical responsibilities for an estimated 1.0 cFTE intensivist. Out of a total of 156 PICUs in the PC3N, the response rate was 46 (30%) to all three distributed surveys. Respondents used one of four models to describe the construction of a cFTE—total clinical hours, total clinical shifts, total weeks of service, or % full-time equivalent. Results were stratified by unit size. The model used for construction of a cFTE did not vary significantly by the total number of faculty nor the total number of beds. The median (interquartile range) of clinical responsibilities annually for a 1.0 cFTE were: total clinical hours 1750 (1483–1858), total clinical shifts 142 (129–177); total weeks of service 13.0 (11.3–16.0); and total night shifts 52 (36–60). When stratified by unit size, larger units had fewer nights or overnight hours, but covered more beds per shift.

CONCLUSIONS:
This survey of the PC3N (2020–2022) provides the most contemporary description of clinical responsibilities associated with a cFTE physician in PCC. A 1.0 cFTE varies depending on unit size. There is no correlation between the model used to construct a cFTE and the associated clinical responsibilities.
Feasibility Analysis of Individualized Low Flow Rate Abdominal Contrast-Enhanced Computed Tomography in Chemotherapy Patients: Dual-Source Computed Tomography With Low Tube Voltage
Authors: Zhang Yicun , Yuan Dian , Qi Ke , Zhang Mengyuan , Zhang Weiting , Wei Nannan , Li Linfeng , Lv Peijie , Gao Jianbo , Liu Jie 
Published: May 2024

Purpose
The aim of the study is to investigate the feasibility of using dual-source computed tomography (CT) combined with low flow rate and low tube voltage for postchemotherapy image assessment in cancer patients.

Methods
Ninety patients undergoing contrast-enhanced CT scans of the upper abdomen were prospectively enrolled and randomly assigned to groups A, B, and C (n = 30 each). In group A, patients underwent scans at 120 kVp with 448 mgI/kg. Patients in group B underwent scans at 100 kVp with 336 mgI/kg. Patient in group C underwent scans at 70 kVp with of 224 mgI/kg. Quantitative measurements including the CT number, standard deviation of CT number, signal-to-noise ratio, contrast-to-noise ratio, subjective reader scores, and the volume and flow rate of contrast agent were evaluated for each group.

Results
There was no statistically significant difference in the subjective image scores within the three groups except for the kidney (all P > 0.05). Group C showed significantly higher CT values, lower noise levels, and higher signal-to-noise ratio and contrast-to-noise ratio values in the majority of the regions of interest compared to the other groups (P < 0.05). In group C, the contrast agent dose was decreased by 46% compared to group A (79.48 ± 12.24 vs 42.7 ± 8.6, P < 0.01), and the contrast agent injection rate was reduced by 22% (2.7 ± 0.41 vs 2.1 ± 0.4, P < 0.01).

Conclusions
The use of 70 kVp tube voltage combined with low iodine flow rates prove to be a more effective approach in solving the challenge of compromised blood vessels in postchemotherapy tumor patients, without reducing image quality and diagnostic confidence.
Imaging Diagnosis of Thoracic Elastofibroma Dorsi
Authors: Pi Yeli , Hammer Mark M. 
Published: May 2024

Objective
Elastofibroma dorsi (ED) is an uncommon benign tumor that is commonly incidentally discovered on thoracic imaging and at times misinterpreted as a more aggressive lesion. The objective of the study is to characterize the typical cross-sectional imaging findings of elastofibroma dorsi and quantify the risk of masquerading malignancy.

Methods
Retrospective search of radiology and pathology reports over a 12-year period identified 409 cases of suspected ED. Pertinent imaging was reviewed with a focus on computed tomography (CT) and magnetic resonance imaging (MRI), specifically assessing lesion location, presence of interspersed fat, and appearances on follow-up.

Results
Typical imaging appearances of 310 ED, including 10% with pathologic confirmation, were that of a mass deep to the serratus anterior (98%) and near the scapular tip (98%). Intralesional interspersed fat was present in 87% of cases imaged with CT and in 90% of cases imaged with MRI. In the 43 cases imaged with both modalities, 8 (19%) did not have interspersed fat on CT, but 7 (88%) of these did have interspersed fat on MRI. Twelve tumors (benign and malignant) were included, of which only 17% were deep to serratus anterior and 25% were at the scapular tip, P = 0.0001 and P < 0.0001 versus ED. Only a single tumor contained interspersed fat, P < 0.001 versus ED, which had benign pathology on biopsy.

Conclusions
Elastofibroma dorsi can be diagnosed with a high degree of certainty in the presence of classic location and imaging characteristics, obviating the need for further imaging or biopsy.
Tumors Affect the Metabolic Connectivity of the Human Brain Measured by 18F-FDG PET
Authors: Pasquini Luca , Jenabi Mehrnaz , Graham Maya , Peck Kyung K. , Schöder Heiko , Holodny Andrei I. , Krebs Simone 
Published: May 2024

Purpose

18F-FDG PET captures the relationship between glucose metabolism and synaptic activity, allowing for modeling brain function through metabolic connectivity. We investigated tumor-induced modifications of brain metabolic connectivity.

Patients and Methods
Forty-three patients with left hemispheric tumors and 18F-FDG PET/MRI were retrospectively recruited. We included 37 healthy controls (HCs) from the database CERMEP-IDB-MRXFDG. We analyzed the whole brain and right versus left hemispheres connectivity in patients and HC, frontal versus temporal tumors, active tumors versus radiation necrosis, and patients with high Karnofsky performance score (KPS = 100) versus low KPS (KPS < 70). Results were compared with 2-sided t test (P < 0.05).

Results
Twenty high-grade glioma, 4 low-grade glioma, and 19 metastases were included. The patients’ whole-brain network displayed lower connectivity metrics compared with HC (P < 0.001), except assortativity and betweenness centrality (P = 0.001). The patients’ left hemispheres showed decreased similarity, and lower connectivity metrics compared with the right (P < 0.01), with the exception of betweenness centrality (P = 0.002). HC did not show significant hemispheric differences. Frontal tumors showed higher connectivity metrics (P < 0.001) than temporal tumors, but lower betweenness centrality (P = 4.5−7). Patients with high KPS showed higher distance local efficiency (P = 0.01), rich club coefficient (P = 0.0048), clustering coefficient (P = 0.00032), betweenness centrality (P = 0.008), and similarity (P = 0.0027) compared with low KPS. Patients with active tumor(s) (14/43) demonstrated significantly lower connectivity metrics compared with necroses.

Conclusions
Tumors cause reorganization of metabolic brain networks, characterized by formation of new connections and decreased centrality. Patients with frontal tumors retained a more efficient, centralized, and segregated network than patients with temporal tumors. Stronger metabolic connectivity was associated with higher KPS.
High frequency of artemisinin partial resistance mutations in the great lake region revealed through rapid pooled deep sequencing
Authors: Young Neeva Wernsman , Gashema Pierre , Giesbrecht David , Munyaneza Tharcisse , Maisha Felicien , Mwebembezi Fred , Budodo Rule , Leonetti Alec , Crudale Rebecca , Iradukunda Vincent , Bosco Ntwari Jean , Boyce Ross M. , Mandara Celine I. , Kanyankole Grace K. , Mulogo Edgar , Ishengoma Deus S. , Hangi Stan , Karema Corine , Mazarati Jean-Baptiste , Juliano Jonathan J , Bailey Jeffrey A. 
Published: May 2024

AbstractIn Africa, the firstPlasmodium falciparumKelch13 (K13) artemisinin partial resistance mutation 561H was first detected and validated in Rwanda. Surveillance to better define the extent of the emergence in Rwanda and neighboring countries as other mutations arise in East Africa is critical. We employ a novel scheme of liquid blood drop preservation combined with pooled sequencing to provide a cost-effective rapid assessment of resistance mutation frequencies at multiple collection sites across Rwanda and neighboring countries. Malaria-positive samples (n=5,465) were collected from 39 health facilities in Rwanda, Uganda, Tanzania, and the Democratic Republic of the Congo (DRC) between May 2022 and March 2023 and sequenced in 199 pools. In Rwanda, K13 561H and 675V were detected in 90% and 65% of sites with an average frequency of 19.0% (0-54.5%) and 5.0% (0-35.5%), respectively. In Tanzania, 561H had high frequency in multiple sites while it was absent from the DRC although 675V was seen at low frequency. Conceringly candidate mutations were observed: 441L, 449A, and 469F co-occurred with validated mutations suggesting they are arising under the same pressures. Other resistance markers associated with artemether-lumefantrine are common:P. falciparummultidrug resistance protein 1 N86 at 98.0% and 184F at 47.0% (0-94.3%) andP. falciparumchloroquine resistance transporter 76T at 14.7% (0-58.6%). Additionally, sulfadoxine-pyrimethamine-associated mutations show high frequencies.Overall,K13mutations are rapidly expanding in the region further endangering control efforts with the potential of engendering partner drug resistance.
Impact of year-long cannabis use for medical symptoms on brain activation during cognitive processes
Authors: Burdinski Debbie , Kodibagkar Alisha , Potter Kevin , Schuster Randi , Evins A. Eden , Ghosh Satrajit , Gilman Jodi 
Published: May 2024

AbstractImportance:Cannabis is increasingly being used to treat medical symptoms, but the effects of cannabis use on brain function in those using cannabis for these symptoms is not known.Objective:To test whether brain activation during working memory, reward, and inhibitory control tasks, areas of cognition impacted by cannabis, showed increases following one year of cannabis use for medical symptoms.Design:This observational cohort study took place from July 2017 to July 2020 and is reported on in 2024.Setting:Participants were from the greater Boston area.Participants:Participants were recruited as part of a clinical trial based on seeking medical cannabis cards for anxiety, depression, pain, or sleep disorders, and were between 18 and 65 years. Exclusion criteria were daily cannabis use and cannabis use disorder at baseline.Main Outcomes and Measures:Outcomes were whole brain functional activation during tasks involving working memory, reward and inhibitory control at baseline and after one year of cannabis use.Results:Imaging was collected in participants before and one year after obtaining medical cannabis cards; 57 at baseline (38 female [66.7%]; mean [SD] age, 38.0 [14.6] years) at baseline, and 54 at one-year (37 female [68.5%]; mean [SD] age, 38.7 [14.3] years). Imaging was also collected in 32 healthy control participants (22 female [68.8%]; mean [SD] age, 33.8 [11.8] years) at baseline. In all groups and at both time points, functional imaging revealed canonical activations of the probed cognitive processes. No statistically significant difference in brain activation between the two timepoints (baseline and one-year) in those with medical cannabis cards and no association of changes in cannabis use frequency with brain activation were found.Conclusions and Relevance:Findings suggest that adults do not show significant neural effects in the areas of cognition of working memory, reward, and inhibitory control after one year of cannabis use for medical symptoms. The results warrant further studies that probe effects of cannabis at higher doses, with greater frequency, in younger age groups, and with larger, more diverse cohorts.Trial Registration:NCT03224468,https://clinicaltrials.gov/Key PointsQuestion:This study investigated the impact of year-long cannabis use for medical symptoms on brain activation during cognitive processes implicated in cannabis use.Findings:Functional magnetic resonance imaging during a working memory, reward, and inhibitory control task was collected at baseline and after one year of medical cannabis card ownership. After one year, brain activation did not differ statistically from baseline and was not associated with changes in cannabis use frequency.Meaning:The absence of activation differences suggests that adults using cannabis for medical conditions may not experience significant neural effects in regards to reward, working memory, or inhibitory control.
Serum cytokine and inflammatory markers in individuals with heroin use disorder: potential biomarkers for diagnosis and disease severity
Authors: Butelman Eduardo R. , Huang Yuefeng , Cathomas Flurin , Gaudreault Pierre-Olivier , Roussos Panos , Russo Scott J. , Goldstein Rita Z. , Alia-Klein Nelly 
Published: May 2024

AbstractOpioid use disorders cause major morbidity and mortality, and there is a pressing need for novel mechanistic targets and biomarkers for diagnosis and prognosis. Exposure to mu-opioid receptor (MOR) agonists causes changes in cytokine and inflammatory protein networks in peripheral blood, and also in brain glia and neurons. Individuals with heroin use disorder (iHUD) show dysregulated levels of several cytokines in blood. However, there is limited data on a comprehensive panel of such markers in iHUD versus healthy controls (HC), especially as a multi-target biomarker. We used a validated proximity extension assay for relative quantification of 92 cytokines and inflammatory proteins in serum of iHUD on medication assisted therapy (MAT; n=21), versus HC (n=24). Twenty-nine targets showed significant group differences (primarily iHUD>HC), surviving multiple comparison correction (p=0.05). This included 19 members of canonical cytokine families, including specific chemokines, interleukins, growth factors, and tumor necrosis factor (TNF)-related proteins. For dimensionality reduction, data from these 19 cytokines were entered into a principal component (PC) analysis, and PC1 scores were iHUD>HC (p<0.0001). A receiver-operating characteristic (ROC) curve analysis yielded an AUROC=91.7% (p<0.0001). This PC1 score remained a positive predictor of being in the HUD group in a multivariable logistic regression, which included demographic/clinical variables. Overall, this study shows a panel of cytokines that differ significantly between iHUD and HC, and provides a multi-target “cytokine biomarker score” for potential diagnostic purposes, and examination of disease severity.
Inflammation Proteomic Profiling of Psychosis in Young Adults: findings from the ALSPAC birth cohort
Authors: Tsang Ruby S. M. , Timpson Nicholas J. , Khandaker Golam M. 
Published: May 2024

AbstractPsychotic disorder is associated with altered levels of various inflammatory markers in blood, but existing studies have typically focused on a few selected biomarkers, have not examined specific symptom domains notably negative symptoms, and are based on individuals with established/chronic illness. Based on data from young people aged 24 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, we have examined the associations of 67 plasma immune/inflammatory proteins assayed using the Olink Target 96 Inflammation panel with psychotic disorder, positive (any psychotic experiences and definite psychotic experiences) and negative symptoms, using linear models with empirical Bayes estimation. The analyses included between 2641 and 2854 individuals. After adjustment for age, sex, body mass index and smoking and correction for multiple testing, upregulation of CDCP1 and IL-6 were consistently associated with positive symptoms and psychotic disorder, while psychotic disorder was additionally associated with upregulation of MMP-10. Negative symptoms were associated with upregulation of the highest number of proteins (n=11), including cytokines, chemokines and growth factors which partly overlap with proteins associated with positive symptoms or psychotic disorder (CDCP1, IL-6 and MMP-10). Our findings highlight associations of inflammatory proteins involved in immune regulation, immune cell activation/migration, blood-brain barrier disruption, and extracellular matrix abnormalities with psychosis or psychotic symptoms in young people, consistent with a role of inflammation and immune dysfunction in the pathogenesis of psychotic disorders.
The Effectiveness of Using a Clinical Support Tool in Managing Adolescents with Non-Traumatic Knee Pain (MAP-Knee): protocol for a cluster-randomised superiority trial with delayed intervention and embedded realist evaluation
Authors: Riel Henrik , Johansen Simon Kristoffer , Andersen Erika Maria , Bruun Malene Kjær , Bruun Niels Henrik , Djurtoft Chris , Doessing Simon , Heyckendorff-Diebold Tina , Hölmich Per , Jensen Martin Bach , Kaalund Søren , Kaldau Niels-Christian , Oehlenschlaeger Tommy Frisgaard , Overgaard Charlotte , Rahbek Ole , Rasmussen Dorthe Brøndum , Schaarup Susanne Olesen , Sørensen Thomas , Thomsen Louise Lund Holm , Rathleff Michael Skovdal 
Published: May 2024

AbstractBackgroundKnee pain affects one in three adolescents, which makes it one of the most common pain sites. Guideline recommendations about the clinical selection of patients likely to benefit from interventions are unclear, which leads to treatment heterogeneity and the potential of wasted resources among adolescents with a good prognosis. In contrast, adolescents with a poorer prognosis may not receive sufficient care. A newly developed clinical decision-support tool (The MAP-Knee Tool) intends to support clinicians in engaging with patients and adjusting the clinicians’ evidence-based practices to accommodate patient preferences and treatment needs via a shared decision-making process. The aims of this trial are 1) to investigate the effectiveness of using a clinical decision-support tool (The MAP-Knee Tool) compared with usual care in adolescents with non-traumatic knee pain in reducing pain measured by KOOS-Child Pain after 12 weeks and 2) to investigate how the intervention worked, for whom, why and under which circumstances applying realist evaluation methodology.MethodsThis trial is a cluster-randomised superiority trial with a delayed intervention and a realist evaluation. Six hospital departments start with a usual care period of 4 months before randomly crossing over to using the intervention (The MAP-Knee Tool) after 4, 6, or 8 months, respectively. We will recruit 290 adolescents suffering from non-traumatic knee pain diagnoses who are followed for one year, with the change in KOOS-Child Pain after 12 weeks considered the primary endpoint. Secondary outcomes include 1) Global Rating of Change, 2) EQ-5D-Youth, 3) Anterior Knee Pain Youth, 4) the International Physical Activity Questionnaire short version, and 5) sports participation. The realist evaluation will utilise a prospective, qualitative approach for collecting data needed to develop and test a program theory and identify context-mechanism-outcome configurations essential for understanding how outcomes are achieved within specific contexts.DiscussionThis trial focuses on how the initial clinical encounter can be improved to meet the support and management needs of adolescents with chronic knee pain seeking treatment for knee pain in secondary care and investigates how the intervention worked, for whom, why and under which circumstances.Trial registrationClinicaltrials.gov(NCT05791513). Prospectively registered on March 30th, 2023.