bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Transcendental Meditation on Academic Physician Burnout and Depression: A Mixed Methods Randomized Controlled Trial
Authors: Loiselle Marie , Brown Carla , Travis Frederick , Gruener Gregory , Rainforth Maxwell , Nidich Sanford 
Published: January 2023

Introduction:
Burnout is pervasive among physicians and has widespread implications for individuals and institutions. This research study examines, for the first time, the effects of the Transcendental Meditation (TM) technique on academic physician burnout and depression.

Methods:
A mixed methods randomized controlled trial was conducted with 40 academic physicians representing 15 specialties at a medical school and affiliated VA hospital using the TM technique as the active intervention. Physicians were measured at baseline, 1 month, and 4 months using the Maslach Burnout Inventory, Beck Depression Inventory, Insomnia Severity Index, Perceived Stress Scale, and Brief Resilience Scale. Repeated measures analysis of covariance was used to assess adjusted mean change scores for the 1- and 4-months posttests. Qualitative interviews were conducted at baseline and 4 months and compared with the quantitative measurements.

Results:
Significant improvements were found for the TM group compared with controls at 4 months in total burnout (p = .020) including the Maslach Burnout Inventory dimensions of emotional exhaustion (p = .042) and personal accomplishment (p = .018) and depression (p = .016). Qualitative interviews supported quantitative outcomes. Physicians reported classic burnout and depression symptoms in baseline interviews. Those regularly practicing the TM technique reported relief from those symptoms. The control group did not state similar changes.

Discussion:
Mixed methods findings suggest the TM technique is a viable and effective intervention to decrease burnout and depression for academic physicians. Larger longitudinal studies with a wider range of health care providers are needed to validate these findings for extrapolation to the greater medical community.
Gemini Anastomosis for Dual Venous Anastomosis in Head and Neck Reconstruction
Authors: Hamahata Atsumori , Beppu Takeshi , Kirita Miho , Konoeda Hisato , Sakurai Hiroyuki 
Published: January 2023

Summary:
Free tissue transfer has been frequently used in head and neck reconstruction. However, vascular problems still cause serious damage to patients when thromboses occur in microvascular anastomoses. In the Gemini anastomosis procedure, two flap pedicle veins are anastomosed adjacently to the internal jugular vein using the end-to-side anastomosis method. From April 2019 to March 2021, 12 patients whose free flaps had two pedicle veins underwent head and neck surgery in Saitama Cancer Center (Saitama, Japan). In six patients, the veins were anastomosed adjacently to the internal jugular vein using the Gemini procedure (Gemini group). In the other six patients, the veins were anastomosed to the internal jugular vein using the end-to-side anastomosis method at a distance from each other (control group). The anastomosis time was measured retrospectively by reviewing video from the operations and comparing them across groups. There were no reoperations in any patients, and all flaps survived without exhibiting any circulatory problems. The mean total anastomosis time in the Gemini group was 21 minutes 38 seconds ± 75 seconds. The mean total anastomosis time in the control group was 34 minutes 14 seconds ± 121 seconds. The mean flap ischemic time in the Gemini group was 124 minutes ± 3 minutes. The mean flap ischemic time in the control group was 135 minutes ± 6 minutes. The Gemini anastomosis procedure is effective and convenient when the pedicle has two veins and the recipient vein choice is only the internal jugular vein in head and neck reconstruction.
Pancreatic cancer with ovarian metastasis: cases report and literature review
Authors: Li Zeru , Zhou Xingtong , Zhao Bangbo , Zheng Zhibo , Qin Cheng , Liu Xudong , Xue Huadan , Wang Weibin 
Published: January 2023

Background:
Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed. Patients with ovarian metastases are first diagnosed with ovarian cancer and may miss the opportunity to receive surgical operation. We report 7 rare cases of ovarian metastases secondary to pancreatic adenocarcinoma and review the literature to analyze clinical characteristics, diagnostic methods, and potential therapeutic strategies for the rare malignancy.

Cases Summary:
We retrospectively analyzed the clinical data of 7 female patients with ovarian metastases of primary pancreatic cancer who were admitted to our hospital from January 01, 1985, to April 1, 2020. These 7 patients were diagnosed with ovarian metastasis at an average age of 52.28 (38–69) years. The reason for the patient’s visit was generally a mass in the lower abdomen and/or abdominal pain. Six of them had significantly higher serum Carbohydrate antigen19-9 (CA19-9) levels, 6 patients had pancreatic tumors located in the body or tail, and 1 patient had one in the head of the pancreas. All patients underwent excision of ovarian tumors and resection or biopsy of pancreatic tumors. Five patients had pancreatic ductal adenocarcinoma (PDAC), and 2 had pancreatic cystadenocarcinoma (PCC), all of which were revealed by the pathological results. Ovarian tumors were assessed by pathology and were consistent with pancreatic metastasis. Currently, all 7 patients have died (follow-up to January 2, 2021). The median survival time for all patients was 13.7 months (2.9–27 months).

Conclusions:
For this rare tumor, elevated serum CA19-9 may indicate that the primary lesion is in the pancreas. Enhanced pancreatic Computed Tomography (CT) can facilitate diagnostic localization. In addition, if the pancreatic tumor cannot be removed, the ovarian tumor should still be resected to reduce the tumor load and improve the quality of life.
Hereditary Bilateral Synchronous Pheochromocytomas in a Tibetan Pedigree With a Germline Adenomatous Polyposis Coli (APC) Mutation
Authors: Yang Bin , Yan Ye , Xie Chao , Jiang Jie , Liu Lei , Zhu Xuehua , Liu Zenan , Lu Min , Ma Lulin , Lu Jian 
Published: January 2023

Background:
Germline pathogenic mutations associated with pheochromocytoma (PHEO) are present in most patients with hereditary bilateral PHEOs. Adenomatous polyposis coli (APC) gene has previously been identified as a tumor suppressor gene in familial adenomatous polyposis and colorectal cancers, but not PHEO.

Methods:
A father and a son from Tibet were clinically diagnosed with bilateral synchronous PHEOs. The son underwent staged retroperitoneal laparoscopic bilateral total adrenalectomy, and the father underwent retroperitoneal laparoscopic left adrenalectomy. A pedigree investigation was performed with a follow-up of 4 years. Whole-exome sequencing was performed to reveal the susceptibility genes in the pedigree.

Results:
The adrenal masses in the father and son were pathologically diagnosed as hereditary bilateral synchronous PHEOs. A pedigree investigation of 26 family members spanning 3 generations was performed. Multiple endocrine gland–related tumors, including PHEO, pancreatic neuroendocrine tumor, and pituitary adenoma, were diagnosed in the family. DNA sequencing identified a novel heterozygous germline missense mutation (c.896C>G) of the APC gene in the proband. The same heterozygous germline mutation of the APC gene was also present in the pedigree.

Conclusions:
We reported a pedigree from Tibet with hereditary bilateral synchronous PHEOs, which revealed a novel heterozygous germline missense mutation of the APC gene that may predispose to PHEO.
A Clinician's Guide to Targeted Precision Imaging in Patients With Prostate Cancer (RADAR VI)
Authors: Crawford E. David , Albala David M. , Harris Richard G. , Slovin Susan F. , Bryce Alan H. , Carroll Peter R. , Finkelstein Steven E. , Garnick Marc B. , Gomella Leonard G. , Higano Celestia S. , Koo Sonya J. , Petrylak Daniel P. , Sellinger Scott B. , Yu Evan Y. , McKay Rana R. , Crosby Mike “Bing” , Cooperberg Matthew R. , Koo Phillip J. 
Published: January 2023

Purpose:
The advent of new imaging agents offers enhanced sensitivity and specificity in the detection and staging of prostate cancer. A growing array of treatment options and ongoing advancements in imaging technologies allow earlier and more extensive detection of metastatic disease and shifting the boundaries between disease states previously defined by conventional imaging. This review seeks to synthesize existing data and expert opinion to better guide patient management in the new era of targeted precision imaging (TPI).

Materials and Methods:
The Radiographic Assessments for Detection of Advanced Recurrence VI Group gathered to develop pathways/recommendations regarding how TPI could best be deployed, given approvals of key radiotracers including 18F-fluciclovine, 68Ga-PSMA, and 18F-DCFPyL positron emission tomography/CT.

Results:
Radiographic Assessments for Detection of Advanced Recurrence VI Group members developed consensus pathways/suggestions based on the best available evidence for use of TPI in prostate cancer.

Conclusions:
Patients with prostate cancer have the potential to benefit from judicious use of TPI. However, additional research is needed to ensure that TPI is used appropriately and provides actionable findings that inform treatment decisions for these patients.
Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study
Authors: Omaña Humberto , Frengopoulos Courtney , Montero-Odasso Manuel , Payne Michael W. , Viana Ricardo , Hunter Susan W. 
Published: January 2023

Introduction:
Falls are common for people with lower-limb amputations (PLLA). Low balance confidence is also prevalent, is worse in PLLA not reporting walking automaticity, and is known to negatively affect prosthesis use, social engagement, and quality of life. Moreover, walking with a prosthesis requires continuous attention. Low balance confidence may act as a distractor imposing an additional cognitive load on the already cognitively demanding task of walking with a prosthesis.

Methods:
Adults with unilateral, transtibial amputations were recruited. The Activities-specific Balance Confidence (ABC) scale quantified balance confidence. The L Test assessed basic walking abilities under single-task (ST) (usual) and dual-task (DT) (walking while counting backwards) conditions. The relative change in gait and secondary task performance between conditions (ie, DT cost) was calculated. Separate multivariable linear regressions examined the association of balance confidence on the L Test.

Results:
Forty-four PLLA (56.6 ± 12.6 years) participated. An independent association of the ABC to ST (P < 0.001, R2 = 0.56) and DT (P = 0.008, R2 = 0.43) L Test performance was observed. A 1% ABC increase was related with a 0.24 (95% confidence interval, 0.35–0.14) and 0.23 (95% confidence interval, 0.39–0.06) second reduction with the ST and DT L Test, respectively. No association to DT cost was observed.

Conclusions:
Balance confidence influences basic walking abilities yet does not modulate the added cognitive load associated with DT. Interventions that address balance confidence may be beneficial throughout rehabilitation. This research is novel and offers the possibility for alternative avenues for focus in rehabilitation and falls prevention in a population at high risk for falls.
THE INITIAL ION SHIFT INDEX AS A PROGNOSTIC INDICATOR TO PREDICT PATIENT SURVIVAL IN TRAUMATIC DAMAGE CONTROL LAPAROTOMY PATIENTS
Authors: Jang Hyunseok , Jeung Kyung Woon , Kang Ji-Hyoun , Jo Younggoun , Jeong Euisung , Lee Naa , Kim Jungchul , Park Yunchul 
Published: January 2023

ABSTRACT

Objective: The ion shift index (ISI), which considers extracellular fluid ions such as phosphate, calcium, and magnesium, represents the ion shift following ischemia; concentrations of these ions are maintained within narrow normal ranges by adenosine triphosphate-dependent homeostasis. The ISI is defined as follows: {potassium (mmol/L-1) + phosphate (mmol/L-1) + Mg (mmol/L-1)}/calcium (mmol/L-1). This study investigated the possibility of predicting the 30-day survival rate of patients who underwent traumatic damage control laparotomy by comparing ISI and other laboratory findings, as well as the initial Trauma and Injury Severity Score (TRISS) and shock indices. Methods: Among the 134 patients who underwent damage control surgery between November 2012 and December 2021, 115 patients were enrolled in this study. Data regarding injury mechanism, age, sex, laboratory findings, vital signs, Glasgow Coma Scale score, Injury Severity Score, Abbreviated Injury Scale score, blood component transfusion, type of surgery, postoperative laboratory outcomes, morbidity, mortality rates, fluids administered, and volume of transfusions were collected and analyzed. Results: In univariate analysis, the odds ratio of the initial ISI was 2.875 (95% confidence interval, 1.52–5.43; P = 0.04), which showed a higher correlation with mortality compared with other indices. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were derived from different multivariable logistic regression models. The initial ISI had high sensitivity and specificity in predicting patient mortality (AUC, 0.7378). In addition, in the model combining the initial ISI, crystalloids, and TRISS, the AUC showed a high value (AUC, 0.8227). Conclusion: The ISI evaluated using electrolytes immediately after admission in patients undergoing traumatic damage control surgery may be a predictor of patient mortality.
NEUROLOGIC IMPAIRMENT IN PATIENTS WITH EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION SUPPORT: CLINICAL FEATURES AND LONG-TERM OUTCOMES
Authors: Shi Xiaobei , Zhang Lili , Zeng Xiaokang , Li Yiwei , Hu Wei , Xi Shaosong 
Published: January 2023

ABSTRACT

Introduction: The present study aimed to explore the clinical features and long-term outcomes associated with neurologic impairment in patients with cardiac arrest (CA) who received extracorporeal cardiopulmonary resuscitation (ECPR). Methods: A total of 37 adult CA patients who underwent venoarterial extracorporeal membrane oxygenation and were admitted to our department between January 2015 and February 2022 were divided according to neurologic impairment. Baseline and CPR- and ECMO-related characteristics were compared between the two groups. Long-term neurologic outcomes were collected via telephone follow-ups. Results: Twenty-four (64.9%) ECPR-supported patients developed neurologic impairments. The two groups differed significantly in median age (P = 0.026), proportion of intra-aortic balloon pump (IABP) support (P = 0.011), proportion of continuous renal replacement therapy (P = 0.025), and median serum creatinine (Cr) level (P = 0.012) pre-ECMO. The 28-day mortality (P = 0.001), hospital mortality (P = 0.003), median duration from CA to restoration of spontaneous circulation (P = 0.029), proportion of patients with nonpulsatile perfusion (NP) >12 hours (P = 0.040), and median ECMO duration (P = 0.047) were higher in the neurologic impairment group. In contrast, the group without neurologic impairment exhibited a longer median intensive care unit length of stay (P = 0.047), longer median hospital LOS (P = 0.031), and more successful ECMO weaning (P = 0.049). Moreover, NP >12 hours combined with IABP support (odds ratio [OR], 14.769; 95% confidence interval [CI], 1.417~153.889; P = 0.024) and serum Cr level (OR, 1.028; 95% CI, 1.001~1.056; P = 0.043) were independent risk factors for neurologic impairment. Furthermore, neurologic impairment was associated with significantly worse 90-day survival (hazards ratio, 4.218; 95% CI, 1.745~10.2; P = 0.0014). Conclusions: The incidence of neurologic impairment was higher in patients who received ECPR and was closely related to 28-day mortality and discharge survival. NP >12 hours combined with IABP support and serum Cr levels were independent risk factors for neurologic impairments in ECPR-supported patients. Neurologic impairment significantly adversely affected the long-term outcomes of ECPR-supported patients after discharge.
Maximize Donor Cornea Use in a Hepatitis B Endemic Area via Serology Matching
Authors: Chu Hsiao-Sang , Killeen Olivia J. , Hsieh Yi-Ting , Su Tung-Hung , Soong H. Kaz , Shih Chung-Liang , Hu Fung-Rong 
Published: January 2023

Background.
This study aims to investigate the rationality of the allocation guidelines in a hepatitis B endemic area that uses corneas from hepatitis B donors.

Methods.
Under Taiwan’s current guidelines, corneas donated from hepatitis B surface antigen (HBsAg)(+) donors can be allocated to HBsAg(+) or hepatitis B surface antibody recipients. From January 1, 2015, to December 31, 2019, corneas donated to National Taiwan University Hospital were divided into HBsAg(+), HBsAg(–)/hepatitis B core antibody (anti-HBc)(+), and HBsAg(–)/anti-HBc(–) groups. Hepatitis B virus (HBV) DNA extracted from corneoscleral rims was quantified by polymerase chain reaction and correlated with donor serum HBsAg, anti-HBc, and HBV DNA. Recipients of HBV DNA(+) grafts were called back for serology and serum HBV DNA tests.

Results.
The corneoscleral HBV DNA of 170 corneas (113 donors) was quantified, of which 45 corneas were from 28 HBsAg(+) donors, 87 were from 57 HBsAg(–)/anti-HBc(+) donors, and 38 were from 28 HBsAg(–)/anti-HBc(–) donors, and HBV DNA was detected in 80.0%, 9.2%, and 0% of the corneoscleral rims in each group. Donor anti-HBc(+) provided the highest sensitivity (1.00) and negative predictive value (1.00) for corneoscleral HBV DNA. Twenty-eight of 40 recipients (70%) using HBV DNA(+) grafts were called back, and none developed hepatitis in follow-up periods ranging from 6 to 55.5 mo.

Conclusions.
Donor anti-HBc should be tested routinely with HBsAg. Allocating corneas from HBsAg(+) or anti-HBc(+) donors to HBsAg(+) or hepatitis B surface antibody recipients maximizes cornea usage from hepatitis B donors without compromising transplant safety in a hepatitis B endemic setting.
Outcomes of Declined Deceased Donor Kidney Offers That Are Subsequently Implanted: A UK Registry Study
Authors: Ibrahim Maria , Mehew Jennifer , Martin Kate , Forsythe John , Johnson Rachel J. , Callaghan Chris 
Published: January 2023

Background.
Deceased donor kidneys are often declined for ≥1 patients but then implanted into another. Studies are needed to guide transplant clinicians and patients, especially given the increasing age and comorbidity of donors. This study compares outcomes of recipients of transplanted kidneys that were initially declined with outcomes of patients who remained on the waiting list.

Methods.
This UK Transplant Registry study examined named-patient, adult donation after brain death donor single kidney-only offers that were declined for donor- or organ-related reasons (DORRs), in which the kidney was subsequently transplanted from January 1, 2010, to December 31, 2018. Outcomes included graft function and survival of kidneys transplanted following DORR decline, survival and transplant status of patients who had a kidney declined, and intercenter decline rates.

Results.
A total of 4722 kidneys declined for DORRs, which eventually resulted in single kidney-only transplants, were examined. One year after the offer decline, 35% of patients for whom the organ was declined remained on the list, 55% received a deceased donor transplant at a median of 174 d after the initial offer decline, and 4% had been removed or died. For patients transplanted following offer decline, there was no significant difference in 5-y graft survival when comparing the outcomes to those recipients who received the declined kidney. There was significant variation in DORR decline rates between UK transplant units (17%–54%).

Conclusions.
This study shows reasonable outcomes of kidneys previously declined for DORRs and supports the utilization of those considered to be of higher risk for carefully selected recipients.
Recent research advances in young-onset dementia
Authors: Loi Samantha M. , Pijnenburg Yolande , Velakoulis Dennis 
Published: January 2023

Purpose of review
Young-onset dementia (YOD) refers to a dementia for which symptom onset occurs below the age of 65. This review summarizes the recent literature in this area, focusing on updates in epidemiology, diagnosis and service provision.

Recent findings
In the last year, internationally, the prevalence of YOD was reported as 119 per 100 000, but this may vary according to population types. Although the commonest causes of YOD are Alzheimer's disease (AD) and frontotemporal dementia (FTD), there is increasing recognition that YOD is diagnostically and phenotypically broader than AD and FTD. YOD may be due to many other diseases (e.g. Huntington's disease, vascular dementia) whereas accumulation of the same protein (e.g. amyloid protein) may lead to different phenotypes of Alzheimer's disease (such as posterior cortical atrophy and behavioural-variant/frontal-variant AD). This heterogeneity of phenotypic presentation is also seen in YOD due to known genetic mutations. Biomarkers such as plasma and cerebrospinal fluid proteins, neuroimaging and genetics have shown promise in the early identification of YOD as well as providing further understanding behind the overlap between psychiatric and neurodegenerative conditions occurring in younger people. The management of YOD needs to consider age-specific issues for younger people with dementia and their family networks together with better integration with other health services such as aged, disability and improved access to services and financial assistance.

Summary
These findings emphasize the need for early identification and appropriate age-specific and person-centred management for people with young-onset dementia.
Down syndrome regression disorder: updates and therapeutic advances
Authors: Santoro Jonathan D. , Filipink Robyn A. , Baumer Nicole T. , Bulova Peter D. , Handen Benjamin L. 
Published: January 2023

Purpose of review
Down syndrome regression disorder (DSRD) is a symptom cluster consisting of neuropsychiatric regression without cause. Although knowledge of this condition has accelerated over the last decade, prior studies have been limited by heterogenous nomenclature, diagnostic approaches and therapeutic interventions. This review highlights recent advances in the diagnosis and clinical approach to DSRD and reviews the most up-to-date literature on therapeutic interventions for this condition.

Recent findings
Several multicentre studies have reported exciting findings on the presence of neurodiagnostic study abnormalities and responses to a variety of therapeutics, including psychotropics (including benzodiazepines), electroconvulsive therapy and immunotherapy. Differential response rates have been observed in the presence and absence of a variety of clinical and diagnostic factors.

Summary
Individuals with DSRD are responsive to a variety of psychiatric pharmacotherapy and immunotherapy underscoring this phenotype may have multiple causes. Multidisciplinary care is helpful in the evaluation and management of individuals with this condition.