bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of decision aid on health help-seeking for medical students
Authors: Strawbridge Lisa , Mackie Shona , Bharath Nikita , Shahaf-Oren Bar , Madan Ira , Henderson Claire 
Published: December 2021

Abstract

Background
Rates of mental health problems are increasing among medical students, who have added pressures compared with non-medical students. Medical student populations exhibit low rates of help-seeking and often struggle with disclosing health conditions due to the barriers experienced and concerns over negative repercussions.

Aims
This study aimed to create and test the feasibility and potential efficacy of an online decision aid (DA) tool that provides medical students with resources for disclosing and help-seeking for their health concerns.

Methods
The research used mixed methods, comprising two rounds of testing, the first used the Think-Aloud method to identify modifications needed, and both of which measured feasibility and assessed decision making outcomes pre and post use of the DA utilizing O’Connor’s Decisional Conflict Scale (DCS) (2010) and Stage of Decision Making (SDM) (2003) measures.

Results
Results showed good feasibility of the DA. The mean DCS total score decreased from 32 to 16.75, (Wilcoxon signed-rank tests Z = −3.06, P &lt; 0.05). There was no significant change in the SDM.

Conclusions
The results suggest that the DA may reduce decisional conflict, improving their certainty and confidence in decision making, but had no immediate impact on their SDM, consistent with some other DAs. Further longitudinal research would be beneficial.
Depression Predicts Chronic Pain Interference in Racially Diverse, Income-Disadvantaged Patients
Authors: Nephew Benjamin C , Incollingo Rodriguez Angela C , Melican Veronica , Polcari Justin J , Nippert Kathryn E , Rashkovskii Mikhail , Linnell Lilly-Beth , Hu Ruofan , Ruiz Carolina , King Jean A , Gardiner Paula 
Published: December 2021

Abstract

Background
Chronic pain is one of the most common reason adults seek medical care in the United States, with prevalence estimates ranging from 11% to 40%. Mindfulness meditation has been associated with significant improvements in pain, depression, physical and mental health, sleep, and overall quality of life. Group medical visits are increasingly common and are effective at treating myriad illnesses, including chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence based integrative medicine, and medical group visits and can be used as adjuncts to medications, particularly in diverse underserved populations with limited access to non-pharmacological therapies.

Objective and Design
The objective of the present study was to use a blended analytical approach of machine learning and regression analyses to evaluate the potential relationship between depression and chronic pain in data from a randomized clinical trial of IMGV in diverse, income-disadvantaged patients suffering from chronic pain and depression.

Methods
The analytical approach used machine learning to assess the predictive relationship between depression and pain and identify and select key mediators, which were then assessed with regression analyses. It was hypothesized that depression would predict the pain outcomes of average pain, pain severity, and pain interference.

Results
Our analyses identified and characterized a predictive relationship between depression and chronic pain interference. This prediction was mediated by high perceived stress, low pain self-efficacy, and poor sleep quality, potential targets for attenuating the adverse effects of depression on functional outcomes.

Conclusions
In the context of the associated clinical trial and similar interventions, these insights may inform future treatment optimization, targeting, and application efforts in racialized, income-disadvantaged populations, demographics often neglected in studies of chronic pain.
Validation of Somno-Art Software, a novel approach of sleep staging, compared with polysomnography in disturbed sleep profiles
Authors: Thiesse Laurie , Staner Luc , Bourgin Patrice , Roth Thomas , Fuchs Gil , Kirscher Debora , Schaffhauser Jean-Yves , Saoud Jay B , Viola Antoine U 
Published: December 2021

AbstractStudy ObjectivesIntegrated analysis of heart rate (electrocardiogram [ECG]) and body movements (actimetry) during sleep in healthy subjects have previously been shown to generate similar evaluation of sleep architecture and continuity with Somno-Art Software compared to polysomnography (PSG), the gold standard. However, the performance of this new approach of sleep staging has not yet been evaluated on patients with disturbed sleep.MethodsSleep staging from 458 sleep recordings from multiple studies comprising healthy and patient population (obstructive sleep apnea [OSA], insomnia, major depressive disorder [MDD]) was obtained from PSG visual scoring using the American Academy of Sleep Medicine rules and from Somno-Art Software analysis on synchronized ECG and actimetry.ResultsInter-rater reliability (IRR), evaluated with 95% absolute agreement intra-class correlation coefficient, was rated as “excellent” (ICCAAAvg95% ≥ 0.75) or “good” (ICCAAAvg95% ≥ 0.60) for all sleep parameters assessed, except non-REM (NREM) and N3 sleep in healthy participants (ICCAAAvg95% = 0.43, ICCAAAvg95% = 0.56) and N3 sleep in OSA patients (ICCAAAvg95% = 0.59) rated as “fair” IRR. Overall sensitivity, specificity, accuracy, and Cohen’s kappa coefficient of agreement (κ) on the entire sample were respectively of 93.3%, 69.5%, 87.8%, and 0.65 for wake/sleep classification and accuracy and κ were of 68.5% and 0.55 for W/N1+N2/N3/rapid eye movement (REM) classification. These performances were similar in healthy and patient population.ConclusionsThe present results suggest that Somno-Art can be a valid sleep-staging tool in both healthy subjects and patients with OSA, insomnia, or MDD. It could complement existing non-attended techniques measuring sleep-related breathing patterns or be a useful alternative to laboratory-based PSG when this latter is not available.
Impact of Future Elevated Carbon Dioxide on C3Plant Resistance to Biotic Stresses
Authors: Bazinet Quinn , Tang Lawrence , Bede Jacqueline C. 
Published: December 2021

Before the end of the century, atmospheric carbon dioxide levels are predicted to increase to approximately 900 ppm. This will dramatically affect plant physiology and influence environmental interactions and, in particular, plant resistance to biotic stresses. This review is a broad survey of the current research on the effects of elevated CO2(eCO2) on phytohormone-mediated resistance of C3agricultural crops and related model species to pathogens and insect herbivores. In general, while plants grown in eCO2often have increased constitutive and induced salicylic acid levels and suppressed induced jasmonate levels, there are exceptions that implicate other environmental factors, such as light and nitrogen fertilization in modulating these responses. Therefore, this review sets the stage for future studies to delve into understanding the mechanistic basis behind how eCO2will affect plant defensive phytohormone signaling pathways under future predicted environmental conditions that could threaten global food security to inform the best agricultural management practices.[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Hepatopancreatoduodenectomy With Delayed Division of the Pancreatic Parenchyma
Authors: Sugiura Teiichi , Uesaka Katsuhiko , Ashida Ryo , Ohgi Katsuhisa , Okamura Yukiyasu , Yamada Mihoko , Otsuka Shimpei 
Published: December 2021

Objectives:
To review our novel technique of hepatopancreatoduodenectomy (HPD) with delayed division of the pancreatic parenchyma (DDPP) for reducing postoperative pancreatic fistula (POPF).

Background:
The high operative morbidity and mortality rates after HPD remains a major issue. One of the most troublesome complications is POPF, which might possibly be caused by peripancreatic saponification due to long interval between pancreas resection and reconstruction, as most surgeons prefer a caudocranial approach, performing pancreatoduodenectomy (PD) first and then hepatectomy (conventional HPD [C-HPD]).

Methods:
A review of the patients undergoing C-HPD and HPD with DDPP was performed. Postoperative outcomes were compared. Multivariable analysis was conducted to evaluate the risk factors of POPF after HPD.

Results:
One-hundred two patients comprised of 50 patients undergoing C-HPD and 52 patients undergoing HPD with DDPP. The interval between pancreas resection and reconstruction was significantly shorter in HPD with DDPP group than in C-HPD group (51 vs 263 minutes; P < 0.001). The incidence of POPF was significantly lower in HPD with DDPP group than in C-HPD group (32.7% vs 77.3%; P < 0.001). The postoperative hospital stay was shorter in patients undergoing HPD with DDPP than in those undergoing C-HPD (32 vs 45 days). A multivariate analysis revealed that body mass index >24 kg/m2 and conventional (PD first) procedure were significant risk factors for POPF after HPD.

Conclusions:
A novel technique of HPD with DDPP is a simple procedure and the optimal treatment choice to reduce the risk of developing POPF after this extensive surgery.
Surgical Factors and Treatment Severity for Perioperative Complications Predict Hospital Length of Stay in Adult Spinal Deformity Surgery
Authors: Le Hai V. , Wick Joseph B. , Lafage Renaud , Kelly Michael P. , Kim Han Jo , Gupta Munish C. , Bess Shay , Burton Douglas C. , Ames Christopher P. , Smith Justin S. , Shaffrey Christopher I. , Schwab Frank J. , Passias Peter G. , Protopsaltis Themistocles S. , Lafage Virginie , Klineberg Eric O. 
Published: December 2021

Study Design.
Retrospective review of prospectively collected multicenter registry data.

Objective.
The aim of this study was to determine whether surgical variables and complications as graded by treatment severity impact postoperative hospital length of stay (LOS).

Summary of Background Data.
Surgical treatment can substantially improve quality of life for patients with adult spinal deformity (ASD). However, surgical treatment is associated with high complication rates, which may impact hospital LOS. Classifying complications by severity of subsequent treatment may allow surgeons to better understand complications and predict their impact on important outcome metrics, including LOS.

Methods.
Patients enrolled in a multicenter, prospectively enrolled database for ASD were assessed for study inclusion. Complications were graded based on intervention severity. Associations between LOS, complication intervention severity, and surgical variables (fusion length, use of interbody fusion, use of major osteotomy, primary versus revision surgery, same day vs. staged surgery, and surgical approach), were assessed. Two multivariate regression models were constructed to assess for independent associations with LOS.

Results.
Of 1183 patients meeting inclusion criteria, 708 did not and 475 did experience a perioperative complication during their index hospitalization, with 660 and 436 included in the final cohorts, respectively. Among those with complications, intervention severities included 14.9% with no intervention, 68.6% with minor, 8.9% with moderate, and 7.6% with severe interventions. Multivariate regression modeling demonstrated that length of posterior fusion, use of major osteotomy, staged surgery, and severity of intervention for complications were significantly associated with LOS.

Conclusion.
Careful selection of surgical factors may help reduce hospital LOS following surgery for ASD. Classification of complications by treatment severity can help surgeons better understand and predict the implications of complications, in turn assisting with surgical planning and patient counseling.

Level of Evidence: 4
Prospective Randomized Control Pilot Study to Compare the Role of Injection Cerebrolysin in Operated cases of Degenerative Cervical Myelopathy
Authors: Sharma Ayush , Marathe Nandan , Aggarwal Romit , Singh Vijay , Shakya Akash , Kamble Prashant , Jaiswal Ajay , Mangale Nilesh , Rocos Brett 
Published: December 2021

Study Design.
Prospective randomized control trial.

Objective.
The aim of this study was to analyze role of cerebrolysin in patients of degenerative cervical myelopathy (DCM) managed by surgical modalities.

Summary of Background Data.
Cerebrolysin has been extensively researched with variable success in neurodegenerative pathologies. There has been only one study in published literature till date that has studied role of cerebrolysin in DCM in conservatively managed patients but none in the patients treated surgically. We present our pilot study which analyzes the role of cerebrolysin in patients of DCM managed by surgical modalities.

Methods.
This prospective randomized control trial was conducted at a tertiary care institute in Mumbai. Sixty operated cases of DCM were randomly divided into 2 groups. The first group was given Injection Cerebrolysin 5 mL diluted in 100 mL Normal Saline over 30 minutes once a day for 21 days postoperatively. The second group was given placebo. Modified Japanese Orthopedic Association scores (mJOA) and visual analog scale (VAS) were used to document functional outcomes at 3 weeks, 3 months, 6 months, and 1 year. Recovery of hand function was separately accessed by improvement in hand power and sensations.

Results.
Preoperative mJOA and VAS scores were comparable between 2 groups. Both groups showed significant improvement in both mJOA and VAS scores at 3weeks, 3 months, 6 months and 1-year follow-up (P < 0.01). In comparing the two groups, there was no difference in improvement of mJOA and VAS scores. However, cerebrolysin group showed significant improvement in hand function at 1 year compared to the placebo. Postoperative neurological recovery was better in the cerebrolysin group with 66.7% patients showing complete neurological recovery compared to 56.7% for placebo, but this was statistically insignificant. Two patients developed headache and one patient complained of dizziness in the cerebrolysin group, but these resolved without any intervention.

Conclusion.
Use of cerebrolysin in postoperative cases of DCM is safe and results in improved hand function.

Level of Evidence: 1
Interferon-gamma inhibits aldehyde dehydrogenasebright cancer stem cells in the 4T1 mouse model of breast cancer
Authors: Zhuang Xiufen , Shi Guilan , Hu Xiao , Wang Huiru , Sun Wen , Wu Yanhong 
Published: December 2021

Abstract

Background:
Despite improvements in disease diagnosis, treatment, and prognosis, breast cancer is still a leading cause of cancer death for women. Compelling evidence suggests that targeting cancer stem cells (CSCs) have a crucial impact on overcoming the current shortcomings of chemotherapy and radiotherapy. In the present study, we aimed to study the effects of T cells and a critical anti-tumor cytokine, interferon-gamma (IFN-γ), on breast cancer stem cells.

Methods:
BALB/c mice and BALB/c nude mice were subcutaneously injected with 4T1 tumor cells. Tumor growth and pulmonary metastasis were assessed. ALDEFLOUR™ assays were performed to identify aldehyde dehydrogenasebright (ALDHbr) tumor cells. ALDHbr cells as well as T cells from tumor-bearing BALB/c mice were analyzed using flow cytometry. The effects of CD8+ T cells on ALDHbr tumor cells were assessed in vitro and in vivo. The expression profiles of ALDHbr and ALDHdim 4T1 tumor cells were determined. The levels of plasma IFN-γ were measured by enzyme-linked immunosorbent assay, and their associations with the percentages of ALDHbr tumor cells were evaluated. The effects of IFN-γ on ALDH expression and the malignancy of 4T1 tumor cells were analyzed in vitro.

Results:
There were fewer metastatic nodules in tumor-bearing BALB/c mice than those in tumor-bearing BALB/c nude mice (25.40 vs. 54.67, P < 0.050). CD8+ T cells decreased the percentages of ALDHbr 4T1 tumor cells in vitro (control vs. effector to target ratio of 1:1, 10.15% vs. 5.76%, P < 0.050) and in vivo (control vs. CD8+ T cell depletion, 10.15% vs. 21.75%, P < 0.001). The functions of upregulated genes in ALDHbr 4T1 tumor cells were enriched in the pathway of response to IFN-γ. The levels of plasma IFN-γ decreased gradually in tumor-bearing BALB/c mice, while the percentages of ALDHbr tumor cells in primary tumors increased. IFN-γ at a concentration of 26.68 ng/mL decreased the percentages of ALDHbr 4T1 tumor cells (22.88% vs. 9.88%, P < 0.050) and the protein levels of aldehyde dehydrogenase 1 family member A1 in 4T1 tumor cells (0.86 vs. 0.49, P < 0.050) and inhibited the abilities of sphere formation (sphere diameter <200 μm, 159.50 vs. 72.0; ≥200 μm, 127.0 vs. 59.0; both P < 0.050) and invasion (89.67 vs. 67.67, P < 0.001) of 4T1 tumor cells.

Conclusion:
CD8+ T cells and IFN-γ decreased CSC numbers in a 4T1 mouse model of breast cancer. The application of IFN-γ may be a potential strategy for reducing CSCs in breast cancer.
Outcomes of Sentinel Lymph Node Biopsy for Primary Cutaneous Squamous Cell Carcinoma of the Head and Neck
Authors: Pride Renee L. D. , Lopez Jonathan J. , Brewer Jerry D. , Price Daniel L. , Otley Clark C. , Roenigk Randall K. , Arpey Christopher J. , Baum Christian L. 
Published: December 2021

BACKGROUND
Limited data exist on sentinel lymph node biopsy (SLNB) for cutaneous squamous cell carcinoma (cSCC) of the head and neck.

OBJECTIVE
To review the results of SLNB for patients with cSCC of the head and neck at the authors’ institution.

MATERIALS AND METHODS
A retrospective review was completed for patients who underwent SLNB for cSCC of the head and neck over 19 years. Patient demographics, immune status, tumor stage, total patients with positive SLNB, local recurrence, nodal recurrence, in-transit metastasis, and disease-specific death were recorded.

RESULTS
Sixty patients underwent lymphoscintigraphy, and an SLN was identified in 58 patients. The mean follow-up was 3.2 years (range, 15 days–16 years). Four patients (6.9%) had a positive SLNB. All were Brigham and Women's Hospital (BWH) stage T2b tumors. Three of these patients were immunosuppressed, 3 patients underwent neck dissection, and 2 patients received adjuvant radiation. None developed local or regional recurrence. Of the 53 patients with a negative SLNB, there were 4 local recurrences, 2 in-transit metastases, and no nodal recurrences.

CONCLUSION
Immunosuppressed patients with tumors BWH stage T2b or greater may be a reasonable cohort to focus future prospective studies on the utility of SLNB in cSCC of the head and neck.
Laser Treatment of Hypopigmentation in Scars: A Review
Authors: Baugh Erica G. , Anagu Olive , Kelly Kristen M. 
Published: December 2021

BACKGROUND
Despite history of multiple treatment modalities, repigmentation of hypopigmented scars remains a difficult clinical problem.

OBJECTIVE
The purpose of this review is to evaluate the literature on laser and combination laser plus adjunct topical therapy for hypopigmented burn and traumatic scars.

MATERIALS AND METHODS
A search on PubMed and on Oxford Academic was conducted with additional relevant literature obtained from reference lists.

RESULTS
Treatment regimens that address hypopigmentation within scars were reviewed. A combination of nonablative fractional or ablative fractional laser treatment with topical prostaglandin analogue with or without topical retinoid were found to result in superior repigmentation.

CONCLUSION
Reliable improvement of hypopigmentation in scars after laser treatment is challenging. Laser can achieve success in some cases. Ultraviolet laser can achieve modest repigmentation; however, results are short-lived and require continued re-treatment. Modest improvement in pigmentation is seen with nonablative fractional laser or ablative fractional laser alone and enhanced repigmentation is demonstrated when combining fractional laser resurfacing with topical application of synthetic prostaglandin analogues and other known modulators of melanogenesis.
Estrogen-Induced Uterine Vasodilation in Pregnancy and Preeclampsia
Authors: Li Yan , Han Baoshi , Salmeron Alejandra Garcia , Bai Jin , Chen Dong-bao 
Published: December 2021

Abstract
Normal pregnancy is associated with dramatically increased estrogen biosynthesis whose role is believed to raise uterine blood flow to facilitate the bi-directional maternal-fetal exchanges of gases (O2 and CO2), to deliver nutrients, and exhaust wastes to support fetal development and survival. Constrained uterine blood flow in pregnancy is a leading cause of preeclampsia with fetal growth restriction, rendering investigations of uterine hemodynamics to hold a high promise to inform pathways as targets for therapeutic interventions for preeclampsia. The mechanisms of estrogen-induced uterine vasodilation in pregnancy have long been attributed to enhanced endothelium production of nitric oxide, but clinical trials targeting this pathway that dominates uterine hemodynamics have achieved no to little success. Emerging evidence has recently shown a novel proangiogenic vasodilatory role of hydrogen sulfide in regulating uterine hemodynamics in pregnancy and preeclampsia, provoking a new field of perinatal research in searching for alternative pathways for pregnancy disorders especially preeclampsia and intrauterine growth restriction. This minireview is intended to summarize the nitric oxide pathway and to discuss the emerging hydrogen sulfide pathway in modulating estrogen-induced uterine vasodilation in pregnancy and preeclampsia.
Viral Infections During Pregnancy: The Big Challenge Threatening Maternal and Fetal Health
Authors: Yu Wenzhe , Hu Xiaoqian , Cao Bin 
Published: December 2021

Abstract
Viral infections during pregnancy are associated with adverse pregnancy outcomes, including maternal and fetal mortality, pregnancy loss, premature labor, and congenital anomalies. Mammalian gestation encounters an immunological paradox wherein the placenta balances the tolerance of an allogeneic fetus with protection against pathogens. Viruses cannot easily transmit from mother to fetus due to physical and immunological barriers at the maternal-fetal interface posing a restricted threat to the fetus and newborns. Despite this, the unknown strategies utilized by certain viruses could weaken the placental barrier to trigger severe maternal and fetal health issues especially through vertical transmission, which was not fully understood until now. In this review, we summarize diverse aspects of the major viral infections relevant to pregnancy, including the characteristics of pathogenesis, related maternal-fetal complications, and the underlying molecular and cellular mechanisms of vertical transmission. We highlight the fundamental signatures of complex placental defense mechanisms, which will prepare us to fight the next emerging and re-emerging infectious disease in the pregnancy population.