bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain-relieving Effects of Autologous Fat Grafting in Breast Cancer Surgery: A Scoping Review
Authors: Sowa Yoshihiro , Nakayama Ichiro , Toyohara Yoshihiro , Higai Shino , Yoshimura Kotaro 
Published: June 2024

Background:
Chronic pain is relatively common after breast cancer surgery, including breast reconstruction. Autologous fat grafting (AFG) has gained attention as a novel method for breast reconstruction, and recent clinical studies have also shown effects of AFG on alleviation of chronic pain after breast cancer surgery. Our objective was to conduct a scoping review of studies that have examined these effects with clearly defined clinical outcomes.

Methods:
A literature search was conducted using three databases: PubMed, MEDLINE, and Google Scholar, following PRISMA guidelines and the Arkesy and O’Malley framework. The search focused on clinical studies of the effects of AFG on chronic pain after breast cancer surgery. All studies reporting functional outcomes, return to work, and secondary surgery in a repeat operation were identified.

Results:
Of the 148 studies identified in the search, 11 studies with a total of 684 patients were included in the review. The average volume of fat grafted was approximately 128 mL over an average of 1.6 sessions. The most common time point for assessment was 1 year post-AFG. In all studies with an evidence level of 3 or lower, AFG showed positive results in alleviating pain after breast cancer surgery. However, one of the three randomized controlled trials did not show clinically significant effects.

Conclusions:
Most of the studies examined in this review suggested pain-relieving effects of AFG. However, there was one randomized controlled trial in which these effects were not confirmed, indicating a need for further accumulation of cases and performance of new, well-designed randomized controlled trials.
Integration of Virtual and Traditional Medical Education: Scholarship Pivots from the COVID-19 Pandemic
Authors: Berberoglu Ipek , Tang Sherry Y. Q. , Kozlow Jeffrey H. , Sezgin Billur , Sandhu Gurjit , Cederna Paul S. 
Published: June 2024

Background:
The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic.

Methods:
An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction.

Results:
A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach.

Conclusions:
Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.
Association of Sarcopenia and Oxygen Uptake Efficiency Slope in Male Patients With Heart Failure
Authors: Bispo Henrique Nunes , Rondon Eduardo , dos Santos Marcelo Rodrigues , de Souza Francis Ribeiro , da Costa Marcel José Andrade , Pereira Rosa Maria Rodrigues , Negrão Carlos Eduardo , Carson Brian P. , Alves Maria-janieire de Nazaré Nunes , da Fonseca Guilherme Wesley Peixoto 
Published: June 2024

Purpose:
Sarcopenia, the loss of muscle mass and function, is a common comorbidity in patients with heart failure (HF). The skeletal muscle modulates the respiratory response during exercise. However, whether ventilatory behavior is affected by sarcopenia is still unknown.

Methods:
We enrolled 169 male patients with HF. Muscle strength was measured by a handgrip dynamometer. Body composition was measured with dual-energy X-ray absorptiometry. Sarcopenia was defined by handgrip strength <27 kg and appendicular lean mass divided by height squared (ALM/height2) <7.0 kg/m2. Oxygen uptake efficiency slope (OUES), ventilation (VE), oxygen uptake (VO2), and carbon dioxide output (VCO2) were measured by a cardiopulmonary exercise test.

Results:
Sarcopenia was identified in 29 patients (17%). At the first ventilatory threshold, VE/VO2 (36.9 ± 5.9 vs 32.7 ± 6.5; P = .003) and VE/VCO2 (39.8 ± 7.2 vs 35.3 ± 6.9; P = .004) were higher in patients with sarcopenia compared to those without sarcopenia. At the exercise peak, compared to patients without sarcopenia, patients with sarcopenia had lower OUES (1186 ± 295 vs 1634 ± 564; P < .001), relative VO2 (16.2 ± 5.0 vs 19.5 ± 6.5 mL/kg/min; P = .01), and VE (47.3 ± 10.1 vs 63.0 ± 18.2 L/min; P < .0001), while VE/VCO2 (42.9 ± 8.9 vs 38.7 ± 8.4; P = .025) was increased. OUES was positively correlated with ALM/height2 (r = 0.36; P < .0001) and handgrip strength (r = 0.31; P < .001). Hemoglobin (OR = 1.149; 95% CI, 0.842-1.570; P = .038), ALM/height2 (OR = 2.166; 95% CI, 1.338-3.504; P = .002), and VO2peak (OR = 1.377; 95% CI, 1.218-1.557; P < .001) were independently associated with OUES adjusted by cofounders.

Conclusions:
Our results suggest that sarcopenia is related to impaired ventilatory response during exercise in patients with HF.
Joint association of physical activity and dietary quality with survival among US cancer survivors: a population-based cohort study
Authors: Wei Xiaoyuan , Min Yu , Xiang Zhongzheng , Zeng Yuanyuan , Wang Jun , Liu Lei 
Published: June 2024

Background:
Limited studies have explored the joint effect of physical activity (PA) and dietary quality (DQ) on the mortality outcomes of the cancer population. The authors aim to investigate the separate and joint prognostic effect of PA and DQ on the survival of US cancer survivors.

Methods:
Data of cancer survivors (n=3007, representing 22 million cancer survivors) were from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. PA was assessed using the self-reported Global Physical Activity Questionnaire (GPAQ) and DQ was evaluated through the Health Eating Index-2015 (HEI-2015). Kaplan–Meier (KM) curves and the Cox proportional hazard model were used to evaluate the associations between separate and joint prognostic effects of PA and DQ with mortality outcomes among cancer survivors.

Results:
In the joint analyses, cancer survivors with sufficiently active PA (≥600 MET-min/week) and qualified DQ (≥60) presented reduced risks of all-cause mortality (HR 0.45, 95% CI: 0.35–0.59) as compared with each lifestyle intervention separately. Meanwhile, the joint effects of either insufficiently or sufficiently active PA (>0 MET-min/week) and qualified DQ (≥60) were associated with lower risks for cancer (HR 0.60, 95% CI: 0.40–0.90) and noncancer mortality (HR 0.43, 95% CI: 0.32–0.59).

Conclusions:
Our study highlights the combination of active PA and qualified DQ was strongly associated with reduced mortality risk of cancer survivors. Our findings might help to refine the lifestyle intervention recommendations for this population.
Thyroid cancer-specific mortality during 2005–2018 in Korea, aftermath of the overdiagnosis issue: a nationwide population-based cohort study
Authors: Kim Kyeong Jin , Choi Jimi , Park Sue K. , Park Young Joo , Kim Sin Gon 
Published: June 2024

Background:
Thyroid cancer (TC) has underwent notable changes in its diagnosis and treatments following the concerns regarding overdiagnosis and overtreatment. However, there is little research on evaluating the effects of these alterations on TC-specific mortality.

Materials and methods:
This population-based cohort study included 434 228 patients with TC using Korean National Health Insurance Service-National Health Information Database. The age-standardized and sex-standardized mortality rates of TC per 1000 person-years were calculated considering the number of patients diagnosed with TC in 2013 per our database to evaluate the TC-specific mortality trends according to the year of TC diagnosis.

Results:
The authors enrolled 434 228 patients with TC, including 352 678 women and 81 550 men, with a mean age of 48.6±12.5 years and a median follow-up duration of 7.4 (interquartile range: 4.5–10.1) years. TC incidence increased from 2005 to 2012, with a standardized rate of 91.9 per 100 000 people in 2012, decreased rapidly to 50.6 in 2015, and remained stable until 2018. However, TC-specific age-standardized and sex-standardized mortality rates decreased from 1.94 per 1000 person-years in 2005 to 0.76 per 1000 person-years in 2013 and then increased to 2.70 per 1000 person-years in 2018. The TC-specific age-standardized and sex-standardized mortality rates of patients who had undergone hemithyroidectomy or subtotal thyroidectomy remained steady during 2005–2018, but increased in patients who had undergone total thyroidectomy or not undergone thyroidectomy between 2013 and 2018.

Conclusions:
The TC-specific mortality rates among patients with TC diagnosed since 2015 have increased, in contrast to the significant decline in TC incidence during the same period. This underscores the importance of appropriate diagnosis and treatment in patients with TC at high-risk of progression, simultaneously emphasizing efforts to reduce overdiagnosis and overtreatment in those with low-risk TC.
WTAP participates in neuronal damage by protein translation of NLRP3 in an m6A-YTHDF1-dependent manner after traumatic brain injury
Authors: Chen Yuhua , Long Tianlin , Chen Junhui , Wei Hong , Meng Jiao , Kang Meili , Wang Juning , Zhang Xin , Xu Quanhua , Zhang Chi , Xiong Kun 
Published: June 2024

Background
Traumatic brain injury (TBI) is a common complication of acute and severe neurosurgery. Remodeling of N6-methyladenosine (m6A) stabilization may be an attractive treatment option for neurological dysfunction after TBI. In the present study, the authors explored the epigenetic methylation of RNA-mediated NLRP3 inflammasome activation after TBI.

Methods
Neurological dysfunction, histopathology, and associated molecules were examined in conditional knockout (CKO) WTAP[flox/flox, Camk2a-cre], WTAPflox/flox, and pAAV-U6-shRNA-YTHDF1-transfected mice. Primary neurons were used in vitro to further explore the molecular mechanisms of action of WTAP/YTHDF1 following neural damage.

Results
The authors found that WTAP and m6A levels were upregulated at an early stage after TBI, and conditional deletion of WTAP in neurons did not affect neurological function but promoted functional recovery after TBI. Conditional deletion of WTAP in neurons suppressed neuroinflammation at the TBI early phase: WTAP could directly act on NLRP3 mRNA, regulate NLRP3 mRNA m6A level, and promote NLRP3 expression after neuronal injury. Further investigation found that YTH domain of YTHDF1 could directly bind to NLRP3 mRNA and regulate NLRP3 protein expression. YTHDF1 mutation or silencing improved neuronal injury, inhibited Caspase-1 activation, and decreased IL-1β levels. This effect was mediated via suppression of NLRP3 protein translation, which also reversed the stimulative effect of WTAP overexpression on NLRP3 expression and inflammation.

Conclusions
Our results indicate that WTAP participates in neuronal damage by protein translation of NLRP3 in an m6A-YTHDF1-dependent manner after TBI and that WTAP/m6A/YTHDF1 downregulation therapeutics is a viable and promising approach for preserving neuronal function after TBI, which can provide support for targeted drug development.
Long-term outcomes of active vaccination against de novo hepatitis B among pediatric recipients of living donor liver transplantations with anti-HBc (+) grafts: a retrospective case–control study
Authors: Yong Chee-Chien , Lin Yu-Hung , Espinosa Wendell Z. , Chen I-Hsuan , Wang Shih-Ho , Chan Yi-Chia , Chen Chao-Long , Lin Chih-Che 
Published: June 2024

Background:
Active vaccination has been utilized to prevent de novo hepatitis B virus infection (DNHB) in anti-HBc (+) grafts after liver transplantation. However, the long-term efficacy of active vaccination and graft/patient outcomes of anti-HBc (+) grafts have yet to be comprehensively investigated.

Materials and methods:
Among 204 pediatric patients enrolled in the study, 82 recipients received anti-HBc (+) grafts. For DNHB prevention, active vaccination was repeatedly administered prior to transplant. Antiviral therapy was given to patients with pretransplant anti-HBs <1000 IU/ml (nonrobust response) for 2 years and discontinued when post-transplant patients achieved anti-HBs >1000 IU/ml, while antiviral therapy was not given in patients with an anti-HBs titer over 1000 IU/ml. The primary outcome was to investigate the long-term efficacy of active vaccination, while the secondary outcomes included the graft and patient survival rates.

Results:
Among the 82 anti-HBc (+) transplant patients, 68% of recipients achieved a robust immune response, thus not requiring antiviral therapy. Two patients (2.4%) developed DNHB infection, one of which was due to an escape mutant. With a median follow-up of 150 months, the overall 10-year patient and graft survival rates were significantly worse in recipients of anti-HBc (+) grafts than those of anti-HBc (-) grafts (85.2 vs 93.4%, P=0.026; 85.1 vs 93.4%, P=0.034, respectively). Additionally, the 10-year patient and graft outcomes of the anti-HBc (+) graft recipients were significantly worse than those of the anti-HBc (-) graft recipients after excluding early mortality and nongraft mortality values (90.8 vs 96.6%, P=0.036; 93.0 vs 98.3%, P=0.011, respectively).

Conclusion:
Our long-term follow-up study demonstrates that active vaccination is a simple, cost-effective strategy against DNHB infection in anti-HBc (+) graft patients, whereby the need for life-long antiviral therapy is removed. Notably, both the anti-HBc (+) grafts and patients exhibited inferior long-term survival rates, although the exact mechanisms remain unclear.
Association between magnesium depletion score and the prevalence of kidney stones in the low primary income ratio: a cross-sectional study of NHANES 2007–2018
Authors: Wang Jiahao , Xiao Yunfei , Yang Yaqing , Yin Shan , Cui Jianwei , Huang Ke , Wang Jia , Bai Yunjin 
Published: June 2024

Introduction:
To explore the association between magnesium depletion score (MgDS) and the prevalence of kidney stones in the low primary income ratio (PIR).

Method:
A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 2007–2018. Within the low PIR, people aged ≥20 years with complete information on MgDS and kidney stones questionnaires were enrolled. Multivariable logistic regression and stratified logistic regression analyses were performed to examine the association between MgDS and the prevalence of kidney stones and the recurrence of kidney stones by confounding factors adjusted. Stratified and interaction analysis was conducted to find whether some factors modified the association. In addition, sensitive analyses were also conducted to observe the stability. The work has been reported in line with the strengthening the reporting of cohort, cross-sectional, and case–control studies in surgery (STROCSS) criteria (Supplemental Digital Content 1, http://links.lww.com/JS9/C781).

Result:
A total of 7600 adults were involved in the study, and the individuals were classified into four groups: 0 points for MgDS (n=3814), 1 point for MgDS (n=2229), 2 points for MgDS (n=1020), and ≥3 points for MgDS (n=537). The multivariable logistic regression suggested that a positive association between MgDS and the prevalence of kidney stones (OR=1.123, 95% CI: 1.019–1.238) in the fully adjusted model. Compared with the lowest group, people with ≥3 points of MgDS had a significant relationship with kidney stones (OR=1.417, 95% CI: 1.013–1.983). No significant association was observed between the recurrence of kidney stones and MgDS. The result of the sensitive analysis showed the robustness of the main analysis.

Conclusion:
The prevalence of kidney stones is positively correlated with MgDS, which suggests that maintaining a higher MgDS is accompanied by higher prevalence rates of kidney stones in the low PIR.
Enhancing WHO prescription writing guideline adherence through an educational intervention: a quality improvement study of Azad Jammu and Kashmir
Authors: Ahmed Mushood , Ahsan Areeba , Selal Zia Muhammad , Tul Ain Qura , Khurshid Salwa , Basit Jawad , Ahmad Tagwa Kalool Fadlalla 
Published: June 2024

Background:
Prescription writing is an important component of healthcare delivery and can directly influence patient safety and treatment outcomes. Prescription errors are common in developing countries because of the lack of national guidelines. This two-cycle clinical audit assessed the impact of educational interventions on improving prescription writing practices.

Methods:
A cross-sectional prospective clinical audit was conducted in the Out Patients Department (OPD) of the District Head Quarters (DHQ) Hospital in Bhimber, Azad Jammu, and Kashmir. A total of 100 randomly selected prescriptions were reviewed for each cycle from July to August 2023. The authors recorded compliance with WHO guidelines for prescription writing before and after the educational intervention. Microsoft Excel and SPSS version 25.0 were used for statistical analysis. Categorical variables were analyzed using frequencies and percentages.

Results:
An improvement in compliance was observed during the second audit cycle, after the educational intervention. The greatest improvement was observed in documenting the allergic status of patients (62%) and the direction of drug administration (40%). The authors also observed improvements in the treatment duration (>10%), patient weight, physician registration number, diagnosis, and follow-up advice. The legibility of prescriptions also improved during the second audit cycle.

Conclusion:
This study shows that integrating an educational intervention into a clinical audit can improve prescription writing practices and ultimately result in a better quality of care for patients.
Comprehensive deep learning-based assessment of living liver donor CT angiography: from vascular segmentation to volumetric analysis
Authors: Oh Namkee , Kim Jae-Hun , Rhu Jinsoo , Jeong Woo Kyoung , Choi Gyu-Seong , Kim Jongman , Joh Jae-Won 
Published: June 2024

Background:
Precise preoperative assessment of liver vasculature and volume in living donor liver transplantation is essential for donor safety and recipient surgery. Traditional manual segmentation methods are being supplemented by deep learning (DL) models, which may offer more consistent and efficient volumetric evaluations.

Methods:
This study analyzed living liver donors from Samsung Medical Center using preoperative CT angiography data between April 2022 and February 2023. A DL-based 3D residual U-Net model was developed and trained on segmented CT images to calculate the liver volume and segment vasculature, with its performance compared to traditional manual segmentation by surgeons and actual graft weight.

Results:
The DL model achieved high concordance with manual methods, exhibiting Dice Similarity Coefficients of 0.94±0.01 for the right lobe and 0.91±0.02 for the left lobe. The liver volume estimates by DL model closely matched those of surgeons, with a mean discrepancy of 9.18 ml, and correlated more strongly with actual graft weights (R-squared value of 0.76 compared to 0.68 for surgeons).

Conclusion:
The DL model demonstrates potential as a reliable tool for enhancing preoperative planning in liver transplantation, offering consistency and efficiency in volumetric assessment. Further validation is required to establish its generalizability across various clinical settings and imaging protocols.
Clinical study of dance art therapy on hospitalized patients with chronic schizophrenia
Authors: Kong Yan , Min Haiying , Zhu Xiaochun , Zhang Lei , Hu Jianjun 
Published: June 2024

Background:
To explore the effect of dance art on the treatment of hospitalized patients with chronic schizophrenia.

Methods:
In a prospective randomized controlled study conducted from June 2019 to June 2020, 120 patients from Shanghai Pudong New Area Mental Health Center were divided into intervention (n = 60) and control (n = 60) groups using a random number table. Control patients received standard drug treatment and nursing care, while the intervention group underwent dance art therapy sessions for 90 minutes twice weekly, in addition to standard care. Treatment outcomes after 6 and 12 weeks were measured using the positive and negative symptom scale (PANSS), Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MoCA), and body mass index (BMI).

Results:
This study involved 120 male patients with chronic schizophrenia, aged 30 to 60 years. After 6 and 12 weeks, the intervention group showed a greater reduction in PANSS scores (intervention group: from 49.02 ± 2.53 to 37.02 ± 1.83, control group: from 49.08 ± 2.59 to 44.91 ± 2.35, P < .05). In the WCST, the intervention group exhibited a higher increase in classification completion and correct answers, and a greater decrease in errors (P < .05). MoCA scores improved significantly in the intervention group compared to the control group (P < .05). BMI decreased in both groups, with a more pronounced reduction in the intervention group (intervention group: from 26.47 ± 1.05 kg/m² to 22.87 ± 0.73 kg/m², control group: from 26.50 ± 1.03 kg/m² to 26.22 ± 0.80 kg/m², P < .05).

Conclusion:
Based on routine drug treatment and routine nursing care, dance art has a better clinical effect in treating hospitalized patients with chronic schizophrenia, which can improve cognitive function, alleviate clinical symptoms, and reduce BMI.