bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Activity and Patient-Reported Outcomes in Monoclonal Plasma Cell Disorders
Authors: Joseph Janine , Hillengass Michaela , Sweeney Nathan W. , Molina Thomas H. , Ahlstrom Jennifer M. , Moysich Kirsten , Cannioto Rikki , Hillengass Jens 
Published: July 2023

ABSTRACT

Introduction
Plasma cell disorders (PCD) are a group of conditions characterized by disproportionate proliferation of a single clone of B lymphocytes. Multiple myeloma (MM) is a malignant type of PCD. Improvements in MM survival have led patients and physicians to pursue strategies to improve quality of life for those living longer with this disease. Bone disease and instability associated with MM have made physicians reluctant to recommend physical activity (PA) to this patient population. The goal of this study was to examine the relationship between PA and physical and psychosocial patient-reported outcomes (PRO) in patients with MM and precursor conditions.

Methods
We employed a cross-sectional study design. Questionnaires on PA, demographics, fatigue, distress, and other aspects of quality of life were posted on the HealthTree® Cure Hub website, a patient portal through which individuals with MM and related disorders obtain support, track labs and other information about their diseases, and participate in research.

Results
A total of 794 individuals, including 664 with MM, are included in the current analysis. We observed potential inverse associations between PA and poor quality of life, including problems with sleep, fatigue, neuropathy, distress, and several psychosocial states. On average, patients reported that their PA levels have declined since diagnosis and that they would like to be even more active in the future than they were prior to their diagnosis.

Conclusions
In our cross-sectional study, regular physical activity was associated with multiple quality-of-life indicators and other PROs, including better sleep and less fatigue, neuropathy, and distress. The findings of this study can help guide the design of prospective studies of the role of PA in MM survivorship.
Acute Exercise Increases NK Cell Mitochondrial Respiration and Cytotoxicity against Triple-Negative Breast Cancer Cells under Hypoxic Conditions
Authors: CHO EUNHAN , STAMPLEY JAMES , WALL RACHEL , MATTHEWS RACHEL , ZUNICA ELIZABETH , BROWN JUSTIN C. , JOHANNSEN NEIL M. , IRVING BRIAN A. , SPIELMANN GUILLAUME 
Published: July 2023

ABSTRACT

Purpose
Triple-negative breast cancer (TNBC) is an aggressive, highly metastatic malignancy with high recurrence rates. Hypoxia is a hallmark of the TNBC tumor microenvironment, which promotes tumor growth while impairing natural killer (NK) cell cytotoxic functions. Although acute exercise improves NK cell function under normoxic conditions, the effect of exercise on NK cell cytotoxic functions under hypoxic conditions mimicking O2 tensions observed in solid tumors is unknown.

Methods
The cytotoxic functions of resting and postexercise NK cells isolated from thirteen young inactive healthy women were assessed against breast cancer cells expressing different levels of hormone receptors (MCF-7 and MDA-MB-231) under normoxic and hypoxic conditions. Mitochondrial respiration and H2O2 efflux rates of the TNBC-activated NK cells were assessed via high-resolution respirometry.

Results
Under hypoxia, postexercise NK cells exhibited greater killing of TNBC than resting NK cells. Further, postexercise NK cells were more likely to kill TNBC under hypoxia than normoxic conditions. In addition, mitochondrial respiration associated with oxidative (OXPHOS) capacity of TNBC-activated NK cells was greater in postexercise cells than resting cells under normoxia, but not under hypoxia. Finally, acute exercise was associated with reduced mitochondrial H2O2 efflux by NK cells in both conditions.

Conclusions
Together, we present crucial interrelationships between hypoxia and exercise-induced changes in NK cell functions against TNBC cells. By modulating their mitochondrial bioenergetic functions, we postulate that acute exercise improves NK cell function under hypoxic conditions. Specifically, NK cell O2 and H2O2 flow (pmol·s−1·million NK cells−1) changes in response to 30-min cycling suggest that exercise primes NK cell tumor killing by reducing mitochondrial oxidative stress and, thus, rescuing their function when exposed to harsh hypoxic environments as observed in the microenvironment of breast solid tumors.
Bone, Estrogen, Strength Training Study Translation to Osteoporosis Prevention Research and Education
Authors: Milliken Laurie , Houtkooper Linda , Metcalfe Lauve , Farrell Vanessa , Going Scott , Lohman Timothy 
Published: July 2023

ABSTRACT

Introduction/Purpose: Osteoporosis is a bone disease that a combination of exercise, hormone replacement therapy (HT), and calcium intake may help prevent by preserving or increasing bone mineral density (BMD) in postmenopausal women. The Bone, Estrogen, Strength Training (BEST) Study clinical trial was designed to determine the effects of exercise training on BMD in postmenopausal women either with or without HT. Methods: The BEST Study was unique because it included progressive resistance and weight-bearing exercises, addressed HT use, supplemented and documented calcium intake, provided robust intervention support, and extended the intervention protocol for multiple years. Results: The study findings demonstrated that postmenopausal women who had adequate calcium intake and followed the BEST exercise program maintained or increased their BMD. This article describes key lessons learned from the longitudinal BEST Study for translating the findings to the research community to improve future intervention research studies and to health professionals to inform osteoporosis prevention and bone health education. The BEST Study produced five lessons that can inform and improve osteoporosis prevention research and educational practice: 1) long-term bone health effects are important to study and require proactive strategies to obtain longitudinal funding support, 2) long-term retention of participants and compliance with study protocols require a participant focused study design and protocols, 3) extensive documentation of intervention protocols and sophisticated analytical strategies are essential to determine study intervention effects, 4) heterogeneity in responses to research study interventions should be expected and explored, and 5) osteoporosis prevention can be facilitated by translating the positive results from the BEST Study into practical educational tools. Conclusion: The BEST Study results can be translated into effective exercise and dietary practices to help prevent osteoporosis. Future research studies that use participant motivation and support protocols and meticulous documentation will further advance research in the prevention of osteoporosis.
The Physiological and Subjective Effects of Exercising with a Face Mask at Different Intensities
Authors: Campbell Nicholas S. , LaBotz Michele , Visich Paul S. 
Published: July 2023

ABSTRACT

Introduction
Face masks are used to reduce the spread of respiratory diseases. Physical exertion increases distance traveled by expelled particles, so masking while exercising is recommended to help prevent disease transmission. However, there is limited literature assessing masking during higher-intensity exercise.

Purpose
This study aimed to compare the impact of surgical masks on physiological and subjective measures during 45 min of a progressive exercise protocol as compared with unmasked exercise.

Methods
Each subject completed two random 45-min exercise trials (15 min each at 40%, 60%, and 80% of their oxygen uptake reserve) with and without a surgical mask in random order. Heart rate, oxygen saturation, respiratory rate (RR), ratings of perceived exertion, and dyspnea (Dys) were measured at each intensity. Repeated-measures ANOVA was utilized, and significance was set at P < 0.05.

Results
Thirty subjects (age, 20.4 ± 1.2 yr; peak oxygen uptake, 40.12 ± 11.05 mL·kg−1·min−1; 57% female) completed the study. When comparing masked and unmasked trials at each exercise intensity, differences were found only in RR (40%: 17.6 ± 4.9 vs 15.8 ± 4.9, P < 0.02, d = 0.4; 60%: 23.7 ± 5.5 vs 21.3 ± 6.2, P < 0.01, d = 0.4; 80%: 35.8 ± 9.0 vs 30.1 ± 8.8, P < 0.01, d = 0.6). When comparing masked with unmasked trials across all intensities, a difference was found in Dys (3.5 ± 2.4 vs 2.9 ± 2.2, respectively; P < 0.001, d = 0.3).

Conclusions
The use of surgical masks seems to impact RR and one’s perception of Dys, but has minimal influences on heart rate, oxygen saturation, and rating of perceived exertion. Other than increasing one’s RR and perceptions of Dys, it seems that exercising with a mask at moderate and vigorous intensities is acceptable in healthy individuals.
Seeds of trust ripe as luscious fruits: Faculty mentorship forum at Aga Khan University Medical College
Authors: Ali Rahila , Rehman Dr Rehana , Khalid Saira , Ali Tazeen Saeed 
Published: July 2023

Background & Objective: Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by ‘Faculty Mentorship Program’ at AKU- MC.
Methods: We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators and dean of AKU- MC were included in the study. The interview guide was developed, validated and reviewed by experts. After piloting, four focused group discussions and 8 in-depth interviews were conducted in AKU- MC.
Results: The findings described the transition from informal to formal mentorship, identified challenges faced by mentors and mentees and suggested the role of leadership / administrators. The themes identified were “Continuous improvement of mentoring practices”, “Building strong foundations for mentoring relationships”, and “Growth and development through challenging experiences”
Conclusion: The faculty mentorship program at AKU-MC was in line with the goals and vision of the institution. All participants identified the need of additional resources, administrative support, rewards, incentives and recognition of mentors for sustainability of the program.
doi: https://doi.org/10.12669/pjms.39.5.7175
How to cite this: Rehman R, Ali R, Khalid S, Ali TS. Seeds of trust ripe as luscious fruits: Faculty mentorship forum at Aga Khan University Medical College. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7175
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparing the efficacy of EUS versus MRCP with ERCP as gold standard in patients presenting with partial biliary obstruction – finding a better diagnostic tool
Authors: Khan Rao Saad Ali , Alam Laima , Khan Zoya Ali , Khan Uzair Ali 
Published: July 2023

Objective: To evaluate the diagnostic accuracy of different imaging modalities in patients with partial biliary obstruction with no obvious aetiology on initial imaging.
Methods: This is a prospective single-centre cohort study carried out at Pak Emirates Military Hospital, Rawalpindi from June 2019 to June 2021 with non-probability consecutive sampling. Patients with ages 16 to 75 years, presenting with partial biliary obstruction and undetermined aetiology on initial imaging (TUS and MRCP) were enrolled. EUS was performed for each of these patients and the case was regarded as “true positive” or “true negative” if the findings of imaging modality correlated to those of ERCP. ROC curve, sensitivity, specificity, PPV, NPV and AUC (with 95% confidence interval) were drawn for all the diagnostic tools using SPSS V. 21.
Results: A total of 65 patients were enrolled over a period of two years with male to female ratio of 1.4:1. Forty-four patients had an intermediate risk of choledocholithiasis upon preliminary evaluation whereas, 48(74%) of the participants had CBD calculi or sludge confirmed upon subsequent ERCP. Trans-abdominal ultrasound showed the lowest sensitivity (29.2%), specificity (85%), NPV 12% and PPV 93% for diagnosing CBD calculi. This was followed by MRCP with a sensitivity of 37.5%, specificity of 100%, NPV of 36.2% and PPV of 100%. EUS showed the maximum diagnostic accuracy with AUC of 1.0 and a 100% sensitivity and specificity when compared with ERCP as gold standard.
Conclusion: EUS is superior to MRCP in terms of diagnostic accuracy as minimally invasive diagnostic tool and EUS superiority is particularly relevant in patients with intermediate risk of choledocholithiasis.
doi: https://doi.org/10.12669/pjms.39.5.7280
How to cite this: Khan RSA, Alam L, Khan ZA, Khan UA. Comparing the efficacy of EUS versus MRCP with ERCP as gold standard in patients presenting with partial biliary obstruction – finding a better diagnostic tool. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7280
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Team based collaborative care model, facilitated by mHealth enabled and trained nurses, for management of heart failure with reduced ejection fraction in India (TIME-HF): design and rationale of a parallel group, open label, multi-centric cluster randomised controlled trial
Authors: Jeemon Panniyammakal , Bahuleyan Charantharalyil Gopalan , Chandgalu Javaregowda Devaraju , Punnoose Eapen , Rajendiran Gopalan , Unni Govindan , Abdullakutty Jabir , Balakrishnan Jayakumar , Joseph Johny , Gnanaraj Justin Paul , Sreedharan Madhu , Pillai Meera R , KR Neenumol , Thomas Paul , Sebastian Placid , Daniel Rachel , Edakutty Rajeev , Ahmad Sajan , Mattummal Shafeeq , Thomas Sunu C , Joseph Stigi , Pisharody Sunil , Chacko Susanna , Syam N , Nair Tiny , Nanjappa Veena , Ganesan Vijayan , George Vijo , Ganapathi Sanjay , Harikrishnan Sivadasanpillai 
Published: July 2023

Background: Heart failure (HF) is a debilitating condition associated with enormous public health burden. Management of HF is complex as it requires care-coordination with different cadres of health care providers. We propose to develop a team based collaborative care model (CCM), facilitated by trained nurses, for management of HF with the support of mHealth and evaluate its acceptability and effectiveness in Indian setting. Methods: The proposed study will use mixed-methods research. Formative qualitative research will identify barriers and facilitators for implementing CCM for the management of HF. Subsequently, a cluster randomised controlled trial (RCT) involving 22 centres (tertiary-care hospitals) and more than 1500 HF patients will be conducted to assess the efficacy of the CCM in improving the overall survival as well as days alive and out of hospital (DAOH) at two-years (CTRI/2021/11/037797). The DAOH will be calculated by subtracting days in hospital and days from death until end of study follow-up from the total follow-up time. Poisson regression with a robust variance estimate and an offset term to account for clustering will be employed in the analyses of DAOH. A rate ratio and its 95% confidence interval (CI) will be estimated. The scalability of the proposed intervention model will be assessed through economic analyses (cost-effectiveness) and the acceptability of the intervention at both the provider and patient level will be understood through both qualitative and quantitative process evaluation methods. Potential Impact: The TIME-HF trial will provide evidence on whether a CCM with mHealth support is effective in improving the clinical outcomes of HF with reduced ejection fraction in India. The findings may change the practice of management of HF in low and middle-income countries.
Effectiveness of incisional negative pressure wound therapy after major lower extremity amputation: a randomised controlled trial
Authors: Vaddavalli VV , Girdhani B , Savlania A , Behera A , Rastogi A , Kaman L , Abuji K 
Published: July 2023

Introduction The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD). Methods This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement. Results It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group (p = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant (p > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, p = 0.002). Conclusions iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.
Generation of sub-100  fs pulses from a SESAM-NPE hybrid mode-locked Yb-doped fiber laser at a fundamental repetition rate of 1.15  GHz
Authors: Sui Qinglin , Ou Shangming , Chen Yun , Zhang Nan , Liu Huanhuan , Shum Perry Ping , Ma Menglong , Guo Liang , Zhang Qingmao 
Published: July 2023

Supercontinuum generation via direct pumping of unamplified high-repetition-rate, sub-100 fs pulses with a pulse energy lower than 50 pJ is superior in noise performance and features a high acquisition speed. We demonstrate a novel, to the best of our knowledge, gigahertz-repetition-rate, mode-locked Yb-doped fiber laser, where the hybrid mode-locking approach is employed. The laser has a low initiating threshold of 300 mW and a broad mode-locking range of 600 mW (300–900 mW) in terms of pump power. The shortest obtained pulse width of the laser after compression is 95 fs, and the highest output pulse energy is 92.9 pJ at a fundamental repetition rate of 1.15 GHz. Moreover, the laser’s output polarization states are switchable, and it has a polarization extinction ratio of 17.9 dB.
The impact of angles of insonation on left and right ventricular global longitudinal strain estimation in fetal speckle tracking echocardiography
Authors: Nichting Thomas J. , de Vet Chantelle M. , van der Ven Myrthe , van der Woude Daisy A. A. , Regis Marta , van Sloun Ruud J. G. , Oei S. Guid , van Laar Judith O. E. H. , van Oostrum Noortje H. M. 
Published: July 2023

Objectives
Two-dimensional speckle tracking echocardiography has been considered an angle-independent modality. However, current literature is limited and inconclusive on the actual impact of angle of insonation on strain values. Therefore, the primary objective of this study was to assess the impact of angles of insonation on the estimation of fetal left ventricular and right ventricular global longitudinal strain. Secondarily, the impact of different definitions for angles of insonation was investigated in a sensitivity analysis.

Methods
This is a retrospective analysis of a prospective longitudinal cohort study with 124 healthy subjects. The analyses were based on the four-chamber view ultrasound clips taken between 18+0 and 21+6 weeks of gestation. Angles of insonation were categorized into three groups: up/down, oblique and perpendicular. The mean fetal left and right ventricular and global longitudinal strain values corresponding to these three groups were compared by an ANOVA test corrected for heteroscedasticity.

Results
Fetal left and right ventricular global longitudinal strain values were not statistically different between the three angles of insonation (p-value >0.062 and >0.149, respectively). When applying another definition for angles of insonation in the sensitivity analysis, the mean left ventricular global longitudinal strain value was significantly decreased for the oblique compared to the up/down angle of insonation (p-value 0.041).

Conclusions
There is no evidence of a difference in fetal left and right ventricular global longitudinal strain between the different angles of insonation in fetal two-dimensional speckle tracking echocardiography.
Long-Term Follow-Up of Colonoscopy Quality Monitoring
Authors: Patel Feenalie , Dilly Christen , Fayad Nabil , Marri Smitha , Eckert George J. , Kahi Charles 
Published: July 2023

INTRODUCTION:
High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear.

METHODS:
We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly.

RESULTS:
Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements (P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from −4.7% to +6.8%.

DISCUSSION:
Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.