bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary Traumatic Stress in Medical Students During Clinical Clerkships
Authors: Grush Kira A. , Christensen Wendy , Lockspeiser Tai , Adams Jennifer E. 
Published: December 2024

Abstract

Purpose
Health care workers exposed to traumatic events while working with patients are at risk for secondary traumatic stress (STS). Data on this phenomenon in medical students are limited. This prospective study examines the trajectory and prevalence of STS among medical students during clinical clerkships.

Method
The study at The University of Colorado School of Medicine was conducted in 2 phases: the first evaluated STS across multiple time points in a single year (n = 187); the second assessed STS prevalence at the end of the clerkship year in 3 cohorts (2020–2023) (n = 482). The study used a validated Secondary Traumatic Stress Scale (STSS). Multilevel growth curve modeling was used to explore the change trajectory of STSS scores across the year after controlling for covariates.

Results
In phase 1, the quadratic trend coefficient was negative (−1.56), indicating a predicted trajectory in STSS total scores that started lower at clerkship year start, reached an apex during the year, and decreased by year end (P < .001). The intercept (32.73) and linear (5.17) coefficient estimates together (37.90) predicted a total score increase indicating mild STS to a total score at the cutoff for moderate STS between July–October (P < .001). The only statistically significant covariate was reporting an influential psychiatric condition (4.86, P < .001). Phase 2 revealed an end-of-year prevalence of moderate to severe STS of 35.7%, stable across all 3 cohorts. In phase 2, STS categories were significantly different for those reporting a psychiatric condition (P = .007).

Conclusions
Medical student STS symptoms increase during the clerkship year and do not return to baseline for many by the end. More research is warranted to understand risk and protective factors for STS, strategies to mitigate symptom development, and how much of the observed STS is attributable to the COVID-19 pandemic.
Ecological Psychology: A Framework for Mentoring and Career Development in Academic Medicine
Authors: Penner John C. , Durning Steven J. , Rencic Joseph J. , Donato Anthony A. , Cleland Jennifer A. 
Published: December 2024

Abstract
Effective mentoring can help individuals navigate the complex, dynamic environment of academic medicine as they work to develop meaningful and fulfilling careers. Despite robust research into the characteristics of effective mentoring relationships and successful mentoring programs, resources that support mentors and mentees in engaging in career development in academic medicine are limited. Ecological psychology, a theory focusing on how the dynamic interplay between individuals and their environment influences cognition and behavior, offers a promising framework for exploring how mentors and mentees can support positive career development outcomes. In this article, the authors introduce selected principles derived from ecological psychology and supplement these principles with practical, hypothetical examples that demonstrate the use of ecological psychology across the continuum of career development (e.g., from early to middle to late career decisions). By focusing on interactions between individuals and their environment, ecological psychology offers a valuable and practical complement to other theories and frameworks that address career development, such as social cognitive career theory and landscapes of practice. By centering on the dynamic interactions between individuals and their professional environments, ecological psychology offers mentors, mentees, and academic medical centers a practical structure for navigating the intricacies and challenges of career development in academic medicine.
Relationship of epicardial adipose tissue measured by transthoracic echocardiography with coronary artery disease
Authors: Baraka Mahmoud , Leon Ramez , Guindy Ramez , Abdelrazek Ali Yasmin 
Published: December 2024

Background and purpose:
Coronary artery disease (CAD) remains one of the leading causes of death worldwide. Its relationship with epicardial adipose tissue (EAT) is still not yet fully established. This study aimed to investigate the correlation between EAT thickness as measured by two-dimensional (2D) echocardiography and the presence of CAD.

Methods:
This comparative cross-sectional study included 100 patients presenting with chest pain who underwent echocardiography and coronary angiography. Patients with a history of ischemic heart disease, chronic liver disease, or familial hypercholesterolemia were excluded. Participants were divided into two groups; Group A (50 patients) with significant coronary artery stenosis (>70%) on angiography, and Group B (50 patients) with normal coronary findings on angiography.

Results:
Our study has shown that EAT thickness was significantly greater in Group A compared to Group B, with an average EAT thickness of 8.5 ± 2.2 mm and 5.4 ± 1.7 mm respectively (P < 0.001). A cut-off value of 6.6 mm thickness for EAT thickness was closely associated with significant CAD, demonstrating 94% sensitivity and 90% specificity. Multivariate analysis, adjusting for confounding factors, showed that EAT thickness (odds ratio [OR]: 29.16, P < 0.001) was independently correlated to the presence of significant CAD.

Conclusions:
EAT thickness measured by echocardiography correlates with the presence of obstructive CAD in patients presenting with acute coronary syndrome (ACS). A cut-off value of 6.6 mm is strongly linked with this condition.
Impact of Boldine Treatment on Hypertrophy and Lipid Peroxidation in the Right Ventricle Subjected to Experimental Adrenergic Overstimulation
Authors: Fernandes Elissa Kerli , Türck Patrick , Carraro Cristina Campos , de Mello Palma Victor , de Lima Rosa Gabriel , Coitinho Adriana Simon , Visioli Fernanda , Belló-Klein Adriane , de Castro Alexandre Luz , Araujo Alex Sander da Rosa 
Published: December 2024

Abstract:
Adrenergic overstimulation is detrimental to the left ventricle. However, its effects on the right ventricle (RV) are not clear. Because adrenergic overload increases metabolic demand and oxidative stress, boldine could be a therapeutic option in the treatment of cardiovascular disease because of its antioxidant role. This study aimed to investigate the impact of adrenergic overload on RV remodeling and the cardioprotective effect of boldine. Animals were divided into 4 groups: control (C), boldine (25 mg/kg i. P.) (B), isoproterenol (ISO) (5 mg/kg subcutaneously), and boldine+isoproterenol (B+ISO). Echocardiography, Fulton index (FI), histology, oxidative stress, inflammation, and β-adrenergic receptor (ADR) were analyzed. The diastolic parasternal length [C 0.698 (0.623–0.724) versus ISO 0.77 (0.73–0.81)], FI [C 0.268 (0.231–0.275) versus ISO 0.340 (0.280–0.353)], inflammatory infiltration (∼40%), and ADR [C 0.78 (0.71–0.84) versus ISO 1.74 (1.52–2.00)] were increased in the ISO group (P < 0.05). Boldine treatment (B+ISO) reduced the FI [0.240 (0.228–0.263)], lipid peroxidation [2.07 (2.01–2.61)], and ADR [0.71(0.62–0.80)]. Boldine increased total SH levels in B+ISO [C 2.4 (1.78–2.71); ISO 4.01 (2.95–4.66) versus B+ISO 6.77(5.15–8.60)] (P < 0.05). There was a positive correlation between lipid peroxidation and the FI, and a negative correlation between total SH and the FI (P < 0.05). This is the first study to explore the effects of adrenergic overstimulation on RV and the protective effect of boldine. Such data pave the way for further research involving RV remodeling, such as in pulmonary hypertension, and a new therapeutic option.
Lip Feminization and Rejuvenation in Patients Assigned Male at Birth With Gender Dysphoria: Our 27-year Experience
Authors: Cárdenas-Camarena Lázaro , Guerrero-García María Teresa , Diaz-Barriga Julio César 
Published: December 2024

Background:
Despite the increasing demand, the combination of lip feminization and rejuvenation in patients assigned male at birth with gender dysphoria is rarely reported in the medical literature. We present our 27 years of experience performing these procedures in this patient population

Methods:
All patients assigned male at birth with gender dysphoria from 1997 to 2023 were included and grouped into 4 age categories. Combined surgical procedures were performed to achieve lip rejuvenation and feminization, with detailed descriptions of the techniques used. Results were evaluated three months postsurgery using the Global Aesthetic Improvement Scale and the Global Satisfaction Scale. Complications and outcomes were documented, and statistical analysis was conducted to compare the differences between the results obtained.

Results:
During a 27-year period, 988 patients underwent 1789 procedures. Of these, 79.8% were younger than 50 years, with the largest group being between 20 and 35 years (47.6%). However, patients older than 65 had the highest average number of procedures (2.4 per patient). The results showed a high degree of improvement and satisfaction on both evaluated scales. There were only 2 hematomas, both resolved without incident. The main issues were volume loss after fat infiltration (14.3%) and poorly positioned scars in lip lifts (13.2%).

Conclusions:
Surgical procedures to feminize and rejuvenate lips can be combined in patients assigned male at birth with gender dysphoria, achieving highly satisfactory results, high patient satisfaction, and few complications
Optimizing Delivery Timing in Pregnant Patients With Chronic Hypertension at Term
Authors: Hamilton Ira , Liu James , Wajahat Labeena , DeFranco Emily A. , Rossi Robert 
Published: December 2024

OBJECTIVE:
To estimate the optimal timing of delivery among pregnant patients with chronic hypertension at term.

METHODS:
We performed a population-based retrospective cohort study including all nonanomalous singleton term (37–42 weeks of gestation) births in the United States from 2014 to 2018 among patients with chronic hypertension, excluding those with superimposed preeclampsia, eclampsia, and pregestational diabetes. The rates of stillbirth, infant death (within 1 year of life), and neonatal morbidity were compared at each week of term pregnancy. Neonatal morbidity was defined as a composite of neonatal intensive care unit admission, ventilation for 6 hours or longer, low 5-minute Apgar score (3 or lower), and seizures. To estimate the optimal delivery timing among pregnant patients with chronic hypertension, the risk of delivery at each week (ie, the rate of infant death or neonatal morbidity) was compared with the risk of expectant management (ie, the rate of stillbirth over that week plus rate of infant death or neonatal morbidity in the subsequent week) for an additional week. Subgroup analyses were performed for pregnancies complicated by fetal growth restriction and among non-Hispanic Black patients with chronic hypertension.

RESULTS:
Among pregnant patients with chronic hypertension at term (N=227,977), the rate of stillbirth (per 10,000 ongoing pregnancies) overall increased with gestational age and was lowest at 38 weeks (6.5, 95% CI, 5.4–7.7). The rates of infant death and neonatal morbidity were lowest at 40 weeks (18.0/10,000 live births, 95% CI, 13.7–23.6) and 39 weeks (637/10,000 live births, 95% CI, 619–654), respectively. The risk of delivery (per 10,000 pregnancies) was higher at 38 weeks of gestation (815, 95% CI, 793–836) compared with the composite risk of expectant management for an additional week (657.7, 95% CI, 640–676); however, at 39 weeks, the risk of delivery was lower (651, 95% CI, 633–670) compared with the composite risk of expectant management for an additional week (750, 95% CI, 720–781).

CONCLUSION:
Among patients with chronic hypertension, delivery at 39 weeks of gestation provides the optimal balance between absolute rates of infant death or neonatal morbidity and stillbirth. This finding is consistent for non-Hispanic Black patients with chronic hypertension and for those pregnancies complicated by fetal growth restriction. This is consistent with current practice guidelines.
Body weight changes in people with HIV starting dolutegravir versus efavirenz-based regimens in a large cohort in rural Tanzania
Authors: Weisser Maja , Mapesi Herry , Vanobberghen Fiona , Okuma James , Eichenberger Anna , Wilson Herieth Ismael , Paris Daniel Henry , Kalinjuma Aneth Vedastus , Luoga Ezekiel , Wilson Lulu , Glass Tracy Renée , Franzeck Fabian Christoph ,   the KIULARCO Study Group
Published: December 2024

Objectives:
To analyze weight changes associated with dolutegravir- versus efavirenz-based antiretroviral therapy (ART) in people with HIV (PWH) in rural Tanzania, where undernutrition is prevalent.

Design:
Longitudinal, observational study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO).

Methods:
We included adult, ART-naïve, nonpregnant PWH initiating efavirenz-based ART 12/2016–02/2019 or dolutegravir-based ART 03/2019–12/2022. We used multivariable linear mixed-effects models to assess adjusted weight changes during 18 months after ART start and Cox regression models to assess factors associated with incident obesity, weight gain ≥10% and hypertension.

Results:
Of 1205 PWH at ART start [median age 40 years (interquartile range (IQR) 32–48); 719 (59.7%) females], 166 (13.8%) individuals were underweight and 317 (26.3%) overweight/obese; 621 (51.5%) initiated efavirenz-based and 584 (48.5%) dolutegravir-based ART. After 18 months, estimated weight gain was 5.1 kg [95% confidence interval (CI) 4.7–5.5] in the dolutegravir versus 4.0 kg (95% CI 3.7–4.4) in the efavirenz group. The weight gain difference between treatment groups was high in men (1.7 kg (95% CI 0.8–2.6; P < 0.001)), in those aged 30–49 years (1.5 kg (0.8–2.1); P < 0.001) and those with CD4+ cell count ≥500/ul (2.5 kg (1.4–3.7), P < 0.001)). Cumulative obesity incidence at 18 months was 10.9% (95% CI 8.3–14.0) in the dolutegravir and 5.1% (95% CI 3.6–7.1) in the efavirenz group. Associated factors were dolutegravir and a pre-ART body mass index (BMI) of 25–29 kg/m2. Dolutegravir and age, but not weight gain were associated with incident of hypertension.

Conclusions:
Dolutegravir-based ART was associated with more weight gain, higher obesity and hypertension – especially in those with a higher pre-ART BMI compared to efavirenz-based regimens.
Gadolinium Elimination in a Gadolinium Deposition Disease Population After a Single Exposure to Gadolinium-Based Contrast Agents
Authors: Ramalho Joana , Ramalho Miguel , Semelka Richard C. 
Published: December 2024

Purpose
This study documents the gadolinium (Gd) content in urine over time after the administration of a single dose of Gd-based contrast agent (GBCA) in patients diagnosed with Gd deposition disease.

Materials and Methods
In this retrospective observational study, 45 subjects with normal renal function who had performed 1 contrast-enhanced magnetic resonance imaging and had a nonprovoked (native) 24-hour urine test for Gd quantification after the examination were evaluated. The GBCA brand and the time interval in days between the GBCA administration and 24-hour urine Gd measurements were recorded. Log-log plot visualization of time points for urine Gd content was obtained.

Results
Time points collected for urine Gd content showed that Gd was above the reference levels for 3 months postinjection. The urinary concentration of Gd was similar for all agents, including linear and macrocyclic. The urinary content decreased in a dog-leg fashion. Gd urine content was substantially elevated at 1 month and decreased to remain above the accepted normal range by 3 months.

Conclusions
Gd is retained in the body and shows demonstrable continued spontaneous elimination in urine for at least several months after administration, including the most stable macrocyclic agents. The Gd elimination pattern shows a logarithmic decrease pattern between 1 and 3 months for all agents, regardless of their structure.
A Solid Pseudopapillary Tumor of the Pancreas Incidentally Detected by 68Ga-Pentixafor PET/CT in a Patient With Primary Aldosteronism
Authors: Chen Xiang , Xing Yan , Liu Changcun , Zhang Rui , Zhao Jinhua 
Published: December 2024

Abstract
A 27-year-old woman underwent 68Ga-pentixafor PET/CT for primary aldosteronism localization and characterization. No functional adrenal nodules were detected by 68Ga-pentixafor PET/CT, whereas a hypodense nodule with focal pentixafor uptake was incidentally discovered in the head of pancreas. Retrospective analysis of contrast-enhanced CT scan revealed a subtly enhancing nodule devoid of calcification in the pancreatic head. Pancreatic cancer cannot be excluded. 18F-FDG PET/CT was suggested, and the scan showed an FDG-avid lesion in the same region. Needle biopsy was performed, and the pathological result is solid pseudopapillary tumor, a rare pancreatic tumor of low malignant potential.
Early Diagnosis and Prognostic Prediction of Colorectal Cancer through Plasma Methylation Regions
Authors: Zhu Lingqin , Yang Lang , Men Fangli , Yu Jianwei , Sun Shuyang , Li Chenguang , Ma Xianzong , Xu Junfeng , Li Yangjie , Tian Ju , Wang Xin , Xie Hui , Kang Qian , Duan Linghui , Yi Xiang , Guo Wei , Gong Xueqing , Guo Ni , Lu Youyong , Leung Joseph , He Yuqi , Sheng Jianqiu 
Published: December 2024

AbstractThe methylation of plasma cell-free DNA (cfDNA) has emerged as a valuable diagnostic and prognostic biomarker in various cancers including colorectal cancer (CRC). Currently, there are no biomarkers that serve simultaneously for early diagnosis and prognostic prediction in CRC patients. Herein, we developed a plasma panel (27 DMRs, differential methylated regions) and validated its superior performance across CRC diagnosis and prognosis prediction in an independent cohort. We first conducted a preliminary screening of 119 CRC tissue samples to identify CRC-specific methylation features. Subsequently, a CRC-specific methylation panel was developed by further filtering 161 plasma samples. Then machine learning algorithms were applied to develop diagnosis and prognosis models using cfDNA samples from 51 CRC patients and 33 normal controls. The diagnosis model was tested in a cohort consisting of 30 CRC, 37 advanced adenoma (AA), and 14 healthy plasma samples, independently validated in a cohort consisting of 18 CRC, 91 NAA, 23 AA and 34 healthy plasma samples. In the tissue external validation cohort (GSE48684), the cfDNA methylation diagnosis model conducted with the panel, have the area under the curve (AUC) reached 0.983, and for the plasma cfDNA model in the external validation cohort, the sensitivities for NAA, AA and CRC 0 -Ⅱ are 48.4%. 52.2% and 66.7% respectively, with a specificity of 88%. Additionally, the panel was applied to patient staging and metastasis, performing well in predicting CRC distant metastasis (AUC = 0.955) and prognosis (AUC = 0.867). Using normal samples as control, the changes in methylation score in both tissue and plasma were consistent across different lesions, although the degree of alterations varied with severity. The methylation scores vary between paired tissue and blood samples, suggesting distinct mechanisms of migration from tumor tissue to blood for the 27 DMRs. Together, Our cfDNA methylation models based on 27 DMRs can identify different stages of CRC and predict metastasis and prognosis, ultimately enabling early intervention and risk stratification for CRC patients.
A penalized distributed-lag non-linear model for modeling the joint delayed effect of two predictors: impact of minimum and maximum temperature on mortality
Authors: Rutten Sara , Duarte Elisa , Neyens Thomas , Lauwaet Dirk , Faes Christel 
Published: December 2024

SummaryDistributed lag non-linear models (DLNMs) offer a flexible approach towards modelling time-delayed exposures. They are popular to study the effect of environmental exposure on health outcomes, such as the effect of temperature on mortality. Conventional distributed lag non-linear models typically focus on a single exposure variable, potentially overlooking complex interactions between multiple predictors. In this paper, we propose a distributed lag non-linear model that captures the joint delayed impact of two exposure variables by incorporating their interaction through a tensor basis constructed from univariate P-splines. This model is compared to a model assuming an additive effect of delayed exposures. Our model is used to examine the joint impacts of maximum and minimum temperatures on all-cause mortality in Flanders during summer. The results show that our model provides a flexible strategy towards the analysis of two predictors with interacting time-delayed effects on an outcome of interest. The importance of both maximum and minimum temperatures in explaining variability in mortality is illustrated, and we show that the interaction effect varies across age and gender groups. A spatial risk analysis at the municipality level reveals that mortality is attributed differently to temperature exposure across different areas, due to temperature variations as well as spatial trends in age and gender.
Macropinocytosis controls metabolic stress-driven CAF subtype identity in pancreatic cancer
Authors: Zhang Yijuan , Ling Li , Maganti Swetha , Hope Jennifer L. , Galapate Cheska Marie , Carrette Florent , Duong-Polk Karen , Bagchi Anindya , Scott David A. , Lowy Andrew M. , Bradley Linda M. , Commisso Cosimo 
Published: December 2024

SummaryPancreatic ductal adenocarcinoma (PDAC) tumors are deficient in glutamine, an amino acid that tumor cells and CAFs use to sustain their fitness. In PDAC, both cell types stimulate macropinocytosis as an adaptive response to glutamine depletion. CAFs play a critical role in sculpting the tumor microenvironment, yet how adaptations to metabolic stress impact the stromal architecture remains elusive. In this study, we find that macropinocytosis functions to control CAF subtype identity when glutamine is limiting. Our data demonstrate that metabolic stress leads to an intrinsic inflammatory CAF (iCAF) program driven by MEK/ERK signaling. Utilizingin vivomodels, we find that blocking macropinocytosis alters CAF subtypes and reorganizes the tumor stroma. Importantly, these changes in stromal architecture can be exploited to sensitize PDAC to immunotherapy and chemotherapy. Our findings demonstrate that metabolic stress plays a role in shaping the tumor microenvironment, and that this attribute can be harnessed for therapeutic impact.Graphical Abstract