bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students
Authors: Milam Adam J. , Brown Italo , Edwards-Johnson Jennifer , McDougle Leon , Sousa Aron , Furr-Holden Debra 
Published: February 2022

Purpose
To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.

Method
This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author’s social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.

Results
Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination).

Conclusions
Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.
Learning NOTSS While Tying Knots: Integrating the Nontechnical Skills for Surgeons Course With Technical Surgical Skills Training, A Mixed Methods Study
Authors: Abahuje Egide , Bartuska Andrew , Dias Roger D. , Muneza Eugène , Sibomana Isaie , Williams Wendy , Koch Rachel , Robertson Jamie M. , Ntakiyiruta George , Evans Faye , Riviello Robert , Yule Steven 
Published: February 2022

Objective:
The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals.

Background:
Surgical errors and resulting adverse events are due to variability in both technical and nontechnical surgical skills. Providing technical and nontechnical skills training to the perioperative team may enhance the learning of both of these skills and promote safe intraoperative patient care.

Methods:
A quality improvement framework guided the process of integrating essential surgical skills and nontechnical skills into a single training program for surgical teams. The resulting 2-day training program was delivered to 68-person teams from 17 hospitals. Nontechnical skills for surgeons was taught through didactics and in the operating room, where preoperative briefing, intraoperative interactions, and postoperative debriefing were used as essential and nontechnical skills teaching moments. Postcourse surveys, follow-up interviews, focus groups, and direct observation of participants in the operating room were conducted to assess how participants implemented the knowledge and skills from the training into practice.

Results:
Ninety-seven percent of the participants reported that they were satisfied with the course. Follow-up participant interviews and focus groups reported that the course helped them to improve their preoperative planning, intraoperative communication, decision-making, and postoperative debriefing.

Conclusions:
It is possible to implement an integrated essential surgical skills and nontechnical skills training course. Integrating nontechnical skills into essential surgical skills courses may enhance learning of these skills.
A Prospective, 3-year Longitudinal Study of Modic Changes of the Lumbar Spine in a Population-based Cohort
Authors: Tamai Hidenobu , Teraguchi Masatoshi , Hashizume Hiroshi , Oka Hiroyuki , Cheung Jason P.Y. , Samartzis Dino , Muraki Shigeyuki , Akune Toru , Kawaguchi Hiroshi , Nakamura Kozo , Tanaka Sakae , Yoshida Munehito , Yoshimura Noriko , Yamada Hiroshi 
Published: February 2022

Study Design.
Large-scale, prospective, population-based, longitudinal observational study.

Objective.
The aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period.

Summary of Background Data.
Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only.

Methods.
Overall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up.

Results.
Overall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively.

Conclusion.
This study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.

Level of Evidence: 2
Identifying Sensitive Windows of Exposure to NO2 and Fetal Growth Trajectories in a Spanish Birth Cohort
Authors: Whitworth Kristina W. , Rector Alison , Ish Jennifer , Chauhan Suneet P. J. , Ibarluzea Jesús , Guxens Mònica , Swartz Michael D. , Symanski Elaine , Iñiguez Carmen 
Published: February 2022

Background:
We previously identified associations between trimester-specific NO2 exposures and reduced fetal growth in the Spanish INfancia y Medio Ambiente (INMA) project. Here, we use temporally refined exposure estimates to explore the impact of narrow (weekly) windows of exposure on fetal growth.

Methods:
We included 1,685 women from INMA with serial ultrasounds at 12, 20, and 34 gestational weeks. We measured biparietal diameter (BPD), femur length, and abdominal circumference (AC) and from them calculated estimated fetal weight (EFW). We calculated z-scores describing trajectories of each parameter during early (0–12 weeks), mid (12–20 weeks), and late (20–34 weeks) pregnancy, based on longitudinal growth curves from mixed-effects models. We estimated weekly NO2 exposures at each woman’s residence using land-use regression models. We applied distributed lag nonlinear models to identify sensitive windows of exposure. We present effect estimates as the percentage change in fetal growth per 10 μg/m3 increase in NO2 exposure, and we calculated cumulative effect estimates by aggregating estimates across adjacent lags.

Results:
We identified weeks 5–12 as a sensitive window for NO2 exposure on late EFW (cumulative β = −3.0%; 95% CI = −4.1%, −1.9%). We identified weeks 6–19 as a sensitive window for late growth in BPD (cumulative β = −2.0%; 95% CI = −2.7%, −1.4%) and weeks 8–13 for AC (cumulative β = −0.68%; 95% CI = −0.97%, −0.40%). We found suggestive evidence that third trimester NO2 exposure is associated with increased AC, BPD, and EFW growth in late pregnancy.

Conclusions:
Our findings are consistent with the hypothesis that NO2 exposure is associated with alterations in growth of EFW, BPD, and AC dependent on the specific timing of exposure during gestation.
A Prospective Cohort Study of Seasonal Variation in Spontaneous Abortion
Authors: Wesselink Amelia K. , Wise Lauren A. , Hatch Elizabeth E. , Mikkelsen Ellen M. , Savitz David A. , Kirwa Kipruto , Rothman Kenneth J. 
Published: February 2022

Background:
Up to 30% of pregnancies end in spontaneous abortion, yet few risk factors have been identified. Examining seasonal patterns in risk of spontaneous abortion can generate new hypotheses regarding environmental and lifestyle determinants.

Methods:
We used data from Pregnancy Study Online—a preconception cohort study of pregnancy planners from the United States and Canada—to examine seasonal variation in spontaneous abortion risk. We enrolled 12,197 women during 2013 to 2020, 6104 of whom reported a conception within 12 months of enrollment. On follow-up questionnaires, participants reported date of spontaneous abortion and weeks gestation at time of loss. We used periodic regression to estimate two aspects of seasonal occurrence: peak/low ratio—a measure of intensity of seasonal variation—and peak timing. We examined season at risk (from the date of each gestational week) in relation to spontaneous abortion; in a secondary analysis, we examined season of conception in relation to spontaneous abortion. We controlled for seasonal patterns in attempt initiation via month the pregnancy attempt began.

Results:
Almost 20% of women experienced spontaneous abortion. Risk was highest in late August, with a peak/low ratio of 1.3 (95% confidence interval [CI] = 1.1, 1.6). This seasonal pattern was evident almost exclusively for spontaneous abortion at <8 weeks since the last menstrual period date (peak/low ratio = 1.4; 95% CI = 1.2, 1.8), and associations were stronger among women living in the Southern and Midwestern United States.

Conclusions:
Environmental or lifestyle factors more prevalent in late summer may be associated with increased risk of early spontaneous abortion.
PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CHOROIDAL METASTASES
Authors: Nguyen Minh T. , Stacey Andrew W. 
Published: February 2022

Purpose:
To investigate the efficacy and safety of photodynamic therapy (PDT) in the treatment of choroidal metastasis.

Methods:
We conducted a systematic review of all reported cases of choroidal metastases treated with PDT in literature, and included the cases from our institution, for a comprehensive meta-analysis.

Results:
We identified 52 tumors in 40 eyes of 34 patients. The mean age was 60 years (range 28–77). The mean tumor thickness was 1.9 mm (range 0–4.8 mm), whereas the mean largest basal diameter was 8.2 mm (range 1.5–30 mm) on presentation. After an average of 1.4 treatment visit, PDT resulted in decreased tumor thickness (mean 1.9 mm before vs. 1.0 mm after PDT, P < 0.0001) and decreased central macular thickness (mean 454 µm before vs. 289 µm after PDT, P = 0.03). After PDT, 82% of tumors had reduced thickness, and subretinal fluid resolved in 75% of eyes. Photodynamic therapy also resulted in stable or improved vision in 78% of treated eyes (logMAR 0.50 before vs. 0.56 after PDT, P = 0.54). No adverse events were reported, and PDT was effective in treating the most common choroidal metastases (tumor control rate of 94% in 16 lung adenocarcinoma and 92% in 26 breast carcinoma metastasis cases).

Conclusion:
Photodynamic therapy is effective at controlling tumors and preserving vision in patients with some choroidal metastases. Because of its minimal time commitment and good safety profile, PDT should be considered as a potential first-line treatment for small choroidal metastases.
A COMMON FINDING IN FOVEAL-SPARING EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN IMPLICATES BASAL LAMINAR DEPOSITS
Authors: Fragiotta Serena , Parravano Mariacristina , Sacconi Riccardo , Costanzo Eliana , Viggiano Pasquale , Prascina Francesco , Capuano Vittorio , Souied Eric H. , Querques Giuseppe 
Published: February 2022

Purpose:
To characterize structural and clinical alterations preceding the diffuse macular atrophy in extensive macular atrophy with pseudodrusen (EMAP) and their evolution toward atrophic changes.

Methods:
A retrospective chart review was performed of patients with early-onset reticular pseudodrusen (i.e., pre-EMAP) younger than 55 years and EMAP with foveal sparing. Patients were included if they had complete medical records and multimodal imaging.

Results:
A total of 12 patients were reviewed, of whom 4 of 12 patients (7 eyes) presented a pre-EMAP stage, characterized by the presence of pseudodrusen-like deposits without atrophic changes, while the remaining 8 of 12 patients (10 eyes) exhibited EMAP with foveal sparing (60.1 ± 6.4 years). Subretinal deposits of various stages tended to fade, leaving subretinal pigment epithelium accumulation of hyperreflective material with a physical separation between the retinal pigment epithelium–basal lamina and the Bruch membrane, along with the persistence of hyperreflective material after retinal pigment epithelium loss. These findings preceded atrophy development in a pre-EMAP stage and the EMAP stage with foveal sparing.

Conclusion:
Our findings presented distinct multimodal imaging features in eyes with reticular pseudodrusen depicting a peculiar phenotype of rapidly progressing atrophy in midlife. The disease spectrum may include other forms of geographic atrophy allied by thickened basal laminar deposits.
Electro-acupuncture for post-stroke cognitive impairment
Authors: Xie Guanli , Tang Xiaoxia , Luo Wen , Xu Yanfei , Li Deguang , Wang Zhe , Yuan Changfei , Xia Yibo , Zhou Xiaohan , Tian Miao , Yuan Zhifa , Wang Tao , Liao Jianglong 
Published: February 2022

Abstract

Background:
A considerable number of stroke survivors suffered from cognitive impairment, and more than one third of stroke survivors are affected at 3 and 12 months after the stroke. Although the published systematic reviews suggest that acupuncture can help improve post-stroke cognitive dysfunction, the power of the results is low due to study limitations. Therefore, this review is necessary to analyze the effect of acupuncture on cognitive impairment after stroke and to provide evidence for cognitive impairment in stroke.

Methods:
This study will be carried out in strict accordance with the Cochrane Handbook for Systematic Reviews of Interventions. According to the pre-established search strategy (PICOS framework), all the literature will be obtained from online databases including Cochrane Central Register of Controlled Trials in the Cochrane Library, Medline (via PubMed), EMBASE (via embase.com), CINAHL (via EBSCOhost), China National Knowledge Infrastructure database, WanFang Database, Chinese Science and Technology Periodical Database, and Sino-Med Database from inception until December 31, 2021 with no language limitations. Two reviewers will screen the records and include quality studies according to inclusion criteria independently. The data needed will be extracted independently by 2 authors according to a table of data extraction. Any inconsistencies in literature screening and data collection will be resolved to reach a consensus via discussion with a third author. Risk of bias for each study will be assessed using risk of bias tool. RevMan5.3 will be used to analyze the data. Heterogeneity will be identified and measured by Chi2. Subgroup analyses and sensitivity analysis will be carried out. Grading of Recommendations Assessment, Development and Evaluation will be used to evaluate the evidence for each outcome.

Conclusion:
The results of this study will provide a theoretical basis for the clinical use of electro-acupuncture to treat cognitive dysfunction after stroke.

Unique INPLASY number:
INPLASY202210038
A case report of intracardiac bone cement embolization after posterior decompression and cement-enhanced pedicle screw fixation for osteoporosis and lumbar degeneration
Authors: Sun Kui , Huang Fuli , Liang Biru 
Published: February 2022

Abstract

Rationale:
Bone cement leakage is a common complication of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) surgery and has also been reported in posterior decompression and cement-enhanced pedicle screw fixation. When bone cement leaks through the venous system, it will have serious consequences and even endanger the life of the patient, especially when the bone cement causes intracardiac embolism.

Patient concerns:
A 70-year-old woman developed chest tightness and decreased blood oxygen saturation following posterior decompression and cement-enhanced pedicle screw fixation.

Diagnosis:
After the patient was given symptomatic treatment, the symptoms were not relieved, the high-sensitivity troponin I level continued to rise, the electrocardiogram results were abnormal, and chest computed tomography (CT) revealed multiple flaky and strip-shaped dense shadows in the heart.

Intervention:
The patient underwent removal of foreign bodies from the heart under cardiopulmonary bypass and tricuspid valvuloplasty, removal of intracardiac bone cement, and repair of the tricuspid valve and chordae.

Outcome:
The patient recovered well postoperatively and was discharged from the hospital after 3 weeks. There were no intracardiac foreign bodies observed on chest CT after the operation.

Lessons:
For patients with cardiopulmonary discomfort after posterior decompression and bone cement-enhanced pedicle screw fixation, in view of the limitations of radiographic examination, we recommend performing chest CT examination to confirm the diagnosis. For patients with intravascular foreign body embolism, multidisciplinary team joint treatment saves lives.
Incidental adenocarcinoma of the gallbladder in a patient with Y insertion gallbladder duplication in the context of recurrent biliary colic
Authors: Jefferys Dustin , Roy Susmit , Majid Adeeb 
Published: February 2022

Abstract

Rationale:
Gallbladder cancer is the most common malignancy of the biliary tree. Despite this, the only curative therapy remains surgical resection of the lesion achieving microscopically clear margins before malignant spread has occurred. Gallbladder duplication is an uncommon anatomical variance which occurs globally. It can present in a range of ways dependent on the embryological origin of the variance.

Case:
A 52-year-old female presented for planned laparoscopic cholecystectomy in the context of cholelithiasis resulting in recurrent biliary colic. The patient had no personal history of malignancy or significant medical comorbidities.

Diagnosis:
Intraoperatively, the patient was found to have Y-insertion variation of gallbladder duplication. Histopathology of the resected gallbladders showed an incidental invasive gallbladder adenocarcinoma affecting one of the gallbladders.

Intervention:
Both gallbladders were laparoscopically resected en-bloc.

Outcomes:
The patient underwent oncology staging, which found no evidence of metastatic spread. Regular surveillance is attended with no recurrence of disease identified.

Conclusion:
There are few reported cases detailing the occurrence of gallbladder adenocarcinoma in the presence of duplication of the gallbladder. This case demonstrates the clinical benefit of R0 surgical resection of gallbladder cancer, whilst highlighting the difficulties of diagnosing duplication of the gallbladder or gallbladder adenocarcinoma.
Acupuncturing of myofascial pain trigger points for the treatment of knee osteoarthritis
Authors: Lin Xingzhen , Li Fei , Lu Hualong , Zhu Manhua , Peng Tian Zhong 
Published: February 2022

Abstract

Background:
Osteoarthritis of the knee is one of the major disorders leading to social dysfunction, economic loss and social development. This study was conducted to systematically evaluate the efficacy and safety effectiveness of acupuncture inactivation of myofascial pain trigger points in the treatment of osteoarthritis of the knee.

Methods:
Randomized Controlled Trials (RCTs) on the treatment of knee pain were searched by computer from PubMed, The Cochrane Library, China journal full-text database (CNKI), Chinese biomedical literature database (CBM), China academic journal database (Wanfang Data) databases from the date of creation to December 2021, and the data were analyzed by Reman 5.3 software for data analysis.

Results:
A total of 724 patients from 9 RCTs were finally included, and the results of meta-analysis showed that the acupuncture myofascial pain trigger point group was better than the control group in terms of total effective rate, cure rate, VAS score, Lysholm score, and WOMAC score.

Conclusion:
The efficacy and safety of acupuncturing myofascial pain trigger points in the treatment of knee osteoarthritis is positive, but due to the limited number of literature included in this study and the low quality of the included literature, there is still a need for high-quality and large sample size RCTs for the analysis of this treatment option.
The effect of music therapy on the anxiety, depression and sleep quality in intensive care unit patients
Authors: Li Dan , Yao Yunhua , Chen Jia , Xiong Gang 
Published: February 2022

Abstract

Background:
Music therapy serves as a non-pharmacological intervention for a variety of disorders with promising results. However, the effect of music therapy on improving anxiety, depression, and sleep quality in intensive care unit (ICU) patients remains unclear. This meta-analysis aims to evaluate the effect of music therapy on improving anxiety, depression, and sleep quality in ICU patients, thus providing evidences to support music therapy as a novel complementary alternative therapy.

Methods:
Randomized controlled trials (RCTs) reporting the efficacy of music therapy on improving anxiety, depression and sleep quality in ICU patients published before January 2022 will be searched in online databases, including the PubMed, the Cochrane Library, Web of Science, Embase, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database, and WanFang Database. Literature screening, data extraction, and evaluation of risk of bias will be independently performed by two investigators. Meta-analysis will be performed using Stata 14.0 software.

Results:
The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:
This study will provide reliable evidence-based evidence for the effect of music therapy on anxiety, depression, and sleep quality in ICU patients.

Ethics and dissemination:
Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF Registration number:
DOI 10.17605/OSF.IO/EXAZ6.