bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of ertugliflozin in patients with nonalcoholic fatty liver disease associated with type 2 diabetes mellitus: A randomized controlled trial
Authors: Khaliq Adil , Badshah Haroon , Shah Yasar , Rehman Inayat Ur , Khan Kashif Ullah , Ming Long Chiau , Cheng Maong Hui 
Published: November 2024

Background:
Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with liver inflammation, fibrosis, and cirrhosis and is associated with a greater risk of hepatocarcinoma. Nonalcoholic steatohepatitis (NASH) is a persistent and progressive form of NAFLD. Recent evidence suggested that ertugliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2), suppresses NAFLD development in patients with type 2 diabetes mellitus (T2DM). The objective of this study was to determine the impact of ertugliflozin on improving NAFLD in patients with T2DM and the function of liver enzymes.

Methods:
This prospective, randomized, double-blind, placebo-controlled, interventional study aimed to determine the effectiveness of 15 mg of ertugliflozin versus 30 mg of the standard therapy pioglitazone versus placebo in NAFLD patients with T2DM. The study was established based on patient randomization in three groups: ertugliflozin, pioglitazone, and a placebo. This study was registered under the Australian New Zealand Clinical Trial Registry (Trial ID: ACTRN12624000032550).

Results:
The impact of therapy was determined in the treatment groups by utilizing liver ultrasonography and biochemical parameters. After 24 weeks of clinical study, the results revealed significant improvement in the grades of fatty liver, especially in the ertugliflozin group. The number of patients with hepatic steatosis significantly decreased among the respective groups classified according to fatty liver grade. Among patients in the ertugliflozin and pioglitazone groups, 45% to 23.4% and 41.7% to 26.6%, respectively, decreased in the Grade 2 group. The aspartate aminotransferase and alanine aminotransferase levels were significantly lower in all the study groups, especially in the ertugliflozin group (P ≤ .001).

Conclusion:
The present study revealed that the concomitant use of ertugliflozin has favorable effects on liver enzymes, as it decreases liver fat intake and reduces complications in patients with NAFLD-associated T2DM. However, more in-depth studies will be required to observe every aspect of ertugliflozin.
Novel presentation of acalvaria with clavicular absence: A case report
Authors: Alhroub Wasef , Jabareen Maaweya , Humeedat Mousa , Anati Mosaikah , Qanaeer Bashar , Alhroub Asrar 
Published: November 2024

Rationale:
Acalvaria is an exceptionally rare congenital disorder marked by the absence of flat bones of the cranial vault, dura mater, and associated muscles, while the facial bones and base of the skull remain intact. Typically, the central nervous system is unaffected. Due to their extreme rarity, reported cases in the literature are infrequent. This condition often results in fatalities, as newborns with this anomaly generally have short life expectancies. However, there are a few documented cases of prolonged survival.

Patient concerns:
A 1-day-old full-term Palestinian male born to first-cousin parents at 37 + 6 weeks gestational age presented with an excessively soft skull without scalp abnormalities. The mother experienced polyhydramnios during the last 7 weeks of pregnancy.

Diagnoses:
Head ultrasound and X-rays confirmed the absence of skull vault bones and clavicles with normal facial bones. A CT scan showed well-formed brain structures and foci of hemorrhage in the left frontal lobe.

Interventions:
Supportive care was the primary management approach. The patient received comprehensive care in the neonatal intensive care unit, with a focus on stabilization and monitoring.

Outcome:
After 3 weeks in the neonatal intensive care unit, the patient showed normal feeding and function, but the prognosis remained poor. The patient’s family was informed about the poor prognosis.

Lessons:
This case reveals a unique combination of acalvaria and absent clavicles. Early antenatal diagnosis is essential but was delayed here. More research is needed to understand and improve the diagnosis of these conditions.
Bladder perforation due to laparoscopic peritoneal dialysis catheterization: A case report and literature review
Authors: Shao Xiaoyun , Zhang Yanling , Xu Weixing 
Published: November 2024

Rationale:
Complications related to the peritoneal dialysis (PD) catheter are the primary cause of treatment failure in PD, and bladder perforation is a rare complication of PD catheter placement. To date, there have been no reported cases of bladder perforation occurring during laparoscopic PD catheter placement.

Patient concerns:
An 80-year-old woman was admitted to Shaoxing Second Hospital due to a decade-long history of high blood creatinine levels. She was diagnosed with end-stage renal disease and underwent laparoscopic PD catheter placement. On the third day post-operation, she experienced frequent urination and urgency during her initial peritoneal dialysis fluid exchange.

Diagnoses:
The urine analysis indicated sterility. Both ultrasound and computed tomography scans suggested that the PD catheter was positioned in the bladder. We suspect a bladder perforation following laparoscopic placement of the PD catheter.

Interventions:
The patient underwent emergency surgery, during which the PD catheter was removed and subsequently replaced using laparoscopy. Additionally, due to a bladder perforation, peritoneal dialysis was temporarily suspended for 10 days postoperatively.

Outcomes:
On the 11th postoperative day, the patient underwent a low-dose peritoneal dialysis, and the procedure was uneventful.

Lessons:
During laparoscopy, PD catheter placement still carries the risk of rare complications such as bladder perforation. If postoperative PD catheter patients experience urinary urgency and frequency, there should be a high suspicion of bladder perforation. Early diagnosis and surgical intervention are crucial for improving patient prognosis.
A review of the potential use of melatonin in cancer treatment: Data analysis from Clinicaltrials.gov
Authors: Alshehri Fahad S. , Althobaiti Yusuf S. 
Published: November 2024

Background:
Melatonin’s antioxidative and immune effects suggest potential in cancer therapy. This review assesses related clinical trials on ClinicalTrials.gov.

Methods:
All ClinicalTrials.gov trials registered up to January 17, 2024 were examined, focusing on trials that involved use of melatonin in cancer treatment. A 46 trials were summarized by their study status, study phase, study type, funder type and study results in the use of melatonin in cancer treatment.

Results:
The examination of the research data revealed a collective count of 46 clinical trials enlisted on ClinicalTrials.gov, all focus around the utilization of melatonin in cancer treatment. Among these, 24 trials had reached completion, constituting 91.3% of the entire trials, while 5 trials were presently in the recruitment phase, making up 10.8% of the total. None of these trials had received approval for marketing yet. The majority focus of the analysis encompassed interventional studies, around 42 trials and representing 91.3% of the overall trials, thereby incorporating most enrolled patients. In contrast, observational studies are a smaller fraction, comprising 4 trials (8.6% of the total), with a correspondingly lower number of involved patients. Regarding funding sources, most registered studies secured funding from diverse entities such as individuals, universities, and organizations, constituting 95.6% of all trials. In comparison, a minority of studies received funding from the National Institutes of Health, comprising 5 trials and accounting for 10.8% of the total trials.

Conclusion:
The analysis of 46 clinical trials on melatonin’s use in cancer treatment reveals a significant importance on interventional studies. Overall, these findings contribute to the evolving understanding of melatonin’s role in cancer treatment.
Experiences of moral distress among health care professionals in oncology and palliative care in Australia: a qualitative investigation
Authors: Ratcliffe Sarah E. , Rosenberg Jodie , Stafford Lesley , Kelly Brian J. , Agar Meera , Best Megan , Boon Kym , Dhillon Haryana M. , Kissane David , Lobb Elizabeth A. , Milne Donna , Philip Jennifer , Turner Jane , Shaw Joanne M. 
Published: November 2024

Abstract

Background:
Cancer care involves challenging clinical problems requiring expertise of multiple disciplines and frequently necessitates nuanced decision-making. When decision-making and patterns of care conflict with the values of health care professionals (HCPs), moral distress may arise. Moral distress is defined as the unease resulting from the perceived violation of professional or personal values and ethical principles. It has been associated with increased burnout and lower workforce retention among HCPs. This study aimed to investigate moral distress among Australian oncology and palliative care HCPs to understand how, when, and why it is experienced.

Method:
We conducted a qualitative interview study, with an online survey to collect demographic, practice-related characteristics, and level of moral distress. Interviews were conducted with oncology and palliative care HCPs in Australia to explore participants' experiences of moral distress. Interviews were audio-recorded and transcribed. A thematic analysis was conducted using a framework analysis approach.

Results:
We interviewed 33 participants, who were predominantly female (78%) and nurses (42%) with 50% having 15 years or more experience in oncology/palliative care. Thematic analysis revealed one meta-theme, Power and Hierarchy, and four themes: (1) values and their conflicts; (2) moral distress and the system; (3) moral distress and interpersonal interactions; and (4) internalized moral distress. At the core of HCPs' experiences of moral distress were patient-centered and care-centered values and the imperative to not violate the oath to “Do No Harm.” Moral distress was perceived to be covert, primarily arising in response to day-to-day clinical dilemmas and resulted from interactions with other HCPs and structural factors. Moral distress appeared to be cumulative over time.

Conclusion:
Moral distress arises when there are conflicts between an individual's values and organizational culture, within teams, and within the HCPs themselves. Power and hierarchy within health care are critical elements contributing to moral distress where poor communication and limited recognition of differing views are present. There is a need for interventions facilitating open discussion of ethical concerns to reduce likelihood of moral distress and retain an experienced oncology and palliative workforce.
Management of Venoarterial Extracorporeal Membrane Oxygenation Cannulation-Associated Groin Wound Complications With Muscle Flaps at a High-Acuity Cardiac Referral Center
Authors: Kuonqui Kevin , Diaddigo Sarah E. , LaValley Myles N. , Dagi Alexander F. , Dugue David , Imahiyerobo Thomas A. , Bogue Jarrod T. 
Published: November 2024

Background
The insertion of large bore cannulas into the femoral vessels for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) administration has been associated with significant acute and chronic wound complications in patients with significant medical and surgical comorbidities, including vessel exposure and lymphocele development. In this series, we report our experience using muscle flap reconstruction in the management of post-ECMO groin wounds, with particular emphasis on groin lymphocele.

Methods
VA-ECMO patients at a high-acuity cardiac referral center who developed groin cannulation site complications requiring muscle flap closure were included for retrospective review. Preoperative, perioperative, and postoperative factors were analyzed.

Results
Fifteen patients were included. The most common comorbidities were hypertension (66.7%), diabetes (46.7%), and renal failure (60.0%). Eight (53.3%) patients were immunosuppressed. The most frequent indications for surgery were groin lymphocele (n = 8, 53.3%) and exposed femoral vessels (n = 7, 46.7%). Median time from ECMO decannulation to reconstruction was 49.0 days. Most reconstructions were performed using a rectus femoris flap (n = 13, 86.7%). Two (13.3%) shallow wounds were covered with a sartorius muscle flap. Intraoperative cultures were positive in 9 (60.0%) patients. Seven (46.7%) patients experienced complications, including hematoma (n = 5), dehiscence (n = 1), recipient site infection (n = 1), and donor site infection (n = 1). In both groups, there were no cases involving lymphocele recurrence following reconstruction. There were no flap-specific complications and no cases of amputation. Four patients died within 1 year from septic shock (n = 3) and heart failure (n = 1).

Conclusions
We report successful reconstruction in the majority of patients. In particular, muscle flap reconstruction is a useful technique for addressing ECMO-associated lymphocele development and recurrence. Future studies are needed to determine ideal timing of reconstruction and if early plastic surgeon involvement can reduce morbidity and mortality of these difficult to treat infections.
Repair of Radiation Ulcers After Breast Cancer Surgery With Simple Local Random Flaps
Authors: Wang Gaofei , Meng Jialin , Huang Wen 
Published: November 2024

Background
Radiation ulcers that develop after breast cancer surgery are mainly repaired with pedicled flaps or free flaps rather than local random flaps or skin grafts due to large skin defects and poor wound healing. Complicated surgical techniques and donor site reconstruction increase the risk of failure. We report our experience of using the local random long neck reading man flap (LNRMF) to cover large chest wall radiation ulcers, achieving good outcomes.

Methods
Eight patients who developed chest radiation ulcers after breast cancer surgery and were treated between January 2024 and June 2024 were included. The duration of the wounds ranged from 8 to 35 days. Necrotic and ischemic tissues were completely surgically removed, and subsequent wounds were repaired with LNRMFs. The wounds ranged from 6 cm × 8 cm to 15 cm × 16 cm in size. Visual analog scale scores were recorded during therapy.

Results
Eight patients healed well after the first stage. The sutures were removed 10–17 days (average, 12.63 days) after surgery, and no infections, necrosis, or necrotic skin flaps were observed. The average Visual analog scale score was 2.5. The follow-up period was 2–6 months (mean, 4.7 months). Slight linear scarring was observed, and no limitations in shoulder elevation were observed in seven patients; however, 1 patient had slightly limited shoulder elevation. The average SCAR scale score was 3.88, and all sensation scores (according to the Medical Research Council scale) were S3+.

Conclusions
LNRMFs are easily created and effectively repair secondary wounds that develop after the resection of radiation ulcers that develop after breast cancer surgery and large skin defects. These flaps can be widely used and should be promoted at the grassroots level.
Application Discrepancies in the 2023–2024 Integrated Plastic Surgery Match
Authors: Godbe Kerilyn N. , Sinik Lauren M. , Guest Rachel , Nazir Niaman , Egan Katie , Mathes David , Farmer Rebecca , Butterworth James 
Published: November 2024

Background
The Plastic Surgery Common Application (PSCA) was introduced in the 2020–2021 integrated plastic surgery match cycle. We investigated the accuracy of medical student–reported quantitative metrics in the PSCA.

Methods
Quantifiable data from 1 year of PSCA applications were compared between matched and unmatched students. Discrepancies were identified by reviewing publicly available data and from Electronic Residency Application Service (ERAS) applications.

Results
A total of 330 PSCAs were analyzed and divided into two groups: matched (n = 196) and unmatched (n = 134). Of the 71 medical schools with multiple applicants, 23.9% (17/71) and 31.0% (22/71) had contradicting reports of Alpha Omega Alpha and Gold Humanism Honor Society availability. Three matched applicants, with an average numeric Step 1 score of 228, reported scores as “pass.” Four applicants did not disclose a prior failing Step 1 score. More matched students had research discrepancies than unmatched students for first author (56%, 111/196; 50%, 67/132; P = 0.24) and total publications (66.8%, 131/196; 53%, 71/134; P = 0.011). The mean discrepancy number between matched and unmatched students was similar for first author (3.0 vs 3.2, P = 0.61) and total publications (4.3 vs 4.5, P = 0.61). Reasons for discrepancies included counting accepted articles (20.2%), submitted articles (7.5%), non–peer reviewed (3.1%) articles, and other endeavors (6.2%) in publication counts, with 52% of applicants having multiple reasons for discrepancies.

Conclusions
Matched and unmatched applicants applying to plastic surgery had honor society and Step 1 score discrepancies, and inaccurate research reporting. NBME score verification and PubMed indexing may be a warranted addition to PSCA applications to guarantee application consistency.
Circ_0068655 silencing ameliorates hypoxia-induced human cardiomyocyte injury by regulating apoptotic and inflammatory responses
Authors: You Ting , Peng Kang , Yi Jing , Du Yafang , Jiang Peiyong , Zeng Dianmei , Wu Ji , Liu Jian , Wu Songjiang 
Published: November 2024

Abstract

Background
There is growing evidence suggesting that the dysregulation of circular RNAs (circRNAs) plays a significant role in various myocardial disorders, including myocardial ischemia (MI). This study aimed to explore the function of hsa_circ_0068655 (circ_0068655) in hypoxia-induced cardiomyocyte injury.

Methods
Human AC16 cardiomyocyte cells were cultured under anaerobic condition to induce an in vitro model of MI. Cell apoptosis was assessed by Annexin V-fluorescein isothiocyanate staining and caspase-3 and caspase-9 activity assays. Cell proliferation was analyzed by 5-Ethynyl-2’-deoxyuridine (EdU) incorporation assay. Inflammation was evaluated by enzyme-linked immunosorbent assays. Circ_0068655, miR-370-3p and BCL-2-like 11 (BCL2L11) expression were detected by real-time quantitative polymerase chain reaction or western blotting. The target interactions among circ_0068655, miR-370-3p and BCL2L11 were predicted using bioinformatics tools and validated using dual-luciferase reporter assays and RNA immunoprecipitation assays.

Results
Hypoxia treatment led to upregulated expression of circ_0068655 and BCL2L11, and downregulated expression of miR-370-3p in AC16 cells. This treatment also resulted in reduced cell viability, increased apoptosis rate, elevated caspase-9/3 activities and cleavage, and enhanced production of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β. Notably, knockdown of circ_0068655 alleviated these detrimental effects. In addition, circ_0068655 silencing-mediated effects were restored by decreasing miR-370-3p expression in hypoxia-treated AC16 cells. Moreover, ectopic BCL2L11 expression remitted the effects of miR-370-3p overexpression on hypoxia-treated AC16 cells. Mechanistically, circ_0068655 was found to act as a sponge for miR-370-3p, thereby regulating BCL2L11 expression.

Conclusion
Circ_0068655 silencing ameliorated hypoxia-induced human cardiomyocyte injury through the miR-370-3p/BCL2L11 axis.
INHIBITING SIRT2 ATTENUATES SEPSIS-INDUCED ACUTE KIDNEY INJURY VIA FOXO1 ACETYLATION-MEDIATED AUTOPHAGY ACTIVATION
Authors: Yu Binmei , Weng Lijun , Li Jiaxin , Wang Tingjie , Qiu Weihuang , Li Yuying , Shi Menglu , Lin Bo , Lin Xianzhong , Chen Zhongqing , Zeng Zhenhua , Gao Youguang 
Published: November 2024

ABSTRACT
Sepsis-associated acute kidney injury (SAKI), a common complication in intensive care units (ICUs), is linked to high morbidity and mortality. Sirtuin 2 (SIRT2), an NAD+-dependent deacetylase, has been shown to have distinct effects on autophagy regulation compared to other sirtuins, but its role in SAKI remains unclear. This study explored the potential of SIRT2 as a therapeutic target for SAKI. We found that inhibition of SIRT2 with the antagonist AGK2 improved the survival of septic mice. SIRT2 inhibition reduced kidney injury, as indicated by lower levels of KIM-1, NGAL, serum creatinine, blood urea nitrogen, and proinflammatory cytokines following cecal ligation and puncture. Pretreatment with AGK2 in septic mice increased autophagosome and autolysosome formation in renal tubular epithelial cells and upregulated LC3 II expression in the renal cortex. Consistent with in vivo findings, SIRT2 gene silencing promoted autophagy in LPS-treated HK-2 cells, whereas SIRT2 overexpression inhibited it. Mechanistically, SIRT2 inhibition increased FOXO1 acetylation, inducing its nuclear-to-cytoplasmic translocation, which promoted kidney autophagy and alleviated SAKI. Our study suggests SIRT2 as a potential target for SAKI therapy.
Respiratory variation of velocity time integral and peak velocity of left ventricular outflow tract for predicting hypotension after induction of general anesthesia in elderly patients
Authors: Wan Jingjie , Jin Xiaofei , Chen Jun , Peng Ke , Xie Jin 
Published: November 2024

Abstract

Background
Hypotension after induction of general anesthesia may lead to severe complications in elderly patients. This study investigated whether the respiratory variation of velocity time integral (ΔVTI) and peak velocity (ΔVpeak) of left ventricular outflow tract (LVOT) could predict hypotension after induction of general anesthesia in elderly patients.

Methods
120 elderly patients undergoing selective operation under general anesthesia were enrolled in this study. ΔVTI and ΔVpeak of LVOT were measured by transthoracic echocardiography before induction of general anesthesia. After induction, mean arterial pressure (MAP) was recorded every 1 minute for 15 min. Hypotension was defined as a decrease of more than 30% in MAP at baseline or MAP below 65 mmHg from the start of induction. Receiver operating characteristic curves with gray zone and multivariate logistic regression analysis were used to assess the ability of ΔVTI and ΔVpeak of LVOT to predict hypotension after induction of general anesthesia.

Results
Hypotension occurred in 64 (53.3%) patients after induction of general anesthesia. The area under receiver operating characteristic curves (AUC) for ΔVpeak of LVOT to predict hypotension after induction of general anesthesia was 0.811, and the optimal cutoff value was 13.1% with a gray zone of 9.9% to 13.8%, including 45.0% of patients. The AUC for ΔVTI of LVOT was 0.890, and the optimal cutoff value was 13.8% with a gray zone of 11.1% to 13.9%, including 25.8% of patients. After adjusting for confounders, ΔVTI (Odds ratio = 2.24) and ΔVpeak (Odds ratio = 2.09) of LVOT were two significant independent predictors of hypotension after induction of general anesthesia.

Conclusions
ΔVTI of LVOT was a reliable predictor of hypotension after the induction of general anesthesia in elderly patients. ΔVpeak of LVOT should be used cautiously to predict hypotension after induction of general anesthesia due to nearly half of elderly patients in the gray zone.

Trial registration

This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2300077117).