bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acknowledging the risk of suicidal ideation, depression, and anxiety in PAs
Authors: Smith Noël E. , Sierra Talia , Brown Heidi 
Published: March 2023

ABSTRACT
The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.
Assessing the utility of pepsinogens and gastrin-17 in gastric cancer detection
Authors: Gašenko Evita , Bogdanova Inga , Sjomina Olga , Aleksandraviča Ilona , Kiršners Arnis , Ancāns Guntis , Rudzīte Dace , Vangravs Reinis , Sīviņš Armands , Škapars Roberts , Tzivian Lilian , Polaka Inese , Folkmanis Valdis , Leja Mārcis 
Published: March 2023

Objectives
The aim of the study was to determine the proportion of gastric cancer patients with decreased levels of pepsinogen and gastrin-17 in plasma, with the goal of providing indirect evidence of the sensitivity of these biomarkers when applied in a cancer screening setting.

Methods
The levels of pepsinogens I and II, gastrin-17, and Helicobacter pylori immunoglobulin antibodies in plasma samples of gastric cancer patients were evaluated using the GastroPanel test system (Biohit Oyj, Helsinki, Finland). A decreased level of the pepsinogen I/II ratio was defined as less than three, while a decrease in gastrin-17 was defined as less than 1 pmol/L. Univariate analysis using non-parametric tests was used to investigate differences between normal and low concentrations of biomarkers.

Results
In total, 481 plasma samples from patients (59.9% male) with a median age of 64 years (ranging from 27 to 88 years) were analyzed. Out of the 400 cases of gastric cancer (83.2% of the total), 182 were categorized as the intestinal type, 141 as the diffuse type, 60 as the mixed type, and 17 as indeterminate according to the Lauren classification system. The H. pylori immunoglobulin test was positive in 74.0% of the patients. Pepsinogen I/II ratio was decreased in 32.4% (36.8% of the intestinal type); gastrin-17 in 12.3% (10.1% of the antral region) of all cases.

Conclusion
The majority of gastric cancer patients had normal levels of pepsinogen and gastrin-17, suggesting that these biomarkers have limited application as screening tools in the Caucasian population.
The construction and analysis of a prognostic assessment model based on P53-related multi-genes in breast carcinoma
Authors: Cai Yangjun , Wang Linyi , Xu Wangjin , Huang Shifen , Xie Bojian , Zeng Hanqian 
Published: March 2023

Background
Breast cancer ranks second in female tumor mortality, with an estimation of 2 million new cases diagnosed each year worldwide.

Methods
In our current study, we screened 13 genes highly distributed on the P53 phenotype which were significantly expressed and had a strong correlation with survival in the Cancer Genome Atlas breast cancer dataset. Least absolute shrinkage and selection operator Cox regression was conducted to construct the risk assessment model. Based on bioinformatics and statistical methods, we confirmed the credibility and validity of the model by training set and testing set.

Results
The result of comparing the other two previous hypoxia models was also satisfying. We also verified the model on one of the Gene Expression Omnibus datasets—GSE20685. Using clinical data from patients in the Cancer Genome Atlas, we acknowledged the risk score as an independent influence on breast cancer survival prognosis, and strong relevance was suggested between risk signature and age, lymphatic metastasis, tumor size and clinical stage by performing univariate and multivariate analysis. Immunology analysis demonstrated that the macrophages subset was positively associated with a risk score and other immune cell types had a negative effect with the risk score increases. The risk score was also emerging as a valuable prognostic factor for the prediction of chemotherapy drug curative effect because Gemcitabine, vinorelbine, paclitaxel and cisplatin known as a generic drug for breast cancer had more pleasing sensitivity in high-scored patients than low-scored patients.

Conclusion
The P53-related risk assessment model is promising to be a potential predictor for the prognosis of patients with breast cancer and a powerful guide for the selection of therapeutic strategies.
Counseling on hormone replacement therapy: the real risks and benefits
Authors: Voedisch Amy J. 
Published: March 2023

Purpose of review
The menopause transition can be a time of great upheaval and suffering for some patients. Hormone replacement therapy (HRT) can relieve symptoms and improve quality of life but the perceived risks of HRT have decreased use over the past two decades. Understanding the real risks and benefits will ease physician and other healthcare professionals discomfort with counseling and prescribing this potentially life changing therapy in appropriate patients.

Recent findings
Menopausal symptoms may persist several years beyond the final menstrual period. Previously stated risks of HRT overestimated the concern with menopausal therapy. New data indicates there are medical benefits to HRT beyond quality of life measures.

Summary
In appropriate patients, the benefits of hormone replacement therapy outweigh the risks. Extended use of hormone replacement therapy is reasonable in patients with persistent symptoms.
Aspirin in pregnancy: a review of indications, timing, dosing and efficacy
Authors: Joudi Noor , Rode Martha 
Published: March 2023

Purpose of review
The aim of this study was to evaluate the recent literature examining the utility of low-dose daily aspirin (LDA) in the prevention of preeclampsia and other potential adverse perinatal sequelae. The evidence supporting various aspirin doses and timing of initiation of treatment for this purpose will be examined. The potential benefits of LDA therapy in pregnancy will be discussed weighing against any potential associated harm.

Recent findings
Findings from several recent meta-analyses of randomized controlled trials are consistent with prior studies in showing a reduction in risk for preeclampsia with LDA use in individuals at an increased risk for this complication. Some studies suggest aspirin at a dose greater than the current recommended 81 mg is associated with the highest reduction in preterm PE.
Several studies have demonstrated a reduction in risk for preterm birth, small for gestational age (SGA) infant or intrauterine growth restriction (IUGR), and a reduction in the risk of perinatal mortality associated with aspirin use. The findings of reduced preterm birth (PTB) and IUGR were also demonstrated among low-risk patients.
Identifying patients at risk was re-evaluated, with resulting changes to existing United States Preventive Services Task Force (USPSTF) guidelines.

Summary
This review of recent evidence suggests a decreased rate of preeclampsia at aspirin doses higher than the standardly used 81 mg when treatment is initiated prior to 16 weeks of gestation. Although LDA use seems promising for other outcomes such as preterm delivery and IUGR, further studies to strengthen recommendations are warranted.
Menopause, weight, and metabolic health – considerations for a patient centered, multidisciplinary approach
Authors: Lowy Leasa , Kasianchuk Anastasia 
Published: March 2023

Purpose of review
To examine the complexity of weight and metabolic changes during the menopausal transition and propose a multidisciplinary care approach to support long-term metabolic health.

Recent findings
Menopause, weight and metabolic health changes are influenced by many interplaying factors, and therefore, require a multipronged, multidisciplinary patient centered approach. This approach should start with a medical history and examination. Additional key components include: behavior change principles, mental health evaluation, gynecological care, nutrition, exercise recommendations and sleep care. In addition, when appropriate, weight loss pharmacotherapy and surgical options should be considered. Metabolic health is a long-term chronic process and improvement requires a chronic management approach.

Summary
Applying the framework of chronic disease prevention and treatment to optimizing metabolic health and body weight in peri and postmenopausal women offers an approach that works with the dynamic nature of metabolism changes that occur during aging and the menopausal transition. Using patient-centered care and behavior change principles with this multidisciplinary approach can strengthen its long-term effect.
Understanding the distinction between cleft lip and cleft palate: a critical step for successful prenatal detection
Authors: Minor Kathleen , Chueh Jane 
Published: March 2023

Purpose of review
Orofacial clefts (OCs) are among the most common congenital anomalies, however, prenatal detection of cleft palate without cleft lip (CP) remains low. CP is associated with a higher risk of associated structural anomalies, recurrence risk and genetic aberrations. There is opportunity to optimize prenatal diagnosis, counseling and diagnostic genetic testing for OCs.

Recent findings
Improving prenatal diagnosis of CP requires understanding that embryologically, the secondary palate develops from the 6th to the 10th week and fuses with the primary palate by the 12th week. Multiple first, second and third trimester 2D ultrasonographic markers for OCs have been described including the maxillary gap, frontal space, maxilla-nasion-mandible angle, retronasal triangle, palatino-maxillary diameter, equal sign, nonvisualization or gap in the soft to hard palate interface and loss of the superimposed line. We discuss the technique, evidence and limitations of each.

Summary
Prenatal detection of OC can be optimized by employing 2D sonographic markers. Prenatal detection of CP may be improved by recognizing its high association with retrognathia/micrognathia.
Fetal growth disorders in twin gestations
Authors: Blumenfeld Yair J. , Anderson Jill N. 
Published: March 2023

Purpose of review
Twin gestations account for approximately 3% of all births. Although there appear to be physiologic differences in the third trimester growth of twins compared with singleton gestations, reasons for this remain unclear. As growth-restricted fetuses and neonates are at increased risk for adverse outcomes, there is a clinical need to optimize our ability to delineate normally from pathologically grown twins.

Recent findings
Recent studies have addressed current limitations in the way growth restriction is diagnosed in twin gestations. Twin-specific fetal and neonatal growth charts have been shown to decrease the number of cases inappropriately labeled as growth restricted compared with singleton nomograms. In addition, individual growth assessment (IGA) is a promising method of diagnosing pathological growth using each fetus's growth potential rather than a comparison of the estimated fetal weight with population nomograms.

Summary
There is a recent focus on improving our understanding of physiologic and pathologic twin growth. The increased use of twin-specific growth curves is likely to result in a decrease in the incidence of FGR diagnosis among twin gestations and could improve the outcomes of twins currently misclassified as FGR. Future research will hopefully clarify the reasons behind differences seen in twin versus singleton third trimester twin growth.
Perimenopausal depression: review of recent findings and implications for future research
Authors: Williams Katherine 
Published: March 2023

Purpose of review
The purpose of this review is to provide an update on the most recent research regarding potential causes and treatments for perimenopausal depression.

Recent findings
Erratic estrogen fluctuations and alterations in the neurosteroid allopregnanolone are important contributors to perimenopausal mood symptoms. These hormone changes augment increased risk associated with recent stressful events, as well as early life childhood events. Perimenopausal depressions have different clinical presentations and may respond to differential treatment approaches.

Summary
Future research should focus on these recent findings of interindividual hormonal sensitivity, childhood trauma histories, and varying depression symptom profiles for a personalized treatment approach to perimenopausal depression.
Treatment options for endometrial hypoproliferation
Authors: Cakiroglu Yigit , Tiras Bulent , Franasiak Jason , Seli Emre 
Published: March 2023

Purpose of review
Endometrial hypoproliferation refers to the failure of the endometrium to reach optimal thickness during fresh or frozen embryo transfer cycles in women undergoing infertility treatment with in-vitro fertilization (IVF). This review discusses the treatment options for endometrial hypoproliferation.

Recent findings
Apart from factors related to the embryo quality, ultrasonographic findings associated with the endometrium, such as endometrial thickness, endometrial pattern and subendometrial blood flow, are considered key factors associated with the outcome of assisted reproductive treatment. To date, a consensus has not been reached regarding the definition of thin endometrium, while thresholds of 6, 7 or 8 mm have been used in the literature. Strategies to increase endometrial thickness can be reviewed in three groups: endocrine approaches, vitamins & supplements, and new experimental therapeutic interventions. Some of the recently introduced experimental therapeutic interventions such as platelet-rich plasma injection, stem cell treatment and tissue bioengineering are exciting potential therapies that need to be further studied.

Summary
Despite a large number of publications on the topic, diagnosing and treating endometrial hypoproliferation remains a challenge. Well designed studies are needed to establish a widely accepted endometrial thickness cut-off value below which endometrial hypoproliferation is diagnosed and to generate meaningful data that would allow an evidence-based discussion of available therapeutic options with patients.
Double stimulation for the management of poor-prognosis patients: where are we going?
Authors: Petrone Pasquale , Vaiarelli Alberto , Blockeel Christophe 
Published: March 2023

Purpose of review
The technical improvements in IVF allowed the implementation of nonconventional ovarian stimulation protocols for some specific patients. Where time is crucial, such as with oncologic patients, poor-prognosis patients, patients with low ovarian reserve, and those with advanced maternal age, access to IVF treatment is even more critical. Some of these protocols might start in the late follicular phase, luteal phase, or involve both stimulations within the same ovarian cycle.

Recent findings
Until now, published evidence showed that oocytes retrieved from unconventional protocol seem to be developmentally, genetically, and reproductively competent. Second stimulation in the same ovarian cycle after the conventional approach may represent a sound alternative to oocyte accumulation. This can be proposed in progress after careful counselling focused on the patients’ chances of finding at least one euploid embryo on account of their age and of the number of blastocysts obtained after the conventional approach.

Summary
The adoption of these new strategies, known as double stimulation protocol, can be conceived as a real full-personalization of ovarian stimulation. Multicentre prospective RCTs are urgently needed to evaluate the efficacy, efficiency, and costs of double stimulation versus two consecutive conventional approaches with standard or mild stimulation and in a different IVF setting.
A Comprehensive Secondary Prevention Benchmark (2PBM) Score Identifying Differences in Secondary Prevention Care in Patients After Acute Coronary Syndrome
Authors: Haegele Matthias , Liu Yu-Ching , Frey Simon , Strebel Ivo , Jordan Fabian , Wick Rupprecht , Burkard Thilo , Clerc Olivier Florian , Pfister Otmar 
Published: March 2023

Purpose:
The objective of this study was to quantify secondary prevention care by creating a secondary prevention benchmark (2PBM) score for patients undergoing ambulatory cardiac rehabilitation (CR) after acute coronary syndrome (ACS).

Methods:
In this observational cohort study, 472 consecutive ACS patients who completed the ambulatory CR program between 2017 and 2019 were included. Benchmarks for secondary prevention medication and clinical and lifestyle targets were predefined and combined in the comprehensive 2PBM score with maximum 10 points. The association of patient characteristics and achievement rates of components and the 2PBM were assessed using multivariable logistic regression analysis.

Results:
Patients were on average 62 ± 11 yr of age and predominantly male (n = 406; 86%). The types of ACS were ST-elevation myocardial infarction (STEMI) in 241 patients (51%) and non–ST-elevation myocardial infarction in 216 patients (46%). Achievement rates for components of the 2PBM were 71% for medication, 35% for clinical benchmark, and 61% for lifestyle benchmark. Achievement of medication benchmark was associated with younger age (OR = 0.979: 95% CI, 0.959-0.996, P = .021), STEMI (OR = 2.05: 95% CI, 1.35-3.12, P = .001), and clinical benchmark (OR = 1.80: 95% CI, 1.15-2.88, P = .011). Overall ≥8 of 10 points were reached by 77% and complete 2PBM by 16%, which was independently associated with STEMI (OR = 1.79: 95% CI, 1.06-3.08, P = .032).

Conclusions:
Benchmarking with 2PBM identifies gaps and achievements in secondary prevention care. ST-elevation myocardial infarction was associated with the highest 2PBM scores, suggesting best secondary prevention care in patients after ST-elevation myocardial infarction.
In Silico and In Vitro Approach for Validating the Inhibition of Matrix Metalloproteinase-9 by Quercetin
Authors: Huynh Cassandra Bonnie , Nagaarudkumaran Nijani , Kalyaanamoorthy Subha , Ngo William 
Published: March 2023

Purpose:
To validate the mechanism and inhibitory activity of quercetin against matrix metalloproteinase-9 (MMP-9) using a hybrid in silico and in vitro approach.

Methods:
The structure of MMP-9 was obtained from the Protein Data Bank, and the active site was identified using previous annotations from the Universal Protein Resource. The structure of quercetin was obtained from ZINC15. Molecular docking was performed to quantify the binding affinity of quercetin to the active site of MMP-9. The inhibitory effect of various concentrations of quercetin (0.0025, 0.025, 0.25, 1.0, and 1.5 mM) on MMP-9 was quantified using a commercially available fluorometric assay. The cytotoxicity of quercetin to immortalized human corneal epithelial cells (HCECs) was quantified by obtaining the metabolic activities of the cells exposed to various concentrations of quercetin for 24 hr.

Results:
Quercetin interacts with MMP-9 by binding within the active site pocket and interacting with residues LEU 188, ALA 189, GLU 227, and MET 247. The binding affinity predicted by molecular docking was −9.9 kcal/mol. All concentrations of quercetin demonstrated significant inhibition of MMP-9 enzyme activity (all P<0.03). There was little to no reduction of HCEC metabolic activity after a 24-hr exposure to all concentrations of quercetin (P>0.99).

Conclusions:
Quercetin inhibited MMP-9 in a dose-dependent manner and was well-tolerated by HCECs, suggesting a potential role in therapy for diseases with upregulated MMP-9 as part of its pathogenesis.
Comparison of stone-free rate between percutaneous nephrolithotomy and retrograde intrarenal surgery
Authors: Chen Peng , Wei Tony Tzu-Chun , Huang Eric Yi-Hsiu , Lin Tzu-Ping , Huang Tzu-Hao , Lin Chih-Chieh , Huang I-Shen , Huang William J. 
Published: March 2023

Background:
The management of urolithiasis in the kidney has been drastically changed in the era of endourology, mainly consisting of three surgical procedures: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). Since ESWL is usually less invasive via ambulatory clinic routes, this study aimed to examine the stone-free rate (SFR) between PCNL and RIRS.

Methods:
We retrospectively reviewed patients who had renal stones and were treated with either PCNL or RIRS from June 2016 to June 2018. Staghorn stones, stones with diameters <1 cm, and stones with diameters >2 cm were excluded. Patients who underwent multiple surgeries for bilateral renal stones and those with graft kidney stones were excluded from the study. X-ray, sonography, and/or computed tomography (CT) were used to calculate the size of the stones. Follow-up was evaluated by the same image examination within three months after surgery. Stone-free was defined as no residual stone or the presence of asymptomatic calculi <4 mm. The operation time was defined as a skin-to-skin interval.

Results:
Following exclusion criteria, there were 39 patients in each arm, with no difference in age, sex, or any other demographic data. The average stone size in the PCNL and RIRS groups was 16.3 and 14.0 mm, respectively (p = 0.009). There was no significant difference in SFR (71.8% vs 61.5%, p = 0.337); the operation time was significant longer (p < 0.001), and the hospital stay was significantly shorter (p < 0.001) in the RIRS group.

Conclusion:
PCNL and RIRS are both feasible options for managing kidney stones. However, the initial stone size might affect the selection of operation. The SFR in the PCNL group was numerically but not statistically higher. The RIRS group, on the other hand, had a longer operation time but a shorter hospital stays.