bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of stem cell–derived exosome therapy on erectile dysfunction: a systematic review and meta-analysis of preclinical studies
Authors: Zhu Yunpei , Jiang Tiancheng , Yao Chi , Zhang Jiawei , Sun Chao , Chen Shuqiu , Chen Ming 
Published: March 2023

AbstractIntroductionErectile dysfunction (ED) is a common disease among elderly men, and novel therapy methods are needed for drug-refractory ED. As an extracellular vesicle, stem cell–derived exosomes displayed erectile function improvement in rat ED models in some preclinical studies. However, the therapeutic efficacy has not been comprehensively evaluated.AimTo study the therapeutic effects of stem cell–derived exosomes on ED in preclinical studies and to investigate the potential mechanisms responsible for the efficacy.MethodsThe systematic literature search was conducted in Web of Science, PubMed, and Embase to retrieve studies utilizing stem cell–derived exosomes for ED treatment. We extracted data of intracavernous pressure/mean artery pressure (ICP/MAP), and cavernosum structural changes in rat ED models before and after stem cell-derived exosome therapy. RevMan 5.3 was used to perform meta-analyses of ICP/MAP and cavernosum microstructural changes. Publication bias was assessed with the Egger test and funnel plot by Stata 15.0 (StataCorp).Main Outcome MeasuresOutcomes included ICP/MAP, smooth muscle, and endothelial markers—such as the ratio of smooth muscle to collagen and the expression of α-SMA (alpha smooth muscle actin), CD31 (cluster of differentiation 31), nNOS and eNOS (neuronal and endothelial nitric oxide synthase), TGF-β1 (transforming growth factor β1), and caspase 3 protein-to evaluate erectile function and microstructural changes. Forest plots of effect sizes were performed.ResultsOf 146 studies retrieved, 11 studies were eligible. Pooled analysis showed that stem cell–derived exosomes ameliorated damaged ICP/MAP (standardized mean difference, 3.68; 95% CI, 2.64-4.72; P &lt; .001) and structural changes, including the ratio of smooth muscle to collagen and the expression of α-SMA, CD31, nNOS, eNOS, TGF-β1, and caspase 3 protein. Subgroup analysis indicated that exosome type and ED model type made no difference to curative effects.ConclusionThis meta-analysis suggests the therapeutic efficacy of stem cell–derived exosomes for ED. Exosomes may restore erectile function by optimizing cavernosum microstructures.
Trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment
Authors: Chan Julia , Ng Danielle Wing Lam , Liao Qiuyan , Fielding Richard , Soong Inda , Chan Karen Kar Loen , Lee Conrad , Ng Alice Wan Ying , Sze Wing Kin , Chan Wing Lok , Lee Victor Ho Fun , Lam Wendy Wing Tak 
Published: March 2023

Abstract

Study Objectives
To examine the trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment and to investigate whether psychological, cognitive, and physical factors differentiate trajectories.

Methods
A total of 623 Chinese cancer survivors of diverse cancer types participated in a 2-year-long prospective study after the completion of cancer treatment. Sleep disturbance was measured using Pittsburgh Sleep Quality Index at 3 (T2), 6 (T3), 12 (T4), 18 (T5), and 24 (T6) months after baseline (within 6-months post-treatment; T1). Latent growth mixture modeling identified distinctive sleep disturbance trajectories and tested if these longitudinal patterns were predicted by baseline psychological distress, attentional control, attentional bias and physical symptom distress and T2 cancer-related distress. Fully adjusted multinomial logistic regression then identified whether these factors differentiated trajectories.

Results
Two distinct sleep disturbance trajectories were identified, namely stable good sleepers (69.7%) and persistent high sleep disturbance (30.3%). Compared to those in the stable good sleep group, patients in the persistent high sleep disturbance group were less likely to report avoidant (OR=0.49, 95% CI = 0.26–0.90), while more likely to report intrusive thoughts (OR = 1.76, 95% CI = 1.06–2.92) and cancer-related hyperarousal (OR = 3.37, 95% CI = 1.78–6.38). Higher depression scores also predicted persistent high sleep disturbance group membership (OR = 1.13, 95% CI = 1.03–1.25). Attentional bias, attentional control, anxiety, and physical symptom distress did not predict sleep trajectory membership.

Conclusions
One in three cancer survivors experienced persistent high sleep disturbance. Screening and managing depressive symptoms and cancer-related distress in early cancer rehabilitation may reduce risk of persistent sleep disturbance among cancer survivors.
Restless legs syndrome in patients with epilepsy: risk analysis, polysomnography, and quality of life evaluation
Authors: Li Ying-Sheng , Yeh Wei-Chih , Chang Ya-Hsien , Hsu Chung-Yao 
Published: March 2023

Abstract

Study Objectives
Restless legs syndrome (RLS) is a circadian rhythm related sensorimotor disorder due to brain iron deficiency, with lesion sites at the putamen and substantia nigra. However, epilepsy is a disease with abnormal electric discharge from the cortex and can be triggered with iron disequilibrium. We designed a case–control study to discover the association between epilepsy and RLS.

Methods
A total of 24 patients with epilepsy and RLS and 72 patients with epilepsy without RLS were included. Most of the patients underwent polysomnography and video electroencephalogram tests and took sleep questionnaires. We collected information on seizure characteristics, including general or focal onset, epileptogenic focus, current antiseizure medications, medically responsive epilepsy or refractory epilepsy, and nocturnal attacks. The sleep architectures of the two groups were compared. We analyzed the risk factors for RLS using multivariate logistic regression.

Results
Among the patients with epilepsy, the occurrence of RLS was associated with refractory epilepsy (OR 6.422, p = 0.002) and nocturnal seizures (OR 4.960, p = 0.005). Sleep parameters were not significantly associated with RLS status. Quality of life was significantly impaired in the group with RLS in both the physical and mental domains.

Conclusions
Refractory epilepsy and nocturnal seizures were strongly correlated with RLS in patients with epilepsy. RLS should be considered a predictable comorbidity in patients with epilepsy. The management of RLS not only led to better control of the patient’s epilepsy but also improved their quality of life.
Supporting Medical Student Scholarship: A Novel Case Report Elective to Teach the Writing and Publishing Process
Authors: Bauler Laura , Jones Steven 
Published: March 2023

Problem
Successful residency placement requires medical students to pursue activities beyond formal education, including showing their commitment to the specialty. Case reports are a common publication pursued by medical students, which provide trainees with opportunities to show commitment to the specialty, broaden their clinical and scholarly knowledge, improve their ability to find and interpret literature, and gain faculty mentorship. However, case reports can be intimidating to trainees with limited exposure to medical writing and publishing. The authors describe a case report elective designed specifically for medical students.

Approach
Since 2018, Western Michigan University Homer Stryker M.D. School of Medicine has offered a week-long medical student elective designed to teach the process of writing and publishing a case report. Students wrote a first draft of a case report during the elective. Students could pursue publication, including revisions and journal submission, after the elective. An optional, anonymous survey was sent to students who participated in the elective to evaluate their experience with the elective, motivations for taking the elective, and perceived outcomes.

Outcomes
Between 2018 and 2021, the elective was taken by 41 second-year medical students. Five scholarship outcomes of the elective were measured, including conference presentations (35, 85% of students) and publications (20, 49% of students). Students who completed the survey (n = 26) indicated the elective was very valuable with an average score of 85 ± 15.6 (range: minimally valuable [0] to extremely valuable [100]).

Next Steps
Next steps for this elective will be to allocate more faculty time to this curriculum promoting both education and scholarship at the institution, and to curate a list of journals to ease the publication process. Overall, student experiences with this case report elective were positive. This report aims to provide a framework for other schools to implement similar courses for their preclinical students.
A radiation-related second primary gastrointestinal stromal tumor in the bladder
Authors: Hori Mai , Maki Kazuki , Okuno Yumiko , Mikami Koji , Takeuchi Takumi 
Published: March 2023

Abstract
A 69-year-old man underwent 78 Gy/39 Fr of intensity-modulated radiation therapy for prostate cancer. Seven years after radiotherapy, a nonpapillary bladder tumor was identified. Transurethral resection of the bladder tumor was performed, and the pathological diagnosis was spindle cell sarcoma. Immunostaining revealed KIT−, DOG1++, CD34−, Actin++, Cytokeratin−, Desmin−, S100 protein−, and Vimentin++. No tumor recurrence was observed until 17 months after tumor resection. DOG1 is strongly and specifically expressed in gastrointestinal stromal tumors. This was a rare case of bladder gastrointestinal stromal tumor as a radiation-related second primary tumor.
US Racial–Ethnic Mortality Gap Adjusted for Population Structure
Authors: Pifarré i Arolas Héctor , Acosta Enrique , Dudel Christian , Mhairi Hale Jo , Myrskylä Mikko 
Published: March 2023

Background:
US racial–ethnic mortality disparities are well documented and central to debates on social inequalities in health. Standard measures, such as life expectancy or years of life lost, are based on synthetic populations and do not account for the real underlying populations experiencing the inequalities.

Methods:
We analyze US mortality disparities comparing Asian Americans, Blacks, Hispanics, and Native Americans/Alaska Natives to Whites using 2019 CDC and NCHS data, using a novel approach that estimates the mortality gap, adjusted for population structure by accounting for real-population exposures. This measure is tailored for analyses where age structures are fundamental, not merely a confounder. We highlight the magnitude of inequalities by comparing the population structure-adjusted mortality gap against standard metrics’ estimates of loss of life due to leading causes.

Results:
Based on the population structure-adjusted mortality gap, Black and Native American mortality disadvantage exceedsmortality from circulatory diseases. The disadvantage is 72% among Blacks (men: 47%, women: 98%) and 65% among Native Americans (men: 45%, women: 92%), larger than life expectancy measured disadvantage. In contrast, estimated advantages for Asian Americans are over three times (men: 176%, women: 283%) and, for Hispanics, two times (men: 123%; women: 190%) larger than those based on life expectancy.

Conclusions:
Mortality inequalities based on standard metrics’ synthetic populations can differ markedly from estimates of the population structure-adjusted mortality gap. We demonstrate that standard metrics underestimate racial–ethnic disparities through disregarding actual population age structures. Exposure-corrected measures of inequality may better inform health policies around allocation of scarce resources.
Improving Biomarker-based HIV Incidence Estimation in the Treatment Era
Authors: Fellows Ian E. , Hladik Wolfgang , Eaton Jeffrey W. , Voetsch Andrew C. , Parekh Bharat S. , Shiraishi Ray W. 
Published: March 2023

Background:
Estimating HIV-1 incidence using biomarker assays in cross-sectional surveys is important for understanding the HIV pandemic. However, the utility of these estimates has been limited by uncertainty about what input parameters to use for false recency rate (FRR) and mean duration of recent infection (MDRI) after applying a recent infection testing algorithm (RITA).

Methods:
This article shows how testing and diagnosis reduce both FRR and mean duration of recent infection compared to a treatment-naive population. A new method is proposed for calculating appropriate context-specific estimates of FRR and mean duration of recent infection. The result of this is a new formula for incidence that depends only on reference FRR and mean duration of recent infection parameters derived in an undiagnosed, treatment-naive, nonelite controller, non-AIDS-progressed population.

Results:
Applying the methodology to eleven cross-sectional surveys in Africa results in good agreement with previous incidence estimates, except in 2 countries with very high reported testing rates.

Conclusions:
Incidence estimation equations can be adapted to account for the dynamics of treatment and recent infection testing algorithms. This provides a rigorous mathematical foundation for the application of HIV recency assays in cross-sectional surveys.
Age, Sex, and Comedication Effects on the Steady-State Plasma Concentrations of Amisulpride in Chinese Patients with Schizophrenia
Authors: Yang Shuo , Wang HaiYan , Zheng Gao Feng , Wang Yi 
Published: March 2023

Background:
Amisulpride, a second-generation atypical antipsychotic drug, was first marketed in Europe in the 1990s. This study aimed to provide a reference for the clinical application of amisulpride. The effects of age, sex, or specific comedications on amisulpride concentrations in Chinese patients with schizophrenia in the real world were investigated.

Methods:
A retrospective study was conducted of data on amisulpride based on the therapeutic drug monitoring service database at the Zigong Affiliated Hospital of Southwest Medical University.

Results:
Based on the inclusion criteria, 195 plasma samples from 173 patients (67.05% female and 32.95% male patients) were included for in-depth analysis. The median daily dose of amisulpride was 400 mg/d, median plasma concentration was 457.50 ng/mL, and median concentration/dose (C/D) ratio was 1.04 ng/mL/mg/d. The daily dose of amisulpride positively correlated with measured steady-state plasma concentrations. A significant difference was observed in the subgroup analysis of the combination with valproic acid, zopiclone, or aripiprazole on plasma concentrations. Combining amisulpride with these drugs increased the C/D ratios by 0.56-, 2.31-, and 0.77-fold, respectively. After adjusting for age, the median C/D ratio was found to be significantly different between female and male patients. However, no significant differences in daily dose, plasma concentration, and C/D ratio were noted with respect to sex and age of the patients.

Conclusions:
Sex differences were inferred for the first time in this study, with differential effects on daily dose, steady-state plasma concentration, and C/D ratio associated with the population. In the included study samples, blood concentrations were distributed in the range of 223.25–823.55 ng/mL, which perhaps needs to be evaluated in line with the reference range of ammonia–sulfur ratios in the Chinese population.
Phase I cardiac rehabilitation with 5-phase music after emergency percutaneous coronary intervention for acute myocardial infarction: A prospective randomized study
Authors: Yao Xu , Jin Yi , Gao Chunlan , Zhang Yuqin , Lu Yun , Li Xiaoting , Ma Lili 
Published: March 2023

Background:
Five-phase music therapy was reported to be effective in the treatment and rehabilitation of several diseases. This study explored the effect of phase I cardiac rehabilitation combined with 5-phase music in acute myocardial infarction (AMI) patients after emergency percutaneous coronary intervention.

Methods:
This prospective pilot study enrolled AMI patients who received percutaneous coronary intervention from the Traditional Chinese Medicine Hospital from July 2018 to December 2019. The participants were randomized in a 1:1:1 ratio to the control, cardiac rehabilitation, and rehabilitation-music groups. The primary endpoint was the hospital anxiety and depression scale. The secondary endpoints were the myocardial infarction dimensional assessment scale, self-rating sleep status, 6-minute walk test, and left ventricular ejection fraction.

Results:
The study included 150 AMI patients (n = 50/group). Hospital anxiety and depression scale showed significant time effects for both anxiety and depression (both P < .05), a treatment effect for depression (P = .02), and an interaction effect for anxiety (P = .02). A time effect was also observed for diet, sleep disorders, 6-minute walk test, and left ventricular ejection fraction (all P < .001). A difference among groups was observed for emotional reaction (P = .001). Interactions effects were observed for diet (P = .01) and sleep disorders (P = .03).

Conclusion:
Phase I cardiac rehabilitation combined with 5-phase music could alleviate anxiety and depression and improve sleep quality.
Circulating protein and lipid markers of early sepsis diagnosis and prognosis: a scoping review
Authors: Barber Gemma , Tanic Jelena , Leligdowicz Aleksandra 
Published: March 2023

Purpose of review
Sepsis is the extreme response to infection associated with high mortality, yet reliable biomarkers for its identification and stratification are lacking.

Recent findings
Our scoping review of studies published from January 2017 to September 2022 that investigated circulating protein and lipid markers to inform non-COVID-19 sepsis diagnosis and prognosis identified interleukin (IL)-6, IL-8, heparin-binding protein (HBP), and angiopoietin-2 as having the most evidence. Biomarkers can be grouped according to sepsis pathobiology to inform biological data interpretation and four such physiologic processes include: immune regulation, endothelial injury and coagulopathy, cellular injury, and organ injury. Relative to proteins, the pleiotropic effects of lipid species’ render their categorization more difficult. Circulating lipids are relatively less well studied in sepsis, however, low high-density lipoprotein (HDL) is associated with poor outcome.

Summary
There is a lack of robust, large, and multicenter studies to support the routine use of circulating proteins and lipids for sepsis diagnosis or prognosis. Future studies will benefit from standardizing cohort design as well as analytical and reporting strategies. Incorporating biomarker dynamic changes and clinical data in statistical modeling may improve specificity for sepsis diagnosis and prognosis. To guide future clinical decisions at the bedside, point-of-care circulating biomarker quantification is needed.
Exosomes and lipid metabolism in metabolic and cardiovascular disorders
Authors: Zein Abdin Zina , Geng Apple Ziquan , Chandy Mark 
Published: March 2023

Purpose of review
Exosomes are lipid-bound particles that carry lipids, protein, and nucleic acid and affect cellular function. This review highlights the current knowledge on the crosstalk between exosomes and lipid metabolism and their impact on cardiometabolic disease.

Recent findings
Recent studies revealed that lipids and lipid metabolizing enzymes are important for exosome biogenesis and internalization and conversely how exosomes affect lipid metabolism, secretion, and degradation. The interplay between exosomes and lipid metabolism affects disease pathophysiology. More importantly, exosomes and lipids might function as biomarkers for diagnosis and prognosis or possibly therapies.

Summary
Recent advances in our understanding of exosomes and lipid metabolism have implications for our understanding of normal cellular and physiological functions as well as disease pathogenesis. Exosome and lipid metabolism have implications in novel diagnostic tests and treatments of cardiometabolic disease.
Transperineal vs. transrectal biopsy to reduce postinterventional sepsis
Authors: Stangl-Kremser Judith , Ramaswamy Ashwin , Hu Jim C. 
Published: March 2023

Purpose of review
Prostate biopsy is commonly performed in men suspected to have prostate cancer. It has traditionally been performed using a transrectal approach, but transperineal prostate biopsy has been increasingly adopted in part because of its lower associated infectious risk. We review recent studies evaluating the rate of potentially life-threatening post-biopsy sepsis and potential preventive strategies.

Recent findings
After performing a comprehensive literature search, 926 records were screened and 17 studies published in 2021 or 2022 were found to be relevant. Studies varied in periprocedural perineal and transrectal preparation, antibiotic prophylaxis, and definition of sepsis. The sepsis rates after transperineal ultrasound-guided versus transrectal ultrasound-guided biopsy ranged between 0 and 1 versus 0.4 and 9.8%. Mixed efficacy was found for the topical application of antiseptics before transrectal biopsy to decrease postprocedural sepsis. Promising strategies include the use of topical rectal antiseptics before transrectal prostate biopsy and using a rectal swab to guide the antibiotic selection and the route of the biopsy.

Summary
The transperineal approach to biopsy is increasingly used because of lower associated sepsis rates. Our review of the recent literature supports this practice pattern change. Hence, transperineal biopsy should be offered as an option to all men.
Evaluating patients’ choice of general and spinal anesthesia for elective cesarean section and associated factors: a descriptive study
Authors: Emadi Seyed A. , Gholipour Baradari Afshin , Khademloo Mohammad , Abotorabi Mehdi , Hassanzadeh Kiabi Farshad 
Published: March 2023

Objective:
During an elective cesarean section, the choice of method of anesthesia is critical for maternal and fetal outcomes. However, the anesthesiologist’s decision is dependent on the patient’s desire. This study aimed to determine the choice of general and spinal anesthesia among women undergoing elective cesarean sections and the factors affecting their choice.

Methods:
In this descriptive study, pregnant women who had the ability to undergo both spinal and general anesthesia were referred to public and private hospitals in (Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences). A questionnaire recorded the patient’s demographic data, education and occupation, history of anesthesia, choice of anesthetic method, and reason for selection.

Results:
A total of 384 women were included in the study, of whom 60% selected general anesthesia and 40% selected spinal anesthesia. Among the reasons for not choosing spinal anesthesia, most common were fear of injury to the spinal cord (64.3%) and fear of seeing and hearing during the surgery (53.3%), and among the reasons for not choosing general anesthesia, most common were fear of not waking (54.3%) and a desire to be alert at the time of infant birth (40.7%). Most of the women with a history of spinal anesthesia selected spinal anesthesia (53%), and 62% of those without a history of spinal anesthesia selected general anesthesia. Factors such as age, nonmedical staff advice, and being employed were significantly correlated with the choice of anesthesia (P<0.005).

Conclusion:
The rate of general anesthesia selection was higher than spinal anesthesia. More attention and efforts are required to educate patients regarding the method of anesthesia prior to the surgery.