bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immune checkpoint inhibitor-associated linear IgA bullous dermatosis with recalcitrant ocular involvement: a rare presentation
Authors: Saeed Lina , Hosking Anna-Marie , Grando Sergei A 
Published: January 2025

Abstract
Programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) receptor inhibitors have become imperative in the treatment of advanced solid organ malignancies such as metastatic melanoma. With this disinhibition of certain immune responses to induce an antitumour response, numerous adverse events have been reported, many of which affect the skin. While rare, PD-1/PD-L1 inhibitor-associated severe cutaneous adverse reactions (SCARs) can cause significant morbidity and/or mortality. New SCARs are reported with increasing frequency as immune checkpoint inhibitors become more widely used. Here, we present a rare case of recalcitrant ocular linear IgA bullous dermatosis associated with a PD-1 inhibitor. Awareness of this entity will allow more rapid recognition and initiation of appropriate management and treatment, which would reduce the morbidity and/or mortality associated with these serious adverse reactions.
Senolytic procyanidin C1 alleviates renal fibrosis by promoting apoptosis of senescent renal tubular epithelial cells
Authors: Gan Yu , Wang Kangning , Chen Xiang , Li Yong , He Yao , Zhou Yan , Zhang Bo 
Published: January 2025

AbstractRenal fibrosis is a common pathological process in various chronic kidney diseases. The accumulation of senescent renal tubular epithelial cells (TECs) in renal tissues plays an important role in the development of renal fibrosis. Eliminating senescent TECs has been proven to effectively reduce renal fibrosis. Procyanidin C1 (PCC1) plays a senolytic role by specifically eliminating senescent cells and extending its overall lifespan. However, whether PCC1 can alleviate unilateral ureteral obstruction (UUO)‐induced renal fibrosis and the associated therapeutic mechanisms remains unclear. Here, we observed a marked increase in senescent TECs within obstructed human renal tissue and demonstrated the positive correlation between the accumulation of senescent TECs and renal fibrosis in UUO‐induced renal fibrosis in mice. We found that PCC1 reduced the number of senescent TECs, restored the regenerative phenotype in kidneys with reduced fibrosis, and improved tubular repair after UUO‐induced injury. In vitro, PCC1 effectively cleared senescent HK2 cells by inducing apoptosis via ANGPTL4/NOX4 signaling. Incubation with culture medium from senescent HK2 cells promoted fibroblast activation, whereas PCC1 impeded profibrotic effects by downregulating senescence‐associated secretory phenotype (SASP) factors from senescent HK2 cells. Therefore, PCC1 alleviated interstitial renal fibrosis not only by clearing senescent TECs and improving tubular repair but also by indirectly attenuating myofibroblast activation by reducing the level of SASP. In summary, PCC1 may be a novel therapeutic senolytic agent for treating renal fibrosis.
Psychometric Properties of Entrustable Professional Activity–Based Objective Structured Clinical Examinations During Transition From Undergraduate to Graduate Medical Education: A Generalizability Study
Authors: Suneja Manish , Hanrahan Kate DuChene , Kreiter Clarence , Rowat Jane 
Published: January 2025

Abstract

Purpose
The objective structured clinical examination (OSCE) assesses clinical competence in health sciences education. There is little research regarding the reliability and validity of using an OSCE during the transition from undergraduate to graduate medical education. The goal of this study was to measure the reliability of a unique 2-rater Entrustable Professional Activity (EPA)–based OSCE format for transition to internship using generalizability theory for estimating reliability.

Method
During the 2018 to 2022 academic years, 5 cohorts of interns (n = 230) at the University of Iowa Hospital and Clinics participated in a 6-station OSCE assessment delivered during orientation. A univariate and multivariate generalizability study (G study) was conducted on the scores generated by the 3 cases in the orientation OSCE that shared the 2-rater format. This analysis was supplemented with an associated decision study (D study).

Results
The univariate G study for the cases that used a simulated patient and a faculty rater demonstrated that this OSCE generated a moderately reliable score with 3 cases. The D study showed that increasing the OCSE to 12 cases yielded a mean score reliable enough (G = 0.76) for making high-stakes normative decisions regarding remediation and readiness to practice. The universe score correlation between 2 types of raters was 0.398. The faculty ratings displayed a larger proportion of universe (true) score variance and yielded a more reliable (G = 0.433) score compared with the standardized patient ratings (G = 0.337).

Conclusions
This study provides insight into the development of an EPA-based OSCE. The univariate G study demonstrated that when using the 2 rater types, this assessment could generate a moderately reliable score with 3 cases. The multivariate G study showed that the 2 types of raters assessed different aspects of clinical skills, and faculty raters were more reliable.
Direct Neck Skin Excision for Correction of Aging Signs Confined to Skin Laxity and Sagging Skin in the Neck: A Local Anesthesia–Based Day Surgery Optimal for Younger Women
Authors: Okumuş Ayhan 
Published: January 2025

BACKGROUND
The removal of excessive neck skin is considered the key parameter in the best postoperative outcome after a neck rejuvenation surgery.

OBJECTIVE
To evaluate the utility of a local anesthesia–based direct neck skin excision surgery in patients with skin laxity and sagging skin in the neck in terms of postoperative aesthetic outcome and patient satisfaction within a 12-month follow-up period.

MATERIALS AND METHODS
A total of 47 female patients who underwent local anesthesia–based direct neck skin excision surgery for the rejuvenation of skin laxity and sagging skin in the cervical neck were included. Data on complications and patient-reported outcomes were recorded at the 12th month postoperatively.

RESULTS
Postoperatively, none of the patients developed suture breakage or loosening, infection, or bleeding, while ecchymosis (21.3%) and hypertrophic scar (17.0%) were manageable. At the 12th postoperative month, 93.6% of patients reported improved appearance and high satisfaction with the postoperative outcome in terms of a sustained tighter appearance in the neck.

CONCLUSION
The local anesthesia–based direct neck skin excision surgery in patients with skin laxity and sagging skin in the neck enables achievement and maintenance of a tighter appearance in the neck, with minor and manageable complications and high patient satisfaction.
HBV and HBsAg strongly reshape the phenotype, function, and metabolism of DCs according to patients’ clinical stage
Authors: Dumolard Lucile , Gerster Theophile , Chuffart Florent , Decaens Thomas , Hilleret Marie-Noelle , Larrat Sylvie , Saas Philippe , Jouvin-Marche Evelyne , Durantel David , Marche Patrice N. , Macek Jilkova Zuzana , Aspord Caroline 
Published: January 2025

Background:
Hepatitis B is a liver infection caused by HBV. Infected individuals who fail to control the viral infection develop chronic hepatitis B and are at risk of developing life-threatening liver diseases, such as cirrhosis or liver cancer. Dendritic cells (DCs) play important roles in the immune response against HBV but are functionally impaired in patients with chronic hepatitis B. The underlying mechanisms involved in HBV-induced DC dysfunctions remain to be elucidated.

Methods:
We explored DC modulations by HBV and HBsAg by exposing blood-derived cDC1s, cDC2s, and plasmacytoid DCs from healthy donors to HBV or HBsAg and stimulating them with toll-like receptor ligand. Their phenotypic and functional features, as well as their metabolic profile, were analyzed through multiparametric flow cytometry and multiplex assays and further explored on patients’ samples.

Results:
We found that HBV deeply reshaped the DC secretome in response to toll-like receptor ligand. Strikingly, we observed that HBV-exposed DCs secrete high levels of CX3CL1 (fractalkine), a chemokine responsible for attracting antiviral effectors to the site of infection. HBsAg exposure favored DC activation while drastically altering TRAIL expression in response to toll-like receptor ligand and increasing the secretion of cytokines/chemokines involved in immune tolerance. HBsAg further dampened the metabolism of DC subsets while driving metabolic switches. Notably, the relevance of the CX3CL1/CX3CR1 axis, TGF-β, and metabolic disturbances was demonstrated within intrahepatic DC subsets in patients according to disease stage.

Conclusions:
Our work brings new insights into the immunomodulation induced by HBV on DCs, which contribute to impaired antiviral responses and progression toward chronicity.
Individualizing musical tempo to spontaneous rates maximizes music-induced hypoalgesia
Authors: Yi Wenbo , Palmer Caroline , Serian Angela , Roy Mathieu 
Published: January 2025

Abstract
Music has long been recognized as a noninvasive and cost-effective means of reducing pain. However, the selection of music for pain relief often relies on intuition rather than on a scientific understanding of the impact of basic musical attributes on pain perception. This study examines how a fundamental element of music—tempo—affects its pain-relieving properties. One important finding in research on temporal dynamics of music is that people tend to sing or tap at a characteristic rate when asked to produce a simple melody. This characteristic rate, known as the spontaneous production rate (SPR), is consistent across different rhythm production tasks and may reflect the output of an endogenous oscillator. According to dynamical systems theory, SPRs represent optimal efficiency, minimizing energy expenditure while maximizing behavioral accuracy. This study examined whether aligning music tempo with individual SPRs could enhance the hypoalgesic effects of music. First, participants' SPRs were measured by asking them to produce a familiar melody at a comfortable rate. Next, they were asked to rate painful thermal stimulations under 4 conditions: music modified to match participants' SPR, music modified to be 15% faster or 15% slower than participants' SPR, and silence. Results revealed that musical tempos matching participants' SPR produced stronger reductions in pain compared to faster or slower tempo conditions, supporting the hypothesis that musical tempo aligned with individual rates is optimal for reducing pain. These findings underscore the individual-specific effects of musical tempo on pain perception, offering implications for personalized pain management strategies.
Reimagining Physician Assistant Education: Championing Cognitive Diversity to Promote Inclusivity, Neurodiversity Awareness, and a Sense of Belonging
Authors: George Tonya C. , Hudson Lillie , Brown Sheena D. , Coleman Veronica 
Published: January 2025

Abstract
Neurodiversity, encompassing conditions such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and dyslexia, represents a significant and often under-recognized segment of the population, including within science, technology, engineering, mathematics, and medicine fields like medicine. Neurodiverse individuals possess unique skills, including enhanced creativity, analytical thinking, and meticulous attention to detail, which are valuable in health care professions. However, failure to recognize and support these individuals can result in missed opportunities, social isolation, and mental health challenges. Despite a growing emphasis on diversity, equity, inclusion, and belonging in higher education, neurodiversity is frequently overlooked, particularly in physician assistant (PA) education. This article examines the unique challenges faced by neurodiverse PA student learners and the existing literature gap regarding neurodiversity in PA education. It underscores the need for greater awareness, reduced stigma, and improved support systems. Recommendations include integrating neurodiversity into the PA curriculum, providing faculty training on inclusive teaching practices, and establishing tailored accommodations to foster a sense of belonging. PA programs can foster a more equitable health care system by creating inclusive learning environments that acknowledge and cater to the unique needs of neurodiverse student learners, thereby enhancing student-faculty interactions and promoting academic success. The aim of this article was to facilitate the reimagining of PA education to champion cognitive diversity. By promoting a more inclusive learning environment, PA programs can cultivate future clinicians who are better equipped to serve diverse patient populations.
Bots in white coats: are large language models the future of patient education? a multi-center cross-sectional analysis
Authors: Aghamaliyev Ughur , Karimbayli Javad , Zamparas Athanasios , Bösch Florian , Thomas Michael , Schmidt Thomas , Krautz Christian , Kahlert Christoph , Schölch Sebastian , Angele Martin K. , Niess Hanno , Guba Markus O. , Werner Jens , Ilmer Matthias , Renz Bernhard W. 
Published: January 2025

Objectives:
Every year, around 300 million surgeries are conducted worldwide, with an estimated 4.2 million deaths occurring within 30 days after surgery. Adequate patient education is crucial, but often falls short due to the stress patients experience before surgery. Large language models (LLMs) can significantly enhance this process by delivering thorough information and addressing patient concerns that might otherwise go unnoticed.

Material and Methods:
This cross-sectional study evaluated ChatGPT-4o’s audio-based responses to frequently asked questions (FAQs) regarding six general surgical procedures. Three experienced surgeons and two senior residents formulated seven general and three procedure-specific FAQs for both preoperative and postoperative situations, covering six surgical scenarios (major: pancreatic head resection, rectal resection, total gastrectomy; minor: cholecystectomy, Lichtenstein procedure, hemithyroidectomy). In total, 120 audio responses were generated, transcribed, and assessed by 11 surgeons from six different German university hospitals.

Results:
ChatGPT-4o demonstrated strong performance, achieving an average score of 4.12/5 for accuracy, 4.46/5 for relevance, and 0.22/5 for potential harm across 120 questions. Postoperative responses surpassed preoperative ones in both accuracy and relevance, while also exhibiting lower potential for harm. Additionally, responses related to minor surgeries were minimal, but significantly more accurate compared to those for major surgeries.

Conclusion:
This study underscores GPT-4o’s potential to enhance patient education both before and after surgery by delivering accurate and relevant responses to FAQs about various surgical procedures. Responses regarding the postoperative course proved to be more accurate and less harmful than those addressing preoperative ones. Although a few responses carried moderate risks, the overall performance was robust, indicating GPT-4o’s value in patient education. The study suggests the development of hospital-specific applications or the integration of GPT-4o into interactive robotic systems to provide patients with reliable, immediate answers, thereby improving patient satisfaction and informed decision-making.
Performance of sentinel lymph node biopsy after neoadjuvant chemotherapy in clinically node positive breast cancer patients: systematic review and meta-analysis
Authors: Zahwe Mariam , Ghzaiel Abir , Najia Ahmad , Soueid Lara , Asmar Khalil El , Ghezzawi Malak , Iskandarani Sarah El , Diab Marwa , Jibbawi Miryam El , Hoteit Reem , Sbaity Eman 
Published: January 2025

Background:
The reliability of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) in patients with initially node-positive breast cancer is still controversial. This meta-analysis is conducted to investigate the feasibility and accuracy of SLNB after NACT in patients with initially positive axillary nodes.

Methods:
We conducted a literature search using Medline, PubMed, Embase, Central, and SCOPUS up until April 2021 for studies on the performance of SLNB following NACT. We included prospective studies including breast cancer patients with positive lymph nodes at diagnosis and received NACT before undergoing SLNB irrespective of their molecular subtypes or stage. Our main outcomes of interest were the identification rate (IR) and the false negative rate (FNR) of SLNB.

Results:
We included an aggregate of 33 studies in this meta-analysis enrolling 4,624 patients. The reported IR ranged from a minimum of 77.6% to a maximum of 100% and resulted in a pooled IR of 88% (95%CI: 86-90, I2:80.9%). The FNR reported in the studies ranged from a minimum of 5.1% to a maximum of 43% and showed a pooled FNR of 13% (95% CI: 11-15, I2: 72.31%). The subgroup analysis demonstrated that the usage of dual mapping technique could decrease the FNR and increase the IR. Moreover, the number of lymph nodes retrieved inversely correlated with FNR (p<0.01).

Conclusion:
Our findings support the feasibility and accuracy of SLNB after NACT in initially node-positive breast cancer patients, that converted to clinically node negative when performed in properly selected cases. SLNB offers a less invasive approach in selected patients sparing them the morbidity associated with ALND. This approach aligns with efforts to de-escalate surgical management in breast cancer and reinforces that SLNB post-NACT should be incorporated into clinical practice, provided that stringent patient selection and procedural standards are maintained.
The Impact of Physical Therapy Postprofessional Education Programs on Productivity in a Large Academic Medical Center
Authors: DeWitt John J. , Weber Mark D. , Tichenor Carol Jo , Farrell Joseph P. , Kidder Melissa S. , Olson-Kellogg Becky J. , Hensley Craig P. , Harrington Kendra L. , Briggs Matthew S. 
Published: January 2025

Introduction.
Emerging evidence shows positive impact of postprofessional physical therapy education (residency and fellowship) specific to participants; however, outcomes on organizational impact are largely unknown. The purpose of this project was to describe the impact residency and fellowship training has on financial metrics. A secondary purpose of this case study was to describe trends associated with higher productivity.

Review of Literature.
Previous studies have demonstrated positive professional behavior and generalized operational impact of postprofessional education. No studies have evaluated the impact of residency and fellowship training on individual physical therapist (PT) productivity.

Subjects.
Individual productivity from 191 PTs was collected over a 10-year time frame from a large, ambulatory, rehabilitation department within an academic medical center. Productivity was compared between 4 groups: nonresidency- or fellowship-trained clinicians; residency-trained clinicians; fellowship-trained clinicians; and dual residency and fellowship–trained clinicians.

Methods.
Physical therapists' productivity data were manually extracted retrospectively from operational reports over a 10-year period. Additional data elements extracted included the following: board specialty certification and years employed at the medical center. Data were then categorized as nonresidency/fellowship -trained, residency trained, fellowship trained, or dual residency and fellowship trained. Data were analyzed using descriptive statistics and 1-way analysis of variance (ANOVA).

Results.
Forty-five clinicians with postprofessional training collectively produced $253,617 more in financial annual return to the organization. Fellowship-trained clinicians demonstrated the highest productivity followed by residency-trained and dual residency and fellowship–trained clinicians. Specialty board certification also positively increased productivity regardless of postprofessional training.

Discussion and Conclusion.
Postprofessional training within physical therapy continues to be evaluated in the spectrum of professional development. Evidence supports positive professional behaviors and patient outcomes; however, little is known regarding its impact on productivity metrics. Although no significance was found between the groups with and without postprofessional training, meaningful financial return was demonstrated in clinicians with postprofessional training. The lack of significance may have been influenced by compression because of departmental productivity guidelines. This preliminary data may assist organizations in justifying resources for sustaining and sponsoring future programs.
The disparities of PrEP adherence among men who have sex with men between the Global South and the Global North: An updated determinantal global meta-analysis
Authors: Wang Haoyi , Delnoij Marit , Zimmermann Hanne M.L. , Jonas Kai J. 
Published: January 2025

Background:
Suboptimal adherence to PrEP limits its global impact, with current evidence mostly from the Global North and lacking Global South perspectives. This meta-analysis synthesises the rates and determinants of suboptimal adherence to oral PrEP among MSM in both regions.

Methods:
We searched for literature describing PrEP adherence and its determinants among MSM globally up until October 2024 to conduct a meta-analysis on the rate and determinants of suboptimal adherence in both regions. The definition of (sub-)optimal adherence were study-based.

Results:
We included 82 studies in the meta-analysis, with 24, 53, and 5 stemmed from the Global South, North, and global multicentre studies, respectively. Oral PrEP suboptimal adherence is prevalent among MSM PrEP-users globally (rate=0.33, 95%CI:0.28-0.38) with a significantly higher rate (p=0.021) in the Global South (rate=0.41, 95%CI:0.33-0.50) compared to the Global North (rate=0.29, 95%CI:0.23-0.35). In the Global South, older age (OR=0.57, 95%CI:0.37-0.87), alcohol use (OR=1.28, 95%CI:1.02-1.60) and presenting depressive symptoms (OR=1.47, 95%CI:1.01-2.16) were associated with suboptimal adherence. In the Global North, MSM self-identified as Black (OR=2.27, 95%CI:1.31-3.95) or Other (OR=1.36, 95%CI:1.02-1.81), having a university degree (OR=0.50, 95%CI:0.34-0.73), and presenting depressive symptoms (OR=2.26, 95%CI:1.35-3.78) were associated with suboptimal adherence. On-demand PrEP-users globally demonstrated a higher likelihood of suboptimal adherence (OR=1.59, 95%CI:1.18-2.14).

Conclusions:
Suboptimal adherence to oral PrEP is prevalent among MSM globally, particularly higher in the Global South. Regional differences in determinants highlight the need for tailored interventions. Tailored interventions are required to address mental health with tailored efforts to younger MSM in the Global South, while interventions in the Global North should be tailored to specific sub-groups.