bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of socioeconomic determinants on the speed of epidemic diseases: a comparative analysis
Authors: Dufrénot Gilles , Gallic Ewen , Michel Pierre , Bonou Norgile Midopkè , Gnaba Ségui , Slaoui Iness 
Published: February 2024

Abstract
We study the impact of socioeconomic factors on two key parameters of epidemic dynamics. Specifically, we investigate a parameter capturing the rate of deceleration at the very start of an epidemic, and a parameter that reflects the pre-peak and post-peak dynamics at the turning point of an epidemic like coronavirus disease 2019 (COVID-19). We find two important results. The policies to fight COVID-19 (such as social distancing and containment) have been effective in reducing the overall number of new infections, because they influence not only the epidemic peaks, but also the speed of spread of the disease in its early stages. The second important result of our research concerns the role of healthcare infrastructure. They are just as effective as anti-COVID policies, not only in preventing an epidemic from spreading too quickly at the outset, but also in creating the desired dynamic around peaks: slow spreading, then rapid disappearance.
Competency in medical training: current concepts, assessment modalities, and practical challenges
Authors: Ng Isaac K S , Mok Shao Feng , Teo Desmond 
Published: February 2024

Abstract
In the past two decades, competency-based medical education (CBME) has rapidly become the cornerstone of medical training and accreditation programmes worldwide. It has increasingly replaced traditional time-based educational approaches which were often rigid, fragmented, and overly emphasized clinical content knowledge over practical skillsets and attitudes. CBME adoption was in the hope of better preparing medical graduates for the demands and responsibilities of real-world clinical practice. For all the supposed merits of CBME, there hitherto remains difficulties in arriving at comprehensive and practical ‘competency’ definitions, and actual challenges with implementation of clinical competency assessment modalities pertaining to construct validity, reliability, and applicability with the use and interpretation of evaluation metrics. Therefore, in this article, we describe the various conceptualizations of ‘competency’ in medical education literature and attempt to refine its usage in practice to meet the evolving needs and expectations of healthcare stakeholders, as well as incorporate emerging concepts in the medical education discourse. We herein propose that clinical ‘competencies’ should be defined as multi-domain clinical expertise, comprising medical knowledge, skills, attitudes and metacognitive capabilities that reflects the prevailing needs of healthcare stakeholders, and is inferred from performance evaluations of medical trainees. In order to attain ‘competence’, there must then be a process of integrating multi-domain competencies into meaningful professional identity formation that is commensurate with the context and stage of medical training. In addition, we review the current competency assessment modalities, including common pitfalls with their usage, and sought to provide practical strategies to mitigate the identified challenges.
Renal tubular estrogen ß receptors are expressed at high levels in small vessel vasculitis and are primarily localized in the distal tubule
Authors: Kor Ahmet , Sungu Nuran , Karabulut Şefika , Erten Şükran 
Published: February 2024

AbstractThis study investigated the possible roles of renal estrogen receptors (ER) in glomerulonephritis associated with small vessel vasculitis. The relationships of ERs were investigated in antineutrophilic cytoplasmic antibody (ANCA)‐associated glomerulonephritis and immunoglobulin A (IgA) nephropathy groups, which are small vessel vasculitis subtypes with two different glomerulonephritis development pathophysiologies. The design of this study was prepared as a retrospective cohort study. The study included 42 patients with ANCA‐associated vasculitis and 18 with IgA nephropathy in the small vessel vasculitis group. For the control group, intact renal tissues of 28 patients who underwent nephrectomy due to renal cell carcinoma were used. Renal biopsy samples of the groups were stained with ER beta (ß) and ER alpha (α). Tubular ER ß expression score (TERßES) median values were found to be significantly higher in ANCA‐ associated vasculitis (B = 0.724, OR [95%CI]: 2.064 [1.141–3.731], p = .016) and IgA nephropathy (B = 0.898, OR [95%CI]: 2.454 [1.307–4.609], p = .005) than in intact kidney tissue. It was determined that tubular ERß was most frequently localized in the distal tubule at 57.9% and the second most common in the proximal tubule at 20.4%. The expression of tubular ERß is increased in glomerulonephritis due to small vessel vasculitis. Tubular ERßs are most commonly localized in the distal tubule. Further studies are needed to understand the physiological and pathophysiological effects of altered renal ER levels in small vessel vasculitis.
Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity
Authors: Balmaceno-Criss Mariah , Lafage Renaud , Alsoof Daniel , Daher Mohammad , Hamilton David Kojo , Smith Justin S. , Eastlack Robert K. , Fessler Richard G. , Gum Jeffrey L. , Gupta Munish C. , Hostin Richard , Kebaish Khaled M. , Klineberg Eric O. , Lewis Stephen J. , Line Breton G. , Nunley Pierce D. , Mundis Gregory M. , Passias Peter G. , Protopsaltis Themistocles S. , Buell Thomas , Scheer Justin K. , Mullin Jeffrey P. , Soroceanu Alex , Ames Christopher P. , Lenke Lawrence G. , Bess Shay , Shaffrey Christopher I. , Schwab Frank J. , Lafage Virginie , Burton Douglas C. , Diebo Bassel G. , Daniels Alan H. ,   International Spine Study Group (ISSG)
Published: February 2024

Study Design.
Retrospective review of prospectively collected data.

Objective.
To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD).

Background.
Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD.

Patients and Methods.
In total, 527 preoperative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full-body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation.

Results.
The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, and 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment (P<0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt (P=0.001) and sacrofemoral angle (P<0.001), but increased knee flexion (P=0.012). Regression analysis revealed that with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis (r
2=0.812). Hip osteoarthritis decreased compensation through sacrofemoral angle (β-coefficient=−0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100).

Conclusions.
For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
Serum aryl hydrocarbon receptor activity is associated with survival in patients with alcohol-associated hepatitis
Authors: Yamazaki Tomoo , Kouno Tetsuya , Hsu Cynthia L. , Hartmann Phillipp , Mayo Susan , Zhang Xinlian , Stärkel Peter , Bosques-Padilla Francisco , Verna Elizabeth C. , Abraldes Juan G. , Brown Robert S. , Vargas Victor , Altamirano Jose , Caballería Juan , Shawcross Debbie L. , Louvet Alexandre , Lucey Michael R. , Mathurin Philippe , Garcia-Tsao Guadalupe , Bataller Ramon ,   AlcHepNet Investigators, Schnabl Bernd 
Published: February 2024

Background and Aims:
Patients with alcohol-associated hepatitis (AH) have an altered fecal metabolome, including reduced microbiota-derived tryptophan metabolites, which function as ligands for aryl hydrocarbon receptor (AhR). The aim of this study was to assess serum AhR ligand activity in patients with AH.

Approach and Results:
The study included 74 controls without AUD, 97 patients with AUD, and 330 patients with AH from 2 different multicenter cohorts (InTeam: 134, AlcHepNet: 196). Serum AhR activity was evaluated using an AhR reporter assay with HepG2-Lucia cells incubated with serum for 24 hours. Serum AhR activity was significantly higher in patients with AH compared with both controls (1.59 vs. 0.96-fold change, p < 0.001) and patients with AUD (1.59 vs. 0.93, p < 0.001). In both AH cohorts, patients with AhR activity ≥ 2.09 had significantly lower cumulative survival rates at 30, 60, 90, and 180 days compared to those with AhR activity < 2.09. When serum AhR activity was used to further stratify patients with severe AH, the cumulative 30, 60, 90, and 180-day survival rates for patients with severe AH and the AhR activity ≥ 2.09 group were all significantly lower than those with an AhR activity < 2.09 group.

Conclusions:
Serum AhR activity was significantly higher in patients with AH compared with controls and individuals with AUD, and this increased activity was associated with higher mortality. Consequently, serum AhR activity holds potential as a prognostic marker.
Enhanced SLC35B2/SAV1 sulfation axis promotes tumor growth by inhibiting Hippo signaling in HCC
Authors: He Bo , Huang Zhao , Qin Siyuan , Peng Peilan , Duan Xirui , Wang Longqin , Ye Qin , Wang Kui , Jiang Jingwen , Li Bowen , Liu Rui , Huang Canhua 
Published: February 2024

Background and Aims:
Protein tyrosine sulfation (PTS) is a common posttranslational modification that regulates a variety of physiological and pathological processes. However, the role of PTS in cancer remains poorly understood. The goal of this study was to determine whether and how PTS plays a role in HCC progression.

Approach and Results:
By mass spectrometry and bioinformatics analysis, we identified SAV1 as a novel substrate of PTS in HCC. Oxidative stress upregulates the transcription of SLC35B2, a Golgi-resident transporter of sulfate donor 3ʹ-phosphoadenosine 5ʹ-phosphosulfate, leading to increased sulfation of SAV1. Sulfation of SAV1 disrupts the formation of the SAV1-MST1 complex, resulting in a decrease of MST1 phosphorylation and subsequent inactivation of Hippo signaling. These molecular events ultimately foster the growth of HCC cells both in vivo and in vitro. Moreover, SLC35B2 is a novel transcription target gene of the Hippo pathway, constituting a positive feedback loop that facilitates HCC progression under oxidative stress.

Conclusions:
Our findings reveal a regulatory mechanism of the SLC35B2/SAV1 sulfation axis in response to oxidative stress, highlighting its potential as a promising therapeutic target for HCC.
Pseudopterygia in Fuchs Superficial Marginal Keratitis: Clinical Course and Surgical Outcomes
Authors: Chang Jin-Yu , Huang Tzu-Yu , Kuo Yih-Shiuan , Lin Pei-Yu 
Published: February 2024

Purpose:
Surgery for pseudopterygia in Fuchs superficial marginal keratitis (FSMK) bears the risk of corneal perforation, as described in a few case reports. The aim of this case series was to understand the clinical course and surgical outcomes of pseudopterygia in FSMK.

Methods:
A retrospective case series included patients meeting FSMK criteria with pseudopterygia in at least 1 eye. The severity grading of pseudopterygia and peripheral infiltration events at follow-up were analyzed. Pseudopterygia involving corneal central 3 mm diameter (grade III) received surgery. Peripheral corneal infiltrate events within 1 week after surgery were recorded.

Results:
Thirty-three eyes of 19 patients (8 men, 11 women; age 40–85 years; mean, 65 years) were included, with an average 48.1-month follow-up (range 0–188.8 months). At presentation, 7 eyes (21%) had grade III pseudopterygia. One patient showed corneal perforation 3 days after “pterygium” surgery elsewhere. The contralateral eye met the diagnosis of FSMK. During follow-up, 16 eyes (49%) exhibited peripheral corneal infiltrates, and 7 eyes (21%) showed progression of pseudopterygia to higher grades before or without any surgery. Ten eyes with grade III pseudopterygia underwent surgery. The best-corrected visual acuity in Logarithm of the Minimum Angle of Resolution improved from 0.34 ± 0.18 (range 0.05–0.52) to 0.13 ± 0.11 (range 0.05–0.4) (P = 0.0023). Six eyes (60%) developed peripheral corneal infiltrates within 1 week after surgery, which responded well to topical corticosteroids.

Conclusions:
Pseudopterygia in FSMK may progress to threaten visual acuity. Surgical excision can be safe and can effectively improve vision on the condition that the patients are closely followed in the early postoperative period to notice the corneal infiltrates.
Dealing With Pericylindrical Melts in Keratoprosthesis: Tenon Patch Graft to the Rescue
Authors: Patel Nikunj Vinodbhai , Aggarwal Manvi , Jain Mayur , Gour Abha , Sangwan Virender 
Published: February 2024

Purpose:
The aim of this study was to describe the outcomes of autologous Tenon patch graft in the management of Auro keratoprosthesis–related pericylindrical corneal melt.

Methods:
We report 3 cases of sterile pericylindrical corneal melt in patients with Auro keratoprosthesis implantation after a mean duration of 5 years (1.5–8 years). Case 1 was a patient with severe graft-versus-host disease. Cases 2 and 3 were cases of chemical injury.
All these cases of sterile pericylindrical corneal melt (4–6 mm) underwent autologous Tenon patch graft. The technique included freshening of the edges around the melt, followed by measuring the size of the defect. A Tenon graft harvested from the patient's own eye was used to seal the defect and act as a scaffold. The Tenon patch graft was spread over the melt and held in place by the application of fibrin glue and/or interrupted 10-0 nylon sutures. A bandage contact lens was then placed on the eye.

Results:
Tenon patch graft was well taken in all patients. The mean duration of epithelial healing was 1 month. Globe integrity was well maintained with no postoperative complications at a mean follow-up duration of 12 months (6–18 months).

Conclusions:
Corneal melt is one of the most dreaded complications of KPro because its occurrence could threaten visual prognosis and globe integrity. Autologous Tenon patch is a simple yet innovative and effective option to steer such eyes away from potentially dreadful complications.
Oncoplastic Reconstruction in the Setting of Prior Cosmetic Augmentation
Authors: Camacho Luis , Chu Carrie K. , Mitchell Melissa P. , Nguyen Thuy , Correa Arlene , Mericli Alexander F. 
Published: February 2024

Background:
This study explored the surgical management and reconstruction options for augmented breasts in the context of breast conservation therapy (BCT) for breast cancer. The authors hypothesized that there would be no difference in the rates of complications, revisions, or patient satisfaction in patients who maintained their breast augmentation versus those who had their implants removed in the context of BCT.

Methods:
The authors conducted a retrospective review of 142 patients who underwent BCT at a single center from March of 2016 to March of 2022. The study included patients who had a preexistent cosmetic augmentation at the time of breast cancer diagnosis and BCT. Patient demographics, clinical and treatment characteristics, breast implant details, reconstructive technique, complications, and revisions were recorded. Patient-reported outcomes were assessed using the BREAST-Q BCT module.

Results:
Ninety-three patients (65.5%) chose to maintain their implants, whereas 49 (34.5%) elected to have them removed during BCT. Patients with submuscular implants were more likely to maintain their implants. Oncoplastic mastopexy was associated with higher complication rates, particularly in patients opting for implant downsizing. However, multivariate logistic regression did not identify implant management strategy as an independent predictor for complications or revisions. Surgical-site infection was the only predictor of implant explantation. Patient-reported outcomes did not differ significantly between the different implant management cohorts.

Conclusions:
This study demonstrates that maintaining breast implants during BCT does not increase the risk of complications or revisions. Overall, BCT in augmented women was found to be a safe approach, with high patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
A disparity in prosthetic access for Ecuadorians with lower-limb amputation
Authors: Lipski Emily , Waters William F. , Kenworthy Sally , Mullen Ashley 
Published: February 2024

Background:
Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services.

Objective:
To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry.

Study design:
Retrospective study.

Methods:
A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed.

Results:
A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants’ functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses’ functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment.

Conclusions:
These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study’s analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.
Metastatic Infection Following Ear Piercing Detected by FDG PET/CT
Authors: Lee Jeong Won , Park Jung Wan , Lee Sang Mi 
Published: February 2024

Abstract
Ear piercing is currently a common practice. Although rare, ear piercing can cause systemic infections. We present a case of an 18-year-old woman who underwent FDG PET/CT for prolonged fever and bacteremia. FDG PET/CT showed multifocal FDG uptake at the site of piercing in the left ear, and in the spleen and left atrium and deep thigh vessel. The patient was diagnosed with an ear piercing infection with multiple metastatic infections.
Mandibular Distraction Osteogenesis in Children and Adolescents: A Clinical and Radiographic Research Using Cone-Beam Computed Tomography
Authors: Theologie-Lygidakis Nadia , Kamperos Georgios , Pavli Maria , Christopoulos Panos , Tzermpos Fotios , Tsiklakis Kostas , Iatrou Ioannis 
Published: February 2024

Aim:
The aim of this cross-sectional study was to evaluate, via cone-beam computed tomography, the long-term postoperative outcome in children treated with mandibular distraction osteogenesis.

Materials and Methods:
All young patients treated with mandibular distraction osteogenesis (MDO), during a 16-year period, at the University Department of Oral and Maxillofacial Surgery of a Pediatric Hospital, were recalled, and various clinical and radiographic parameters were recorded.

Results:
Eleven patients were included: 5 with hemifacial microsomia (HFM) and 6 with mandibular micrognathia. In all cases, MDO had been successful in regular follow-up and decannulation, soon after MDO, was achieved in all tracheostomy cases. The long-term result in cases of HFM was found stable, functionally and esthetically accepted, although less satisfactory than in regular follow-up; in micrognathia patients, relapse of different degrees was registered in 4 of 6 cases, without any need for tracheostomy though. Detailed and accurate information was obtained by cone-beam computed tomography (CBCT). The shape of the regenerated bone was irregular in HFM cases and relatively normal in the micrognathia cases. Quality of the regenerated bone was normal in all patients. The irregular shape registered in HFM cases did not compromise a safe orthognathic operation.

Conclusions:
Distraction osteogenesis remains an early treatment choice in cases of mandibular deformities. Long-term findings showed that there is a degree of relapse with growth, which was more obvious in mandibular micrognathia cases. Computed tomography contributes to detailed evaluation of changes at the distraction site.
Looking Across the Drape
Authors: Sinskey Jina L. , Schwartz Rachel , Boscardin Christy K. , Chang Joyce M. , Kumar Sandhya B. , Lebares Carter C. 
Published: February 2024

Objective:
To identify well-being threats for surgeons and anesthesiologists and develop interventions using the quality of life improvement (QOLI) approach.

Background:
Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs.

Methods:
Anesthesia and surgery faculty in 8 perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live voting to identify well-being priorities.

Results:
One hundred four perioperative faculty completed the survey. Across specialties, higher Mental Health Continuum–Short Form scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded 5 areas for intervention: (1) work culture, (2) work environment/resources, (3) sources of fulfillment, (4) work/life harmony, and (5) financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were operating room inefficiencies/delays and excessive workload, whereas anesthesiologists cited understaffing and unpredictable work hours.

Conclusions:
Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions.