bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Uncertainty Among Critically Ill Children Admitted to the PICU: A Multicenter Study
Authors: Cifra Christina L. , Custer Jason W. , Smith Craig M. , Smith Kristen A. , Bagdure Dayanand N. , Bloxham Jodi , Goldhar Emily , Gorga Stephen M. , Hoppe Elizabeth M. , Miller Christina D. , Pizzo Max , Ramesh Sonali , Riffe Joseph , Robb Katharine , Simone Shari L. , Stoll Haley D. , Tumulty Jamie Ann , Wall Stephanie E. , Wolfe Katie K. , Wendt Linder , Ten Eyck Patrick , Landrigan Christopher P. , Dawson Jeffrey D. , Reisinger Heather Schacht , Singh Hardeep , Herwaldt Loreen A. 
Published: November 2024

OBJECTIVES:
This study aimed to identify the prevalence of and factors associated with diagnostic uncertainty when critically ill children are admitted to the PICU. Understanding diagnostic uncertainty is necessary to develop effective strategies to reduce diagnostic errors in the PICU.

DESIGN:
Multicenter retrospective cohort study with structured medical record review by trained clinicians using a standardized instrument to identify diagnostic uncertainty in narrative clinical notes. Diagnoses and diagnostic uncertainty were compared across time from PICU admission to hospital discharge. Generalized linear mixed models were used to determine patient, clinician, and encounter characteristics associated with diagnostic uncertainty at PICU admission.

SETTING:
Four academic tertiary-referral PICUs.

PATIENTS:
Eight hundred eighty-two randomly selected patients 0–18 years old who were nonelectively admitted to participating PICUs.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
PICU admission notes for 228 of 882 patients (25.9%) indicated diagnostic uncertainty. Patients with uncertainty decreased over time but 58 (6.6%) had remaining diagnostic uncertainty at hospital discharge. Multivariable analysis showed that diagnostic uncertainty was significantly associated with off hours admission (odds ratio [OR], 1.52; p = 0.037), greater severity of illness (OR, 1.04; p = 0.025), an atypical presentation (OR, 2.14; p = 0.046), diagnostic discordance at admission between attending intensivists and resident physicians/advanced practice providers (OR, 3.62; p < 0.001), and having a neurologic primary diagnosis (OR, 1.87; p = 0.03). Older patients (OR, 0.96; p = 0.014) and those with a respiratory (OR, 0.58; p = 0.009) or trauma primary diagnosis (OR, 0.08; p < 0.001) were less likely to have diagnostic uncertainty. There were no significant associations between diagnostic uncertainty and attending intensivists’ characteristics.

CONCLUSIONS:
Diagnostic uncertainty at PICU admission was common and was associated with off hours admission, severe illness, atypical presentation, diagnostic discordance between clinicians, and a neurologic primary diagnosis. Further study on the recognition and management of diagnostic uncertainty is needed to inform interventions to improve diagnosis among critically ill children.
Primary Epithelioid Angiosarcoma of the Penis: A Case Report With a Brief Review of the Literature
Authors: Caputo Valentina , Cazzato Gerardo , Brambilla Lucia , Rongioletti Franco 
Published: November 2024

Abstract:
Angiosarcoma of the penis is an exceptionally rare mesenchymal tumor, with only about 30 cases documented in the literature. Because of its rarity and the often nonspecific clinical presentation, histopathological examination plays a critical role in accurate diagnosis. Angiosarcoma of the penis typically arises in the corpus cavernosum but has also been reported in the glans and urethra, often presenting with metastases. This report details a case of epithelioid angiosarcoma of the penis in an 84-year-old man, who presented with a rapidly enlarging, violaceous nodule on the glans penis. Histopathology revealed atypical epithelioid endothelial cells with pleomorphism and mitotic activity, and immunohistochemical markers such as CD31, Erythroblast transformation-specific [ETS]-related gene, and cellular myelocytomatosis oncogene confirmed the malignant endothelial neoplasm. The differential diagnosis excluded conditions such as epithelioid hemangioendothelioma and Kaposi sarcoma. Because of the rarity, standardized treatment protocols are lacking; however, wide excision with tumor-free margins and the potential for targeted therapies based on gene amplification are considered important. The review highlights the diagnostic challenges, prognostic factors, and current therapeutic approaches, emphasizing the need for further research to develop standardized treatment protocols.
Temple Volumization: A Review of Anatomy and Optimal Injection Techniques
Authors: Friedmann Daniel P. , Hinchee-Rodriguez Kathryn , Verma Kritin K. 
Published: November 2024

BACKGROUND
Cosmetically unappealing temporal volume loss can develop as a result of facial aging.

OBJECTIVE
To present an evidenced-based approach towards safe and effective temple filling.

METHODS
We review the underlying anatomy of the temple and optimal anatomy-driven injection techniques associated with temple volumization.

RESULTS
Multiple safe injection planes exist to achieve temporal volumization.

CONCLUSION
A thorough understanding of optimal injection techniques based on the underlying anatomy mitigates the incidence and severity of adverse events, enhancing treatment success.
Fine particulate matter and intima media thickness: Role of endothelial function biomarkers
Authors: Torrico-Lavayen Rocio , Posadas-Sánchez Rosalinda , Osorio-Yáñez Citlalli , Sanchez-Guerra Marco , Texcalac-Sangrador José Luis , Ortiz-Panozo Eduardo , De Vizcaya-Ruiz Andrea , Botello-Taboada Viridiana , Hernández-Rodríguez Elihu Alexander , Gutiérrez-Avila Iván , Vargas-Alarcón Gilberto , Riojas-Rodríguez Horacio 
Published: November 2024

Background:
Ambient fine particulate matter (PM2.5) is a risk factor for atherosclerosis disease. We aimed to assess whether nitric oxide stable metabolites (NOx) and l-arginine mediate the association between PM2.5 and carotid intima media thickness (cIMT) increase.

Methods:
We selected 251 participants from the control group of GEA (Genetics of Atheroslerosis Disease Mexican) study (2008–2013) in Mexico City. Mediation models were carried out using pathway analyses, a special case of structural equation models.

Results:
The median concentration of PM2.5 area under the curve (auc) was 25.2 µg/m3 (interquartile range: 24.2–26.4 µg/m3). Employing participants with observed values for both biomarkers (n = 117), the total effect of PM2.5auc on mean cIMT at bilateral, right, and left was 19.27 µm (95% confidence interval [CI]: 5.77, 32.78; P value = 0.005), 12.69 µm (95% CI: 0.67, 24.71; P value = 0.039), and 25.86 µm (95% CI: 3.18, 48.53; P value = 0.025) per each 1 µg/m3 increase of PM2.5auc. The direct effect of PM2.5auc (per 1 µg/m3 increase) was 18.89 µm (95% CI: 5.37, 32.41; P value = 0.006) for bilateral, 13.65 µm (95% CI: 0.76, 26.55; P value = 0.038) for right, and 24.13 µm (95% CI: 3.22, 45.03; P value = 0.024) for left. The indirect effects of NOx and l-arginine were not statistically significant showing that endothelial function biomarkers did not mediate PM2.5 and cIMT associations. Although l-arginine was not a mediator in the PM2.5 and cIMT pathway, a decrease in l-arginine was significantly associated with PM2.5auc.

Conclusions:
In this study of adults from Mexico City, we found that PM2.5 was associated with an increase in cIMT at bilateral, left, and right, and these associations were not mediated by endothelial function biomarkers (l-arginine and NOx).
Overexpression of TNFα in TNF∆ARE+/− mice increases hepatic periportal inflammation and alters bile acid signaling in mice
Authors: Shearn Colin T. , Anderson Aimee L. , Devereaux Michael W. , Koch Samuel D. , Larsen Leigha D. , Spencer Lisa A. , Orlicky David J. , Colgan Sean P. , Steiner Calen A. , Sokol Ronald J. 
Published: November 2024

Background:
Intestinal inflammation is a common factor in ~70% of patients diagnosed with primary sclerosing cholangitis. The TNF∆ARE+/− mouse overexpresses TNFα and spontaneously develops ileitis after weaning. The aim of this study was to examine the influence of ileitis and TNFα overexpression on hepatic injury, fibrosis, inflammation, and bile acid homeostasis.

Methods:
Using serum, hepatic, and ileal tissue isolated from 24- to 26-week-old C57BL/6 and TNF∆ARE+/− mice, hepatic injury and fibrosis, inflammation, ductal proliferation, and regulation of bile acid synthesis were assessed by immunohistochemical and quantitative PCR methods.

Results:
Compared to age-matched C57BL/6 mice, TNF∆ARE+/− mice exhibited increased serum AST, ALT, and serum bile acids, which corresponded to increased hepatic picrosirius red staining, and an increase in hepatic mRNA expression of Tgfb, Timp1, Col1a1, and MMP9 supporting induction of fibrosis. Examining inflammation, immunohistochemical staining revealed a significant periportal increase in MPO+ neutrophils, CD3+ lymphocytes, and a panlobular increase in F4/80+ macrophages. Importantly, periportal inflammation corresponded to significantly increased proinflammatory chemokines as well as hepatic cytokeratin 7 staining supporting increased ductular proliferation. In the liver, increased mRNA expression of bile acid transporters was associated with suppression of classical but not alternative bile acid synthesis. In the ileum, increased inflammation correlated with suppression of Nr1h4 and increased Fgf15 and Nr0b2 mRNA expression.

Conclusions:
Increased TNFα expression is sufficient to promote both intestinal and hepatobiliary inflammation and fibrotic injury and contributes to hepatic dysregulation of FXR signaling and bile acid homeostasis. Overall, these results suggest that the TNF∆ARE+/− mouse may be a useful model for studying chronic hepatic inflammation.
INCIDENCE AND RISK FACTORS FOR PROGRESSION OF PACHYCHOROID DISEASE SPECTRUM
Authors: Fong Angie Hon Chi , Zhao Jinzhi , Wong Wendy Meihua , Fenner Beau , Sim Shaun , Tan Anna C. S. , Su Xin Yi , Teo Kelvin Y. C. , Cheung Chui Ming Gemmy 
Published: November 2024

Purpose:
To report the 1-year progression rate and associated risk factors in an Asian cohort of patients with pachychoroid disease spectrum phenotype.

Methods:
The authors report the 1-year findings from a prospective observational study, recruiting subjects with subfoveal choroidal thickness of ≥300 µm. Each eye was evaluated at baseline and at month 12 according to a standardized protocol including visual acuity and multimodal imaging.

Results:
A total of 223 eyes of 133 participants (mean age 59.23 ± 9.18 years, 27.1% female) finished 1-year follow-up. Distribution of baseline diagnosis was uncomplicated pachychoroid (43 eyes), pachychoroid pigment epitheliopathy (108 eyes), central serous chorioretinopathy (54 eyes), and pachychoroid neovasculopathy (18 eyes). There was no significant change in the mean best-corrected visual acuity or subfoveal choroidal thickness. Fourteen eyes (6.3%) evolved to a different pachychoroid disease spectrum diagnosis, but there was no significant change in the mean best corrected visual acuity (BCVA) Logarithm of the minimum angle of resolution 0.15 ± 0.18 (Snellen equivalent 20/30) versus 0.07 ± 0.11 (Snellen equivalent 20/25), (P = 0.18) or subfoveal choroidal thickness (426.8 ± 59.2 vs. 456.3 ± 89.5, P = 0.49). Incident neovascularization developed in eight eyes (3.6%, five from pachychoroid pigment epitheliopathy, three from central serous chorioretinopathy). Seven patients received treatment (three anti-vascular endothelial growth factor [VEGF] and four photodynamic therapy). Factors associated with developing neovascularization include older age, smoking, and the presence of shallow irregular retinal pigment epithelium elevation on optical coherence tomography.

Conclusion:
At 1 year, pachychoroid disease spectrum remains relatively stable with low progression rate. Older age, smoking, and the presence of shallow irregular retinal pigment epithelium elevation were associated with higher rates of neovascular complications.
Glaucoma Screening and Referral Risk Factors in a High-Risk Population: Follow-Up Study of the Manhattan Vision Screening Study
Authors: Wang Qing , Valenzuela Ives A. , Harizman Noga , Gorroochurn Prakash , Torres Desiree R. , Maruri Stefania C. , Diamond Daniel F. , Horowitz Jason D. , Friedman David S. , De Moraes C. Gustavo , Cioffi George A. , Liebmann Jeffrey M. , Hark Lisa A. 
Published: November 2024

Précis:
Community-based eye health screenings that incorporated fundus photography and optometric exams in a high-risk NYC population effectively identified a higher than average number of participants that required an in-office glaucoma evaluation.

Purpose:
To report glaucoma screening rates and risk factors associated with referral for in-office glaucoma evaluation in the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT).

Methods:
In this 5-year, cluster-randomized clinical trial, eligible individuals aged 40 and older were recruited from affordable housing developments and senior centers. Visual acuity with correction, intraocular pressure (IOP) measurements, and nonmydriatic fundus photography were conducted. Images were graded by a glaucoma specialist; those with an abnormal image were referred; those who failed the screening or had an unreadable fundus image were examined by the study optometrist. χ2 tests and stepwise multivariate logistic regression analyses were conducted to determine factors associated with glaucoma referral.

Results:
Totally, 708 participants were screened; 189 (26.6%) were referred for an in-office glaucoma evaluation due to an abnormal optic disc image (n=138) or abnormal optometric exam (n=51). Those referred had a mean age 68.5±11.7 years and were 60% female, 57% Black, and 37% Hispanic. Stepwise multivariate logistic regression showed participants with self-reported glaucoma (OR: 8.096, 95% CI: 4.706–13.928, P=0.000), IOP >23 mm Hg at the screening (OR: 3.944, 95% CI: 1.704–9.128, P=0.001), or wore prescription eyeglasses (OR: 1.601, 95% CI: 1.034–2.48, P=0.035) had higher odds of being referred for an in-office glaucoma evaluation. Of those referred, 106 (56%) attended, 36 participants (34%) were diagnosed with glaucoma and 38 participants (35.8%) as glaucoma suspects.

Conclusion:
Our findings support public health approaches that focus on community-based eye health screenings in high-risk populations and prioritize underserved communities.
Risk Factors for Infections Caused by Extended-Spectrum Beta-Lactamase Producing and Carbapenem-Resistant Enterobacterales in Pediatric Critical Care Settings: A Case-Control Study
Authors: Omar Amr , Asmar Basim I. , Ang Jocelyn , Salimnia Hossein , Thomas Ronald A. , Abdel-Haq Nahed 
Published: November 2024

Background:
Infections due to Gram-negative resistant bacterial pathogens are a major concern in intensive care units (ICUs). Risk factors for extended-spectrum beta-lactamase (ESBL)–producing enterobacterales (ESBL-PE) and carbapenem-resistant enterobacterales (CRE) infections in pediatric critical care settings remain unclear.

Methods:
This was a retrospective case-control study of infections due to ESBL-PE and CRE during a 5-year period (2016–2021). Control cases were matched for age, infection site and year of infection, but their cultures grew enterobacterales that were non-ESBL or carbapenemase producers.

Results:
A total of 57 patients with ESBL-PE or CRE infections (cases) and 59 control patients were included. The majority of organisms were Escherichia coli and Klebsiella species recovered from the respiratory tract. There was no difference in prior hospital admission, pediatric ICU, or neonatal ICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (P > 0.3). Risk factors evaluated by univariate analysis included the history of antibiotic use in the last 6 months, antibiotic treatment with cephalosporins including cefepime, cephalosporins treatment duration ≥7 days, treatment with trimethoprim/sulfamethoxazole and carbapenems and vancomycin use ≥ 7 days. However, multivariate logistic regression analysis showed that cefepime use ≥ 7 days was the single best predictor for cases with an odds ratio of 2.205-fold (95% confidence interval, 1.403–3.466; P < 0.001).

Conclusions:
Cefepime use ≥ 7 days was the most predictive risk factor of ESBL-PE and CRE acquisition. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens.
The effect of green tea on patients with type 2 diabetes mellitus: A meta-analysis
Authors: Jia Ming-Jie , Liu Xing-Ning , Liang Ying-Chao , Liu De-Liang , Li Hui-Lin 
Published: November 2024

Background:
To systematically evaluate the effect of green tea on patients with type 2 diabetes.

Methods:
A computer search Cochrane, PubMed, Embase, CNKI, Wanfang, VIP, and other Chinese and English databases were conducted for randomized controlled trials of green tea in the treatment of patients with type 2 diabetes. The duration of these trials spanned from the establishment of the database to January 10, 2024. The obtained data were subjected to meta-analysis using Stata15.1 software. A total of 15 articles were included, encompassing 722 patients.

Results:
The meta-analysis results showed that compared to the control group, green tea intervention significantly improved the improvement of fasting blood glucose (SMD = −0.41, 95% CI: −0.67 to −0.19, P = .001), glycated hemoglobin (SMD = −0.68, 95% CI: −1.15 to 0.21, P = .004) and insulin resistance index (SMD = −0.70, 95% CI: −1.18 to −0.22, P = .005) in the experimental group compared to the control group. The differences were statistically significant (P < .05).

Conclusion:
Green tea significantly improves fasting blood glucose, glycated hemoglobin and insulin resistance in patients with type 2 diabetes.
Efficacy and safety of several common drugs in the treatment of acute respiratory distress syndrome: A systematic review and network meta-analysis
Authors: Liu Qing-Kuo , Xiang Guo-Han , Liu Wen-Li , Dong Jin-Yan , Wen Yu-Qi , Hao Hao 
Published: November 2024

Background:
This study aimed to compare the effectiveness and safety of neuromuscular blockers, mesenchymal stem cells (MSC), and inhaled pulmonary vasodilators (IV) for acute respiratory distress syndrome through a network meta-analysis of randomized controlled trials (RCTs).

Methods:
We searched Chinese and English databases, including China National Knowledge Infrastructure, The Cochrane Library, PubMed, and EMbase, with no time restrictions. We conducted a network meta-analysis and reported the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included 27 clinical RCTs, all of which were two-arm trials, totaling 3492 patients. We selected 28-day mortality as the primary outcome measure, whereas 90-day mortality, ventilator-free days, and oxygenation served as secondary outcome measures for analysis and comparison.

Results:
We selected 3 treatment modalities and evaluated their clinical trials in comparison with the standard control group. For the 28-day in-hospital mortality, we included 21 RCTs, involving 2789 patients. Compared to standard treatment, neuromuscular blockers were associated with reduced 28-day hospital mortality (odds ratios [OR] 0.52, 95% confidence intervals [CI] (0.31, 0.88)), while IV and MSC were not associated with reduced hospital mortality (OR 0.89, 95% CI (0.50, 1.55); OR 0.90, 95% CI (0.49, 1.66)). In terms of 90-day mortality, days free of mechanical ventilation, and improvement in oxygenation, there were no significant differences compared to standard treatment with neuromuscular blockers, MSC, and IV.

Conclusion:
Neuromuscular blockers significantly reduced the 28-day mortality rate in acute respiratory distress syndrome patients. However, in terms of 90-day mortality, ventilator-free days, oxygenation improvement, IV, MSC, and neuromuscular blockers did not significantly improve.
Neuronal intranuclear inclusion disease with subclinical peripheral neuropathy: A case report
Authors: Sun Lu , Zhou Lihua , Ren Liyan , Han Chunru , Xue Qun , Ma Linqing 
Published: November 2024

Rationale:
Neuronal intranuclear inclusion disease (NIID) is a slowly progressing neurodegenerative disease with various manifestations and high heterogeneity. Clinical characteristics, imaging, skin biopsy, and genetic testing are necessary for its diagnosis. Electromyography may also be a useful tool for diagnosing NIID. In this study, we report a patient with motor and sensory nerve demyelination changes accompanied by axonal damage.

Patient concerns:
A 64-year-old woman was admitted to our department with gradually worsening forgetfulness for over a year. After 6 years of follow-up, the symptoms progressively deteriorated.

Diagnoses:
Cerebrospinal fluid analysis revealed increased protein levels. Brain magnetic resonance imaging showed characteristic “ribbon-like” high signals in the corticomedullary junction area on diffusion-weighted imaging. High-intensity signals in the white matter were also observed on T2 and fluid-attenuated inversion recovery imaging. Electromyography revealed multiple peripheral nerve damage and conduction changes, including motor and sensory nerve demyelination changes, accompanied by axonal damage. Skin biopsy revealed inclusion bodies with strong positive staining for P62 and ubiquitin antibodies in the nuclei of sweat gland cells, adipocytes, and fibroblasts. Genetic testing indicated that the number of GGC repeats in NOTCH2NLC alleles were 14 and 134, respectively. Consequently, the patient was diagnosed with NIID.

Interventions:
Currently, no effective treatment is available to delay the progression of the disease.

Lessons:
We report a case of NIID with subclinical peripheral neuropathy, although the patient did not experience sensory symptoms such as numbness in the extremities. Electromyography can be used to detect subclinical peripheral nerve damage.