bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between prolonged weekly duty hours and self-study time among residents: a cross-sectional study
Authors: Nagasaki Kazuya , Nishizaki Yuji , Shinozaki Tomohiro , Shimizu Taro , Yamamoto Yu , Shikino Kiyoshi , Fukui Sho , Nishiguchi Sho , Kurihara Masaru , Katayama Kohta , Kobayashi Hiroyuki , Tokuda Yasuharu 
Published: June 2023

Abstract

Purpose
In 2024, the Japanese government will enforce a maximum 80-hour weekly duty hours (DHs) regulation for medical residents. Although this reduction in weekly DHs could increase the self-study time (SST) of these residents, the relationship between these two variables remains unclear. The aim of the study was to investigate the relationship between the SST and DHs of residents in Japan.

Methods
In this nationwide cross-sectional study, the subjects were candidates of the General Medicine In-Training Examination in the 2020 academic year. We administered questionnaires and categorically asked questions regarding daily SST and weekly DHs during the training period. To account for hospital variability, proportional odds regression models with generalized estimating equations were used to analyse the association between SST and DHs.

Results
Of the surveyed 6117 residents, 32.0% were female, 49.1% were postgraduate year-1 residents, 83.8% were affiliated with community hospitals, and 19.9% worked for ≥80 hours/week. Multivariable analysis revealed that residents working ≥80 hours/week spent more time on self-study than those working 60–70 hours/week. Conversely, residents who worked &lt;50 hours/week spent less time on self-study than those who worked 60–70 hours/week. The factors associated with longer SST were sex, postgraduate year, career aspiration for internal medicine, affiliation with community hospitals, academic involvement, and well-being.

Conclusion
Residents with long DHs had longer SSTs than residents with short DHs. Future DH restrictions may not increase but rather decrease resident SST. Effective measures to encourage self-study are required, as DH restrictions may shorten SST.
Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior, and Physical Fitness: The OPTICARE XL Randomized Controlled Trial
Authors: den Uijl Iris , van den Berg-Emons Rita J G , Sunamura Madoka , Lenzen Mattie J , Stam Henk J , Boersma Eric , Tenbült-van Limpt Nicole C C W , Kemps Hareld M C , Geleijnse Marcel L , ter Hoeve Nienke 
Published: June 2023

Abstract

Objective
Previously published results of the OPTICARE XL open label randomized controlled trial showed no added value of OPTICARE XL CR, a dedicated cardiac rehabilitation (CR) program for patients with obesity, with respect to health–related quality of life (primary outcome). This clinical trial studied the effects of OPTICARE XL CR on several secondary outcomes, which included body weight, physical activity, sedentary behavior, and physical fitness.

Methods
Patients with coronary artery disease or atrial fibrillation and body mass index ≥ 30 were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). OPTICARE XL CR was a 1-year group intervention, specifically designed for patients with obesity that included aerobic and strength exercise, behavioral coaching, and an aftercare program. Standard CR consisted of a 6- to 12-week group aerobic exercise program, supplemented with cardiovascular lifestyle education. Study end points included body weight, physical activity, sedentary behavior (accelerometer), and physical fitness (6-Minute Walk Test and handgrip strength), which were evaluated 6 months after the end of CR (primary endpoint) and 3 months after the start of CR.

Results
Six months after completion of either program, improvements in body weight, physical activity, sedentary behavior, and physical fitness were similar between the groups. Three months after CR start, patients randomized to OPTICARE XL CR showed greater weight loss (mean change = −3.6 vs −1.8 kg) and a larger improvement in physical activity (+880 vs +481 steps per day) than patients randomized to standard CR.

Conclusion
Patients allocated to OPTICARE XL CR lost significantly more body weight and showed promising results with respect to physical activity 3 months after the start of CR; however, these short-term results were not expanded or sustained in the longer term.

Impact
Patients with obesity do not benefit from standard CR programs. The new OPTICARE XL CR program showed its effects in the short term on weight loss and physical activity, and, therefore, redesign of the aftercare phase is recommended.
Single-Cell RNA-Seq Reveals LRRC75A-Expressing Cell Population Involved in VEGF Secretion of Multipotent Mesenchymal Stromal/Stem Cells Under Ischemia
Authors: Miura Takumi , Kouno Tsukasa , Takano Megumi , Kuroda Takuya , Yamamoto Yumiko , Kusakawa Shinji , Morioka Masaki Suimye , Sugawara Tohru , Hirai Takamasa , Yasuda Satoshi , Sawada Rumi , Matsuyama Satoko , Kawaji Hideya , Kasukawa Takeya , Itoh Masayoshi , Matsuyama Akifumi , Shin Jay W , Umezawa Akihiro , Kawai Jun , Sato Yoji 
Published: June 2023

Abstract
Human multipotent mesenchymal stromal/stem cells (MSCs) have been utilized in cell therapy for various diseases and their clinical applications are expected to increase in the future. However, the variation in MSC-based product quality due to the MSC heterogeneity has resulted in significant constraints in the clinical utility of MSCs. Therefore, we hypothesized that it might be important to identify and ensure/enrich suitable cell subpopulations for therapies using MSC-based products. In this study, we aimed to identify functional cell subpopulations to predict the efficacy of angiogenic therapy using bone marrow-derived MSCs (BM-MSCs). To assess its angiogenic potency, we observed various levels of vascular endothelial growth factor (VEGF) secretion among 11 donor-derived BM-MSC lines under in vitro ischemic culture conditions. Next, by clarifying the heterogeneity of BM-MSCs using single-cell RNA-sequencing analysis, we identified a functional cell subpopulation that contributed to the overall VEGF production in BM-MSC lines under ischemic conditions. We also found that leucine-rich repeat-containing 75A (LRRC75A) was more highly expressed in this cell subpopulation than in the others. Importantly, knockdown of LRRC75A using small interfering RNA resulted in significant inhibition of VEGF secretion in ischemic BM-MSCs, indicating that LRRC75A regulates VEGF secretion under ischemic conditions. Therefore, LRRC75A may be a useful biomarker to identify cell subpopulations that contribute to the angiogenic effects of BM-MSCs. Our work provides evidence that a strategy based on single-cell transcriptome profiles is effective for identifying functional cell subpopulations in heterogeneous MSC-based products.
Extra-intestinal complications of Ascaris lumbricoides infections in India: A systematic review and meta-analysis
Authors: Mewara Abhishek , Kanaujia Rimjhim , Malla Nancy 
Published: June 2023

ABSTRACT
The aberrant migration of Ascaris lumbricoides may cause extra-intestinal ascariasis (EIA) involving hepato-biliary-pancreatic (HBP) or other extra-gastro-intestinal (EGI) organs. We performed a systematic review and meta-analysis to study the risk factors and clinical presentations of EIA, and differences in HBP and EGI ascariasis. Medline, Web of Science and Embase were searched for cases of EIA in the English language from India. From 1204 articles, 86 studies (105 cases) were included. The majority of the cases involved the HBP system (78%). Among HBP ascariasis, the most commonly involved site was the bile duct (53.6%). Females had 11.3 times higher odds (95% CI 2.852 to 44.856; p=0.001) of HBP ascariasis, while the pediatric population had lower odds (OR=0.323). Previous gallbladder disease was significantly associated with HBP ascariasis in adults (p=0.046), while a significantly higher number of cases of EGI ascariasis were observed among pediatric patients (p=0.003). Ocular symptoms occurred exclusively in the pediatric population (p=0.017). Overall, death was reported in 3.8% of patients (n=4). This review emphasizes the importance of the complications of EIA. It encourages future research into issues such as the reasons of higher gall bladder ascariasis in females and the implications of Ascaris-related complications following biliary tract interventions. It also suggests considering Ascaris as a differential diagnosis for airway obstuction in intubated critically ill patients.
Murder and Memory in Territorial Hawai‘i: A Moloka‘i Microhistory
Authors: Hoxie Frederick E 
Published: June 2023

Abstract
The murder of Elmer Conant on the tiny island of Moloka‘i in June, 1923, was an act of local resistance to a wave of social and economic change. The hunt for Conant’s murderer, and the subsequent prosecution of a Native Hawaiian man local authorities believed was responsible for it, reveal the power territorial elites could exercise over life in rural Hawai‘i, the ambiguous nature of indigenous response to that rule, and the way colonial power could shape memories of the era. This microhistory reverses the conventional lens used to examine Hawaiian history by concentrating on rural events and ordinary people far removed from the capital city who confronted the forces of colonialism and whose struggles helped shape island history.
Continuous Finger-cuff versus Intermittent Oscillometric Arterial Pressure Monitoring and Hypotension during Induction of Anesthesia and Noncardiac Surgery: The DETECT Randomized Trial
Authors: Kouz Karim , Weidemann Friederike , Naebian Ashkan , Lohr Anneke , Bergholz Alina , Thomsen Kristen K. , Krause Linda , Petzoldt Martin , Moll-Khosrawi Parisa , Sessler Daniel I. , Flick Moritz , Saugel Bernd 
Published: June 2023

Background
Finger-cuff methods allow noninvasive continuous arterial pressure monitoring. This study aimed to determine whether continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery. Specifically, this study tested the hypotheses that continuous finger-cuff—compared to intermittent oscillometric—arterial pressure monitoring helps clinicians reduce the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia and the time-weighted average mean arterial pressure less than 65 mmHg during noncardiac surgery.

Methods
In this single-center trial, 242 noncardiac surgery patients were randomized to unblinded continuous finger-cuff arterial pressure monitoring or to intermittent oscillometric arterial pressure monitoring (with blinded continuous finger-cuff arterial pressure monitoring). The first of two hierarchical primary endpoints was the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia; the second primary endpoint was the time-weighted average mean arterial pressure less than 65 mmHg during surgery.

Results
Within 15 min after starting induction of anesthesia, the median (interquartile range) area under a mean arterial pressure of 65 mmHg was 7 (0, 24) mmHg × min in 109 patients assigned to continuous finger-cuff monitoring versus 19 (0.3, 60) mmHg × min in 113 patients assigned to intermittent oscillometric monitoring (P = 0.004; estimated location shift: −6 [95% CI: −15 to −0.3] mmHg × min). During surgery, the median (interquartile range) time-weighted average mean arterial pressure less than 65 mmHg was 0.04 (0, 0.27) mmHg in 112 patients assigned to continuous finger-cuff monitoring and 0.40 (0.03, 1.74) mmHg in 115 patients assigned to intermittent oscillometric monitoring (P < 0.001; estimated location shift: −0.17 [95% CI: −0.41 to −0.05] mmHg).

Conclusions
Continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery compared to intermittent oscillometric arterial pressure monitoring.

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ATV-Related Trauma in the Pediatric Population
Authors: Giertych Benjamin , Morrow Vincent R. , Rizwan Umer , Danby Grace C. , Lubicky John P. , Hobbs Gerald , Grant Daniel R. 
Published: June 2023

Background:
All-terrain vehicles (ATVs) are prevalent in Appalachia and cause significant morbidity and mortality in the pediatric population. This study investigated the injury types and severity in pediatric patients over a 15-year period.

Methods:
A retrospective chart review was performed on pediatric ATV-related traumas presenting to our institution from 2005 to 2020. Patients were divided into 3 age groups (0–7, 8–12, and 13–17 y) to evaluate differences in accident demographics, hospitalization, Glasgow Coma Scale, Injury Severity Score, substance use, characterization of orthopaedic and nonorthopaedic injuries, and procedures performed.

Results:
Inclusion criteria were met by 802 patients. Males represented 71.7% (n=575) and females 28.3% (n=227); the mean age was 12.4 years. The majority (88.5%, n=710) of patients admitted following their accident had a mean stay length of 3.3 days. Of admissions, intensive care unit admission was required by 23.8%, n=191 (mean stay 4.0 d). There were 7 fatalities. The vast majority of accidents occurred between May and September (79.2%, n=635). In patients with documented helmet status, 45% (n=271) were helmeted. Roughly half of all patients (n=393) sustained a fracture (excluding fractures to the head), 370 sustained an injury to the head/face, 129 sustained intra-abdominal/intra-thoracic injuries, and 29 sustained injuries to all 3 systems. The most common fractures involved the forearm (n=98), femur (n=65), and spine (n=59). The most common open fractures were the tibia (n=12), humerus (n=8), and forearm (n=8). The oldest group was more likely than the middle or younger groups to sustain spine (P<0.0001), pelvis (P=0.0001), hand (P=0.0089), and foot (P=0.0487) fractures. Ethanol testing was positive in 5.0% (n=25) of the oldest group and cannabinoids were present in 6.8% (n=34). The youngest group was significantly more likely to sustain a fracture of the humerus than the middle or older groups (P<0.0001). Orthopaedic surgical management was required in 24.4% (n=196) of patients.

Conclusions:
Pediatric ATV accidents present a significant source of morbidity and mortality. Further intervention is necessary to minimize pediatric ATV injuries.

Level of Evidence:
Level IV—Retrospective Case Series.
Delivery platforms for broadly neutralizing antibodies
Authors: Joshi Lok R. , Gálvez Nicolás M.S. , Ghosh Sukanya , Weiner David B. , Balazs Alejandro B. 
Published: June 2023

Purpose of review
Passive administration of broadly neutralizing antibodies (bNAbs) is being evaluated as a therapeutic approach to prevent or treat HIV infections. However, a number of challenges face the widespread implementation of passive transfer for HIV. To reduce the need of recurrent administrations of bNAbs, gene-based delivery approaches have been developed which overcome the limitations of passive transfer.

Recent findings
The use of DNA and mRNA for the delivery of bNAbs has made significant progress. DNA-encoded monoclonal antibodies (DMAbs) have shown great promise in animal models of disease and the underlying DNA-based technology is now being tested in vaccine trials for a variety of indications. The COVID-19 pandemic greatly accelerated the development of mRNA-based technology to induce protective immunity. These advances are now being successfully applied to the delivery of monoclonal antibodies using mRNA in animal models. Delivery of bNAbs using viral vectors, primarily adeno-associated virus (AAV), has shown great promise in preclinical animal models and more recently in human studies. Most recently, advances in genome editing techniques have led to engineering of monoclonal antibody expression from B cells. These efforts aim to turn B cells into a source of evolving antibodies that can improve through repeated exposure to the respective antigen.

Summary
The use of these different platforms for antibody delivery has been demonstrated across a wide range of animal models and disease indications, including HIV. Although each approach has unique strengths and weaknesses, additional advances in efficiency of gene delivery and reduced immunogenicity will be necessary to drive widespread implementation of these technologies. Considering the mounting clinical evidence of the potential of bNAbs for HIV treatment and prevention, overcoming the remaining technical challenges for gene-based bNAb delivery represents a relatively straightforward path towards practical interventions against HIV infection.
Cannulate, Extubate, Ambulate: How the Pandemic Accelerated Development and Implementation of Early Mobility for Patients Requiring Extracorporeal Membrane Oxygenation
Authors: DiVito Kari , Swisher Anne K. , Hayanga J.W. Awori 
Published: June 2023

Objective:
Extracorporeal membrane oxygenation (ECMO) is a lifesaving modality that was in great demand for persons with severe COVID-19 infection. Although mobility of these patients has previously been safely reported anecdotally, there were no established guidelines to implement in a greatly expanded patient population, as occurred in the pandemic period. We describe the development and implementation of a program (Cannulate, Extubate, Ambulate) for team-based safe mobilization.

Methods:
The 3-phase protocol advances based on patient alertness/ability to actively participate. A physical therapist determined initial stage and progression and recommended mobility activities for carryover by nurses and/or ECMO specialists between skilled sessions.

Results:
The mobility program has been successfully implemented for 104 patients with severe COVID-19 without significant adverse events. Most patients (51%) ambulated while cannulated, and 60% were able to discharge directly home after hospitalization.

Conclusions:
This safe, effective program allowed extension of physical therapy goals in a highly complex patient population during a time of very high demand. Making early mobility a team goal enhanced buy-in, instead of relying exclusively on rehabilitation providers for mobilization. Utilization of the Cannulate, Extubate, Ambulate program may assist other programs to minimize complications of immobility in the ECMO population.
Vitamin D and infertility
Authors: Simpson Samantha , Pal Lubna 
Published: June 2023

Purpose of review
Vitamin D deficiency has been implicated as a contributing factor to a spectrum of reproductive health burden, including difficulty conceiving, pathogenesis of gynaecological disorders such as uterine fibroids and endometriosis, to metabolic and endocrine burden of polycystic ovarian syndrome (PCOS).

Recent findings
There have been recent publications showing that in infertile women who are supplemented with vitamin D, there are higher pregnancy rates; there are improved ovarian reserve parameters in women with diminished ovarian reserve; curtailed fibroid growth in those with uterine myomas; lessened dysmenorrhea in endometriosis patients; and improved menstrual regularity, lowered testosterone, AMH and insulin levels in women with PCOS. In infertile men, sperm parameters, especially motility, are positively correlated with vitamin D serum levels.

Summary
Vitamin D status appears to be relevant to reproductive physiology, and to physiological processes underlying common gynaecological disorders as well as for reproductive success.
Microperimetry in Foveal Sparing Atrophic Late-Onset Retinal Degeneration
Authors: Alex Varsha , Papastavrou Vasileios , Walker Evan H. , Browning Andrew C , Dhillon Baljean , Borooah Shyamanga 
Published: June 2023

ABSTRACT

PURPOSE:
To understand the baseline and longitudinal microperimetry (MP) characteristics in foveal sparing atrophic Late-Onset Retinal Degeneration (L-ORD).

METHOD:
Prospective, cross-sectional, longitudinal study in which patients from the retina clinics of two academic teaching hospitals were included. Mesopic microperimetry was performed using a Nidek MP-1 micro-perimeter. Mean total, foveal, inner ring, and outer ring sensitivities were analyzed.

RESULTS:
A total of 20 eyes from 10 patients had baseline data. The subset of 10 eyes from 5 patients had follow-up data. The mean baseline macular sensitivity was 10.02 dB (+/- 5.26) with findings showing symmetry between both eyes. In the follow-up cohort, there was a significant loss of outer ring (0.83 dB per year, p= 0.0001), inner ring (0.67 dB per year, p=0.034), and foveal sensitivity (0.92dB loss per year, p= 0.015), while the mean sensitivity decreased significantly (0.66 dB per year, p = 0.0008) at 4-year follow-up. The drop in mean sensitivity was associated with significant increases in the number of deep scotoma points (6.20, p=0.037) and a decrease in the number of normal points (-6.30, p=0.022).

CONCLUSION:
Microperimetry is a useful tool for macular function follow-up to measure disease progression in L-ORD.
FOVEA PLANA AND FUNDUS HYPOPIGMENTATION IN PRADER–WILLI SYNDROME
Authors: de Laage de Meux Priscille , Mosbah Héléna , Cotton-Viard Anne , Cohen Salomon Y. 
Published: June 2023

Background/Purpose:
To report a case of fovea plana with fundus hypopigmentation in a patient with Prader‐Willi syndrome (PWS).

Methods:
Case report.

Results:
During a routine examination, fovea plana and fundus hypopigmentation were observed in both eyes in a 34-year-old male patient with PWS and documented with fundus photography, spectral domain optical coherence tomography and optical coherence tomography-angiography.

Conclusion:
Fovea plana and fundus hypopigmentation may be associated with PWS. Indeed, both PWS and oculocutaneous albinism may be explained by the deletion of the same genomic region on chromosome 15. The present case of a patient with PWS with fundus hypopigmentation supports the genetic and clinical overlap between PWS and oculocutaneous albinism.
Double Trouble: An Unusual Keratitis Case of Herpes Simplex Virus and Varicella-Zoster Virus Co-infection
Authors: Matharu Kanwal S. , Mammen Alex , Jhanji Vishal , Kinchington Paul R. , Kowalski Regis P. 
Published: June 2023

Purpose:
The aim of this study was to describe a case of herpes simplex virus (HSV) and varicella-zoster virus (VZV) corneal co-infection in a patient with systemic immunosuppression.

Methods:
A 77-year-old White man who was recently administered pembrolizumab present with reduction in visual acuity in his left eye from 20/25 to 20/50. There was a known history of ocular HSV keratitis. Slit-lamp examination showed superficial dendritic lesions suggestive of VZV.

Results:
Viral polymerase chain reaction testing was positive for both HSV and VZV, confirming clinical diagnosis of VZV keratitis in the setting of recurrent HSV keratitis. The infection responded to treatment with topical trifluridine. Two months later, he had another episode of keratitis based on his symptoms reported through telephone encounter which resolved with trifluridine. Unfortunately, the patient committed suicide 4 months after onset.

Conclusions:
This is the first case of keratitis with HSV and VZV co-infection likely related to systemic immunosuppression. Clinicians should have a high suspicion for viral co-infections in the setting of systemic immunosuppression.