bluuebunny/crossref_metadata_2025_split huggingface dataset:
Personal Financial Wellness Curricula for Medical Trainees: A Systematic Review
Authors: Wesslund Hannah M. , Payne Jeremy S. , Baxter Jared D. , Westmark Danielle M. , Bartels Karsten , Bailey Kristina L. , Krutsinger Dustin C. 
Published: January 2023

Purpose
Education debt, poor financial literacy, and a late start to retirement savings can cause financial stress among physicians. This systematic review identifies methods for curriculum development, methods for curriculum delivery, and outcome measures to evaluate the effectiveness of personal financial wellness curricula for medical students, residents, and fellows.

Method
The authors searched the Embase, MEDLINE (via EBSCO), Scopus, Education Resources Information Center (via EBSCO), and Cochrane Library databases and MedEdPORTAL (via PubMed) on July 28, 2022. Studies must have reported the outcome of at least 1 postcourse assessment to be included.

Results
Of the 1,996 unique citations identified, 13 studies met the inclusion criteria. Three curricula (23.1%) were designed for medical students, 8 (61.5%) for residents, 1 (7.7%) for internal medicine fellows, and 1 (7.7%) for obstetrics–gynecology residents and fellows. The most frequently discussed personal finance topics included student loans, investment options, disability insurance, life insurance, retirement savings, budgeting, debt management, and general personal finance. A median (interquartile range) of 3.5 (1.4–7.0) hours was spent on personal finance topics. Eleven curricula (85.6%) relied on physicians to deliver the content. Four studies (30.8%) reported precourse and postcourse financial literacy evaluations, each showing improved financial literacy after the course. Four studies (30.8%) assessed actual or planned financial behavior changes, each credited with encouraging or assisting with financial behavioral changes. One study (7.7%) assessed participants’ well-being using the Expanded Well-Being Index, which showed an improvement after the course.

Conclusions
Given the impact educational debt and other financial stressors can have on the wellness of medical trainees, institutions should consider investments in teaching financial literacy. Future studies should report more concrete outcome measures, including financial behavior change and validated measures of wellness.
Gender-Based Differences in Language Used by Students to Describe Their Noteworthy Characteristics in Medical Student Performance Evaluations
Authors: Engel-Rebitzer Eden , Kogan Jennifer R. , Heath Janae K. 
Published: January 2023

PurposeThe noteworthy characteristic (NC) section of the medical student performance evaluation (MSPE) was introduced to facilitate holistic review of residency applications and mitigate biases. The student-written aspect of the characteristics, however, may introduce biases resulting from gender differences in self-promotion behaviors. The authors conducted an exploratory analysis of potential gender-based differences in language used in NCs.MethodThe authors performed a single-center cohort analysis of all student-written NCs at the Perelman School of Medicine (2018–2022). NCs were converted into single words and characterized into word categories: ability (e.g., “talent”), standout (“best”), grindstone (“meticulous”), communal (“caring”), or agentic (“ambitious”). The authors qualitatively analyzed NC topic characteristics (i.e., focused on scholarship, community service). Logistic regression was used to identify gender differences in word categories and topics used in NCs.ResultsThe cohort included 2,084 characteristics from 783 MSPEs (47.5%, n = 371 written by women). After adjusting for underrepresented in medicine status, honor society membership, and intended specialty, men were more likely to use standout (OR = 2.00; 95% confidence interval [CI] = 1.35, 2.96;P= .001) and communal (OR = 1.40; 95% CI = 1.03, 1.90;P= .03) words in their NCs compared with women but less likely to use grindstone words (OR = 0.72; 95% CI = 0.53, 0.98;P= .04). Men were more likely than women to discuss scholarship (OR = 2.03; 95% CI = 1.27, 3.23;P= .003), hobbies (OR = 1.45; 95% CI = 1.07, 1.96;P= .02), and/or awards (OR = 1.59; 95% CI = 1.16, 2.16;P= .004) and less likely to highlight community service (OR = 0.66; 95% CI = 0.48, 0.92;P= .02).ConclusionsThe self-written nature of NCs permits language differences that may contribute to gender bias in residency application.
Bethlem Myopathy (Collagen VI-Related Dystrophies): A Retrospective Cohort Study on Musculoskeletal Pathologies and Clinical Course
Authors: Silverstein Rachel S. , Wang Daniel D. , Haruno Lee S. , Lotze Timothy E. , Scott Allison C. , Rosenfeld Scott B. 
Published: January 2023

Background:
Collagen VI-related myopathies with pathologic COL6A1, COL6A2, and COL6A3 variants manifest as a phenotypic continuum of rare disorders, including Bethlem myopathy (BM), characterized by early onset muscle weakness, proximal joint contractures, and distal joint laxity. Herein we discuss the concomitant orthopedic manifestations of BM, potential management strategies, and patient outcomes.

Methods:
An IRB-approved retrospective cohort study (n=23) from 2 pediatric institutions with a confirmed diagnosis of BM. Charts were reviewed for demographic data, age of disease presentation and diagnosis, COL6 genotype, diagnosis method, ambulation status, need for assistance, musculoskeletal abnormalities, other systemic comorbidities, advanced imaging and screening diagnostics, previous surgical interventions, and progression of the disease.

Results:
The mean age was 11.65 years (range 3 to 19 y). Mean age at initial presentation with symptoms was 4.18 years old, whereas diagnosis was delayed until 8.22 years old on average. Muscle weakness was the most common presenting symptom (65.2%), and 73.9% of patients required some use of assistive or mobility devices. Overall, 30.4% of patients were diagnosed with scoliosis; 57.1% required operative intervention for their scoliosis; 43.5% of patients had acetabular dysplasia; 10% required open reduction of a dislocated hip; 10% required closed reduction with hip spica application; 10% required bilateral periacetabular osteotomies for instability; 91.3% of patients developed foot and ankle deformities; 33.3% of patients underwent posteromedial-lateral equinovarus releases; 28.6% required an Achilles tendon lengthening, and 86.9% of patients had muscle tendon contractures, the most common locations being the ankle (55%) and elbow (40%).

Conclusion:
Although often less severe than other more common neuropathies and myopathies like Charcot-Marie-Tooth disease and Duchenne muscular dystrophy, BM does lead to progressive musculoskeletal deformity and disability. Its relative rarity makes it less familiar to providers and likely contributes to delays in diagnosis. Scoliosis, hip dysplasia, and equinus and varus ankle deformities are the most common musculoskeletal deformities. Physicians and surgeons should appropriately counsel patients and families about the clinical course of this disorder and the potential need for mobility assistance or surgical procedures.

Level of Evidence:
III, Prognostic. study.
Efficacy of 2 Nonpharmaceutical (Non-nutritive Sucking and Human Care Contact) Pain Relief Measures for Idiopathic Clubfoot Casted Using Ponseti Technique
Authors: Upadhyay Ankur , Barik Sitanshu , Agarwal Anil , Patel Yogesh 
Published: January 2023

Purpose:
This study aimed at exploring the pain and physiological responses exhibited during Ponseti manipulation and casting in clubfoot infants. In addition, we compared the efficacy of 2 nonpharmaceutical techniques (non-nutritive sucking and human care contact) for tackling these responses.

Methods:
The study included children with unilateral and bilateral idiopathic clubfeet between 15 days to 6 months of age. For comparisons, children were divided into control group without any intervention (group A), non-nutritive sucking group (group B), and human care contact group (group C). Pain score (Neonatal Infant Pain Score), heart rate (HR), and oxygen saturation (SpO2) was assessed before, during and 1 minute after casting. These measurements were compared using statistical methods.

Results:
There were 16 children (11 bilateral) in group A, 17 (10 bilateral) in group B, and 18 (8 bilateral) in group C. Before casting, the baseline parameters (Neonatal Infant Pain Score, HR, and SpO2) of the 3 groups were comparable. Groups B and C had a significant reduction in pain score at casting and in postcasting period when compared with group A (P<0.05). Group B (at casting—mean: 174.1/min, postcasting—mean: 168.2/min) had the lowest HR both during and after cast application. Group B had the highest SpO2 among all the 3 groups, both during casting (mean: 95.7%) and after casting (mean: 97.4%) (P<0.05).

Conclusions:
Infants exhibit moderate pain response and altered physiological responses during and after Ponseti casting. Non-nutritive sucking emerged as a better method to lessen these parameters when compared with the conventional technique and human care contact.

Level of Evidence:
Level II.
HDAC Inhibitors Alleviate Uric Acid–Induced Vascular Endothelial Cell Injury by Way of the HDAC6/FGF21/PI3K/AKT Pathway
Authors: Wang Kaihao , Zhang Youhong , Zhou Min , Du Yipeng , Li Peixin , Guan Chang , Huang Zheng 
Published: January 2023

Abstract:
Uric acid (UA) accumulation triggers endothelial dysfunction, oxidative stress, and inflammation. Histone deacetylase (HDAC) plays a vital role in regulating the pathological processes of various diseases. However, the influence of HDAC inhibitor on UA-induced vascular endothelial cell injury (VECI) remains undefined. Hence, this study aimed to investigate the effect of HDACs inhibition on UA-induced vascular endothelial cell dysfunction and its detailed mechanism. UA was used to induce human umbilical vein endothelial cell (HUVEC) injury. Meanwhile, potassium oxonate–induced and hypoxanthine-induced hyperuricemia mouse models were also constructed. A broad-spectrum HDAC inhibitor trichostatin A (TSA) or selective HDAC6 inhibitor TubastatinA (TubA) was given to HUVECs or mice to determine whether HDACs can affect UA-induced VECI. The results showed pretreatment of HUVECs with TSA or HDAC6 knockdown-attenuated UA-induced VECI and increased FGF21 expression and phosphorylation of AKT, eNOS, and FoxO3a. These effects could be reversed by FGF21 knockdown. In vivo, both TSA and TubA reduced inflammation and tissue injury while increased FGF21 expression and phosphorylation of AKT, eNOS, and FoxO3a in the aortic and renal tissues of hyperuricemia mice. Therefore, HDACs, especially HDAC6 inhibitor, alleviated UA-induced VECI through upregulating FGF21 expression and then activating the PI3K/AKT pathway. This suggests that HDAC6 may serve as a novel therapeutic target for treating UA-induced endothelial dysfunction.
Dual Pathway Inhibition with Rivaroxaban and Aspirin Reduces Inflammatory Biomarkers in Atherosclerosis
Authors: Russo Vincenzo , Fabiani Dario , Leonardi Silvia , Attena Emilio , D'Alterio Giuliano , Cotticelli Ciro , Rago Anna , Sarpa Sara , Maione Benedicta , D'Onofrio Antonio , Golino Paolo , Nigro Gerardo 
Published: January 2023

Abstract:
Dual pathway inhibition (DPI) with low-dose rivaroxaban and aspirin in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD) reduces the occurrence of cardiovascular (CV) events; however, the underlying mechanisms explaining these latter CV benefits are not clearly understood. Our explorative observational study aimed to evaluate the effect of dual pathway inhibition on plasma inflammation and coagulation markers among real-world patients with CAD and/or PAD. We prospectively included all consecutive patients with an established diagnosis of CAD and/or PAD treated with aspirin 100 mg once daily (OD) and rivaroxaban 2.5 mg twice daily (TD). Clinical evaluation and laboratory analyses, including hemoglobin, renal function (creatinine, urea, and cystatin-C), coagulation markers (INR and aPTT), inflammation markers (IL-6, CRP, lipoprotein-associated phospholipase A2, and copeptin), and growth differentiation factor-15 (GDF-15), were conducted at baseline, before starting treatment, and at 4 and 24 weeks after study drug administration. Fifty-four consecutive patients (mean age 66 ± 7 years; male 83%) who completed the 6-month follow-up were included. At 24-week follow-up, a statistically significant reduction in IL-6 serum levels [4.6 (3.5–6.5) vs. 3.4 (2.4–4.3) pg/mL; P = 0.0001] and fibrinogen [336 (290–390) vs. 310 (275–364) mg/dL; P = 0.04] was shown; moreover, a significant increase in GDF-15 serum level [1309 (974–1961) vs. 1538 (1286–2913) pg/mL; P = 0.002] was observed. Hemoglobin, renal function, and cardiovascular homeostasis biomarkers remain stable over the time. The anti-Xa activity at both [0.005 (0–0.02) vs. 0.2 (0.1–0.34); P < 0.0001) significantly increased. The dual pathway inhibitions with low-dose rivaroxaban and aspirin in patients with CAD and/or PAD were associated with the reduction of inflammation biomarkers.
Challenges of Agitation in Dementia: A Plea for Early Discussion
Authors: Richler Leah G. , Shimizu Mariko , Huang Hsiang , Kester Rachel 
Published: January 2023

Abstract
Behavioral and psychological symptoms of dementia (BPSD) occur frequently among people with dementia and are known precipitants for placement in care facilities. Despite the social, financial, and psychological impact on dementia care, education and discussions on BPSD have not been routinely included in advance care planning (ACP). As a result, families can face great challenges in making complex medical decisions when their loved ones are admitted to the geriatric psychiatric inpatient unit with refractory BPSD. We present the case of an 83-year-old gentleman with BPSD to illustrate universal struggles in dementia care experienced by many families, which could have been alleviated by education and discussions around BPSD earlier in the patient’s dementia course. A literature search did not yield any articles that mention discussions of BPSD in ACP. The lack of literature referencing BPSD in ACP supports our clinical experiences with the case and highlights the need for improvement in current dementia care. We propose a guideline for providers to facilitate conversations around BPSD as an integral part of ACP, including discussions of four key points related to the progressive nature of dementia, the commonality of BPSD, the lack of FDA-approved treatment for BPSD, and the difficulty in balancing agitation and sedation to allow safe placement. We firmly believe it is important to start discussion on BPSD as part of ACP as early as possible. Early education and discussion will help to facilitate meaningful care decisions as patients and families navigate the challenges associated with this progressive disease.
Head Trauma and Concussions in Film and Television Stunt Performers
Authors: Senn Ariana B. , McMichael Leslie P. , Stewart Lori J. , Russell Jeffrey A. 
Published: January 2023

ObjectivesThe aims of the study were to assess prevalence and management of head impacts in stunt performers and to evaluate performers’ quality of life and ability to work after head injury.MethodsStunt performers completed an online survey about head impacts/head whips history, diagnosed concussions, reasons for not reporting injuries, health care sought after head impacts, attitudes toward on-set concussion management, perceived ability to work as a stunt performer, and health-related quality of life.ResultsOne hundred seventy-three performers (80%) indicated at least one head impact/head whip during their stunt career. Of these, 86% exhibited concussion-like symptoms and 38% received one or more concussion diagnoses. Sixty-five percent continued working with concussion-like symptoms. Short Form-12 mental component scores were suggestive of depression in 42%.ConclusionsConcussion seems to be a serious occupational health issue in stunt performers. We suggest that concussion management, risk reduction, and education should be addressed in this community.
Development of fatty acid metabolism-related models in lung adenocarcinomaA Review
Authors: Ye Wei , Li Xingxing 
Published: January 2023

Backgroud:
Lung adenocarcinoma (LUAD) is 1 of the common malignancy with a poor prognosis.

Materials and Methods:
Based on bioinformatics, the fatty acid metabolism model of LUAD was developed. We downloaded LUAD transcriptome data from the cancer genome atlas and gene expression omnibus databases. We used bioinformatics methods to construct a fatty acid metabolism-related predictive risk model to predict the prognosis of LUAD. We further explored the relationship between prognostic models and survival and immunity.

Results:
We identified 17 prognosis-related fatty acid-associated genes and constructed prognostic models. In the the cancer genome atlas cohort, the prognosis was worse in the high-risk score group compared to the low-risk score group. The ROC curve confirmed its accuracy. Subsequently, we used the gene expression omnibus database to confirm the above findings. There were differences in immune infiltrating cell abundance and immune function between the high-risk score group and low-risk score group. The immune dysfunction and exclusion (TIDE) based algorithm showed that the low-risk score group was more suitable for the immune treatment.

Conclusion:
Fatty acid metabolic patterns can deepen the understanding of the immune microenvironment of LUAD and be used to guide the formulation of immunotherapy protocols.
Adherence to Guidelines Influenced the Mortality, Hospital Stay, and Health Care System Costs in Patients With Acute Pancreatitis
Authors: Ricci Claudio , Ingaldi Carlo , Alberici Laura , Marasco Giovanni , Pagano Nico , Mosconi Cristina , Migliori Marina , Serra Carla , Davidovich Ida , Sermonesi Giacomo , Alemanni Luigina Vanessa , Rossini Benedetta , Isopi Claudio , Casadei Riccardo 
Published: January 2023

Objectives
The primary end point was the compliance rate with guidelines. The secondaries were mortality, hospital stay, and costs.

Methods
This study included 1904 patients with acute pancreatitis (AP): group A, diagnosed before 2013, and group B, after 2013.

Results
The compliance rate was 0.6%. The compliance rates increased for fluid resuscitation (3.3% vs 13.7%, P < 0.001), for antibiotics use (21.9% vs 28.1%, P = 0.002), for oral feeding (55.0% vs 49.7%, P = 0.007), and for correct use of endoscopic retrograde cholangiopancreatography (ERCP) (83% vs 91.9%, P < 0.001). Compliance to severity assessment with computed tomography (odds ratio [OR], 0.4; P = 0.029), parenteral nutrition recommendations (OR, 0.3; P = 0.009), and early surgery (OR, 0.3; P = 0.010) reduced the mortality. Compliance to antibiotic therapy (OR, 0.6; P < 0.001), correct use of parenteral nutrition (OR, 0.3; P < 0.001), correct use of ERCP (OR, 0.5; P < 0.001), and early surgery (OR, 0.3; P = 0.010) reduced hospital stay. The compliance reduced the costs for parenteral nutrition (P < 0.001), correct use of ERCP (P = 0.011), and surgery (P = 0.010).

Conclusions
The adherence to guidelines for AP was low. Compliance could reduce mortality, prolonged hospital stay, and costs.
Circular RNA Fibroblast Growth Factor Receptor 1 Promotes Pancreatic Cancer Progression by Targeting MicroRNA-532-3p/PIK3CB Axis
Authors: Wang Kai-Qiong , Ye Mu-Lin , Qiao Xin , Yu Zhi-Wei , Wu Chang-Xiong , Zheng Jin-Fang 
Published: January 2023

Objective
The aim of the study is to explore the contribution and mechanism of circular RNA fibroblast growth factor receptor 1 (circFGFR1) in pancreatic ductal adenocarcinoma (PDAC) progression.

Methods
Expressions of circFGFR1, microRNA (miR)-532-3p, and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit beta (PIK3CB) were assessed by quantitative real-time polymerase chain reaction or in situ hybridization. Fluorescence in situ hybridization determined the subcellular localization of circFGFR1. Immunohistochemistry was used to detect PIK3CB expression in PDAC tissues. Cell growth was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and colony formation assays. Wound healing, transwell, and flow cytometry assays examined the migration, invasion, and apoptosis. Dual-luciferase and RNA pull-down assay verified the interactions between circFGFR1/PIK3CB and miR-532-3p. In vivo xenograft tumor growth and lung metastasis were assessed in nude mice.

Results
Functionally, knockdown of circFGFR1 restrained in vitro PDAC cell growth, migration, invasion, and in vivo xenograft tumor growth and lung metastasis. In addition, circFGFR1 could sponge miR-532-3p to upregulate PIK3CB level. Rescue experiments revealed that the tumor-suppressive effects caused by miR-532-3p mimics could be reversed by circFGFR1 or PIK3CB overexpression.

Conclusions
Our data revealed that circFGFR1 driven the malignant progression of PDAC by targeting miR-532-3p/PIK3CB axis, suggesting that inhibition of circFGFR1 might be considered as a therapeutic target for PDAC.
Pancreatic Stones and Extracorporeal Shockwave Lithotripsy
Authors: Gnecco James , Brown Landon K. , Boregowda Umesha , Abidali Hussein , Saligram Shreyas , Rosenkranz Laura , Patel Sandeep , Haluskza Oleh , Sayana Hari 
Published: January 2023

Abstract
Pancreatic stones are sequelae of chronic pancreatitis, resulting in poor quality of life, frequent hospitalizations, and a significant economic burden. Extracorporeal shock wave lithotripsy (ESWL) can be used to treat pancreatic stones and is less invasive when compared to other modalities. In this review article, we have discussed the role of ESWL in the treatment of pancreatic stones and how it differs from other modalities. Databases were searched electronically for articles discussing the treatment of pancreatic ductal stones by ESWL or other modalities. Articles discussing or comparing treatment success rates were preferentially included. An inductive approach was used to identify articles related to the treatment of pancreatic stones with ESWL throughout the review process. Although laser lithotripsy and electrohydraulic lithotripsy appear to have higher success rates, the potential for ESWL to affect clinical outcomes is substantial, especially in individuals with a higher risk for invasive procedures. The decision to perform ESWL should be considered if the outcome will substantially alter the clinical management when performed by an experienced endoscopist. Further randomized controlled trials are needed to compare ESWL and peroral pancreatic lithotripsy methods.