bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Sudarshan Kriya Yoga (SKY) on the stress and self-esteem of medical doctors in a tertiary care hospital: a prospective analytical study
Authors: Khadka Bharat , Dhakal Bishal , Dhakal Binaya , Adhikari Purushottam , Piya Utsav , Ghimire Shreejan , Dawadi Sagun , Pasakhala Kshitiz , Mahat Krish , Adhikari Suman Prasad , Manandhar Pradeep , Mansingh Yujal 
Published: June 2024

Objectives:
Sudarshan Kriya Yoga (SKY) is a unique yoga practice incorporated into the Art of Living course. It is found to have a beneficial effect on different psychiatric disorders. This study was conducted to investigate the impact of SKY practice on stress and self-esteem among medical doctors.

Materials and methods:
A prospective study was conducted among medical doctors (interns, residents, and consultants) in a tertiary care center. The Perceived Stress Scale and Rosenberg Self-Esteem Scale were used for the assessment of stress and self-esteem levels, respectively. The parameters were assessed at baseline, 3-day and 40-day follow-up of SKY practice. The statistical analysis was performed using Statistical Package for Social Sciences, version 25.

Results:
A total of 58 participants were included in the study. The scores for stress decreased (19.07 to 18.62 to 16.33) and self-esteem levels increased (19.09 to 19.64 to 20.81) after the practice signifying the beneficial impact. It was statistically significant (P<0.05) with considerable effect sizes (Cohen’s d 0.2–0.5 and >0.5 for self-esteem and stress levels, respectively). On MANOVA, gender (more in male participants) was significantly associated with stress levels even after the practice of SKY (P=0.042).

Conclusion:
Amid the hectic schedule, regular practice of SKY is proven beneficial for medical doctors with its positive impact on stress, and self-esteem levels by our study.
Coexisting trichorrhexis nodosa and pili annulati: a case report of hair shaft abnormalities in a Syrian family
Authors: Roumi Jamal Bakri , Breim Fatima , Zakour Joud , Marachli Besher , Abubakir Malaka , Abdul Rahman Noura , Ishkhanian Silva 
Published: June 2024

Introduction:
Pili annulati (PA) and trichorrhexis nodosa (TN) are rare genetic hair disorders. PA presents with sparkly, spotted hair due to air-filled cavities in the cortex, mainly affecting the scalp. TN causes brittle, breakable hair shafts, often due to physical or chemical damage.

Case Presentation:
A 23-year-old Syrian woman presented with glistening, brittle hair and whitish nodules since puberty, reminiscent of TN. Trichoscopy confirmed TN alongside PA, displaying characteristic dark-light bands. Interestingly, TN breakage occurred within the PA bands. Her aunt displayed similar TN patterns. Microscopy revealed ring-like structures and a ‘thrust paint brush’ appearance, indicative of TN, within PA-affected regions. Management included avoidance of hair treatments and prescription of vitamins and minoxidil to enhance hair strength and density.

Discussion:
PA is usually congenital and autosomal dominant, often without causing hair fragility. However, some cases report fragility, particularly in light bands. While PA is typically benign, its combination with TN underscores the complexity of hair shaft disorders. Only five such cases exist. Proposed causes for PA and TN include genetic factors and hair shaft abnormalities. PA’s fragility may stem from band stiffness differences and lower cysteine content. Treatment is typically unnecessary, but avoiding excessive heat styling is advised.

Conclusion:
This case highlights the rare co-occurrence of PA and TN, emphasizing the need for further research into their relationship and potential systemic associations. Understanding the underlying mechanisms is crucial for informing treatment and counseling patients effectively, especially considering the rarity of this association.
Post-cholecystectomy clip migration: an unusual nidus of choledocholithiasis: a case report
Authors: Kafle Pradip Kumar , Pokhrel Biraj , Bhattrai Tulsiram , Lamsal Manoj , Kafle Brindeswari , Jha Anurag , Hamal Rabin , Pathak Rahul 
Published: June 2024

Introduction and importance:
Laparoscopic cholecystectomy is one of the common surgeries occurring worldwide and the gold standard for the management of gallstone disease. The non-absorbable surgical clips may slip and can migrate causing a variety of problems as such, choledocholithiasis.

Case presentation:
The authors report a case of 43-year-old female who presented with the complaint epigastric pain. She had undergone cholecystectomy 7 years back for symptomatic cholelithiasis. Ultrasonography of the abdomen showed a dilated common bile duct following which endoscopic retrograde cholangiopancreatography was done. A single black-colored stone with the metal clip was retrieved.

Clinical discussion:
Post-cholecystectomy clip migration should be considered as one of the differentials for choledocholithiasis. Ultrasonography of the abdomen shows the dilated common bile duct. Further management is done by endoscopic retrograde cholangiopancreatography.

Conclusion:
Surgical clips acting as nidus for choledocholithiasis is rare these days but should be considered as one of the differentials for pain abdomen.
The Effect of Self-efficacy–Enhancing Interventions on Quality of Life of Cancer Survivors
Authors: Yan Kailei , Lengacher Cecile A. , Dandamrongrak Chawisa , Wang Hsiao-Lan , Hanson Ardis , Beckie Theresa 
Published: June 2024

Background
The influence of self-efficacy–enhancing interventions on quality of life (QOL) is not clear with recent randomized controlled trials (RCTs) because current reviews only evaluated self-efficacy as an outcome.

Objectives
We conducted a systematic review to examine the effect of self-efficacy–enhancing interventions on QOL among patients with cancer and to summarize the effective determinants for designing self-efficacy–enhancing interventions.

Methods
A systematic search was performed on studies published from January 2003 to May 2023 using PubMed, CINAHL, PsycINFO, and Web of Science. Included studies were RCTs, adults diagnosed with cancer, interventions with explicit self-efficacy components, and QOL as the outcome.

Results
Nineteen RCTs were included. Risk-of-bias assessment revealed 12 studies with some concerns and 7 with high risk of bias. The mean intervention adherence rate was 88.2%; the most frequently listed reason for dropout was medical conditions and mortality. Self-efficacy interventions were shown to significantly improve at least 1 subscale of QOL in 9 of 19 studies, of which 7 studies used Bandura’s 4 sources of self-efficacy. The interventions with between-session intervals shorter than 2 weeks, of 12-week duration, and with an in-person delivery approach were the most effective.

Conclusions
Self-efficacy–enhancing interventions show potential beneficial effects on QOL among cancer survivors. Interventions that use Bandura’s 4 sources of self-efficacy strategies and have between-session intervals shorter than 2 weeks, an in-person approach, and 12-week intervention duration are recommended.

Implications for practice
Properly designed self-efficacy–enhancing interventions can facilitate behavioral change and improve QOL in cancer survivors.
Breast Surgery in Adolescents
Authors: Hassan Bashar , Zeitouni Ferris , Ascha Mona , Sanders Renata , Berger Zackary , Fields Errol , Liang Fan 
Published: June 2024

Purpose
Both breast reduction surgery (BRS) in adolescent girls and chest masculinization surgery (CMS) transgender and nonbinary (TGNB) individuals improve physical discomfort and psychological well-being. Nonetheless, CMS in adolescents is highly contested due to concerns regarding safety and capacity for consent. Here, we compare both procedures to quantify trends in incidence, minimum age, and surgical outcomes.

Methods
The National Surgical Quality Improvement Program database was queried from 2018 to 2021 for cisgender and TGNB adolescents 18 years or younger who underwent BRS or CMS. Our primary outcome was the incidence of postoperative complications within 30 days of surgery. Multivariate logistic regression was performed to determine if CMS was associated with postoperative complications.

Results
Of 2504 adolescents, the majority (n = 2186 [87.3%]) were cisgender female patients who underwent BRS, compared with TGNB adolescents (n = 318 [12.7%]) who underwent CMS. BRS patients were younger at time of surgery (mean [SD] 16.7 [1.2], 17.5 [0.9]; P < 0.001). The minimum age for BRS was consistently 2 to 3 years younger than that for CMS (12.1 to 12.6 years vs 14.0 to 15.1 years). A comparable frequency of BRS and CMS patients developed 1 or more complications within 30 days of surgery (n = 98 [4.5%], n = 13 [4.1%]; P = 0.775).

Conclusion
Cisgender female adolescents undergo breast surgery at a 7-fold rate compared with TGNB adolescents and do so at significantly younger ages. Given the favorable effects of BRS and CMS on psychosocial well-being and their comparable surgical risk of complications, our data help recontextualize the concerns surrounding adolescent CMS.
Indocyanine Green Angiography for Detecting Quantitative Perfusion Changes in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Second Venous Drainage
Authors: Kramer Aviv , Lava Christian X. , Li Karen R. , Berger Lauren E. , Khayat Elias , Song David H. 
Published: June 2024

Background
This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions.

Methods
Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected.

Results
Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively (P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively (P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively (P = 0.012).

Conclusion
These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.
Clinical Insights and Optimization of Surgical Approach for Lateral Femoral Cutaneous Nerve Injury/Entrapment
Authors: Rowley Emma , Suresh Rachana , de Rutier A. Godard , Dellon Lee , Tollestrup Tim W. 
Published: June 2024

Background
Entrapment or injury of the lateral femoral cutaneous nerve (LFCN) is being recognized with increasing frequency, often requiring a surgical approach to relieve symptoms. The presence of anatomic variations can lead to errors in diagnosis and intraoperative decision-making.

Methods
This study presents the experience of a single surgeon (T.W.T.) in managing 184 patients referred with clinical issues related to the LFCN. A comprehensive review of these cases was conducted to develop a prospective surgical management algorithm. Data on the LFCN's anatomic course, pain relief outcomes, comorbidities, body mass index, and sex were extracted from patients' medical charts and operative notes. Pain relief was assessed subjectively, categorized into “excellent relief” for complete pain resolution, “good” for substantial pain reduction with some residual discomfort, and “failure” for cases with no pain relief necessitating reoperation.

Results
The decision tree is dichotomized based on the mechanism of LFCN pathology: compression (requiring neurolysis) versus history of trauma, surgery, and/or obesity (requiring resection). Forty-seven percent of the patients in this series had an anatomic variation. It was found that failure to relieve symptoms of compression often indicated the presence of anatomic variation of the LFCN or intraneural changes consistent with a neuroma, even if adequate decompression was achieved. With respect to pain relief as the outcome measure, recognition of LFCN anatomic variability and use of this algorithm resulted in 75% excellent results, 10% good results, and 15% failures. Twenty-seven of the 36 failures originally had neurolysis as the surgical approach. Twelve of those failures had a second surgery, an LFCN neurectomy, resulting in 10 excellent, 1 good, and 1 persistent failure.

Conclusion
This article establishes an algorithm for the surgical treatment of MP, incorporating clinical experience and anatomical insights to guide treatment decisions. Criteria for considering neurectomy may include a history of trauma, prior local surgery, anatomical LFCN variations, and severe nerve damage due to chronic compression.
Balancing the Scales
Authors: Ewing Jane N. , Niu Ellen F. , Amro Chris , Gala Zachary , Lemdani Mehdi S. , Chang Ashley E. , Broach Robyn B. , Serletti Joseph M. , Fischer John P. 
Published: June 2024

Introduction
The prevalence of obesity has risen worldwide, posing a problem to surgeons as obesity is a well-known risk factor for surgical outcomes. While prior studies have suggested performing reduction mammaplasty (RM) in patients with obesity, the variance in outcomes and quality of life (QoL) for obesity classes are ill-defined. We investigated whether obesity classes should be considered for RM by examining the surgical outcomes and QoL across different weight classes, aiming to pinpoint when outcomes become less favorable.

Methods
Patients undergoing RM by nine surgeons from 2016 to 2022 were included. Body mass index (BMI) cohorts were formed according to the Center for Disease Control and Prevention (CDC) guidelines: Healthy (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obesity class I (30–34.9 kg/m2), II (35–39.9 kg/m2), and III (>40 kg/m2). QoL was assessed by comparing preoperative and postoperative BREAST-Q scores within cohorts. A comparison analysis was performed between weight classes.

Results
A total of 461 RM patients were identified (healthy: 83, overweight: 178, I: 142, II: 39, III: 19). Percentage of Black patients, procedure length, weight of tissue removed, and inferior pedicle technique all significantly increased as BMI increased (P < 0.001). Higher BMI cohorts, especially class III, had significantly higher rates of surgical site infections (healthy: 0%, overweight: 1.1%, I: 1.4%, II: 0%, III: 15.8%, P < 0.01), fat necrosis (healthy: 1.2%, overweight: 5.1%, I: 7%, II: 0%, III: 22.2%, P = 0.01), dehiscence (healthy: 3.6%, overweight: 2.8%, I: 2.1%, II: 5.1%, III: 31.6%, P < 0.01), delayed healing (health: 4.8%, overweight: 11.2%, I: 16.9%, II: 28.2%, III: 42.1%, P < 0.01), minor T-point breakdown (healthy: 10.8%, overweight: 15.7%, I: 23.9%, II: 23.1%, III: 52.6%, P = 0.01), and surgical site occurrence requiring procedural intervention (healthy: 6.0%, overweight: 5.6%, I: 6.3%, II: 15.4%, III: 21.1%, P < 0.05). When compared to the other weight classes independently, class III was associated with unfavorable outcomes (P < 0.05). Significant improvement in average postoperative QoL scores in satisfaction with breast, psychosocial well-being, sexual well-being, and physical well-being were seen in all cohorts except class III (P < 0.05).

Conclusions
Severe obesity class III patients undergoing RM have a higher yet still acceptable risk profile and should be counseled on the risks despite its improved quality of life.
Rare germline disorders implicate long non-coding RNAs disrupted by chromosomal structural rearrangements
Authors: Andersen Rebecca E. , Alkuraya Ibrahim F. , Ajeesh Abna , Sakamoto Tyler , Mena Elijah L. , Amr Sami S. , Romi Hila , Kenna Margaret A. , Robson Caroline D. , Wilch Ellen S. , Nalbandian Katarena , Piña-Aguilar Raul , Walsh Christopher A. , Morton Cynthia C. 
Published: June 2024

AbstractIn recent years, there has been increased focus on exploring the role the non-protein-coding genome plays in Mendelian disorders. One class of particular interest is long non-coding RNAs (lncRNAs), which has recently been implicated in the regulation of diverse molecular processes. However, because lncRNAs do not encode protein, there is uncertainty regarding what constitutes a pathogenic lncRNA variant, and thus annotating such elements is challenging. The Developmental Genome Anatomy Project (DGAP) and similar projects recruit individuals with apparently balanced chromosomal abnormalities (BCAs) that disrupt or dysregulate genes in order to annotate the human genome. We hypothesized that rearrangements disrupting lncRNAs could be the underlying genetic etiology for the phenotypes of a subset of these individuals. Thus, we assessed 279 cases with BCAs and selected 191 cases with simple BCAs (breakpoints at only two genomic locations) for further analysis of lncRNA disruptions. From these, we identified 66 cases in which the chromosomal rearrangements directly disrupt lncRNAs. Strikingly, the lncRNAsMEF2C-AS1andENSG00000257522are each disrupted in two unrelated cases. Furthermore, in 30 cases, no genes of any other class aside from lncRNAs are directly disrupted, consistent with the hypothesis that lncRNA disruptions could underly the phenotypes of these individuals. To showcase the power of this genomic approach for annotating lncRNAs, here we focus on clinical reports and genetic analysis of two individuals with BCAs and additionally highlight six individuals with likely developmental etiologies due to lncRNA disruptions.
Theta-burst stimulation over primary somatosensory cortex modulates tactile acuity of tongue
Authors: Tang Ding-lan , Tommerdahl Mark , Niziolek Caroline A. , Parrell Benjamin 
Published: June 2024

AbstractBackgroundEmerging studies in humans have established the modulatory effects of repetitive transcranial magnetic stimulation (rTMS) over primary somatosensory cortex (S1) on somatosensory cortex activity and perception. However, to date, research in this area has primarily focused on the hand and fingers, leaving a gap in our understanding of the modulatory effects of rTMS on somatosensory perception of the orofacial system and speech articulators.ObjectiveThe present study aimed to examine the effects of different types of theta-burst stimulation—continuous TBS (cTBS), intermittent TBS (iTBS), or sham—over the tongue representation of left S1 on tactile acuity of the tongue.MethodsIn a repeated-measures design, fifteen volunteers participated in four separate sessions, where cTBS, iTBS, sham, or no stimulation was applied over the tongue representation of left S1. Effects of TBS were measured on both temporal and spatial perceptual acuity of tongue using a custom vibrotactile stimulator.ResultsCTBS significantly impaired spatial amplitude threshold at the time window of 16-30 minutes after stimulation, while iTBS improved it at the same time window. The effect of iTBS, however, was smaller than cTBS. In contrast, neither cTBS nor iTBS had any effect on the temporal discrimination threshold.ConclusionsThe current study establishes the validity of using TBS to modulate somatosensory perception of the orofacial system. Directly modifying somatosensation in the orofacial system has the potential to benefit clinical populations with abnormal tactile acuity, improve our understanding of the role of sensory systems in speech production, and enhance speech motor learning and rehabilitation.HighlightsTheta-burst stimulation (TBS) can modulate somatosensation in the orofacial systemcTBS over S1 impaired spatial acuity of tongueiTBS over S1 improved spatial acuity of tongue
Optimizing Ocular Pathology Classification with CNNs and OCT Imaging: A Systematic and Performance Review
Authors: Hauri-Rosales Walter , Pérez Oswaldo , Garcia-Roa Marlon , López-Star Ellery , Olivares-Pinto Ulises 
Published: June 2024

ABSTRACTVision loss due to chronic-degenerative diseases is a primary cause of blindness worldwide. Deep learning architectures utilizing optical coherence tomography images have proven effective for the early diagnosis of ocular pathologies. Nevertheless, most studies have emphasized the best outcomes using optimal hyperparameter combinations and extensive data availability. This focus has eclipsed the exploration of how model learning capacity varies with different data volumes. The current study evaluates the learning capabilities of efficient deep-learning classification models across various data amounts, aiming to determine the necessary data portion for effective clinical trial classifications of ocular pathologies. A comprehensive review was conducted, which included 295 papers that employed OCT images to classify one or more of the following retinal pathologies: Drusen, Diabetic Macular Edema, and Choroidal Neovascularization. Performance metrics and dataset details were extracted from these studies. Four Convolutional Neural Networks were selected and trained using three strategies: initializing with random weights, fine-tuning, and retraining only the classification layers. The resultant performance was compared based on training size and strategy to identify the optimal combination of model size, dataset size, and training approach. The findings revealed that, among the models trained with various strategies and data volumes, three achieved 99.9% accuracy, precision, recall, and F1 score. Two of these models were fine-tuned, and one used random weight initialization. Remarkably, two models reached 99% accuracy using only 10% of the original training dataset. Additionally, a model that was less than 10% the size of the others achieved 98.7% accuracy and an F1 score on the test set while requiring 100 times less computing time. This study is the first to assess the impact of training data size and model complexity on performance metrics across three scenarios: random weights initialization, fine-tuning, and retraining classification layers only, specifically utilizing optical coherence tomography images.