bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modification of an inpatient medical management protocol for pediatric Avoidant/Restrictive Food Intake Disorder: improving the standard of care
Authors: Gorrell Sasha , Vendlinski Siena S. , Thompson Arianna S. , Downey Amanda E. , Kramer Rachel , Hail Lisa , Clifton Sharon , Forsberg Sarah , Reilly Erin E. , Saunders Elizabeth , Buckelew Sara M. , Le Grange Daniel 
Published: September 2023

Abstract
Background
No guidelines currently exist that represent a standardization of care for Avoidant/Restrictive Food Intake Disorder (ARFID) on an inpatient service. Unique features of this diagnosis (e.g., sensory sensitivity contributing to involuntary emesis) suggest that established protocols that were developed for anorexia nervosa might be less effective for adolescents with ARFID. To inform improved inpatient medical stabilization and care for these patients, we first provide an overview of clinical characteristics for patients with ARFID who presented to a pediatric hospital for inpatient eating disorder care. We use these descriptives to outline the rationale for, and executions of, modifications to an inpatient protocol designed to flexibly meet the needs of this clinical population.

Methods
Chart review with descriptive statistics were conducted for patients who had received an ARFID diagnosis from March 2019 to March 2023 (N = 32, aged 9–23). We then present a case series (n = 3) of adolescents who either transitioned to a novel adjusted protocol from an original standard of care on the inpatient service, or who received only the standard protocol.

Results
The sample was aged M(SD) = 15.6 (3.3) years, 53% male, and a majority (69%) presented with the ARFID presentation specific to fear of negative consequences. On average, patients had deviated from their growth curve for just over two years and presented with mean 76% of their estimated body weight. Of those requiring nasogastric tube insertion during admission (n = 8, 25%), average duration of tube placement was 15 days. From within this sample, case series data suggest that the adjusted protocol will continue to have a positive impact on care trajectory among adolescents admitted for ARFID including improved weight gain, reduction of emesis, and improved food intake.

Conclusions
Findings demonstrate the likely need to tailor established medical inpatient protocols for those with ARFID given different symptom presentation and maintenance factors compared to patients with anorexia nervosa. Further research is warranted to explore the longer-term impact of protocol changes and to inform standardization of care for this high priority clinical population across care sites.
Climbing strategies of Taiwan climbers
Authors: Chen Po-Hao , Chung An-Ching , Lin Hung-Chih , Yang Sheng-Zehn 
Published: September 2023

Abstract
Background
The climbing strategies of lianas and herbaceous vines influence climber competition abilities and survival. The aim of this study was to investigate the climbing strategies of each plant species and observe their organs of origin.

Results
The results showed that all Taiwan climbers were approximately 555 species, accounting for 11% of the native flora. Among the 555 climbers, the twining stem type was the most common, with a total of 255 species (46%), the remaining climbing methods accounted for 300 species. Approximately twenty one climbing methods, including nine combination types, were exhibited, of which the most common type was the twining stem, followed by simple scrambling and twining tendrils. Most species of Fabaceae and Apocynaceae were twining stems in dextrorse, excluding Wisteriopsis reticulata and Alyxia taiwanensis, which were in sinistrorse. The prehensile branch of Fissistigma genus, Ventilago genus, and Dalbergia benthamii, originated from second-order or modified stems. In the simple scrambling type, some climbers were covered spines and prickles to attach the host, and the others were clinging to the supports or creeping on the ground without speculation. The hooks or grapnels of the genus Uncaria are derived from the branches, and a pair of curved hooks or a spine of Artabotrys hexapetalus are originated from the inflorescence to tightly attach to a host. The Piper genus use adhesive roots to climb their hosts. Among the genus Trichosanthes, only Trichosanthes homophylla exhibits a combination of twining modified shoots and adhesive roots. Gentianales includes four families with seven climbing mechanisms, while Fabales includes only Fabaceae, which presents six climbing methods.

Conclusions
The twining tendrils had nine organs of origin in Taiwan climber, that these opinions of originated organs might be available to the studies of convergent evolution. The data presented herein provide crucial basic information of the climber habits types and origin structures, which are available for terms standardization to improve field investigation. The terminologies would aid in the establishment of climber habits as commonly taxon-specific and the combination of two climber habits could be a characteristic of taxonomic value.
Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme – a prospective observational study
Authors: Åkesson Karin Sturesdotter , Sundén Anne , Stigmar Kjerstin , Eek Frida , Pawlikowska Teresa , Hansson Eva Ekvall 
Published: September 2023

Abstract
Background
Osteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP.

Methods
Patients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1–5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0–12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations.

Results
One hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05).

Conclusions
Health-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP.

Trial registration
ClinicalTrials.gov. Identification number: NCT 02974036. First registration 28/11/2016, retrospectively registered.
The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data
Authors: Liu Lin , Lan Xiaomeng , Yang Yili , Luo Yuying , Zhang Xueli , Wang Xiuli , Pan Jay 
Published: September 2023

Abstract
Background
Healthy China is a nationwide health strategy aiming at improving health from diverse dimensions, and strengthening high-quality assessment is essential for its stimulation. However, there is limited evidence in the surveillance of the actual performance of the initiative at regional levels. This study innovatively proposes a two-step surveillance process which comprehensively monitors Healthy China Initiative based on regional realities, thus provides guidance for policymaking.

Methods
A flexible indicator system was firstly developed basing on Delphi survey and focus group discussions. And then the Analysis Hierarchical Process and the TOPSIS method were used to determine the weights of indicators and calculate comprehensive indexes as the surveillance outcomes. A pilot study was conducted in a typical area in China to verify the applicability of the process.

Results
Following the surveillance process and basing on the implementation of Healthy China Initiative in the target region, an indicator system comprised of 5 domains and 23 indicators with weights was first developed specifically for the pilot area. Then 1848 interagency data of the study area were collected from 8 provincial institutions/departments to calculate the indexes and ranks of the five domains which were health level, healthy living, disease prevention and control, health service, and healthy environment. The outcomes showed that Healthy China Initiative in the pilot area had been constantly improved since the strategy proposed, while there were still issues to be tackled such as the deficient monitoring mechanisms and unevenly development progress.

Conclusions
This study proposed a pragmatic surveillance process with indicators which could be tailored for specific context of target regions and produce meaningful surveillance outcomes to inform decision-making for policymakers, and also provided a theoretical foundation as well as empirical evidence for further health strategies and plannings assessment studies.
High performance strain sensor based on leather activated by micro-cracking conductive layer
Authors: Ma Jianzhong , Cheng Zhijie , Tan Sha , Zheng Tian , Zong Yan 
Published: September 2023

AbstractFlexible strain sensors are capable to detect external force induced strain change owing to their unique ability to convert deformation into electrical signals. Generally, micro/nano patterning of conductive layer in strain sensor is an effective method to improve its sensitivity, however the sophisticated manipulation process is limited only in laboratory scale. In this report, a simple and scalable fabrication strategy was used to create micro-cracking conductive layer as an alternative patterning method to achieve high performance of strain sensor. In details, the sensor was fabricated using leather as the substrate to filtrated acidified multi-walled carbon nanotubes (a-MWCNTs)/layered double hydroxides (LDHs) suspension. During stretching process, micro-cracking structure emerged on the percolated a-MWCNTs/LDHs layer, causing a rise up of resistance according to increasing strain and generated a detectable electrical signal. The prepared sensor had a large detecting range (60%), high sensitivity (GF of 7238.92 at strain 30–60%), fast response (tensile response time of 270 ms), good stability and repeatability. The sensor also inherited the advantages of leather, such as biodegradability and good air permeability, and the introduction of a-MWCNTs/LDHs further enhanced its fire retardancy properties. These features ensured the sensor as an eco-friendly, comfortable and safe electronic device for human motion detection.
Graphical abstract
Addressing Domain Specificity in the Development of a Cell-Based Binding Assay for the Detection of Neutralizing Antibodies Against a CD47xPD-L1 Bispecific Antibody
Authors: Luong Michael , Wang Ying , Donnelly Brianna B. , Lepsy Christopher 
Published: September 2023

AbstractPF-07257876 is a bispecific antibody being developed for the treatment of certain advanced or metastatic solid tumors. To support clinical development of PF-07257876, neutralizing antibody (NAb) assays were developed as part of a tiered immunogenicity testing approach. Because PF-07257876 targets both CD47 and PD-L1, determination of domain specificity of a NAb response may provide additional insight relating to PK, efficacy, and safety. Due to limitations of functional cell systems, two cell-based binding assays were developed using electrochemiluminescence to detect domain-specific NAb. While both NAb assays utilized a cell-based binding approach and shared certain requirements, such as sensitivity and tolerance to potentially interfering substances, the development of each assay faced unique challenges. Among the hurdles encountered, achieving drug tolerance while preserving domain specificity for CD47 proved particularly challenging. Consequently, a sample pretreatment procedure to isolate NAb from potentially interfering substances was necessary. The sample pretreatment procedure developed was based on a bead-extraction and acid dissociation (BEAD) approach. However, the use of the standard BEAD approach with whole drug to capture NAb resulted in loss of NAb detection under certain circumstances. Specifically, mock samples containing a mixture of NAb positive controls against both binding domains of the bispecific antibody produced false-negative results in the cell-based binding assay. An adaptation made to the standard BEAD approach restored domain-specific NAb detection, while also contributing to an assay sensitivity of 1 µg/mL in the presence of a clinically relevant drug tolerance level of up to 400 µg/mL.
Graphical Abstract
Increased Risk of Vertebral Fractures in Patients With Mild Autonomous Cortisol Secretion
Authors: Favero Vittoria , Eller-Vainicher Cristina , Morelli Valentina , Cairoli Elisa , Salcuni Antonio Stefano , Scillitani Alfredo , Corbetta Sabrina , Casa Silvia Della , Muscogiuri Giovanna , Persani Luca , Chiodini Iacopo 
Published: September 2023

Abstract

Context
The risk of vertebral fractures (VFx) in patients with adrenal incidentalomas (AI) and mild autonomous cortisol secretion (MACS) is debated.

Objective
To evaluate the VFx prevalence and incidence in patients with AI and MACS.

Methods
This cross-sectional and longitudinal study using retrospective data from 4 Italian endocrinology units included 444 patients (cross-sectional arm) and 126 patients (longitudinal arm, 24.9 ± 5.3 months follow-up) to evaluate prevalent and incident VFx, respectively, in patients with MACS (MACS-yes) and without MACS (MACS-no). The main outcome measures were serum cortisol after a 1-mg dexamethasone test (F-1mgDST), bone mineral density (BMD) by dual-energy x-ray absorptiometry at spine (LS) and femur (FN), and VFx presence by x-ray.

Results
Cross-sectional arm: 214 and 230 patients were MACS-yes and MACS-no, respectively, based on F-1mgDST &gt;1.8 µg/dL (50 nmol/L). Patients with MACS had higher VFx prevalence (62.6%) than those without MACS (22.9%, P &lt; .001); MACS was associated with prevalent VFx (odds ratio, 5.203; 95% CI, 3.361-8.055; P &lt; .001; relative risk [RR] 2.07), regardless of age, body mass index, gender distribution, LS-BMD, and presence of type 2 diabetes mellitus (T2D). Longitudinal arm: 66 and 60 patients were MACS-no and MACS-yes, respectively. Patients without MACS showed higher number of incident VFx (36.4%) than patients without MACS (10.0%, P &lt; .001); MACS was associated with the presence of an incident VFx (RR 4.561; 95% CI, 1.600-13.003; P = .005) regardless of age, LS-BMD, gender distribution, presence of prevalent VFx, and T2D. Results were confirmed in women and men when separately evaluated.

Conclusion
Women and men with AI and MACS are at higher risk of VFx.
Neuronal AR Regulates Glucose Homeostasis and Energy Expenditure in Lean Female Mice With Androgen Excess
Authors: Ubba Vaibhave , Joseph Serene , Awe Olubusayo , Jones Dustin , Dsilva Milan K , Feng Mingxiao , Wang Junjiang , Fu Xiaomin , Akbar Razeen J , Bodnar Brittany H , Hu Wenhui , Wang Hong , Yang Xiaofeng , Yang Ling , Yang Peixin , Ahima Rexford , Divall Sara , Wu Sheng 
Published: September 2023

AbstractHyperandrogenemia and polycystic ovary syndrome are a result of the imbalance of androgen levels in females. Androgen receptor (Ar) mediates the effect of androgen, and this study examines how neuronal Ar in the central nervous system mediates metabolism under normal and increased androgen conditions in female mice. The neuron-specific ARKO mouse (SynARKO) was created from female (Ar fl/wt; synapsin promoter driven Cre) and male (Ar fl/y) mice. A glucose tolerance test revealed impaired glucose tolerance that was partially alleviated in the SynARKO-dihydrotestosterone (DHT) mice compared with Con-DHT mice after 4 months of DHT treatment. Heat production and food intake was higher in Con-DHT mice than in Con-veh mice; these effects were not altered between SynARKO-veh and SynARKO-DHT mice, indicating that excess androgens may partially alter calorie intake and energy expenditure in females via the neuronal Ar. The pAkt/Akt activity was higher in the hypothalamus in Con-DHT mice than in Con-veh mice, and this effect was attenuated in SynARKO-DHT mice. Western blot studies show that markers of inflammation and microglia activation, such as NF-kB p-65 and IBA1, increased in the hypothalamus of Con-DHT mice compared with Con-veh. These studies suggest that neuronal Ar mediates the metabolic impacts of androgen excess in females.
Metastatic Merkel Cell Carcinoma Within a Cortisol-producing Adrenal Adenoma
Authors: Cutrone Lauren , Subauste Jose , Gomez-Sanchez Celso , Joiner Sarah 
Published: September 2023

Abstract
A 54-year-old man with hypertension, type 2 diabetes mellitus, and a history of Merkel cell carcinoma (MCC) of the right thigh presented to the emergency department with a 4-day history of right lower-quadrant abdominal pain associated with constipation and decreased appetite. Workup showed a heterogenous 6-cm right adrenal mass with macroscopic fat. Imaging was suggestive of benign pathology. Hormonal workup for the adrenal nodule led to the diagnosis of Cushing syndrome. The patient underwent a right adrenalectomy for Cushing syndrome with pathology revealing a 6.5-cm adrenocortical adenoma harboring a 2-cm, well-circumscribed neuroendocrine tumor consistent with metastatic MCC. Adrenal collision tumors are exceedingly rare. This case describes a collision tumor that has not previously been identified—a cortisol-producing adrenal adenoma and metastatic MCC.
A Case of Congenital Disorder of Glycosylation Type 1b Presenting as Hyperinsulinemic Hypoglycemia and Failure to Thrive
Authors: Rani Swati , Sahai Inderneel , Misra Madhusmita 
Published: September 2023

Abstract
We describe initial manifestations, approach to diagnosis, and treatment of a patient with congenital disorder of glycosylation type 1b (CDG 1b), previously managed as acetylcarnitine deficiency. A 9-year-old girl initially diagnosed with and treated for acetylcarnitine deficiency at an outside hospital presented with recurrent hypoglycemia, failure to thrive, poor weight gain, and short stature. She had discontinued levocarnitine therapy because of lack of response, and testing with us demonstrated a normal carnitine and acyl carnitine panel and hyperinsulinemic hypoglycemia during a diagnostic fast. Oral diazoxide and hydrochlorothiazide were initiated with resolution of hypoglycemia. She had iron deficiency anemia, but an upper gastrointestinal evaluation was normal. Genetic testing confirmed a diagnosis of CDG 1b caused by deficiency of mannose phosphate isomerase. Oral mannose was started with gradual reduction in and eventual discontinuation of the diazoxide dose. Hypoglycemia in the pediatric age group needs a systematic approach. It is important to raise awareness of CDG 1b, which can present as persistent hyperinsulinemic hypoglycemia. Mannose supplementation can ameliorate clinical symptoms and biochemical abnormalities.
External Beam Radiotherapy in Advanced Pheochromocytoma and Paraganglioma: An Observation of a Rare Abscopal Effect
Authors: Terakawa Aiko , Tanabe Akiyo , Nakayama Hidetsugu , Minamimoto Ryogo 
Published: September 2023

Abstract
Metastatic pheochromocytoma and paraganglioma are incurable, and effective treatment of systemic symptoms resulting from catecholamine excess and local symptoms from tumor growth are crucial to prolong survival and improve quality of life. We report the first case of metastatic pheochromocytoma wherein external beam radiotherapy (EBRT) demonstrated efficacy in both target and nontarget lesions, demonstrating the “abscopal effect.” EBRT reduced tumor volume and catecholamine secretion and improved catecholamine excess-related complications, including glycemic control. EBRT is an effective treatment option for metastatic pheochromocytoma and paraganglioma because of its minimal invasiveness, safety, and potential for the rare abscopal effect.
Primary Adenoma Arising From Two Ipsilateral Supernumerary Inferior Parathyroid Adenomas
Authors: Bolliet Marine , Katuwal Binit , Kolachalam Ramachandra 
Published: September 2023

Abstract
A single parathyroid adenoma is the most common cause of primary hyperparathyroidism (PHPT). However, multiple synchronous adenomas can be found at surgery. More uncommon are ipsilateral synchronous adenomas, and that combined with a supernumerary gland, is even more rare. Here we present a case of PHPT due to an ipsilateral double adenoma of the inferior parathyroid gland, which was supernumerary. The diagnosis was made preoperatively by ultrasonography; however, sestamibi scan showed only a single hyperfunctioning gland on the left side. This was further substantiated by the use of intraoperative parathyroid hormone (PTH) monitoring, wherein PTH levels decreased to less than 50% of preoperative values only after the complete removal of the second adenomatous gland. This case report highlights the importance of preoperative localization and intraoperative PTH monitoring in evaluating patients with PHPT in the setting of multiple synchronous parathyroid adenoma.