bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelets as key cells in endometriosis patients: Insights from small extracellular vesicles in peritoneal fluid and endometriotic lesions analysis
Authors: Bortot Barbara , Di Florio Roberta , Merighi Simona , Peacock Ben , Lees Rebecca , Valle Francesco , Brucale Marco , Mangogna Alessandro , Di Lorenzo Giovanni , Romano Federico , Zito Gabriella , Zanconati Fabrizio , Ricci Giuseppe , Cancila Valeria , Belmonte Beatrice , Biffi Stefania 
Published: December 2024

AbstractEndometriosis is a chronic inflammatory condition characterized by the presence of endometrium‐like tissue outside the uterus, primarily affecting pelvic organs and tissues. In this study, we explored platelet activation in endometriosis. We utilized the STRING database to analyze the functional interactions among proteins previously identified in small extracellular vesicles (EVs) isolated from the peritoneal fluid of endometriosis patients and controls. The bioinformatic analysis indicated enriched signaling pathways related to platelet activation, hemostasis, and neutrophil degranulation. Double immunohistochemistry analysis for CD61 and MPO revealed a significant presence of neutrophils and platelets in close contact infiltrating endometriotic lesions, suggesting potential cell–cell interactions. Subsequently, we isolated small EVs from the peritoneal fluid of women diagnosed with endometriosis and from women without endometriosis who underwent surgery for non‐inflammatory benign diseases. We performed single‐particle phenotyping analysis based on platelet biomarkers GPIIb/IIIa and PF4 using nanoflow cytometry, as well as single‐particle morphological and nanomechanical characterization through atomic force microscopy. The study demonstrated that patients with endometriosis had a notably higher proportion of particles testing positive for platelet biomarkers compared to the total number of EVs. This finding implies a potential role for platelets in the pathogenesis of endometriosis. Further research is necessary to delve into the mechanisms underlying this phenomenon and its implications for disease progression.
Demystifying AI: Current State and Future Role in Medical Education Assessment
Authors: Turner Laurah , Hashimoto Daniel A. , Vasisht Shubha , Schaye Verity 
Published: December 2024

Abstract
Medical education assessment faces multifaceted challenges, including data complexity, resource constraints, bias, feedback translation, and educational continuity. Traditional approaches often fail to adequately address these issues, creating stressful and inequitable learning environments. This article introduces the concept of precision education, a data-driven paradigm aimed at personalizing the educational experience for each learner. It explores how artificial intelligence (AI), including its subsets machine learning (ML) and deep learning (DL), can augment this model to tackle the inherent limitations of traditional assessment methods.
AI can enable proactive data collection, offering consistent and objective assessments while reducing resource burdens. It has the potential to revolutionize not only competency assessment but also participatory interventions, such as personalized coaching and predictive analytics for at-risk trainees. The article also discusses key challenges and ethical considerations in integrating AI into medical education, such as algorithmic transparency, data privacy, and the potential for bias propagation.
AI’s capacity to process large datasets and identify patterns allows for a more nuanced, individualized approach to medical education. It offers promising avenues not only to improve the efficiency of educational assessments but also to make them more equitable. However, the ethical and technical challenges must be diligently addressed. The article concludes that embracing AI in medical education assessment is a strategic move toward creating a more personalized, effective, and fair educational landscape. This necessitates collaborative, multidisciplinary research and ethical vigilance to ensure that the technology serves educational goals while upholding social justice and ethical integrity.
Haptics: The Science of Touch As a Foundational Pathway to Precision Education and Assessment
Authors: Perrone Kenneth. H. , Abdelaal Alaa Eldin , Pugh Carla M. , Okamura Allison M. 
Published: December 2024

Abstract
Clinical touch is the cornerstone of the doctor-patient relationship and can impact patient experience and outcomes. In the current era, driven by an ever-increasing infusion of point-of-care technologies, physical exam skills have become undervalued. Moreover, touch and hands-on skills have been difficult to teach due to inaccurate assessments and difficulty with learning transfer through observation. In this article, the authors argue that haptics, the science of touch, provides a unique opportunity to explore new pathways to facilitate touch training. Furthermore, haptics can dramatically increase the density of touch-based assessments without increasing human rater burden—essential for realizing precision assessment. The science of haptics is reviewed, including the benefits of using haptics-informed language for objective structured clinical examinations. The authors describe how haptic devices and haptic language have and can be used to facilitate learning, communication, documentation and a much-needed reinvigoration of physical examination, and touch excellence at the point of care. The synergy of haptic devices, artificial intelligence, and virtual reality environments are discussed. The authors conclude with challenges of scaling haptic technology in medical education, such as cost and translational needs, and opportunities to achieve wider adoption of this transformative approach to precision education.
Covert Perioperative Strokes in Older Patients Having Noncardiac Surgery (PRECISION): A Prospective Cohort Analysis
Authors: Cui Qianyu , Zhao Weixing , Chen Hongyan , Ren Yue , Yin Xueke , Zheng Maoyao , Li Muhan , Wang Jie , Wang Juan , Zeng Min , Li Shu , Zhang Kai , Wu Xiaodong , Zhou Liye , Jiao Youyou , Sessler Daniel I. , Mi Weidong , Peng Yuming 
Published: December 2024

Background:
Perioperative strokes may promote postoperative neurocognitive dysfunction. This study thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from noncardiac surgery.

Methods:
The Postoperative Covert Stroke and Cognitive Dysfunction among Elderly Patients Undergoing Noncardiac Surgery study (PRECISION) was a two-center prospective cohort study evaluating patients aged 60 yr or older who had elective, noncardiac inpatient surgery at two Chinese academic centers. Postoperative strokes were evaluated by scheduled magnetic resonance brain imaging within 7 days. The primary outcome was the cumulative incidence of postoperative stroke. Secondary outcomes included postoperative delirium within the first 5 days after surgery, neurocognitive decline at 12 months, and the association between stroke and neurocognitive dysfunction.

Results:
Among 934 patients (mean age, 67 yr; 45% male) included in the analyses, two thirds had neurosurgical craniotomies. There were 111 (11.9%; 95% CI, 9.8 to 14.0%) covert strokes within 7 days after surgery and no overt strokes. Postoperative delirium was observed in 117 patients (12.5%; 95% CI, 10.4 to 14.7%) within 5 days, and neurocognitive decline was observed in 147 patients (18.8%; 95% CI, 16.0 to 21.5%) at 1 yr after surgery. Postoperative covert strokes were significantly associated with delirium (adjusted odds ratio, 2.18; 95% CI, 1.31 to 3.62; P = 0.003) and 1-yr neurocognitive decline (adjusted odds ratio, 2.33; 95% CI, 1.31 to 4.13; P = 0.004) in overall participants.

Conclusions:
Among patients aged 60 yr and older who had major noncardiac surgery, mainly intracranial, one in nine patients experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.
Oncologic Outcomes of Laparoscopic Radical Hysterectomy Incorporating Modified Tumor-Free Techniques
Authors: Li Yuan , Zhao Jiayuan , Ding Xuesong , Liang Chao , Wang Weidi , Ren Tong , Jiang Fang , Yang Junjun , Xiang Yang 
Published: December 2024

OBJECTIVE:
It remains unclear whether modifying laparoscopic radical hysterectomy to adopt tumor-free principles can improve oncologic outcomes in patients with early-stage cervical cancer.

METHODS:
We performed a single-center retrospective cohort study of 276 patients with early-stage cervical cancer who were treated between January 2017 and January 2023, including 151 patients who underwent laparoscopic radical hysterectomy that incorporated modified tumor-free techniques (MTF group) and 125 patients who underwent conventional laparoscopic radical hysterectomy with a uterine manipulator and unprotected intracorporeal colpotomy (non-MTF group). Oncologic outcomes and perioperative results were analyzed using inverse probability treatment weighting (IPTW).

RESULTS:
Patients in the MTF group had shorter length of hospital stay than those in the non-MTF group. However, there were no significant differences in operative time, decrease in hemoglobin, or complications. After a median follow-up of 36.0 months (range 15.3–62.0 months) for the MTF group and 66.8 months (range 3.0–82.5 months) for the non-MTF group, recurrence was observed in two (1.3%) and 16 (12.8%) of the patients, respectively. The 2-year disease-free survival (DFS) rates in the MTF group and non-MTF group were 99.3% and 91.9%, respectively. In the primary analysis limited to 2-year survival, the adjusted multivariate analysis showed that use of modified tumor-free techniques was an independent predictor of longer DFS (hazard ratio 0.10 95% CI, 0.01–0.77, P=.027). After IPTW, patients in the MTF group had a more favorable DFS than those in the non-MTF group (log-rank P=.031).

CONCLUSION:
Laparoscopic radical hysterectomy that incorporates modified tumor-free techniques is a feasible treatment for patients with early-stage cervical cancer. Oncologic outcomes of individuals who underwent this procedure were more favorable than those of conventional laparoscopic radical hysterectomy.
Evaluating the Impact of Eosinophil Count on the Long-term Clinical Outcomes of Patients With an Acute ST-segment Elevation Myocardial Infarction Who Require Emergency Percutaneous Coronary Intervention: Results of a Multicenter Cohort Study
Authors: Guo Lei , Liu Hao , Dong Zhichao , Zhou Xuchen , Zhu Hao , Gu Xia , Zhang Bo 
Published: December 2024

Abstract

Objective:
Eosinophils (EOS) are inflammatory innate immune cells that play an important role in arterial thrombogenesis. There is a paucity of data on whether EOS levels have an impact on long-term outcomes following ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the impact of EOS count on the clinical outcomes of STEMI patients who underwent emergency percutaneous coronary intervention (PCI).

Methods:
This is a retrospective multicenter cohort study. A total of 754 patients with STEMI who required emergency PCI at 5 centers were screened between October 2015 and November 2016. Patients were divided into 2 groups based on EOS count: EOS count <0.02 × 109/L group (n = 264) and EOS count ≥0.02 × 109/L group (n = 490). Baseline demographic characteristics, clinical information, and medical test data were collected at study entry. The primary endpoint was all-cause death. The secondary endpoint was a major adverse cardiac event. Multivariablete Cox regression analysis was performed to identify the independent predictors of all-cause death, with a follow-up period of 5 years.

Results:
The incidence of all-cause death (14.8% vs. 7.6%, P = 0.002) and major adverse cardiac event (20.1% vs. 13.1%, P = 0.011) were significantly higher in EOS count <0.02 × 109/L group compared with ≥0.02 × 109/L group. Multivariablete Cox regression analysis showed that an EOS count <0.02 × 109/L, age ≥65 years, previous heart failure, previous stroke, and left ventricular ejection fraction ≤ 40% were independent predictors of all-cause death in patients with STEMI who underwent an emergency PCI.

Conclusions:
Low EOS counts were associated with all-cause mortality in STEMI patients who underwent emergency PCI.
International trends in biliary tract cancer–related mortality, 2000–2022: An observational study of the World Health Organization Mortality Database
Authors: Vu Quynh Thi , Nishimura Yoshito , Harada Ko , Ito Hiroki , Higashionna Tsukasa , Maruo Akinari , Harada Keisaku , Takeda Tatsuaki , Hamano Hirofumi , Zamami Yoshito , Hagiya Hideharu , Koyama Toshihiro 
Published: December 2024

Background and Aims:
Biliary tract cancers (BTCs), including intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary cancer, exhibit poor prognosis. This study examined temporal trends in mortality due to BTCs and their major subtypes at international, regional, and national levels.

Approach and Results:
This observational study used the World Health Organization mortality database. Locally weighted regression (LOESS) was used to produce a smoothed curve of long-term international and regional BTC and major subtype-related mortality rates in 2000–2022 based on available data from countries. Trends in age-standardized mortality rates (ASRs) during 2013–2022 for individual countries were examined using joinpoint regression analysis. Internationally, LOESS-smoothed ASRs per 100,000 population due to BTCs were 2.8 (95% CI: 2.5–3.1) in 2000, and 2.7 (2.3–3.1) in 2022. LOESS-smoothed BTC-related ASRs were the highest in the Western Pacific region at 4.2 (1.8–6.6) in 2022, compared with those in the European and American regions at 2.6 (2.3–2.9) and 2.2 (1.8–2.6), respectively. Among major subtypes, LOESS-smoothed ASRs due to iCCA increased by 120.0%, those due to gallbladder cancer decreased by 45.5%, and those due to extrahepatic cholangiocarcinoma remained stable between 2000 and 2022. Disparities in BTC and major subtype-related ASR trends were observed between countries during 2013–2022, with iCCA-associated ASRs showing increasing trends in many countries.

Conclusions:
Although internationally estimated BTC-associated ASRs showed a stable trend over the last 2 decades, a large increase in estimated iCCA-associated ASRs necessitates developing effective screening for high-risk individuals and disease management strategies.
Sports Medicine Physician Confidence in Concussion Assessments for Postconcussion Return-to-Play Decisions
Authors: Miller Jacob J. , Hansen Kelsey , Dorman Jason , Jensen Katie , Gurumoorthy Aarabhi , Combs Josefine 
Published: December 2024

Objective:
To identify sport-related concussion (SRC) assessments sports medicine physicians perform and in which they place confidence when making return-to-play (RTP) decisions.

Design:
Cross-sectional study.

Setting:
Online survey.

Participants:
Active members of the American Medical Society for Sports Medicine (AMSSM) at the fellowship level or higher making RTP decisions following concussion within the last year.

Interventions:
An electronic REDCap survey gathering demographic and practice information and responses to clinical scenarios was sent to AMSSM members.

Main Outcome Measures:
The primary outcome was the SRC assessment(s) in which physicians expressed the most confidence for RTP decisions.

Results:
Four hundred thirty AMSSM members responded to the survey, 392 of which met inclusion criteria. The graded symptom checklist was rated the most useful test for making return-to-play decisions, and respondents felt most confident starting the RTP process if the graded symptom checklist was normal. An assessment was considered most useful if it closely reflected resolution of SRC's pathological processes. Computerized neurocognitive testing was most likely to be ignored if abnormal. An abnormal neurological examination made physicians feel least confident SRC had resolved.

Conclusions:
Sports medicine physicians view the graded symptom checklist as a useful tool for making RTP decisions. Physicians expressed less confidence in computerized neurocognitive testing to determine RTP readiness. This study uncovered reliance on symptom reporting by sports medicine physicians and an opportunity for the creation of concussion clinical decision tools.
Cozen's phenomenon
Authors: Sepúlveda Matias , Ulloa Macarena , Birrer Estefanía 
Published: December 2024

Purpose of review
The purpose of this review is to describe the current trends in the treatment of Cozen's phenomenon and evaluate if there are changes in the treatment paradigm due to the advent of implant-mediated guided growth.

Recent findings
Current literature emphasizes the need for early recognition of Cozen's phenomenon (tibia valgus), with a high incidence associated with proximal tibia fractures. There are cases with late onset progression of the valgus deformity, which can be easily treated with implant-mediated guided growth.

Summary
Clinical observation continues to be the current standard of treatment for this phenomenon. An average surveillance time of 2 years postfracture is recommended to observe for valgus deformity of the tibia. During this period, implant-mediated guided growth may be utilized to correct tibial deformity, which is an easier and safer solution than tibial osteotomy.
What's up with patella alta?
Authors: Jones Ruth H. , Lijesen Emilie , Green Daniel W. 
Published: December 2024

Purpose of review
Patella alta, which describes an abnormally proximally positioned patella, has become of particular interest as it has been identified as a potential factor in patellofemoral instability (PFI) and other common pediatric orthopedic conditions. The purpose of this review is to describe the condition, measuring techniques, and its association with pediatric orthopedic conditions, and to evaluate methods of correction of patella alta.

Recent findings
Recent literature has explored the etiology of patella alta by investigating patellar height as age increases, with inconclusive findings as to whether the condition is congenital or acquired over time. Additionally, patella alta has been identified to be associated with several pediatric orthopedic conditions, including PFI, anterior knee pain, and cerebral palsy. As such, methods of correction for patella alta, including medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle distalization, and patella tendon imbrication, have been studied.

Summary
Patella alta, defined by an abnormally high patellar height, is associated with patellofemoral instability, anterior knee pain, and cerebral palsy. Various indices have been developed to measure and define patellar height, including the Caton-Deschamps Index and Koshino-Sugimoto Index which are applicable to a pediatric population. Treatments include isolated or concomitant MPFLR, distalizing tibial tubercle osteotomy, and patella tendon imbrication, which have shown success in reducing patellar height and improving patella alta, though risks for complications do exist.
Should healthcare organizations be accountable for child community health indicators at the community level?
Authors: Kelleher Kelly J. , Hardy Rose 
Published: December 2024

Purpose of review
This paper reviews options for including community health accountability metrics for child healthcare systems, international and regional experience with such metrics, and some specific candidates for metric consideration.

Recent findings
The inclusion of community metrics in child health accountability systems requires expanded accountability frameworks and re-education of clinicians. Most of the experience with use of community metrics in accountability systems comes from international settings. Lessons learned in these settings include the importance of linking the metrics to various policy and practice implementation measures while balancing the incentives for such ‘horizontal’ or communitywide indicators with current incentives. The Accountable Communities for Health movement may be the best-known example of US community health indicators for accountability. Four new papers suggest specific child metrics for consideration as child metrics, but only infant mortality rates and high school graduation rates are sufficiently standardized and nationally reported to be useful for such efforts.

Summary
Healthcare accountability for child community health is an important next step, but the coordination with existing accountability systems, data collection systems, and financial incentives require more research to be effective in helping children. Infant mortality rates and high school graduation rates have the most potential as cross system accountability metrics.
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Authors: Lavoie Noemie C , Poulain Alexandre J 
Published: December 2024

Redox reactions play a critical role in determining the availability of mercury species, HgII and Hg0, to anaerobic microbes responsible for methylating inorganic mercury into toxic monomethylmercury. Some anaerobes also contribute to Hg cycling in methylation hotspots by reducing HgII to its gaseous elemental form, Hg0. However, their contributions remain poorly quantified due to limited mechanistic insights and the absence of genetic targets. In this study, we investigated the mechanisms of anaerobic HgII reduction in the versatile anoxygenic photoheterotroph and fermenter Heliomicrobium modesticaldum Ice1. Given HgII strong electrophilic affinity for thiol groups, we hypothesized that cellular thiols are key interaction sites mediating HgII reduction. Exposure of H. modesticaldum to the thiol-alkylating agent N-ethylmaleimide (NEM), which irreversibly binds thiols, resulted in a concentration-dependent inhibition of Hg0 production during both photoheterotrophy and fermentation. Hg partitioning assays with Escherichia coli cells revealed no significant differences in Hg-cell partitioning in the presence or absence of NEM, suggesting that HgII reduction is dependent on intracellular thiol interactions. These findings highlight the importance of thiol-mediated pathways in Heliobacterial HgII reduction. Although the exact cellular components remain unidentified, we discuss potential thiol-containing coupling sites that warrant further investigation.