bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of extrusion on energy and nutrient digestibility of lentil-based diets containing either supplemental plant or animal protein fed to growing pigs
Authors: Sanchez-Zannatta Joaquin , Wang Li Fang , Beltranena Eduardo , Zijlstra Ruurd T 
Published: February 2024

Abstract
Non-food grade and excess lentil grain production may be included in swine feeds to provide starch and protein and reduce feed cost. Extrusion processing may increase energy and nutrient digestibility of lentil-based diets containing either supplemental plant or animal protein sources. Therefore, the apparent ileal digestibility (AID) of crude protein (CP) and amino acids (AA), apparent total tract digestibility (ATTD) of gross energy (GE), and digestible energy (DE) value of lentil-based diets were assessed in growing pigs. Two diets were formulated to provide 2.4 Mcal net energy (NE)/kg and 4.35 g standardized ileal digestible lysine/Mcal NE: (1) soybean meal (SBM) diet, containing 50% lentil, 31% wheat, and 12.8% SBM; and (2) fish meal (FM) diet, containing 40% lentil, 45% wheat, and 10% FM. Following mixing, each diet batch was divided into two parts: one part remained as mash, whereas the other part was extruded using a single-screw extruder (400 rpm, 250 kg/h). Eight ileal-cannulated barrows (32.3 ± 1.5 kg) were fed the four diets at 2.8 times maintenance DE requirement (110 kcal per kg of body weight0.75) for four 9-d periods in a double 4 × 4 Latin square to achieve 8 observations per diet. Data were analyzed as a 2 × 2 factorial arrangement including protein source, post-mixing processing, and their interaction as fixed effects. The lentil sample contained 32.3% starch, 24.4% CP, 9.3% total dietary fiber, and 1.7 mg/g of trypsin inhibitor activity on as is-basis. Interactions between dietary protein source and post-mixing processing were not observed. Feeding FM diets resulted in greater (P &lt; 0.05) AID of dry matter (DM), GE, and most AA, and ATTD of CP, but lower apparent hindgut fermentation of DM and GE than SBM diets. Extrusion increased (P &lt; 0.05) the ATTD of GE and DE value of diets. The AID of CP and AA was 3.2 and 4.7%-units greater (P &lt; 0.05), respectively, for the extruded than mash diets. In conclusion, feeding FM diets resulted in greater ileal digestibility of DM, GE, and AA than SBM diets. Extrusion increased the AID of CP and most AA, and DE value of lentil-based diets containing either supplemental plant protein or animal-protein, indicating that extrusion can increase the energy and protein value of plant-based diets fed to pigs.
One-shot technology for three-dimensional imaging of large animals: perspectives for ruminant management
Authors: Le Cozler Yannick , Dumesny Maxime , Delouard Jean-Michel , Delattre Laurent , Luginbühl Thibault , Faverdin Philippe 
Published: February 2024

Abstract
In numerous systems of animal production, there is increasing interest in the use of three-dimensional (3D)-imaging technology on farms for its ability to easily and safely measure traits of interest in living animals. With this information, it is possible to evaluate multiple morphological indicators of interest, either directly or indirectly, and follow them through time. Several tools for this purpose were developed, but one of their main weaknesses was their sensitivity to light and animal movement, which limited their potential for large-scale application on farms. To address this, a new device, called Deffilait3D and based on depth camera technology, was developed. In tests on 31 Holstein dairy cows and 13 Holstein heifers, the values generated for most measured indicators were highly repeatable and reproducible, with coefficients of variation lower than 4%. A comparison of measurements obtained from both Deffilait3D and the previous validated system, called Morpho3D, revealed a high degree of similarity for most selected traits, e.g., less than 0.2% variation for animal volume and 1.2% for chest depth, with the highest degree of difference (8%) noted for animal surface area. Previously published equations used to estimate body weight with the Morpho3D device were equally valid using Deffilait3D. This new device was able to record 3D images regardless of the movement of animals and it is affected only by direct daylight. The ongoing step is now to develop methods for automated analysis and extraction from images, which should enable the rapid development of new tools and potentially lead to the large-scale adoption of this type of device on commercial farms.
Development of Health Professions Education Competencies for a National Fellowship Program: A Group Consensus Process
Authors: Caloudas Alexandra B. , Arredondo Kelley , Godwin Kyler M. , Watts Bradley V. , Croom Travis , O’Brien Bridget , Topor David R. , Battistone Michael J. , Edens Ellen L. , Singh Mamta K. , Horstman Molly J. 
Published: February 2024

Abstract
Health professions educators need knowledge, skills, and attitudes to provide high-quality education within dynamic clinical learning environments. Although postgraduate training opportunities in health professions education (HPE) have increased significantly, no shared competencies exist across the field. This article describes the systematic development of postgraduate HPE competencies for the Health Professions Education, Evaluation, and Research (HPEER) Advanced Fellowship, a 2-year, interprofessional, post–master’s degree and postdoctoral HPE training program funded through the Department of Veterans Affairs’ Office of Academic Affiliations. Using a modified RAND/University of California at Los Angeles Appropriateness Method, the authors developed competencies from March 2021 to August 2021 that were informed by current practices and standards in HPE. Literature reviews were conducted of published literature from November 2020 to February 2021 and gray literature from February to March 2021, identifying 78 and 274 HPE training competencies, respectively. These competencies were combined with 71 competencies submitted by program faculty from 6 HPEER fellowship sites, resulting in 423 initial competencies. Competencies were organized into 6 primary domains and condensed by deleting redundant items and combining overlapping concepts. Eight subject matter experts completed 3 Delphi surveys and met during 2 nominal group technique meetings. The final 25 competencies spanned 6 domains: teaching methods and learning theories; educational assessment and program evaluation; educational research methods; diversity, equity, and inclusion; interprofessional practice and team science; and leadership and management. In addition to informing the national HPEER curriculum, program evaluation, and learner assessment, these advanced competencies describe the knowledge, skills, and attitudes health professions educators need to provide high-quality education with an emphasis on the global and societal impact of HPE. These competencies represent a step toward leveraging HPE expertise to establish competencies to drive HPE program changes. Other programs should report their competencies and competency development processes to spur further dialog and progress.
Antithrombotic Stewardship: Evaluation of Platelet Reactivity-Guided Cangrelor Dosing Using the VerifyNow Assay
Authors: Connery Alexander , Ahuja Tania , Katz Alyson , Arnouk Serena , Zhu Eric , Papadopoulos John , Rao Sunil , Merchan Cristian 
Published: February 2024

Abstract:
Cangrelor may be used as a bridge when temporary interruption of dual antiplatelet therapy is necessary. However, the optimal dose and monitoring of cangrelor in patients remains unknown, especially in the setting of mechanical circulatory support (MCS). We conducted an observational, single-center, retrospective cohort study of patients who had percutaneous coronary intervention within 3 months and received cangrelor while admitted to any intensive care unit. The primary outcome was the incidence of any major adverse cardiovascular event. Secondary outcomes included VerifyNow platelet reactivity units (PRUs) measured while on cangrelor and any bleeding events while on cangrelor. A total of 92 patients were included. The most common reason for cangrelor use was in the periprocedural setting, with or without MCS (42%–45%), followed by NPO status (26%–28%) and MCS alone (22%–24%). The primary outcome of major adverse cardiovascular event occurred in 1 patient (1.1%). Of 92 patients, 77% had a P2Y12 level collected within 24 hours, and 89% of the cohort was able to achieve the goal P2Y12 PRU of <194. The median P2Y12 value within 24 hours of cangrelor initation was 115 PRU (40–168 PRU). We observed a bleed event rate of 23% (21/92). We found a standardized protocol of cangrelor dosing in critically ill patients who received a drug-eluting stent in the past 3 months to be successful in achieving a goal P2Y12 PRU. Although the optimal PRU remains unknown, cardiovascular clinicians may monitor these levels to help guide decisions regarding cangrelor management. Future randomized controlled trials should evaluate the optimal PRU threshold to balance risks of ischemia and bleeding.
Sex differences in facial expressions of pain: results from a combined sample
Authors: Schneider Pia , Lautenbacher Stefan , Kunz Miriam 
Published: February 2024

Abstract
Facial expressions of pain play an important role in pain diagnostics and social interactions. Given the prominent impact of sex on various aspects of pain, it is not surprising that sex differences have also been explored regarding facial expressions of pain; however, with inconclusive findings. We aim to further investigate sex differences in facial expressions of pain by using a large, combined sample to maximize statistical power. Data from 7 previous studies of our group were merged, combining in total the data of 392 participants (male: 192, female: 200). All participants received phasic heat pain, with intensities being tailored to the individual pain threshold. Pain intensity ratings were assessed, and facial responses were manually analyzed using the Facial Action Coding. To compare facial and subjective responses between sexes, linear mixed-effects models were used, with study ID as a random effect. We found significant sex differences in facial responses, with females showing elevated facial responses to pain, although they received lower physical heat intensities (women had lower pain thresholds). In contrast, pain intensity ratings did not differ between sexes. Additionally, facial and subjective responses to pain were significantly associated across sexes, with females showing slightly stronger associations. Although variations in facial expressions of pain are very large even within each sex, our findings demonstrate that women facially communicate pain more intensively and with a better match to their subjective experience compared with men. This indicates that women might be better in using facial communication of pain in an intensity-discriminative manner.
Case report: Lateral medullary syndrome with eight-and-a-half syndromes
Authors: Zuo Chun , Zhao Mingmin , Zhao Lei , Meng Nan , Xing Xing , Li Na 
Published: February 2024

Rationale:
Lateral medullary syndrome is caused by atherosclerosis or embolism of the vertebral artery and its branches or the posterior inferior cerebellar artery (PICA).The eight-and-a-half syndrome is a rare pontocerebellar nerve-ocular syndrome presenting as a one-and-a-half syndrome plus ipsilateral seventh cerebral nerve palsy. The dorsolateral medullary syndrome combined with the eight-and-a-half syndromes is even rarer, so it is important to recognize the features of the classical brainstem syndrome and the eight-and-a-half syndromes.

Patient concerns:
Most patients with dorsolateral medullary syndrome combined with eight-and-a-half syndromes have a good prognosis, with recovery occurring within a few weeks to a few months, although a few patients may take longer to recover.

Diagnosis interventions:
In the course of disease development, the patient developed dysarthria, dysphagia, hypothermia, ipsilateral Horner sign and ataxia. Computed tomography was performed which showed cerebral infarction in the left brainstem. Cranial diffusion-weighted imaging + magnetic resonance angiography showed acute infarction in the left cerebellar hemisphere, with a high probability of severe stenosis or occlusion in the intracranial and proximal segments of the basilar arteries. This supports the diagnosis of dorsolateral medullary syndrome. The patient’s limited adduction and abduction of the left eye and limited adduction of the right eye, combined with peripheral paralysis of the affected lateral nerve, supported the diagnosis of eight-and-a-half syndromes. The administration of antiplatelet and anti-ester fixation treatment can effectively improve the symptoms and shorten the course of the disease.

Outcomes:
After antiplatelet and anti-ester fixation treatment, the symptoms improved and the patient was discharged.

Lessons:
Dorsolateral medullary syndrome combined with eight-and-a-half syndromes is a rare clinical condition, and therefore more attention should be paid to the early diagnosis and treatment of such patients.
A case report and literature review of rectal lipoma
Authors: Gao Wenguang , Zhang Kun , You Feng 
Published: February 2024

Rationale:
Colonic lipomas are uncommon benign submucosal adipose tumors that are usually asymptomatic. In principle, large lipomas can cause symptoms that require further treatment. Here, we report a case of prolapsed giant rectal lipoma and transanal mass resection.

Patient concerns:
A 65-year-old male developed rectal mass prolapse with bloody stool for 1 day.

Diagnoses:
The pathological findings were rectal lipoma.

Intervention:
After resection of the anal tumor, the patient postoperative symptoms quickly disappeared.

Outcomes:
No recurrence of the condition was observed after 6 months of follow-up after surgery.

Lessons:
It is safe and feasible for us to perform transanal mass resection for giant rectal lipomas that protrude outside the anus.
Delayed discharge from post-anesthesia care unit: A 20-case retrospective series
Authors: Liu Xiaohui , Zhang Yimin , Cai Xingzhi , Kan Huili , Yu Ailan 
Published: February 2024

Objective:
To summarize the characteristics of patients with delayed discharge from the post-anesthesia care unit and to analyze the factors and outcomes of delayed discharge.

Methods:
Twenty cases of delayed discharge from the PACU (PACU stay >2 hours after surgery) of the main operating room in Liaocheng People’s Hospital, a class A tertiary comprehensive hospital, between January 1, 2021, and December 31, 2022, among 28,084 patients who were transferred to the PACU from the operating rooms after surgery, were retrospectively analyzed. The collected data included patient characteristics, American society of anesthesiologists grade, information related to surgery and anesthesia, and outcomes. The factors for delay were assigned to 1 of 6 groups: delayed recovery from anesthesia, surgical complications, cardiovascular instability, hypoxia, inadequate analgesia, and waiting for the operating room.

Results:
The incidence of delayed discharge from PACU was 0.7‰. Among 20 patients, more than half of the patients were over 65 years of age, American society of anesthesiologists grade II~III, body mass index <30 kg/m2, and urological surgery (7, 35%), liver surgery (4, 20%), thoracic surgery (4, 20%) accounted for a relatively high proportion. Nineteen (95%) patients received general anesthesia with or without peripheral nerve block. The main factors included delayed recovery from anesthesia (6, 30%), surgical complications (5, 25%), cardiovascular complications (4, 20%), hypoxia (3,15%). After discharge from the PACU, 1 (5%) died in the intensive care unit, and the other 19 (95%) patients were safely discharged from the hospital.

Conclusion:
The incidence of delayed discharge from the PACU was low, and it was more likely to occur in the elderly, during major operations, and under general anesthesia. Delayed recovery from anesthesia was the most common factor. Most patients were safely discharged from the hospital.
Effect of repetition of rTMS at different frequencies on the efficacy of swallowing disorders after stroke: A systematic review and meta-analysis
Authors: Sun Meixia , Chen Kang , He Yanwen , Zhang Yukun , Zhuo Yue , Zhuang He 
Published: February 2024

Background:
To systematically evaluate the curative effect of repeated transcranial magnetic stimulation at different frequencies on swallowing disorders after stroke.

Methods:
A search was conducted for randomized controlled trials of repeated transcranial magnetic stimulation for stroke patients in CNKI, Wanfang, VIP, ProQuest, PubMed, Cochrane Library, Scopus, and Web of Science databases until December 2022. The 2 researchers strictly screened and checked the included documents, extracted relevant data, assessed the risk quality of the literature using the Cochrane manual, and conducted a network meta-analysis of the data using State16.0.

Results:
Eighteen studies included 680 participants. The results of the reticular meta-analysis showed that in the leakage-aspiration scale (PAS) indicators, 1 Hz, 3 Hz, 5 Hz, and 10 Hz were all better treatment effects compared with the control group, and there was a statistically significant difference (P < .05). In the standard swallowing function assessment (SSA) index, 3 Hz, 5 Hz, and 10 Hz compared with the control group were statistically significant (P < .05); there was no difference between 1 Hz and the control group (P > .05). The cumulative probability ranking results showed that the intervention effect of 3 Hz was the best in the PAS index, much greater than that of other frequencies, and the intervention effects of 10 Hz and 5 Hz were similar. For the SSA index, the intervention effect was optimal at 10 Hz, followed by 5 Hz. Note that the treatment effect of 1 Hz ranked last, even lower than that of the control group. The results of the 5 Hz treatment site grouping analysis showed that the affected side was > bilateral > healthy in PAS and > bilateral > healthy in SSA.

Conclusion subsections:
Based on the current study, the optimal frequency and site selection results of the 2 evaluation indicators are not uniform, but from the combination of the 2 evaluation indicators, the treatment effect of 10H is good, and the effect of bilateral stimulation for the selection of stimulation sites is good. The above conclusions need to be verified in high-quality studies.
Neuromyelitis optica spectrum disorder with herpes simplex viral infection presenting with syndrome of inappropriate antidiuretic hormone: A case report
Authors: Chung Ji Yeon , Lee Chang Ju , Bong Jeong Bin , Shin Byoung-Soo , Ryu Han Uk , Kang Hyun Goo 
Published: February 2024

Rationale:
Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disease that causes lesions in areas with abundant aquaporin-4 (AQP4) channels, including the hypothalamus. Hypothalamic lesions can disrupt antidiuretic hormone regulation, resulting in hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH). Various factors can trigger NMOSD, including viral infections. We report the case of a young female patient who presented with hyponatremia due to SIADH and was found to have bilateral hypothalamic lesions along with positive serum herpes simplex virus immunoglobulin M.

Patient concerns:
An 18-year old female patient presented with fever and nausea that had persisted for 5 days. Three days after hospitalization, the patient complained of blurred vision, hiccups, and excessive daytime sleepiness.

Diagnosis:
The patient hyponatremia was attributed to SIADH. Magnetic resonance imaging revealed bilateral lesions in the hypothalamus, and serum laboratory tests were positive for herpes simplex virus immunoglobulin M. On the 15th day of admission, the anti-AQP4 antibody test result was positive, leading to the diagnosis of NMOSD.

Interventions:
On the initial suspicion of herpes encephalitis, treatment with acyclovir was initiated. However, upon the confirmation of after anti-AQP4 antibody, the patient was additionally treated with a high-dose intravenous steroid for 5 days.

Outcomes:
The patient fever, nausea, visual disturbances, and other complaints improved within 1 week of initiating steroid treatment.

Lessons:
In young patients presenting with hyponatremia and suspected SIADH accompanied by neurological abnormalities, it is crucial to differentiate central nervous system diseases, including NMOSD, which can involve lesions in AQP4-abundant areas, such as the hypothalamus.
Efficacy of immune nutrients in severe acute pancreatitis: A network meta-analysis
Authors: Tao Xin , Yang Yurui , Xu Shanshan , Xiong Qing 
Published: February 2024

Background:
The use of immune nutrients in the treatment of severe pancreatitis remains controversial. No study has yet compared the effects of different immune nutrients on patients with severe acute pancreatitis. This study aimed to compare the effects of different immune nutrients in treating severe acute pancreatitis through a network meta-analysis.

Methods:
PubMed, Embase, Cochrane Library, Web of Science, and Scopus were used to search randomized controlled trials from the inception to July 2023. Information was collected from patients with severe acute pancreatitis and their intervention methods, which included the administration of glutamine, omega-3 polyunsaturated fatty acids, arginine, and nucleotides. The evaluated outcomes included mortality, infection, the length of the hospital stay (LOH), the length of intensive care unit stay (LOI), and C-reactive protein (CRP). Risk ratio (95% confidence interval [CI]) and mean difference (MD) (95% CI) were calculated using a network meta-analysis random-effects model. The ranking between interventions was calculated using the surface under the cumulative ranking curve. The Cochrane Risk of Bias tool 2 was used to assess the risk of bias. The sources of heterogeneity were assessed using sensitivity analysis and network meta-regression. The credibility of the evidence was assessed using grading of recommendations assessment, development, and evaluation.

Results:
Nineteen studies with 1035 patients were included in this network meta-analysis. Parenteral glutamine was more effective in reducing mortality, infection, LOH, and LOI, as well as in the downregulation of CRP compared to the control. Risk ratio (95%CI) or MD (95%CI) were 0.38 (0.16, 0.90), 0.35 (0.14, 0.90), −3.32 (−4.90, −1.75), −2.53 (−4.46, −0.61), and −17.78 (−28.77, −6.78), respectively. Parenteral omega-3 polyunsaturated fatty acids was more effective in reducing LOH and LOI, as well as in the downregulation of CRP. MD (95%CI) were −6.77 (−11.40, −2.14), −5.19 (−7.80, −2.57), and −26.20 (−39.71, −12.68), respectively. Immune nutrients in the other groups did not exert any effect compared to the control regarding all the outcomes. Parenteral glutamine ranked best in reducing infections. Parenteral omega-3 polyunsaturated fatty acids ranked best in reducing mortality, LOH, and LOI, as well as in the downregulation of CRP.

Conclusion:
Some immune nutrients were beneficial for patients with severe acute pancreatitis. Parenteral administration could be better than enteral administration.