bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polystyrene microplastic alters the redox state and arsenic metabolization in the freshwater bivalve Limnoperna fortunei
Authors: Nunes Silvana Manske , Josende Marcelo Estrella , Fattorini Daniele , Regoli Francesco , Monserrat José Maria , Ventura-Lima Juliane 
Published: August 2023

Abstract
Most organisms possess the capacity to metabolize arsenic (As) accumulating compounds to less toxic forms, thus minimizing the adverse effect induced by this metalloid. However, other contaminants may to interfere with As metabolism, contributing to the accumulation of more toxic compounds. Microplastics (MPs) are omnipresent in aquatic environment and may induce toxicological effects (alone or in combination with other contaminants) on living organisms. Therefore, the objective of the present study was to evaluate the effect of the exposure of the freshwater clam Limnoperna fortunei to a combination of MP (4 and 40 μg/L of polystyrene microbeads, 1.05 μm) and As (50 μg/L) for 48 h, evaluating the accumulation and metabolization of As and oxidative stress parameters, such as catalase (CAT), glutathione-S-transferase activities, total antioxidant competence, reduced glutathione (GSH), and lipid damage in the gills and digestive glands. Results revealed that low MP concentration disrupts the redox state of the digestive gland by a decrease in the antioxidant activity (CAT and total antioxidant capacity). GSH levels in the gills of animals exposed to MP (4 μg/L) alone and the combination of MP + As increased, concomitant with an increase in the percentage of toxic compounds, indicating the effect of MP on As metabolism. Although, few studies evaluated the effect of coexposure to MP + As by considering metabolization of metalloid in freshwater bivalve, our results revealed that exposure to MP reduced the metabolization capacity of As, favoring the accumulation of more toxic compounds besides the MP alone, which showed a pro-oxidant effect in L. fortunei.
A systems approach reveals species differences in hepatic stress response capacity
Authors: Russomanno Giusy , Sison-Young Rowena , Livoti Lucia A , Coghlan Hannah , Jenkins Rosalind E , Kunnen Steven J , Fisher Ciarán P , Reddyhoff Dennis , Gardner Iain , Rehman Adeeb H , Fenwick Stephen W , Jones Andrew R , Vermeil De Conchard Guy , Simonin Gilles , Bertheux Helene , Weaver Richard J , Johnson Robert L , Liguori Michael J , Clausznitzer Diana , Stevens James L , Goldring Christopher E , Copple Ian M 
Published: August 2023

Abstract
To minimize the occurrence of unexpected toxicities in early phase preclinical studies of new drugs, it is vital to understand fundamental similarities and differences between preclinical species and humans. Species differences in sensitivity to acetaminophen (APAP) liver injury have been related to differences in the fraction of the drug that is bioactivated to the reactive metabolite N-acetyl-p-benzoquinoneimine (NAPQI). We have used physiologically based pharmacokinetic modeling to identify oral doses of APAP (300 and 1000 mg/kg in mice and rats, respectively) yielding similar hepatic burdens of NAPQI to enable the comparison of temporal liver tissue responses under conditions of equivalent chemical insult. Despite pharmacokinetic and biochemical verification of the equivalent NAPQI insult, serum biomarker and tissue histopathology analyses revealed that mice still exhibited a greater degree of liver injury than rats. Transcriptomic and proteomic analyses highlighted the stronger activation of stress response pathways (including the Nrf2 oxidative stress response and autophagy) in the livers of rats, indicative of a more robust transcriptional adaptation to the equivalent insult. Components of these pathways were also found to be expressed at a higher basal level in the livers of rats compared with both mice and humans. Our findings exemplify a systems approach to understanding differential species sensitivity to hepatotoxicity. Multiomics analysis indicated that rats possess a greater basal and adaptive capacity for hepatic stress responses than mice and humans, with important implications for species selection and human translation in the safety testing of new drug candidates associated with reactive metabolite formation.
Criminal Justice Referrals to Cannabis Use Disorder Treatment among Adolescents and Young Adults following Recreational Cannabis Legalization in the United States
Authors: Mennis Jeremy , Stahler Gerald J. , McKeon Thomas P. 
Published: August 2023

Objectives
This study investigates whether the proportion of referrals to cannabis use disorder (CUD) treatment from the criminal justice system declined among adolescents (aged 12–17 years) and young adults (aged 18–24 years) following state recreational (adult use) cannabis legalization in the United States between 2008 and 2019.

Methods
Cannabis use disorder treatment referral data were extracted from the Treatment Episode Dataset—Admissions and used to calculate trends in the number and proportion of criminal justice referrals. Difference-in-differences analysis was used to estimate the effect of recreational legalization on the state-level proportion of criminal justice referrals as a share of all admissions.

Results
Nationwide, the number and proportion of adolescent and young adult criminal justice referrals to CUD treatment declined over the study period. The proportion of young adult criminal justice referrals declined significantly more rapidly after recreational legalization as compared with before (β = −0.045; 95% confidence interval, −0.079 to −0.010; P = 0.01). Among adolescents, the trajectory of decline in the proportion of criminal justice referrals did not change significantly following recreational legalization (β = −0.033; 95% confidence interval, −0.073 to 0.008; P = 0.11)

Conclusions
The decline in the proportion of young adult criminal justice referrals to CUD treatment following recreational legalization is likely due to falling cannabis-related arrests. Although cannabis criminalization may result in court-mandated CUD treatment for some young adults without CUD, the decline in CUD treatment admissions during a period of increasing CUD risk factors associated with recreational legalization represents a key health concern. Promoting screening and other CUD treatment referral sources, such as through primary care, may be warranted.
Artificial Intelligence to Preoperatively Predict Proximal Junction Kyphosis Following Adult Spinal Deformity Surgery: Soft Tissue Imaging May Be Necessary for Accurate Models
Authors: Johnson Graham W. , Chanbour Hani , Ali Mir Amaan , Chen Jeffrey , Metcalf Tyler , Doss Derek , Younus Iyan , Jonzzon Soren , Roth Steven G. , Abtahi Amir M. , Stephens Byron F. , Zuckerman Scott L. 
Published: August 2023

Study Design.
Retrospective cohort.

Objective:
In a cohort of patients undergoing adult spinal deformity (ASD) surgery, we used artificial intelligence to compare three models of preoperatively predicting radiographic proximal junction kyphosis (PJK) using: (1) traditional demographics and radiographic measurements, (2) raw preoperative scoliosis radiographs, and (3) raw preoperative thoracic magnetic resonance imaging (MRI).

Summary of Background Data.
Despite many proposed risk factors, PJK following ASD surgery remains difficult to predict.

Materials and Methods.
A single-institution, retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009 to 2021. PJK was defined as a sagittal Cobb angle of upper-instrumented vertebra (UIV) and UIV+2>10° and a postoperative change in UIV/UIV+2>10°. For model 1, a support vector machine was used to predict PJK within 2 years postoperatively using clinical and traditional sagittal/coronal radiographic variables and intended levels of instrumentation. Next, for model 2, a convolutional neural network (CNN) was trained on raw preoperative lateral and posterior-anterior scoliosis radiographs. Finally, for model 3, a CNN was trained on raw preoperative thoracic T1 MRIs.

Results.
A total of 191 patients underwent ASD surgery with at least 2-year follow-up and 89 (46.6%) developed radiographic PJK within 2 years. Model 1: Using clinical variables and traditional radiographic measurements, the model achieved a sensitivity: 57.2% and a specificity: 56.3%. Model 2: a CNN with raw scoliosis x-rays predicted PJK with a sensitivity: 68.2% and specificity: 58.3%. Model 3: a CNN with raw thoracic MRIs predicted PJK with average sensitivity: 73.1% and specificity: 79.5%. Finally, an attention map outlined the imaging features used by model 3 elucidated that soft tissue features predominated all true positive PJK predictions.

Conclusions.
The use of raw MRIs in an artificial intelligence model improved the accuracy of PJK prediction compared with raw scoliosis radiographs and traditional clinical/radiographic measurements. The improved predictive accuracy using MRI may indicate that PJK is best predicted by soft tissue degeneration and muscle atrophy.
Advances in immunotherapy for biliary tract cancers
Authors: Zhao Yuhao , Yang Mao , Feng Jiayi , Wang Xu'an , Liu Yingbin 
Published: August 2023

Abstract
Biliary tract cancers (BTC), a heterogeneous disease with poor prognosis, including gallbladder cancer (GBC), intrahepatic cholangiocarcinoma (ICC), and extrahepatic cholangiocarcinoma (ECC). Although surgery is currently the primary regimen to treat BTC, most BTC patients are diagnosed at an advanced stage and miss the opportunity of surgical eradication. As a result, non-surgical therapy serves as the main intervention for advanced BTC. In recent years, immunotherapy has emerged as one of the most promising therapies in a number of solid cancers, and it includes immune checkpoint inhibitors (ICIs) monotherapy or combined therapy, tumor vaccines, oncolytic virus immunotherapy, adoptive cell therapy (ACT), and cytokine therapy. However, these therapies have been practiced in limited clinical settings in patients with BTC. In this review, we focus on the discussion of latest advances of immunotherapy in BTC and update the progress of multiple current clinical trials with different immunotherapies.
Genetically predicted waist circumference and risk of atrial fibrillation
Authors: Wang Wenting , Tan Jiang-shan , Wang Jingyang , Xu Wei , Bai Liting , Jin Yu , Gao Peng , Zhang Peiyao , Li Yixuan , Yang Yanmin , Liu Jinping 
Published: August 2023

Abstract

Introduction:
Observational studies have revealed an association between waist circumference (WC) and atrial fibrillation (AF). However, it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors. Therefore, the causal role of WC in AF is unclear. This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization (MR) analysis.

Methods:
In our two-sample MR analysis, the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study (GWAS) of WC (42 single nucleotide polymorphisms with a genetic significance of P <5 × 10–8). The data of WC (from the Genetic Investigation of ANthropometric Traits consortium, containing 232,101 participants) and the data of AF (from the European Bioinformatics Institute database, containing 55,114 AF cases and 482,295 controls) were used to assess the causal role of WC on AF. Three different approaches (inverse variance weighted [IVW], MR–Egger, and weighted median regression) were used to ensure that our results more reliable.

Results:
All three MR analyses provided evidence of a positive causal association between high WC and AF. High WC was suggested to increase the risk of AF based on the IVW method (odds ratio [OR] = 1.43, 95% confidence interval [CI], 1.30–1.58, P = 2.51 × 10-13). The results of MR–Egger and weighted median regression exhibited similar trends (MR–Egger OR = 1.40 [95% CI, 1.08–1.81], P = 1.61 × 10-2; weighted median OR = 1.39 [95% CI, 1.21–1.61], P = 1.62 × 10-6). MR–Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF.

Conclusions:
Our findings suggest that greater WC is associated with an increased risk of AF. Taking measures to reduce WC may help prevent the occurrence of AF.
Novel Biomaterial Containing Gelatin, Manuka Honey, and Hydroxyapatite Enhanced Secondary Intention Healing Versus Standard Secondary Intention Healing in Mohs Surgical Defects on the Head and Distal Lower Extremities—A Randomized Controlled Trial: Pilot Study
Authors: Arnaud Karen , Wallace Matthew M. , Wheless Lee E. , Stebbins William G. , Clayton Anna S. 
Published: August 2023

BACKGROUND
Randomized, comparative studies evaluating augmented secondary intention healing (SIH) compared with conventional SIH in dermatologic surgery are limited. This study aimed to evaluate whether the use of a novel biomaterial enhances SIH, particularly in shortening time to complete re-epithelialization.

OBJECTIVE
The purpose of this study was to elucidate whether a novel biomaterial containing gelatin, manuka honey, and hydroxyapatite enhances SIH when compared with conventional SIH for surgical defects after Mohs micrographic surgery (MMS) on the head and distal lower extremities.

MATERIALS AND METHODS
Thirty-seven patients were enrolled in this randomized controlled trial. Patients undergoing MMS on the head or distal lower extremities were eligible for recruitment. After clear surgical margins were obtained post-MMS, patients were randomized to receive standard SIH or biomaterial enhanced SIH. Patients had regularly scheduled follow-ups with questionnaires at each visit until complete re-epithelialization was achieved.

RESULTS
Overall, there was no significant difference in time to re-epithelialization between standard SIH and biomaterial-enhanced SIH. However, there was a significant decrease in pain scores and skin thickness in the biomaterial-enhanced SIH group.

CONCLUSION
Biomaterial-enhanced SIH is noninferior to standard SIH and produces less pain and favorable skin thickness compared with standard SIH. ClinicalTrials.gov listing: NCT04545476.
Supporting Women’s BIA-ALCL Decision-making: Role of the Individual Consult in Empowering the Patient–Physician Team
Authors: Park Jade O. , Webb Carmen E. , Temple-Oberle Claire F. 
Published: August 2023

Background:
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell non-Hodgkin’s lymphoma and an uncommon risk of textured breast implants. Over the past decade, concern about BIA-ALCL has been increasing among both patients and surgeons. Patients are seeking a better understanding of their BIA-ALCL risk toward identifying a personalized care plan. This quality improvement project examines the value added by pairing group-based patient education seminars with one-on-one consults.

Methods:
Individual consults were held following educational group seminars. Consult field notes underwent qualitative thematic analysis. Themes were cross referenced against a quantitative chart review of patient BIA-ALCL prophylaxis decisions over time.

Results:
Four key themes were identified: weighing, perceiving, guiding, and supporting. Weighing considers the risk-benefit assessments patients make when weighing their BIA-ALCL risk. Perceiving describes the underlying psychosocial factors that frame patient perceptions of BIA-ALCL risk. Guiding presents the levels of guidance that patients require when making BIA-ALCL prophylaxis decisions. Supporting explores the therapeutic value of the individual consult. Ultimately, 41% of post-seminar consult attendees sought explantation, compared with 4% among patients who did not participate in this program (P < 0.001).

Conclusions:
Key lessons include the following: (1) patients weigh BIA-ALCL risk against perceived surgical risks and the value of their reconstruction; (2) patients can benefit from a personalized balance of autonomy and surgeon guidance when selecting a BIA-ALCL prevention plan; (3) surgeons should seek to understand the psychosocial factors that may underlie patient perceptions of BIA-ALCL risk; and (4) individual consults can be therapeutic and help strengthen the patient–surgeon relationship.
Evaluation of Artificial Intelligence–generated Responses to Common Plastic Surgery Questions
Authors: Copeland-Halperin Libby R. , O’Brien Lauren , Copeland Michelle 
Published: August 2023

Background:
Artificial intelligence (AI) is increasingly used to answer questions, yet the accuracy and validity of current tools are uncertain. In contrast to internet queries, AI generates summary responses as definitive. The internet is rife with inaccuracies, and plastic surgery management guidelines evolve, making verifiable information important.

Methods:
We posed 10 questions about breast implant-associated illness, anaplastic large lymphoma, and squamous carcinoma to Bing, using the “more balanced” option, and to ChatGPT. Answers were reviewed by two plastic surgeons for accuracy and fidelity to information on the Food and Drug Administration (FDA) and American Society of Plastic Surgeons (ASPS) websites. We also presented 10 multiple-choice questions from the 2022 plastic surgery in-service examination to Bing, using the “more precise” option, and ChatGPT. Questions were repeated three times over consecutive weeks, and answers were evaluated for accuracy and stability.

Results:
Compared with answers from the FDA and ASPS, Bing and ChatGPT were accurate. Bing answered 10 of the 30 multiple-choice questions correctly, nine incorrectly, and did not answer 11. ChatGPT correctly answered 16 and incorrectly answered 14. In both parts, responses from Bing were shorter, less detailed, and referred to verified and unverified sources; ChatGPT did not provide citations.

Conclusions:
These AI tools provided accurate information from the FDA and ASPS websites, but neither consistently answered questions requiring nuanced decision-making correctly. Advances in applications to plastic surgery will require algorithms that selectively identify, evaluate, and exclude information to enhance the accuracy, precision, validity, reliability, and utility of AI-generated responses.
Students' Perception of Servant Leadership by Physical Therapy Faculty Mentors Is Associated With Interprofessional Socialization
Authors: Willis Brad W. 
Published: August 2023

Introduction.
Promoting interprofessional collaborative practice (IPCP) is necessary. Consequently, investigating strategies associated with increased interprofessional socialization, the beliefs, behaviors, and attitudes underlying socialization toward IPCP is suggested. The purpose of this study was to examine the relationship, in the presence of control variables, between students' perception of servant leadership by physical therapy faculty mentors and interprofessional socialization.

Review of the Literature.
Although faculty mentors are associated with influencing students' socialization process and servant leadership is suggested to support collaborative care, investigations exploring these concepts within physical therapy education are limited.

Subjects.
Three cohorts of students (60 each) at an entry-level physical therapist education program in the Midwest of the United States. One hundred seventy individuals completed an anonymous paper-based composite survey, with 117 identifying the presence of an informal physical therapy faculty mentor.

Methods.
This cross-sectional survey study, inclusive of student demographic control variables, examined the relationship between interprofessional socialization and perceptions of physical therapy faculty mentors, as measured by the Interprofessional Socialization and Valuing Scale (ISVS-21) and the Servant Leadership Measure (SL-7), respectively. Multiple linear regression was used to obtain the semi-partial correlation (sr) between the SL-7 and the ISVS-21, with significance accepted at P < .05.

Results.
Upon necessary assumptions being met, 114 participants were included with an analysis of variance identifying the model to be significant (F(8,105) = 2.59, P = .01). Multiple linear regression analysis found that the SL-7, in the presence of control variables, was associated with a significant proportion of ISVS-21 scores (R
2 = 0.17, F(8,105) = 2.59, P = .01). Notably, only the SL-7 demonstrated a significant contribution to ISVS-21 estimates (β = 0.358, P < .001), with a significant and positive sr of 0.34 (P < .001).

Discussion and Conclusion.
Perceptions of servant leadership by faculty mentors were positively correlated with interprofessional socialization. Findings bolster the theoretical link between servant leadership and interprofessional socialization, servant leadership in the development of faculty and mentorship programs, and the relevance of informal social interactions.
What the X? Understanding changes in buprenorphine prescribing regulation
Authors: Speight Chandra 
Published: August 2023

ABSTRACTOpioid use disorder remains an epidemic in the United States. Buprenorphine is a Food and Drug Administration–approved medication for opioid use disorder that is associated with decreased opioid-related mortality and morbidity. Until recently, providers had to have a specialized wavier, a Drug Enforcement Agency (DEA) X, to prescribe buprenorphine for opioid use disorder. The 2023 Consolidated Appropriations Act, signed into law by President Biden, removed X waiver requirements and implements new training requirements for all new and renewing DEA registrants. This brief report outlines the history of buprenorphine prescribing regulation, reviews the recent regulatory changes and their implications for nurse practitioner buprenorphine prescribing, and concludes by considering the importance of promoting buprenorphine access.
Point-of-care Ultrasound (POCUS) Program for Critical Care Nurse Practitioners and Physician Assistants in an Oncological Intensive Care Unit and Rapid Response Team
Authors: Chen Leon L. , Tayban Kate , Tomicich Joanna , Buchholz Tara , Barzola Melissa , Mead Elena , Halpern Neil A. 
Published: August 2023

ABSTRACT
Implementation of a comprehensive point-of-care ultrasound (POCUS) program for nurse practitioners (NPs) and physician assistants (PAs) in an intensive care unit (ICU) setting improves their diagnostic and therapeutic skills and enhances patient care. Overcoming staffing, IT infrastructure, and administrative challenges has allowed our critical care medicine service to develop a successful program that empowers NPs and PAs and boosts their professional growth. Our POCUS program underscores the necessity of institutional support, dedicated mentorship, collaboration with qualified faculty, and creation and maintenance of a curriculum that adheres to accepted national guidelines. Insights gained from our experiences can serve as a valuable resource for institutions aiming to develop their own POCUS programs.