bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glucagon-Like Peptide 1–Based Therapies and Risk of Pancreatic Cancer in Patients With Diabetes and Obesity
Authors: Krishnan Arunkumar , Hadi Yousaf , Hutson William R. , Thakkar Shyam , Singh Shailendra 
Published: April 2023

Objectives
There have been conflicting reports concerning an increased risk of pancreatic cancer (PC) in new users of glucagon-like peptide-1 agonists (GLP-1As). We aimed to explore whether the use of GLP-1A is associated with an increased risk of PC.

Methods
A multicenter, retrospective cohort study was conducted using TriNetX. Adult patients with diabetes and/or overweight and obesity who were newly treated with GLP-1A or metformin for the first time between 2006 and 2021 were matched 1:1 using propensity score matching. The risk of PC was estimated using a Cox proportional hazards model.

Results
A total of 492,760 patients were identified in the GLP-1A and 918,711 patients in the metformin group. After propensity score matching, both cohorts (370,490 each) were well matched. During follow-up, 351 patients in the GLP-1A and 956 on metformin developed PC after an exposure lag of 1 year. Glucagon-like peptide-1 agonists was associated with a significantly lower risk of PC (hazard ratio, 0.47; 95% confidence interval, 0.42–0.52).

Conclusions
The use of GLP-1A in patients with obesity/diabetes is associated with a lower risk of PC compared with a similar cohort of patients using metformin. Our study findings reassure clinicians and patients with apprehensions about any possible association between GLP-1A and PC.
Role of Somatostatin Receptor 2 in Nonfunctional Pancreatic Neuroendocrine Tumors
Authors: Hu Hai-Feng , Hu Yu-Heng , Xu Xiao-Wu , Ye Zeng , Lou Xin , Zhang Wu-Hu , Chen Xue-Min , Zhang Yue , Yu Xian-Jun , Gao He-Li , Xu Jun-Yan , Ji Shun-Rong 
Published: April 2023

Objectives
Somatostatin receptors are commonly expressed in most pancreatic neuroendocrine tumors (pNETs), a rare type of pancreatic tumors with high heterogeneity. However, the role of somatostatin receptor 2 (SSTR2) has seldom been investigated separately in pNET. This retrospective study aims to evaluate the role of SSTR2 in the clinicopathological features and genomic background of nonfunctional and well-differentiated pNET.

Methods
A total of 223 cases of nonfunctional well-differentiated pNET were included, and the correlation between SSTR2 status and clinicopathological outcome was evaluated. In addition, we performed whole exome sequencing in SSTR2-positive and SSTR2-negative pNETs and identified that the 2 lesions harbored different mutational landscapes.

Results
Negative SSTR2 immunochemistry staining was significantly related to an earlier onset of disease, larger tumor size, advanced stage of American Joint Committee on Cancer, and tumor metastasis in lymph nodes and liver. Under pathological assessment, positive peripheral aggression, vascular invasion, and perineural invasion were markedly increased in SSTR2-negative cases. Moreover, SSTR2-negative patients exhibited significantly worse progression-free survival than SSTR2-positive patients (hazard ratio, 0.23; 95% confidence interval, 0.10–0.53; P = 0.001).

Conclusions
Somatostatin receptor 2–negative nonfunctional pNET might represent a subtype of pNET with poor outcomes and evolve from a different genomic background.
Factors Predicting the Development of Necrosis in Patients Presenting With Edematous Acute Pancreatitis
Authors: Acehan Fatih , Comoglu Mustafa , Kayserili Fatih Mehmet , Hayat Büşra , Ates Ihsan 
Published: April 2023

Objectives
There is no marker that can accurately predict the development of pancreatic necrosis in edematous acute pancreatitis (AP). This study aimed to investigate the factors associated with necrosis development in cases of edematous AP and to create an easy-to-use scoring system.

Methods
We retrospectively reviewed patients diagnosed with edematous AP between 2010 and 2021. Among the patients, those who were found to have developed necrosis during follow-up were categorized as the necrotizing group, whereas the others constituted the edematous group.

Results
With multivariate analysis, white blood cell, hematocrit, lactate dehydrogenase, and C-reactive protein levels at the 48th hour were revealed to be independent risk factors for necrosis. Using these 4 independent predictors, the Necrosis Development Score 48 (NDS-48) was derived. While the cutoff value was 2.5, the sensitivity and specificity of the NDS-48 for necrosis were 92.5% and 85.9%, respectively. The area under the curve value of the NDS-48 for necrosis was 0.949 (95% confidence interval, 0.920–0.977).

Conclusions
White blood cell, hematocrit, lactate dehydrogenase, and C-reactive protein levels at the 48th hour are independent predictors of necrosis development. The NDS-48, a new scoring system created with these 4 predictors, satisfactorily predicted the development of necrosis.
Peri-Intubation Adverse Events in the Critically Ill Child After Hematopoietic Cell Transplant
Authors: Lenz Kyle B. , Nishisaki Akira , Lindell Robert B. , Yehya Nadir , Laverriere Elizabeth K. , Bruins Benjamin B. , Napolitano Natalie , Traynor Danielle M. , Rowan Courtney M. , Fitzgerald Julie C. 
Published: April 2023

Objectives:
Mechanically ventilated children post-hematopoietic cell transplant (HCT) have increased morbidity and mortality compared with other mechanically ventilated critically ill children. Tracheal intubation-associated adverse events (TIAEs) and peri-intubation hypoxemia universally portend worse outcomes. We investigated whether adverse peri-intubation associated events occur at increased frequency in patients with HCT compared with non-HCT oncologic or other PICU patients and therefore might contribute to increased mortality.

Design:
Retrospective cohort between 2014 and 2019.

Setting:
Single-center academic noncardiac PICU.

Patients:
Critically ill children who underwent tracheal intubation (TI).

Interventions:
None.

Measurements and Main Results:
Data from the local airway management quality improvement databases and Virtual Pediatric Systems were merged. These data were supplemented with a retrospective chart review for HCT-related data, including HCT indication, transplant-related comorbidity status, and patient condition at the time of TI procedure. The primary outcome was defined as the composite of hemodynamic TIAE (hypo/hypertension, arrhythmia, cardiac arrest) and/or peri-intubation hypoxemia (oxygen saturation < 80%) events. One thousand nine hundred thirty-one encounters underwent TI, of which 92 (4.8%) were post-HCT, while 319 (16.5%) had history of malignancy without HCT, and 1,520 (78.7%) had neither HCT nor malignancy. Children post-HCT were older more often had respiratory failure as an indication for intubation, use of catecholamine infusions peri-intubation, and use of noninvasive ventilation prior to intubation. Hemodynamic TIAE or peri-intubation hypoxemia were not different across three groups (HCT 16%, non-HCT with malignancy 10%, other 15). After adjusting for age, difficult airway feature, provider type, device, apneic oxygenation use, and indication for intubation, we did not identify an association between HCT status and the adverse TI outcome (odds ratio, 1.32 for HCT status vs other; 95% CI, 0.72–2.41; p = 0.37).

Conclusions:
In this single-center study, we did not identify an association between HCT status and hemodynamic TIAE or peri-intubation hypoxemia during TI.
Low Diagnostic Utility of Frequent Serial Tracheal Aspirate Cultures in the PICU*
Authors: Feldman Evin , Shah Shivang S. , Ahn Danielle 
Published: April 2023

OBJECTIVES:
To determine the diagnostic outcomes of serial tracheal aspirate cultures (TACs) in the PICU.

DESIGN:
A retrospective chart review of TAC utilization was performed. Items recorded for each TAC included the time and date of culture acquisition, result, changes in microbial resistance patterns, antimicrobial therapy, and patient clinical course.

SETTING:
A single urban tertiary care children’s hospital in the United States.

SUBJECTS:
Patients admitted to the PICU from January 1, to October 31, 2021, for whom a TAC was performed.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
One hundred fifty unique subjects had 582 TACs performed during the study period, of which 145 (24.9%) were serially repeated within 72 hours. Of these serial TACs, 82 (56.6%) had no growth, 41 (28.3%) grew the same organism as the prior culture, with most (36/41) displaying no major change in antimicrobial susceptibilities, 11 (7.6%) grew a new organism previously grown during the admission, and 11 (7.6%) grew a new organism not previously grown during the admission. Overall, only 26 of these serial TACs (17.9%) provided new diagnostic information, whereas only five (3.4%) led to a change in management.

CONCLUSIONS:
Frequent serial TAC sampling in the PICU is common and infrequently yields new data that impact clinical decision-making. Considering worsening antimicrobial resistance and the role of diagnostic stewardship in mitigating it, these findings further support a 72-hour reassessment period before performing a repeat TAC in critically ill children.
Medico-Legal Evaluation of Keloid Formation Following Prominent Ear Correction: Malpractice or Complication?
Authors: Demir Canser Yilmaz , Hekimoglu Yavuz , Asirdizer Mahmut 
Published: April 2023

<p> </p>
<p>Prominent ear is an anatomic auricular deformity seen in 5% of the population.</p>
<p>Keloid formation may occur following prominent ear correction operations.</p>
<p>Such undesirable results can lead to a claim of medical malpractice.</p>
<p>It is necessary to determine whether the undesired outcome is a complication or malpractice.</p>
<p>The physician’s compliance with the standards of care and patient rights is decisive in this distinction.</p>
Influence of Residual Quadrupolar Interaction on Quantitative Sodium Brain Magnetic Resonance Imaging of Patients With Multiple Sclerosis
Authors: Wilferth Tobias , Mennecke Angelika , Huhn Konstantin , Uder Michael , Doerfler Arnd , Schmidt Manuel , Nagel Armin M. 
Published: April 2023

Objectives
The purpose of this work was to evaluate the influence of residual quadrupolar interaction on the determination of human brain apparent tissue sodium concentrations (aTSCs) using quantitative sodium magnetic resonance imaging (23Na MRI) in healthy controls (HCs) and patients with multiple sclerosis (MS). Especially, it was investigated if the more detailed examination of residual quadrupolar interaction effects enables further analysis of the observed 23Na MRI signal increase in MS patients.

Materials and Methods

23Na MRI with a 7 T MR system was performed on 21 HC and 50 MS patients covering all MS subtypes (25 patients with relapsing-remitting MS, 14 patients with secondary progressive MS, and 11 patients with primary progressive MS) using 2 different 23Na pulse sequences for quantification: a commonly used standard sequence (aTSCStd) as well as a sequence with shorter excitation pulse length and lower flip angle for minimizing signal loss resulting from residual quadrupolar interactions (aTSCSP). Apparent tissue sodium concentration was determined using the same postprocessing pipeline including correction of the receive profile of the radiofrequency coil, partial volume correction, and relaxation correction. Spin dynamic simulations of spin-3/2 nuclei were performed to aid in the understanding of the measurement results and to get deeper insight in the underlying mechanisms.

Results
In normal-appearing white matter (NAWM) of HC and all MS subtypes, the aTSCSP values were approximately 20% higher than the aTSCStd values (P < 0.001). In addition, the ratio aTSCSP/aTSCStd was significantly higher in NAWM than in normal-appearing gray matter (NAGM) for all subject cohorts (P < 0.002). In NAWM, aTSCStd values were significantly higher in primary progressive MS compared with HC (P = 0.01) as well as relapsing-remitting MS (P = 0.03). However, in contrast, no significant differences between the subject cohorts were found for aTSCSP. Spin simulations assuming the occurrence of residual quadrupolar interaction in NAWM were in good accordance with the measurement results, in particular, the ratio aTSCSP/aTSCStd in NAWM and NAGM.

Conclusions
Our results showed that residual quadrupolar interactions in white matter regions of the human brain have an influence on aTSC quantification and therefore must be considered, especially in pathologies with expected microstructural changes such as loss of myelin in MS. Furthermore, the more detailed examination of residual quadrupolar interactions may lead to a better understanding of the pathologies themselves.
High Effectiveness of Midazolam and Lidocaine in the Treatment of Acute Neonatal Seizures
Authors: Castro Conde José Ramón , González Campo Candelaria , González Barrios Desiré , Reyes Millán Beatriz , Díaz González Candelaria Leticia , Jiménez Sosa Alejandro 
Published: April 2023

Purpose:
To assess the clinical effectiveness of treating acute seizures with midazolam and lidocaine infusion.

Methods:
This single-center historical cohort study included 39 term neonates with electrographic seizures who underwent treatment with midazolam (1st line) and lidocaine (2nd line). Therapeutic response was measured using continuous video-EEG monitoring. The EEG measurements included total seizure burden (minutes), maximum ictal fraction (minutes/hour), and EEG-background (normal/slightly abnormal vs. abnormal). Treatment response was considered good (seizure control with midazolam infusion), intermediate (need to add lidocaine to the control), or no response. Using clinical assessments supplemented by BSID-III and/or ASQ-3 at 2 to 9 years old age, neurodevelopment was classified as normal, borderline, or abnormal.

Results:
A good therapeutic response was obtained in 24 neonates, an intermediate response in 15, and no response in any of the neonates. Babies with good response showed lower values in maximum ictal fraction compared with those with intermediate response (95% CI: 5.85–8.64 vs. 9.14–19.14, P = 0.002). Neurodevelopment was considered normal in 24 children, borderline in five, and abnormal in other 10 children. Abnormal neurodevelopment was significantly associated with an abnormal EEG background, maximum ictal fraction >11 minutes, and total seizure burden >25 minutes (odds ratio 95% CI: 4.74–1708.52, P = 0.003; 1.72–200, P = 0.016; 1.72–142.86, P = 0.026, respectively) but not with the therapeutic response. Serious adverse effects were not recorded.

Conclusions:
This retrospective study suggests that the midazolam/lidocaine association could potentially be efficacious in decreasing seizure burden in term neonates with acute seizures. These results would justify testing the midazolam/lidocaine combination as a first-line treatment for neonatal seizures in future clinical trials.
Mid-pregnancy sleep disturbances are not associated with mid-pregnancy maternal glycemia
Authors: Hawkins Marquis , Feghali Maisa , Abebe Kaleab Z , Scifres Christina M. , Lalama Christina M , Costacou Tina , Catalano Patrick , Simhan Hyagriv , Orris Steve , Mendez Dara , Buysse Daniel J. , Davis Esa M 
Published: April 2023

AbstractBackgroundIn pregnancy, epidemiological data have consistently shown strong associations between sleep quality and duration and maternal glycemia. However, other sleep disturbances such as difficulty falling asleep and staying asleep are common in pregnancy. They may contribute to impaired maternal glycemia through sympathetic nervous system activity, systemic inflammation, and hormonal pathways. However, there is little research examining associations between these specific sleep disturbances and maternal glycemia.ObjectiveThis study aimed to investigate the associations of sleep disturbances during mid-pregnancy and mid-pregnancy maternal glycemia and gestational diabetes subtypes.Study DesignThis is a secondary data analysis of the Comparison of Two Screening Strategies for Gestational Diabetes trial. Participants (n = 828) self-reported the frequency of sleep disturbances (i.e., trouble falling asleep, trouble staying asleep, waking several times per night, and waking feeling tired or worn out) in mid-pregnancy. Gestational diabetes was diagnosed using either the International Associations of Diabetes and Pregnancy Study Groups or Carpenter-Coustan approach. We defined gestational diabetes subtypes based on the degree of insulin resistance and beta-cell dysfunction. We used multinomial logistic regression to examine associations of sleep disturbances with gestational diabetes status (i.e., normal, mild glycemic dysfunction, and gestational diabetes) and gestational diabetes subtypes (i.e., neither insulin resistance or beta-cell dysfunction, insulin resistance only, beta-cell dysfunction only, and insulin resistance and beta- cell dysfunction).ResultsA total of 665 participants (80%) had normal glycemia, 81 (10%) mild hyperglycemia, and 80 (10%) had gestational diabetes. Among participants with gestational diabetes, 62 (78%) had both insulin resistance and beta-cell dysfunction, 15 (19 %) had insulin resistance only, and 3 had beta-cell dysfunction only or neither insulin resistance nor beta-cell dysfunction. Sleep disturbance frequency was not associated with maternal glycemia or gestational diabetes subtypes.ConclusionsSleep disturbances in mid-pregnancy were not associated with maternal glycemia during mid-pregnancy. Future research should collect data on sleep disturbances at multiple time points in pregnancy and in combination with other sleep disturbances to determine whether sleep plays any role in maternal glycemic control.
Surveillance of Vermont wildlife in 2021-2022 reveals no detected SARS-CoV-2 viral RNA
Authors: Despres Hannah W. , Mills Margaret G. , Schmidt Madaline M. , Gov Jolene , Perez Yael , Jindrich Mars , Crawford Allison M. L. , Kohl Warren T. , Rosenblatt Elias , Kubinski Hannah C. , Simmons Benjamin C. , Nippes Miles C. , Goldenberg Anne J. , Murtha Kristina E. , Nicoloro Samantha , Harris Mia J. , Feeley Avery C. , Gelinas Taylor K. , Cronin Maeve K. , Frederick Robert S. , Thomas Matthew , Johnson Meaghan E. , Murphy James , Lenzini Elle B. , Carr Peter A. , Berger Danielle H. , Mehta Soham P. , Floreani Christopher J. , Koval Amelia C. , Young Aleah L. , Fish Jess H. , Wallace Jack , Chaney Ella , Ushay Grace , Ross Rebecca S. , Vostal Erin M. , Thisner Maya C. , Gonet Kyliegh E. , Deane Owen C. , Pelletiere Kari R. , Rockafeller Vegas C. , Waterman Madeline , Barry Tyler W. , Goering Catriona C. , Shipman Sarah D. , Shiers Allie C. , Reilly Claire E. , Duff Alanna M. , Shirley David J. , Jerome Keith R. , Pérez-Osorio Ailyn C. , Greninger Alexander L. , Fortin Nick , Mosher Brittany A. , Bruce Emily A. 
Published: April 2023

AbstractPrevious studies have documented natural infections of SARS-CoV-2 in various domestic and wild animals. More recently, studies have been published noting the susceptibility of members of the Cervidae family, and infections in both wild and captive cervid populations. In this study, we investigated the presence of SARS-CoV-2 in mammalian wildlife within the state of Vermont. 739 nasal or throat samples were collected from wildlife throughout the state during the 2021 and 2022 harvest season. Data was collected from red and gray foxes (Vulpes vulplesandUrocyon cineroargentus, respectively), fishers (Martes pennati), river otters (Lutra canadensis), coyotes (Canis lantrans), bobcats (Lynx rufus rufus), black bears (Ursus americanus), and white-tailed deer (Odocoileus virginianus). Samples were tested for the presence of SARS-CoV-2 via quantitative RT-qPCR using the CDC N1/N2 primer set and/or the WHO-E gene primer set. Our results indicate that no sampled wildlife were positive for SARS-CoV-2. This finding is surprising, given that most published North America studies have found SARS-CoV-2 within their deer populations. The absence of SARS-CoV-2 RNA in populations sampled here may provide insights in to the various environmental and anthropogenic factors that reduce spillover and spread in North American’s wildlife populations.
A hybrid machine learning approach for analysis of stegomalware
Authors: Kadebu Prudence , Shoniwa Robert T.R. , Zvarevashe Kudakwashe , Mukwazvure Addlight , Mapanga Innocent , Thusabantu Nyasha Fadzai , Gotora Tatenda Trust 
Published: April 2023

PurposeGiven how smart today’s malware authors have become through employing highly sophisticated techniques, it is only logical that methods be developed to combat the most potent threats, particularly where the malware is stealthy and makes indicators of compromise (IOC) difficult to detect. After the analysis is completed, the output can be employed to detect and then counteract the attack. The goal of this work is to propose a machine learning approach to improve malware detection by combining the strengths of both supervised and unsupervised machine learning techniques. This study is essential as malware has certainly become ubiquitous as cyber-criminals use it to attack systems in cyberspace. Malware analysis is required to reveal hidden IOC, to comprehend the attacker’s goal and the severity of the damage and to find vulnerabilities within the system.Design/methodology/approachThis research proposes a hybrid approach for dynamic and static malware analysis that combines unsupervised and supervised machine learning algorithms and goes on to show how Malware exploiting steganography can be exposed.FindingsThe tactics used by malware developers to circumvent detection are becoming more advanced with steganography becoming a popular technique applied in obfuscation to evade mechanisms for detection. Malware analysis continues to call for continuous improvement of existing techniques. State-of-the-art approaches applying machine learning have become increasingly popular with highly promising results.Originality/valueCyber security researchers globally are grappling with devising innovative strategies to identify and defend against the threat of extremely sophisticated malware attacks on key infrastructure containing sensitive data. The process of detecting the presence of malware requires expertise in malware analysis. Applying intelligent methods to this process can aid practitioners in identifying malware’s behaviour and features. This is especially expedient where the malware is stealthy, hiding IOC.
Supply chain network structures and firm financial performance: the moderating role of international relations
Authors: Luo Peng , Ngai Eric W.T. , Cheng T.C. Edwin 
Published: April 2023

PurposeThis paper examines the relationship between supply chain network structures and firm financial performance and the moderating role of international relations. In this study, which is grounded in social capital theory and applies the perspective of systemic risk, the authors theorize the effects of supply chain network structures on firm performance.Design/methodology/approachThe authors extracted data from two Chinese databases and constructed a supply chain network of the firms concerned based on nearly 4,300 supply chain relations between 2009 and 2018. The authors adopted the fixed effects model to investigate the relationship between supply chain network structures and firm financial performance.FindingsThe econometrics results indicate that network structures, including the degree, centrality, clustering coefficients and structural holes, are significantly related to firm financial performance. A significant and negative relationship exists between international relations and firm financial performance. The authors also find that international relations strongly weaken the relationship between supply chain network structures and firm financial performance.Originality/valueThis study, which collects secondary data from developing countries (e.g. China) and explores the impacts of supply chain network structures on firm stock performance, contributes to the existing literature and provides practical implications.