bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Hounsfield Units and Severe Multifidus Sarcopenia Are Independent Predictors of Increased Risk for Proximal Junctional Kyphosis and Failure Following Thoracolumbar Fusion
Authors: Pinter Zachariah W. , Mikula Anthony L. , Townsley Sarah E. , Salmons IV Harold I. , Lakomkin Nikita , Michalopoulos Giorgos D. , Nassr Ahmad , Freedman Brett A. , Bydon Mohamad , Fogelson Jeremy , Sebastian Arjun S. , Elder Benjamin D. 
Published: January 2023

Study Design.Retrospective cohort study.Objective.The purpose of the present study was to assess the impact of sarcopenia on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following thoracolumbar spine fusion surgery using opportunistic evaluation of paraspinal fatty degeneration on preoperative magnetic resonance imaging.Summary of Background Data.While paraspinal sarcopenia has been shown to have detrimental consequences following posterior cervicothoracic fusions, the impact of paraspinal sarcopenia on PJK and PJF following thoracolumbar spine fusion surgery remains unknown.Materials and Methods.We performed a retrospective review of patients who underwent posterior spine fusion surgery that extended caudally to the pelvis and terminated cranially between T10 and L2 between 2010 and 2017. The cohort was divided into three groups: (1) patients without PJK or PJF, (2) patients with PJK but no PJF, and (3) patients with PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications.Results.We identified 150 patients for inclusion in this study. Mean Hounsfield Units at the upper instrumented vertebra (UIV) was 148.3±34.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK (117.8±41.9) and PJF (118.8±41.8) subgroups (P<0.001). Severe multifidus sarcopenia was identified at a much higher rate in the subgroups of patients who developed PJK (76.0%) and PJF (78.9%) than in the subgroup of patients who developed neither PJK nor PJF (34.0%;P<0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF.Conclusion.The results of this study suggest severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF, while markers of systemic frailty such as modified Frailty Index and Charlson Comorbidity Index are not associated with an increased risk of these complications.Level of Evidence.III.
Implementation and Utilization of a Web-Based Departmental Annual Faculty Review Program
Authors: Mueller Stephanie K. , Pascal Christina , Spiers John , Seely Ellen W. 
Published: January 2023

Abstract
Supporting faculty in their professional development is a central mission of academic medical centers (AMCs), assisted by routine assessment of faculty development. However, AMCs face barriers to standard faculty assessment, particularly among large departments with diverse faculty roles. We report on the development, implementation, and utilization of a standardized, web-based faculty annual career review (FACR) process deployed within the Department of Medicine at a large AMC, composed of 22 divisions and 1400 faculty. The FACR process was developed to achieve the following goals: Creation of a trackable review of professional goals and barriers to professional development; provide longitudinal faculty reflection on professional growth; and provide data to identify faculty development needs to target initiatives. The FACR was initiated in 2008. We provide specific case examples of utilization of the FACR data for targeted faculty development initiatives, including (1) division benchmarking; (2) targeting career opportunities to individual faculty members; and (3) longitudinal data analysis of 5-year trends of FACR response, including subanalysis by gender, to target faculty development initiatives across the DOM. In summary, we demonstrate successful development, implementation, and utilization of a web-based standard faculty annual review program within a large AMC that allows for systematic evaluation and reflection of professional development by faculty members and their supervisors and allows for data collection and analysis to help target faculty development initiatives.
An umbrella systematic review of the effect of physical exercise on mental health of women in menopause
Authors: Fausto Danielly Y. , Leitão Alice E. , Silveira Juliana , Martins Julia B. B. , Dominski Fábio H. , Guimarães Adriana C. A. 
Published: January 2023

Abstract

Importance
The menopausal transition has been related to worsening mental health. The literature also points out that being physically active during menopause is associated with a favorable effect on climacteric symptoms, specifically on psychological aspects.

Objectives
The aims of the study are to analyze the effects of physical activity on mental health during menopause through an umbrella review and to evaluate the quality of the included Systematic Reviews and meta-analyses (MAs).

Evidence Review
A MeaSurement Tool to Assess Systematic Reviews was used to evaluate the methodological quality of the included studies and the Grading of Recommendations Assessment, Development and Evaluation was applied to assess the level of the evidence of the results. In addition, the effect size of the revised meta-analyses (MAs) was calculated.

Findings
A total of 9 systematic reviews/MAs were included, published between 2014 and 2020. In the A MeaSurement Tool to Assess Systematic Reviews methodological quality assessment, 8 studies were classified as “high quality” and 1 as “low quality.” In terms of quality of the evidence for each result through the Grading of Recommendations Assessment, Development and Evaluation classification, approximately 75% of the studies were classified as “moderate quality,” 22.2% as “high quality,” and 22.2% as “low quality,” with the greatest bias concerning the high heterogeneity of the included studies. In addition, the studies showed low overlap. Despite the high heterogeneity, we can highlight the importance of the practice of physical activity by women in menopause, to prevent and/or reduce problems related to mental health.

Conclusions and Relevance
There was a positive effect of the interventions on depression, however, with no difference between durations (short or long). Regarding stress, the interventions applied did not show a positive effect. The studies that investigated depression linked to anxiety presented conflicting results.
The effect of Cornus mas fruit extract on vasomotor symptoms and sex hormones in postmenopausal women: a randomized, double-blind, clinical trial
Authors: Rimaz Shahnaz , Rahideh Seyedeh Tayebeh , Abolghasemi Jamileh , Jazayeri Shima , Jamshidi Sanaz , Motevalian Manijeh , Solaymani-Dodaran Masoud , Taghizadeh Mohsen , Gholamrezayi Afsaneh , Aryaeian Naheed 
Published: January 2023

Abstract

Objectives

Cornus mas fruit has various antioxidants and anti-inflammatory properties, so this study aims at assessing its effect on menopausal symptoms and sex hormones in postmenopausal women.

Methods
In the current randomized, double-blind clinical trial, 84 individuals (42 per group) were participated. C mas hydroalcoholic extract was prepared, and participants received 300 mg C mas extract or placebo three times a day (900 g in total) for 8 weeks. The demographic, dietary intake, and physical activity information were gathered. Anthropometric indices were measured by standard methods. Furthermore, menopause symptoms were assessed by Greene Climacteric Scale. Also, sex hormones were measured by enzyme-linked immunosorbent assay.

Results
Based on the results, there was a significant difference in total Greene score reduction between the intervention and placebo groups (−3.19 ± 0.54, −0.76 ± 0.32, and P < 0.001). In addition, vasomotor symptoms had a remarkable decrease in the C mas extract group (P < 0.001). Also, the intervention group demonstrated a decreasing trend in the number and duration of hot flushes. Moreover, follicle-stimulating hormone remarkably decreased and estradiol increased in the intervention group (P = 0.016 and P = 0.018).

Conclusions
It has been found that the extract of C mas fruit has a favorable effect on vasomotor symptoms, sex hormones, and related complications in women experiencing menopausal symptoms.
Superficial dyspareunia treatment with hyperstacking of erbium:yttrium-aluminum-garnet SMOOTH laser: a short-term, pilot study in breast cancer survivors
Authors: Fidecicchi Tiziana , Gaspar Adrian , Gambacciani Marco 
Published: January 2023

Abstract

Objective
This prospective pilot study aimed to evaluate the effects of a modified vaginal erbium laser (VEL) protocol, using the hyperstack mode on the vaginal vestibulum and introitus to treat superficial dyspareunia in postmenopausal breast cancer survivors suffering from the genitourinary syndrome of menopause.

Methods
In this pilot, prospective, randomized study, two groups of postmenopausal women suffering from superficial dyspareunia were included: 34 women (VEL group) were treated with erbium laser crystal yttrium-aluminum-garnet (XS Fotona SMOOTH; Fotona, Ljubljana, Slovenia) with a wavelength of 2,940 nm; for the other 34 (hyperstack group), a modified second step of the VEL protocol for the treatment of vestibulum and introitus was used, with hyperstacked (repeating a number of) subablative, long pulses with very low fluences. For each group, three laser applications at 30-day intervals were performed. Symptoms were assessed before, after each application, and after 1 and 3 months from the last laser application, using the visual analog scale score for superficial dyspareunia.

Results
Superficial dyspareunia improved in both groups over time (P < 0.001), regardless of age and years since menopause status. The reduction in visual analog scale score after the third laser application was 58% in VEL versus 73.5% in hyperstack. The hyperstack group, since the first laser application, showed a greater (P < 0.001) and persistent improvement of superficial dyspareunia.

Conclusions
The hyperstack treatment of the introitus and vestibulum in breast cancer survivors leads to a more significant improvement in superficial dyspareunia than the VEL alone.
One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites
Authors: Singh Nikhi P. , Boyd Carter J. , Aluri Akshay , Kovac Stefan , Mainali Bipul , Girardi Abdias , Duke Riley , King Timothy W. , de la Torre Jorge 
Published: January 2023

Background:
There is an increasing trend of nonplastic surgeons performing breast surgery. Within, we evaluate the representation of plastic surgeons listed for breast reconstruction on major hospital system websites within the United States.

Methods:
The website search engines for the top 20 US medical centers according to the US News and World Report’s Hospital Rankings from 2020 to 2021 were queried for search terms pertaining to breast reconstruction. Information collected for search results included gender, if they were a physician, medical specialty, medical school and residency attended, and each individual’s position within the search results.

Results:
Across 80 distinct search attempts, 27 searches (34%) produced no results. The search term “breast reconstruction” yielded the most plastic surgeon search results, with plastic surgeons composing 39% of all search results. The search term “mastectomy” generated the least number of plastic surgeon results, with a 16% representation of plastic surgeons. Nearly two-thirds of physicians identified were nonplastic surgeons (67%). Other surgeons represented 47% of search results and obstetricians/gynecologists, 2%. Nonsurgeons represented 18% of queries. On average, plastic surgeons appeared higher on search lists than nonplastic surgeons, 13th to 39th, respectively (P < 0.001).

Conclusions:
Plastic surgeons composed only a third of physicians identified, and a third of searches produced no results. Patients interested in breast reconstruction may encounter difficulty finding an appropriate plastic surgeon. Inadequate search engines on hospital websites introduce inefficiencies for the entire health care systems and may negatively impact hospital and physician bottom line.
Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study
Authors: Zhang Haijun , Yang Lili , Yu Ziniu , Li Dan , Li Lei , Li Shuangxi , Yan Jun , Li Xun 
Published: January 2023

Background:
HVPG measurement is the gold standard for assessing portal hypertension. Many patients decline HVPG measurements due to associated pain. According to previous studies, propofol sedation during HVPG measurements potentially alters HVPG readings. However, opioid analgesics’ effects on HVPG await full elucidation. This study aimed to evaluate fentanyl analgesia’s effects on HVPG measurement accuracy in patients with cirrhosis.

Methods:
This prospective, multicenter study included patients with cirrhosis undergoing HVPG measurements, which were performed preanalgesia and under analgesia with fentanyl injection (1.0 or 1.5 μg/kg).

Results:
Of the 48 enrolled patients with cirrhosis, 23 were administered 1.0 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 13.4±4.9 mm Hg in preanalgesia and 13.5±5.2 mm Hg under analgesia. HVPG measurement accuracy was not altered after fentanyl analgesia (p = 0.801). The following measures also did not change: heart rate (p = 0.132), mean arterial pressure (p = 0.348), and blood oxygen saturation (p = 0.748); however, respiratory rate (p = 0.001) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p = 0.001). Twenty-five patients were administered 1.5 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 19.5±5.7 mm Hg in preanalgesia and 19.6±5.6 mm Hg under analgesia. HVPG measurement accuracy did not alter after fentanyl analgesia (p = 0.469). Similarly, the following measures did not change: mean arterial pressure (p = 0.871) and oxygen saturation (p = 0.327); nevertheless, respiratory rate (p = 0.015) and heart rate (p = 0.019) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p < 0.001).

Conclusion:
Fentanyl analgesia did not alter HVPG measurement accuracy, and fentanyl improved comfort in patients with cirrhosis during HVPG measurements.
Exosomal proteomics identifies RAB13 as a potential regulator of metastasis for HCC
Authors: Huang Xiu-Yan , Zhang Jun-Tao , Li Feng , Li Ting-Ting , Shi Xiang-Jun , Huang Jin , Huang Xin-Yu , Zhou Jian , Tang Zhao-You , Huang Zi-Li 
Published: January 2023

Background:
Exosomal proteins from cancer cells are becoming new biomarkers for cancer monitoring and efficacy evaluation. However, their biological function and molecular mechanism underlying tumor metastasis are largely unknown.

Methods:
Bioinformatic methods such as bulk gene expression analysis, single-cell RNA sequencing data analysis, and gene set enrichment analysis were employed to identify metastasis-associated proteins. The in vitro and in vivo experiments were used to investigate the function of RAB13 in HCC metastasis.

Results:
We identified RAB13 as one of the critical regulators of metastasis in HCC-derived exosomes for the first time. In vitro, the invasiveness of HCC cell lines could be attenuated by RAB13 silence. In vivo, tumor size and proportion of high-grade lung metastatic nodule could be reduced in the mice with orthotopic transplantation of tumors and intravenously injected with exosomes derived from MHCC97H cell with RAB13 silence (si-RAB13-Exo), as compared with those without RAB13 silence (si-NC-Exo). Moreover, in si-RAB13-Exo group, circulating tumor cell counts were decreased at the third, fourth, and fifth weeks after orthotopic transplantation of tumors, and MMP2 (matrix metalloproteinase 2)/TIMP2 (tissue inhibitor of metalloproteinases 2) ratio was also significantly decreased. In addition, RAB13 expression was also associated with VEGF levels, microvessel density, and tube formation of vascular endothelial cells by both in vitro and in vivo models, indicating that RAB13 was associated with angiogenesis in HCC.

Conclusions:
We have demonstrated exosomal RAB13 as a potential regulator of metastasis for HCC by in silico, in vitro, and in vivo methods, which greatly improve our understanding of the functional impact of exosomal proteins on HCC metastasis.
Autopsy histology data suggest cirrhosis is frequently under-reported on death certificates
Authors: Hagström Hannes , Simon Tracey G. , Söderling Jonas , Ludvigsson Jonas F. 
Published: January 2023

Background:
Cirrhosis may be asymptomatic yet contribute to ill health. Here, we studied how often cirrhosis is discovered first at an autopsy. We also examined how frequent this finding was not reported on formal death certificates.

Methods:
We used register-based data from all liver biopsies in Sweden performed after death. Cross-linkage to national registers was performed to examine how often such patients had accurate coding for cirrhosis on their death certificates.

Findings:
A total of 6187 patients with a liver biopsy performed after death, showing cirrhosis. Of these, 2523 (41%) did not have a diagnosis corresponding to cirrhosis on their final death certificate.
The Experience of Palliative Care Nurses in Qatar During the Time of COVID-19: A Qualitative Study
Authors: JOHNSON Jessie , AL BULUSHI Asma , IDRIS Zeinab , ESSA Ziad Abu , HASSAN Azza 
Published: January 2023

ABSTRACT

Background
The COVID-19 pandemic has been a source of significant confusion and fear for healthcare workers as they try to maintain some sense of normalcy within their daily practices. One of the many areas affected by this pandemic has been palliative care. Palliative care nurses were thrust into a world of chaos as they faced increasing numbers of patients who were in the process of dying.

Purpose
The aim of this research was to explore the caring experiences of palliative care nurses during the COVID-19 pandemic.

Methods
A qualitative interpretive description design was used to explore the experience of nurses caring for dying patients in a palliative care unit during the COVID-19 pandemic. Twenty-two nurses working in a palliative care unit participated in this study. Data were collected during 1.5- to 2-hour focus group sessions that were guided by open-ended questions.

Results
The collected data were analyzed and coded into themes, including (a) transitioning to the new normal, (b) ethical dilemmas, and (c) collaboration and support for fellow colleagues.

Conclusions
Although the COVID-19 pandemic has not yet ended, this study provides relevant implications for practice. These implications include (a) holding continuing education sessions to help nurses better understand the meaning of pandemic conditions and how best to respond and (b) supporting nurses to better cope with the additional burdens faced because of increased patient loads. Overall, the nurses in this study were shown to have demonstrated reliance and resilience in the face of COVID-19.
Development and Evaluation of Neighborhood Care Volunteer Training Programs—Preparing for Older Adult Community Care in Taiwan
Authors: KUNG Pen-Chen , CHE Hui-Lian , WONG Alice M. K. , LIAO Yen Ting , SUNG Ya Li , HUANG Huei-Ling 
Published: January 2023

ABSTRACT

Background
The prevalence of chronic diseases and functional disorders is projected to escalate as the older adult population increases. Thus, the demand for and burdens of long-term care are increasing. Training middle-aged and older volunteers at the community level will enhance health promotion and disease prevention in communities.

Purpose
In this study, multilevel volunteer training programs and related implementation methods were designed for neighborhood caregivers

Methods
This study was divided into two phases. In Phase 1, an expert review was conducted using the modified Delphi method to congregate expert opinions into an interdisciplinary consensus and establish the content and methods of implementation of the multilevel training program. In Phase 2, the training programs were implemented and evaluated.

Results
In Phase 1, 17 experts in geriatric and long-term care were enrolled in the Delphi surveys. Consensus was defined as at least 80% agreement. These experts devised volunteer training programs for neighborhood caregivers at three levels: basic caregiver training, advanced caregiver training, and volunteer caregiver instructor training. The curriculum focused on fulfilling the health demands of neighborhood care; adopted disability-prevention and disability-delaying healthcare as the basic framework; and referred to the attention, relevance, confidence, and satisfaction model of motivational design. This model of motivational design drew on the attributes of volunteers and the current state of care programs, including interest, program difficulty, and feasibility of future services. In Phase 2, 50 community middle-aged and older volunteers enrolled in the training programs and, after completing the program, were asked to evaluate their satisfaction with the program content and program effectiveness. A high level of satisfaction was reported across all three levels.

Conclusions/Implications for Practice
The training programs achieved satisfactory consistency and convergence and were well received by the volunteer trainees. These programs may be referenced in the development of future training programs and the creation of a model of community healthcare services. The curriculum was designed from the learners' perspective with direct healthcare applications. A progressive multilevel set of neighborhood care volunteer training programs was offered to cultivate community volunteers.
Complications and Utility of Gastrointestinal Endoscopy Post Hematopoietic Stem Cell Transplantation: An 11 Year Experience
Authors: Chan Joseph , Ganosi Vasiliki , Basude Dharamveer , Mirci-Danicar Oana C. , Wiskin Anthony E. 
Published: January 2023

Objectives:
Diagnostic gastrointestinal (GI) endoscopy is used to differentiate GI graft versus host disease (GI-GvHD), which requires escalation of immunosuppressive treatment (IST), from other conditions such as viral infection, which may require reduction of IST. The aim of this study was to establish the clinical utility of GI endoscopy post hematopoietic stem cell transplant (HSCT) and the complication rate of these procedures.

Methods:
This was a single-center observational retrospective cohort study. Hospital pediatric endoscopy and HSCT databases identified patients between January 2010 and December 2020. GI-GvHD was diagnosed if there were positive histological findings and clinical context. Data collected included demographics, timing of endoscopy post-HSCT, clinical utility, and complications of endoscopy. The endoscopy was deemed to be “clinically useful” if it resulted in a change of clinical management or helped to narrow down the differential diagnosis for the clinical team.

Results:
Three hundred thirty-nine HSCT occurred in 320 children during the study period. Sixty-six of 339 (19%) HSCT needed an “endoscopy episode.” One hundred nineteen endoscopies were performed (53 concurrent upper and lower GI endoscopies, 11 upper GI endoscopies, and 2 lower GI endoscopies). Four of 119 (3%) endoscopies had complications: septic shock (1), duodenal hematoma (1), GI bleeding (1), and colonic perforation (1). Four patients had incomplete records to assess utility of endoscopy. Fifty-seven of 62 (92%) endoscopy episodes were “clinically useful,” and 41 of 62 (66%) had a change in IST.

Conclusions:
The clinical utility of endoscopy is high and in the majority of cases is associated with a change in patient management. Children post-HSCT are at high risk of complications from endoscopy; this should be made clear in the process of obtaining consent for procedures.