bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of FDG PET/CT Scan in Changing Management of Well-Differentiated Neuroendocrine Tumors With Ki67 Index Less Than or Equal to 5%
Authors: Choudhury Sayak , Agrawal Archi , Rangarajan Venkatesh , Puranik Ameya , Bal Munita , Chaudhari Vikram , Bhandare Manish , Purandare Nilendu , Shah Sneha , Ramaswamy Anant , Ostwal Vikas , Shrikhande Shailesh V. 
Published: October 2022

Objectives
This study aimed to see the impact of FDG PET/CT with somatostatin receptor PET (SSTR PET) in directing the treatment plan in lower-grade well-differentiated neuroendocrine tumors (NETs) with Ki67 index ≤5%.

Methods
Sixty-three NET cases with Ki67 index ≤5% with both FDG PET and SSTR PET (68Ga-DOTANOC PET) were included for this retrospective observational study. FDG PET findings were classified into positive, weakly positive, and negative based on a visual scale. Clinical factors considered while referring for FDG PET scan were audited from electronic medical records. The addition of chemotherapy was considered as FDG-directed change in treatment.

Results
Sixty patients showed intense SSTR expression in the primary and metastatic sites (if present). Three patients showed no evidence of SSTR expression, in whom the scans were done after resection of the primary tumor. The FDG PET was positive in 25 (39.6%), weakly positive in 11 (17.4%), and negative in 27 (42.8%). Specific clinical reason for doing FDG PET was found in 34 patients, and in the remaining 29, there was no justification or specific indication for doing the FDG study; 73.5% of patients from the former group was either FDG positive or weakly positive, and 26.5% were negative; in the other group, 62.1% were FDG-negative, and 37.9% were positive (P = 0.004). Treatment-naive patients with symptom duration of ≤5 months were associated with more FDG positivity than patients with >5 months' symptom duration (P = 0.006). FDG PET/CT led to change in management in 17.4% of all the patients, 9.6% of grade 1, and 25% of grade 2 patients.

Conclusions
In lower-grade NET, FDG positivity was seen in a sizable number of the cases, and this led to change in management in 17.4% of the cases. Specific clinical features could be utilized to successfully discriminate between FDG-avid and non–FDG-avid disease in lower-grade NETs, and this had impact in management change as well.
Orbital Extenteration Defects: Ablative and Reconstructive Flowchart Proposal
Authors: Mannelli Giuditta , Comini Lara V. , Marzola Antonio , Volpe Yari , Mazzini Cinzia , Santoro Nicola , Delcroix Luca , Molteni Gabriele , Spinelli Giuseppe 
Published: October 2022

Abstract:
Orbital exenteration is a radical and disfiguring operation. It is still under debate the absence of correlation between the term describing the resulting orbital defect and the type of reconstruction. Authors’ goal was to propose a consistent and uniform terminology for Orbital Exenteration surgery in anticipation of patients’ tailored management. Twenty-five patients who underwent orbital exenteration between 2014 and 2020 were reviewed. A parallel comprehensive literature review was carried on. Five different types of orbital exenteration where outlined. Multiple reconstructive procedures were enclosed. An algorithm for orbital reconstruction was proposed based on anatomic boundaries restoration. Eyelid removal was first considered as an independent reconstructive factor, and both orbital roof and floor were indicated as independent reconstructive goals, which deserve different defect classification. In our opinion, this algorithm could be a useful tool for patient counseling and treatment selection, which might allow a more tailored patient care protocol.

Level of Evidence
Level III.
Postgraduate Surgical Education in East, Central, and Southern Africa: A Needs Assessment Survey
Authors: Elmaraghi Shady , Park Keon Min , Rashidian Nikdokht , Yap Ava , Faktor Kara , Ozgediz Doruk , Borgstein Eric , Bekele Abebe , Alseidi Adnan , Tefera Girma 
Published: October 2022

Background:
The Lancet Commission on Global Surgery has identified workforce development as an important component of National Surgical Plans to advance the treatment of surgical disease in low- and middle- income countries. The goal of our study is to identify priorities of surgeon educators in the region so that collaboration and intervention may be appropriately targeted.

Study Design:
The American College of Surgeons (ACS) Operation Giving Back (OGB), in collaboration with leaders of the College of Surgeons of Eastern, Central and Southern Africa (COSECSA), developed a survey to assess the needs and limitations of surgical educators working under their organizational purview. COSECSA members were invited to complete an online survey to identify and prioritize factors within five domains: (1) Curriculum Development, (2) Faculty Development, (3) Structured Educational Content, (4) Skills and Simulation Training, and (5) Trainee Assessment and Feedback.

Results:
One-hundred sixty-six responses were received after three calls for participation, representing all countries in which COSECSA operates. The majority of respondents (78%) work in tertiary referral centers. Areas of greatest perceived need were identified in the Faculty Development and Skills and Simulation domains. Although responses differed between domains, clinical responsibilities, cost, and technical support were commonly cited as barriers to development.

Conclusion:
This needs assessment identified educational needs and priorities of COSECSA surgeons. Our study will serve as a foundation for interventions aimed at further improving graduate surgical education and ultimately patient care in the region.
Alfentanil Pretreatment for Electroconvulsive Therapy–Associated Hemodynamic Lability
Authors: McCutchen Thomas M. , Gligorovic Predrag V. , Tighe Nathaniel T.G. , Templeton T. Wesley , Saha Amit K. 
Published: October 2022

Objectives
Electroconvulsive therapy (ECT) is frequently associated with significant hemodynamic changes that increase myocardial oxygen demand including significant hypertension poststimulus. This raises concern about the cumulative effect of repetitive stress from ECT. Historically, various agents have been used to blunt this response and reduce hemodynamic fluctuations in these patients with varying degrees of efficacy. We hypothesized that bolus alfentanil administration timed with the ECT stimulus may reduce near-term hypertension and heart rate (HR) increases in patients undergoing ECT.

Methods
A randomized, double-blind, placebo-controlled AB/BA crossover trial of 87 patients 18 years or older with mood disorders was carried out. Patients received a standardized anesthetic regimen including induction with methohexital and succinylcholine and were randomized to receive either 20 μg/kg ideal bodyweight of alfentanil or placebo 60 seconds before the ECT stimulus for the first treatment and then crossed over to the other group for the second treatment. The primary outcome was the within-individual difference in preinduction systolic blood pressure and the first systolic blood pressure after the ECT stimulus.

Results
Eighty-seven patients completed the protocol. The primary outcome of increase in systolic blood pressure pre-ECT to post-ECT was 16.9 mm Hg less in the alfentanil group than the placebo group (95% confidence interval, −26.0 to −7.8; P < 0.001). The maximum HR was 6.5 beats per minute lower (95% confidence interval, −12.1 to −0.9; P = 0.024) when patients received alfentanil compared with placebo.

Conclusions
Premedication with alfentanil reduces poststimulus hypertension and increased HR in patients receiving ECT and therefore, may reduce morbidity related to this in susceptible patients.
Acute and Prophylactic Management of Postictal Agitation in Electroconvulsive Therapy
Authors: Sterina Evelina , Gregory Neha , Hermida Adriana P. 
Published: October 2022

Abstract
Postictal agitation (PIA) is a common adverse effect of electroconvulsive therapy (ECT), a treatment used for a variety of psychiatric disorders. Because of risk of harm to patients and health providers when patients develop PIA, its acute management and prophylaxis are of vital importance for ECT practitioners. This article describes PIA risk factors, as well as practical steps to manage this ECT complication. Nonpharmacologic patient safety interventions are critical components of PIA management. Benzodiazepines, antipsychotics, and additional anesthetic doses are discussed as acute treatment interventions. Prophylactic pharmacologic choices described include antipsychotics, postseizure anesthetics, and dexmedetomidine. Exploratory choices such as melatonin and intranasal formulations of sedatives are also discussed. This review suggests that common medication like olanzapine and propofol are cost-effective considerations to decrease PIA incidence and/or severity after ECT. In addition, dexmedetomidine presents a management alternative for treatment-resistant PIA. This literature review outlines treatment choices while suggesting future directions for considering effective treatments of postictal agitation in clinical settings.
Preparing future STEM faculty nationwide through flexible teaching professional development
Authors: Goldberg B. B. , Bruff D. , Greenler R. , Barnicle K. , Green N. , Campbell L. E. P. , Laursen S. L. , Ford M. , Serafini A. , Mack C. , Carley T. , Maimone C. , Campa H. 
Published: October 2022

AbstractWe report on a five-year initiative that has prepared thousands of future STEM faculty around the world to adopt evidence-based instructional practices by participating in two massive open online courses (MOOCs) and facilitated in-person learning communities. This novel combination of asynchronous online and coordinated, structured face-to-face learning community experiences provides flexible options for STEM graduate students and postdoctoral fellows to pursue teaching professional development, while leveraging the affordances of educational technologies and the geographically clustered nature of this target learner demographic. A total of 14,977 participants enrolled in seven offerings of the introductory course held 2014-2018, with 1,725 participants from approximately 60 countries completing at an average course completion rate of 13%. The preparation of future STEM faculty makes an important difference in establishing high-quality instruction that meets the diverse needs of all undergraduate students, and the initiative described here can serve as a model for increasing access to such preparation.
Initiation of glucose-lowering drugs reduces the anticoagulant effect of warfarin – but not through altered drug metabolism in patients with type 2 diabetes
Authors: Dunvald Ann-Cathrine Dalgård , Nielsen Flemming , Olsen Dorte Aalund , Ernst Martin Thomsen , Donnelly Louise , Soto-Pedre Enrique , Kristiansen Maja Refshauge , Nielsen Jens Steen , Persson Frederik , Højlund Kurt , Madsen Jonna Skov , Søndergaard Jens , Pearson Ewan , Pottegård Anton , Stage Tore Bjerregaard 
Published: October 2022

ABSTRACTDrug metabolism might be altered in patients with type 2 diabetes. We aimed to evaluate if initiation of glucose-lowering drugs impacts warfarin efficacy and drug metabolism.First, we conducted a register-based self-controlled cohort study on Danish and Scottish warfarin users. Warfarin efficacy (International Normalized Ratio (INR)) was compared before and after initiation of glucose-lowering drugs. Second, we conducted a clinical pharmacokinetic trial comprising treatment-naïve type 2 diabetes patients. Patients ingested probe drugs for drug-metabolizing enzymes (the Basel Cocktail) before initiating glucose-lowering treatment, and after three and 12 weeks of treatment. Drug metabolism, glycemic control, and inflammation were assessed on each visit.In the Danish and Scottish cohorts, initiating glucose-lowering drugs reduced warfarin efficacy (n=982 and n=44, respectively). INR decreased from 2.47 to 2.21 in the Danish cohort (mean difference -0.26; 95% CI -0.35;-0.17) and from 2.33 to 2.13 in the Scottish cohort (−0.21; 95% CI - 0.52;0.11) after initiation of glucose-lowering treatment. This impact on INR was more pronounced among individuals with stronger effects of glucose-lowering treatment. In the clinical pharmacokinetic trial (n=10), initiating metformin did not affect drug metabolism after three weeks (geometric mean ratio of CYP3A4 metabolic ratio: 1.12 (95% CI: 0.95;1.32)) or 12 weeks of metformin treatment. Glycemic control improved during treatment, while inflammation remained low and unchanged during treatment.In conclusion, initiation of glucose-lowering drugs among chronic warfarin users is associated with a reduction in INR, particularly among individuals with a large decrease in HbA1c. This effect seems unrelated to CYP enzyme activity and warfarin drug metabolism.Registry numberClinicalTrials.govidentifierNCT04504045.
Detection of maternal transmission of resistant Gram-negative bacteria in a Cambodian hospital setting
Authors: Chomkatekaew Chalita , Thaipadungpanit Janjira , Hearn Pasco , Soeng Sona , Pol Sreymom , Neou Leakhena , Hopkins Jill , Turner Paul , Batty Elizabeth M. 
Published: October 2022

AbstractInfection with Extended-spectrum beta-lactamase -producingEnterobacterales(ESBL-E) is common in infants leading to increased intensive care unit admission and mortality, but the role of maternal transmission in colonisation of infants is unclear. Using paired isolates from 50 pairs of mothers and neonates admitted to a Cambodian hospital, we investigated antimicrobial resistance inEscherichia coliandKlebsiella pneumoniaeusing whole genome sequencing. We detected a wide variety of ESBL-E genes present in this population along with high levels of multidrug resistance. From 21 pairs where the same organism was present in both mother and neonate, we identified eight pairs with identical or near-identical isolates from both individuals suggestive of transmission at or around birth, including a pair with transmission of multiple strains. We found no evidence for transmission of plasmids only from mother to infant. This suggests vertical transmission outside hospitals as a common cause of ESBL-E colonisation in neonates.
Altered brain dynamics across bipolar disorder and schizophrenia revealed by overlapping brain states
Authors: Ye Jean , Sun Huili , Gao Siyuan , Dadashkarimi Javid , Rosenblatt Matthew , Rodriguez Raimundo X. , Mehta Saloni , Jiang Rongtao , Noble Stephanie , Westwater Margaret L. , Scheinost Dustin 
Published: October 2022

AbstractAberrant brain dynamics putatively characterize bipolar disorder (BD) and schizophrenia (SCZ). Previous studies often adopted a state discretization approach when investigating how individuals recruited recurring brain states. Since multiple brain states are likely engaged simultaneously at any given moment, focusing on the dominant state can obscure changes in less prominent but critical brain states in clinical populations. To address this limitation, we introduced a novel framework to simultaneously assess brain state engagement for multiple brain states, and we examined how brain state engagement differs in patients with BD or SCZ compared to healthy controls (HC). Using task-based data from the Human Connectome Project, we applied nonlinear manifold learning and K-means clustering to identify four recurring brain states. We then examined how the engagement and transition variability of these four states differed between patients with BD, SCZ, and HC across two other international, open-source datasets. Comparing these measures across groups revealed significantly altered state transition variability, but not engagement, across all four states in individuals with BD and SCZ during both resting-state and task-based fMRI. In our post hoc and exploratory analysis, we also observed associations between state transition variability and age as well as avolition. Our results suggest that disrupted state transition variability affects multiple brain states in BD and SCZ. By studying several brain states simultaneously, our framework more comprehensively reveals how brain dynamics differ across individuals and in psychiatric disorders.
Sex-Specific Association Between Genetic Risk of Psychiatric Disorders and Cardiovascular Diseases
Authors: Jiang Jiayue-Clara , Singh Kritika , Davis Lea K. , Wray Naomi R. , Shah Sonia 
Published: October 2022

AbstractBackgroundThe lack of research on female-specific risk factors for cardiovascular diseases (CVD) has led to sex-based disparities in cardiovascular health. Though epidemiological studies show increased CVD risks amongst individuals with psychiatric disorders, findings on sex differences in comorbidity have been inconsistent.MethodsThis genetic epidemiology study examined the sex-specific association between the genetic risk of three psychiatric disorders [major depression (MD), schizophrenia and bipolar disorder], estimated using polygenic scores (PGS), and risks of three CVDs [atrial fibrillation (AF), coronary artery disease (CAD) and heart failure (HF)] in 345,169 European-ancestry individuals (UK Biobank), with analyses replicated in an independent BioVU cohort (N=49,057). Mediation analysis was conducted to determine whether traditional CVD risk factors could explain any observed sex difference.ResultsIn UK Biobank, PGSMDwas significantly associated with the incident risks of all three CVDs in females after multiple testing correction [hazard ratio (HR)AF-female=1.04 (95% CI: 1.02-1.06; p=0.00015); HRCAD-female=1.07 (1.04-1.11; p=2.6E-06); HRHF-female=1.09 (1.06-1.13; p=9.7E-10)], but not in males. These female-specific associations remained even in the absence of any psychiatric disorder diagnosis or psychiatric medication use. Although mediation analysis demonstrated that the association between PGSMDand CVDs in females was partly mediated by baseline BMI, hypercholesterolemia, hypertension and smoking, these risk factors did not explain the higher risk compared to males. The association between PGSMDand CAD was consistent between females who were pre-menopausal and post-menopausal at baseline (mean baseline age of 44.9 and 60.8 years, respectively), while the association with AF and HF was only observed in the baseline post-menopausal cohort. No significant association with CVD risks was observed for the PGS of schizophrenia or bipolar disorder. The positive association of PGSMDwith CAD and HF risk in females was replicated in BioVU, where the corresponding associations in males also reached nominal significance.ConclusionsGenetic predisposition to MD confers a greater risk of CVDs in females versus males, even in the absence of any depression diagnosis. This study warrants further investigation into whether genetic predisposition to depression could be useful for improving cardiovascular risk prediction even in the absence of a depression diagnosis, especially in women.
Associations Between Reported Post-COVID-19 Symptoms and Subjective Well-Being, Israel, July 2021 -April 2022
Authors: Gorelik Yanay , Dror Amiel , Zayyad Hiba , Wertheim Ofir , Jabal Kamal Abu , Nazzal Saleh , Otiku Paul , Elsinga Jelte , Glikman Daniel , Edelstein Michael 
Published: October 2022

SummaryThe impact of individual symptoms reported post-COVID-19 on subjective well-being (SWB) is unknown. We described associations between SWB and selected reported symptoms following SARS-CoV-2 infection. We analysed reported symptoms and subjective well being from 2295 participants (of which 576 reporting previous infection) in an ongoing longitudinal cohort study taking place in Israel. We estimated changes in SWB associated with reported selected symptoms at three follow-up time points (3-6, 6-12, and 12-18 months post infection) among participants reporting previous SARS-CoV-2 infection, adjusted for key demographic variables, using linear regression. Our results suggest that the biggest and most sustained changes in SWB stems from non-specific symptoms (fatigue −7.7 percentage points (pp), confusion/ lack of concentration −10.7 pp, and sleep disorders −11.5pp, p<0.005), whereas the effect of system-specific symptoms, such as musculoskeletal symptoms (weakness in muscles and muscle pain) on SWB, are less profound and more transient. Taking a similar approach for other symptoms and following individuals over time to describe trends in SWB changes attributable to specific symptoms will help understand the post-acute phase of COVID-19 and how it should be defined and better managed.
Chromosome territory reorganization through artificial chromosome fusion is negligible to cell fate determination and mouse development
Authors: Wang Yuang , Qu Zhen , Fang Yi , Chen Yulong , Peng Jiayin , Song Jiawen , Li Jinsong , Shi Jiantao , Zhou Jin-Qiu , Zhao Yun 
Published: October 2022

SummaryChromosomes occupy discrete spaces in the interphase cell nucleus, called chromosome territory. The structural and functional relevance of chromosome territory remains elusive. We fused chromosome 15 and 17 in mouse haploid embryonic stem cells (haESCs), resulting in distinct changes of territories in the corresponding native chromosomes, but affecting little on gene expression, pluripotency and gamete functions of haESCs. The karyotype engineered haESCs were successfully implemented in cultivating heterozygous (2n=39) and homozygous (2n=38) mouse models. The mice containing fusion-chromosome are fertile, and their representative tissues and organs display no phenotypic abnormalities, suggesting mouse development unscathed. These results indicate that the mammalian chromosome architectures are highly resilient, and reorganization of chromosome territories can be readily tolerated during cell differentiation and mouse development.
Metagenomic analysis unravels novel taxonomic differences in the uterine microbiome between healthy mares and mares with endometritis
Authors: Virendra Aeknath , Gulavane Sarita U. , Ahmed Zulfikar A. , Reddy Ravi , Chaudhari Ravindra J. , Gaikwad Sandeep M. , Shelar Raju R. , Ingole Shailesh D. , Thorat Varsha D. , Khanam Afroza , Khan Firdous Ahmad 
Published: October 2022

AbstractThe application of high throughput technologies has enabled unravelling of unique differences between healthy mares and mares with endometritis at transcriptomic and proteomic levels. However, differences in the uterine microbiome are yet to be investigated. The present study was aimed at evaluating the differences in uterine microbiome between healthy mares and mares with endometritis. Low-volume lavage (LVL) samples were collected from the uterus of 30 mares classified into healthy (n=15) and endometritis (n=15) based on their reproductive history, intrauterine fluid accumulation, gross appearance of LVL samples, endometrial cytology, and bacterial culture. The samples were subjected to metagenomic analysis using 16S rRNA sequencing. Notable differences in the uterine microbiome were observed between healthy mares and mares with endometritis at various taxonomic levels. In healthy mares, the most abundant phylum, class, order, and family were Firmicutes, Bacilli, Bacillales, and Paenibacillaceae, respectively. In contrast, the most abundant corresponding taxonomic levels in mares with endometritis were Proteobacteria, Gammaproteobacteria, Enterobacterales, and Enterobacteriaceae, respectively. At the genus level,BrevibacillusandPaenibacilluswere more abundant in healthy mares, whereasEscherichia, Salmonella, andKlebsiellawere more abundant in mares with endometritis. In healthy mares,Brevibacillus breviswas the most abundant species, followed byBrevibacillus choshinensisandPaenibacillus sp JDR-2. However, in mares with endometritis,Escherichia coliwas the most abundant species, followed bySalmonella entericaandKlebsiella pneumoniae. These results indicate novel differences in the uterine microbiome between healthy mares and mares with endometritis. The findings can potentially help formulate new approaches to prevent or treat equine endometritis.