bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations
Authors: Le Saux Olivia , Canada Brice , Debarnot Ursula , Haouhache Nour El Houda , Lehot Jean Jacques , Binay Marion , Cortet Marion , Rimmelé Thomas , Duclos Antoine , Rode Gilles , Lilot Marc , Schlatter Sophie 
Published: March 2024

Abstract

Purpose
Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students.

Method
A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models.

Results
Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness (β = 10.27 [95% confidence interval {CI}, 7.40–13.13; P < .001] and β = 3.42 [95% CI, 0.98–5.85; P = .006], respectively) and lower openness (β = −4.95; 95% CI, −7.40 to −2.49; P < .001). As compared with the control intervention, both stress management interventions led to lower levels of psychological (P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological (β = −5.66; 95% CI, −10.83 to −0.50; P = .03) and physiological stress reduction (β = −0.002; 95% CI, −0.003 to −0.00004; P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction (β = −7.87; 95% CI, −13.05 to −2.68; P = .003).

Conclusions
Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.
Long-Term Outcomes of Robotic Versus Laparoscopic Total Mesorectal Excisions: A Propensity-Score Matched Cohort study of 5-year survival outcomes
Authors: Duhoky Rauand , Rutgers Marieke L. W. , Burghgraef Thijs A. , Stefan Samuel , Masum Shamsul , Piozzi Guglielmo N. , Sagias Filippos , Khan Jim S. 
Published: March 2024

Objective:
To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center.

Background:
Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome.

Methods:
We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes.

Results:
A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0–13.0) vs 6.0 (4.0–8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010).

Conclusions:
This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.
Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography
Authors: Huang Xinyan , Cheng Xiang , Gao Sijie , Liu Yinxin , Su Yuxi , Feng Chuan 
Published: March 2024

Background:
The shape of the labrum is strongly correlated with outcomes of developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) is the generally preferred imaging technique for observing the labrum.

Purpose:
We aimed to find a correlation between the labrum shape and anterior–posterior (AP) pelvic measurements in children with DDH.

Methods:
Preoperative AP pelvic x-ray radiographs and MRI of patients with DDH from January 2019 to December 2021 were retrospectively collected and divided into three groups by labrum shape on MRI: everted, partly inverted, and inverted. The acetabular length ratio (RAL) in patients with unilateral DDH and the ratio of acetabular length to interpedicular distance (RALI) in all patients were calculated. T-tests were used to analyze differences between the groups. Receiver operating characteristic curve (ROC) analysis was performed between the everted group and the partly inverted and inverted groups.

Results:
We found significant differences in RAL between the everted and partly inverted groups, everted and inverted groups, and everted and combined groups. The ROC analysis showed that the best cutoff value for RAL was 0.945 between the everted and combined groups, with an area under the curve (AUC) of 88.4%. The sensitivity at the best RAL value was 0.783, and the specificity was 0.887. Moreover, we observed a significant difference in RALI between the everted, partly inverted, and inverted groups, as well as between the everted and combined groups. The optimal cutoff value for RALI between the everted and combined groups was 0.575, with an AUC of 74.5%. The sensitivity at the best RALI value was 0.765, and the specificity was 0.674.

Conclusion:
The RAL or RALI values on pelvic AP radiographs can be used to predict the shape of the labrum.

Level of Evidence:
III.
Novel proteomic signatures may indicate MRI-assessed intrahepatic fat state and changes: The DIRECT PLUS clinical trial
Authors: Goldberg Dana T. , Yaskolka Meir Anat , Tsaban Gal , Rinott Ehud , Kaplan Alon , Zelicha Hila , Klöting Nora , Ceglarek Uta , Iserman Berend , Shelef Ilan , Rosen Philip , Blüher Matthias , Stumvoll Michael , Etzion Ohad , Stampfer Meir J. , Hu Frank B. , Shai Iris 
Published: March 2024

Background and Aims:
We demonstrated in the randomized 18-month DIRECT PLUS trial (n = 294) that a Mediterranean (MED) diet, supplemented with polyphenol-rich Mankai duckweed, green tea, and walnuts and restricted in red/processed meat, caused substantial intrahepatic fat (IHF%) loss compared with 2 other healthy diets, reducing NAFLD by half, regardless of similar weight loss. Here, we investigated the baseline proteomic profile associated with IHF% and the changes in proteomics associated with IHF% changes induced by lifestyle intervention.

Approach and Results:
We calculated IHF% by proton magnetic resonance spectroscopy (normal IHF% <5% and abnormal IHF% ≥5%). We assayed baseline and 18-month samples for 95 proteomic biomarkers.Participants (age = 51.3 ± 10.8 y; 89% men; and body mass index = 31.3 ± 3.9 kg/m2) had an 89.8% 18-month retention rate; 83% had eligible follow-up proteomics measurements, and 78% had follow-up proton magnetic resonance spectroscopy. At baseline, 39 candidate proteins were significantly associated with IHF% (false discovery rate <0.05), mostly related to immune function pathways (eg, hydroxyacid oxidase 1). An IHF% prediction based on the DIRECT PLUS by combined model (R
2 = 0.47, root mean square error = 1.05) successfully predicted IHF% (R
2 = 0.53) during testing and was stronger than separately inputting proteins/traditional markers (R
2 = 0.43/0.44). The 18-month lifestyle intervention induced changes in 18 of the 39 candidate proteins, which were significantly associated with IHF% change, with proteins related to metabolism, extracellular matrix remodeling, and immune function pathways. Thrombospondin-2 protein change was higher in the green-MED compared to the MED group, beyond weight and IHF% loss (p = 0.01). Protein principal component analysis revealed differences in the third principal component time distinct interactions across abnormal/normal IHF% trajectory combinations; p < 0.05 for all).

Conclusions:
Our findings suggest novel proteomic signatures that may indicate MRI-assessed IHF state and changes during lifestyle intervention. Specifically, carbonic anhydrase 5A, hydroxyacid oxidase 1, and thrombospondin-2 protein changes are independently associated with IHF% change, and thrombospondin-2 protein change is greater in the green-MED/high polyphenols diet.
Comprehensive molecular classification predicted microenvironment profiles and therapy response for HCC
Authors: Chen Yihong , Deng Xiangying , Li Yin , Han Ying , Peng Yinghui , Wu Wantao , Wang Xinwen , Ma Jiayao , Hu Erya , Zhou Xin , Shen Edward , Zeng Shan , Cai Changjing , Qin Yiming , Shen Hong 
Published: March 2024

Background and Aims:
Tumor microenvironment (TME) heterogeneity leads to a discrepancy in survival prognosis and clinical treatment response for patients with HCC. The clinical applications of documented molecular subtypes are constrained by several issues.

Approach and Results:
We integrated 3 single-cell data sets to describe the TME landscape and identified 6 prognosis-related cell subclusters. Unsupervised clustering of subcluster-specific markers was performed to generate transcriptomic subtypes. The predictive value of these molecular subtypes for prognosis and treatment response was explored in multiple external HCC cohorts and the Xiangya HCC cohort. TME features were estimated using single-cell immune repertoire sequencing, mass cytometry, and multiplex immunofluorescence. The prognosis-related score was constructed based on a machine-learning algorithm. Comprehensive single-cell analysis described TME heterogeneity in HCC. The 5 transcriptomic subtypes possessed different clinical prognoses, stemness characteristics, immune landscapes, and therapeutic responses. Class 1 exhibited an inflamed phenotype with better clinical outcomes, while classes 2 and 4 were characterized by a lack of T-cell infiltration. Classes 5 and 3 indicated an inhibitory tumor immune microenvironment. Analysis of multiple therapeutic cohorts suggested that classes 5 and 3 were sensitive to immune checkpoint blockade and targeted therapy, whereas classes 1 and 2 were more responsive to transcatheter arterial chemoembolization treatment. Class 4 displayed resistance to all conventional HCC therapies. Four potential therapeutic agents and 4 targets were further identified for high prognosis-related score patients with HCC.

Conclusions:
Our study generated a clinically valid molecular classification to guide precision medicine in patients with HCC.
Determinants of Type-Specific Human Papillomavirus Concordance Across Anatomic Sites in Young Men Who Have Sex With Men and Transgender Women, 3 U.S. Cities, 2016–2018
Authors: Shah Adeel , Meites Elissa , Lin John , Hughes James P. , Gorbach Pamina M. , Mustanski Brian , Crosby Richard A. , Unger Elizabeth R. , Querec Troy , Golden Matthew , Markowitz Lauri E. , Winer Rachel L. 
Published: March 2024

Abstract

Background
Among men who have sex with men (MSM) and transgender women (TGW), the dynamics of human papillomavirus (HPV) infections at different anatomical sites are not well understood. Information on HPV concordance between anatomic sites can inform the extent of autoinoculation, and susceptibility of different anatomic areas to HPV infection. We described and assessed correlates of HPV concordance across anal, oral, and genital samples.

Methods
We enrolled 1876 MSM and TGW aged 18 to 26 years in 3 US cities. Oral, genital, and anal samples were self-collected for type-specific HPV DNA testing (37 types). Demographics, sexual behaviors, and health history were self-reported. Kappa statistics based on percent positive agreement (kappa+) and generalized estimating equations were used to describe and identify correlates of HPV type-specific concordance between anatomic sample pairs.

Results
Any HPV was detected in 69.9%, 48.6%, and 7.4% of anal, genital, and oral samples, respectively. Detection of any HPV (concurrence) was most common in anal-genital pairs (40.9%) and uncommon in oral-genital and oral-anal pairs (3.4% and 6.5% respectively). Type-specific concordance was poor across all sample pairs (kappa+ <0.20). Younger age and older age at first sex were positively associated with type-concordant anal-genital infections. Sexual behaviors were unassociated with concordance.

Conclusions
Poor oral/anogenital concordance suggests the oral mucosa has different susceptibility to HPV infection, differential clearance and/or autoinoculation between oral and anogenital sites is unlikely. There was some observed concurrence and concordance between anal and genital sites, unassociated with sexual behavior, suggesting autoinoculation. Longitudinal studies are necessary to further elucidate mechanisms of multisite infections.
Behavioral economic incentives to support HIV care: Results from a randomized controlled trial in Uganda
Authors: Linnemayr Sebastian , Wagner Zachary , Saya Uzaib Y. , Stecher Chad , Lunkuse Lillian , Wabukala Peter , Odiit Mary , Mukasa Barbara 
Published: March 2024

Background:
This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with one approach being low-cost.

Setting:
329 adults at Mildmay Hospital in Kampala, Uganda on ART for at least two years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown.

Methods:
We randomized participants into one of three (1:1:1) groups: usual care (‘control’ group; n=109) or one of two intervention groups where eligibility for non-monetary prizes was based on: showing at least 90% electronically measured ART adherence (‘adherence-linked’ group, n=111); or keeping clinic appointments as scheduled (‘clinic-linked’; n=109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777.

Results:
Neither incentive arm increased adherence compared to the control; we estimate a 3.9 percentage point increase in ‘adherence-linked’ arm [95% CI -0.70 to 8.60 (p=0.10)], and 0.024 in the ‘clinic-linked’ arm [95% CI -0.02 to 0.07 (p=0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI 0.01, 0.15; p=0.04, ‘adherence-linked’) and 5.60 percentage points (95% CI -0.01, 0.12; p=0.10, ‘clinic-linked’). We find no effects on clinic attendance or viral suppression.

Conclusions:
Incentives did not improve viral suppression or ART adherence overall but worked for the pre-specified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.
The association of intraocular efavirenz concentrations and HIV-1 viral load among persons with HIV
Authors: Qian Yiwen , Zhang Pei , Wang Luoziyi , Suo Jinshan , Yin Lin , Wang Yuceng , zhang Lijun , Wang Zhiliang 
Published: March 2024

Objective:
Efavirenz (EFV) is commonly used in combination antiretroviral therapy (cART). However, in our previous study, many persons living with human immunodeficiency virus (HIV) exhibited ocular complications despite undergoing effective cART. Here, we aimed to determine the intraocular EFV concentrations in the vitreous and analyze the factors affecting viral load in the vitreous in patients with HIV-associated retinopathies.

Design:
Observational, retrospective study.

Methods:
Fourteen patients receiving EFV in combination with an antiretroviral therapy who underwent pars plana vitrectomy (PPV) were enrolled between January 2019 and August 2022. The patients were divided into two groups based on presence or absence of retinal detachment (RD). Patient characteristics and HIV-1 RNA levels in plasma and vitreous were recorded during PPV. Paired blood plasma and vitreous samples were obtained for EFV concentration analysis using using ultra-high-performance liquid chromatography/tandem mass spectrometry (UHPLC–MS/MS) .

Results:
The median age of the enrolled patients was 48 years (interquartile range [IQR], 32.25–53.25), including 12 men and 2 females. Median vitreous and plasma EFV concentrations were 141.5 (IQR, 69.63–323.75) and 2,620 ng/mL (1,680–4,207.5), respectively. Median ratio of vitreous/plasma EFV concentrations in the paired samples among all participants was 0.053 (0.018–0.118). Median vitreous/plasma EFV concentrations significantly differed between the non-RD and RD groups (0,04 vs 0.12, p = 0.042) .
Conclusions
The vitreous EFV concentrations were insufficient to inhibit viral replication in intraocular tissues, which may be due to poor penetration of the blood–retinal barrier. High vitreous EFV concentrations were associated with retinal detachment, indicating a correlation between the EFV concentration and the severity of blood–retinal barrier disruption. It implied that EFV was not a suitable antiviral drug to inhibit the HIV-1 replication in ocular tissues.
18F-FDG PET/CT in Lupus Enteritis Presenting With Fever and Abdominal Pain
Authors: Preet Komal , Mittal Bhagwant Rai , Singh Harmandeep , Kumar Rajender , Sekar Aravind , Kurdia Kailash 
Published: March 2024

Abstract
Systemic lupus erythematosus is a systemic autoimmune disease associated with various manifestations. Here, we report a compelling case of a 42-year-old woman who presented with lupus enteritis as a sole manifestation of systemic lupus erythematosus and underwent 18F-FDG PET/CT. The resected bowel segment revealed vasculitis, and subsequent workup revealed positive antinuclear and anti–double-stranded antibody levels, confirming lupus enteritis, thus highlighting the diagnostic role of 18F-FDG PET/CT in reaching the final diagnosis.
An Unexpected Seminal Vesicle Pitfall in PSMA PET
Authors: Bronte Angela , Rosales Juan J. , Torres Roca Marcos , Miñana Bernardino , Rodríguez-Fraile Macarena 
Published: March 2024

Abstract
A 76-year-old man undergoing hormone therapy for prostate cancer was referred for 68Ga-PSMA-11-PET (PSMA PET) due to persistently detectable PSA level. No PSMA-positive tumor lesions were detected, so a delayed phase imaging was performed, which revealed focal PSMA uptake in the right seminal vesicle together with contrast accumulation on excretory phase contrast-enhanced CT. These findings were finally determined to be secondary to urinary reflux as a consequence of a prostatic enucleation he had undergone 5 months earlier following an episode of acute urinary retention.
Unusual Renal Uptake of 131I-MIBG in a Young Hypertensive With Renal Artery Stenosis
Authors: Roopal Agrawal , Gaurav Malhotra 
Published: March 2024

Abstract
A 10-year-old hypertensive girl underwent 131I-MIBG scan to rule out neural crest derived tumor. The whole-body images revealed diffuse intense tracer uptake in the right kidney, which persisted in 96-hour images as well. CT renal angiography revealed 90% to 95% right renal artery stenosis. Thereafter, she underwent baseline and angiotensin receptor blockade renal dynamic imaging, which revealed hemodynamically significant renal artery stenosis. Pattern of diffuse and intense 131I-MIBG uptake, albeit rare, still warrants further evaluation to rule out renal artery stenosis and investigate its hemodynamic significance for appropriate management.
Occult SMARCA4-Deficient Undifferentiated Carcinoma Unmasked by 68Ga-FAPI-46 PET/CT
Authors: Xu Weizhi , Zhao Long , Cai Jiayu , Chen Haojun 
Published: March 2024

Abstract
SMARCA4-deficient undifferentiated tumors (SMARCA4-dUT) are rare and aggressive neoplasms commonly found in male smokers and portend a poor prognosis. In this case, we reported 18F-FDG and 68Ga-FAPI-46 PET/CT findings in an occult SMARCA4-dUT located in the left pulmonary hilum along with mediastinal lymph node metastases. 68Ga-FAPI-46 PET/CT showed superiority over 18F-FDG for detecting SMARCA4-dUT lesions. This case highlighted that 68Ga-FAPI-46 PET/CT may be a promising imaging modality in the evaluation of SMARCA4-dUT, particularly for detecting the occult SMARCA4-dUT arising in uncommon sites.
18F-FET PET/CT in Calcifying Pseudoneoplasm of the Neuraxis
Authors: Aricò Demetrio , Giacoppo Giulia , Bambaci Michelangelo , Marino Lorenza , Girlando Andrea , Sortino Giuseppe , Leone Giorgia , Fernandes Bethania , Alì Marco , Evangelista Laura , Romano Alberto 
Published: March 2024

Abstract
A 66-year-old man has been treated in a psychiatric department for 4–5 years for a depressive syndrome, which is associated with poor motor initiative, confusional state, and dysosmia. Dynamic 18F-FET PET/CT showed only faint uptake of radiotracer just above the background on the left frontal calcific lesion. The time-activity curve of the neoplasms showed a descending pattern. After a left fronto-orbitary minicraniotomy surgery, histology examination concluded for a rare calcifying pseudoneoplasm of the neuraxis (CAPNON). To our knowledge, no data are available on the metabolic behavior of CAPNON in 18F-FET PET/CT. This case highlighted that a faint uptake and descending pattern on dynamic 18F-FET PET/CT may be helpful in suspected CAPNON before surgery.
The Use of E-Learning in Peyton’s 4-Step Approach: Evaluation of Facial Computed Tomography Scans
Authors: Yoong Celine Shuen Yin , Goh Doreen Shu Lin , Wong Yu Cong , Ho Cowan , Cai Elijah Zhengyang , Hing Angela , Liang Shen , Yap Yan Lin , Lim Jane , Lim Thiam Chye 
Published: March 2024

Imparting procedural skills is challenging. Peyton’s approach is an effective face-to-face teaching technique increasingly used in complex skills training. Institutions are beginning to incorporate online training as part of their procedural curriculum. We developed E-Peyton’s to employ Peyton’s approach through an electronic learning platform. The efficacy of E-Peyton’s approach in teaching the interpretation of facial computed tomography (CT) scans is evaluated in this study. Naïve learners (n=41) were randomized into 2 groups based on teaching techniques employed: E-Peyton’s (n=20) and Peyton’s (n=21) approaches. The distance between the infraorbital margin and the posterior ledge was measured using a 3-part standardized measuring protocol on OsiriX. Twenty measurements were assessed for accuracy against the benchmark (±2 mm) at week 0 and week 1. Training durations were compared. Questionnaires were administered before and after the study to identify learners’ acceptance of teaching techniques and their confidence in interpreting facial CT scans. Learners in both teaching techniques had comparable skills retention. Gap scores indicate significant improvement in learner’s confidence levels regardless of teaching technique (P<0.05). Both teaching techniques were well-accepted by learners. E-Peyton’s and Peyton’s approaches required a similar training duration. The COVID-19 pandemic highlights the importance of effective remote learning platforms. E-Peyton’s approach is comparable to that of Peyton’s in all areas of assessment. E-Peyton’s approach effectively automates Peyton’s approach, allowing for standardized, high-quality procedural skills training while reducing manpower burden.