bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leaf sheath stomata density is a driver of water use in a grass crop: genetic and physiological evidence on barley
Authors: Zhen Xiaoxing , Zhang Yangyang , López José R , Qiu Yinjie , Muehlbauer Gary J , Sadok Walid 
Published: February 2025

Abstract
Recent evidence pointed to functional stomata on the abaxial side of barley leaf sheaths. However, the extent to which variation in sheath stomata densities (SD SheathAb) drives canopy water use and whether it has a genetic basis remains unknown. To address this, we phenotyped, twice, a mapping population consisting of 156 barley genotypes (936 plants) for their abaxial and adaxial leaf sheath and blade SDs, whole-plant transpiration rate (TR) and canopy conductance (Gs). Across the four SD traits, SD SheathAb exhibited the highest repeatability (0.73) and was the only one that correlated significantly and positively with TR and Gs. None of the quantitative trait loci (QTL) controlling leaf blade SD co-localized with TR and Gs QTL. In contrast, a major QTL common to SD SheathAb, TR and Gs was found on Chr 2H (PVE up to 50%), and mapped to a region enriched in F-box protein genes that included Ppd-H1. Gas exchange measurements confirmed that increases in SD SheathAb cause higher sheath-based transpiration, photosynthesis and stomatal conductance, and that sheath transpiration positively tracked with TR. Our investigation provides first-time evidence that genetic manipulation of SD SheathAb could improve crop water-use efficiency, with no apparent trade-offs with leaf blade gas exchange.
Intra-annual stem radius growth and cell formation of two diffuse-porous tree species in a subtropical forest in Southwest China
Authors: Zhang Yi-Xue , Fu Pei-Li , Yan Qiao-Shun , Bräuning Achim , Fan Ze-Xin 
Published: February 2025

Abstract
Studying tree growth and xylem formation is essential for understanding tree resilience to extreme droughts, which are expected to intensify with climate warming. However, researches on intra-annual stem growth and xylogenesis remain limited, particularly in moist subtropical forests. This study monitored the intra-annual stem radius growth and xylem formation of two diffuse-porous tree species, Stewartia pteropetiolata and Schima noronhae, in a subtropical evergreen broadleaved forest in Southwest China, using high-resolution dendrometer measurements for recording stem growth and micro-coring for xylem formation. We analyzed the seasonal patterns of stem radius growth and xylem formation, and their responses to seasonal climate variability. Our results revealed that S. noronhae, found at lower elevations, exhibited a later onset of stem growth and xylogenesis, developing wider vessels with thinner walls during a longer enlarging phase. In contrast, S. pteropetiolata, which is distributed at higher elevations, produced smaller vessels with thicker walls during a longer cell wall thickening phase. Both species showed high relative growth rates under conditions of high temperatures and low vapor pressure deficit (VPD). More specifically, S. noronhae maintained higher relative growth rates under a narrower range of favorable temperature and soil water conditions during the rainy season, while S. pteropetiolata sustained growth for a longer growth period in colder and drier conditions. These findings enhance the understanding of angiosperm wood cell kinetics and the eco-physiological response of diffuse-porous trees to climate change in moist subtropical forests.
Umbilical Cord pH Levels and Neonatal Morbidity and Mortality
Authors: Andersson Charlotte Brix , Klingenberg Claus , Thellesen Line , Johnsen Søren Paaske , Kesmodel Ulrik Schiøler , Petersen Jesper Padkaer 
Published: February 2025

(Abstracted from JAMA Network Open 2024;7:e2427604)
Umbilical cord pH (UC-pH) is a measure used to identify infants with intrapartum hypoxia leading to acidosis. Severe acidosis can lead to hypoxic-ischemic encephalopathy, and severe intrapartum hypoxia can result in multiorgan injury.
Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence: A Randomized Clinical Trial
Authors: Wang Xiuqi , Qiu Jin , Li Dan , Wang Zhongmin , Yang Yanjing , Fan Guorong , Mao Xiaoyan , Wang Jiandi , Gao Shan , Zhu Xihui , Xu Tao , Sun Zhijing 
Published: February 2025

(Abstracted from JAMA Netw Open 2024;7:e2442925)
Pelvic floor dysfunction is common to a variety of conditions, the most prevalent of which is stress urinary incontinence (SUI). This condition can have significant impact on physical and psychological health, quality of life, as well as cause increased socio-economic burden.
What Provides the Best Value for Your Time in Spine Surgery? An Analysis of Relative Value Units
Authors: Tariq Muhammad B. , Simcox Trevor , Becker Jacob , Petrizzo Anthony , Hishmeh Shuriz 
Published: February 2025

Design:
Retrospective database analysis.

Objective:
This study aims to assess the RVU compensation model for the most common spine surgeries.

Background:
Physician work is commonly valued by utilizing the relative value unit (RVU) model for compensation. Our aim in this study was to assess RVU and RVU per minute valuations of the most common spine procedures comparing cervical versus lumbar and fusion versus non-fusion cases.

Methods:
The ACS-NSQIP database was utilized to identify the most commonly performed spine procedures. RVU and RVU per minute values were calculated and compared in each group.

Results:
In all, 18,779 entries encompassing 28 CPT codes/code combinations were identified. Average RVUs were higher in cervical spine cases compared with lumbar cases (29 vs. 20 RVUs, respectively). Furthermore, cervical cases had significantly higher RVUs per minute compensation compared with lumbar cases (0.26 vs. 0.18 RVUs/min; P=0.01). Fusion cases also fared higher average RVUs compared with nonfusion cases (28 vs. 19 RVUs, respectively). However, when corrected for operative time, fusion cases did not differ significantly in RVUs per minute (P=0.13).

Conclusions:
Cervical spine surgery provides the best value for the surgeon in terms of RVUs per minute. We highlight key aspects of the compensation model in spine surgery.

Level of Evidence:
Level III—economic study.
Readability of Patient Education Materials in Plastic Surgery: Assessing 14 Years of Progress
Authors: Wirth Peter J. , Warden Aleah M. , Moura Steven P. , Attaluri Pradeep K. , Larson Jeffrey D. 
Published: February 2025

Background:
Current recommendations suggest that patient education materials (PEMs) be written at or below the sixth-grade reading level. In a 2010 study, the average readability of PEMs on the American Society of Plastic Surgeons (ASPS) and The Aesthetic Society (AS) websites was found to be at the 11th-grade level or higher. We sought to assess progress made toward providing accessible PEMs.

Methods:
PEMs were obtained from the ASPS and AS websites. The PEMs were entered into an online scoring tool. PEMs were scored on 3 common readability indices: Flesch–Kincaid, Simple Measure of Gobbledygook, and Flesch Reading Ease (FRE).

Results:
The average grade level of ASPS PEMs calculated using the Flesch–Kincaid, Simple Measure of Gobbledygook, and FRE readability models were 9.7 ± 1.1, 12.6 ± 0.7, and 47.6 ± 6.2, respectively. This FRE score corresponds to approximately grade 13–16 reading levels. The average of AS PEMs were 9.3 ± 0.5, 12.3 ± 0.3, and 51.3 ± 3.9, respectively; this FRE corresponds to grade 10–12 reading levels. There were no PEMs written at or below the recommended sixth-grade reading level found on ASPS and AS websites.

Conclusions:
Despite increasing awareness of the need for equitable access to healthcare, PEMs continue to be written at a reading level well above the recommendation. Over the past 14 years, we have seen only modest improvement in readability indices. In addition to advocating for more accessible PEMs, we must gather a deeper understanding of how patients seek information about plastic surgery.
First case report of long-term latent infection paracoccidioidomycosis in China
Authors: Dong Haiping , Feng Jingyuan , Wu Shaoling , Liang Feng , Li Hua , Liang Xiaocheng , Liao Weixiang , Pan Yanshan , Tang Guidan , Li Donghai , Zhou Wei , Cao Zhizhong , Wang Weiyong , Hu Jinxing 
Published: February 2025

Rationale:
Although paracoccidioidomycosis is one of the most prevalent endemic mycoses in Latin American countries, where at least 10 million people are infected, the prevalence of paracoccidioidomycosis in China remains unknown because no related case has been reported, and its diagnosis is extremely challenging for local clinicians because of the complexity of disease progression and lack of specific evidence.

Patient concerns:
Here, we report the first case of PCM in a male patient with a long-term latent infection in China.

Diagnosis:
The results of special staining, immunohistochemistry, lymph node biopsy pathology, and metagenomic second-generation sequencing indicated that the patient was infected with Paracoccidioides brasiliensis.

Interventions:
In this case, the patient was administered voriconazole 200 mg twice daily.

Outcomes:
After continuous treatment for 6 months, the patient’s symptoms improved significantly, and the medication was discontinued. The outpatient follow-up revealed no discomfort.

Lessons:
This case is of great value for the early diagnosis, treatment, and prevention of the spread of this emerging infectious disease in China.
A case report of epithelial adenomatoid hamartoma misdiagnosed as a nasal poly
Authors: Liu Siyu , Bai Bin , Feng Yu , Li Maocai , Li Lianqing , Gong Lili 
Published: February 2025

Rationale:
Respiratory epithelial adenomatoid hamartomas (REAH) are benign tumors. The clinical presentation of REAH often resembles that of nasal polyps or inverted papillomas. Owing to the lack of specific clinical symptoms or imaging findings, the diagnosis is usually confirmed only by pathological examination after surgery and misdiagnosis is common. Therefore, we report this case of nasal REAH that was misdiagnosed as a nasal polyp. Clinical cases of nasal polyps with hamartoma are very rare. Pathological biopsy, complete removal of the lesion by surgery and postoperative follow-up are essential for the diagnosis and treatment of REAH.

Patient concerns:
The patient had been experiencing bilateral anosmia for 6 years without any obvious triggers. He also experienced nasal congestion and mucopurulent nasal discharge after exposure to cold and alcohol.

Diagnosis:
Analyzing the pathological findings that the patient was diagnosed with right-sided respiratory epithelial adenomatoid pleomorphic histiocytoma and left-sided nasal polyps.

Interventions:
Nasal endoscopic surgery was performed to remove bilateral nasal lesions and send them for routine pathological examination.

Outcomes:
After surgery, the patient’s sense of smell was slightly restored to normal.

Lessons:
Our case report findings suggest that clinical attention should be paid to the possibility of nasal REAH with nasal polyps in bilateral nasal polypoid masses, particularly if the olfactory fissure is involved.
Abducens nerve palsy in patients with spontaneous intraventricular hemorrhage: A case report
Authors: Li Chenyan , Cai Yong , Zhong Xingming , Shen Lijuan 
Published: February 2025

Rationale:
The purpose of this case report is to describe the process of the patient developing abductor nerve paralysis, analyze the causes of this symptom, provide new diagnostic and treatment ideas for patients with spontaneous intraventricular hemorrhage who develop abductor nerve paralysis, and be alert to the occurrence of abductor nerve paralysis in such patients.

Patient concerns:
A 49-year-old man was admitted to our hospital with a spontaneous intraventricular hemorrhage. After performing digital subtraction angiography of the whole brain under local anesthesia, his eyes were limited in abduction, accompanied by hemorrhage and exudation of the optic papilla. Edema is an extremely rare condition.

Diagnoses:
Transient intracranial hypertension was considered after reexamination with computed tomography.

Interventions:
The application of mannitol and the release of cerebrospinal fluid were used to reduce intracranial pressure and provide patient-related symptomatic treatment.

Outcomes:
After 1 month, the patient’s eyes had no abduction limitation and showed good activity.

Lessons:
Abducens nerve palsy is a common condition. Owing to its complex etiology, a careful and comprehensive examination is necessary. In particular, patients with spontaneous cerebral hemorrhage who undergo digital subtraction angiography should pay more attention to the abducens nerve.
Case report and literature review: Misdiagnoses of contrast encephalopathy as stroke
Authors: Qi Xiangjia , Gao Liqian , Qi Lifeng 
Published: February 2025

Rationale:
Contrast-induced encephalopathy (CIE) is a rare complication following carotid artery stenting, often mimicking stroke symptoms such as focal neurological deficits. Its transient nature and reversibility necessitate differentiation from critical complications like cerebral hemorrhage or infarction, as management strategies differ substantially. This case underscores the diagnostic challenges and clinical implications of CIE in endovascular procedures.

Patient concerns:
A 65-year-old woman with a history of cerebral infarction and prior carotid artery stenting presented with persistent numbness in her extremities for over 1 month. Post-carotid artery stenting, she developed acute slurred speech and right-sided limb weakness within 1 hour, raising concerns for stroke or procedural complications.

Diagnoses:
Emergency cranial computed tomography revealed left cerebral hemisphere swelling and linear hyperdensities, while magnetic resonance imaging demonstrated punctate diffusion-weighted imaging hyperintensities in the left parietal lobe. Temporal correlation of symptoms with iodixanol contrast administration (150 mL) supported a diagnosis of CIE, excluding acute infarction or hemorrhage.

Interventions:
Immediate management included antiplatelet therapy (tirofiban), thrombolysis (urokinase), corticosteroids (methylprednisolone), and antiedema agents (mannitol and albumin). Supportive care emphasized hydration and neurological monitoring.

Outcomes:
The patient exhibited progressive improvement, with complete resolution of speech and motor deficits by postoperative day 3. Neuroimaging abnormalities regressed, aligning with the transient nature of CIE.

Lessons:
This case highlights the critical role of prompt neuroimaging to exclude life-threatening differentials and confirms CIE’s reversibility with supportive care. Risk factors such as contrast volume and cerebral circulation dynamics warrant attention. Clinicians should exercise caution in readministering iodinated contrast to patients with prior CIE episodes.
Symmetrical peripheral gangrene after cardiac surgery: A case report and review of literature
Authors: Chen Xiaoliang , Shao Guofeng , Zhao Shunying , Li Ni 
Published: February 2025

Rationale:
Cardiac surgery can cause arrhythmias and low cardiac output syndrome through various mechanisms, including cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest, and ischemia resulting from coronary or graft occlusion. Symmetric peripheral gangrene is a rare but serious complication that can occur after cardiac surgery. Here, we present a case of symmetric peripheral gangrene shortly after cardiac surgery for mitral valve replacement.

Patient concerns:
A 76-year-old male with rheumatic heart disease and severe mitral stenosis underwent mitral valve replacement. He experienced postoperative bleeding on the first day after the cardiac surgery. After experiencing ventricular fibrillation, cardiogenic shock, acute hepatic failure, and disseminated intravascular coagulation (DIC), he developed symmetrical peripheral gangrene on the fifth day after cardiac surgery.

Diagnoses:
The patient presented with postoperative bleeding, cardiogenic shock, and DIC complicated by symmetrical peripheral gangrene following cardiac surgery.

Interventions:
During cardiosurgery intensive care unit admission, the patient received positive inotropic agents and vasopressors, blood transfusion, and antithrombotic treatment with low -molecular-weight heparin. Because of the severe general condition of the patient, amputation was not performed.

Outcomes:
The patient died on the 80th day after cardiac surgery because of multiorgan failure and DIC.

Lessons:
Physicians should be vigilant for comorbid symmetrical peripheral gangrene in patients undergoing cardiac surgery who present with postoperative bleeding, cardiogenic shock, and DIC. Early recognition of acrocyanosis, prompt management of cardiogenic shock, correction of anemia, hemodynamic stabilization, and properly controlled use of anticoagulation may help prevent symmetrical peripheral gangrene.
Primary small cell neuroendocrine carcinoma of the larynx: A detailed case report
Authors: Mu Siqi , Wu Xiaosong 
Published: February 2025

Rationale:
Small cell neuroendocrine carcinoma (SCNEC) of the larynx is a rare and aggressive malignancy, notorious for its rapid progression and poor prognosis. Early diagnosis and effective management are crucial, particularly for high-risk populations such as long-term smokers.

Patient concerns:
A young male smoker presented with progressive laryngeal symptoms, which prompted further investigation due to the severity and progression of his symptoms.

Diagnoses:
The patient was diagnosed with SCNEC of the larynx after presenting with symptoms. Diagnostic procedures confirmed the presence of a localized tumor without distant metastasis.

Interventions:
In response to the diagnosis, the patient underwent a surgical intervention that achieved clear margins, chosen based on the tumor’s localized nature at diagnosis. This approach emphasized comprehensive initial surgical management.

Outcomes:
The absence of immediate postoperative recurrence highlights the potential effectiveness of the surgical approach as a standalone treatment in selected cases of SCNEC.

Lessons:
This case underscores the importance of considering SCNEC in the differential diagnosis when young smokers present with laryngeal symptoms. It highlights the need for proactive surgical strategies to manage this aggressive cancer effectively. Additionally, it emphasizes that despite the favorable initial outcome, the high risk of recurrence necessitates rigorous long-term follow-up and a structured surveillance strategy to enhance early detection and potentially improve long-term outcomes. This report offers significant insights into the rapid progression and nuanced management of SCNEC, providing valuable lessons for clinical practice.
Examining the Sequential Relationships Between Voice Changes, Symptom Experiences, Fear of Cancer Recurrence, and Voice-Related Quality of Life in Patients With Thyroid Cancer
Authors: Lee Myung Kyung , Oh Jihyun 
Published: February 2025

Background
Thyroid cancer is considered lower-grade cancer with a high survival rate; however, the voice changes, and the presence of other diverse symptoms following a thyroidectomy can impact a patient’s voice-related quality of life (VRQOL).

Objective
This study aimed to examine the serial multiple mediating effects of voice changes, symptom experiences, and fear of cancer recurrence on the VRQOL among patients diagnosed with thyroid cancer postthyroidectomy.

Methods
This cross-sectional study used a descriptive, structured self-report questionnaire. A total of 225 individuals participated who were 20 years and older, had been diagnosed with thyroid cancer and had undergone thyroidectomy surgery at comprehensive university hospitals in Daegu, Daejeon, Sejong, and Anyang in South Korea before data collection.

Results
The study’s findings revealed a statistically significant direct impact between patients’ voice changes and their VRQOL. Moreover, the serial mediation model highlighted that as the severity of patients’ voice changes escalated, the intensity of their other symptom experiences and fear of cancer recurrence increased, resulting in a deterioration in their VRQOL. The study’s findings identified partial mediating effects of symptom experiences and the fear of cancer recurrence in the association between voice changes and the VRQOL.

Conclusions
These findings underscore the importance of adopting a modeling approach that considers the simultaneous sequential relationships among 4 pivotal variables, namely, voice changes, symptom experiences, fear of cancer recurrence, and VRQOL.

Implications for Practice
The findings highlight the crucial impact of voice changes on patients’ VRQOL, which is closely linked to various psychological aspects of the disease.
Management of Maternal Genetic Conditions in Pregnancy, Part 1: Disorders of the Connective Tissue, Muscle, Vascular, and Skeletal Systems
Authors: Mardy Anne , Whitney Madeline 
Published: February 2025

Importance
The number of patients with various genetic syndromes who are or seek to become pregnant is increasing due to advances in medical care and assisted reproductive technologies. Management of these patients requires multidisciplinary care teams and knowledge of the risks of increased morbidity and mortality. In addition, many of these inheritance patterns are autosomal dominant, with a 50% risk of an offspring inheriting the disorder with each pregnancy.

Objective
In this first of a 2-part series, common syndromes with connective tissue, muscle, vascular, or skeletal involvement will be discussed regarding surveillance and management of mother and fetus.

Evidence Acquisition
A literature search was performed for important updates in the literature regarding management of patients with genetic connective tissue disorders, aortopathies, muscular dystrophies, vascular disorders, and skeletal dysplasias.

Results
Updates have been incorporated since the last publication in 2011, including updated diagnostic criteria for several conditions (such as Marfan syndrome), international guidelines in management of aortopathies and achondroplasia, an expanded section on hypermobile Ehlers-Danlos syndrome, and a new section on familial cerebral cavernous malformation.

Conclusions
Since the last publication, many guidelines have been published or updated regarding management of pregnancies in patients with genetic disorders and are reviewed in this article.

Relevance
Clinicians who care for pregnant patients with genetic disorders should be aware of updated guidelines and recommendations in order to optimize their care during pregnancy.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After participating in this activity, physicians should be better able to (1) describe how to manage patients with genetic disorders that place them at high risk for aortic dissection, uterine rupture, and cerebral hemorrhage during pregnancy; (2) formulate delivery plans for patients with skeletal dysplasias; (3) interpret ultrasound findings in the context of parental genetic disorders; and (4) explain how to counsel patients with genetic disorders regarding inheritance pattern and options for preimplantation and prenatal testing.
Ovarian Cancer Risk Among Older Patients With Stable Adnexal Masses
Authors: Suh-Burgmann Elizabeth J. , Hung Yun-Yi , Schmittdiel Julie A. 
Published: February 2025

(Abstracted from Am J Obstet Gynecol 2024;231(4):440.e1–440.e7)
Adnexal masses represent a clinical challenge in the field of gynecology; the only way to rule out cancer in these cases is through surgical intervention, but most masses are benign, so surgical intervention in many cases could cause more harm than good. The risk of delay in cancer diagnosis must be weighed against the potential harms of unneeded surgical intervention.