bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design and Rationale for the Use of Magnetic Resonance Imaging Biomarkers to Predict Diabetes After Acute Pancreatitis in the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study
Authors: Tirkes Temel , Chinchilli Vernon M. , Bagci Ulas , Parker Jason G. , Zhao Xuandong , Dasyam Anil K. , Feranec Nicholas , Grajo Joseph R. , Shah Zarine K. , Poullos Peter D. , Spilseth Benjamin , Zaheer Atif , Xie Karen L. , Wachsman Ashley M. , Campbell-Thompson Martha , Conwell Darwin L. , Fogel Evan L. , Forsmark Christopher E. , Hart Phil A. , Pandol Stephen J. , Park Walter G. , Pratley Richard E. , Yazici Cemal , Laughlin Maren R. , Andersen Dana K. , Serrano Jose , Bellin Melena D. , Yadav Dhiraj ,   on behalf of the Type 1 Diabetes in Acute Pancreatitis Consortium (T1DAPC)
Published: October 2022

Abstract
This core component of the Diabetes RElated to Acute pancreatitis and its Mechanisms (DREAM) study will examine the hypothesis that advanced magnetic resonance imaging (MRI) techniques can reflect underlying pathophysiologic changes and provide imaging biomarkers that predict diabetes mellitus (DM) after acute pancreatitis (AP). A subset of participants in the DREAM study will enroll and undergo serial MRI examinations using a specific research protocol. The aim of the study is to differentiate at-risk individuals from those who remain euglycemic by identifying parenchymal features after AP. Performing longitudinal MRI will enable us to observe and understand the natural history of post-AP DM. We will compare MRI parameters obtained by interrogating tissue properties in euglycemic, prediabetic, and incident diabetes subjects and correlate them with metabolic, genetic, and immunological phenotypes. Differentiating imaging parameters will be combined to develop a quantitative composite risk score. This composite risk score will potentially have the ability to monitor the risk of DM in clinical practice or trials. We will use artificial intelligence, specifically deep learning, algorithms to optimize the predictive ability of MRI. In addition to the research MRI, the DREAM study will also correlate clinical computed tomography and MRI scans with DM development.
Telomere Attrition in Intraductal Papillary Mucinous Neoplasms of the Pancreas Associated With Carcinogenesis and Aging
Authors: Miki Atsushi , Matsuda Yoko , Aida Junko , Watanabe Jun , Sanada Yukihiro , Sakuma Yasunaru , Lefor Alan K. , Fukushima Noriyoshi , Sata Naohiro , Arai Tomio , Takubo Kaiyo , Ishiwata Toshiyuki 
Published: October 2022

Objectives
It is challenging to preoperatively distinguish malignant and benign forms of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. The aims of this study were to investigate whether telomere length is associated with pathological grade of IPMNs and age and to clarify the utility of telomere length as a marker to identify malignant IPMNs.

Methods
Pancreas tissue was obtained from 28 patients after resection. We measured the telomere lengths of tumor cells in IPMNs and normal duct cells by quantitative fluorescence in situ hybridization. The association of normalized telomere-centromere ratio (NTCR) to pathological grade of IPMNs and age were determined.

Results
The NTCR showed a gradual decrease with increasing pathological grade of IPMNs. The NTCR in intermediate- and high-grade dysplasia and adenocarcinoma lesions was significantly shorter than in normal pancreatic ducts (P < 0.05). In multivariate analysis, telomere length was most associated with carcinogenesis. When the cutoff value of NTCR was set to 0.74, the sensitivity for detection of high-grade dysplasia and adenocarcinoma was 82.8%, with a specificity of 87.5%.

Conclusions
Telomere shortening occurs with carcinogenesis and aging. A significant reduction of telomere length in IPMNs may be useful for surgical decision making.
Organoids
Authors: Navarro-Serer Bernat , Wood Laura D. 
Published: October 2022

Abstract
Pancreatic cancer is one of the most lethal cancer types, estimated to become the second leading cause of cancer-related deaths in the United States in 2030. The use of 3-dimensional culture systems has greatly expanded over the past few years, providing a valuable tool for the study of pancreatic cancer. In this review, we highlight some of the preclinical in vitro and in vivo models used in pancreatic cancer research, each with its own advantages and disadvantages, and focus on one of the recently used 3-dimensional culture models: organoids. Organoids are multicellular units derived from tissue samples and embedded within extracellular matrix gels after mechanical and enzymatic digestion. We define organoids, differentiate them from other 3-dimensional culture systems such as spheroids, and describe some applications of this model that have recently advanced our understanding of pancreatic cancer and its tumor microenvironment. Organoids have provided valuable insights into pancreatic cancer progression, heterogeneity, and invasion, and they have enabled the creation of biobanks, providing a platform for drug screening. In addition, we discuss some of the future directions and challenges in this model when addressing research questions.
Helping Patients Understand Pancreatic Cancer Using Animated Pancreas Patient Education With Visual Formats of Learning
Authors: Munigala Satish , Gardner Timothy B. , O'Reilly Eileen M. , Fernández-del Castillo Carlos , Ko Andrew H. , Pleskow Douglas , Vollmer Charles M. , Searle Nicholas A. , Bakelman David , Holt Jane M. , Gelrud Andres 
Published: October 2022

Objectives
Patient education and resources that address barriers to health literacy to improve understanding in pancreatic cancer are limited. We evaluated the impact and outcomes benefits of Animated Pancreas Patient (APP) cancer educational modules (APP website and YouTube).

Methods
A retrospective study of APP metrics and utilization data from September 2013 to February 2021 was conducted. We evaluated audience reach and calculated top views by media type (animation/expert video/patient video/slideshow) and top retention videos from the modules.

Results
During the study period, APP had 4,551,079 views worldwide of which 2,757,064 unique visitors or 60% were from the United States. Of these, 54% were patients, 17% were family members or caregivers, 16% were health care providers, and 13% were other. The most popular topic viewed among the animations was “Understanding Clinical Trials” (n = 182,217), and the most common expert video viewed was “What are the different stages of pancreatic cancer?” (n = 15,357).

Conclusions
Pancreatic cancer patient education using APP's visual formats of learning demonstrated a wide reach and had a significant impact on improved understanding among patients, families, and caregivers. Continued efforts should be made to provide patient resources that address health literacy, better quality of life and improved health outcomes in pancreatic cancer.
Reducing Inpatient Psychiatric Unit Denials
Authors: Baum Gwen , Sullivan Michaela , Kohne Lisa , Seaberry Colette , Powers Taryn 
Published: October 2022

Purpose of Project:
The purpose of the inpatient psychiatric unit denials reduction project was to establish a taskforce to analyze denials data for root cause and identify an effective solution to prevent denials through improved provider documentation.

Primary Practice Setting:
The development and implementation of the project occurred at Stanford Health Care, a nonprofit Level 1 trauma hospital, with a 29-bed inpatient psychiatric unit containing both open and secured levels of care. The project was led by the Utilization/Denials Management team, which is subteam within the Case Management Department. Team members are Nurse Case Managers specializing in the management of denials and appeals, data analysis and trending of denials, denial avoidance, and reduction of financial risk.

Methodology:
Denials data analysis revealed the Psychiatry Service Line was responsible for over 70% of payer denials within the Length of Stay Write-offs category. In early 2019, the Utilization/Denials Management team initiated a quality improvement project using A3 Lean Approach methodology and evidence-based practice to guide the implementation. The partnership and collaboration included Case Management, Revenue Cycle, Clinical Documentation Improvement, Technology and Digital Solutions, and Psychiatry Service Line leadership that had an interest in reducing payer denials.

Results:
Outcomes measured for the project were based on denials data for (fiscal year) FY19, the preintervention period, compared to FY20 and FY21, the postintervention period. From FY19 to FY20, revenue loss decreased by 42%. The downward trend continued from FY20 to FY21 with a recorded decrease by 69%.

Implications for Case Management Practice:
The most important implication of the project was improved physician documentation and medical necessity supporting the severity and intensity of inpatient psychiatric level of care, and medical justification for the inpatient stay not only to prevent medical necessity denials but to accurately reflect the care that was provided. High-quality documentation correlates to the high quality of care being provided. This project is far reaching not only for psychiatric units but also reproducible for other acute hospital service lines. Case Management is a multidisciplinary role, and this work is most meaningful for a Nurse Case Manager engaged in care coordination, including utilization and denials management.
Objective evaluation of face-lift outcomes through a new composite photo-numerical scale: The face and neck lift Objective Photo-Numerical Assessment Scale
Authors: La Padula Simone , Coiante Edoardo , Pizza Chiara , D’Andrea Francesco , Rega Umberto , Hersant Barbara , Meningaud Jean Paul 
Published: October 2022

Background:
Success or failure of plastic surgery procedures relies on cosmetic results. Understanding the objective perception of favourable aesthetic results is critical to ensure patient satisfaction. The aim of this study was to develop and to validate a new facial rating scale that could objectively assess face and neck lift outcomes: The face and neck li
ft Objective Photo-Numerical Assessment Scale.

Material and Methods:
One thousand Caucasian patients were included in our study and assessed. To validate our scale the inter-rater reliability and the test-retest reliability were analysed. The Rasch model was used as part of the scale validation process.

Results:
Eleven scales for face and neck lift outcomes assessment were developed. All scales exceeded criteria for acceptability, reliability and validity. The inter and intra-rater reliabilities were good with a substantial or virtually perfect inter-rater reliability for the total score (p=0.15).

Conclusion:
Our results allowed us to validate the face and neck lift Objective Photo-Numerical Assessment Scale as a reliable and reproducible tool to assess face and neck lift outcomes. This scale could be also considered as an important new metrics to be used in facial rejuvenation surgery clinical research.
Traditional versus laterally extended upper blepharoplasty skin excisions: objective and patient reported outcomes
Authors: Hollander Maria H.J. , Contini Mark , Delli Konstantina , Vissink Arjan , Schepers Rutger H. , Jansma Johan , Schortinghuis Jurjen 
Published: October 2022

Background:
Different skin excision shapes may result in different aesthetic outcomes when performing an upper blepharoplasty.

Methods:
Two skin-only excision shapes were objectively and subjectively evaluated in 28 matched patients: the laterally extended skin excision (A) and traditional elliptical skin excision (B). The pretarsal show, lateral eyebrow height, amount of scarring (Patient and Observer Scar Assessment Scale), and patient reported aesthetic results (FACE-Q questionnaires) were scored and compared at 6 and 12 months postoperatively.

Results:
In both groups, the pretarsal show improved significantly after the blepharoplasty. The homogeneity of the pretarsal show improved significantly in the lateral extension group (A), together with a slightly more pretarsal show (0.5–0.8 mm at central pupil region) at 6 and 12 months follow up compared to group B (p=0.004). A trend was observed in the Exocanthion45°(EX-EX45) measurement where group A showed 0.6mm more pretarsal show at 6 months postoperative. The homogeneity of the pretarsal show had significantly improved in group A 12 months after the blepharoplasty, but not in group B. No other significant differences were observed between the groups regarding the pretarsal show measurements or FACE-Q scores. Both groups showed descent of the lateral eyebrow, but this was only significant in group B. Group B showed 1.4 to 2.0mm more descent compared to group A. Both groups’ scarring and adverse effects scores were low and did not differ.

Conclusion:
Both excision shapes result in positive aesthetic results, but the laterally extended skin excision technique is accompanied by a slightly more favourable outcome.
Resistant herpes simplex virus infections – who, when, and what's new?
Authors: Kotton Benjamin D. , Kotton Camille N. 
Published: October 2022

Purpose of review
This review summarizes the literature on acyclovir resistant herpes infections and the most recent data pertinent to diagnosis and treatment in the immunocompromised patient population.

Recent findings
Although fairly rare, acyclovir resistant herpes infections can be challenging to diagnose. Clinicians should be aware of this entity when facing refractory herpes infections. With updated diagnostics, the diagnosis is usually made through viral culture and sequencing. Therapeutic choices depend on the extent of disease. Topical therapy may be appropriate for mucocutaneous disease. Intravenous antiviral therapies such as foscarnet and cidofovir may be necessary for disseminated, ophthalmologic, central nervous system, or visceral disease. Experimental therapies such as pritelivir are in clinical trials.

Summary
Immunosuppressed patients are at risk for developing acyclovir-resistant herpes, which can be challenging to diagnose and treat, although emerging therapeutic options look promising.
Building an Optimal Pediatric Trauma Program
Authors: Upperman Jeffrey S. 
Published: October 2022

Abstract
In this brief review, I suggest a framework for the ideal pediatric trauma program. I provide a trauma program construct devised by the American College of Surgeons. I expand on this design by offering some concepts around how trauma programs can maximize their effectiveness in care, education, and research. This review was a preamble for a minisymposium focused on pediatric hemorrhagic shock and resuscitation.

Level of Evidence
IV
Multicompartmental traumatic injury and the microbiome: Shift to a pathobiome
Authors: Munley Jennifer A. , Kelly Lauren S. , Pons Erick E. , Kannan Kolenkode B. , Coldwell Preston S. , Whitley Elizabeth M. , Gillies Gwendolyn S. , Efron Philip A. , Nagpal Ravinder , Mohr Alicia M. 
Published: October 2022

BACKGROUND
Previous animal models have demonstrated altered gut microbiome after mild traumatic injury; however, the impact of injury severity and critical illness is unknown. We hypothesized that a rodent model of severe multicompartmental injuries and chronic stress would demonstrate microbiome alterations toward a “pathobiome” characterized by an overabundance of pathogenic organisms, which would persist 1 week after injury.

METHODS
Male Sprague-Dawley rats (n = 8 per group) were subjected to either multiple injuries (PT) (lung contusion, hemorrhagic shock, cecectomy, and bifemoral pseudofractures), PT plus daily chronic restraint stress for 2 hours (PT/CS), or naive controls. Fecal microbiome was measured on days 0, 3, and 7 using high-throughput 16S rRNA sequencing and Quantitative Insights Into Microbial Ecology 2 bioinformatics analysis. Microbial α diversity was assessed using Chao1 and Shannon indices, and β diversity with principle coordinate analysis. Intestinal permeability was evaluated by plasma occludin; ileum and descending colon tissues were reviewed for injury. Analyses were performed in GraphPad (GraphPad Software, La Jolla, CA) and R (R Foundation for Statistical Computing, Vienna, Austria), with significance defined as p < 0.05.

RESULTS
There were significant alterations in β diversity at day 3 and between all groups. By day 3, both PT and PT/CS demonstrated significantly depleted bacterial diversity (Chao1) (p = 0.01 and p = 0.001, respectively) versus naive, which persisted up to day 7 in PT/CS only (p = 0.001). Anaerostipes and Rothia dominated PT and Lactobacillus bloomed in PT/CS cohorts by day 7. Plasma occludin was significantly elevated in PT/CS compared with naive (p = 0.04), and descending colon of both PT and PT/CS showed significantly higher injury compared with naive (p = 0.005, p = 0.006).

CONCLUSIONS
Multiple injuries with and without chronic stress induces significant alterations in microbiome diversity and composition within 3 days; these changes are more prominent and persist for 1 week postinjury with stress. This rapid and persistent transition to a “pathobiome” phenotype represents a critical phenomenon that may influence outcomes after severe trauma and critical illness.
Venous thromboembolism risk after spinal cord injury: A secondary analysis of the CLOTT study
Authors: Godat Laura N. , Haut Elliott R. , Moore Ernest E. , Knudson M. Margaret , Costantini Todd W. 
Published: October 2022

INTRODUCTION
Patients with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE). Pharmacologic VTE prophylaxis (VTEppx) is frequently delayed in patients with SCI because of concerns for bleeding risk. Here, we hypothesized that delaying VTEppx until >48 hours would be associated with increased risk of thrombotic events.

METHODS
This is a secondary analysis of the 2018 to 2020 prospective, observational, cohort Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study of patients aged 18 to 40 years, at 17 US level 1 trauma centers. Patients admitted for >48 hours with documented SCI were evaluated. Timing of initiation of VTEppx, rates of thrombotic events (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and missed VTEppx doses were analyzed. The primary outcome was VTE (DVT + PE).

RESULTS
There were 343 patients with SCI. The mean ± SD age was 29.0 ± 6.6 years, 77.3% were male, and 78.7% sustained blunt mechanism. Thrombotic events occurred in 33 patients (9.6%): 30 DVTs (8.7%) and 3 PEs (0.9%). Venous thromboembolism prophylaxis started at ≤24 hours in 21.3% of patients and 49.3% at ≤48 hours. The rate of VTE for patients started on VTEppx ≤48 hours was 7.1% versus 12.1% if started after 48 hours (p = 0.119). After adjusting for differences in risk factors between cohorts, starting ≤48 hours was independently associated with fewer VTEs (odds ratio, 0.45; 95% confidence interval, 0.101–0.978; p = 0.044). Unfractionated heparin was associated with a VTE rate of 21.0% versus 7.5% in those receiving enoxaparin as prophylaxis (p = 0.003). Missed doses of VTEppx were common (29.7%) and associated with increased thrombotic events, although this was not significant on multivariate analysis.

CONCLUSION
Rates of thrombotic events in patients with SCI are high. Prompt initiation of VTEppx with enoxaparin and efforts aimed at avoiding missed doses are critical to limit thrombotic events in these high-risk patients.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Poor Physical Function Trajectory Predicts Impaired Patient Survival in Older Recipients of Deceased Donor Kidneys: A Prospective Cohort Study
Authors: Tsarpali Vasiliki , Midtvedt Karsten , Lønning Kjersti , Bernklev Tomm , Åsberg Anders , von der Lippe Nanna , Reisæter Anna Varberg , Heldal Kristian 
Published: October 2022

Background.
Optimized health-related quality of life (HRQOL) at the time of kidney transplantation (KT) is associated with improved survival. In older KT recipients, we aimed to prospectively evaluate if HRQOL evolution during the first posttransplant year was associated with long-term patient survival.

Methods.
Recipients older than 65 y at KT who received an organ from a deceased brain-dead donor and survived >12 mo posttransplant were eligible. HRQOL was assessed pre-KT, at 10 wk, 6 mo, and 12 mo post-KT, using the Kidney Disease Quality of Life Short Form version 1.3 survey. A mixed-effect model was used to explore HRQOL evolution during the first posttransplant year in long-term survivors compared with nonsurvivors. Distinct HRQOL clusters were identified using a group-based trajectory modeling and their association with patient survival was investigated with Cox proportional hazard regression models.

Results.
We included 192 elderly recipients of deceased brain-dead donor kidneys who were transplanted from 2013 to 2020. Eleven died during the first year leaving 181 for evaluation (male, 125; mean age at KT, 72 y [65–84 y]). During a median observation time post-KT of 4.9 y (11.1–8.5 y), 57 recipients died. In survivors, all the generic and kidney-specific HRQOL domains substantially improved during the first year, whereas in nonsurvivors HRQOL deteriorated. Three longitudinal HRQOL trajectories indicating poor, fair, and good HRQOL evolution were identified. Poor physical function trajectory was significantly associated with higher mortality risk independent of covariates, as compared with good physical trajectory (hazard ratio, 2.38; 95% confidence interval, 1.15–5.01).

Conclusions.
In elderly KT recipients, detection of declining posttransplant physical function may imply impaired survival. Systematic HRQOL monitoring following KT provides added value when evaluating mortality and may guide therapeutic decisions.
Both cell autonomous and non-autonomous processes modulate the association between replication timing and mutation rate
Authors: Vardi-Yaacov Oriya , Yaacov Adar , Rosenberg Shai , Simon Itamar 
Published: October 2022

AbstractCancer somatic mutations are the product of multiple mutational and repair processes, both of which are tightly associated with DNA replication. Mutation rates (MR) are known to be higher in late replication timing (RT) regions, but different processes can affect this association. Systematic analysis of the mutational landscape of 2,787 tumors from 32 tumor types revealed that the tumors can be divided into two groups with approximately one third of the tumor samples show weak association between replication timing and mutation rate. Analyses of the two groups revealed that both mutational signatures and mutation in genes involved in DNA replication, DNA repair and chromatin structure impact the association between RT and MR. Surprisingly, analysis of differentially expressed genes between the two groups revealed involvement of cell-cell communication and of the interaction with immune cells in modulating the effect of RT on MR. This provides evidence of the recently described association between mutagenic processes and the immune system in patients’ tumor samples.