bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Discrimination and Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Adolescents With Overweight and Obesity: Does Context Matter?
Authors: Emlaw Jonel E. , Ajibewa Tiwaloluwa A. , Toledo-Corral Claudia M. , Hasson Rebecca E. 
Published: July 2023

ABSTRACT

Objectives
In adolescents at higher risk for chronic disease, the role that context of a discriminatory event may play on cortisol dysregulation is unclear. The purpose of this study was to perform a cross-sectional analysis examining the association between racial discrimination context (peer, educational, institutional, and cumulative) and diurnal cortisol patterning in adolescents with overweight and obesity.

Methods
One hundred adolescents (13–19 years; 49% non-Hispanic Black; 65% female; body mass index percentile = 93.9% [4.14%]) were included in this analysis. Racial discrimination context was measured using the self-reported Adolescent Discrimination Distress Index. Salivary cortisol, collected across 3 days at five time points during the day, was used to calculate Δ 0–30 minutes, diurnal slope, and average total diurnal cortisol area under the curve. Sixteen separate multivariable linear regression models were performed to analyze the relationship between racial discrimination and diurnal cortisol patterns.

Results
Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004, p = .03; peer: β = 0.023 ± 0.010, p = .026).

Conclusions
Findings from this study identified cross-sectional associations between racial discrimination experienced among peers and diurnal cortisol patterns in adolescents with overweight/obesity. If our findings were to be confirmed in longitudinal analyses, evidence-based programs should be considered to buffer the effects of discrimination on adolescent health, and more importantly, policy makers should work to eliminate discrimination exposure.
Radiologists' Expectations of Artificial Intelligence in Pancreatic Cancer Imaging: How Good Is Good Enough?
Authors: Chu Linda C. , Ahmed Taha , Blanco Alejandra , Javed Ammar , Weisberg Edmund M. , Kawamoto Satomi , Hruban Ralph H. , Kinzler Kenneth W. , Vogelstein Bert , Fishman Elliot K. 
Published: July 2023

Background
Existing (artificial intelligence [AI]) tools in radiology are modeled without necessarily considering the expectations and experience of the end user—the radiologist. The literature is scarce on the tangible parameters that AI capabilities need to meet for radiologists to consider them useful tools.

Objective
The purpose of this study is to explore radiologists' attitudes toward AI tools in pancreatic cancer imaging and to quantitatively assess their expectations of these tools.

Methods
A link to the survey was posted on the www.ctisus.com website, advertised in the www.ctisus.com email newsletter, and publicized on LinkedIn, Facebook, and Twitter accounts. This survey asked participants about their demographics, practice, and current attitudes toward AI. They were also asked about their expectations of what constitutes a clinically useful AI tool. The survey consisted of 17 questions, which included 9 multiple choice questions, 2 Likert scale questions, 4 binary (yes/no) questions, 1 rank order question, and 1 free text question.

Results
A total of 161 respondents completed the survey, yielding a response rate of 46.3% of the total 348 clicks on the survey link. The minimum acceptable sensitivity of an AI program for the detection of pancreatic cancer chosen by most respondents was either 90% or 95% at a specificity of 95%. The minimum size of pancreatic cancer that most respondents would find an AI useful at detecting was 5 mm. Respondents preferred AI tools that demonstrated greater sensitivity over those with greater specificity. Over half of respondents anticipated incorporating AI tools into their clinical practice within the next 5 years.

Conclusion
Radiologists are open to the idea of integrating AI-based tools and have high expectations regarding the performance of these tools. Consideration of radiologists' input is important to contextualize expectations and optimize clinical adoption of existing and future AI tools.
Comparisons of Two-dimensional Echocardiographic Aortic Dimensions Between Chinese, Japanese, and Europeans
Authors: Hu Xiaoxia , Lin Zongwei , Li Ying , Chen Xiangyun , Zhao Yuanyuan , Xu Hongxiao , Sun Hui , Sun Xiaoqian , Liu Yan , Zhang Mei , Zhang Yun , Lu Huixia , Yao Guihua 
Published: July 2023

Purpose:
We aimed to investigate the impacts of age, gender, and race on aortic dimensions in healthy adults.

Methods:
We analyzed data from 3 large population-based sample studies, including Chinese Echocardiographic Measurements in Normal Chinese Adults, Japanese the Normal Values for Echocardiographic Measurements Project, and European Normal Reference Ranges for Echocardiography, to compare the two-dimensional echocardiography-derived aortic diameters at different levels and to explore the effects of age, gender, and race on aortic measurements. We also compared the values corrected by body surface area (BSA) or height.

Results:
The results are as follows: (1) Aortic diameters showed positive correlations with age (r=0.12-0.42, P<0.05), and there were significant inter-age group differences before and after indexing to BSA (P<0.05); (2) Men had greater measurements of aortic diameters than women, with the differences being the same when indexed to height. However, indexing to BSA reversed the differences; (3) The aortic diameters at annulus (Ao-a) and sinus (Ao-s) levels were very close with minor differences between the Chinese and Japanese regardless of whether BSA was used for correction; and (4) The aortic measurements at Ao-s and proximal ascending aorta (Ao-asc) levels in the Chinese were significantly lower than in the Europeans for both genders, with the differences remaining the same even after indexing to BSA or height (P<0.05).

Conclusion:
Aortic dimensions vary with age and gender, and there are significant differences between races or ethnicities even when stratified by gender and age. The indexation by BSA or height cannot eliminate these differences. Therefore, age-specific, gender-specific, race-specific, and nationality-specific reference values may be more appropriate at present for clinical practice to avoid misdiagnosis and misclassification of aortic dilation.
Safety and Feasibility of Mediastinoscopy-assisted Esophagectomy: A Meta-analysis
Authors: Zhang Zhan , He Houle , Lu Shengxun , Yang Mengnan , Luo Junhui 
Published: July 2023

Background:
The objective of the current study was to investigate the safety and feasibility of mediastinoscopy-assisted esophagectomy (MAE).

Methods:
A meta-analysis was conducted between MAE and traditional transthoracic esophagectomy (TTE). For a comparative analysis of MAE and TTE, we searched PubMed, the Cochrane Library, Embase, and Web of Science databases. We identified the relevant literature and extracted the relevant data. Finally, RevMan 5.3 software was applied to conduct a meta-analysis of the data.

Results:
A total of 1256 people were enrolled in 16 studies, comprising 575 patients with MAE and 681 with TTE. The findings revealed that the pulmonary complications, cardiac complications, and postoperative hospital stay in the MAE group were significantly better than those in the TTE group. No significant differences were found between the 2 groups in postoperative chylothorax, anastomotic fistula, and postoperative mortality. But the incidence of recurrent laryngeal nerve injury in the MAE group was higher than that in the TTE group (odds ratio=1.64, 95% CI, 1.15 to 2.35, P=0.006). The MAE group had less lymph node dissection than the TTE group (mean difference=−4.62, 95% CI, −5.97 to 3.45, P<0.00001).

Conclusions:
This meta-analysis presented that MAE was safe and feasible, reduced postoperative pulmonary and cardiac complications, and shortened hospital stay, but lymph node dissection was less, recurrent laryngeal nerve injury was higher, and the impact of long-term survival prognosis required more randomized controlled trials.
Comparison of Short-term Outcomes Between Esophageal Bypass Surgery and Self-expanding Stent Insertion in Esophageal Cancer: A Propensity Score-matched Analysis Using a Large-scale Inpatient Database
Authors: Yamamoto Yuta , Kitazawa Masato , Otsubo Tetsuya , Tokumaru Shigeo , Nakamura Satoshi , Koyama Makoto , Hondo Nao , Kataoka Masahiro , Seharada Kai , Soejima Yuji 
Published: July 2023

Background:
Advanced esophageal cancer is occasionally accompanied by difficulty swallowing owing to esophageal stenosis or tracheoesophageal fistula formation. Esophageal bypass surgery and stent insertion are considered feasible palliative management options. The aim of this study was to evaluate the short-term outcomes of these palliative treatments.

Materials and Methods:
Patient data were obtained from a large-scale inpatient database of 42 National University Hospitals in Japan. Patients with advanced esophageal cancer who underwent esophageal bypass surgery or stent insertion between April 2016 and March 2021 were included in this study. One-to-one propensity score matching of patients who underwent bypass surgery or stent insertion was performed. The primary outcomes were time to diet resumption and length of hospital stay after surgery. The secondary outcome was the incidence of postoperative complications.

Results:
In 43 propensity score-matched pairs, the incidence of postoperative respiratory complications was significantly higher in the bypass group than in the stent group (32.6% vs. 9.3%, P = 0.008). Postoperative length of hospital stay was longer in the bypass group than in the stent group (24 vs. 10 d, P < 0.001). Logistic regression analysis revealed that stent insertion was associated with a decreased risk of respiratory complications (odds ratio 0.077, P < 0.007). Among patients who underwent the interventions (bypass surgery or stent insertion) and subsequently underwent anticancer therapy (chemotherapy/radiotherapy) during hospitalization, the interval between the intervention and anticancer therapy was longer in the bypass group than in the stent group (25 vs. 7 d, P = 0.003).

Conclusions:
Esophageal stent insertion provides better short-term outcomes than bypass surgery in patients with advanced unresectable esophageal cancer.
Combining Oxygenated Cold Perfusion With Normothermic Ex Vivo Perfusion Improves the Outcome of Donation After Circulatory Death Porcine Kidney Transplantation
Authors: Mazilescu Laura Ioana , Goto Toru , John Rohan , Rosales Roizar , Ganesh Sujani , Yu Frank , Noguchi Yuki , Kawamura Masataka , Dezard Victoria , Gao Fei , Urbanellis Peter , Parmentier Catherine , Konvalinka Ana , Bagli Darius J. , Reichman Trevor W. , Robinson Lisa A. , Selzner Markus 
Published: July 2023

Background.
Ex vivo machine perfusion is a novel preservation technique for storing and assessing marginal kidney grafts. All ex vivo perfusion techniques have advantages and shortcomings. The current study analyzed whether a combination of oxygenated hypothermic machine perfusion (oxHMP) followed by a short period of normothermic ex vivo kidney perfusion (NEVKP) could combine the advantages of both techniques.

Methods.
Porcine kidneys were exposed to 30 min of warm ischemia followed by perfusion. Kidneys underwent either 16-h NEVKP or 16-h oxHMP. The third group was exposed to 16-h oxHMP followed by 3-h NEVKP (oxHMP + NEVKP group). After contralateral nephrectomy, grafts were autotransplanted and animals were followed up for 8 d.

Results.
All animals survived the follow-up period. Grafts preserved by continuous NEVKP showed improved function with lower peak serum creatinine and more rapid recovery compared with the other 2 groups. Urine neutrophil gelatinase-associated lipocalin, a marker of kidney injury, was found to be significantly lowered on postoperative day 3 in the oxHMP + NEVKP group compared with the other 2 groups.

Conclusions.
A short period of NEVKP after oxHMP provides comparable short-term outcomes to prolonged NEVKP and is superior to oxHMP alone. A combination of oxHMP with end-ischemic NEVKP could be an attractive, practical strategy to combine the advantages of both preservation techniques.
Old muscle, new tricks: a clinician perspective on sarcopenia and where to next
Authors: Schütze Katie , Schopp Madeline , Fairchild Timothy J. , Needham Merrilee 
Published: July 2023

Purpose of review
This review offers a contemporary clinical approach to the recognition, prevention and management of sarcopenia, and discusses recent clinically relevant advances in the aetiopathogenesis of muscle ageing that may lead to future therapeutic targets.

Recent findings
The key recent directions for sarcopenia are in the diagnosis, understanding molecular mechanisms and management. Regarding the recognition of the condition, it has become increasingly clear that different definitions hamper progress in understanding. Therefore, the Global Leadership in Sarcopenia has been established in 2022 to develop a universally accepted definition. Moreover, substantial work is occurring to understand the various roles and contribution of inflammation, oxidative stress, mitochondrial dysfunction and metabolic dysregulation on skeletal muscle function and ageing. Finally, the role of resistance-based exercise regimes has been continually emphasised. However, the role of protein supplementation and hormone replacement therapy (HRT) are still under debate, and current clinical trials are underway.

Summary
With the global ageing of our population, there is increasing emphasis on maintaining good health. Maintenance of skeletal muscle strength and function are key to preventing frailty, morbidity and death.
Axonal stimulation affects the linear summation of single-point perception in three Argus II users
Authors: Hou Yuchen , Nanduri Devyani , Granley Jacob , Weiland James D. , Beyeler Michael 
Published: July 2023

AbstractPurposeRetinal implants use electrical stimulation to elicit perceived flashes of light (“phosphenes”). Single-electrode phosphene shape has been shown to vary systematically with stimulus parameters and the retinal location of the stimulating electrode, due to incidental activation of passing nerve fiber bundles. However, this knowledge has yet to be extended to paired-electrode stimulation.MethodsWe retrospectively analyzed 3548 phosphene drawings made by three blind participants implanted with an Argus II Retinal Prosthesis. Phosphene shape (characterized by area, perimeter, major and minor axis length) and number of perceived phosphenes were averaged across trials and correlated with the corresponding single-electrode parameters. In addition, the number of phosphenes was correlated with stimulus amplitude and neuroanatomical parameters: electrode-retina and electrode-fovea distance as well as the electrode-electrode distance to (“between-axon”) and along axon bundles (“along-axon”). Statistical analyses were conducted using linear regression and partial correlation analysis.ResultsSimple regression revealed that each paired-electrode shape descriptor could be predicted by the sum of the two corresponding single-electrode shape descriptors (p <.001). Multiple regression revealed that paired-electrode phosphene shape was primarily predicted by stimulus amplitude and electrode-fovea distance (p <.05). Interestingly, the number of elicited phosphenes tended to increase with between-axon distance (p <.05), but not with along-axon distance, in two out of three participants.ConclusionsThe shape of phosphenes elicited by paired-electrode stimulation was well predicted by the shape of their corresponding single-electrode phosphenes, suggesting that two-point perception can be expressed as the linear summation of single-point perception. The notable impact of the between-axon distance on the perceived number of phosphenes provides further evidence in support of the axon map model for epiretinal stimulation. These findings contribute to the growing literature on phosphene perception and have important implications for the design of future retinal prostheses.
Age- and sex-specific differences in immune responses to BNT162b2 COVID-19 and live-attenuated influenza vaccines in UK adolescents
Authors: Jay Cecilia , Adland Emily , Csala Anna , Lim Nicholas , Longet Stephanie , Ogbe Ane ,   Consortium PITCH, Ratcliff Jeremy , Sampson Oliver , Thompson Craig P , Turtle Lance , Barnes Eleanor , Dunachie Susanna , Klenerman Paul , Carroll Miles , Goulder Philip 
Published: July 2023

AbstractKey to understanding COVID-19 correlates of protection is assessing vaccine-induced immunity in different demographic groups. Sex- and age-specific immune differences have a wide impact on outcomes from infections and immunisations. Typically, adult females make stronger immune responses and have better disease outcomes but suffer more adverse events following vaccination and are more prone to autoimmune disease. To understand better the mechanisms underlying these differences in vaccine responses, we studied immune responses to two doses of BNT162b2 Pfizer COVID-19 vaccine in an adolescent cohort (n=34, ages 12-16), an age group previously shown to make significantly greater immune responses to the same vaccine compared to young adults. At the same time, we were able to evaluate immune responses to the co-administered live attenuated influenza vaccine, which has been shown to induce stronger immune responses in adult females. Blood samples from 34 adolescents taken pre- and post-vaccination with COVID-19 and influenza vaccines were assayed for SARS-CoV-2-specific IgG and neutralising antibodies, and cellular immunity specific for SARS-CoV-2 and endemic betacoronaviruses. IgG targeting influenza lineages contained in the influenza vaccine was also assessed. As previously demonstrated, total IgG responses to SARS-CoV-2 Spike antigens were significantly higher among vaccinated adolescents compared to adults (aged 32-52) who received the BNT162b2 vaccine (comparing infection-naïve, 49,696 vs 33,339; p=0.03; comparing SARS-CoV-2 previously-infected, 743,691 vs 269,985; p<0.0001) by MSD v-plex assay. However, unexpectedly, antibody responses to BNT162b2 and the live-attenuated influenza vaccine were not higher among female adolescents compared to males; among infection-naïve adolescents, antibody responses to BNT162b2 were higher in males than females (62,270 vs 36,951 p=0.008). No sex difference was identified in vaccinated adults. These unexpected findings may result from the introduction of novel mRNA vaccination platforms, generating patterns of immunity divergent from established trends, and providing new insights into what might be protective following COVID-19 vaccination.
Industry payments to anesthesiologists in the United States between 2014 and 2022
Authors: Murayama Anju 
Published: July 2023

AbstractBackgroundFinancial relationships between physicians and the healthcare industry could be beneficial to improve patient care, but could lead to conflicts of interest. However, there was no study specifically evaluating the extent of financial relationships between anesthesiologists and the healthcare industry in the United States.MethodsUsing the Open Payments Database between 2014 and 2022, this longitudinal cross-sectional study examined the size, prevalence and trends of general (non-research) payments made by the healthcare industry to all anesthesiologists in the United States.ResultsOver the nine-year period, 67.0% of all anesthesiologists received general payments totaling $272.0 million over nine years, while 21.0% to 35.3% of anesthesiologists received one or more general payments each year. Median annual general payments to anesthesiologists ranged from $57 to $115. The top 1%, 5%, and 10% of anesthesiologists received 73.4%, 90.3%, and 94.8% of all general payments, respectively. There were no constant yearly trends in the total amounts and per-anesthesiologist general payments between 2014 and 2019, but significant declines occurred in 2020, likely due to the COVID-19 pandemic. Pain medicine physicians received the highest median general payments of $4,426 in nine-year combined total amounts, followed by addiction medicine ($431), critical care medicine ($277), and general anesthesiology ($256).ConclusionThis study reveals significant financial relationships between the healthcare industry and anesthesiologists, with a disproportionate concentration of payments among a minority of anesthesiologists. While no clear trends in payments were evident before the pandemic, there was a substantial reduction during the COVID-19 outbreak.
Concomitant Use of VA-ECMO and Impella Support for Cardiogenic Shock
Authors: Modi Shan P. , Hong Yeahwa , Sicke McKenzie M. , Hess Nicholas R. , Klass Wyatt J. , Ziegler Luke A. , Rivosecchi Ryan M. , Hickey Gavin W. , Kaczorowski David J. , Ramanan Raj 
Published: July 2023

AbstractBackgroundVA-ECMO with concomitant Impella support (ECpella) is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with ECpella support have not been well-described.MethodsThis study was a retrospective, single-center analysis of patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with ECpella from December 2020 to January 2023. Primary outcomes included 90-day survival post-discharge and destination after support. Secondary outcomes included complications post-ECpella support.ResultsA total of 44 patients were included (AMI-CS,n =20, and ADHF-CS,n= 24). Patients with AMI-CS and ADHF-CS had similar survival 90 days post-discharge (p= .267) with similar destinations after ECpella support (p =.220). Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS (p=.013;p= .030). Patients with initial Impella support were more likely to survive ECpella support and be bridged to transplant (p=.033) and less likely to have a cerebrovascular accident(p=.016). Sub-analysis of ADHF-CS patients into acute-on-chronic decompensated heart failure and de novo heart failure demonstrated no difference in survival or destination.ConclusionECpella can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS in patients with ECpella support. Patients with initial Impella support are more likely to survive ECpella support and bridge to transplant. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with ECpella support.Clinical PerspectivesWhat is New?ECpella support is a feasible support strategy for allcomers in severe cardiogenic shock. This study demonstrates that ECpella can be utilized not only as a salvage therapy and venting strategy for those in cardiogenic shock on VA-ECMO, but also can be utilized as a method for additional cardiac support for patients with initial Impella support. There were no differences in survival between cardiogenic shock secondary to acute myocardial infarction and cardiogenic secondary to acute decompensated heart failure.What are the clinical implications?Although ECpella patients that received initial Impella support have higher success in bridging to heart transplant, allcomers on ECpella support should be evaluated for advanced therapies early in their clinical course. Further studies are required to ascertain the differences in pathophysiology between cardiogenic shock secondary to acute myocardial infarction and cardiogenic secondary to acute decompensated heart failure and determine appropriate support strategies for differing cardiogenic shock phenotypes.