bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spermatogenesis after gonadotoxic childhood treatment: follow-up of 12 patients
Authors: Delgouffe E , Braye A , Vloeberghs V , Mateizel I , Ernst C , Ferster A , Devalck C , Tournaye H , Gies I , Goossens E 
Published: July 2023

Abstract

STUDY QUESTION
What is the long-term impact of presumed gonadotoxic treatment during childhood on the patient’s testicular function at adulthood?

SUMMARY ANSWER
Although most patients showed low testicular volumes and some degree of reproductive hormone disruption 12.3 (2.3–21.0) years after gonadotoxic childhood therapy, active spermatogenesis was demonstrated in the semen sample of 8 out of the 12 patients.

WHAT IS KNOWN ALREADY
In recent decades, experimental testicular tissue banking programmes have been set up to safeguard the future fertility of young boys requiring chemo- and/or radiotherapy with significant gonadotoxicity. Although the risk of azoospermia following such therapies is estimated to be high, only limited long-term data are available on the reproductive potential at adulthood.

STUDY DESIGN, SIZE, DURATION
This single-centre prospective cohort study was conducted between September 2020 and February 2023 and involved 12 adult patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS
This study was carried out in a tertiary care centre and included 12 young adults (18.1–28.3 years old) who had been offered testicular tissue banking prior to gonadotoxic treatment during childhood. All patients had a consultation and physical examination with a fertility specialist, a scrotal ultrasound to measure the testicular volumes and evaluate the testicular parenchyma, a blood test for assessment of reproductive hormones, and a semen analysis.

MAIN RESULTS AND THE ROLE OF CHANCE
Testicular tissue was banked prior to the gonadotoxic treatment for 10 out of the 12 included patients. Testicular volumes were low for 9 patients, and 10 patients showed some degree of reproductive hormone disruption. Remarkably, ongoing spermatogenesis was demonstrated in 8 patients at a median 12.3 (range 2.3–21.0) years post-treatment.

LIMITATIONS, REASONS FOR CAUTION
This study had a limited sample size, making additional research with a larger study population necessary to verify these preliminary findings.

WIDER IMPLICATIONS OF THE FINDINGS
These findings highlight the need for multicentric research with a larger study population to establish universal inclusion criteria for immature testicular tissue banking.

STUDY FUNDING/COMPETING INTEREST(S)
This study was conducted with financial support from the Research Programme of the Research Foundation-Flanders (G010918N), Kom Op Tegen Kanker, and Scientific Fund Willy Gepts (WFWG19-03). The authors declare no competing interests.

TRIAL REGISTRATION NUMBER
NCT04202094; https://clinicaltrials.gov/ct2/show/NCT04202094?id=NCT04202094&draw=2&rank=1 This study was registered on 6 December 2019, and the first patient was enrolled on 8 September 2020.
Experimental and histological evaluation of different clamp technique for pulmonary artery
Authors: Chiba Yoshiki , Takahashi Yuki , Takase Yoshiaki , Tsuruta Kodai , Maki Ryunosuke , Miyajima Masahiro , Ohnishi Hirofumi , Watanabe Atsushi 
Published: July 2023

Abstract

OBJECTIVES
The double-loop technique has been used in our clinical settings for pulmonary arterioplasty and/or injured artery repair during thoracoscopic anatomical lung resection. We evaluated the pressure resistance capacity and intimal load to determine the effectiveness and safety of the double-loop technique.

METHODS
The double-loop technique, DeBakey clamp, Fogarty clamp, endovascular clips and vessel loop technique were evaluated. During an experimental study, a polyvinyl alcohol main pulmonary artery model, manometer and in-deflation device were used to measure the burst pressure. The maximum clamp pressure was measured using a pressure-measuring film. Each measurement was performed 10 times. During the histological study, we measured the burst pressure and evaluated the intimal damage of the human pulmonary artery associated with the double-loop technique and DeBakey clamp.

RESULTS
The experimental burst pressure (mmHg) and maximum clamp pressure (MPa) between the double-loop technique and DeBakey at the third notch were not significantly different (24.6 ± 2.8 and 21.8 ± 2.8, P = 0.094; 1.54 ± 0.12 and 1.49 ± 0.12, P = 0.954). During the histological study, the burst pressures of the double-loop technique and DeBakey at the third notch were also not significantly different (P = 0.754). Furthermore, the double-loop technique resulted in only intimal deformation in each five samples.

CONCLUSIONS
The double-loop technique is feasible for thoracoscopic anatomical lung resection because it has similar pressure resistance capacity and intimal load as DeBakey at the 3rd notch.
A Method for Change. Lacanian Discourse Analysis: A Glimpse into Climate Policy
Authors: Tolis Valeria 
Published: July 2023

Abstract
In this article, I propose a return to Jacques Lacan, I develop a Lacanian discourse analysis (LDA) as one possible method in international relations and demonstrate its potential by sketching out the case of climate change policy within the European Union. Lacan’s theory of the four discourses as conceptual “mind maps” informs a method of discourse analysis enabling researchers to empirically investigate how a hegemonic discourse can be challenged and potentially subverted. A Lacanian perspective emphasizes the “subject of the enunciation” and conceptualizes subjects as socially produced but lacking: Discourse provides an historicized socio-linguistic structure sustaining the subject’s societal relations, but the speaking activity always produces a cut within subjectivity, which manifests as an excess-loss of meaning in the enunciation. Via the case study of the energy efficiency policy in the EU, I first illustrate how an LDA allows us to investigate climate knowledge and the authority of the discourse. Then, by looking at how energy efficiency is spoken in the enunciation, I expose the excess of meaning produced as an effect of language, which “fractures” the discourse. Finally, I show how to leverage on these produced fractures to assess the transformative and empowering potential of the observed discourse.
Pulmonary microbiota intervention alleviates fine particulate matter-induced lung inflammation in broilers
Authors: Zhou Zilin , Shen Dan , Wang Kai , Liu Junze , Li Mingyang , Win-Shwe Tin-Tin , Nagaoka Kentaro , Li Chunmei 
Published: July 2023

Abstract
Fine particulate matter (PM2.5) released during the livestock industry endangers the respiratory health of animals. Our previous findings suggested that broilers exposed to PM2.5 exhibited lung inflammation and changes in the pulmonary microbiome. Therefore, this study was to investigate whether the pulmonary microbiota plays a causal role in the pathogenesis of PM2.5-induced lung inflammation. We first used antibiotics to establish a pulmonary microbiota intervention broiler model, which showed a significantly reduced total bacterial load in the lungs without affecting the microbiota composition or structure. Based on it, 45 AA broilers of similar body weight were randomly assigned to three groups: control (CON), PM2.5 (PM), and pulmonary microbiota intervention (ABX-PM). From 21 d of age, broilers in the ABX-PM group were intratracheally instilled with antibiotics once a day for 3 d. Meanwhile, broilers in the other two groups were simultaneously instilled with sterile saline. On 24 and 26 d of age, broilers in the PM and ABX-PM groups were intratracheally instilled with PM2.5 suspension to induce lung inflammation, and broilers in the CON group were simultaneously instilled with sterile saline. The lung histomorphology, inflammatory cytokines’ expression levels, lung microbiome, and microbial growth conditions were analyzed to determine the effect of the pulmonary microbiota on PM2.5-induced lung inflammation. Broilers in the PM group showed lung histological injury, while broilers in the ABX-PM group had normal lung histomorphology. Furthermore, microbiota intervention significantly reduced mRNA expression levels of interleukin-1β, tumor necrosis factor-α, interleukin-6, interleukin-8, toll-like receptor 4 and nuclear factor kappa-B. PM2.5 induced significant changes in the β diversity and structure of the pulmonary microbiota in the PM group. However, no significant changes in microbiota structure were observed in the ABX-PM group. Moreover, the relative abundance of Enterococcus cecorum in the PM group was significantly higher than that in the CON and ABX-PM groups. And sterile bronchoalveolar lavage fluid from the PM group significantly promoted the growth of E. cecorum, indicating that PM2.5 altered the microbiota’s growth condition. In conclusion, pulmonary microbiota can affect PM2.5-induced lung inflammation in broilers. PM2.5 can alter the bacterial growth environment and promote dysbiosis, potentially exacerbating inflammation.
Bilateral adrenal hemorrhage after pancreaticoduodenectomy
Authors: Andres Sarah , Suchak Nikki , Brady Maureen , Kukar Moshim , Sarkar Joy 
Published: July 2023

Abstract
The incidence of bilateral adrenal hemorrhage (BAH) in the postoperative setting is rare, but potentially life threatening. A literature review of postoperative BAH reveals that there is limited data on BAH following abdominal surgery. We present a case of BAH following pancreaticoduodenectomy, which has not been previously documented in the literature. A 70-year-old male patient with no previous history of adrenal disease underwent an uncomplicated pancreaticoduodenectomy and was discharged after a typical postoperative course. He was readmitted with abdominal pain and ileus on POD 8 and a computed tomography (CT) scan was initially unremarkable, but a repeat CT scan on POD 11 demonstrated BAH. He was found to have adrenal insufficiency and was successfully treated with steroids. Clinicians should be aware of the possibility of adrenal hemorrhage postoperatively as it can potentially be a fatal surgical complication. To enhance patient outcomes, early detection and appropriate treatment are essential.
Maximizing the Potential of Air National Guard International Health Specialists for Global Health Engagement
Authors: Moore David C , Harder Amanda M , Peterson Matthew J , Blum Scott A 
Published: July 2023

ABSTRACT
The Air Force International Health Specialist program provides expert medical and public health support to enhance global health engagement efforts. National Guardsmen possess unique civilian health care expertise to support global health engagement. The DoD must increase support for Air National Guard International Health Specialist involvement, including training and development opportunities.
Characterization and Management of Adverse Reactions in Patients With Advanced Endometrial Cancer Receiving Lenvatinib Plus Pembrolizumab
Authors: Colombo Nicoletta , Lorusso Domenica , Monk Bradley J , Slomovitz Brian , Hasegawa Kosei , Nogueira-Rodrigues Angélica , Zale Melissa , Okpara Chinyere E , Barresi Gianmaria , McKenzie Jodi , Makker Vicky 
Published: July 2023

Abstract

Background
Lenvatinib plus pembrolizumab significantly improved efficacy compared with chemotherapy in patients with advanced endometrial cancer (aEC) regardless of microsatellite instability status or histologic subtype, who had disease progression following prior platinum-based therapy, in Study-309/KEYNOTE-775. The safety profile of the combination was generally consistent with that of each monotherapy drug and of the combination in patients with endometrial cancer and other solid tumors. Given the medical complexity of patients with aEC, this paper aims to characterize key adverse reactions (ARs) of the combination treatment and review management strategies, providing a guide for AR management to maximize anticancer benefits and minimize treatment discontinuation.

Materials and Methods
In Study-309/KEYNOTE-775, patients received lenvatinib (20 mg orally once daily) plus pembrolizumab (200 mg intravenously every 3 weeks) or chemotherapy (doxorubicin or paclitaxel). The incidence and median time to the first onset of ARs, dose modifications, and concomitant medications are described. Key ARs characterized include hypothyroidism, hypertension, fatigue, diarrhea, musculoskeletal disorders, nausea, decreased appetite, vomiting, stomatitis, weight decreased, proteinuria, and palmar-plantar erythrodysesthesia syndrome.

Results
As expected, the most common any-grade key ARs included: hypothyroidism, hypertension, fatigue, diarrhea, and musculoskeletal disorders. Grades 3-4 key ARs with incidence ≥10% included: hypertension, fatigue, and weight decreased. Key ARs first occurred within approximately 3 months of treatment initiation. AR management strategies consistent with the prescribing information and the study protocol are discussed.

Conclusion
Successful AR management strategies for lenvatinib plus pembrolizumab include education of the patient and entire treatment team, preventative measures and close monitoring, and judicious use of dose modifications and concomitant medications.

Clinicaltrials.gov ID
NCT03517449
Quality of Life and Treatment-Related Side Effects in Patients With HR+/HER2− Advanced Breast Cancer: Findings From a Multicountry Survey
Authors: Cardoso Fatima , Rihani Julie , Harmer Victoria , Harbeck Nadia , Casas Ana , Rugo Hope S , Fasching Peter A , Moore Adam , de Courcy Joanna , Pathak Purnima , Haftchenary Sina , Aubel Dawn , Schumacher-Wulf Eva 
Published: July 2023

Abstract

Background
Quality of life (QOL) is a critical factor in decision-making for advanced breast cancer (ABC). There is a need to improve how QOL and treatment-related side effects (SEs) that impact it are clinically assessed. We examined healthcare professionals’ (HCPs’) and patients’ perspectives on the importance of QOL discussions and the impact of SEs on QOL in clinical settings.

Patients and Methods
A cross-sectional online survey was conducted (7/2020-5/2021) among oncologists, nurses, and patients with HR+/HER2− ABC in 7 countries.

Results
The survey was completed by 502 HCPs and 467 patients. Overall, 88% of oncologists and 49% of patients recalled QOL discussions at follow-up. In the first- through fourth-line (1L, 2L, 3L, and 4L) settings, respectively, 48%, 57%, 79%, and 85% of oncologists reported QOL was very important; 73% and 45% of patients receiving 1L and 2L treatment and 40% receiving 3L+ treatment indicated QOL was important. Patients reported that insomnia, anxiety, back pain, fatigue, diarrhea, hot flashes, low sexual interest, and loss of appetite had a moderate/severe impact on QOL. Of patients experiencing certain SEs, ≥64% did not discuss them with HCPs until there was a moderate/severe impact on QOL. In patients receiving a CDK4/6 inhibitor, SEs, including insomnia, diarrhea, back pain, and fatigue, had a moderate/severe impact on QOL.

Conclusions
This survey discovered disconnects between HCPs and patients with ABC on the importance of QOL discussions and the impact of SEs on QOL. These data support the use of ABC-specific QOL questionnaires that closely monitor SEs impacting QOL.
Patient-reported quality of life and working status outcomes in ambulatory patients with idiopathic inflammatory myopathy
Authors: Peng Zhao , Wang Yanhong , Liu Ning , Zhou Shuang , Zhao Jiuliang , Xu Dong , Li Mengtao , Wu Chanyuan , Zeng Xiaofeng , Wang Qian 
Published: July 2023

Abstract

Objective
To investigate the health-related quality of life (HR-QoL), work productivity and activity impairment and associated factors among patients with idiopathic inflammatory myopathy (IIM).

Methods
This was an observational, cross-sectional study. The 189 ambulatory patients with IIM were recruited from May 2019 to May 2022. HR-QoL was measured by the European Quality of Life 5-Dimension (EQ-5D) questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used to evaluate work productivity and activity impairment. The IIM-related parameters were assessed by the 8-item Manual Muscle Test (MMT-8), Myositis Disease Activity Assessment visual analogue scale (MYOACT), Myositis Damage Index (MDI), Disease Activity Score (DAS) and Physician/Patient Global Assessment (PhGA/PtGA). Quantile regression and ordinal logistic regression were performed to identify the factors, considering EQ-5D or WPAI scores as dependent variables, respectively.

Results
Of the 189 IIM patients enrolled, 60% had DM, 13% had PM and 27% had clinical amyopathic DM. The median EQ-5D score was 1.00 (95% CI 0.73, 1.00), 28% were employed and 45% of overall work was impaired due to health problems. EQ-5D values were positively associated with MMT-8 and negatively with MYOACT, DAS, MDI-global and PhGA/PtGA. For the WPAI, activity impairment was associated with a lower MMT-8 score, older onset age and higher PhGA only in 25th–75th percentile. Increased PtGA was associated with increased activity and overall working productivity impairment in most quantiles (P&lt;0.05).

Conclusion
Multiple disease characteristics were associated with reduced HR-QoL or working productivity impairment in patients with IIM, especially for PtGA.
Multi-dimensional sleep and mortality: The Multi-Ethnic Study of Atherosclerosis
Authors: Chung Joon , Goodman Matthew , Huang Tianyi , Wallace Meredith L , Lutsey Pamela L , Chen Jarvis T , Castro-Diehl Cecilia , Bertisch Suzanne , Redline Susan 
Published: July 2023

Abstract

Study Objectives
Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality.

Methods
The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010–2013). 1726 participants were followed for a median of 6.9 years (Q1–Q3, 6.4–7.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori.

Results
After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index.

Conclusion
More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.
Diversity and Phenology of Soybean Seed Fungal Endophyte Communities in the Upper Midwest United States
Authors: Batzer Jean Carlson , Shirazi Amin , Lawson Maia , Dangal Nabin K. , Sureshbabu Bijula M. , Mathew Febina M. , Smith Damon L. , Mueller Daren S. 
Published: July 2023

Infection over time by endophytic fungi in soybean seed and pods was documented in Iowa and Wisconsin in 2018. Three reproductive stages were sampled from six cultivars, with maturity groups (MG) ranging from 1.1 to 4.7, and included 216 blemish-free pods and 1,836 healthy seeds that were heavily disinfested to remove epiphytes. Thirty-five species and 11 genera were identified from 1,799 isolates using morphological and molecular evidence. Alternaria, Diaporthe, and Fusarium were dominant. The timing of endophyte infection was documented relative to MG. The lowest number of fungi were recovered from seed at R6, and infection sharply increased at R7. The abundance of Diaporthe and Fusarium isolates differed across MG and reproductive stage; shorter MGs had more Diaporthe isolates at earlier reproductive stages than longer MGs. Fusarium counts differed across MG but did not show consistent trends with seed maturity. Alternaria counts declined as seed matured but were not affected by MG. We used nonmetric multidimensional scaling to elucidate the phenology of seed infection within the endophyte community. This method helps represent the data in a lower dimension by measuring the similarity or dissimilarity between data points, making it a useful tool for grouping similar endophyte communities. The nonmetric multidimensional scaling ordination analysis of fungal taxa within endophyte communities revealed that the dominant genera in filled green pods were highly similar. However, this similarity was not observed among different stages of seed development, indicating that each taxon had distinct modes of infecting the seeds. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Constructing “Burnout”: A Critical Discourse Analysis of Burnout in Postgraduate Medical Education
Authors: Khan Rabia , Hodges Brian David , Martimianakis Maria Athina 
Published: July 2023

Purpose
In 1974, Dr. Herbert Freudenberger coined the term burnout. With the creation of the Maslach Burnout Inventory in 1984, burnout went from a pop psychology term to a highly studied phenomenon in medicine. Exponential growth in studies of burnout culminated in its adoption into the International Classification of Diseases-11 in 2022. Yet, despite increased awareness and efforts aimed at addressing burnout in medicine, many surveys report burnout rates have increased among trainees. The authors aimed to identify different discourses that legitimate or function to mobilize burnout in postgraduate medical education (PGME), to answer the question: Why does burnout persist in PGME despite efforts to ameliorate it?

Method
Using a Foucauldian discourse analysis, this study examined the socializing period of PGME as an entry point into burnout’s persistence. The archive from which the discourses were constructed included over 500 academic articles, numerous policy documents, autobiographies, videos, documentaries, social media, materials from conferences, and threads in forums including Reddit.

Results
This study identified 3 discourses of burnout from 1974–2019: burnout as illness, burnout as occupational stress, and burnout as existentialism. Each discourse was associated with statements of truth, signs and signifiers, roles that individuals play within the discourse, and different institutions that gained visibility as a result of differing discourses.

Conclusions
Burnout persists despite effort to ameliorate it because it is a productive construct for organizations. In its current form, it depoliticizes issues of health in favor of wellness and gives voice to the challenge of making meaning from the experience of being a clinician.