bluuebunny/crossref_metadata_2025_split huggingface dataset:
The burden of peri-operative work at night as perceived by anaesthesiologists
Authors: Cortegiani Andrea , Ippolito Mariachiara , Lakbar Ines , Afshari Arash , Kranke Peter , Garcia Carolina Soledad Romero , Myatra Sheila Nainan , Schultz Marcus J. , Giarratano Antonino , Bilotta Federico , De Robertis Edoardo , Noto Alberto , Einav Sharon 
Published: January 2023

BACKGROUND
No international data are available on the night working conditions and workload of anaesthesiologists and their opinions about associated risks.

OBJECTIVE
The aim of this international survey was to describe the peri-operative night working conditions of anaesthesiologists and their perception of the impact these conditions have on patient outcomes and their own quality of life.

DESIGN
Cross-sectional survey.

SETTING
Not applicable.

PARTICIPANTS
Anaesthesiologists providing peri-operative care during night shifts responded to an online survey promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC).

INTERVENTIONS
None.

MAIN OUTCOME MEASURE
Twenty-eight closed questions.

RESULTS
Overall 5292 complete responses were analysed. Of these, 920 were from trainees. The median reported monthly number of night shifts was 4 [IQR 3–6]. An irregular weekly night shift schedule was most common (51%). Almost all the respondents (98%) declared that their centres have no relevant institutional programmes to monitor stress or fatigue. Most respondents (90%) had received no training or information regarding performance improvement methods for night work. Most respondents were of the opinion that sleep deprivation affects their professional performance (71%) and that their fatigue during night work may increase the peri-operative risk for their patients (74%). Furthermore, 81% of the respondents agreed or strongly agreed that night work represents an additional risk per se for patient safety, and 77% stated that their night work affects the quality of their daily life significantly or extremely.

CONCLUSION
Anaesthesiologists commonly perform perioperative night work without appropriate training, education or support on this specific condition. They perceive current practice as adversely affecting their professional performance and the safety of their patients. They also report significant effects on their own quality of life. Adequate training and education for night work may ally some of these concerns and programmes to monitor workers’ stress and fatigue should be mandated to assess whether these concerns are justified.

TRIAL REGISTRATION
Not applicable.
Inhibiting NFAT5 With KRN2 Mitigates Acute Allograft Rejection in a Murine Heart Transplantation Model
Authors: Li Chenghao , Chen Xing , Wang Yixuan , Huang Yajun , Wang Guohua 
Published: January 2023

Abstract:
Despite advancements in immunosuppressive therapy, acute allograft rejection remains an important challenge for heart transplantation patients. Nuclear factor of activated T-cells 5 (NFAT5), a member of the family of Rel homology domain-containing factors that plays an important role in regulating immune responses of T lymphocytes, may be closely associated with cardiac rejection. KRN2, as a specific inhibitor of NFAT5, is injected intraperitoneally daily starting from day 0 after murine heart transplantation. When compared with saline treatment, KRN2 treatment can improve allograft survival. Histologic examination revealed that the KRN2 treatment group experienced less-severe rejection, and enzyme-linked immunosorbent assay revealed lower levels of inflammatory cytokines in circulating serum. The proportion and number of T-cell subpopulations in the spleens were analyzed by flow cytometry. We found that KRN2 treatment reduced the proportions of CD4+ IFN-γ+, CD4+IL-17A+, and CD4+IL-4+ Th cells, whereas increasing CD4+ Foxp3+ Treg cells compared with the control group. These findings suggest that KRN2 attenuates acute allograft rejection by regulating CD4+ T lymphocyte responses. NFAT5 could be a promising therapeutic target for preventing acute allograft rejection.
Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction
Authors: Johnstone Thomas , Lipman Kelsey , Makarewicz Nathan , Shah Jennifer , Turner Elizabeth , Posternak Victoria , Chang Daniel , Thornton Brian , Nazerali Rahim 
Published: January 2023

Background:
Periprosthetic infections remain a major challenge for breast reconstruction. Local antibiotic delivery systems, such as antibiotic beads and spacers, have been widely used within other surgical fields, but their use within plastic surgery remains scarce. In this study, we demonstrate the use of antibiotic-impregnated polymethylmethacrylate (PMMA) plates for infection prophylaxis in tissue expander (TE)-based breast reconstruction.

Methods:
A retrospective review of patients who underwent immediate breast reconstruction with prepectoral TEs over the span of 5 years performed by two surgeons was completed, revealing a total of 447 patients. Data pertaining to patient demographics, operative details, and postoperative outcomes were recorded. Fifty patients underwent TE reconstruction with the addition of a PMMA plate (Stryker, Kalamazoo, Michigan) impregnated with tobramycin and vancomycin. Antibiotic plates were removed at the time of TE-to-implant exchange. Patient-matching analysis was performed using the 397 patients without PMMA plates to generate a 50-patient nonintervention cohort for statistical analysis.

Results:
The intervention cohort (n = 50) and 1:1 patient-matched nonintervention cohort (n = 50) demonstrated no statistically significant differences in patient demographics or operative characteristics other than PMMA plate placement. The rate of operative periprosthetic infection was 4% in the intervention group and 14% in the nonintervention group (P = 0.047). The rate of TE explantation was also reduced in the intervention group (6% versus 18%; P = 0.036). Follow-up averaged 9.1 and 8.9 months for the intervention and nonintervention groups, respectively (P = 0.255).

Conclusion:
Local antibiotic delivery using antibiotic-impregnated PMMA plates can be safely and effectively used for infection prevention with TE-based breast reconstruction.
Multicentered study of patient outcomes after declined for early liver transplantation in severe alcohol-associated hepatitis
Authors: Hsu Christine C. , Dodge Jennifer L. , Weinberg Ethan , Im Gene , Ko Jimin , Davis William , Rutledge Stephanie , Dukewich Matthew , Shoreibah Mohamed , Aryan Mahmoud , Vosooghi Aidan , Lucey Michael , Rice John , Terrault Norah A. , Lee Brian P. 
Published: January 2023

Background:
Early liver transplantation for alcohol-associated hepatitis is controversial in part because patients may recover, and obviate the need for liver transplantation.

Methods:
In this retrospective study among 5 ACCELERATE-AH sites, we randomly sampled patients evaluated and then declined for liver transplantation for alcohol-associated hepatitis. All had Model of End-Stage Liver Disease (MELD) >20 and <6 months of abstinence. Recompensation was defined as MELD <15 without variceal bleeding, ascites, or overt HE requiring treatment. Multilevel mixed effects linear regression was used to calculate probabilities of recompensation; multivariable Cox regression was used for mortality analyses.

Results:
Among 145 patients [61% men; median abstinence time and MELD-Na was 33 days (interquartile range: 13–70) and 31 (interquartile range: 26–36), respectively], 56% were declined for psychosocial reasons. Probability of 30-day, 90-day, 6-month, and 1-year survival were 76% (95% CI, 68%–82%), 59% (95% CI, 50%–66%), 49% (95% CI, 40%–57%), and 46% (95% CI, 37%–55%), respectively. Probability of 1-year recompensation was low at 10.0% (95% CI, 4.5%–15.4%). Among patients declined because of clinical improvement, 1-year probability of recompensation was 28.0% (95% CI, 5.7%–50.3%). Among survivors, median MELD-Na at 30 days, 90 days, and 1-year were 29 (interquartile range: 22–38), 19 (interquartile range : 14–29), and 11 (interquartile range : 7–17). Increased MELD-Na (adjusted HR: 1.13, p<0.001) and age (adjusted HR: 1.03, p<0.001) were associated with early (≤90 d) death, and only history of failed alcohol rehabilitation (adjusted HR: 1.76, p=0.02) was associated with late death.

Conclusions:
Liver recompensation is infrequent among severe alcohol-associated hepatitis patients declined for liver transplantation. Higher MELD-Na and age were associated with short-term mortality, whereas only history of failed alcohol rehabilitation was associated with long-term mortality. The distinction between survival and liver recompensation merits further attention.
Regulatory role and translational potential of CCL11 in liver fibrosis
Authors: Kong Ming , Dong Wenhui , Kang Aoqi , Kuai Yameng , Xu Tongchang , Fan Zhiwen , Shi Longqing , Sun Donglin , Lu Yunjie , Li Zilong , Xu Yong 
Published: January 2023

Background and Aims:
Myofibroblasts are considered the major effector cell type of liver fibrosis and primarily derived from hepatic stellate cells (HSCs). In the present study, we investigated the contribution of C-C motif chemokine (CCL11) to HSC-myofibroblast trans-differentiation and its implication in liver fibrosis.

Approach and Results:
We report that CCL11 levels were elevated in HSCs, but not in hepatocytes or Kupffer cells, isolated from mice with liver fibrosis compared with the control mice. CCL11 levels were also up-regulated by 2 pro-fibrogenic growth factors TGF-β and platelet derived growth factor in cultured HSCs. Mechanistically, zinc finger factor 281 bound to the CCL11 promoter and mediated CCL11 trans-activation in HSCs. Depletion of CCL11 attenuated whereas treatment with recombinant CCL11 promoted HSC activation. Further, global CCL11 deletion (CCL11
−/−) or HSC/myofibroblast-specific CCL11 knockdown mitigated fibrogenesis in mice. RNA-sequencing revealed that CCL11 might regulate HSC activation by stimulating the transcription of Jagged 1. Reconstitution of Jagged 1 restored the fibrogenic response in CCL11
−/− mice. Finally, several targeting strategies that aimed at blockading CCL11 signaling, either by administration of an antagonist to its receptor C-C motif chemokine receptor 3 or neutralizing antibodies against CCL11/C-C motif chemokine receptor 3, ameliorated liver fibrosis in mice.

Conclusions:
Our data unveil a previously unrecognized role for CCL11 in liver fibrosis and provide proof-of-concept evidence that targeting CCL11 can be considered as an effective therapeutic approach.
Circ_0001326 suppresses trophoblast cell proliferation, invasion, migration and epithelial–mesenchymal transition progression in preeclampsia by miR-188-3p/HtrA serine peptidase 1 axis
Authors: Gao Xue , Qu Haina , Zhang Yue 
Published: January 2023

Background:
It has been reported that the alteration of circular RNAs (circRNAs) during preeclampsia (PE) can be associated with the pathogenesis of this disease. Herein, this work investigated the potential functions and mechanism of circ_0001326 in PE process.

Methods:
The levels of genes and proteins were evaluated by quantitative real-time PCR (qRT-PCR) and western blotting. The functional experiments were conducted using cell counting kit-8 (CCK-8), 5-ethynyl-2’-deoxyuridine (EdU), flow cytometry, transwell, and wound healing assays, respectively. The binding between miR-188-3p and circ_0001326 or HtrA serine peptidase 1 (HTRA1) was verified by bioinformatics analysis and dual-luciferase reporter assays.

Results:
Circ_0001326 and HTRA1 expression was increased, while miR-188-3p expression was decreased in the placental tissues of preeclamptic singleton pregnant women compared with the normal pregnant women. Functionally, up-regulation of circ_0001326 or HTRA1, or down-regulation of miR-188-3p led to the arrest of cell growth, invasion, migration and epithelial–mesenchymal transition (EMT) process in trophoblast cells. Mechanistically, circ_0001326 acted as a sponge for miR-188-3p, which directly targeted HTRA1. Moreover, circ_0001326 could regulate HTRA1 through sequestering miR-188-3p. A series of rescue experiments showed that miR-188-3p reversed the inhibitory effects of circ_0001326 knockdown on above behaviors of trophoblast cells. Besides that, HTRA1 silencing attenuated the action of miR-188-3p inhibitor on trophoblast cell phenotype alteration.

Conclusion:
Our study demonstrated that circ_0001326 could promote trophoblast cell proliferation, invasion, migration and EMT in PE by miR-188-3p/HTRA1 axis, indicating a novel insight into the pathogenesis of PE.
Combined effects of hypertension, hyperlipidemia, and diabetes mellitus on the presence and severity of carotid atherosclerosis in community-dwelling elders: A community-based study
Authors: Lu Shu-Xin , Wu Tzu-Wei , Chou Chao-Liang , Cheng Chun-Fang , Wang Li-Yu 
Published: January 2023

Background:
Hypertension, hyperlipidemia, and diabetes mellitus (DM) are common cardiovascular disease (CVD) comorbidities and well-known major determinants of atherosclerosis. However, their combined effects and relative contributions have not been well explored. This study aimed to characterize the characteristics of carotid atherosclerosis and dissect the relative effects of these common CVD comorbidities on the presence and severity of carotid atherosclerosis in community-dwelling elderly individuals.

Methods:
We enrolled 817 elders from communities in northern Taiwan. We evaluated their cardiovascular risk profiles and scanned their extracranial carotid arteries using high-resolution ultrasonography systems.

Results:
The prevalence rates for hypertension, hyperlipidemia, and DM were 45.4%, 37.1%, and 16.8%, respectively. Sixty-two (7.6%) and 188 (23.0%) elderly had all three and two of these common CVD comorbidities, respectively. The prevalent rates of carotid plaque and moderate-to-severe atherosclerosis were 62.9% and 35.5%, respectively. The percentages of one or more common CVD comorbidities in elders with carotid plaque and moderate-to-severe atherosclerosis were 78.2% and 83.1%, respectively. Multivariate analyses showed that the number of common CVD comorbidities was the most predictive determinant. Multivariable-adjusted odds ratios (ORs) per comorbidity for the presence of carotid plaque and advanced carotid atherosclerosis were 1.52 (95% CI, 1.28-1.81) and 1.57 (95% CI, 1.28-1.93), respectively. Models containing hypertension and DM were the second most predictive. Combinatory analyses showed distinct relationship patterns between carotid atherosclerosis and hypertension, hyperlipidemia, and DM. Hypertension was significantly correlated with higher ORs for the presence of carotid plaque and advanced carotid atherosclerosis but not for hyperlipidemia.

Conclusion:
Carotid plaques are highly prevalent in community-dwelling elders. The number of common CVD comorbidities was the most predictive determinant of carotid plaques and advanced carotid atherosclerosis. Our results indicate that to reduce the impact of atherosclerotic diseases, blood pressure controls precede the control of blood lipids and glucose in the community-dwelling elders.
Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection
Authors: Chen Kuan-Jung , Huang Yen-Chun , Yao Yu-Cheng , Yang Tzu-Cheng , Lin Hsi-Hsien , Wang Shih-Tien , Chang Ming-Chau , Chou Po-Hsin 
Published: January 2023

Background:
Postvertebroplasty infection (PVI) is a catastrophic complication after vertebroplasty (VP). Although the urinary tract has been considered as a source of infectious pathogens, whether asymptomatic bacteriuria (ASB) is a risk factors for PVI remains unknown.

Methods:
This retrospective study included 716 patients (207 males; 509 females) treated with VP for osteoporotic vertebral fractures in a single medical center between May 2015 and December 2019. Clinical symptoms, urinalysis results, and culture data were collected preoperatively to identify patients with ASB. The primary outcome was PVI at the index level during follow-up. Demographic data and laboratory test results were compared between the PVI and non-PVI groups.

Results:
The mean age of the cohort was 78.6 ± 9.6 (range, 63–106). The prevalence of ASB was 14.1%, with female predominance (63.4%). The overall PVI rate was 1.26% (9/716). The PVI group had more patients with ASB (4/9, 44.4%) than did the non-PVI group (97/707, 13.7%) (p = 0.027). The rate of ASB treatment was similar between the PVI and non-PVI groups (25% vs. 23.7%, respectively). No case of PVI was caused by the urine culture pathogen. Multivariate analysis identified the following risk factors for PVI: ASB (odds ratio [OR], 5.61; 95% CI, 1.14–27.66; p = 0.034), smoking (OR, 16.26; 95% CI, 2.58–102.65; p = 0.003), and malignancy (OR 7.27; 95% CI, 1.31–40.31; p = 0.023).

Conclusion:
ASB was not uncommon among patients admitted for VP and should be considered a marker of relatively poor host immunity. Preoperative ASB, a history of malignancy, and smoking were identified as significant risk factors for PVI.
Transparency of Parental Leave Policies to Prospective Students in US Physician Assistant Programs: A Cross-Sectional Study
Authors: Neary Stephanie , Kamauf Renée , Ruggeri Mary 
Published: January 2023

Introduction
Parental leave policies are not well established or always available for prospective graduate students. This study examined the availability and inclusivity of PA program parental leave policies to prospective students at accredited US programs.

Methods
The websites and available student handbooks of the 282 currently accredited PA programs were searched for the terms “pregnant,” “pregnancy,” “maternity,” “parent,” “family,” “child,” and/or “birth.” Descriptive statistics and Pearson’s chi-square test were used to analyze the data.

Results
In total, 13.5% (38/282) of PA program websites and available handbooks met search criteria. Of these 38 programs, 23 (60.5%) provide information with gendered language that discriminates based on sex, most commonly only mentioning the pregnant female.

Discussion
PA programs should create specific policies for pregnancy-related and parental leaves that are inclusive to heteronormative families as well as nontraditional and nonnuclear families, and these policies should be widely available to potential applicants and students.
From Protocol to Definitive Study—The State of Randomized Controlled Trial Evidence in Sports Medicine Research: A Systematic Review and Survey Study
Authors: Pellarin Mitchell , Youmbi Cheikh Tchouambou , Lotchuang Joyce , Tejpal Tushar , Thangathurai Gowtham , Khan Abdullah , Cohen Dan , Simunovic Nicole , Duong Andrew , Ayeni Olufemi R. 
Published: January 2023

Objective:
To evaluate the progression, quality, and challenges associated with conducting and publishing randomized controlled trials (RCTs) in sports medicine.

Design:
Systematic review and survey.

Setting:
MEDLINE and Embase were searched for all publications before September 17, 2021. A targeted search of clinicaltrials.gov, BMC Musculoskeletal Disorders, PubMed, and Google Scholar were also conducted. The survey was administered to authors using REDCap.

Participants:
Where the systematic search revealed no corresponding published definitive trial, authors of the published pilots were surveyed.

Interventions:
Survey assessing limitations to definitive trials.

Main Outcome Measures:
Protocol/method articles, pilot articles, and relevant clinical trial registry records with corresponding definitive trials were pooled.

Results:
Our literature search yielded 27 006 studies; of which, we included 208 studies (60 (28.8%) pilot RCTs, 84 (40.4%) protocol/method articles, and 64 (30.8%) trial registry records). From these, 44 corresponding definitive RCTs were identified. Pilot study and definitive RCT methodological quality increased on average most significantly during the duration of this review (30.6% and 8.2%). Of the 176 authors surveyed, 59 (33.5%) responded; 24.6% (14/57) stated that they completed an unpublished definitive trial, while 52.6% (30/57) reported having one underway.

Conclusions:
The quality and number of RCT publications within the field of sports medicine has been increasing since 1999. The number of sports medicine–related protocol and pilot articles preceding a definitive trial publication showed a sharp increase over the past 10 years, although only 5 pilot studies have progressed to a definitive RCT.
Lanthony D15 for Occupational Testing: Short-term Repeatability
Authors: Lo Genna , Ng Jason S. 
Published: January 2023

SIGNIFICANCE
The Lanthony D15 has been reported to have poorer repeatability than the Farnsworth D15. This study found that two trials of the test provide high short-term repeatability and can be administered this way for occupational testing.

PURPOSE
This study aimed to determine the short-term repeatability of the Lanthony D15 in patients with color vision deficiency. Repeated trials were used to examine if learning effects occur and to determine how many trials would be necessary to ensure the highest short-term repeatability for occupational testing.

METHODS
Twenty male subjects (mean [standard deviation] age, 27.2 [4.3] years) with congenital color vision deficiency, ranging from mild to severe, participated in this single-visit study. Visual acuity, color vision book screening, Farnsworth D15, and anomaloscope testing were performed for classification purposes. Ten trials of the Lanthony D15 were performed. Color confusion index scores from each trial were determined, and a repeated-measures analysis of variance was used to compare the scores across trials. Orthogonal polynomial analysis was performed to detect any trends across trials through the third order. The intraclass correlation coefficient was calculated.

RESULTS
No differences in color confusion index (mean [standard error of the mean], 3.57 [0.04]) were found across the 10 trials (P = .18). Legendre polynomials showed no statistical significance (all P > .39). The intraclass correlation coefficient was 0.81 (95% confidence interval, 0.70 to 0.90). Based on the method of Shrout and Fleiss, intraclass correlation coefficients of 0.7, 0.8, and 0.9 could be achieved with an average of one, two, and four trials of the test, respectively. However, empirically, 0.9 was not achievable.

CONCLUSIONS
The Lanthony D15 test has fairly high short-term repeatability. Thus, although more trials would likely improve clinical certainty, the mean result of two trials appears sufficient for occupational testing.