bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building Your “Educational Peloton:” Cycling Together for Success During Uncertain Times
Authors: Berkowitz Lori R. , Dzara Kristina , Simpkin Arabella L. 
Published: January 2021

Abstract:
Burnout is a pervasive concern that negatively impacts physicians, patients, and healthcare organizations. Stress, uncertainty, clinical demands, and rapidly changing teams threaten the learning environment, where connection is key to resilience. The COVID-19 pandemic amplifies these challenges. Building an “educational peloton” to provide a safe and protective educational community may help optimize learning and team performance. Easily implementable strategies include: (1) Maximize learning opportunities, particularly small ones; (2) Ensure quality feedback; and (3) Facilitate collegiality. Intentionally nurturing an “educational peloton”—especially during times of uncertainty and change—can help drive engagement and work satisfaction, which can improve patient safety and healthcare outcomes, as well as boost human connection and promote community.
Leadership Development Projects: Bidirectional Impact on Faculty and Institutions
Authors: Lewis Vivian , Baldwin Constance D. , Morahan Page S. , Thorndyke Luanne E. , Gusic Maryellen E. 
Published: January 2021

Introduction:
The Hedwig von Ameringen Executive Leadership in Academic Medicine program (ELAM) is a national professional development program for women that includes institutional action projects (IAPs). Although benefits of ELAM participation are well documented, the value of the IAPs has not been specifically evaluated. We explored the experience of ELAM Fellows and leaders from one institution to elucidate how institutional factors influence project implementation and outcomes.

Methods:
Fellows and deans participated in semistructured interviews. We analyzed the transcripts qualitatively to develop themes and describe factors that influenced IAP implementation and outcomes. We used the New World Kirkpatrick Model, an updated version of the widely used Kirkpatrick model of educational program evaluation, as a framework to elucidate how participants applied their leadership learning through project work, and to analyze early results of projects that indicated institutional impact.

Results:
Project work had bidirectional impact on the fellows in the program and on the institution itself. Project enablers included: focusing projects on institutional priorities, obtaining sustainable support, and navigating institutional complexity. Leading indicators of institutional outcomes included contributions to institutional leadership and culture, and mutual enhancement of the reputation of the fellow and of the institution.

Discussion:
By examining enablers and barriers for institutionally based projects conducted in a national leadership development program, we identified the drivers that facilitated application of leadership learning. Leading indicators of project outcomes reflected bidirectional impact on fellows and the institution, demonstrating outcomes at the highest levels of the New World Kirkpatrick Model.
A National Survey of Provider's Preparedness to Care for Persons Living With HIV Aged ≥50 Years
Authors: Sangarlangkarn Aroonsiri , Rizza Stacy A. , Mahmood Maryam , Cummins Nathan W. , Temesgen Zelalem 
Published: January 2021

Introduction:
With increasing longevity among persons living with HIV (PLWH), HIV providers must manage age-related diseases despite limited geriatric training. We surveyed HIV providers to assess perceived preparedness in caring for aging PLWH and knowledge gaps.

Methods:
We surveyed HIV providers from October to December 2018 on preparedness (1 = strongly unprepared to 5 = strongly prepared), topics of interest, and participant characteristics including the number of years after training, number of PLWH aged ≥50 years seen/month, degree types (MD/DO versus others), and practice setting (academic versus nonacademic). We grouped “strongly prepared/somewhat prepared” responses as “prepared” and “neutral/somewhat unprepared/strongly unprepared” as “unprepared.” The effects of participant characteristics on preparedness were determined using chi-square test.

Results:
Of 226 participants, 54% were physicians, 27% were NP/PA, 19% were PharmD, and 40% practiced in academic settings. The average preparedness score was 3.37 out of 5.0. Approximately half of participants (56%) were classified as “prepared.” The mode number of years in practice was “10 to <20” (22%); mode number of PLWH aged ≥50 years seen/month was “1 to 25” (50%). HIV-associated neurocognitive disorder (73%) and geriatric syndrome screening (63%) were the most chosen areas of interest. Unprepared participants were interested in topics of cardiovascular disease (odds ratio [OR], 2.38; P = .002) and palliative care (OR, 1.92; P = .02). Having >20 years after training increased preparedness (“20 to <30” years versus “none”: OR, 3.37; P = .03; “≥30 years” versus “none”: OR, 3.66; P = .04).

Conclusion:
Approximately half of the surveyed HIV providers felt prepared to care for aging PLWH. HIV-associated neurocognitive disorder, geriatric syndrome screening, cardiovascular diseases, and palliative care were areas of interest. Having >20 years after training increases preparedness.
Preliminary adipose removal did not prevent diet-induced metabolic disorders in mice
Authors: Liu Lin , Liang Chen-Xi , Wang Xiao-Wei , Pei Ke-Xin , Ma Xin-Di , Zhang Chun-Xi , Dong Jing-Hui , Gao Ming-Ming , Liao Jia-Wei 
Published: January 2021

Abstract

Background:
Obesity is a fundamental factor in metabolic disorders such as hyperlipidemia, insulin resistance, fatty liver, and atherosclerosis. However, effective preventive measures are still lacking. This study aimed to investigate different surgical protocols for removing partial adipose tissue before the onset of obesity and determine whether, and by which protocol, preliminary adipose removal could exert potent preventive effects against diet-induced metabolic disorders.

Methods:
Male low-density lipoprotein receptor (LDL-R) knockout (KO) mice were randomly divided into four groups and subjected to epididymal fat removal (Epi-FR) surgery, subcutaneous fat removal (suQ-FR) surgery, both subcutaneous and epididymal fat removal (Epi + suQ-FR) surgery, or sham-operation. After 1 week of recovery, all mice were given a high-fat diet (HFD) for 10 weeks to induce metabolic disorders.

Results:
In the Epi-FR group and the sham-operated group, the mean numbers of the residual subcutaneous fat were 28.59 mg/g and 18.56 mg/g, respectively. The expression of relative genes such as Pparg, Cebpa, Dgat2, Fabp4 and Cd36 in the residual subcutaneous fat increased 2.62, 3.90, 3.11, 2.06, 1.78 times in the Epi-FR group compared with that in the sham-operated group. Whereas in the other fat-removal groups, the residual fat depots had no significant change in either size or gene expression, as compared with those of the sham-operated group. Plasma lipid and glucose levels and insulin sensitivity, as detected by the glucose tolerance test, were not significantly alleviated in the three fat removal groups. Liver mass or lipid content was not attenuated in any of the three fat removal groups. The atherosclerosis burdens in the entire inner aorta and aortic root did not decrease in any of the three fat removal groups.

Conclusions:
Our data suggest that removal of epididymal adipose or subcutaneous adipose alone or in combination before the onset of obesity did not protect against hyperlipidemia, insulin resistance, fatty liver, or atherosclerosis in LDL-R KO mice fed with a HFD. Hence, adipose removal possibly does not represent a potential approach in preventing obesity-related metabolic disorders in the obesity-susceptible population.
Postoperative Observation Versus Radiotherapy for Pathologic N1 Oral Cavity Squamous Cell Carcinoma
Authors: Xiang Michael , Holsinger Floyd Christopher , Gensheimer Michael F. , Divi Vasu , Pollom Erqi L. , Colevas Alexander Dimitrios , Le Quynh-Thu , Beadle Beth M. 
Published: January 2021

Objectives:
To investigate the benefit of postoperative radiotherapy (PORT) for low-volume (pN1) nodal disease after resection of oral cavity squamous cell carcinoma.

Materials and Methods:
The National Cancer Database was queried for adults with nonmetastatic squamous cell carcinoma of the oral cavity treated by surgical resection with pathologic stage T1-2 N0-2 (American Joint Committee on Cancer 7th edition) and with the maximal exclusion of standard indications for PORT. Overall survival was compared within pN1 for observation versus PORT and then compared for pN1 versus pN0 and versus pN2 stratified by receipt of observation or PORT. Multivariable Cox regression was used to adjust for potential confounders between PORT and survival, including comorbidity and age.

Results:
Overall 5017 pN0, 530 pN1, and 253 pN2 patients were identified, of whom 9%, 35%, and 64% received PORT, respectively. Within the pN1 cohort, PORT was associated with improved survival versus observation (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.97; P=0.03). Among observed patients, the prognosis of pN1 was equivalent to pN2 and inferior to pN0; in contrast, among patients treated with PORT, the prognosis of pN1 was equivalent to pN0 and superior to pN2. Without PORT, pN1 remained an adverse risk factor relative to pN0 regardless of the depth of invasion, lymph node size, lymph node location, and extent of lymph node dissection.

Conclusions:
PORT was associated with a survival benefit compared with observation. Notably, pN1 was an adverse risk factor relative to pN0 if, and only if, patients did not receive PORT, suggesting pN1 by itself may be an indication for PORT.
Proliferating Pilar Tumors: Can Immunohistochemistry Differentiate Benign and Malignant Forms?
Authors: Yildiz Pelin , Aydin Ulgen Ovgu , Yol Cansu , Demirkesen Cuyan 
Published: January 2021

Background:
Proliferating pilar tumor (PPT) is an adnexal tumor of purported differentiation toward the follicular outer root sheath. Immunohistochemistry has been suggested to differentiate between benign and malignant forms.

Methods:
Eleven benign (PPT) and 9 malignant PPT lesions were reviewed; Ki67, p27, and p53 were applied. The staining intensity (strong, moderate, weak, and negative), positive cell numbers, and marker indexes (%) were scored using image-analysis software (ViraSoft).

Results:
Overall, there was no significant correlation between Ki67 and p53 and histopathological features. However, malignant PPTs had significantly lower numbers of p27-positive cells (P = 0.030).

Conclusions:
Our study includes the largest group of patients in whom image analysis of p53, Ki67, and p27 has been used to try to separate benign from malignant lesions. Although there were no significant differences regarding Ki67 and p53, malignant lesions have a statistically lower expression of p27. Further studies may be needed to determine the clinical usefulness of image analysis in this differential diagnosis.
A Prospective Ultrasound Study of Plasma Polychlorinated Biphenyl Concentrations and Incidence of Uterine Leiomyomata
Authors: Wesselink Amelia K. , Claus Henn Birgit , Fruh Victoria , Orta Olivia R. , Weuve Jennifer , Hauser Russ , Williams Paige L. , McClean Michael D. , Sjodin Andreas , Bethea Traci N. , Brasky Theodore M. , Baird Donna D. , Wise Lauren A. 
Published: January 2021

Background:
Uterine leiomyomata, or fibroids, are hormone-dependent neoplasms of the myometrium that can cause severe gynecologic morbidity. In previous studies, incidence of these lesions has been positively associated with exposure to polychlorinated biphenyls (PCBs), a class of persistent endocrine-disrupting chemicals. However, previous studies have been retrospective in design and none has used ultrasound to reduce disease misclassification.

Methods:
The Study of Environment, Lifestyle, and Fibroids is a prospective cohort of 1,693 reproductive-aged Black women residing in Detroit, Michigan (enrolled during 2010–2012). At baseline and every 20 months for 5 years, women completed questionnaires, provided blood samples, and underwent transvaginal ultrasound to detect incident fibroids. We analyzed 754 baseline plasma samples for concentrations of 24 PCB congeners using a case–cohort study design. We used multivariable Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals for the association between plasma PCB concentrations and ultrasound-detected fibroid incidence over a 5-year period.

Results:
We observed little association between PCB congener concentrations and fibroid incidence. The HR for a one-standard deviation increase in log-transformed total PCBs was 0.94 (95% CI = 0.78, 1.1). The PCB congener with the largest effect estimate was PCB 187 (HR for a one-standard deviation increase in log-transformed exposure = 0.88, 95% CI = 0.73, 1.1). Associations did not seem to vary strongly across PCB groupings based on hormonal activity.

Conclusions:
In this cohort of reproductive-aged Black women, plasma PCB concentrations typical of the contemporary general population were not appreciably associated with higher risk of fibroids.
Pharmacologic Prevention of Myocardial Ischemia–Reperfusion Injury in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Authors: Kakavand Hessam , Aghakouchakzadeh Maryam , Coons James C. , Talasaz Azita H. 
Published: January 2021

Abstract:
Establishing efficient perfusion into the myocardium is the main purpose in patients with acute coronary syndrome, but the process of reperfusion is not without risk and can damage the myocardium paradoxically. Unfortunately, there is no effective treatment for reperfusion injury, and efforts to find an efficient preventive approach are still ongoing. In the past 3 decades, there have been many successful animal studies on how to prevent reperfusion injury; nonetheless, translation to the clinical setting has almost always proven disappointing. In this article, we review clinical studies on the prevention of reperfusion injury in patients with acute coronary syndrome undergoing primary percutaneous coronary intervention in a pharmacologic-based approach. We categorize all the agents that are evaluated for the prevention of myocardial reperfusion injury based on their mechanisms of action into 5 groups: drugs that can reduce oxidative stress, drugs that can affect cellular metabolism, rheological agents that target microvascular obstruction, anti-inflammatory agents, and agents with mixed mechanisms of action. Then, review all the clinical studies of these agents in the setting of primary percutaneous coronary intervention. Finally, we will discuss the possible reasons for the failure in translation of studies into practice and propose potential solutions to overcome this problem.
Ethically Justified, Practical Guidance for the Professionally Responsible Investigation of Maternal-Fetal Intervention for Fetal or Neonatal Benefit
Authors: Chervenak Frank A. , McCullough Laurence B. 
Published: January 2021

Abstract
This paper provides ethical guidance for the professionally responsible clinical investigation of maternal-fetal investigation for fetal or neonatal benefit and its transition into clinical practice. We present an ethical framework based on the ethical principles of beneficence, respect for autonomy, and justice, the professional virtue of integrity, and the ethical concept of the fetus as a patient. We identify the implications of this ethical framework for the qualifications that centers for maternal-fetal intervention should satisfy. These centers have the ethical obligation to provide prospective review and oversight of both innovation (an experiment undertaken to benefit an individual patient) and research (an experiment undertaken to create generalizable knowledge). We describe ethically justified criteria for innovation and early-phase research, for randomized clinical trials, and for the responsible transition into clinical practice. We also identify the elements of the informed consent process, including measures to prevent therapeutic misconception by pregnant patients during the informed consent process. The scientific, clinical, and ethical requirements of maternal-fetal investigation are demanding. However, the commitment to safety and quality requires that they be met. Fulfilling this commitment will result in well-documented professionally responsible investigation of maternal-fetal intervention for fetal and neonatal benefit.
QR678 & QR678 Neo Hair Growth Formulations: A Cellular Toxicity & Animal Efficacy Study
Authors: Kapoor Rinky , Shome Debraj , Vadera Sapna , Kumar Vaibhav , Ram Male Shiva 
Published: January 2021

Background:Current treatment modalities are limited in their approach and success for hair loss. QR 678 & QR 678 Neo are new formulations, consisting of a combination of growth factors and peptides. This study demonstrates safety analysis of QR 678 & QR 678 Neo formulation, using in vitro cytotoxicity assay and in vivo animal efficacy.Methods:Factors including vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor-1, keratinocyte growth factor, and copper tripeptide 1 (QR 678) or their biomimetic peptides (QR678 Neo) were suspended in a sterile injectable vehicle. The 3-2,5-diphenyl tetrazolium bromide assay was used to explore the cytotoxic effects of each factor used in the compositions in human keratinocyte cell and human fibroblast cell assays. An in vivo analysis, wherein study animals were given intradermal QR 678 & QR 678 Neo injections, was conducted to assess whether the formulations produce hair growth. Also, hair follicle viability was checked by intradermal injection of the pharmaceutical compositions in secondary alopecia.Results:In both formulations, a positive response was observed with respect to the number of mice exhibiting hair growth at the injection sites. The injections caused retention of hair in a 0.25-cm radius around the injection site. On cytotoxicity study, all the factors were found to be safe in human keratinocyte cell and human fibroblast cell assay. A positive response was demonstrated in animals on treatment with the chemotherapeutic agent.Conclusions:Intradermal injections of QR 678 & QR 678 Neo hair growth factor formulations are a safe and efficacious option for alopecia. Results seem encouraging enough to warrant a trial in humans with secondary alopecia, post cancer chemotherapy.
The Use of Radiofrequency in Aesthetic Surgery
Authors: Dayan Erez , Burns A. Jay , Rohrich Rod J. , Theodorou Spero 
Published: January 2021

Summary:The use of radiofrequency for soft tissue tightening has increased over the past 10 years. Both minimally invasive and noninvasive devices are frequently in use. This article describes the different types of radiofrequency technology and the current evidence behind their safety and efficacy.
Revision and Secondary Facelift: Problems Frequently Encountered
Authors: Skouras George A. , Skouras Athanasios G. , Skoura Elena A. 
Published: January 2021

Background:
Revision facelift is a very challenging operation. The goal of our study was to examine the most common problems that the facelift surgeon has to face in a revision case and to suggest ways of solving them.

Methods:
A review of all patients from 2012 to 2017 in whom rhytidectomy was performed by the senior author was conducted.

Results:
During the 5-year study period, the author performed 552 face lifts. After the review to confirm revision procedures, a total of 72 revision facelifts were found. On reviewing the most common problems encountered in our facelifts, we found that in addition to the stigmata of the primary facelift, which are thoroughly analyzed in our article, a new type of stigmata has been added nowadays to the revision facelift—that of the various noninvasive interventions that patients undergo after their first facelift, in their effort to postpone or avoid a second operation. In all the abovementioned cases, the surgeon has to modify his basic surgical plan accordingly, to be able to improve or solve all of those problems during the revision surgery.

Conclusions:
The modern facelift surgeon often has to face much more than the stigmata of the primary facelift or the natural aging process. Thus, he/she should be appropriately trained to solve any problem we might encounter in a revision case.
Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review
Authors: Alfonso Allyson R. , Ramly Elie P. , Kantar Rami S. , Rifkin William J. , Diaz-Siso J. Rodrigo , Gelb Bruce E. , Yeh Joseph S. , Espina Mark F. , Jain Sudheer K. , Piper Greta L. , Rodriguez Eduardo D. 
Published: January 2021

Background:
Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field.

Methods:
An institutional “FT Anesthesia Protocol” was developed and applied to 2 face transplants. A systematic review of 3 databases captured FTs in the peer-reviewed literature up to February 2020. Two reviewers independently screened titles and abstracts to include all clinical articles with FT recipient and/or donor-specific preoperative, intraoperative, and relevant postoperative anesthetic variables. Data charting guided a narrative synthesis, and quantitative synthesis reported variables as median (range).

Results:
Our institutional experience emphasizes the importance of on-site rehearsals, anticipation of patient-specific anesthetic and resuscitative requirements, and long-term pain management. Systematic search identified 1092 unique records, and 129 met inclusion criteria. Reports of 37 FTs in the literature informed the following anesthetic axes: donor pre- and intraoperative management during facial allograft procurement, recipient perioperative care, immunotherapy, antimicrobial prophylaxis, and pain management. Quantitative synthesis of 30 articles showed a median operative time of 18 hours (range, 9–28) and fluid replacement with 13 L (5–18) of crystalloids, 13 units (0–66) of packed red blood cells, 10 units (0–63) of fresh frozen plasma, and 1 unit (0–9) of platelets.

Conclusions:
Anesthetic considerations in FT span the continuum of care. Future efforts should guide standard reporting to establish evidence-based strategies that promote quality improvement and patient safety.