bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Drives Clinicians to Teach While Caring for Patients?
Authors: Lessing Juan N. , Chopra Vineet 
Published: December 2024

Abstract
Past medical education scholarship has explored what to teach, how to teach it better, and the evaluation of what these efforts provide learners. Missing from this dialogue has been the question of what clinician-educators gain from teaching. In this Invited Commentary on Frija-Gruman and colleagues’ article “Learning Through Teaching: How Physicians Learn Medicine in Authentic Clinical Contexts,” the authors go beyond how and what clinician-educators learn through teaching to what drives clinicians to teach while caring for patients. Using a conceptual framework put forth by Daniel Pink built around the intrinsic domains of autonomy, mastery, and purpose, the authors posit that there are deep-seated psychological motivational principles underpinning the passion for teaching. The authors explore how teaching within patient care uniquely fosters and enhances autonomy (choice over what to do and how), mastery (the pursuit of betterment), and purpose (doing something that feels deeply meaningful and important), and in doing so, they present their rationale for how teaching gives back more to the teacher than is typically recognized. The authors then discuss the obstacles to the realization of teaching’s full potential and conclude with a call for recognizing the intrinsic motivators as a key element for clinician-educators and clinical education to thrive.
Formal Physical Therapy Improves Patient-Reported Outcome Measurement Information System Physical Function for High Anxiety Patients After Ankle ORIF
Authors: Dong Willie , Mau Makoa , Soule Silvia , Sato Eleanor , Thorne Tyler , Higgins Thomas , Rothberg David , Marchand Lucas , Haller Justin 
Published: December 2024

OBJECTIVES:
To compare outcomes after ankle fracture fixation between those receiving formal physical therapy (PT) versus no formal PT and those with high versus low patient-reported outcome measurement information system (PROMIS) anxiety score (AS), and to evaluate the effect of PT in the setting of PROMIS ASs.

METHODS:

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patient Selection Criteria:
Patients aged >18 years undergoing isolated ankle fracture (OTA/AO 44A, 44B, 44C) fixation with documented PROMIS scores postoperatively.

Outcome Measures and Comparisons:
The postoperative PROMIS physical function (PF) and pain interference (PI) were compared between patients receiving formal PT versus those receiving no PT and those with baseline high versus low PROMIS ASs. A subanalysis was performed between patients with low anxiety and no PT (LANP) versus low anxiety with PT (LAP) versus high anxiety and no PT (HANP), and high anxiety with PT (HAP).

RESULTS:
A total of 161 patients, 111 women (68.9%), with an average age of 46 years (range: 18–72 years), were included in this study: 127 PT, 34 no PT, 88 low anxiety, and 73 high anxiety. PT did not yield any significant differences in PROMIS PF (44.9 PT vs. 42.6 no PT, P = 0.180) or PI (53.5 PT vs. 54.4 no PT, P = 0.656) at final follow-up. At final follow-up, patients with high anxiety had similar PROMIS PF (43.0) versus patients with low anxiety (45.5, P = 0.088), but significantly worse PROMIS PI scores (51.5 vs. 56.7, respectively; P = 0.001). Univariate analysis demonstrated a significant difference in age between patients with high and low anxiety and was thus selected as a control variable in the analysis of HANP, HAP, LANP, and LAP. After controlling for age, pairwise comparisons of estimated PROMIS PF scores at final follow-up were significantly lower for HANP (39.0) than for HAP (43.9, P = 0.05), LANP (45.1, P = 0.05), and LAP patients (45.9, P = 0.04). Final PROMIS PI scores were significantly worse for HANP (59.1) and HAP (56.5) when compared with LANP (51.3, P = 0.021 vs. HANP, P = 0.049 vs. HAP) and LAP (51.3, P = 0.005 vs. HANP, P = 0.004 vs. HAP) groups.

CONCLUSIONS:
Patients with high anxiety who undergo isolated ankle fracture fixation perform worse regarding PROMIS PI irrespective of PT status. However, some patients with high anxiety may benefit from formal PT referral to maximize their functional outcomes.

LEVEL OF EVIDENCE:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Wide Awake Surgery Is Safe and Feasible in Pediatric Orthopaedic Surgery
Authors: Tamburini Lisa M. , Ashraf Asad , Gunda Bhavana , Weaver Adam , Chaudhry Sonia 
Published: December 2024

Objective:
Wide awake local anesthesia no tourniquet (WALANT) techniques are increasingly utilized for hand surgeries in adults, given the clinical benefits to patients, reduced environmental waste during surgery, and lower costs to the health care system. This technique is not widely employed for pediatric hand surgeries given concerns for parental and patient anxiety, noncompliance during surgery, and tolerance of administration of local anesthesia. Select patients undergoing amenable procedures can potentially benefit from this method and enjoy the lower morbidities and costs that adult patients enjoy. It was hypothesized that WALANT technique would be safe, efficient, and feasible in a pediatric cohort.

Methods:
A retrospective chart review of all 223 upper extremity surgeries performed by a single surgeon at a pediatric hospital and its surgery center was performed. Patients aged 7 to 20 years scheduled for local anesthesia without monitored anesthesia care were included. These patients were not instructed to fast before their procedure. Patient demographics, surgical and recovery room times, pain scores, and complications were recorded.

Results:
Eighty-six patients underwent surgery under local anesthesia and were compared with 76 patients undergoing similar surgeries under general anesthesia. Both soft tissue and bony surgeries were included. The WALANT group had both significantly shorter average length of surgery and time spent in recovery compared with the general anesthesia group, translating into significant cost savings. Lower pain scores and fewer narcotic prescriptions were noted. There were no conversions to any type of monitored anesthesia care, nor cancellations due to inability to tolerate administration of local. No difference in infection rates or other complications were noted between groups.

Conclusions:
WALANT is safe, efficient, and feasible in a pediatric hospital for a variety of surgeries. Expanding this technique for use in select children allows patients, their families, and the health care system to enjoy the clinical, financial, and environmental benefits of WALANT surgery.

Level of Evidence:
Level III—retrospective comparative study.
Tumor-derived CCL2 drives tumor growth and immunosuppression in IDH1-mutant cholangiocarcinoma
Authors: Zabransky Daniel J. , Kartalia Emma , Lee Jae W. , Leatherman James M. , Charmsaz Soren , Young Sara E. , Chhabra Yash , Franch-Expósito Sebastià , Kang Martin , Maru Saumya , Rastkari Noushin , Davis Michael , Dalton William Brian , Oshima Kiyoko , Baretti Marina , Azad Nilofer S. , Jaffee Elizabeth M. , Yarchoan Mark 
Published: December 2024

Background and Aims:
Isocitrate dehydrogenase 1 (IDH1)-mutant cholangiocarcinoma (CCA) is a highly lethal subtype of hepatobiliary cancer that is often resistant to immune checkpoint inhibitor therapies. We evaluated the effects of IDH1 mutations in CCA cells on the tumor immune microenvironment and identified opportunities for therapeutic intervention.

Approach and Results:
Analysis of 2606 human CCA tumors using deconvolution of RNA-sequencing data identified decreased CD8+ T cell and increased M2-like tumor-associated macrophage (TAM) infiltration in IDH1-mutant compared to IDH1 wild-type tumors. To model the tumor immune microenvironment of IDH1-mutant CCA in vivo, we generated an isogenic cell line panel of mouse SB1 CCA cells containing a heterozygous IDH1 R132C (SB1mIDH1) or control (SB1WT) mutation using CRISPR-mediated homology-directed repair. SB1mIDH1 cells recapitulated features of human IDH1-mutant CCA including D-2-hydroxyglutarate production and increased M2-like TAM infiltration. SB1mIDH1 cells and tumors produced increased levels of CCL2, a chemokine involved in the recruitment and polarization of M2-like TAMs, compared to wild-type controls. In vivo neutralization of CCL2 led to decreased M2-like TAM infiltration, reduced tumor size, and improved overall survival in mice harboring SB1mIDH1 tumors.

Conclusions:

IDH1-mutant CCA is characterized by an increased abundance of M2-like TAMs. Targeting CCL2 remodels the tumor immune microenvironment and improves outcomes in preclinical models of IDH1-mutant CCA, highlighting the role of myeloid-targeted immunotherapies in the treatment of this cancer.
FACTORS PREDICTIVE OF PERSISTENT SUBRETINAL FLUID IN ACUTE CENTRAL SEROUS CHORIORETINOPATHY
Authors: Hatakeyama Chika , Kataoka Keiko , Yoshikawa Yuji , Nakayama Makiko , Yamamoto Akiko , Okada Annabelle A. 
Published: December 2024

Purpose:
To identify the clinical parameters predictive of persistent subretinal fluid in acute central serous chorioretinopathy (CSC).

Methods:
Clinical data of consecutive eyes diagnosed with first-time, acute, treatment-naïve CSC followed up for at least 6 months from symptom onset were evaluated retrospectively. Acute CSC was defined as CSC in which symptoms were noticed within 3 months of presentation. Subretinal fluid, central retinal thickness, subfoveal choroidal thickness, and fundus autofluorescence were examined.

Results:
Of the 48 eyes in 48 patients, 38% exhibited subretinal fluid persisting for at least 6 months after the symptom onset. Fundus autofluorescence alterations at baseline were observed in 52% and 36% of affected and fellow eyes, respectively. Multivariable analysis showed that persistent fluid was significantly associated with the presence of fundus autofluorescence alterations in fellow eyes (odds ratio = 23.5, P = 0.024), in addition to greater age (odds ratio = 1.16, P = 0.015) and thicker central retinal thickness (odds ratio = 1.01, P = 0.022).

Conclusion:
Fellow eye fundus autofluorescence alterations, in addition to older age and thicker central retinal thickness, were significant predictors of persistent subretinal fluid in patients with acute CSC. These findings underscore CSC's bilateral aspects and noninvasive markers' role in predicting persistent subretinal fluid.
PNEUMATIC RETINOPEXY FOR GIANT RETINAL TEAR–ASSOCIATED RETINAL DETACHMENT
Authors: Cruz-Pimentel Miguel , Alfalah Mohammed , Lee Wei Wei , Martins-Melo Isabela , Wong Jovi C. , Pirouzmand Neda , Pecaku Aurora , Demian Sueellen , Maniyali Faryal , Kertes Peter J. , Muni Rajeev H. 
Published: December 2024

Purpose:
To report the technique and long-term outcomes of patients with giant retinal tear–associated retinal detachment treated with pneumatic retinopexy (PnR).

Methods:
Retrospective cohort study. All patients presenting with giant retinal tear–associated retinal detachment with tears in the superior ten-clock hours who underwent primary PnR were included in this study.

Results:
Thirty-one patients were included in the study. Of these, 61.2% (19 of 31) achieved primary reattachment rate (PARR) with PnR at 3 months and 58.0% (18 of 31) at the final follow-up. Patients included in this study had a median follow-up of 24 months (interquartile range 46.5 months). The absence of retinal tears elsewhere at baseline was associated with a final PARR of 80% (16 of 20) (P = 0.007). Thirteen eyes required pars plana vitrectomy after a failed PnR. Two eyes required the intraoperative use of perfluorocarbon liquids. No eyes required silicone oil. Visual acuity improved significantly from baseline to the last follow-up. Final anatomical reattachment rate was 100% (31 of 31).

Conclusion:
For selected cases of giant retinal tear associated retinal detachments affecting the superior ten-clock hours, PnR could be a possible treatment option when patients consent to extra visits and the surgeon has substantial expertise. When lacking this extensive experience and comfort with PnR, pars plana vitrectomy remains the treatment that is most likely to result in a primary anatomical reattachment. Although this study provides guidance on PnR technique for giant retinal tear associated retinal detachment, it is essential to note that the reported PARR may be contingent on the expertise of the surgeon/center, and the authors recommend that those new to PnR first gain substantial experience in cases meeting clinical trial criteria.
Double-Suture Scleral-Fixated Intraocular Lens With 2 Polypropylene Sutures
Authors: Lam Christine C. Y. , Kam Ka Wai , Young Alvin L. 
Published: December 2024

Purpose:
We present a modified technique in performing scleral fixation of a posterior chamber intraocular lens (IOL) using 2 pairs of double-armed 9-O polypropylene sutures and an ab-externo technique, in 2 patients with surgical aphakia after complicated cataract surgery.

Methods:
Two eyes of 2 patients underwent this modified technique by an experienced cataract surgeon (A.L.Y.) in 2022. We evaluated pre- and postoperative best-corrected visual acuity, perioperative complications, corneal endothelial cell density by specular microscopy, and IOL position by anterior segment optical coherence tomography and ultrasound biomicroscopy.

Results:
Both patients achieved an improvement in best-corrected visual acuity from 20/50 to 20/30 and 20/80 to 20/50, respectively. There was a loss in endothelial cell count in both cases (8% and 23%, respectively). No complications were noted in both cases, and postoperative anterior segment optical coherence tomography and ultrasound biomicroscopy showed a stable scleral fixation of IOL at more than 20 months postoperatively.

Conclusions:
The utilization of 2 pairs of double-armed 9-O Prolene suture may provide a stronger alternative than conventional scleral fixation of IOL with single suture.
Assessment of Structural Progression in Glaucoma Through Automated Optic Nerve Head Hemoglobin Measurements
Authors: Rocha Janaina Andrade Guimarães , Goytacaz Thaíssa Cristina Affonso Nazareth , Calzavara Lemos Maria Betânia , Paranhos Augusto , Teixeira Sérgio Henrique , Kanadani Fábio Nishimura , Gracitelli Carolina Pelegrini Barbosa , Prata Tiago Santos 
Published: December 2024

Précis:
Automated optic nerve head hemoglobin measurements through change over time in the Globin Individual Pointer (GIP) index, provided by the Laguna ONhE software, can be useful to evaluate structural progression in glaucoma.

Purpose:
To assess the performance of automated optic nerve head hemoglobin measurements (ONH Hb) for detection of structural progression in glaucoma patients using event analysis.

Patients and Methods:
Treated glaucoma patients were included in this cross-sectional study. Two experienced examiners classified patients into progressors and non-progressors (controls) based on serial color retinographies (CR). Progressors were then subdivided in structural changes of the neuroretinal rim (NR) or retinal nerve fiber layer (RNFL). Globin individual pointer (GIP) index, derived from ONH Hb measurements, was calculated for each CR using the Laguna ONhE software. Differences in GIP values, ​​between baseline and last visit CRs, were used to assess structural progression. Sensitivity at a fixed specificity (50%; median GIP difference in controls) and areas under receiver operating characteristic curves (AUROC) were calculated.

Results:
Eight-seven eyes (35 progressors and 52 controls) from 64 patients were enrolled. Mean GIP reduction over time was greater in progressors (−13.0±18.6) than controls (−2.9±10.4; P=0.001). In progressors, mean GIP reduction was greater in patients with NR changes (−19.6±19.5) than RNFL changes (−3.1±12.1; P=0.008). GIP difference correctly identified 69% of the progressors (AUROC: 0.66), being 76% of these progressions related to NR changes (AUROC: 0.76) and 57% to RNFL changes (AUROC: 0.52).

Conclusions:
The GIP index, based on automated ONH Hb measurements demonstrated good sensitivity to differentiate progressors from controls, especially in cases in which progression was documented through structural NR changes. Using only 2 CRs and event analysis, GIP changes over time can be a useful screening tool to evaluate structural progression.
Oncogenic KRAS Promotes Ferroptosis in Pancreatic Cancer Through Regulation of the Fosl1-Tfrc Axis
Authors: Zhao Huijia , Huang Qi , Liu Ying-ao , Wu Wenming 
Published: December 2024

Abstract
Mutant KRAS activation occurs in most of pancreatic ductal adenocarcinoma (PDAC), which induce the sensitivity to ferroptosis of PDAC cells, but the underlying mechanism is still poorly understood. Here, we show how KRAS acts in signaling to activate transcription factor FOSL1, which promotes the expression of the iron uptake receptor TFRC. In PDAC cells, repression of TFRC by KRAS/FOSL1 signaling inhibited intracellular iron levels, thereby restricting the occurrence of ferroptosis. Furthermore, the KRAS/FOSL1/TFRC axis can make the PDAC cells vulnerable to alteration of the iron level in the tumor microenvironment. Our study highlights a pivotal mechanism of PDAC ferroptosis through iron metabolism and supports a new therapeutic strategy for PDAC with superior potential.
Brief Report: The Implications of Removing Race From Interpretation of Pulmonary Function Among Persons With or Without HIV
Authors: Wang Richard J. , Kunisaki Ken M. , Morris Alison , Drummond M. Bradley , Nouraie Mehdi , Huang Laurence , Tien Phyllis C. , Baugh Aaron D. , Barjaktarevic Igor , Bhandari Neha , Bhatt Surya P. , D'Souza Gypsamber , Fischl Margaret A. , Foronjy Robert F. , Jensen Robert L. , Lazarous Deepa G. , Ofotokun Ighovwerha , Reddy Divya , Stosor Valentina , McCormack Meredith C. , Raju Sarath 
Published: December 2024

Background:
Studies suggest that the use of race-specific pulmonary function reference equations may obscure racial inequities in respiratory health. Whether removing race from the interpretation of pulmonary function would influence analyses of HIV and pulmonary function is unknown.

Setting:
Pulmonary function measurements from 1067 men (591 with HIV) in the Multicenter AIDS Cohort Study and 1661 women (1175 with HIV) in the Women's Interagency HIV Study were analyzed.

Methods:
Percent-of-predicted values for spirometry and single-breath diffusing capacity of carbon monoxide (DLCO) measurements were generated with race-specific reference equations derived from the National Health and Nutrition Examination Survey and with the race-neutral application of reference equations derived from the Global Lung Function Initiative database. Regression models were used to evaluate the association between HIV and percent-of-predicted measures of pulmonary function. Alpaydin's F test was used to compare how well these values predicted self-reported respiratory health-related quality of life.

Results:
Persons with HIV were observed to have significantly lower percent-of-predicted diffusing capacity for carbon monoxide (DLCO) than those without HIV but no significant differences in spirometric measures of pulmonary function, regardless of whether a race-specific or race-neutral approach was used. Among men, but not women, the race-neutral application of reference equations to generate percent-of-predicted DLCO values performed better for predicting respiratory-related quality of life.

Conclusions:
The race-neutral application of pulmonary function reference equations continues to identify lung function impairment in persons with or at risk for HIV and, for DLCO, may be superior to the use of race-specific reference equations in identifying clinically relevant impairments.
18F-AlF-NOTA-FAPI-04 Superior to 18F-FDG PET/CT in Detecting Primary Tumor and Metastatic Lymph Nodes in a Cervical Cancer Patient
Authors: Wei Jinhui , Feng Qiaochu , Liu Haodong , Zheng Hongna , Li Longjie 
Published: December 2024

Abstract
A 41-year-old woman with an enlarged right supraclavicular lymph node underwent a fine-needle biopsy, which confirmed the presence of metastatic squamous cell carcinoma. To identify the primary tumor, an 18F-FDG PET/CT scan was performed, revealing multiple metabolically active lymph nodes throughout the body, but no primary lesion was identified. Subsequently, an 18F-AlF-NOTA-FAPI-04 PET/CT scan was conducted, which demonstrated increased abnormal uptake in the cervix and revealed additional metabolically active lymph nodes. Thus, a biopsy of the uterine cervical region was performed, and the results confirmed cervical squamous cell carcinoma.
Development of a Novel Hybprinter-SAM for Functionally Graded Tissue Engineering Constructs with Patterned and Localized Biochemical Signals
Authors: Li Jiannan , Kim Carolyn , Alizadeh Hossein V. , Garg Shreya , Bruyas Arnaud , Zhao Peng , Passos Isadora S. D. , Pérez Andrea S. Flores , Yang Yunzhi P. 
Published: December 2024

AbstractEngineering native-mimetic tissue constructs is challenging due to their intricate biological and structural gradients. To address this, Hybprinter-SAM was developed by integrating three bioprinting technologies: syringe extrusion (SE), acoustic droplet ejection (ADE) and molten material extrusion (MME). This system enables not only the creation of mechanical gradients by combining soft and rigid materials but also precise patterning and controlled localization of biochemical signals within printed scaffolds. This capability is beneficial in replicating the complexity of native tissues to enhance functionality. Both the printing process and biomaterials were optimized to balance printability, mechanical integrity, and biocompatibility. As a proof of concept, Hybprinter-SAM was used in a bone-tendon regeneration study to engineer a multi-material construct with patterned fibroblast growth factor 2 (FGF-2), resulting in markers indicative of fibrocartilage development. These findings highlight the potential of Hybprinter-SAM as a versatile platform for diverse tissue engineering applications that require complex, functionally graded tissue constructs.
Structural Convergence and Water-Mediated Substrate Mimicry Enable Broad Neuraminidase Inhibition by Human Antibodies
Authors: Lederhofer Julia , Borst Andrew J. , Nguyen Lam , Gillespie Rebecca A. , Williams Connor J. , Walker Emma L. , Raab Julie E. , Yap Christina , Ellis Daniel , Creanga Adrian , Tan Hyon-Xhi , Do Thi H. T. , Ravichandran Michelle , McDermott Adrian B. , Sage Valerie Le , Andrews Sarah F. , Graham Barney S. , Wheatley Adam K. , Reed Douglas S. , King Neil P. , Kanekiyo Masaru 
Published: December 2024

AbstractInfluenza has been responsible for multiple global pandemics and seasonal epidemics and claimed millions of lives. The imminent threat of a panzootic outbreak of avian influenza H5N1 virus underscores the urgent need for pandemic preparedness and effective countermeasures, including monoclonal antibodies (mAbs). Here, we characterize human mAbs that target the highly conserved catalytic site of viral neuraminidase (NA), termed NCS mAbs, and the molecular basis of their broad specificity. Cross-reactive NA-specific B cells were isolated by using stabilized NA probes of non-circulating subtypes. We found that NCS mAbs recognized multiple NAs of influenza A as well as influenza B NAs and conferred prophylactic protections in mice against H1N1, H5N1, and influenza B viruses. Cryo-electron microscopy structures of two NCS mAbs revealed that they rely on structural mimicry of sialic acid, the substrate of NA, by coordinating not only amino acid side chains but also water molecules, enabling inhibition of NA activity across multiple influenza A and B viruses, including avian influenza H5N1 clade 2.3.4.4b viruses. Our results provide a molecular basis for the broad reactivity and inhibitory activity of NCS mAbs targeting the catalytic site of NA through substrate mimicry.