bluuebunny/crossref_metadata_2025_split huggingface dataset:
E21 Pain catastrophism in Juvenile Idiopathic Arthritis
Authors: Boudriga Ons , Ferjani Hanene , Nessib Dorra Ben , Rabhi Emna , Kaffel Dhia , Maatallah Kaouther , Hamdi Wafa 
Published: August 2023

Abstract

Introduction
Catastrophism, or dramatization, is a cognitive and affective response that is based on an inadequate perception of pain. It is characterized by a negative mindset and magnification of pain through the interaction of physiological and psychological processes. Thanks to the development of a pediatric version of the Pain Catastrophizing Scale (PCS), the interest in pain catastrophizing in the pediatric area is progressively increasing.
Persistent pain is the most common and bothersome symptom of Juvenile Idiopathic Arthritis (JIA). Our goal was to evaluate pain catastrophism in JIA patients as well as the factors that are associated.

Patients and Methods
We conducted a cross-sectional monocentric study on 12–18-year-old patients with JIA. Only those who agreed to participate were included. We collected socio-demographic and clinical data including Juvenile Arthritis Disease Activity Score (JADAS) and Patient Global Assessment (PGA). Catastrophism was evaluated by the French version of the Pain Catastrophizing Scale (PCS) adapted for adolescents (PCS-Ado). A PCS score of 30 or more represents a high level of catastrophism. Regarding quantitative variables, the normality of the variables was assessed by the Kolmogorov-Smirnov test. We calculated the median and variance of data with no Gaussian distribution and the mean with Standard deviation in quantitative variables with the normal curve. For the comparison of 2 independent series, we used the Mann–Whitney test for independent series. The Spearman test was used to calculate the correlation coefficient (r) between two quantitative variables. The significance level in all statistical tests was set at 0.05.

Results
Our study included a total of 20 JIA patients with a male predominance of 65%. The mean age was 14.30 ± 1.87 years and the mean disease duration was 3.39 ± 2.49 years. The Enthesitis Related Arthritis (ERA) form was noted in 50% of JIA patients. The average PGA was 3.86 ± 2.88. Mean JADAS was 6.45 ± 6.05. The PCS-Ado score was 32/52 on average. In 60% of cases, there was a high level of catastrophism (PCS-Ado ≥30). No statistically significant differences were seen in PCS-Ado based on gender, age, disease duration, or JADAS. However, statistical analysis showed that the ERA form had significantly higher PCS-Ado than the non-ERA form (mean PCS-Ado: 36.87 vs 26.75; P = 0.026). We also found a positive correlation between PCS-Ado and PGA (P = 0.026; r = 0.591).

Conclusion
In our study, more than half of patients with JIA had high PCS scores with a significant relationship to ERA form and PGA. This leads us to systematically detect catastrophist thinking in this population to avoid amplifying pain and installing emotional distress and pain-related disability.
E28 Juvenile idiopathic arthritis: a preliminary study of 29 cases
Authors: Ramy Ben Tekaya , Mahbouba Jguirim , Saoussen Zrour , Ismail Bejia , Mongi Touzi , Naceur Bergaoui 
Published: August 2023

Abstract

Introduction
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory rheumatic diseases in children. It is defined as arthritis that began before the age of 16 years, lasting at least 6 weeks and without an identifiable cause. Our objective is to describe the clinical and immunologic profile of JIA.

Patients and methods
Descriptive, retrospective study of 9 years [2013– 2022] of rheumatology services at the CHU Fattouma Bourguiba Monastir. We retrieved 29 files of children diagnosed with JIA according to International League of Associations for Rheumatology (ILAR) criteria.

Results
There were 16 girls (55.17%) and 13 boys (44.83%). The mean age of onset of the disease was 9.38 ± 3,1 years with a range of 3–16 years. Five (19%) patients had a family history of chronic rheumatic diseases. Polyarthritis was seen in 16 (55.2%), oligoarthritis in 7 (24.1%) and mono-arthritis in 6 (20.6%). The forms of JIA in descending order: polyarticular in 11(37.9%), oligoarticular in 6 (20.7%), seropositive polyarticular form in 5 (17.2%), enthesitis related arthritis in 3 (10.3%), systemic JIA in 3(10.3%) and psoriatic arthritis in 1(3.4%).
The presence of biological inflammatory syndrome in 82.7%: an accelerated ESR (68.9%) and positive CRP (65.5%), anaemia (51.72%), hyperleukocytosis (10.7%) and thrombocytosis (3.44%), and 2 patients presented with bicytopenia (10.3%). The immunological workup was marked by presence of: RF (7 cases), Anti-CCP (3 cases), Antinuclear antibodies (ANA) (4 cases). The symptomatic treatment included analgesics (91%), corticosteroids (62%), salazopyrine in 13.7%, methotrexate in 62% of cases and 3 patients under biotherapy. The evolution was good in most cases. The prognosis was life-threatening in two patients with a systemic JIA complicated by macrophagic activation syndrome.

Conclusion
Immunology was not sufficiently contributive. A cohort study in a general population is necessary to better to better elucidate the characteristics of JIA in Tunisia.
E52 Juvenile spondyloarthritis, when the pragmatic approach is absent: a case report
Authors: Hadef Djohra , Salhi Badereddine , Benbouzid Nourhane , Bahamma Hayette , Haddadi Meriem , Slimani Samy 
Published: August 2023

Abstract

Introduction
Juvenile spondyloarthritis is a rare condition in which differential diagnosis is the key step that every practitioner must take to avoid missing other pathologies that can be serious and require early and specific management, such as malignancy. In case of doubt, referring the patient to a referent seems to be the best attitude to adopt.

Aim
We report a case of a girl who was misdiagnosed as juvenile spondyloarthritis when it was acute lymphoblastic leukaemia with vertebral bone involvement.

Observation
A 7-year-old girl was referred to us for better management of her juvenile spondyloarthritis refractory to usual treatments. The child first consulted us for excruciating back pain. Diagnosed as juvenile spondylitis, the patient was placed on NSAIDs and then corticosteroids but without any response. On the contrary, her general condition got worsen and her back pain increased. At our level, further questioning found out that the girl had asthenia, anorexia, excruciating low back pain radiating to the lower limbs with neck pain, and abdominal pain that had been evolving for 40 days. On examination, the child was febrile at 40 °C with mucocutaneous palor, she had hepatosplenomegaly with painful palpation of the lumbar vertebrae. On biological examination, the blood count formula showed normochromic normocytic anaemia, hyperleukocytosis with a normal platelet count. Blood smear; presence of 07% blasts. Medullogram: infiltration of 66% of young lymphoid cells. Immunophenotyping was in favor of B-II acute lymphoblastic leukaemia (B-II ALL). The MRI (magnetic resonance imaging) of the spinal cord showed a total and diffuse infiltration of all the dorsal-lumbar and pelvic vertebral parts, resulting in a real spinal cord replacement secondary to a probable hemopathy. The patient was transferred to the pediatric oncology department and commenced chemotherapy.

Conclusion
Through our observation, JIA is a diagnosis of exclusion and must be considered only after a complete investigation of the other pathologies which require a specific management.
Infrastructure Quality and FDI Inflows: Evidence from the Arrival of High-Speed Internet in Africa
Authors: Mensah Justice Tei , Traore Nouhoum 
Published: August 2023

Abstract
Does ambient infrastructural quality affect foreign direct investment (FDI) in developing countries? This paper investigates how the arrival of high-speed internet in Africa triggered FDI into the region. It also explores the role of complementary infrastructure, such as access to electricity and road connectivity, in amplifying the impact of internet connectivity on investment. To causally estimate impacts, the paper exploits plausibly exogenous variations in access to high-speed internet induced by the staggered arrival of submarine fiber-optic internet cables and spatial variations in terrestrial fiber cable networks across locations on the continent. Findings from the paper indicate that access to high-speed internet induces FDI, particularly in the service sector, with the finance, technology, retail, and health services subsectors as the main beneficiaries. Access to (hard) infrastructure, such as electricity and roads, amplifies the impact of internet connectivity on FDI, thus highlighting the role of complementarities in the impact of infrastructure. Further, the results suggest that improvement in quality of governance and increased performance of incumbent firms are plausible mechanisms.
PCSK9 causes inflammation and cGAS/STING pathway activation in diabetic nephropathy
Authors: Feng Zhicai , Liao Xiangyu , Peng Juan , Quan Jingjing , Zhang Hao , Huang Zhijun , Yi Bin 
Published: August 2023

AbstractOur previous research revealed that an increase in PCSK9 is linked to aggravated inflammation in the kidneys of mice affected by a high‐fat diet and streptozotocin (HFD/STZ) or in HGPA‐induced HK‐2 cells. Furthermore, the cGAS/STING pathway has been reported to be involved in diabetic nephropathy (DN). Therefore, in this study, we aimed to examine the correlation between the proinflammatory effect of PCSK9 and the cGAS/STING pathway in DN. We used PCSK9 mAbs to inhibit PCSK9 in vivo and PCSK9 siRNA in vitro and measured the inflammatory phenotype in HFD/STZ‐treated mice or HGPA‐induced HK‐2 cells, and observed decreased blood urea nitrogen, creatinine, UACR, and kidney injury in response to the PCSK9 mAb in HFD/STZ‐treated mice. Moreover, IL‐1 β, MCP‐1, and TNF‐α levels were reduced by the PCSK9 mAb in vivo and PCSK9 siRNA in vitro. We observed increased mtDNA damage and activation of the cGAS‐STING signaling pathway during DN, as well as the downstream targets p‐TBK1, p‐NF‐κB p65, and IL‐1β. In a further experiment with an HGPA‐induced DN model in HK‐2 cells, we revealed that mtDNA damage was increased, which led to the activation of the cGAS/STING system and its downstream targets. Notably, the cGAS‐STING signaling pathway was inhibited by the PCSK9 mAb in vivo and PCSK9 siRNA in vitro. In addition, inhibition of STING with C‐176 in HGPA‐induced HK‐2 cells markedly blocked inflammation. In conclusion, we report for the first time that PCSK9 triggers mitochondrial DNA damage and activates the cGAS‐STING pathway in DN, which leads to a series of inflammation cascades. PCSK9‐targeted intervention can effectively reduce DN inflammation and delay its progression. Moreover, the inhibition of STING significantly abrogated the inflammation triggered by HGPA in HK‐2 cells.
Having a Bad Day Is Not an Option: Learner Perspectives on Learner Handover
Authors: Shaw Tammy , LaDonna Kori A. , Hauer Karen E. , Khalife Roy , Sheu Leslie , Wood Timothy J. , Montgomery Anne , Rauscher Scott , Aggarwal Simran , Humphrey-Murto Susan 
Published: August 2023

Purpose
Learner handover is the sharing of learner-related information between supervisors involved in their education. The practice allows learners to build upon previous assessments and can support the growth-oriented focus of competency-based medical education. However, learner handover also carries the risk of biasing future assessments and breaching learner confidentiality. Little is known about learner handover’s educational impact, and what is known is largely informed by faculty and institutional perspectives. The purpose of this study was to explore learner handover from the learner perspective.

Method
Constructivist grounded theory was used to explore learners’ perspectives and beliefs around learner handover. Twenty-nine semistructured interviews were completed with medical students and residents from the University of Ottawa and University of California, San Francisco. Interviews took place between April and December 2020. Using the constant comparative approach, themes were identified through an iterative process.

Results
Learners were generally unaware of specific learner handover practices, although most recognized circumstances where both formal and informal handovers may occur. Learners appreciated the potential for learner handover to tailor education, guide entrustment and supervision decisions, and support patient safety, but worried about its potential to bias future assessments and breach confidentiality. Furthermore, learners were concerned that information-sharing may be more akin to gossip rather than focused on their educational needs and feared unfair scrutiny and irreversible long-term career consequences from one shared mediocre performance. Altogether, these concerns fueled an overwhelming pressure to perform.

Conclusions
While learners recognized the rationale for learner handover, they feared the possible inadvertent short- and long-term impact on their training and future careers. Designing policies that support transparency and build awareness around learner handover may mitigate unintended consequences that can threaten learning and the learner–supervisor relationship, ensuring learner handover benefits the learner as intended.
Retrieval of Intra-abdominal Fetal Scalp Electrode 4 Years After Cesarean Birth
Authors: Gao Joanna , Southern Graysan Kirk , Shockley Marie Erin 
Published: August 2023

BACKGROUND:
Fetal scalp electrodes are used routinely for intrapartum fetal heart rate monitoring. The electrode is typically removed from the newborn's scalp immediately after vaginal delivery. However, there is no guidance on the timing of fetal scalp electrode removal in the event of an unplanned cesarean delivery.

CASE:
A 43-year-old woman with a prior cesarean delivery presented for gynecologic care with the chief symptom of chronic abdominal pain for 2 years. Imaging revealed a retained fetal scalp electrode in the abdominal cavity. The patient underwent an uncomplicated surgical extraction of the retained item, and her symptoms resolved.

CONCLUSION:
A standardized protocol to manage and account for fetal scalp electrodes during an unplanned cesarean delivery is an important patient-safety measure to prevent surgical retention of fetal scalp electrodes.
Management of a Retained Broken Suture Needle During Cerclage Placement
Authors: Wodoslawsky Sascha , Mossayebi Matthew H. , Alleyne Gregg , Al-Kouatly Huda B. 
Published: August 2023

BACKGROUND:
Broken suture needles with unintentional foreign body retention are an uncommon occurrence during obstetric procedures. Few reports exist in the literature of cases in pregnant patients. We report a case with the pregnancy management of a broken needle during cerclage placement that was retained in the cervix until repeat cesarean delivery.

CASE:
A 36-year-old woman, gravida 12 para 5, presented at 13 weeks of gestation for a history-indicated cerclage. The suture needle broke during the cerclage procedure, leaving a 35-mm needle fragment inside the cervical stroma between the 11 and 2 o'clock position that could not be recovered after multiple attempts. The procedure continued without needle recovery. Intraoperative pelvic X-ray was performed, demonstrating the retained fragment. No further attempts at recovery were made during the pregnancy, and a plan was made to proceed with removal at the patient’s repeat cesarean delivery. The patient presented in labor at 32 1/7 weeks of gestation and underwent an uncomplicated cesarean delivery. The retained needle was subsequently removed after manual palpation of the fragment transvaginally.

CONCLUSION:
Retained broken suture needles during obstetric procedures require careful management decisions in pregnant patients. Retention of a needle fragment until delivery may be considered if risks of removal outweigh the anticipated benefits.
Associations Among Menstrual Cycle Length, Coronavirus Disease 2019 (COVID-19), and Vaccination
Authors: Alvergne Alexandra , Boniface Emily , Darney Blair , Shea Amanda , Weber Kirsten , Ventola Cécile , Vitzthum Virginia J. , Edelman Alison 
Published: August 2023

OBJECTIVE:
To assess whether coronavirus disease 2019 (COVID-19) is associated with menstrual cycle length changes and, if so, how that compares with those undergoing vaccination or no event (control).

METHODS:
We conducted a retrospective cohort analysis in which we analyzed prospectively tracked cycle-length data from users of a period tracker application who also responded to a survey regarding COVID-19 symptoms and vaccination. We restricted our sample to users aged 16–45 years, with normal cycle lengths (24–38 days) and regular tracking behavior during the five cycles around COVID-19 symptoms or vaccination or a similar time period for those experiencing no event (control group). We calculated the within-user change in cycle length (days) from the three consecutive cycles preevent average (either vaccination, disease, or neither; cycles 1–3) to the event (cycle 4) and postevent (cycle 5) cycles. We used mixed-effects models to estimate the age- and country-adjusted difference in change in cycle length across the groups.

RESULTS:
We included 6,514 users from 110 countries representing 32,570 cycles (COVID-19 symptoms: 1,450; COVID-19 vaccination: 4,643; control: 421). The COVID-19 cohort experienced a 1.45-day adjusted increase in cycle length during cycle 4 (COVID-19) compared with their three preevent cycles (95% CI 0.86–2.04). The vaccinated group experienced a 1.14-day adjusted increase in cycle length during cycle 4 (COVID-19 vaccine) compared with their preevent average (95% CI 0.60–1.69). The control group (neither vaccine nor disease) experienced a 0.68-day decrease (95% CI −1.18 to −0.19) in a similar time period. Post hoc tests showed no significant differences in the magnitude of changes between the COVID-19 and vaccination cohorts. In both cohorts, cycle length changes disappeared in the postevent cycle.

CONCLUSION:
Experiencing COVID-19 is associated with a small change in cycle length similar to COVID-19 vaccination. These changes resolve quickly within the next cycle.
Influence of Anxiety and Depression on Opioid Use Following Lumbar Spine Fusion
Authors: Makanji Heeren , Solomito Matthew J. , Kostyun Regina , Esmende Sean 
Published: August 2023

Study Design:
Retrospective database.

Objective:
The purpose of this study was to understand how a mental health disorder, specifically anxiety and depression, influences a patient’s postoperative opioid needs following single-level lumbar spine fusion.

Summary of Background Data:
Patients with spine pathology commonly demonstrate symptoms of an active psychiatric disorder. Mental health significantly influences how a patient perceives pain and a patient’s opioid pain control needs after surgery.

Materials and Methods:
The Pearldiver Patient Claims Database was used to identify patients undergoing single-level posterior spine fusion within the United States between 2010 and 2020. Patients were placed into 1 of 4 groups: those with a diagnosis of depression, those with a diagnosis of anxiety, those with a diagnosis of both anxiety and depression, and a control group. χ2 tests were used to assess differences in the number of patients filling initial and additional opioid prescriptions for up to 90 days following their fusion.

Results:
The control group filled significantly more initial opioid prescriptions within the first 90 days following their spine fusion (P<0.001). However, there was no difference among the study groups in regard to the additional need for prescriptions.

Conclusion:
Patients with mental health diagnoses may present as complex patients to spine surgeons; however, this study suggests they do not require additional opioid pain control following a single-level lumbar fusion.
Assessment of Endocrine Disruptor Exposure in Hospital Professionals Using Hair and Urine Analyses: An Awareness Campaign
Authors: Robin Julien , Albouy Marion , Jourdain Bernard , Binson Guillaume , Sauvaget Alexis , Pierre-Eugène Pascale , Wu Luyao , Migeot Virginie , Dupuis Antoine , Venisse Nicolas 
Published: August 2023

Background:
In 2021, French public authorities initiated the fourth National Environmental Health Plan to prevent environment-related health risks. This plan primarily focuses on the sensitization of health professionals and health care institutions. Endocrine disruptors (EDs) are environmental factors associated with several adverse health effects, such as reproductive disorders, obesity, and cancer. This study aimed to conduct an awareness campaign among professionals at a general hospital center on the risks related to EDs.

Methods:
Hospital professionals were directly involved in this study, and urine and hair samples were collected to determine bisphenol and paraben exposure levels. Analyses were performed using validated liquid chromatography-tandem mass spectrometry methods, enabling the simultaneous determination of bisphenols and parabens. A questionnaire on lifestyle habits was distributed to assess its relationship with the exposure profiles. Nineteen professionals were recruited for the study.

Results:
Bisphenol A was detected in 95% of the urine samples, and the chlorinated derivatives of bisphenol A were between 16% and 63%. parabens showed detection frequencies between 37% and 100%, and methylparaben was quantified at an average concentration of 0.45 ± 0.46 ng/mL. In hair samples, bisphenols A, F, and S were detected at 95%–100%, chlorinated derivatives of bisphenol A were detected at 37%–68%, and parabens were detected at 100%.

Conclusions:
This awareness campaign may encourage health care institutions to adopt a policy of reducing endocrine disruptor exposure among their patients and professionals, who could be educated regarding the risks associated with EDs. Conducting a multicenter study to refine the results herein and establish a dynamic to prevent endocrine disruptor and environmental risks in health care systems would be valuable.