bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glans ischaemia after circumcision in adult males: A two-patient case series and a narrative review of the literature
Authors: Schifano Nicolò , Capogrosso Paolo , Villano Alessio , Baldini Sara , Antonini Gabriele , Deho’ Federico 
Published: August 2024

Introduction: Glans necrosis after circumcision is an exceedingly rare complication among adult males, with only a handful of cases being reported in the literature. Materials and methods: We present here two cases of glans ischaemia observations after circumcision in both a 19-year-old and a 26-year-old patient; both were managed with oral medications in the outpatient setting, with complete restitutio-ad-integrum. A narrative review of the literature was also performed to better describe the possible predisposing factors; the treatment/management options; and the typical outcomes among the adult males experiencing with this complication. Results: Penile dorsal anaesthetic blocks, monopolar cautery usage and compressive wound dressing are all reported to play a role as co-factors for glans ischaemia after circumcision, hence their adoption should be mindful. There is no consensus on the management of ischaemia of the glans after male circumcision. Conclusions: The favourable outcomes being reported for most of the literature cases of glans ischaemia after circumcision among adults despite the adoption of diverse empirical therapeutic strategies suggest that the role of the proactive management may be questionable.
Snodgrass (tubularized incised plate) versus Mathieu repair of distal hypospadias: A systematic review and meta-analysis of randomized controlled trials
Authors: Borkar Nitinkumar , Tiwari Charu , Nair Abhijit , Das Kanishka , Sinha Chandrasen K 
Published: August 2024

Introduction: Distal hypospadias accounts for the majority of hypospadias. Mathieu and Snodgrass techniques are widely used for repair of distal hypospadias but their comparative efficacy and reported outcomes are still debated. We conducted a systematic review and meta-analysis to compare the outcomes of these two techniques. Methods: Electronic databases and trial registries were searched for randomized controlled trials (RCTs) comparing Mathieu and Snodgrass techniques for primary distal hypospadias repair. Outcome measures included complication rates and cosmetic outcomes. Risk of bias assessment was performed using the ROB2. Data was analyzed using Review Manager 5.4; Trial Sequential Analysis (TSA) also was conducted for important outcomes. Results: Twelve RCTs were eligible for inclusion. The Snodgrass technique showed a significantly lower incidence of urethrocutaneous fistula (UCF) (RR 0.48, 95% CI [0.30–0.77]). However, there was no significant difference in the incidence of meatal stenosis (MS) between the two (RR 1.64, 95% CI [0.85–3.15]). TSA supports the findings for outcome UCF but not for MS. Operative time was shorter with the Snodgrass technique. Conclusion: This SRMA indicates a lower incidence of UCF with Snodgrass technique compared to the Mathieu technique in distal hypospadias repair. However, there was no significant difference in the risk of MS.
Deictic Gesture Production in Children with Autism Spectrum Disorder, Down Syndrome, and Typically Developing Children During Dyadic Interaction
Authors: Monish V.  , Catherine S. PowlinArockia , Rajasekar M. K. 
Published: August 2024

Background: Deictic gestures are the first intentional form of communication that predict the emergence of first words. Deictic gestures include reaching, pointing, giving, and showing. Method: Forty-five Tamil-speaking children (28 male and 17 female) and their parents participated in this study. They were divided into three groups (ASD, DS, and TD). The parents were instructed to play and interact with their children, as they do at home, using the provided toy set, and this session was video-recorded. Deictic gestures such as reaching, pointing, giving, and showing were analyzed with a specific coding scheme. Results: On a Kruskal–Wallis test, a statistically significant difference across the three groups ( P < .05) was obtained for the total frequency of deictic gestures, use of pointing, giving, and showing gestures. The total frequency of deictic gestures and their types, such as pointing, giving, and showing gestures, used by the ASD group was less compared to the DS and TD groups. Conclusion: This study highlighted that, along with speech and language difficulties, children with ASD have deficits in producing deictic gestures. Children with DS have speech and language difficulties, but they use deictic gestures in order to communicate with their parents during interaction. This varied profile of deictic gesture use can be used for early identification, differential diagnosis, and setting intervention goals.
Achieving gender equity in academic psychiatry – barriers to involvement and solutions for success
Authors: Galbally Megan , Kotze Beth , Bell Caroline , Quadrio Carolyn , Galletly Cherrie , Herrman Helen , Milroy Helen , Curtis Jackie , Green Jessica , Power Josephine , Hope Judy , Sevar Katherine , Dean Kimberlie , Northwood Korinne , Lampe Lisa , Kalucy Megan , Korman Nicole , Lautenschlager Nicola , Warren Nicola , Chua Phyllis , Anglin Rebecca , De Alwis Seneviratne Ruwanthi , Loi Samantha , Burton Sara , Arunogiri Shalini , Morgan Shirlony 
Published: August 2024

Objective Women face considerable barriers in pursuing careers in academic psychiatry. Methods A group of Australian and New Zealand academic women psychiatrists convened in September 2022 to identify and propose solutions to increase opportunities for women in academic psychiatry. Results Limiting factors were identified in pathways to academia including financial support, engagement and coordination between academia and clinical services, and flexible working conditions. Gender biases and the risk of burnout were additional and fundamental barriers. Potential solutions include offering advanced training certificates to enable trainees to commence a PhD and Fellowship contemporaneously; improved financial support; expanding opportunities for research involvement; establishing mentoring opportunities and communities of practice; and strategies to enhance safety at work and redress gender bias and imbalance in academia. Conclusions Support for women in research careers will decrease gender disparity in academic psychiatry and may decrease problematic gender bias in research. Fellows and trainees, the RANZCP, universities, research institutes, governments, industry and health services should collaborate to develop and implement policies supporting changes in working conditions and training. Facilitating the entry and retention of women to careers in academic psychiatry requires mentoring and development of a community of practice to provide and enable support, role modelling, and inspiration.
Correlation Between Serum and CSF Concentrations of Midazolam and 1-Hydroxy-Midazolam in Critically Ill Neurosurgical Patients
Authors: Farrar Julie E. , Stefanos Sylvia S. , Cava Luis , Kiser Tyree H. , Mueller Scott W. , Neumann Robert , Reynolds Paul M. , Sherman Deb S. , MacLaren Robert 
Published: August 2024

Background: Midazolam (MZ) is commonly used in critically ill neurosurgical patients. Neuro-penetration of MZ and its metabolite, 1-hydroxy-midazolam (1-OH-MZ), is not well characterized. Objective: This study evaluated correlations between serum and cerebrospinal fluid (CSF) concentrations of MZ and 1-OH-MZ and assessed implications on patient sedation. Methods: Adults in the neurosurgical intensive care unit (ICU) with external ventricular drains receiving MZ via continuous infusion were prospectively studied. Serum and CSF samples were obtained 12-24 h and 72-96 h after initiation, and concentrations were determined in duplicate by high-performance liquid chromatography with tandem mass spectrometry. Bivariate correlation analyses used Pearson coefficient. Results: A total of 31 serum and CSF samples were obtained from 18 subjects. At sampling, mean MZ infusion rate was 3.9 ± 4.4 mg/h, and previous 12-h cumulative dose was 51.4 ± 78.2 mg. Mean concentrations of MZ and 1-OH-MZ in serum and CSF were similar between timepoints. Similarly, ratios of 1-OH-MZ to MZ in serum and CSF remained stable over time. Serum MZ (126.2 ± 89.3 ng/mL) showed moderate correlation (r2 = 0.68, P < 0.001) with serum 1-OH-MZ (17.7 ± 17.6 ng/mL) but not CSF MZ (3.9 ± 2.5 ng/mL; r2 = 0.24, P = 0.005) or CSF 1-OH-MZ (2.5 ± 0.6 ng/mL; r2 = 0.47, P = 0.30). CSF MZ did not correlate with CSF 1-OH-MZ (r2 = 0.003, P < 0.001). Mean serum ratio of 1-OH-MZ to MZ (0.14 ± 0.2 ng/mL) did not correlate with CSF ratio (1.06 ± 0.83 ng/mL; r2 = 0.06, P = 0.19). Concentrations and ratios were unrelated to MZ infusion rate or 12-h cumulative dose. Sedation was weakly correlated with CSF 1-OH-MZ, but not with serum MZ, serum 1-OH-MZ, or CSF MZ. Conclusion and Relevance: Continuous infusions of MZ result in measurable concentrations of MZ and 1-OH-MZ in CSF; however, CSF concentrations of MZ and 1-OH-MZ poorly represent serum concentrations or dosages. Accumulation of MZ and 1-OH-MZ in serum or CSF over time was not evident. Concentrations of MZ and 1-OH-MZ do not predict sedation levels, reinforcing that pharmacodynamic assessments are warranted.
Peripheral venous dilation using flow-mediated dilation response: A randomized crossover study
Authors: Endo Hiroya , Sekiguchi Ryo , Kinoshita Michiko , Tanaka Katsuya 
Published: August 2024

Background: Venodilation is crucial in enhancing the success rate of peripheral intravenous cannulation. Flow-mediated dilation (FMD) is a vasodilatory response initiated by temporary ischemia followed by reperfusion. This crossover study aimed to test the hypothesis that FMD induces dilation of the peripheral veins of the forearm. Methods: Fifteen healthy volunteers underwent the FMD and control conditions in a randomized order. FMD involved a 5-min occlusion of blood flow in the brachial artery, followed by reperfusion, achieved by inflating and deflating a cuff placed on the upper arm. The control condition involved participants remaining at rest. The primary outcome measure was a change in the cross-sectional area of the cephalic vein post-intervention. The secondary outcomes included changes in venous diameter and perfusion index (PI). Results: FMD significantly increased the cross-sectional area of the cephalic vein compared with the control condition (relative change to baseline: 37.7% (31.4) vs 2.2% (11.7)), with a mean difference of 35.4% (95% confidence interval (CI): 16.4–54.5, p = 0.001). Both longitudinal and transverse diameters were significantly expanded with FMD compared to the control (relative change to baseline: 15.7% (15.4) vs 2.6% (3.6), p = 0.004; 18.9% (15.6) vs −0.0 (10.2), p = 0.003, respectively). Additionally, PI significantly increased with FMD compared with the control (relative change to baseline: 77.8% (56.9) vs 14.6% (36.0)), with a mean difference of 63.2% (95% CI: 31.2–95.2, p = 0.001). Conclusion: FMD application induced dilation of the cephalic vein of the forearm. The findings suggest that FMD is an effective technique for dilating the venous area and potentially improving the success rate of peripheral intravenous cannulation.
Stagnation in old age mortality among Finnish women: cause-of-death decomposition of life expectancy trends by income
Authors: Malmberg Satu , Tarkiainen Lasse , Junna Liina , Martikainen Pekka 
Published: August 2024

Aims: The decline in old age mortality and subsequent increase in life expectancy among older women has stalled in some high-income countries. The contribution of causes of death to and sub-group variations in these trends are generally not well understood. We assess trends in mortality and cause-of-death decomposition of life expectancy by income over the past 30 years in Finland. Methods: We obtained total population, annual register-based data on individuals (aged 30–89 years) residing in Finland in 1991–2020. We examined the trends in age-specific mortality rates and decomposed the contribution of various causes of death to changes in partial life expectancy among women aged 65–79 years over time and within each income quintile. In addition, we estimated life expectancy trends for the total population and by income quintile with and without causes related to alcohol consumption and smoking. Results: Our results indicate stagnation in mortality development among women in Finland aged 65–79 years. The slowdown of improvements in circulatory and heart disease mortality contributed substantially to the observed stagnation, although similar trends were observed in virtually all the causes of death we studied. The lowest income groups experienced the most adverse developments during the study period. Conclusions: The stagnating life expectancy observed among Finnish women cannot be attributed solely to one cause of death. In contrast to findings on the topic from many other developed countries, smoking-related causes of death were of little significance. The stagnation is linked to growing inequality in mortality development among older women in Finland, which affects the overall trend.
The risk of long-term opioid use among immigrants: a national registry-linkage study
Authors: Nestvold Håkon H. , Skurtveit Svetlana , Hamina Aleksi , Hjellvik Vidar , Odsbu Ingvild 
Published: August 2024

Aims: We aimed to investigate the association between being an immigrant and long-term prescription opioid use in Norway in 2010–2019. Methods: Nested case–control study. The cases were all persons 18 years of age or older with long-term opioid use – that is, the use of prescription opioids longer than 3 months ( N=215,642). Cases were matched to four controls who filled at least one opioid prescription, but never developed long-term opioid use in the study period ( N=862,568) on sex, age and year of starting long-term/short-term opioid use. Being an immigrant was defined as being born outside of Norway to two foreign-born parents and four foreign-born grandparents. Adjusting for socioeconomic variables and clinical confounders, analyses were stratified on three age groups (18-44 years, 45-67 years and ⩾68 years). Results: For the youngest age group, being an immigrant was inversely associated with long-term opioid use (adjusted odds ratio 0.75; 95% confidence interval [0.72–0.77]) compared with being native-born people. For this age group, the odds ratio differed between people born in Africa (0.56 [0.52–0.62]), Central or South America (0.70 [0.62–0.79]), Europe outside the European Union (EU) (0.71 [0.65–0.77]), Asia including Turkey (0.80 [0.77–0.84]) and EU/European Economic Area (EEA) (0.81 [0.77–0.85]). For the middle age group, increased odds were found for immigrants versus natives (1.05 [1.02–1.08]) in particular for those born in North America (1.26 [1.13–1.40]) and the EU/EEA (1.13 [1.09–1.18]). There was no association in the oldest group. Conclusions: Compared with native-born people, immigrants had lower odds of long-term opioid use among younger adults, higher odds among middle-aged and similar odds among older adults.
Tumor-Associated Macrophage-Derived TGF-β1 Activates GLI2 via the Smad2/3 Signaling Pathway to Affect Cisplatin Resistance in Lung Adenocarcinoma
Authors: Lan Xiaoling , Wei Dalong , Fang Lini , Wu Xiangsheng , Wu Biaoliang 
Published: August 2024

Background Transforming growth factor-β1 (TGF-β1) is an immunosuppressive cytokine that is highly expressed in the tumor microenvironment (TME) of lung adenocarcinoma (LUAD). TGF-β1 plays important roles in regulating tumor metastasis and chemotherapy resistance. However, the specific molecular mechanisms by which TGF-β1 regulates cisplatin resistance in the TAM of LUAD remain unclear. Materials and methods THP-1 induced macrophages were co-cultured with A549 and H1975 cells, and subsequently transfected with silencing TGF-β1 (siTGF-β1), GLI2 (siGLI2), a GLI2 overexpression plasmid, and their negative controls. Cellular activity was measured by CCK-8 and colony formation assays. Cell apoptosis was evaluated by flow cytometry and TUNEL staining. Transwell assays were performed to assess cell migration and invasion capabilities. The levels of Smad2/3, GLI2, cyclin D, and cyclin E expression were evaluated by qPCR, western blotting, and immunofluorescence methods. TGF-β1 levels were determined by ELISA. Results Macrophages suppressed the apoptosis and promoted the migration and invasion of LUAD cells. TAM siTGF-β1 downregulated the Smad2/3 signaling pathways and GLI2 expression, deceased cell proliferation, and promoted apoptosis. SiGLI2 increased apoptosis and decreased the proliferation of LUAD cell lines. GLI2 decreased cisplatin resistance in LUAD cells. Conclusion High expression of TGF-β1 in the TAM positively activates GLI2 expression via the Smad2/3 pathway, which subsequently regulates cyclin D and cyclin E expression, and promotes the cisplatin resistance of LUAD.
Clinical outcome of elbow extension restoration by posterior deltoid-to-triceps transfer in tetraplegia: a retrospective review of 51 patients
Authors: Schibli Silvia , Koch-Borner Sabrina , Arnet Ursina , Fridén Jan 
Published: August 2024

In this study, we report the functional and perceived outcomes of 51 posterior deltoid-to-triceps transfers in patients with tetraplegia. With a minimum follow-up of 12 months, patients were divided into two subcategories based on preoperative posterior deltoid strength: Medical Research Council (MRC) 3 and MRC 4/5. At 12-month follow-up, all patients achieved antigravity elbow extension. Patients with a stronger posterior deltoid (MRC 4/5) attained an elbow extension with a strength grade MRC 3.7 (SD 0.6), while those with a weaker posterior deltoid (MRC 3) reached an elbow extension of MRC 3.1 (SD 0.6). Patient-reported outcome measure was evaluated using the Canadian Occupational Performance Measure (COPM) and demonstrated a significant improvement for both performance and satisfaction. No difference in the COPM scores could be found between the two subcategories. This study indicates that tetraplegic patients with a posterior deltoid strength grade of both MRC 4/5 as well as MRC 3 benefit from the procedure. Level of evidence: III
Virtual global health education partnerships for health professional students: a scoping review
Authors: Lenhard Nora K. , An Crystal , Jasthi Divya , Laurel-Vargas Veronica , Weinstein Ilon , Lam Suet K. 
Published: August 2024

Introduction: Although there is rising interest in virtual global health (GH) education in light of the COVID-19 pandemic, there has been no report on the body of literature describing virtual education partnerships for health professional students. This scoping review examines virtual GH partnerships involving health professional students, including any barriers identified or best practices and ways to address them. Methods: We searched PubMed for studies describing virtual GH education partnerships using keywords related to GH, virtual learning, and partnerships. Inclusion criteria were that the activity was virtual, involved health professional students in two or more countries, and was reported in English or Spanish. In-person clinical electives and interventions that had not yet occurred were excluded. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Results: The search algorithm yielded 308 articles. Seventeen studies met full inclusion criteria. Four studies described asynchronous formats, whereas 13 were synchronous. Common challenges included scheduling challenges, language barriers, and technological limitations. Suggested improvements included having increased faculty support and expanding partnerships to multiple languages. The median MERSQI score was 8.25 out of 18 possible points. Conclusion: There are limited studies investigating the effectiveness of virtual GH education partnerships, and more robust evaluation is needed to further understand the optimal role of virtual education in teaching GH skills. Despite logistical challenges, virtual partnerships can provide innovative GH education through bidirectional educational exchanges that students find valuable.
Rigidone or ent-perezone?
Authors: Bucio-Vásquez Ma Alvina , Fuentes-Figueroa Miguel Ángel , Hernández-Barragan Angelina , Zepeda-Vallejo Luis Gerardo , Burgueño-Tapia Eleuterio , Joseph-Nathan Pedro 
Published: August 2024

Introduction The 13C-NMR data described for perezone (1), a 3-hydroxy p-quinone stated as the first natural product isolated as crystals in the New World, and rigidone (2), a 4-hydroxy o-quinone isolated from a coral species, are essentially the same. Some years ago, we described, using theoretical calculations, that a 4-hydroxy-1,2-quinone is more than 11 kcal/mol less stable than a 3-hydroxy-1,4-quinone making coexistence in nature of this type of quinones. In the present study, we approach the situation by comparing of the experimental 13C-NMR data for 1 and those described for 2 with the calculated using computational methods. Additional evidence was obtained from a X-ray diffraction analysis for the reaction product of perezone with o-phenylendiamine. Methods The 13C-NMR data for the quinoid rings were calculated using the GIAO and CSGT methods, density functional theory (DFT) and the functional/basis set pairs B3LYP/6-31 g(d,p) and MPW1PW91/6-31 g(d,p); and TPSSTPSS/cc-PVTZ and PBE1PBE/aug-cc-PVDZ. Perezone reaction with o-phenylenediamine was achieved using a described method in MeOH at room temperature. X-Ray diffraction analysis of phenazine from perezone reaction was done using Mo Kα radiation. The data were used to calculate the Flack parameter. Results After conformational analysis, complete optimization of the geometry of the conformers found and, calculation of the 13C-NMR chemical shifts for the quinone ring of 1 and 2, in all cases a better agreement was observed between the experimental data for 1 versus 2. Perezone reaction with o-phenylenediamine afforded the corresponding phenazine in its amine-keto tautomeric form as evidenced from a X-ray diffraction study. Conclusion The better agreement observed between the experimental and calculated data for 1 versus 2, along with the free energy difference of more than 11 kcal/mol in favor of the 3-hydroxy p-quinone versus 4-hydroxy o-quinone, previously established for us, allow to say that the structure described for rigidone corresponds to ent -perezone.
Lower Extremity Hockey Puck Impaction Fractures in Professional Hockey Players: A Case Series and Review of the Literature
Authors: Ambus Nicholas G. , Swiergol Max , Sherman Nathan C. , Latt Leonard Daniel 
Published: August 2024

Hockey is a contact sport notorious for injuries. The hockey puck is a projectile that can impart substantial energy when it impacts a player. Hockey puck impact is a frequent and underreported cause of injury. This case report describes the clinical course of 3 professional hockey players who sustained injuries to the lower leg and ankle from projectile hockey pucks. Each player sustained a unique injury with associated complications affecting return to play. We aim to bring attention to this injury mechanism that can cause significant morbidity among players. Levels of Evidence: IV