bluuebunny/crossref_metadata_2025_split huggingface dataset:
QUANTITATIVE MEASUREMENT OF EMPATHY AND ANALYSIS OF ITS CORRELATION TO CLINICAL FACTORS IN KOREAN PATIENTS WITH HYPERTENSION
Authors: Heo Ran , Shin Jinho , Kim Byung Sik , Kim Hyun-Jin 
Published: June 2023

Objective:
We aim to evaluate empathy using the Korean Consultation and Relational Empathy (CARE) measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with hypertension.

Design and method:
Empathy is the core of the physician-patient relationship. The CARE measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in hypertension patients in Korea. We aim to evaluate empathy using the Korean CARE measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with hypertension.
Data were collected from patients with hypertension. Patients were from primary, secondary, and tertiary clinics. Characteristics of the patients, physicians, and disease status were collected. The difference in CARE score was studied according to the clinical factors.

Results:
A total of 143 patients with hypertension were included. About 60% of patients were male. The mean age was 62. They had an average number of 2.6 comorbid diseases. More than half of patients experienced overt cardiovascular diseases such as heart failure, and coronary heart disease. About half of them had a history of hospitalization due to cardiovascular disease. The overall average CARE score was 45.6±7.0. The CARE score was not significantly different according to the characteristics of the patient, physician, or disease status. This trend was maintained in hypertensive patients.

Conclusions:
The Korean CARE measure could assess patient-rated empathy in various clinical practices. The empathy of patients was high regardless of multiple factors.
THE SELECTIVE DELETION OF TYROSYNE HYDROXYLASE GENE IN THE ENDOTHELIUM AFFECTS CARDIOVASCULAR FUNCTION
Authors: Fiordelisi Antonella , Gambardella Jessica , Cerasuolo Federica Andrea , Avvisato Roberta , Paolillo Roberta , D’Apice Stefania , Buonaiuto Antonietta , Perrino Cinzia , Ciccarelli Michele , Iaccarino Guido , Sorriento Daniela 
Published: June 2023

Objective:
We showed that the endothelium can synthesize and release catecholamines in response to hypoxia. However, the pathophysiological implications of such findings are still unknown since no mouse model is available to achieve this goal. The aim of the study is the generation and characterization of a transgenic mouse model in which the tyrosine hydroxylase (TH) gene is selectively deleted in the endothelium.

Design and method:
The animal model was generated using the CRE-LOX system with specific tissue expression of the CRE recombinase. TH-FLOX mice and Tie2-CRE mice were crossed to obtain mice with endothelial knock-out of the TH gene (TH - / -). The level of circulating CA was assessed by ELISA assay. We measured blood pressure with a non-invasive method (CODA Tail-Cuff). In vitro, TH gene was deleted in mouse endothelial cells by a specific siRNA to evaluate its effects on endothelial function.

Results:
The level of circulating catecholamines is significantly reduced in TH -/- mice compared to TH +/+ mice, suggesting a key role of the endothelium in the production of circulating CAs. We evaluated blood pressure levels and found a significant increase in TH -/- young mice compared to TH +/+ mice. In vitro, we evaluated the effects of TH deletion on endothelial function. The deletion induced a significant reduction of nitric oxide, angiogenesis on Matrigel, and an increase in apoptosis and inflammatory cytokines suggesting an autocrine effect of catecholamines produced by the endothelium.

Conclusions:
These data indicate that the reduced production of endothelial CA alters vascular function, suggesting that endothelial catecholamines are essential for the proper functioning of the cardiovascular system.
Screening for Late-Onset Gestational Diabetes: Are There Any Clinical Benefits?
Authors: Cauldwell Matthew , Chmielewska Basia , Kaur Kiran , van-de-l'Isle Yolande , Sherry Anneka , Coote Ingrid Watt , Steer Philip J. 
Published: June 2023

(Abstracted from BJOG 2022;129(13):2176–2183
Gestational diabetes mellitus (GDM) affects approximately 1 in 16 women in the United Kingdom. Screening for GDM involves a 2-hour, 75-g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation; a fasting value of plasma glucose of ≥5.6 mM or 2-hour plasma glucose level of ≥7.8 mM indicates GDM. However, as pregnancy progresses, levels of hormones, particularly placental lactogen, change and increase insulin resistance.
Uterine Myoma Position-Based Radiofrequency Ablation (UMP-b RFA): 36 Months Follow-up Clinical Outcomes
Authors: Fasciani Alessandro , Turtulici Giovanni , Pedullà Alessio , Sirito Rodolfo 
Published: June 2023

(Abstracted from Eur J Obstet Gynecol 2023;281:23–28
The most frequently diagnosed benign pathology in the female population, uterine fibromatosis, is also a ubiquitous issue of health. Causing anemia, infertility, sexual intercourse pain, recurrent abortions, uterine bleeding, and pelvic pain, this pathology extends significant repercussions on not only women, but also their work activities and families. Treatments proven over time to be effective, such as gonadotropin hormone-releasing hormone antagonists, ulipristal acetate, or gonadotropin hormone-releasing hormone analogues, also give adverse effects in the process of failing to eliminate the pathology. In addition, these treatments cannot be used by patients attempting pregnancy.
Breaking Down Silos Between Medical Education and Health Systems: Creating an Integrated Multilevel Data Model to Advance the Systems-Based Practice Competency
Authors: Reilly James B. , Kim Jung G. , Cooney Robert , DeWaters Ami L. , Holmboe Eric S. , Mazotti Lindsay , Gonzalo Jed D. 
Published: June 2023

Abstract
The complexity of improving health in the United States and the rising call for outcomes-based physician training present unique challenges and opportunities for both graduate medical education (GME) and health systems. GME programs have been particularly challenged to implement systems-based practice (SBP) as a core physician competency and educational outcome. Disparate definitions and educational approaches to SBP, as well as limited understanding of the complex interactions between GME trainees, programs, and their health system settings, contribute to current suboptimal educational outcomes elated to SBP. To advance SBP competence at individual, program, and institutional levels, the authors present the rationale for an integrated multilevel systems approach to assess and evaluate SBP, propose a conceptual multilevel data model that integrates health system and educational SBP performance, and explore the opportunities and challenges of using multilevel data to promote an empirically driven approach to residency education. The development, study, and adoption of multilevel analytic approaches to GME are imperative to the successful operationalization of SBP and thereby imperative to GME’s social accountability in meeting societal needs for improved health. The authors call for the continued collaboration of national leaders toward producing integrated and multilevel datasets that link health systems and their GME-sponsoring institutions to evolve SBP.
Obstetric Outcomes Among Women With a History of Intimate Partner Violence in the United States
Authors: Mead Julia S. , Pollack Catherine C. , Paris Amy E. , Emeny Rebecca T. , Puleo Robyn A. , St Ivany Amanda R. 
Published: June 2023

OBJECTIVE:
To evaluate the association between exposure to intimate partner violence (IPV) and delivery method in a U.S. obstetric cohort.

METHODS:
The study population included U.S. women with a history of recent live birth, drawn from the 2009–2018 PRAMS (Pregnancy Risk Assessment Monitoring System) cohort. The primary exposure was self-reported IPV. The primary outcome of interest was method of delivery (vaginal or cesarean). Secondary outcomes included preterm birth, small for gestational age (SGA), and admission to the neonatal intensive care unit (NICU). Bivariate associations between the primary exposure (ie, self-report of IPV vs no self-report of IPV) and each covariate of interest were assessed with weighted quasibinomial logistic regression. Weighted multivariable logistic regression was conducted to evaluate the association between IPV and delivery method controlling for confounders.

RESULTS:
A total of 130,000 women were included in this secondary analysis of a cross-sectional sample, representing 7,500,000 women nationwide based on PRAMS sampling design. Of these, 0.8% reported abuse in the 12 months before their current pregnancy and 1.3% reported abuse during pregnancy; 1.6% of the study population reported abuse both before and during pregnancy. After adjusting for maternal sociodemographic characteristics, IPV exposure at any time was not significantly associated with cesarean delivery, compared with no IPV exposure (odds ratio [OR] 0.98, 95% CI 0.86–1.11). Of secondary outcomes, 9.4% of women experienced preterm birth and 15.1% had neonates admitted to the NICU. Exposure to IPV was associated with a 21.0% increased risk of preterm birth, compared with women without exposure (OR 1.21, 95% CI 1.05–1.40), and a 33.3% increased risk of NICU admission (OR 1.33, 95% CI 1.17–1.52) after controlling for confounders. There was no difference in the risk of delivering a neonate who was SGA.

CONCLUSION:
Intimate partner violence was not associated with an increased risk of cesarean delivery. Intimate partner violence before or during pregnancy was associated with increased risk of adverse obstetric outcomes, such as preterm birth and NICU admission, corroborating previous research findings.
Risk of Hysterectomy After Endometrial Ablation
Authors: Oderkerk Tamara J. , Beelen Pleun , Bukkems Ardy L. A. , Van Kuijk Sander M. J. , Sluijter Hilde M. M. , van de Kar Mileen R. D. , Herman Malou C. , Bongers Marlies Y. , Geomini Peggy M. A. J. 
Published: June 2023

OBJECTIVE:
To assess the risk of hysterectomy after nonresectoscopic endometrial ablation in patients with heavy menstrual bleeding.

DATA SOURCES:
The EMBASE, MEDLINE, ClinicalTrials.gov and Cochrane databases were searched for eligible articles from inception until June 13, 2022. We used combinations of search terms for endometrial ablation and hysterectomy.

METHODS OF STUDY SELECTION:
Articles included in the review described the incidence of hysterectomy at a specific point in time after ablation with a minimum follow-up duration of 12 months.

TABULATION, INTEGRATION, AND RESULTS:
The literature search yielded a total of 3,022 hits. A total of 53 studies met our inclusion and exclusion criteria, including six retrospective studies, 24 randomized controlled trials, and 23 prospective studies. A total of 48,071 patients underwent endometrial ablation between 1992 and 2017. Follow-up duration varied between 12 and 120 months. Analyses per follow-up moment showed 4.3% hysterectomy rate at 12 months of follow-up (n=29 studies), 11.1% at 18 months (n=1 study), 8.0% at 24 months (n=11 studies), 10.2% at 36 months (n=12 studies), 7.6% at 48 months (n=2 studies), and 12.4% at 60 months (n=6 studies). Two studies reported a mean hysterectomy rate at 10 years after ablation of 21.3%. Minimal clinically relevant differences in hysterectomy rates were observed among the different study designs. Furthermore, we found no significant differences in hysterectomy rate among the different nonresectoscopic endometrial ablation devices.

CONCLUSION:
The risk of hysterectomy after endometrial ablation seems to increase from 4.3% after 1 year to 12.4% after 5 years. Clinicians can use the results of this review to counsel patients about the 12% risk of hysterectomy 5 years after endometrial ablation.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42020156281.
Efficacy of Propranolol to Reduce Cesarean Delivery in Prolonged Labor
Authors: McCoy Jennifer A. , Walheim Lauren , McCabe Meaghan G. , Levine Lisa D. 
Published: June 2023

OBJECTIVE:
To evaluate the rates of cesarean delivery in patients with prolonged labor randomized to receive intravenous (IV) propranolol compared with placebo.

METHODS:
A double-blind, placebo-controlled, randomized trial was conducted at two hospitals within a large academic health system. Eligible patients were at 36 weeks or more with a singleton gestation and prolonged labor, defined as: 1) prolonged latent phase of labor (dilation less than 6 cm after 8 hours or more with ruptured membranes and receiving oxytocin infusion) or 2) prolonged active phase of labor (dilation 6 cm or greater and less than 1-cm cervical dilation change over 2 hours or more with ruptured membranes and receiving oxytocin infusion). Patients were excluded for severe preeclampsia, maternal heart rate less than 70 beats per minute, maternal blood pressure less than 90/50 mm Hg, asthma, diabetes requiring insulin during labor, or a cardiac contraindication to β-blockade. Patients were randomized to propranolol (2 mg IV) compared with placebo (2 mL normal saline IV), with one possible repeat dose. The primary outcome was cesarean delivery; secondary outcomes included labor duration, shoulder dystocia, and maternal and neonatal morbidity. With an estimated cesarean delivery rate of 45%, α 0.05, and 80% power, we required 163 patients per group to detect a 15% absolute reduction in cesarean delivery rate. A planned interim analysis was performed, and the trial was stopped for futility.

RESULTS:
From July 2020 to June 2022, 349 patients were eligible and approached; 164 were enrolled and randomized, with 84 in the propranolol group and 80 in the placebo group. The rate of cesarean delivery was not different between groups (57.1% propranolol vs 57.5% placebo, relative risk [RR] 0.99, 95% CI 0.76–1.29). Results were similar by subgroup of prolonged latent (n=123) and active (n=41) phases of labor and nulliparous (n=137) and multiparous (n=27) patients. Though not statistically significant, the frequency of postpartum hemorrhage was higher in the propranolol group (20% vs 10%, RR 2.02, 95% CI 0.93–4.43).

CONCLUSION:
In this multisite, double-blind, placebo-controlled randomized trial, there was no difference in cesarean delivery rate for patients who received propranolol compared with those who received placebo for management of prolonged labor.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04299438.
Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis
Authors: Zhang Xintao , Sun Dong , Xu Qiongqian , Liu Han , Li Yunfeng , Wang Dongming , Wang Jian , Zhang Qiangye , Hou Peimin , Mu Weijing , Jia Chunling , Li Aiwu 
Published: June 2023

Background:
The incidence of Hirschsprung disease (HSCR) is nearly 1/5000 and patients with HSCR are usually treated through surgical intervention. Hirschsprung disease-associated enterocolitis (HAEC) is a complication of HSCR with the highest morbidity and mortality in patients. The evidence on the risk factors for HAEC remains inconclusive to date.

Methods:
Four English databases and four Chinese databases were searched for relevant studies published until May 2022. The search retrieved fifty-three relevant studies. The retrieved studies were scored on the Newcastle-Ottawa Scale (NOS) by three researchers. Revman 5.4 software was employed for data synthesis and analysis. Stata 16 software was employed for sensitivity analysis and bias analysis.

Results:
A total of fifty-three articles were retrieved from the database search, which included 10012 cases of HSCR and 2310 cases of HAEC. The systematic analysis revealed anastomotic stenosis or fistula (I
2=66%, RR=1.90, 95% CI 1.34–2.68,
P

<0.001), preoperative enterocolitis (I
2=55%, RR=2.07, 95% CI 1.71–2.51,
P

<0.001), preoperative malnutrition (I
2=0%, RR=1.96, 95% CI 1.52–2.53,
P

<0.001), preoperative respiratory infection or pneumonia (I
2=0%, RR=2.37, 95% CI 1.91–2.93,
P

<0.001), postoperative ileus (I
2=17%, RR=2.41, 95% CI 2.02–2.87,
P

<0.001), length of ganglionless segment>30 cm (I
2=0%, RR=3.64, 95% CI 2.43–5.48,
P

<0.001), preoperative hypoproteinemia (I
2=0%, RR=1.91, 95% CI 1.44–2.54,
P

<0.001), and Down syndrome (I
2=29%, RR=1.65, 95% CI 1.32–2.07,
P

<0.001) as the risk factors for postoperative HAEC. Short-segment HSCR (I
2=46%, RR=0.62, 95% CI 0.54–0.71,
P

<0.001) and transanal operation (I
2=78%, RR=0.56, 95% CI 0.33–0.96,
P
=0.03) were revealed as the protective factors against postoperative HAEC. Preoperative malnutrition (I
2=35
%
,RR=5.33, 95% CI 2.68–10.60,
P

<0.001), preoperative hypoproteinemia (I
2=20%, RR=4.17, 95% CI 1.91–9.12,
P

<0.001), preoperative enterocolitis (I
2=45%, RR=3.51, 95% CI 2.54–4.84,
P

<0.001), and preoperative respiratory infection or pneumonia (I
2=0%, RR=7.20, 95% CI 4.00–12.94,
P

<0.001) were revealed as the risk factors for recurrent HAEC, while short-segment HSCR (I
2=0%, RR=0.40, 95% CI 0.21–0.76,
P
=0.005) was revealed as a protective factor against recurrent HAEC.

Conclusion:
The present review delineated the multiple risk factors for HAEC, which could assist in preventing the development of HAEC.
Neoadjuvant immunochemotherapy for locally advanced resectable oral squamous cell carcinoma: a prospective single-arm trial (Illuminate Trial)
Authors: Huang Yingying , Sun Jingjing , Li Jun , Zhu Dongwang , Dong Minjun , Dou Shengjin , Tang Yong , Shi Wentao , Sun Qi , Zhao Tongchao , Zhou Zhihang , Zhou Xinyu , Liu Ying , Li Jiang , Zhu Guopei , Zhang Ding , Chen Yanan , Zhu Qi , Ju Wutong , Zhong Laiping 
Published: June 2023

Background:
Locally advanced oral squamous cell carcinoma (LAOSCC) is associated with a high rate of recurrence and poor survival. Given the recent successes of neoadjuvant immunochemotherapy (NAICT) in solid tumors, it is promising to use this treatment modality to achieve better pathological response and improve the survival of LAOSCC, and clinical evidence is needed to assess its safety and efficacy.

Patients and methods:
A prospective trial of NAICT with toripalimab (PD-1 inhibitor) and albumin paclitaxel/cisplatin (TTP) was conducted in patients with clinical stage III and IVA OSCC. Intravenous albumin paclitaxel (260 mg/m2), cisplatin (75 mg/m2), and toripalimab (240 mg) were given in sequence on day 1 of each 21-day cycle for two cycles, followed by radical surgery and risk-adapted adjuvant (chemo)radiotherapy. The primary endpoints were safety and major pathological response (MPR). Targeted next generation sequencing and multiplex immunofluorescence were performed to assess clinical molecular characteristics and the tumor immune microenvironment in the pre- and post-NAICT tumor samples.

Results:
Twenty patients were enrolled. NAICT was well-tolerated with a low incidence of grade 3-4 adverse events (AEs) in three patients. The completion rates of NAICT and subsequent R0 resection were 100%. The MPR rate was 60%, including 30% pathological complete response. MPR was achieved in all 4 patients with a combined positive score of PD-L1>10. The density of tertiary lymphatic structure (TLS) in post-NAICT tumor samples predicted the pathological response to NAICT. During the median 23-month follow-up, the disease-free survival was 90%, and the overall survival was 95%.

Conclusions:
NAICT with the TTP protocol in LAOSCC is feasible and well tolerated, with a promising MPR and no obstruction on subsequent surgery. This trial is supportive of further randomized trials using NAICT in LAOSCC.
Cardiovascular outcomes in subclinical thyroid disease: an update
Authors: Ettleson Matthew D. 
Published: June 2023

Purpose of review
Subclinical thyroid disease is defined by a thyroid stimulating hormone (TSH) level outside of the normal range with normal circulating thyroid hormone levels. Excess adverse cardiovascular outcomes have been observed in certain patient populations with subclinical hypothyroidism (SCH) and hyperthyroidism (SCHr). The role of thyroid hormone and antithyroid treatments for subclinical thyroid disease remains debated.

Recent findings
Cardiovascular disease appears to be a major mediator of all-cause mortality in patients with SCH, in particular those aged at least 60 years of age. In contrast, pooled clinical trial results did not find that levothyroxine reduced the incidence of cardiovascular events or mortality in this patient population. The association between SCHr and atrial fibrillation is well established; however, a 5-year follow-up of older patients with mild (TSH 0.1–0.4 mIU/l) SCHr found no increased incidence of atrial fibrillation. Separately, SCHr was associated with derangements in endothelial progenitor cell function that may underlie vascular disease independent from effects on cardiac function.

Summary
The impact of treatment of subclinical thyroid disease on cardiovascular outcomes remains uncertain. Additional prospective and trial data are needed to evaluate treatment effects on cardiovascular outcomes in younger populations.
A Rational and Standardized Prenatal Examination
Authors: Sarosi Ellery , Gatta Luke A. , Berman Deborah R. , Kuller Jeffrey A. 
Published: June 2023

Importance
As prenatal care is in transition after the COVID-19 pandemic, reviewing fundamental physical examination approaches is necessary for providers examining obstetrical patients.

Objective
The objective of this review is 3-fold: (1) convey why the age of telemedicine necessitates reconsideration of the standardized physical examination in routine prenatal care; (2) identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, pelvis, and fetal growth; and (3) propose an evidence-based prenatal physical examination.

Evidence Acquisition
A comprehensive literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines.

Results
We conclude that an evidence-based prenatal examination for asymptomatic patients includes the following maneuvers: inspection and palpation for thyromegaly and cervical lymphadenopathy, cardiac auscultation, fundal height measurement, and a pelvic examination for purposes including testing for gonorrhea and chlamydia, assessing pelvimetry, and assessing cervical dilation later in the pregnancy, intrapartum, or in the setting of ultrasonogram-detected prelabor preterm cervical shortening.

Conclusions and Relevance
Although not true of all physical examination maneuvers, this article demonstrates that there are maneuvers that continue to play important screening roles in asymptomatic patients. With the increase in virtual visits and fewer in-person prenatal appointments, the rational basis for maneuvers recommended in this review should inform decision making around the prenatal examination performed.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to discuss how telemedicine impacts the standardized physical examination in routine prenatal care; identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, fetal growth, and pelvis; and propose an evidence-based prenatal physical examination.