bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Delayed Gastric Emptying After Pancreaticoduodenectomy
Authors: Bilgiç Çağri , Sobutay Erman , Bilge Orhan 
Published: July 2022

Objectives
Delayed gastric emptying (DGE) is a complication that affects the length of hospitalization and associated cost after pancreaticoduodenectomy (PD). The reported risk factors for DGE were controversial. This study aimed to identify risk factors for the development of DGE after PD.

Methods
The patients who underwent PD between October 2010 and October 2020 were retrospectively examined. Multivariate analysis was performed to predict the variables causing DGE.

Results
In total, 225 patients underwent PD. The pylorus preserving PD was applied to 151 patients (67%), whereas standard PD to 74 (33%). The DGE was detected in 26 patients (11.5%). The majority of cases were classified as grade A (57.7%), whereas 38.4% as grade B and 3.9% as grade C. In the multivariate analysis, diabetes mellitus (odds ratio [OR], 3.48; 95% confidence interval [CI], 1.45–8.34; P = 0.05), the preoperative biliary stent (OR, 2.5; 95% CI, 1.04–5.99; P = 0.039), and the pylorus resection (OR, 3.05; 95% CI, 1.28–7.25; P = 0.012) were independently associated with DGE.

Conclusions
We demonstrated that implementation of the preoperative stent, pylorus resection, and diabetes mellitus are independent risk factors for DGE. Pylorus preservation should remain the standard of care in PD.
Benefit From Nonsurgical Treatment for Asymptomatic Pancreatolithiasis
Authors: Yamamoto Satoshi , Inui Kazuo , Katano Yoshiaki , Miyoshi Hironao , Kobayashi Takashi , Tachi Yoshihiko 
Published: July 2022

Objective
Clinical guidelines consider abdominal pain an indication for nonsurgical treatment of pancreatolithiasis. We examined benefit from nonsurgically treating asymptomatic pancreatolithiasis.

Methods
We retrospectively reviewed 165 patients with pancreatolithiasis who underwent nonsurgical treatment between 1992 and 2020. Symptoms were absent in 41, while 124 had abdominal pain. In the asymptomatic group, the median follow-up duration was 8 months (range, 0–166 months), and the median age was 61 years (range, 32–80 years). In patients with pain, the median follow-up duration was 43 months (range, 0–293 months), while the median age was 57 years (range, 22–80 years). The male:female ratio was 3.6:1 for asymptomatic patients and 5.9:1 for those with pain. We compared treatment outcome, stone recurrence rate, and changes in pancreatic exocrine function (bentiromide-p-aminobenzoic acid test results) between groups.

Results
Nonsurgical treatment for patients with asymptomatic pancreatolithiasis had a 63% stone clearance rate, lower than 84% for symptomatic pancreatolithiasis but comparable to outcomes at other institutions. Pancreatic exocrine function values during the year after treatment were mean, 52% (standard deviation, 16%) in the asymptomatic group, similar to mean, 57% (standard deviation, 17%) in the symptomatic group.

Conclusions
Nonsurgical treatment in asymptomatic pancreatolithiasis may preserve pancreatic exocrine function as well as in symptomatic pancreatolithiasis.
Preoperative Predictive Features of Invasive Carcinoma Among Intraductal Papillary Mucinous Neoplasm of the Pancreas
Authors: Kazami Yusuke , Arita Junichi , Nishioka Yujiro , Kawaguchi Yoshikuni , Ichida Akihiko , Ishizawa Takeaki , Akamatsu Nobuhisa , Kaneko Junichi , Nakai Yousuke , Koike Kazuhiko , Hasegawa Kiyoshi 
Published: July 2022

Objective
Noninvasive intraductal papillary mucinous neoplasms (IPMNs) theoretically do not metastasize. The purpose of this study is to preoperatively distinguish invasive carcinomas associated with IPMN from noninvasive IPMN.

Methods
A total of 131 patients who underwent surgical resection for IPMN were retrospectively analyzed to identify the predictors of invasive carcinoma, based on the International Association of Pancreatology Consensus Guidelines.

Results
Of the 131 patients, 29 (22%) had invasive carcinomas and 102 (78%) had noninvasive IPMN. An enhancing mural nodule (MN) greater than or equal to 5 mm, obstructive jaundice, an abrupt change in the caliber of the pancreatic duct (PD) with distal pancreatic atrophy, and lymphadenopathy were the significant predictors of invasive carcinoma in univariate analysis. The optimal cutoff value for the size of the enhancing MN to differentiate invasive carcinoma was 13 mm. In multivariate analysis, enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were the independent predictors. When all these factors were absent, only 17% were invasive carcinomas.

Conclusions
Enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were predictive factors for invasive carcinoma. Systematic lymph node dissection may be omitted when a high-risk patient has none of these factors.
Pediatric Critical Care Nursing Research Priorities in Asia: An eDelphi Study*
Authors: Poh Pei-Fen , Sng Qian Wen , Latour Jos M. , He Linxi , Fong Mei Fung , Muralidharah Jayashree , Abbas Qalab , Matsuishi Yujiro , Lee Jan Hau ,   on behalf of Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN)
Published: July 2022

Objectives:
To identify nursing research priorities in pediatric critical care in Asia.

Design:
We conducted a modified three-round eDelphi survey with pediatric critical care nurses in Asia. The eDelphi technique has been extensively used within health research to achieve a common viewpoint from experts using questionnaires to gather research priorities. In round 1, participants were asked to list three to five research topics that they deemed important. These topics were thematically analyzed and categorized into a questionnaire. Participants rated the research topics in round 2 on a 6-point scale (1 = not important to 6 = extremely important). In round 3, the same questionnaire was used with addition of the calculated mean scores from round 2 for each topic. Research topics ranked among the top 10 were considered extremely important.

Settings:
Twenty-two PICUs in eight Asian countries.

SUBJECTS:
Clinical nurses, managers, educators, and researchers.

Interventions:
None.

Measurements and Main Results:
In round 1, 146 PICU nurses across eight countries provided 520 research topics. Topics from round 1 were categorized into seven domains with 52 research topics. Prioritized research topics included early recognition of patient deterioration (mean 5.58 ± 0.61), prevention of healthcare-associated infections (mean 5.47 ± 0.70), and interventions to reduce compassion fatigue (mean 5.45 ± 0.80). The top three research domains were end-of-life care (mean 5.34 ± 0.68), professionalism (mean 5.34 ± 0.69), and management of pain, sedation, and delirium (5.32 ± 0.72).

Conclusions:
This first PICU nursing research prioritization exercise within Asia identified key nursing research themes that should be prioritized and provide a framework for future collaborative studies.
Treatment Algorithm for Patients With von Willebrand Syndrome Type 2A and Congenital Heart Disease—A Treatment Algorithm May Reduce Perioperative Blood Loss in Children With Congenital Heart Disease
Authors: Wolf Julian , Brandenburger Christina , Dittrich Marcus , Flieder Tobias , Koster Andreas , Budde Ulrich , Knabbe Cornelius , Sandica Eugen , Laser Kai Thorsten , Birschmann Ingvild 
Published: July 2022

Objectives:
In children with congenital heart disease (CHD), excessive perioperative bleeding is associated with increased morbidity and mortality, thus making adequate perioperative hemostasis crucial. We investigate the prevalence of acquired von Willebrand syndrome type 2A (aVWS) in CHD and develop a treatment algorithm for patients with aVWS and CHD (TAPAC) to reduce perioperative blood loss.

Design:
Retrospective cohort study.

Setting:
Single-center study.

Patients:
A total of 627 patients with CHD, undergoing corrective cardiac surgery between January 2008 and May 2017.

Interventions:
The evaluation of perioperative bleeding risk was based on the laboratory parameters von Willebrand factor (VWF) antigen, ristocetin cofactor activity, platelet function analyzer (PFA) closure time adenosine diphosphate, and PFA epinephrine. According to the bleeding risk, treatment was performed with desmopressin or VWF.

Measurements and Main Results:
aVWS was confirmed in 63.3 %, with a prevalence of 45.5% in the moderate and 66.3 % in the high-risk group. In addition, prevalence increased with ascending peak velocity above the stenosis (vmax) from 40.0% at less than or equal to 3 m/s to 83.3% at greater than 5 m/s. TAPAC reduced mean blood loss by 36.3% in comparison with a historical control cohort (p < 0.001), without increasing the number of thrombotic or thromboembolic events during the hospital stay. With ascending vmax, there was an increase in perioperative blood loss in the historical cohort (p < 0.001), which was not evident in the TAPAC cohort (p = 0.230).

Conclusions:
The prevalence of aVWS in CHD seems to be higher than assumed and leads to significantly higher perioperative blood loss, especially at high vmax. Identifying these patients through appropriate laboratory analytics and adequate treatment could reduce blood loss effectively.
“That's frustrating”: Perceptions of ankle foot orthosis provision, use, and needs among people with cerebral palsy and caregivers
Authors: Zaino Nicole L. , Yamagami Momona , Gaebler-Spira Deborah J , Steele Katherine M. , Bjornson Kristie F. , Feldner Heather A. 
Published: July 2022

Background:
Cerebral palsy (CP) affects roughly 3 per 1000 births in the United States and is the most common pediatric developmental motor disability. Ankle foot orthoses (AFOs) are commonly prescribed to provide support and improve function for individuals with CP.

Objectives:
The study objective was to evaluate the lived experiences of individuals with CP and their caregivers regarding AFO access, use, and priorities. We examined experiences around the perceived purpose of AFOs, provision process, current barriers to use, and ideas for future AFO design.

Study design:
Secondary qualitative data analysis.

Methods:
Secondary data analysis was performed on semistructured focus groups that included 68 individuals with CP and 74 caregivers. Of the focus group participants, 66 mentioned AFOs (16 individuals with CP and 50 caregivers). Deidentified transcripts were analyzed using inductive coding, and the codes were consolidated into themes.

Results:
Four themes emerged: 1) AFO provision is a confusing and lengthy process, 2) participants want more information during AFO provision, 3) AFOs are uncomfortable and difficult to use, and 4) AFOs can benefit mobility and independence. Caregivers and individuals with CP recommended ideas such as 3D printing orthoses and education for caregivers on design choices to improve AFO design and provision.

Conclusions:
Individuals with CP and their caregivers found the AFO provision process frustrating but highlight that AFOs support mobility and participation. Further opportunities exist to support function and participation of people with CP by streamlining AFO provision processes, creating educational materials, and improving AFO design for comfort and ease of use.
Synchronous Metastatic Medullary Thyroid Carcinoma and Paraesophageal Parathyroid Adenoma Detected on 18F-Ethylcholine PET/US Fusion Imaging
Authors: Freesmeyer Martin , Müller Ulrich A. , Männel Matthias , Mtuka-Pardon Gabriele , Seifert Philipp 
Published: July 2022

Abstract
An 80-year-old woman with osteoporosis without fractures was referred with asymptomatic primary hyperparathyroidism and elevated calcitonin level. Ultrasound, 99mTc-pertechnetate scintigraphy, 99mTc-MIBI scintigraphy, and CT revealed a suspicious thyroid nodule and enlarged submandibular lymph nodes. However, no parathyroid adenoma was depictable. 18F-choline PET/CT showed increased uptake of the proximal esophagus, but neither CT nor US revealed a parathyroid lesion, and only 18F-choline PET/US fusion imaging confirmed a paraesophageal parathyroid adenoma. Resection of both medullary thyroid carcinoma and ectopic parathyroid adenoma through a single cervicotomy was conducted (thyroidectomy, neck dissection, extirpation of parathyroid adenoma); parathyroid hormone and calcitonin dropped to normal. Multiple endocrine neoplasia IIa syndrome was suspected.
AL-Type Amyloidosis Involving Stomach and Lungs in 99mTc-DPD Bone Scan
Authors: Lee Yeongjoo , Yoo Ie Ryung , O Joo Hyun 
Published: July 2022

Abstract
Systemic AL (amyloid light-chain) amyloidosis is a relatively rare disease. 99mTc-DPD (3,3-diphosphono-1,2-pyrophosphate) bone scan is a highly sensitive diagnostic tool for cardiac amyloidosis of ATTR (transthyretin) type. In AL amyloidosis, there have been some previous reports of extracardiac DPD uptake in liver, kidney, and spleen, but not in stomach. We present 99mTc-DPD bone scan images of AL-type amyloidosis involving stomach and lung.
Trends, Social Context, and Transplant Implications of Obesity Among Incident Dialysis Patients in the United States
Authors: Lavenburg Linda-Marie U. , Kim Yuna , Weinhandl Eric D. , Johansen Kirsten L. , Harhay Meera N. 
Published: July 2022

Background.
Kidney transplant programs have variable thresholds to accept obese candidates. This study aimed to examine trends and the social context of obesity among United States dialysis patients and implications for kidney transplant access.

Methods.
We performed a retrospective cohort study of 1 084 816 adults who initiated dialysis between January 2007 and December 2016 using the United States Renal Data System data. We estimated national body mass index (BMI) trends and 1-y cumulative incidence of waitlisting and death without waitlisting by BMI category (<18.5 kg/m2, ≥18.5 and <25 kg/m2 [normal weight], ≥25 and <30 kg/m2 [overweight], ≥30 and <35 kg/m2 [class 1 obesity], ≥35 and <40 kg/m2 [class 2 obesity], and ≥40 kg/m2 [class 3 obesity]). We then used Fine-Gray subdistribution hazard regression models to examine associations between BMI category and 1-y waitlisting with death as a competing risk and tested for effect modification by End Stage Renal Disease (ESRD) network, patient characteristics, and neighborhood social deprivation index.

Results.
The median age was 65 (interquartile range 54–75) y, 43% were female, and 27% were non-Hispanic Black. From 2007 to 2016, the adjusted prevalence of class 1 obesity or higher increased from 31.9% to 38.2%. Class 2 and 3 obesity but not class 1 obesity were associated with lower waitlisting rates relative to normal BMI, especially for younger individuals, women, those of Asian race, or those living in less disadvantaged neighborhoods (p
interaction < 0.001 for all).

Conclusions.
Obesity prevalence is rising among US incident dialysis patients. Relative to normal BMI, waitlisting rates with class 2 and 3 obesity were lower and varied substantially by region, patient characteristics, and socioeconomic context.
Biomechanical Investigation of Ancient Maya Warfare at Mayapan, Yucatan, Mexico
Authors: Dorranian Darius , Serafin Stanley , Lope Carlos Peraza , González Eunice Uc , Russell Bradley W. , Murphy Ellen , Wilson Laura A. B. 
Published: July 2022

AbstractDespite significant advancements in the reconstruction of activity patterns from skeletal remains and growing scholarly interest in ancient warfare, few biomechanical studies have investigated weaponry use. We adopt a biomechanical approach to investigate who participated in ancient Maya warfare and the types of weaponry used at the Late Postclassic (ca. 1200-1450 A.D.) regional political capital of Mayapán located in northwestern Yucatán, Mexico. This has implications for the nature and scale of Maya warfare and the size of territories that could be controlled by Maya polities. Comparative Finite Element Analysis is a powerful, non-destructive method that can be applied to skeletal remains to model strain, stress and deformation of structures in response to a defined loading regime. Here, biomechanical data extracted using cross-sectional geometry were combined with Finite Element Analysis models of three ancient Maya humeri from Mayapán: one elite male, one elite female, and one commoner female. Models were created with loading conditions of archery and spear use to assess evidence for skeletal adaptation to habitual weapon use. Following suggestions by some Mayanists that elite status males were the principal participants in warfare, we hypothesized that the elite male humerus would exhibit lower strains than the two female humeri in all the loading conditions. This was supported by the Finite Element model results, with the exception of spear throwing. The elite female humerus showed similar trends to the elite male humerus, suggesting the possibility of elite female participation in warfare.
Triterpenoid production with a minimally engineered Saccharomyces cerevisiae chassis
Authors: Guo Hao , Jacobsen Simo Abdessamad Baallal , Walter Kerstin , Lewandowski Anna , Czarnotta Eik , Knuf Christoph , Polakowski Thomas , Maury Jérôme , Lang Christine , Förster Jochen , Blank Lars M. , Ebert Birgitta E. 
Published: July 2022

AbstractTriterpenoids, one of the most diverse classes of natural products, have been used for centuries as active ingredients in essential oils and Chinese medicines and are of interest for many industrial applications ranging from low-calorie sweeteners to cosmetic ingredients and vaccine adjuvants. However, not only can the extraction from plant material be cumbersome due to low concentrations of the specific triterpenoid, but concerns are also increasing regarding the sustainability of wild plant harvest while meeting market demands. The alternative is to produce triterpenoids with engineered microbes. Here, we present a generally applicable strategy for triterpenoid production in the yeast Saccharomyces cerevisiae based on a modified oxidosqualene cyclase Erg7. The modification reduces the flux into the sterol pathway while increasing the precursor supply for triterpenoid production. The minimally engineered strain was exploited for the exemplary production of the lupane triterpenoids betulin, betulin aldehyde, and betulinic acid at a total titer above 6 g/L, the highest reported so far. To further highlight the chassis concept, squalene, oleanane- and dammarane-type triterpenoids were synthesized to titers at a similar gram scale. We propose the developed baker’s yeast as a host for the thousands of triterpenoid synthesis pathways from plants, reducing the pressure on the natural resources.
Mid-summer snow-free albedo across the Arctic tundra was mostly stable or increased over the past two decades
Authors: Plekhanova Elena , Kim Jin-Soo , Oehri Jacqueline , Erb Angela , Schaaf Crystal , Schaepman-Strub Gabriela 
Published: July 2022

AbstractArctic vegetation changes, such as increasing shrub-cover, are expected to accelerate climate warming through increased absorption of incoming radiation and corresponding decrease in summer shortwave albedo. Here we analyze mid-summer shortwave land-surface albedo and its change across the pan-Arctic region based on MODIS satellite observations over the past two decades (2000-2021). In contrast to expectations, we show that terrestrial mid-summer shortwave albedo has not significantly changed in 82% of the pan-Arctic region, while 14% show an increase and 4% a decrease. By analyzing the visible and near-/shortwave-infrared range separately, we demonstrate that the slight increase arises from an albedo increase in the near-/shortwave-infrared range domain while being partly compensated by a decrease in visible albedo. A similar response was found across different tundra vegetation types. We argue that this increase in reflectance is typical with increasing biomass as a result of increased multiple reflection in the canopy. However, CMIP6 global climate model albedo predictions showed the opposite sign and different spatial patterns of snow-free summer albedo change compared to satellite-derived results. We suggest that a more sophisticated vegetation parametrization can reduce this discrepancy, and provide albedo estimates per vegetation type.
Detergent-Free Decellularization Preserves the Structural and Biological Integrity of Murine Tendon
Authors: Marvin Jason C. , Mochida Ai , Paredes Juan , Vaughn Brenna , Andarawis-Puri Nelly 
Published: July 2022

AbstractTissue decellularization has demonstrated widespread applications across numerous organ systems for tissue engineering and regenerative medicine applications. Decellularized tissues are expected to retain structural and/or compositional features of the natural extracellular matrix (ECM), enabling investigation of biochemical factors and cell-ECM interactions that drive tissue homeostasis, healing, and disease. However, the dense collagenous tendon matrix has limited the efficacy of traditional decellularization strategies without the aid of harsh chemical detergents and/or physical agitation that disrupt tissue integrity and denature proteins involved in regulating cell behavior. Here, we adapted and established the advantages of a detergent-free decellularization method that relies on Latrunculin B actin destabilization, alternating hypertonic-hypotonic salt and water incubations, nuclease-assisted elimination of cellular material, and protease inhibitor supplementation under aseptic conditions. Compared with previous tendon decellularization studies, our method minimized collagen denaturation while adequately removing cells and preserving bulk tissue alignment and mechanical properties. Furthermore, we demonstrated that decellularized tendon ECM-derived coatings isolated from different mouse strains, injury states (i.e., naïve and acutely injured/’provisional’), and anatomical sites harness distinct biochemical cues and robustly maintain tendon cell viability in vitro. Together, our work provides a simple and scalable decellularization method to facilitate mechanistic studies that will expand our fundamental understanding of tendon ECM and cell biology.Impact StatementIn this study, we present a decellularization method for tendon that does not rely on any detergents or physical processing techniques. We assessed the impact of detergent-free decellularization using tissue, cellular, and molecular level analyses and validated the preservation of tendon structural organization, collagen molecular integrity, and ECM-associated biological cues that are essential for studying physiological cell-ECM interactions. Lastly, we demonstrated the success of this method on healthy and injured tendon environments, across mouse strains, and for different types of tendons, illustrating the utility of this approach for isolating the contributions of biochemical cues within unique tendon ECM microenvironments.