bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Surgical Program in Innovation (SPIN): A Design and Prototyping Curriculum for Surgical Trainees
Authors: Wong Daniel J. , Miranda-Nieves David , Nandivada Prathima , Patel Madhukar S. , Hashimoto Daniel A. , Kent Daniel O. , Gómez-Márquez José , Lin Samuel J. , Feldman Henry J. , Chaikof Elliot L. 
Published: February 2021

Problem
Health professions education does not routinely incorporate training in innovation or creative problem solving. Although some models of innovation education within graduate medical education exist, they often require participants’ full-time commitment and removal from clinical training or rely upon participants’ existing expertise. There is a need for curricula that teach innovation skills that will enable trainees to identify and solve unmet clinical challenges in everyday practice. To address this gap in surgical graduate education, the authors developed the Surgical Program in Innovation (SPIN).

Approach
SPIN, a 6-month workshop-based curriculum, was established in 2016 in the Beth Israel Deaconess Medical Center Department of Surgery to teach surgical trainees the basics of the innovation process, focusing on surgeon-driven problem identification, product design, prototype fabrication, and initial steps in the commercialization process. Participating surgical residents and graduate students attend monthly workshops taught by medical, engineering, and medical technology (MedTech) industry faculty. Participants collaborate in teams to develop a novel device, fabricate a protype, and pitch their product to a panel of judges.

Outcomes
From academic years 2015–2016 to 2017–2018, 49 trainees, including 41 surgical residents, participated in SPIN. Across this period, 13 teams identified an unmet need, ideated a solution, and designed and pitched a novel device. Ten teams fabricated prototypes. The 22 SPIN participants who responded to both pre- and postcourse surveys reported significant increases in confidence in generating problem statements, computer-aided design, fabrication of a prototype, and initial commercialization steps (product pitching and business planning).

Next Steps
Incorporating innovation education and design thinking into clinical training will prove essential in preparing future physicians to be lifelong problem finders and solvers. The authors plan to expand SPIN to additional clinical specialties, as well as to assess its impact in fostering future innovation and collaboration among program participants.
Increasing Short- and Long-Term Buprenorphine Treatment Capacity: Providing Waiver Training for Medical Students
Authors: Stokes Daniel C. , Perrone Jeanmarie 
Published: February 2021

In the face of an ongoing opioid crisis in the United States, persistent treatment gaps exist for vulnerable populations. Among the 3 Food and Drug Administration-approved medications used to treat opioid use disorder, many patients prefer buprenorphine. But physicians are currently required to register with the Drug Enforcement Administration and complete 8 hours of qualifying training before they can receive a waiver to prescribe buprenorphine to their patients. In this article, the authors summarize the evolution of buprenorphine waiver training in undergraduate medical education and outline 2 potential paths to increase buprenorphine treatment capacity going forward: the curriculum change approach and the training module approach.
As part of the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, the Substance Abuse and Mental Health Services Administration has provided funding for medical schools to adapt their curricula to meet waiver training requirements. To date, however, only one school has had its curriculum approved for this purpose. Additionally, recent political efforts have been directed at eliminating aspects of the waiver training requirement and creating a more direct path to integrating waiver qualification into undergraduate medical education (UME).
Other medical schools have adopted a more pragmatic approach involving the integration of existing online, in-person, and hybrid waiver-qualifying training modules into the curricula, generally for fourth-year students. This training module approach can be more rapidly, broadly, and cost-effectively implemented than the curriculum change approach. It can also be easily integrated into the online medical curricula that schools developed in response to the COVID-19 pandemic. Ultimately both curricular changes and support for student completion of existing training modules should be pursued in concert, but focus should not be single-mindedly on the former at the expense of the latter.
Longitudinal Narrative Analysis of Parent Experiences During Graded Exposure Treatment for Children With Chronic Pain
Authors: Corey Jenelle R. , Heathcote Lauren C. , Mahmud Farah , Kronman Corey , Mukerji Cora , McGinnis Ellen , Noel Melanie , Sieberg Christine , Simons Laura E. 
Published: February 2021

Objectives:
Parents have a vital influence over their child’s chronic pain treatment and management. Graded exposure in vivo treatment (GET) is emerging as a promising intervention for youth with chronic pain. Yet, little is known about how parents perceive GET and its impact on their child’s pain condition. This study aimed to characterize caregivers’ experiences over the course of their child’s GET using longitudinal coding and thematic analysis of parent narratives.

Materials and Methods:
Parent narratives of 15 youth who participated in GET for pediatric chronic pain (GET Living) were elicited from an unstructured dialogue at the start of each treatment session held between the parent(s) and pain psychologist. Narratives were coded for affect and content, and trends were examined in these codes across sessions. Common themes in parent narratives were developed through inductive thematic analysis.

Results:
Parents showed an increase in positive affect, treatment confidence, and optimism over the course of treatment. Narratives also expressed more benefit-finding/growth and less anxiety and protectiveness across GET sessions, with more parents having a resolved orientation towards their child’s pain by the final session. Five common themes were generated: Self-Awareness, Understanding of Their Child’s Perspective, Perceived Treatment Benefit, Internalization of Treatment Principles, and Hopeful Concern for the Future.

Discussion:
Analysis of parent narratives provides a rich and unique method for understanding a parent’s journey during their child’s chronic pain treatment. Clinical application of our findings can be used to guide future developments of targeted topics and interventions in the context of parenting a child with chronic pain.
MicroRNA-23a reduces lipopolysaccharide-induced cellular apoptosis and inflammatory cytokine production through Rho-associated kinase 1/sirtuin-1/nuclear factor-kappa B crosstalk
Authors: Shi Xiao-Jun , Jin Ye , Xu Wei-Ming , Shen Qing , Li Jun , Chen Kang 
Published: February 2021

Abstract

Background:
MicroRNAs are closely associated with the progression and outcomes of multiple human diseases, including sepsis. In this study, we examined the role of miR-23a in septic injury.

Methods:
Lipopolysaccharide (LPS) was used to induce sepsis in a rat model and H9C2 and HK-2 cells. miR-23a expression was evaluated in rat myocardial and kidney tissues, as well as H9C2 and HK-2 cells. A miR-23a mimic was introduced into cells to identify the role of miR-23a in cell viability, apoptosis, and the secretion of inflammatory cytokines. Furthermore, the effect of Rho-associated kinase 1 (ROCK1), a miR-23a target, on cell damage was evaluated, and molecules involved in the underlying mechanism were identified.

Results:
In the rat model, miR-23a was poorly expressed in myocardial (sham vs. sepsis 1.00 ± 0.06 vs. 0.27 ± 0.03, P < 0.01) and kidney tissues (sham vs. sepsis 0.27 ± 0.03 vs. 1.00 ± 0.06, P < 0.01). Artificial overexpression of miR-23a resulted in increased proliferative activity (DNA replication rate: Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 34.13 ± 3.12 vs. 12.94 ± 1.21 vs. 13.31 ± 1.43 vs. 22.94 ± 2.26, P < 0.05; HK-2 cells: 15.17 ± 1.43 vs. 34.52 ± 3.46 vs. 35.19 ± 3.12 vs. 19.87 ± 1.52, P < 0.05), decreased cell apoptosis (Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 11.39 ± 1.04 vs. 32.57 ± 2.29 vs. 33.08 ± 3.12 vs. 21.63 ± 2.35, P < 0.05; HK-2 cells: 15.17 ± 1.43 vs. 34.52 ± 3.46 vs. 35.19 ± 3.12 vs. 19.87 ± 1.52, P < 0.05), and decreased production of inflammatory cytokines, including interleukin-6 (Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 59.61 ± 5.14 vs. 113.54 ± 12.30 vs. 116.51 ± 10.69 vs. 87.69 ± 2.97 ng/mL; P < 0.05, F = 12.67, HK-2 cells: 68.12 ± 6.44 vs. 139.65 ± 16.62 vs. 143.51 ± 13.64 vs. 100.82 ± 9.74 ng/mL, P < 0.05, F = 9.83) and tumor necrosis factor-α (Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 103.20 ± 10.31 vs. 169.67 ± 18.84 vs. 173.61 ± 15.91 vs. 133.36 ± 12.32 ng/mL, P < 0.05, F = 12.67, HK-2 cells: 132.51 ± 13.37 vs. 187.47 ± 16.74 vs. 143.51 ± 13.64 vs. 155.79 ± 15.31 ng/mL, P < 0.05, F = 9.83) in cells. However, ROCK1 was identified as a miR-23a target, and further up-regulation of ROCK1 mitigated the protective function of miR-23a in LPS-treated H9C2 and HK-2 cells. Moreover, ROCK1 suppressed sirtuin-1 (SIRT1) expression to promote the phosphorylation of nuclear factor-kappa B (NF-κB) p65, indicating the possible involvement of this signaling pathway in miR-23a-mediated events.

Conclusion:
Our results indicate that miR-23a could suppress LPS-induced cell damage and inflammatory cytokine secretion by binding to ROCK1, mediated through the potential participation of the SIRT1/NF-κB signaling pathway.
Are periods of feeding and fasting protective during critical illness?
Authors: Puthucheary Zudin , Gunst Jan 
Published: February 2021

Purpose of review
To review the mechanisms how intermittent feeding regimens could be beneficial in critically ill patients.

Recent findings
Large randomized controlled trials (RCTs) have failed to demonstrate consistent benefit of early, enhanced nutritional support to critically ill patients, and some trials even found potential harm. Although speculative, the absence of a clear benefit could be explained by the continuous mode of feeding in these trials, since intermittent feeding regimens had health-promoting effects in healthy animals and humans through mechanisms that also appear relevant in critical illness. Potential protective mechanisms include avoidance of the muscle-full effect and improved protein synthesis, improved insulin sensitivity, better preservation of circadian rhythm, and fasting-induced stimulation of autophagy and ketogenesis. RCTs comparing continuous versus intermittent feeding regimens in critically ill patients have shown mixed results, albeit with different design and inclusion of relatively few patients. In all studies, the fasting interval was relatively short (4–6 h maximum), which may be insufficient to develop a full fasting response and associated benefits.

Summary
These findings open perspectives for the design and clinical validation of intermittent feeding regimens for critically ill patients. The optimal mode and duration of the fasting interval, if any, remain unclear.
Laparoscopic Ventral Mesh Rectopexy (LVMR) for Internal and External Rectal Prolapse: An Analysis of 122 Consecutive Patients
Authors: Shin Jae-Won , Hong Kwang-Dae , Lee Doo-Han , Kim Do-Sun , Lee Doo-Seok 
Published: February 2021

Background:
Even though several reports have been published on the results of laparoscopic ventral mesh rectopexy (LVMR) in Asia, there are few mid-term or long-term results of LVMR. The authors aimed to evaluate the results of LVMR in patients with internal rectal prolapse (IRP) external rectal prolapse (ERP).

Materials and Methods:
From September 2013 to January 2019, 122 patients with IRP (n=48) or ERP (n=74) underwent LVMR. Constipation and fecal incontinence (FI) scores were evaluated using the Cleveland Clinic Florida score preoperatively and postoperatively. The questionnaire for the change of obstructed defecation or FI symptoms after surgery was also administered to grade the results as cured, improved, unchanged, or worsened for each survey.

Results:
The mean age of the patients was 61.9 years. The mean operation time was 116.5 minutes, and the mean hospital stay was 5.1 days. The mean follow-up was 42.1 months. There were no mesh-related complications. Eight patients (10.7%) among the ERP group required additional surgery for recurrent full-thickness prolapse. Eleven patients (14.7%) who had mucosal prolapse within 2 cm underwent stapled hemorrhoidopexy after LVMR. In the postoperative 6-month period, the overall constipation score (7.12) significantly improved compared with the preoperative score (13.03) (P<0.001), whereas the FI score significantly improved after surgery (12.16 to 8.92; P<0.001).

Conclusion:
LVMR is a feasible and safe technique and favorable recurrence for ERP. Functional outcomes of obstructed defecation and FI were improved and the satisfaction of LVMR was high after the surgery. LVMR can be considered a recommended surgical option to treat ERP and IRP.
Endoscopic Vacuum Therapy (EVT) for Persistent Duodenal Stump Dehiscence After Upper Gastrointestinal Surgery in Selected Patients: A Tertiary Referral Center Case Series
Authors: Mutignani Massimiliano , Dioscoridi Lorenzo , Massad Mutaz , Bonato Giulia , Pugliese Francesco , Cintolo Marcello , Forti Edoardo 
Published: February 2021

Introduction:
The usefulness of endoscopic vacuum therapy (EVT) in the setting of postoperative gastrointestinal leaks is widely described. On this basis, we would like to focus a specific application of EVT: the dehiscence of the duodenal stump after upper gastrointestinal surgery. Standard EVT is not applicable in these cases because of technical limitations (length of overtube and devices). However, vacuum stimulates the healing of leaks and fistulas through granulation tissue’s formation and would be effective also in this setting.

Materials and Methods:
Between October 2019 and January 2020, 7 consecutive patients (4 M, 3 F, 62±9 y old) affected by duodenal stump’s dehiscence were endoscopically treated by the placement of a large-bore (14 to 18 Ch) suction tube across the wall’s defect into the peritoneal cavity. Continuous aspiration at −80/−100 mm Hg was applied. Clinical success was established both by fluoroscopic check injecting contrast medium from the tube to verify the fistula’s closure and by abdominal computed tomography scan to exclude residual fluid collections.

Results:
Technical and clinical success were achieved in all the patients. The suction tube was maintained in site for 12±5 days in continuous aspiration. The drainage’s output became null in 2±1 days without any intra-abdominal residual fluid collection. The principle of this technique is to let the duodenal walls’ stump to collapse on the intraluminal part of the tube (with subsequent mucosal intussusception into the holes of the tube itself) creating a sort of vacuum-packed barrier to interrupt the outflow of enteric materials into the fistula’s path. It guarantees the fistula’s closure by the gradual formation of granulation tissue.

Conclusions:
The present technique offers a safe and viable endoscopic alternative to treat duodenal stump’s leaks after upper gastrointestinal surgery.
Synchronizability predicts effective responsive neurostimulation for epilepsy prior to treatment
Authors: Scheid Brittany H. , Bernabei John M. , Khambhati Ankit N. , Jeschke Jay , Bassett Danielle S. , Becker Danielle , Davis Kathryn A. , Lucas Tim , Doyle Werner , Chang Edward F. , Friedman Daniel , Rao Vikram R. , Litt Brian 
Published: February 2021

AbstractDespite the success of responsive neurostimulation (RNS) for epilepsy, clinical outcomes vary significantly and are hard to predict. The ability to forecast clinical response to RNS therapy before device implantation would improve patient selection for RNS surgery and could prevent a costly and ineffective intervention. Determining and validating biomarkers predictive of RNS response is difficult, however, due to the heterogeneity of the RNS patient population and clinical procedures; large, multi-center datasets are needed to quantify patient variability and to account for stereotypy in the treatment paradigm of any one center. Here we use a distributed, cloud-based pipeline to analyze a federated dataset of intracranial EEG recordings, collected prior to RNS surgery, from a retrospective cohort of 30 patients across three major epilepsy centers. Based on recent work modelling the controllability of distributed brain networks, we hypothesize that broader brain network connectivity, beyond the seizure onset zone, can predict RNS response. We demonstrate how intracranial EEG recordings can be leveraged through network analysis to uncover biomarkers that predict response to RNS therapy. Our findings suggest that peri-ictal changes in synchronizability, a global network metric shown to accurately predict outcome from resective epilepsy surgery, can distinguish between good and poor RNS responders under the current RNS therapy guidelines (area under the receiver operating characteristic curve of 0.75). Furthermore, this study also provides a proof-of-concept roadmap for multicenter collaboration where practical considerations impede sharing datasets fully across centers.
COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries
Authors: Engjom Hilde , Aabakke Anna JM , Klungsøyr Kari , Svanvik Teresia , Äyräs Outi , Jonasdottir Eva , Thurn Lars , Jones Elin , Pettersson Karin , Nyfløt Lill Trine , Al-Zirqi Iqbal , Vangen Siri , Júlíusson Pétur B. , Källén Karin , Gissler Mika , Krebs Lone 
Published: February 2021

AbstractIntroductionPopulation-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and health care systems.Material and methodThis study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between March 1 and June 30, 2020 and had a positive SARS-CoV-2 PCR test 14 days or fewer prior to the admission. Cause of admission was classified as obstetric or COVID-19 related.ResultsIn the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women needed hospital care due to COVID-19. The rate of admission due to COVID-19 was 0.4 per 1000 deliveries in Denmark, Finland, and Norway and 3.8 per 1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (P< 0.001) and had migrant background (P< 0.001) compared to the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Preterm delivery (n=12, 25%,P< 0.001) and cesarean delivery (n=21, 43,8%,P< 0.001) were more frequent in women with COVID-19 compared to the women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported.ConclusionsThe risk of admission due to severe COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the rates of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.Key MessageRisk of hospital admission due to COVID-19 infection among pregnant women was low in the Nordic countries, but varied between the countries, which is most likely related to different national public health strategies.
Expression of ACE2 receptor, soluble ACE2, Angiotensin I, Angiotensin II and Angiotensin (1-7), is modulated in COVID-19 patients
Authors: Osman Ikram Omar , Melenotte Cléa , Brouqui Philippe , Million Matthieu , Lagier Jean-Christophe , Parola Philippe , Stein Andréas , Scola Bernard La , Meddeb Line , Mege Jean-Louis , Raoult Didier , DEvaux Christian A. 
Published: February 2021

AbstractAlthough SARS-CoV-2 is primarily a pulmonary-tropic virus, it is nonetheless responsible for multi-organ failure in patients with severe forms of COVID-19, particularly those with hypertension or cardiovascular disease. Infection requires virus binding to the angiotensin I converting enzyme 2 (ACE2) monocarboxypeptidase, a regulator of blood pressure homeostasis through its ability to catalyze the proteolysis of Angiotensin II (AngII) into Ang(1-7). Although assumed, it had not been proven so far whether the SARS-CoV-2 replication in COVID-19 patients could modulate the expression of the ACE2 receptor and/or the AngII plasma levels. We demonstrate here, that in COVID-19 patients the ACE2 mRNA expression is markedly reduced in circulating blood cells. This ACE2 gene dysregulation mainly affects the monocytes which also show a lower expression of membrane ACE2 protein. Moreover, a significant decrease in soluble ACE2 plasma levels is observed in COVID-19 patients, whereas the concentration of sACE2 returns to normal levels in patients recovered from COVID-19. In the plasma of COVID-19 patients, we also found an increase in AngI and AngII. On the other hand, the plasma levels of Ang(1-7) remains almost stable in COVID-19 patients. Despite the Ang(1-7) presence in the plasma of COVID-19 patients it seems insufficient to prevent the effects of massive AngII accumulation. These are the first direct evidence that the SARS-CoV-2 may affect the expression of blood pressure regulators with possible harmful consequences on COVID-19 outcome.
Population-Based Study of anti-SARS-CoV-2, Social Distancing and Government Responses in Joinville, Brazil
Authors: Diegoli Henrique , Conzatti Vivianne Samara , Mazin Suleimy Cristina , Safanelli Juliana , Chiaradia Dellatorre Louise Domenguini , Bett Keli , Radtke Roselaine Elisa , Wollmann Giulia Murillo , Lima Helbert do Nascimento , de França Paulo Henrique Condeixa , da Silva Jean Rodrigues 
Published: February 2021

AbstractBackgroundThe city of Joinville had been mildly affected by the COVID-19 pandemic until June 2020. This study aimed to longitudinally assess the prevalence of exposure to the virus and social distancing practices in the local population.MethodsA randomized selection of households stratified by region was created. From June 15 to August 7, 2020, a dweller was randomized in each household, answered a questionnaire, and performed a test for the detection of SARS-CoV-2 antibodies. The prevalence of positive tests was calculated for each week and adjusted for the test’s sensitivity and specificity.ResultsThe adjusted proportion of positive results increased from 1.4% in the first week (margin of error [ME] 0% to 2.87%) to 13.38% in the eighth week (ME 10.22% to 16.54%). Among the 213 participants that tested positive, 55 (25.82%) were asymptomatic. Only 37 (17.37%) sought medical consultation for any symptom. Among the 77 (36.15%) that were leaving home to work or study, only 18 (23.38%) stopped due to any symptom. The proportion that referred going to bars, restaurants, or making non-essential shopping decreased from 20.56% in the first week to 8.61% during the peak of diagnoses.ConclusionThe low proportion of participants that sought medical consultation or stopped leaving home indicates strategies directed to isolate only those symptomatic reach a low proportion of infected patients.