bluuebunny/crossref_metadata_2025_split huggingface dataset:
Race.Culture.OBGYN: Creating a Database of Diversity, Equity, and Inclusion Resources for Obstetrics and Gynecology Residency Programs [A60]
Authors: Venkatesh Anusha , Udutha Anirudh , Dickinson Micaela , Gandy Asia , Darivemula Shilpa M. 
Published: June 2022

INTRODUCTION:
Multiple studies repeatedly demonstrate that people of color suffer poorer obstetrical and gynecological outcomes in the United States. To improve physician awareness on these inequities, the American College of Obstetricians and Gynecologists released a Committee Opinion on Race and Ethnic Disparities recommending that all obstetrics and gynecology residency programs address inherent bias and systemic racism. However, competing resident educational requirements leaves limited time for a diverse diversity, equity, and inclusion (DEI) education beyond the occasional lecture. The Race.Culture.OBGYN initiative seeks to increase the frequency and quality of GME level DEI education by making it applicable to already existing didactics and clinical duties.

METHODS:
The Race.Culture.OBGYN initiative has curated a wide variety of resources for specific clinical conditions in every subspecialty in obstetrics and gynecology. The resources are curated on an open access website to allow graduate medical education (GME) programs to incorporate DEI knowledge into specific didactic lectures with ease. Our hypothesis is that residents will feel more comfortable applying DEI education to daily clinical encounters. A national survey of the current statuses of DEI education at residency programs and an evaluation of the resources on the website will be collected.

RESULTS:
The Race.Culture.OBGYN project has curated resources and has now expanded into creating a podcast series to elevate voices of resident physicians doing DEI work locally. Survey results are pending.

CONCLUSION:
By creating a single hub of condition-based resources, this project reminds us the issues are more pervasive, present in all aspects of clinical care. Through this, the initiative hopes to transform DEI education for obstetrics and gynecology residents.
Efficacy and Safety of Elagolix 150 mg QD in Women With Uterine Fibroids and Heavy Menstrual Bleeding [A87]
Authors: Kroll Robin , Poindexter Alfred , Ng Juki , Li Hong , Snabes Michael 
Published: June 2022

INTRODUCTION:
Elagolix is an oral GnRH antagonist approved in combination with hormonal add back therapy (elagolix 300 mg BID+estradiol/norethindrone acetate QD) for the treatment of heavy menstrual bleeding (HMB) associated with uterine fibroids (UF) for up to 24 months (M). However, estradiol and/or norethindrone acetate may be contraindicated in some patients with UF and HMB.

METHODS:
This phase 4, randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of elagolix 150 mg QD for UF-associated HMB. Premenopausal women with UF and HMB were randomized 2:1 to elagolix 150 mg QD or placebo for 6M. Assessments included the proportion of patients with menstrual blood loss (MBL) volume less than 80mL at the final month (FM) and greater than or equal to 50% reduction in MBL volume from baseline to FM, and evaluating adverse events (AEs).

RESULTS:
Eighty-two patients were randomized (54 elagolix, 28 placebo). Elagolix 150 mg QD reduced MBL volume to less than 80mL and by greater than or equal to 50% from baseline in a clinically meaningful and statistically significantly larger proportion of patients versus placebo at FM (49.4% versus 23.3%, respectively; difference of 26.1%; P< .05). The most common AEs were headache and hot flush (13.0% and 11.1%, respectively, with elagolix; both 3.6% placebo). The safety profile was consistent with previously established elagolix 150 mg monotherapy safety.

CONCLUSION:
Elagolix 150 mg QD alone significantly reduced HMB in patients with UF after 6M of treatment with no new safety signals and may be an effective therapeutic option for patients with contraindications to estradiol and/or norethindrone acetate.
Assessment of Immune Profiles in Patients With Endometriosis and Associated Patient Outcomes [A88]
Authors: Loret de Mola J. Ricardo , Osorio Erika Gonzalez , Groesch Kathleen , Wilson Teresa , Delfino Kristin , Braundmeier-Fleming Andrea 
Published: June 2022

INTRODUCTION:
Endometriosis is associated with inflammation. We characterized systemic immune populations in patients with endometriosis and identified associations between immune status and therapies (surgical intervention and/or hormonal therapy, HT) on clinical outcomes.

METHODS:
Peripheral blood was collected on the day of surgery (DOS) and ∼1-3 weeks post-surgical intervention (PSI) from consented subjects (IRB approval #14-220). Thirty-three cases (surgically confirmed endometriosis) and nine controls underwent laparoscopy with obstetrics and gynecology faculty at Southern Illinois University School of Medicine. Peripheral tolerant regulatory T-cells (Tregs) and inflammatory T-helper 17 (Th17) cells were identified via flow cytometry. Outcomes (recurrence of pain) were assessed through review of electronic health records. Categorical variables were compared by the Fisher exact test; continuous variables were compared with the Student t-test or nonparametric equivalent. Predictors of pain recurrence were assessed using Cox proportional hazards regression analyses.

RESULTS:
Compared to controls, patients with endometriosis had greater inflammation PSI (P=0.016). Patients with endometriosis who used HT had reduced inflammation compared to patients without HT (1.280 vs. 2.834, respectively; P=.028). In patients with endometriosis, risk of pain recurrence increased with greater inflammation at DOS (P =.003). Additionally, reduction of inflammation at PSI did not result in decreased risk of pain recurrence (P=.034).

CONCLUSION:
Neither surgical intervention nor HT reduced inflammation alone; yet, when used in conjunction, they reduced inflammation in endometriosis patients. Reduction of inflammation following surgical intervention was not effective at reducing the risk of pain recurrence. Thus, while interventional strategies do affect inflammatory status, inflammatory status does not predict clinical outcomes.
Lymph Node Dissection for Uterine Cancer is Associated With a Higher Incidence of Venous Thromboembolism [A112]
Authors: LeBental Alexandra 
Published: June 2022

INTRODUCTION:
The objective of this study was to examine whether lymphadenectomy was associated with development of postoperative venous thromboembolic events (VTE), and ultimately to identify an area for primary prevention of VTE in patients with endometrial cancer undergoing surgical management.

METHODS:
Patients with endometrial cancer who underwent minimally invasive hysterectomy recorded in the American College of Surgeons National Surgical Quality Improvement (NSQIP) database between 2014 and 2017 were identified. Primary exposure was performance of lymphadenectomy. The primary outcome was VTE, including both deep vein thrombosis (DVT) and pulmonary embolism (PE). Associations were examined with bivariable tests and multivariable regression. Effect modification was performed using logistic regression.

RESULTS:
A total of 19,162 women with endometrial cancer who underwent minimally invasive hysterectomy between 2014 and 2017 were identified. Of these, 10,523 underwent lymphadenectomy and 8,639 did not. The odds of DVT with lymphadenectomy versus without lymphadenectomy were 2.59 (1.329-5.046). When adjusted for body mass index (BMI), cancer stage, operative time, and smoking status this remained significant at 2.473 (1.265-4.835). The odds of PE after minimally invasive surgery including lymphadenectomy versus without lymphadenectomy was 2.054 (1.281-3.464). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 1.928 (1.140-3.263).

CONCLUSION:
Lymphadenectomy is associated with increased risk of VTE in patients undergoing minimally invasive surgery for endometrial cancer. Based on this study, the number needed to treat to prevent PE is 333, and the number needed to treat for DVT is 200. The morbidity associated with VTE in patients undergoing minimally invasive surgery for endometrial cancer might be mitigated by prophylactic anticoagulation.
Get It Off Your Chest: A Narrative Review of Breast Ulcers
Authors: Shavit Eran , Alavi Afsaneh 
Published: June 2022

ABSTRACT
Cutaneous breast ulcers are uncommon but important encounters in clinical practice. Myriad causes may introduce ulcers in the breast tissue. Women are more prone to breast ulcers than men because of having heavier breast fatty tissue. Thorough medical history may easily reveal the underlying etiology; however, a tissue biopsy is often required to rule out other potential causes. The clinical presentation varies based on the underlying etiology, but some clues include surgical scars for postoperative wound dehiscence or well-defined violaceous borders with undermined ulcer base in pyoderma gangrenosum. In this article, the authors divide breast cancers into two major groups: with and without underlying mass. Depending on the underlying etiology, treatment may involve topical medications; optimal wound care; systemic medications such as antibiotics, immunosuppressive medications, or biologics; surgery; or a combination of all of the above. This article aims to shed light on a less frequent anatomic location of ulcers and provide advice to clinicians to facilitate accurate diagnosis and treatment.

GENERAL PURPOSE
To provide comprehensive information about breast ulcers to facilitate accurate diagnosis and treatment of these lesions.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:
1. Differentiate common wound complications after mastectomy.
2. Identify the clinical manifestations of various types of breast ulcers.
3. Explain appropriate pharmacologic and nonpharmacologic treatment options for various types of breast ulcers.
“Turning The Tables”: A Technical Tip to Overcome Anatomic Constraints While Distal Locking During Femur Intramedullary Nailing
Authors: Mittal Samarth , Trikha Tanya , Karpe Aashraya , Vatsya Pulak , Trikha Vivek 
Published: June 2022

Introduction:
Interlocking nailing for femoral shaft fractures is one of the most common surgeries by orthopedic traumatologists. With the advent of cephalon-medullary nailing, a center-center position of the head screw has become mandatory. With retroversion or reduced anteversion of neck, a center placement needs internal rotation of the nail. This makes distal locking problematic, as now making a perfect circle is difficult due to the physical constraints of C-arm rotation.

Objective:
To describe a novel technique to overcome the anatomic constraints and get a perfect circle for quick distal locking.

Material and Methods:
We used a novel technique in our routine femur nailing cases. Here, in cases with reduced anteversion of the neck, distal locking was tenuous due to difficulty in making a perfect circle. Thus, we have used a new technique called “Turning the table” where we externally rotate the table, which allows us to get a perfect circle for locking in almost a single exposure.

Results:
This is a useful technique in cases where getting a perfect circle is difficult due to anatomic constraints and variations and can help in getting a perfect circle with limited radiation exposure.
Persistent vascular dysfunction following an acute nonpharmacological reduction in blood pressure in hypertensive patients
Authors: Fermoyle Caitlin C. , Broxterman Ryan M. , La Salle D. Taylor , Ratchford Stephen M. , Hopkins Paul N. , Richardson Russell S. , Trinity Joel D. 
Published: June 2022

Background:
Vascular dysfunction, an independent risk factor for cardiovascular disease, often persists in patients with hypertension, despite improvements in blood pressure control induced by antihypertensive medications.

Methods:
As some of these medications may directly affect vascular function, this study sought to comprehensively examine the impact of reducing blood pressure, by a nonpharmacological approach (5 days of sodium restriction), on vascular function in 22 hypertensive individuals (14 men/8 women, 50 ± 10 years). Following a 2-week withdrawal of antihypertensive medications, two 5-day dietary phases, liberal sodium (liberal sodium, 200 mmol/day) followed by restricted sodium (restricted sodium, 10 mmol/day), were completed. Resting blood pressure was assessed and vascular function, at both the conduit and microvascular levels, was evaluated by brachial artery flow-mediated dilation (FMD), reactive hyperemia, progressive handgrip exercise, and passive leg movement (PLM).

Results:
Despite a sodium restriction-induced fall in blood pressure (liberal sodium: 141 ± 14/85 ± 9; restricted sodium 124 ± 12/79 ± 9 mmHg, P < 0.01 for both SBP and DBP), FMD (liberal sodium: 4.6 ± 1.8%; restricted sodium: 5.1 ± 2.1%, P = 0.27), and reactive hyperemia (liberal sodium: 548 ± 201; restricted sodium: 615 ± 206 ml, P = 0.08) were not altered. Similarly, brachial artery vasodilation during handgrip exercise was not different between conditions (liberal sodium: Δ0.36 ± 0.19 mm; restricted sodium: Δ0.42 ± 0.18 mm, P = 0.16). Lastly, PLM-induced changes in peak blood flow (liberal sodium: 5.3 ± 2.5; restricted sodium: 5.8 ± 3.6 ml/min per mmHg, P = 0.30) and the total vasodilatory response [liberal sodium: 2 (0.9–2.5) vs. restricted sodium: 1.7 (1.1–2.6) ml/min per mmHg; P = 0.5] were also not different between conditions.

Conclusion:
Thus vascular dysfunction, at both the conduit and microvascular levels, persists in patients with hypertension even when blood pressure is acutely reduced by a nonpharmacological approach.
Lifestyle modification and cognitive function among individuals with resistant hypertension: cognitive outcomes from the TRIUMPH trial
Authors: Smith Patrick J. , Sherwood Andrew , Hinderliter Alan L. , Mabe Stephanie , Watkins Lana L. , Craighead Linda , Ingle Krista , Tyson Crystal , Avorgbedor Forgive , Lin Pao-Hwa , Kraus William E. , Liao Lawrence , Blumenthal James A. 
Published: June 2022

Background:
Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia. Lifestyle modification has been suggested to improve cognitive function through its salutary effects on vascular function.

Methods:
Participants included 140 patients with resistant hypertension participating in the TRIUMPH trial. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA). Participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. Biomarkers of vascular [flow mediated dilation of the brachial artery (FMD)], microvascular, and cerebrovascular function were also collected, in addition to weight, fitness, and ambulatory blood pressure.

Results:
Participants averaged 63 years of age, 48% women, 59% black, and obese [mean BMI = 36 kg/m2 (SD = 4)]. Cognitive performance improved across the entire cohort during the 4-month trial [t-scores pretreatment = 48.9 (48, 50) vs. posttreatment = 50.0 (49, 51), P < 0.001]. Postintervention Executive Function/Learning composite performance was higher for participants in C-LIFE compared to SEPA (d = 0.37, P = 0.039). C-LIFE intervention effects on Memory and Processing Speed were moderated by sex and baseline stroke risk, respectively (P = 0.026 and P = 0.043 for interactions), such that males and participants with greater stroke risk showed the greatest cognitive changes. FMD [C-LIFE: +0.3% (−0.3, 1.0) vs. SEPA: −1.4% (−2.5, −0.3), P = 0.022], and microvascular function [C-LIFE: 97 (65, 130) vs. SEPA: 025 (−75, 23), P < 0.001] were improved in C-LIFE compared with SEPA, whereas cerebrovascular reactivity was not [C-LIFE: −0.2 (−0.4, 0) vs. SEPA: 0.1 (−0.2, 0.4), P = 0.197). Mediation analyses suggested that increased executive function/learning was associated with reduced ambulatory SBP levels secondary to weight loss [indirect effect: B = 0.25 (0.03, 0.71)].

Conclusion:
Lifestyle modification individuals with resistant hypertension improves cognition, which appeared to be associated with reduced ambulatory SBP changes through weight loss. Cognitive improvements were accompanied by parallel improvements in endothelial and microvascular function.
CHOROIDAL AMYLOID DEPOSITION
Authors: Mano Fukutaro , Yonekawa Yoshihiro , Kakihara Shinji , Fortun Jorge , Borrelli Enrico , Bandello Francesco , Murata Toshinori , Kusaka Shunji , Dispenzieri Angela , Pulido Jose S. 
Published: June 2022

Purpose:
To characterize choroidal amyloid angiopathy (CAA) using late-phase indocyanine green angiography (ICGA).

Methods:
This was a multicenter retrospective observational case series on patients with transthyretin (ATTR) and AL amyloidosis who underwent ICGA. The timing of hyperfluorescence and longitudinal changes were analyzed.

Results:
Thirty-two patients (27 with ATTR and 5 with AL) with mean age of 58.9 ± 17.4 years were included. Hyperfluorescent spots in the very late phases of ICGA, corresponding to CAA, were observed in 49 of 55 eyes (89%). The median time to maximal staining was 672 (95% confidence interval, 644–752) seconds, which was significantly later than the initial staining (503 [95% confidence interval, 447–521], P < 0.0001; Wilcoxon signed rank test). In seven patients with ATTR amyloidosis who underwent follow-up of ICGA, the CAA was stable in two patients and improved in five patients during treatment. However, 3 patients (43%) had worsening vitreous opacities in both eyes, and 4 patients (57%) developed secondary open-angle glaucoma.

Conclusion:
Most patients with amyloidosis were found to have CAA on ICGA. Up to 12.5 minutes is required for maximal ICG staining. Choroidal amyloid angiopathy improved in most patients with systemic treatment and may serve as a marker of systemic disease status.
Clinical Profile and Treatment Outcomes of Patients With Acremonium Species Positive Keratitis Managed in a Tertiary Eye Care Center
Authors: Maharana Prafulla K. , Saluja Gunjan , Nair Sridevi , Vijay Rahul P. , Nagpal Ritu , Hussain Nishat , Sinha Rajesh , Agarwal Tushar , Sharma Namrata , Titiyal Jeewan S. 
Published: June 2022

Purpose:
To report the clinical profile and treatment outcomes of patients with culture-positive Acremonium keratitis.

Methods:
This is a retrospective observational study. Medical records of all patients treated in a tertiary eye hospital for culture positive infective keratitis from March 2016 to February 2021 were screened, of which those positive for Acremonium species on fungal culture were reviewed. Demographic details, clinical presentation, clinical course, treatment given, total follow-up duration, time taken for ulcer to heal, scar size, and final visual acuity in the last follow-up were recorded.

Results:
Fifty three cases of fungal keratitis caused by Acremonium species were identified, 22 females and 31 males, with average age of 46.39±18.64 years. The mean duration of symptoms being 54.47±50 days. Only five patients had a history of trauma with vegetative matter. Clinical presentation of patients showed a large number of variations, with 2 patients presenting as peripheral ulcerative keratitis and 1 with epithelial plaque. The mean visual acuity of patients at presentation was 2.43±0.46 logMAR units. Thirty-three of 53 patients presented with perforated corneal ulcer and underwent penetrating keratoplasty; 20 patients were medically managed on topical voriconazole 1%, natamycin 5%, and oral voriconazole. The mean duration of healing of epithelial defect was 95±60.62 days (range 60–165 days).

Conclusion:
Acremonium keratitis has a long and indolent course. A prolonged combination therapy of natamycin and voriconazole seems to be effective in the management. A delay in the diagnosis of Acremonium keratitis often leads to clinical worsening requiring keratoplasty.
Dermal Melanocytosis
Authors: Gomez Jason , Admani Shehla 
Published: June 2022

ABSTRACT
Dermal melanocytosis includes a spectrum of benign diseases, including congenital dermal melanocytosis, nevus of Ota, and nevus of Ito. Congenital dermal melanocytosis is blue–gray pigmentation typically on the lumbar or sacral regions. Affected areas outside the lumbar or sacral region are less likely to fade with time. Nevus of Ota is usually a unilateral blue–gray pigmentation change of the face in the distribution of the first and second divisions of the trigeminal nerve. It persists lifelong and can be complicated by ocular melanoma. Nevus of Ito is similar to Nevus of Ota in that it persists lifelong but differs in its location. Nevus of Ito primarily affects the supraclavicular, deltoid, or scapular regions. In select cases, dermal melanocytosis can be treated with cosmetic cover-ups and lasers that target melanin.
A Mixed-Methods Study of Risk Factors and Experiences of Health Care Workers Tested for the Novel Coronavirus in Canada
Authors: Okpani Arnold Ikedichi , Barker Stephen , Lockhart Karen , Grant Jennifer , Delgado-Ron Jorge Andrés , Zungu Muzimkhulu , Naicker Nisha , Ehrlich Rodney , Yassi Annalee 
Published: June 2022

Objective
The aims of this study were to investigate occupational and non–work-related risk factors of coronavirus disease 2019 among health care workers (HCWs) in Vancouver Coastal Health, British Columbia, Canada, and to examine how HCWs described their experiences.

Methods
This was a matched case-control study using data from online and phone questionnaires with optional open-ended questions completed by HCWs who sought severe acute respiratory syndrome coronavirus 2 testing between March 2020 and March 2021. Conditional logistic regression and thematic analysis were utilized.

Results
Providing direct care to coronavirus disease 2019 patients during the intermediate cohort period (adjusted odds ratio, 1.90; 95% confidence interval, 1.04 to 3.46) and community exposure to a known case in the late cohort period (adjusted odds ratio, 3.595%; confidence interval, 1.86 to 6.83) were associated with higher infection odds. Suboptimal communication, mental stress, and situations perceived as unsafe were common sources of dissatisfaction.

Conclusions
Varying levels of risk between occupational groups call for wider targeting of infection prevention measures. Strategies for mitigating community exposure and supporting HCW resilience are required.
Revisiting the relationship between (Pro)Renin receptor and the intrarenal RAS: focus on the soluble receptor
Authors: Yang Tianxin 
Published: June 2022

Purpose of review
The (pro)renin receptor (PRR), also termed as ATPase H+ transporting accessory protein 2 (ATP6AP2), was originally cloned as a specific receptor for prorenin and renin [together called (pro)renin]. Given the wide tissue distribution of PRR, PRR was further postulated to act as a regulator of tissue renin. However, assigning a physiological role of PRR within the renin-angiotensin system (RAS) has been challenging largely due to its pleotropic functions in regulation of embryogenesis, autophagy, and H+ transport. The current review will summarize recent advances in understanding the roles of sPPR within the intrarenal RAS as well as those outside this local system.

Recent findings
Site-1 protease (S1P) is a predominant source of sPPR at least in the kidney. So far most of the known physiological functions of PRR including renal handling of electrolytes and fluid and blood pressure are mediated by sPRR. In particular, sPRR serves as a positive regulator of collecting duct renin to activate the intrarenal RAS during water deprivation or angiotensin-II (AngII) infusion. However, PRR/sPRR can act in renin-independent manner under other circumstances.

Summary
S1P-derived sPRR has emerged as a key regulator of kidney function and blood pressure and its relationship with the intrarenal RAS depends on the physiological context.