bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guidelines in Practice: Minimally Invasive Surgery
Authors: Speth Jennifer 
Published: September 2023

ABSTRACTDuring minimally invasive surgery (MIS), surgeons create small and percutaneous incisions to access internal structures without open surgical incisions. Some MIS equipment is complex and challenging for perioperative nurses to manage. Patients also can experience life‐threatening complications during MIS procedures. The updated AORN “Guideline for minimally invasive surgery” provides recommendations that perioperative nurses can use when caring for patients undergoing MIS procedures. This article provides an overview of the guideline and discusses several recommendations, including creating a safe environment in which to perform MIS procedures; using gas distension media, irrigation and fluid distension media, and computer‐assisted navigation and robotics; and performing intraoperative magnetic resonance imaging in a hybrid OR. It also includes a scenario describing care of a patient undergoing a hysteroscopy. Perioperative nurses who care for patients undergoing MIS procedures should review the guideline in its entirety and apply the recommendations as applicable in their practice.
Protective effect of bromelain on some metabolic enzyme activities in tyloxapol‐induced hyperlipidemic rats
Authors: Sulumer Ayşe Nurseli , Palabıyık Esra , Avcı Bahri , Uguz Handan , Demir Yeliz , Serhat Özaslan Muhammet , Aşkın Hakan 
Published: September 2023

AbstractElevation of one or more plasma lipids, such as phospholipids, cholesterol esters, cholesterol, and triglycerides, is known as hyperlipidemia. In humans and experimental animals, bromelain, the primary active ingredient isolated from pineapple stems, has several positive effects, including anti‐tumor growth, anticoagulation, and anti‐inflammation. Hence, the purpose of this study was to determine the possible protective impact of bromelain on some metabolic enzymes (paraoxonase‐1, glutathione S‐transferase, glutathione reductase, sorbitol dehydrogenase [SDH], aldose reductase [AR], butyrylcholinesterase [BChE], and acetylcholinesterase [AChE]), activity in the heart, kidney, and liver of rats with tyloxapol‐induced hyperlipidemia. Rats were divided into three groups: control group, HL‐control group (tyloxapol 400 mg/kg, i.p. administered group), and HL+bromelain (group receiving bromelain 250 mg/kg/o.d. prior to administration of tyloxapol 400 mg/kg, i.p.). BChE, SDH, and AR enzyme activities were significantly increased in all tissues in HL‐control compared to the control, whereas the activity of other studied enzymes was significantly decreased. Bromelain had a regulatory effect on all tissues and enzyme activities. In conclusion, these results prove that bromelain is a new mediator that decreases hyperlipidemia.
Characterization and discrimination of spike protein in SARS‐CoV‐2 virus‐like particles via surface‐enhanced Raman spectroscopy
Authors: Akdeniz Munevver , Al‐Shaebi Zakarya , Altunbek Mine , Bayraktar Canan , Kayabolen Alisan , Bagci‐Onder Tugba , Aydin Omer 
Published: September 2023

AbstractNon‐infectious virus‐like particles (VLPs) are excellent structures for development of many biomedical applications such as drug delivery systems, vaccine production platforms, and detection techniques for infectious diseases including SARS‐CoV‐2 VLPs. The characterization of biochemical and biophysical properties of purified VLPs is crucial for development of detection methods and therapeutics. The presence of spike (S) protein in their structure is especially important since S protein induces immunological response. In this study, development of a rapid, low‐cost, and easy‐to‐use technique for both characterization and detection of S protein in the two VLPs, which are SARS‐CoV‐2 VLPs and HIV‐based VLPs was achieved using surface‐enhanced Raman spectroscopy (SERS). To analyze and classify datasets of SERS spectra obtained from the VLP groups, machine learning classification techniques including support vector machine (SVM), k‐nearest neighbors (kNN), and random forest (RF) were utilized. Among them, the SVM classification algorithm demonstrated the best classification performance for SARS‐CoV‐2 VLPs and HIV‐based VLPs groups with 87.5% and 92.5% accuracy, respectively. This study could be valuable for the rapid characterization of VLPs for the development of novel therapeutics or detection of structural proteins of viruses leading to a variety of infectious diseases.
Climate risks to the renewable energy sector: Assessment and adaptation within energy companies
Authors: Juhola Sirkku , Laurila Anna‐Greta , Groundstroem Fanny , Klein Johannes 
Published: September 2023

AbstractThe importance of the renewable energy sector in mitigating climate change has received plenty of attention over the years, but climate risks to the renewable energy sector, and the need for adaptation within energy companies, have been largely overlooked. Subsequently, not much is known about the current state of climate risk assessments and adaptation measures within the renewable energy sector. This study addresses this gap by categorising different types of climate risks faced by renewable energy companies and the measures that are used to prepare and adapt to them. We summarise the existing literature on climate risks and adaptation within the renewable energy sector and carry out an interview‐based qualitative case study regarding energy companies' perception and assessment of climate risks in Finland. The results show that while companies are aware of climate risks, particularly concerning the green transition, climate risks are not comprehensively assessed, and adaptation measures mainly account for direct physical risks with little regard for more systemic and complex risks, such as cross‐border impacts or cascading risks.
Risk factors associated with overall survival in patients with multiple myeloma following carfilzomib treatment: A retrospective study from a large claims database in Japan
Authors: Hagiwara Hiromi , Nakayama Takafumi , Hashimoto Hiroya , Kusumoto Shigeru , Fukuta Hidekatsu , Kamiya Takeshi , Ikuta Koichi , Iida Shinsuke 
Published: September 2023

AbstractBackgroundCarfilzomib is a selective proteasome inhibitor approved for treating relapsed or refractory multiple myeloma (RRMM). Carfilzomib improves overall survival (OS) and progression‐free survival (PFS); however, treatment with carfilzomib results in a higher incidence of cardiovascular and renal toxicity. More than 70% of patients with RRMM in clinical practice do not meet the eligibility criteria for randomized clinical trials (RCT). OS and PFS are negatively influenced by complications, concomitant medications and prior treatments. Therefore, we assessed the risk factors influencing the OS and time to next treatment (TTNT) in the real world. TTNT has emerged as a relevant alternative clinical endpoint to PFS.MethodsA retrospective analysis of a large claims database prepared during the post‐marketing stages in Japan was performed. The patients treated with carfilzomib for the first time were identified. Multivariable Cox proportional hazards regression analysis was performed to evaluate the risk factors influencing OS and TTNT following carfilzomib treatment.ResultsA total of 732 patients with RRMM who received carfilzomib‐containing chemotherapy between April 2014 and September 2021 were identified. Multivariable Cox regression analysis for OS and TTNT showed a significantly higher hazard ratio (HR) of 1.48 (95% confidence interval [Cl]: 1.10–2.00; p = 0.010) and 1.38 (95% Cl: 1.15–1.65; p < 0.001), respectively, for patients with renal impairment compared to those without renal impairment. Multivariable Cox regression analysis for OS and TTNT showed a significantly higher HR of 1.80 (95% Cl: 1.27–2.55; p = 0.0010) and 1.38 (95% Cl: 1.14–1.66; p < 0.001), respectively, for patients with prior lenalidomide treatment compared to those without prior lenalidomide treatment.ConclusionComplication of renal impairment and prior lenalidomide treatment could be risk factors influencing OS and TTNT during carfilzomib treatment.
Tumor regression grade combined with post‐therapy lymph node status: A novel independent prognostic factor for patients treated with neoadjuvant therapy followed by surgery in locally advanced gastroesophageal junction and gastric carcinoma
Authors: Yin Hongyan , Yao Qian , Xie Yi , Niu Dongfeng , Jiang Wenya , Cao Huiying , Feng Xujiao , Li Yanyan , Li Yilin , Zhang Xiaotian , Shen Lin , Chen Yang 
Published: September 2023

AbstractBackgroundTumor regression grade (TRG) is a measure of histopathological response to neoadjuvant therapy (NAT). Post‐therapy lymph node (ypN) metastasis was reported as a prognostic factor. However, the evaluation of the treatment effectiveness of NAT has not been well studied. Here, we explored whether TRG combined with ypN status could be a prognostic factor for gastroesophageal junction (GEJ) and gastric cancer (GC). Besides, we aimed at making clear the association of different neoadjuvant regimens with different TRG and ypN status.Methods376 patients with GEJ or GC accepting NAT in Peking University Cancer Hospital were retrospectively collected from January 1, 2003 to June 30, 2021. According to TRG and ypN status, patients were innovatively categorized into four groups: TRG0N0, TRG1‐3N0, TRG0‐1N+, and TRG2‐3N+. We applied Kaplan–Meier method and log‐rank test to testify the differences in disease free survival (DFS) and overall survival (OS) among four groups. Univariate and multivariate analyses were performed to examine the relationships between TRG combined with ypN status and prognosis.ResultsWe observed significant survival differences among the four groups (p < 0.001, respectively). Median DFS and OS of patients with TRG0N0, TRG1‐3N0, and TRG0‐1N+ were not reached, whereas these of patients with TRG2‐3N+ were 17.37 months (95% CI, 14.14–20.60 months) and 39.97 months (95% CI, 27.05–52.89 months). TRG combined with ypN status was still an independent predictor for both DFS (p < 0.001) and OS (p < 0.001) in multivariate analysis. Chi‐squared test showed TRG combined with ypN status was significantly associated with different preoperative treatments (p < 0.001). Patients receiving immunotherapy achieved the highest TRG0N0 rate (31.9%).ConclusionOur results demonstrate that TRG combined with ypN status is a novel independent predictor of both DFS and OS in resectable, locally advanced GEJ and GC. Neoadjuvant immunotherapy achieved the highest TRG0N0 rate.
UK secondary school therapists' online communication with their clients and future intentions
Authors: Hennigan Jeanette , Goss Stephen P 
Published: September 2023

AbstractAimsThis study sought to understand: (1) UK school counsellors' use of computer technology to communicate with pupils as of March 2014; (2) perceived barriers to its further implementation; and (3) practitioners' expectations regarding future use of online therapy, to extend understanding of these issues in UK secondary schools. It is the first study of its kind to be carried out in the United Kingdom.MethodA pluralist, mixed‐methods approach utilised quantitative and thematic qualitative analysis of an Internet survey of UK secondary schools.ResultsOf 3753 schools approached, 246 responded, and of these, 45% had no online communication with their clients and 52% were using various forms of online communication; 43% used online communication (mostly email) for administrative purposes; and 9% offered therapy via email, Skype and Face Time (3% did not respond). The three main motivators for developing therapeutic contact online were as follows: evidence of reaching pupils with psychological barriers to accessing face‐to‐face help, evidence of demand from pupils and access to appropriate training. The main perceived deterrents were as follows: impact on the quality of the relationship, issues around confidentiality, and impact of lack of visual and auditory cues.ConclusionThis mixed landscape in terms of current and planned future use of technology by school counsellors revealed perceived practical and ethical challenges. However, it is notable that all of these can be addressed using currently available resources, for example through exposure to existing literature and research, and through specialist training.
Pediatric primary intraventricular hemorrhage: A case report of isolated fourth ventricle hemorrhage in a 10‐year‐old boy
Authors: Das Aswith , Bhadran Biju , Sanker Vivek , Suresh Vinay , Agarwal Pratik , Dave Tirth 
Published: September 2023

Key Clinical MessagePrimary intraventricular hemorrhage (PIVH) is a rare condition in pediatric patients, presenting with headache, vomiting, and altered mental status. Surgical interventions, such as external ventricular drain placement, followed by ventriculoperitoneal shunting, show promising outcomes. Further research is needed to enhance understanding and optimize management strategies for pediatric PIVH.AbstractThis case report describes a 10‐year‐old boy with isolated primary intraventricular hemorrhage (PIVH) in the fourth ventricle, shedding light on its clinical presentation and management challenges. The patient presented with headache, vomiting, and altered sensorium, and was subsequently diagnosed with obstructive hydrocephalus due to intraventricular bleeding. Emergency external ventricular drain (EVD) insertion was performed, followed by ventriculoperitoneal shunt placement, resulting in a favorable outcome. The etiology of PIVH in children differs from that in adults, with arteriovenous malformations, Moyamoya disease, and aneurysms being commonly implicated causes. Management strategies for pediatric PIVH are challenging due to limited research, but EVD placement and surgical interventions have shown promise.
Surgical treatment for coarctation of the aorta
Authors: Niwa Kosuke , Nishikawa Hiroshi , Ueda Daisuke , Yamashita Keigo 
Published: September 2023

Key Clinical MessageSurgical treatment is a better option for coarctation of the aorta.AbstractA 56‐year‐old man was admitted to the hospital due to chest pain. Computed tomography showed severe coarctation of the aorta distal to the left subclavian artery, with poststenotic dilatation of the descending aorta. A descending aortic replacement was performed in an uneventful manner. The postoperative course was good without symptoms.
Acquired syphilis with flat condyloma in a 3 year‐old girl: A case report
Authors: Hu Qing‐fu , Li Kun‐jie 
Published: September 2023

Key Clinical MessageThe incidence of syphilis in young children is very low, with acquired syphilis exceptionally rare. A 3 year‐old girl presented to our service with a reddish‐brown rash on the external genitals and perianal area. The rash had been apparent for a period of 1 week. The girl was asymptomatic and had no history of sexual contact. Syphilis was suspected and the Treponema pallidum particle agglutination test (TPPA) was found to be positive, as well as the rapid plasma regin ring card test (RPR), with a titer of 1:64. The girl was diagnosed with toddler acquired secondary syphilis. The girl was cured after three treatments with penicillin. This report points out the need for clinicians to be aware of nonsexually transmitted syphilis, acquired in daily life by children without a history of sexual contact.
An Efficient Approach for Quantifying the Mechanical Degradation of Ni‐Rich NMC‐based Cathodes for Lithium‐Ion Batteries using Nano‐XCT Analysis
Authors: Goldbach Daniel , Gluch Jürgen , Graf Tanja , Gaus Michael , Käbitz Stefan , Zillmer Michael , Krewer Ulrike 
Published: September 2023

AbstractLiNi0.8Co0.1Mn0.1O2 has emerged as a promising electrode material for automotive lithium‐ion batteries due to its high specific discharge capacity, cost‐effectiveness, and reduced cobalt content. However, despite all mentioned beneficial attributes, the widespread adoption of this material class is impeded by active material degradation during cycling operation, which is linked to performance loss. This study compares scanning electron microscopy images and nano X‐ray computed tomography scans with a 3D reconstruction of pristine and cycle‐aged battery electrodes to determine structural changes over cycle life. Although a very moderate current rate was chosen for the cycle test, which suggests a homogeneous load across the entire electrode, particle fracture varied across electrode thickness and particle size. A quantitative analysis of the active material‘s gray scale value distribution reveals severe degradation near the separator interface with a reciprocal relationship to particle radius. Remarkably, particle shape and size remain relatively unchanged despite cracking, eliminating the need to adjust these parameters in aging simulations. Moreover, it underscores the practical significance of particle cracking, as it can significantly impact the electrode‘s performance. Thus, analyzing changes in particle shape and size alone is insufficient, and a comprehensive exploration of the particle interior using nano‐XCT is necessary.
Characterization of mismatch‐repair/microsatellite instability‐discordant endometrial cancers
Authors: Riedinger Courtney J. , Esnakula Ashwini , Haight Paulina J. , Suarez Adrian A. , Chen Wei , Gillespie Jessica , Villacres Alyssa , Chassen Alexis , Cohn David E. , Goodfellow Paul J. , Cosgrove Casey M. 
Published: September 2023

AbstractBackgroundMismatch‐repair (MMR)/microsatellite instability (MSI) status has therapeutic implications in endometrial cancer (EC). The authors evaluated the concordance of testing and factors contributing to MMR expression heterogeneity.MethodsSix hundred sixty‐six ECs were characterized using immunohistochemistry (IHC), MSI testing, and mut‐L homolog 1 (MLH1) methylation. Select samples underwent whole‐transcriptome analysis and next‐generation sequencing. MMR expression of metastatic/recurrent sites was evaluated.ResultsMSI testing identified 27.3% of cases as MSI‐high (n = 182), MMR IHC identified 25.1% cases as MMR‐deficient (n = 167), and 3.8% of cases (n = 25) demonstrated discordant results. A review of IHC staining explained discordant results in 18 cases, revealing subclonal loss of MLH1/Pms 1 homolog 2 (PMS2) (n = 10) and heterogeneous MMR IHC (mut‐S homolog 6 [MSH6], n = 7; MLH1/PMS2, n = 1). MSH6‐associated Lynch syndrome was diagnosed in three of six cases with heterogeneous expression. Subclonal or heterogeneous cases had a 38.9% recurrence rate (compared with 16.7% in complete MMR‐deficient cases and 9% in MMR‐proficient cases) and had abnormal MMR IHC results in all metastatic recurrent sites (n = 7). Tumors with subclonal MLH1/PMS2 demonstrated 74 differentially expressed genes (determined using digital spatial transcriptomics) when stratified by MLH1 expression, including many associated with epithelial–mesenchymal transition.ConclusionsSubclonal/heterogeneous MMR IHC cases showed epigenetic loss in 66.7%, germline mutations in 16.7%, and somatic mutations in 16.7%. MMR IHC reported as intact/deficient missed 21% of cases of Lynch syndrome. EC with subclonal/heterogeneous MMR expression demonstrated a high recurrence rate, and metastatic/recurrent sites were MMR‐deficient. Transcriptional analysis indicated an increased risk for migration/metastasis, suggesting that clonal MMR deficiency may be a driver for tumor aggressiveness. Reporting MMR IHC only as intact/deficient, without reporting subclonal and heterogeneous staining, misses opportunities for biomarker‐directed therapy.Plain Language Summary

Endometrial cancer is the most common gynecologic cancer, and 20%–40% of tumors have a defect in DNA proofreading known as mismatch‐repair (MMR) deficiency.
These results can be used to guide therapy.
Tests for this defect can yield differing results, revealing heterogeneous (mixed) proofreading capabilities.
Tumors with discordant testing results and mixed MMR findings can have germline or somatic defects in MMR genes.
Cells with deficient DNA proofreading in tumors with mixed MMR findings have DNA expression profiles linked to more aggressive characteristics and cancer spread.
These MMR‐deficient cells may drive tumor behavior and the risk of spreading cancer.
K2S2O8‐Mediated C‐3 Formylation of Imidazopyridines Using Glyoxylic Acid
Authors: Indurthi Harish K. , Das Samarpita , Saha Pallavi , Sharma Deepak K. 
Published: September 2023

AbstractA metal‐free formylation of imidazopyridines by direct decarboxylative cross‐coupling of glyoxylic acid in presence of K2S2O8 as oxidant under mild and neutral conditions is described. This reaction features a broad substrate scope, good functional group tolerance, and generates products in good yields between 68–85 %. The translational capacity of the reaction from a laboratory methodology to gram‐scale synthesis has also been ensured. The involvement of a radical pathway has been demonstrated by radical trapping experiments with 2,2,6,6‐tetramethylpiperidine‐1‐oxyl (TEMPO) and 2,6‐di‐tert‐butyl‐4‐methylphenol (BHT).
Dual‐laser pulse‐patterned α‐Co(OH)2/rGO heterointerface for accelerated water oxidation and surface phase‐transition via in‐situ Raman spectroscopy
Authors: Lee Yeryeong , Theerthagiri Jayaraman , Min Ahreum , Moon Cheol Joo , Choi Myong Yong 
Published: September 2023

AbstractThe dynamic surface reconstruction of electrodes is a legible sign to understand the deep phase‐transition mechanistic and electrocatalytic origin during the oxygen evolution reaction (OER). Herein, we report a dual‐laser pulse‐patterned heterointerface of α‐Co(OH)2 and reduced graphene oxide (rGO) nanosheets via pulsed laser irradiation in liquid (PLIL) to accelerate OER kinetics. α‐Co(OH)2 was formed from the OH− ions generated during the PLIL of GO at neutral pH. Co2+ modulation in tetrahedral coordination sites benefits as an electrophilic surface for water oxidation. Few d‐vacancies in Co2+ increase its affinity toward oxygen, lowering the energy barrier and generating many CoOOH and CoO2 active sites. rGO with an ordered π‐conjugated system aids the surface adsorption of OOH*, O*, and OH* during OER. α‐Co(OH)2 surface phase‐transition and OER mechanistic steps occurred via phase‐reconstruction to CoOOH and CoO2 reactive intermediates, uncovered using in situ electrochemical–Raman spectroscopy. Our findings in the dual‐laser pulse strategy and the surface reconstruction correlation in active OER catalysts pave the path for paramount in multiple energy technologies.image