bluuebunny/crossref_metadata_2025_split huggingface dataset:
ʻItʼs Not “Uni” Work, itʼs Essential Learning to be a Police Officerʼ: Examining the Higher Education Elements of Police Education Qualifications Framework Programmes
Authors: Honess Richard , Clarke Scott 
Published: May 2023

Abstract
The two ʻpost entryʼ programmes of the Policing Education Qualifications Framework (PEQF); the Police Constable Degree Apprenticeship (PCDA) and Degree Holder Entry Programme (PCDA) have now been running for a few years, to the point where several learning points have been identified. This article discusses these programmes from the point of view of a consortium of Higher Education Providers (HEPs) delivering, in partnership, with several England and Wales Police Forces in the real world. It examines how the Higher Education elements have been integrated (or not) into police recruit education, examines and addresses many of the learning points that have arisen and what work still remains to fully integrate higher education into the police recruit learning process.
Fibroblast growth factor receptor 1 as a potential marker of terminal effector peripheral T helper cells in rheumatoid arthritis patients
Authors: Etori Keishi , Tanaka Shigeru , Tamura Jun , Hattori Koto , Kagami Shin-Ichiro , Nakamura Junichi , Ohtori Seiji , Nakajima Hiroshi 
Published: May 2023

Abstract

Objectives
RA is an autoimmune disease characterized by destructive polyarthritis. CD4+ T cells are pivotal to its pathogenesis, and our previous study revealed the expression of fibroblast growth factor receptor 1 (FGFR1) is modulated by MTX treatment in CD4+ T cells of RA patients; however, the roles of FGFR1 in CD4+ T cells in the pathogenesis of RA is unclear. Therefore, in this study, we aimed to characterize FGFR1-positive CD4+ T cells in RA patients.

Methods
The abundance of FGFR1-positive CD4+ T cells in peripheral blood and synovium was determined. Single-cell RNA sequencing (scRNA-seq) was performed on synovial CD4+ T cells to characterize FGFR1-positive cells. In addition, T cell activation status and cytokine production were determined using flow cytometry.

Results
The percentage of FGFR1-positive CD4+ T cells in the peripheral blood was higher in RA patients than in healthy controls (P =0.0035). They were also present in the synovium of active RA patients. The results of scRNA-seq revealed that peripheral Th (Tph) cells preferentially expressed FGFR1. Additionally, these FGFR1-positive Tph cells displayed a terminal effector cell phenotype. Consistent with this finding, FGFR1-positive CD4+ T cells in peripheral blood expressed IL-21 and IFN-γ.

Conclusion
Our study provides evidence that FGFR1 marks terminal effector Tph cells in patients with RA.
Diagnostic delay is associated with uveitis and inflammatory bowel disease in AS: a study of extra-musculoskeletal manifestations in SpA
Authors: Michelena Xabier , Zhao Sizheng Steven , Marco-Pascual Carla , Almirall Miriam , Collantes-Estevez Eduardo , Font-Ugalde Pilar , López-Medina Clementina , Wei James Cheng-Chung , Morgan Ann W , Rodríguez Jesús , Juanola Xavier , Vázquez-Mellado Janitzia , Marzo-Ortega Helena 
Published: May 2023

Abstract

Objectives
To examine the prevalence of extra-musculoskeletal manifestations (EMM) and the association between diagnostic delay and their incidence in AS and PsA.

Methods
This was a retrospective, cohort study comprising two single centre cohorts in Europe and one multicentre cohort in Latin America (RESPONDIA). Crude prevalence of EMMs (uveitis, IBD and psoriasis) was calculated across geographic area and adjusted by direct standardization. Cox proportional hazard analysis was performed to assess the association between diagnostic delay and EMM incidence.

Results
Of 3553 patients, 2097 had AS and 1456 had PsA. The overall prevalence of uveitis was 22.9% (95% CI: 21.1, 24.8) in AS and 3.8% (95% CI: 2.9, 5.0) in PsA; 8.1% (95% CI: 7.0, 9.4) and 2.1% (1.3, 2.9), respectively, for IBD; and 11.0% (95% CI: 9.7, 12.4) and 94.6% (93.0, 95.9), respectively, for psoriasis. The EMM often presented before the arthritis (uveitis 45.1% and 33.3%, and IBD 37.4% and 70%, in AS and PsA, respectively). In the multivariable model, longer diagnostic delay (≥5 years) associated with more uveitis (hazard ratio [HR] 4.01; 95% CI: 3.23, 4.07) and IBD events (HR 1.85; 95% CI: 1.28, 2.67) in AS. Diagnostic delay was not significantly associated with uveitis (HR 1.57; 95% CI: 0.69, 3.59) or IBD events (HR 1.59; 95% CI: 0.39, 6.37) in PsA.

Conclusion
EMMs are more prevalent in AS than PsA and often present before the onset of the articular disease. A longer diagnostic delay is associated with the ‘de novo’ appearance of uveitis and IBD in AS, highlighting the need to enhance diagnostic strategies to shorten the time from first symptom to diagnosis in SpA.
Visceral adiposity in cirrhosis: Association with disease severity and impact of liver transplantation
Authors: Sharma Rajani , Schluger Aaron , Ahmed Firas S. , Nobel Yael R. , Guo Xiaotao , Zhao Binsheng , Verna Elizabeth C. 
Published: May 2023

Background:
Changes in adipose tissue distribution in liver cirrhosis are poorly characterized and may affect clinical outcomes.

Methods:
Adult liver transplant (LT) January 2008–August 2017 recipients with abdominal MRI within 6 months pre-LT were retrospectively assessed. Visceral adipose tissue, subcutaneous adipose tissue, and skeletal muscle area (cm2) were determined at L3. Visceral-to-subcutaneous adipose tissue ratio (VSR) was used to define relative adipose distribution, stratified by sex. Correlation was tested with Pearson. Body composition measures were compared by Child-Turcotte-Pugh (CTP) class, before and after LT, and evaluated as predictors of clinical outcomes.

Results:
A total of 318 patients were studied. Mean age was 56 years, 33.64% were female, and 47.80% had CTP C cirrhosis. CTP C was associated with a 0.42-point increase in VSR compared with CTP A (95% CI = 0.13–0.71, p < 0.01), adjusting for age, sex, diabetes, and HCC. Among the 79 (24.84%) patients with repeat MRI 1–2 years after LT, VSR significantly improved from before LT (1.31 vs. 0.95, p < 0.01). In adjusted analysis, CTP C was associated with a 0.86-point decrease in post-LT VSR compared with pre-LT VSR (95% CI = −1.27 to −0.44, p < 0.01). Body mass index poorly correlated with VSR before and after LT. Elevated pre-LT VSR trended toward an association with a 7.17-point decrease in pre-LT glomerular filtration rate (95% CI = −14.35 to −0.02, p = 0.05), adjusting for CTP C, age, sex, diabetes, hypertension, pre-LT sarcopenia, and hepatocellular carcinoma. Elevated pre-LT VSR did not affect 3-year post-LT mortality (log-rank p = 0.24).

Conclusions:
Poorly represented by body mass index, visceral adiposity is increased in cirrhosis and is associated with CTP class. However, this adipose redistribution may be modifiable by LT.
Clinical spectrum and genetic causes of mitochondrial hepatopathy phenotype in children
Authors: Squires James E. , Miethke Alexander G. , Valencia C. Alexander , Hawthorne Kieran , Henn Lisa , Van Hove Johan L.K. , Squires Robert H. , Bove Kevin , Horslen Simon , Kohli Rohit , Molleston Jean P. , Romero Rene , Alonso Estella M. , Bezerra Jorge A. , Guthery Stephen L. , Hsu Evelyn , Karpen Saul J. , Loomes Kathleen M. , Ng Vicky L. , Rosenthal Philip , Mysore Krupa , Wang Kasper S. , Friederich Marisa W. , Magee John C. , Sokol Ronald J. ,   On behalf of the Childhood Liver Disease Research Network (ChiLDReN)
Published: May 2023

Background:
Alterations in both mitochondrial DNA (mtDNA) and nuclear DNA genes affect mitochondria function, causing a range of liver-based conditions termed mitochondrial hepatopathies (MH), which are subcategorized as mtDNA depletion, RNA translation, mtDNA deletion, and enzymatic disorders. We aim to enhance the understanding of pathogenesis and natural history of MH.

Methods:
We analyzed data from patients with MH phenotypes to identify genetic causes, characterize the spectrum of clinical presentation, and determine outcomes.

Results:
Three enrollment phenotypes, that is, acute liver failure (ALF, n = 37), chronic liver disease (Chronic, n = 40), and post-liver transplant (n = 9), were analyzed. Patients with ALF were younger [median 0.8 y (range, 0.0, 9.4) vs 3.4 y (0.2, 18.6), p < 0.001] with fewer neurodevelopmental delays (40.0% vs 81.3%, p < 0.001) versus Chronic. Comprehensive testing was performed more often in Chronic than ALF (90.0% vs 43.2%); however, etiology was identified more often in ALF (81.3% vs 61.1%) with mtDNA depletion being most common (ALF: 77% vs Chronic: 41%). Of the sequenced cohort (n = 60), 63% had an identified mitochondrial disorder. Cluster analysis identified a subset without an underlying genetic etiology, despite comprehensive testing. Liver transplant-free survival was 40% at 2 years (ALF vs Chronic, 16% vs 65%, p < 0.001). Eighteen (21%) underwent transplantation. With 33 patient-years of follow-up after the transplant, 3 deaths were reported.

Conclusions:
Differences between ALF and Chronic MH phenotypes included age at diagnosis, systemic involvement, transplant-free survival, and genetic etiology, underscoring the need for ultra-rapid sequencing in the appropriate clinical setting. Cluster analysis revealed a group meeting enrollment criteria but without an identified genetic or enzymatic diagnosis, highlighting the need to identify other etiologies.
Natriuretic peptides as predictors for atrial fibrillation recurrence after catheter ablation: A meta-analysis
Authors: Yuan Yujing , Nie Boyuan , Gao Binbin , Guo Caixia , Li Li 
Published: May 2023

Background:
Catheter ablation (CA) has become the first-line treatment strategy for atrial fibrillation (AF) but remains with a substantial recurrence rate. The aim of this meta-analysis was to determine the association between baseline natriuretic peptide levels and AF recurrence after CA.

Methods:
We systematically searched PubMed, EMBASE, Web of Science, and Wiley-Cochrane Library for relevant studies published up until May 2022. Overall effect analysis and subgroup analysis were performed with Review Manager software.

Results:
Finally, 61 studies that met the inclusion criteria were included in our meta-analysis. Compared with the nonrecurrence group, the recurrence group had increased baseline level of atrial natriuretic peptide (ANP) (standardized mean difference [SMD] = 0.39, 95% confidence interval [CI]: 0.21–0.56), brain natriuretic peptide (BNP) (SMD = 0.51, 95% CI: 0.31–0.71), N-terminal pro-BNP (SMD = 0.71, 95% CI: 0.49–0.92), and midregional N-terminal pro-ANP (SMD = 0.91, 95% CI: 0.27–1.56).

Conclusions:
Increased baseline natriuretic peptide levels, including ANP, BNP, N-terminal pro-BNP, and midregional N-terminal pro-ANP, are associated with a higher risk of AF recurrence after CA. Nonetheless, further studies are needed to elucidate the predictive value of baseline natriuretic peptides in AF patients undergoing CA.
Application of transurethral prostate resection instrumentation for treating rectal anastomotic stenosis: Case series
Authors: Xu Wenshan , Qin Yujie , Yang Faying , Qian Jun , Dong Yanbo , Tu Song , Yao Jiaxi 
Published: May 2023

Background:
Anastomotic stenosis is a common complication of colorectal surgery with anastomosis. To explore a minimally invasive novel approach surgical method for the treatment of rectal anastomotic strictures using transurethral prostate resection instrumentation.

Methods:
From 2012 to 2022, 18 patients for the treatment of rectal anastomotic strictures using transurethral prostate resection instrumentation. The transurethral prostate resection instrumentation enters the rectum through the anus to incise the narrow anastomotic orifice in a 4-point radial manner under the resectoscope.

Results:
The surgery was successfully completed in 18 patients, and there were no postoperative complications. Postoperatively, 12 patients achieved satisfactory improvement in defecation after 1 incision, and 4 patients underwent another incision 3 months later. Two patients underwent incisions thrice, and the ease of defecation improved in a short period; however, they later underwent permanent colostomy due to repeated stenosis and pain.

Conclusion:
The transanal 4-point radial incision of the prostate using transurethral prostate resection instrumentation is a minimally invasive, safe, effective, and simple surgical method for the treatment of rectal anastomotic stenosis supplemented by postoperative dilatation, and is worthy of clinical application.
Strokes and Transient Ischemic Attacks Occurrence During Annual Dual Antiplatelet Therapy
Authors: Serebruany Victor L. , Tanguay Jean-Francois , Gurvich Milana L. , Marciniak Thomas A. , Atar Dan 
Published: May 2023

Background:
The incidence of stroke/TIA during annual dual antiplatelet therapy (ADAPT) for acute coronary syndrome (ACS) remains high. Some evidence suggests that shorter than ADAPT may diminish such risk, still providing adequate vascular protection. However, the precise timing of strokes/TIA occurrences during ADAPT is unclear but may be important for determining optimal preventive treatment duration.

Study Question:
The precise timing of secondary cerebrovascular events over ADAPT.

Study Design:
Access was gained to the FDA-issued Platelet Inhibition and Outcomes (PLATO) trial data set on which post hoc analyses of stroke/TIA timing after ticagrelor and clopidogrel on top of aspirin was explored.

Measures and Outcomes:
Events were counted and plotted over time from day 1 till day 365 after the index ACS event.

Results:
Among 18,624 enrollees, 252 strokes and 49 TIAs were reported. After the exclusion of entries with missing dates, unclear randomization codes, and events beyond 1-year follow-up, 238 strokes and 45 TIAs were analyzed. Overall, most frequent strokes/TIAs occurred within the first day after qualifying ACS, with the gradual declines after day 7 and day 40 reaching background counts thereafter. The strokes/TIAs patterns did not differ much between P2Y12 inhibitors except for twice more events at day 1 and excess exclusions after day 365 in the ticagrelor arm.

Conclusions:
Most cerebrovascular events emerged very early after ACS despite ADAPT. This large hypothesis-generating evidence may justify shorter than the ADAPT duration after ACS. Twice more events at day 1 and excess late ticagrelor exclusions in PLATO deserve further scrutiny.

Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT 00391872.
Factors Affecting the Gut Microbiome in Pediatric Intestinal Failure
Authors: Talathi Saurabh , Wilkinson Linda , Meloni Katie , Shroyer Michelle , Zhang Li , Ding Zhenying , Eipers Peter , Van Der Pol William , Martin Colin , Dimmitt Reed , Yi Nengjun , Morrow Casey , Galloway David 
Published: May 2023

Background:
There is little data on gut microbiome and various factors that lead to dysbiosis in pediatric intestinal failure (PIF). This study aimed to characterize gut microbiome in PIF and determine factors that may affect microbial composition in these patients.

Methods:
This is a single-center, prospective cohort study of children with PIF followed at our intestinal rehabilitation program. Stool samples were collected longitudinally at regular intervals over a 1-year period. Medical records were reviewed, and demographic and clinical data were collected. Medication history including the use of acid blockers, scheduled prophylactic antibiotics, and bile acid sequestrants was obtained. Gut microbial diversity among patients was assessed and compared according to various host characteristics of interest.

Results:
The final analysis included 74 specimens from 12 subjects. Scheduled prophylactic antibiotics, presence of central line associated bloodstream infection (CLABSI) at the time of specimen collection, use of acid blockers, and ≥50% calories delivered via parenteral nutrition (PN) was associated with reduced alpha diversity, whereas increasing age was associated with improved alpha diversity at various microbial levels (P value <0.05). Beta diversity differed with age, presence of CLABSI, use of scheduled antibiotics, acid blockers, percent calories via PN, and presence of oral feeds at various microbial levels (P value <0.05). Single taxon analysis identified several taxa at several microbial levels, which were significantly associated with various host characteristics.

Conclusion:
Gut microbial diversity in PIF subjects is influenced by various factors involved in the rehabilitation process including medications, percent calories received parenterally, CLABSI events, the degree of oral feeding, and age. Additional investigation performed across multiple centers is needed to further understand the impact of these findings on important clinical outcomes in PIF.
Which Groups of Plastic Surgery Patients are Impacted by Social Media Use: An In-Depth Review of Social Media Engagement
Authors: Kinney JacqueLyn R. , Kim Erin , Friedman Rosie , Bustos Valeria , Hassell Natalie , Elmer Nicholas , Lee Bernard T. , Lin Samuel J. 
Published: May 2023

Background:
Empowerment is the process in which patients gain greater control of their health through active and informed decision making. Greater patient empowerment has shown to be positively correlated with improved healthcare outcomes and experiences. It is unclear how social media impacts plastic and reconstructive surgery (PRS) patients' healthcare decision making. This study aims to help quantify how social media sites influence levels of PRS patient empowerment.

Methods:
In this cross-sectional study, a modified Cyber Info-Decisional Empowerment Scale (CIDES)survey was distributed through Amazon Mechanical Turk (mTurk) to U.S. adults. Sociodemographics, PRS history, social media usage and data collected. Wilcoxon signed-rank test and Kruskal-Wallis tests were used to assess for heterogeneity for categorical variables. ANOVA and t-tests were used to evaluate differences in means for Likert scale-based responses.

Results:
473 survey responses were included. The participants were grouped based on their surgical history: cosmetic (187, 39.5%), reconstructive (107, 22.6%), both cosmetic and reconstructive (36, 7.6%), and non-PRS (143, 30.2%). There was increased empowerment depending on the online resources used. Specifically, social media was associated with significantly greater empowerment in six of seven CIDES categories. Of the social media platforms, Facebook was associated with higher empowerment in three of seven CIDES categories.

Conclusion:
Social media use appears to positively impact PRS patients' empowerment, which may reflect better patient decision making and autonomy when consulting with their plastic surgeon.
Can Anterior Osteophyte Fractures Be Distinguished From Fracture Mimics in the Subaxial Cervical Spine? A Retrospective Analysis Evaluating Reported Fractures With Clinical Management Correlation
Authors: Rao Dinesh , Godreau Jean-Paul , Jenson Matthew , Rahmathulla Gazanfar , Fiester Peter , Patel Jeet , Hernandez Mauricio 
Published: May 2023

Objective
This study aimed to retrospectively distinguish true- from false-positive fractures of anterior subaxial cervical osteophytes, which were reported on noncontrast computed tomography reports, and to correlate the imaging findings with patient symptoms and analyze the downstream impact on management of both true and false positive fractures.

Methods
A total of 127 patients had computed tomography reports of anterior osteophyte fractures. Radiology reports and imaging studies were evaluated to distinguish true fractures from fracture mimics. We analyzed imaging features including rigid spine (RS), prevertebral soft tissue swelling (PVSTS), and instability. We categorized symptoms and examination findings into 3 groups (0, asymptomatic; 1, neck pain; 2, neurological symptoms). Management was categorized into 3 groups (0, no treatment; 1, external bracing; 2, surgery). Associations between imaging features, fracture classification, clinical symptoms, magnetic resonance imaging utilization, and management were calculated using χ2 with Cramer V test to determine effect size.

Results
Eighty patients had false-positive fractures, and 47 were true positive. There were significant associations between magnetic resonance imaging utilization and fracture classification (P ≤ 0.001), PVSTS (P ≤ 0.005), patient symptoms (P ≤ 0.001), and patient management (P ≤ 0.001). There were significant associations between patient management and fracture classification (P ≤ 0.001), patient symptoms (P ≤ 0.001), PVSTS (P ≤ 0.001), imaging findings of instability (P ≤ 0.001), and RS (P ≤ 0.021). There were significant associations between fracture classification and patient symptoms (P ≤ 0.045), and RS (P ≤ 0.006).

Conclusions
Subaxial isolated anterior osteophyte fractures fell into 3 major categories. By our methodology, if a suspected fracture was determined to be a fracture mimic in an asymptomatic patient, it was unlikely to be clinically significant. Isolated anterior osteophyte fractures without neurological symptoms or more concerning imaging findings can be treated conservatively. Finally, fractures that demonstrate indirect signs of instability or are associated with RS are more associated with surgical management.
ERAS Protocol Applied to Oncological Colorectal Mini-invasive Surgery Reduces the Surgical Stress Response and Improves Long-term Cancer-specific Survival
Authors: Crippa Jacopo , Calini Giacomo , Santambrogio Gaia , Sassun Richard , Siracusa Claudia , Maggioni Dario , Mari Giulio ,   on behalf of AIMS Academy Clinical Research Network
Published: May 2023

Background:
Enhanced recovery after surgery (ERAS) protocols are known to reduce postoperative complications and improve short-term outcomes by minimizing the surgical stress response (SSR). Retrospective reviews of large cohorts suggest that they may also have an impact on long-term oncological outcomes. In 2016, Mari et al published a randomized trial on ERAS protocol and the impact on the SSR; they found that IL-6 was less expressed in patients who undergo laparoscopic colorectal surgery within an ERAS protocol compared with controls. The aim of the present study is to report the long-term oncological outcomes of patients enrolled 5 years after the conclusion of the study.

Methods:
Patients enrolled had received the indication for major colorectal surgery, aged between 18 and 80 years, with American Society of Anesthesiologists (ASA) grades I to III, autonomous for mobilization and walking, eligible for laparoscopic technique. In total, 140 patients were enrolled and randomized into 2 groups of 70 patients each. Among these patients, 52 in the ERAS group (EG) and 53 in the Standard group (SG) had colorectal cancer. For them, a 5-year oncological follow-up according to the NCCN16 guidelines was planned. IL-6, C-reactive protein, prolactine, white blood cell count, albumin, and prealbumin were compared between oncological patients in the EG and in the SG.

Results:
EG showed lower IL-6 on postoperative day 1 (21.2±9.1 vs. 40.3 ±11.3; P<0.05) and on day 5 (14.9±6.2 vs. 38.7±8.9; P<0.05), lower C-reactive protein on day 1 (48.3±15.7 vs. 89.4±20.3; P<0.05) and on day 5 (38.3±11.4 vs. 74.3±19.7; P<0.05), and lower pre-albumine on day 5 (18.9±7.2 vs. 12.3±6.9; P<0.05) compared with SG. Median oncological follow-up was 57 months [46.5 to 60]. There was no statistically significant difference in overall survival (log rank=0.195) and disease-free survival (Log rank=0.089) between groups. Cancer-specific survival was significantly better (log rank=0.038) in the EG compared with patients in the SG.

Conclusions:
ERAS protocol applied to colorectal laparoscopic surgery for cancer is able to minimize the SSR. As a possible result, cancer-specific survival seems to be improved in patients within enhanced protocols. However, even though there may be an association between an excess of SSR and worse oncological outcomes, the favorable effect of ERAS protocols toward better overall and disease-free survival is yet to be demonstrated.