bluuebunny/crossref_metadata_2025_split huggingface dataset:
First Case of Interstitial Keratitis Secondary to Anaplasma phagocytophilum Infection
Authors: Fabregas-Sanchez-Woodworth Daniela , Eskenazi-Betech Ruth , Valente-Acosta Benjamín , Ramirez-Miranda Arturo , Navas Alejandro , Müller-Morales Carlos Adolfo , Graue-Hernández Enrique O. 
Published: June 2024

Purpose:
To describe the first case of interstitial keratitis (IK) secondary to Anaplasma phagocytophilum infection.

Methods:
We present a case of IK secondary to A. phagocytophilum infection diagnosed using nested polymerase chain reaction.

Results:
A 32-year-old man with an unremarkable medical history presented with a 6-month history of bilateral decreased vision and ocular redness associated with a progressively enlarging white spot in the left eye. The patient was diagnosed with bilateral IK, and a thorough systemic workup was performed. The final diagnosis of A. phagocytophilum was made based on whole-blood Nested-PCR. Doxycycline was initiated with 100-mg BID tablets for 3 weeks. On completion of oral treatment, a left penetrating keratoplasty was performed. The excised cornea showed infiltration of inflammatory cells and scar tissue as well as superficial and deep stromal neovascularization.

Conclusions:

A. phagocytophilum is an underdiagnosed entity, and IK may be associated with its clinical manifestations. We hope that this illustration of a rather atypical finding adds to the clinical spectrum of ophthalmic conditions that can be observed in association with the disease.
Eco-sustainability in ophthalmology
Authors: Lee Gabriela G. , Menean Matteo , Williams Basil K. , Di Nicola Maura 
Published: June 2024

Purpose of review
The purpose of this review is to evaluate the current state of eco-sustainability in ophthalmology, highlighting key practices, recent advancements, and areas requiring improvement. This review aims to provide ophthalmologists with a comprehensive overview of sustainable practices that can reduce environmental impact.

Recent findings
Recent studies have identified several areas within ophthalmology where sustainable practices can be implemented including multidose eyedrops, adjusting surgical packs, making package inserts available electronically, and reusing surgical instruments. Moreover, there is an increasing emphasis on waste reduction both in the surgical and clinical setting, by decreasing the use of unnecessary materials and implementing more efficient use of recycling programs. Telemedicine has also emerged as a sustainable option, reducing the carbon footprint associated with patient travel. Despite these advancements, significant challenges remain, particularly in balancing the cost and accessibility of sustainable options with traditional practices.

Summary
Eco-sustainability in ophthalmology is gaining momentum as the medical community aims to reduce its environmental impact. While progress has been made, further efforts are required to overcome financial and logistical barriers to widespread implementation. Continued research, education, and policy development are essential to advancing eco-sustainable practices, ensuring that environmental considerations become an integral part of ophthalmic care.
Symptomatic treatment of mosquito bites with a thermo-therapeutic medical device: a prospective, intraindividual compared, placebo-controlled, randomized clinical trial
Authors: Wilhelm Dorothea , Lozanovska Ivana , Kapoor Katharina , Ruwe David , Mentel Tim 
Published: June 2024

Objective:
Agonizing itching (pruritus), heat, and burning are common symptoms of mosquito bites. In this study, we present a thermo-therapeutic medical device for the symptomatic treatment of mosquito bites. Current research suggests the potential of a thermal (heat) stimulus for pruriceptor counter-stimulation and reduced histamine-signaling to relieve the symptoms of mosquito bites. The purpose of this clinical investigation was to investigate the efficacy and safety of the thermo-therapeutic medical device (class II) in the symptomatic treatment of mosquito bites in an intraindividual comparison to a placebo device (PD) examined under standardized conditions. This was achieved by assessing pruritus and wheal size over time after induction of a mosquito bite on the volar forearm.

Methods:
The itching was rated on a Visual Analog Scale ranging from 0 mm (no itching) to 100 mm (worst imaginable itching).
The wheal size was measured in approximation to the area of an eclipse before and ~30 minutes after the treatment with the investigational device.
Local tolerability was assessed by the investigator according to a score ranging from 0 (no irritation) to 4 (very strong irritation) and the subjects stated if the itching sensation was completely gone after treatment (yes/no question).

Results:
The mean area under the curve of the difference to baseline for the treatment with the medical device was statistically significantly bigger than for the treatment with the PD (1311.71 vs 914.61, respectively; P = 0.0127).

Conclusions:
Treatment of a mosquito bite with a thermo-therapeutic medical device significantly reduced pruritus and led to a faster reduction of the itching sensation as compared with PD. A significant itch reduction started immediately (1 min) after treatment with the medical device (post hoc analysis). The treatment with the medical device was well tolerated by all subjects and no adverse events related to the medical device occurred.
Predictors of renal replacement therapy following isolated coronary artery surgery: a retrospective case–controlled study
Authors: Krauchuk Alena , Hrapkowicz Tomasz , Suwalski Piotr , Perek Bartłomiej , Jasiński Marek , Hirnle Tomasz , Nadziakiewicz Paweł , Knapik Piotr 
Published: June 2024

Objectives:
Severe acute kidney injury (AKI) requiring postoperative renal replacement therapy (RRT) is associated with increased morbidity and mortality rates following cardiac surgery. Our study aimed to analyze patients requiring postoperative RRT in a population undergoing isolated coronary artery surgery.

Methods:
Following exclusions, we analyzed 124 944 consecutive patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), scheduled for isolated coronary artery surgery between January 2010 and December 2019. Patients who underwent preoperative chronic dialysis were excluded from the study. Data of patients requiring postoperative RRT and patients without postoperative RRT were compared.

Results:
In the analyzed population, 1668 patients (1.3%) developed AKI requiring RRT. In-hospital mortality among patients with and without postoperative RRT was 40.1 and 1.6%, respectively (P<0.001). Patients requiring postoperative RRT had significantly more preoperative co-morbidities and more frequent postoperative complications. Preoperative chronic renal failure and cardiogenic shock were the two most prominent independent risk factors for postoperative RRT in these patients (OR: 5.0, 95% CI: 3.9–6.4, P<0.001 and OR: 3.9, 95% CI: 2.8–5.6, P<0.001, respectively).

Conclusion:
Severe AKI requiring postoperative RRT dramatically increases in-hospital mortality and is associated with the development of serious postoperative complications. The need for postoperative RRT is clearly associated with the presence of preoperative co-morbidities. Preoperative chronic renal failure and cardiogenic shock were particularly related to the development of this complication.
Prognosis Prediction of Sudden Sensorineural Hearing Loss Using Ensemble Artificial Intelligence Learning Models
Authors: Li Kuan-Hui , Chien Chen-Yu , Tai Shu-Yu , Chan Leong-Perng , Chang Ning-Chia , Wang Ling-Feng , Ho Kuen-Yao , Lien Yu-Jui , Ho Wen-Hsien 
Published: June 2024

Objective
We used simple variables to construct prognostic prediction ensemble learning models for patients with sudden sensorineural hearing loss (SSNHL).

Study Design
Retrospectively study.

Setting
Tertiary medical center.

Patients
1,572 patients with SSNHL.

Intervention
Prognostic.

Main Outcome Measures
We selected four variables, namely, age, days after onset of hearing loss, vertigo, and type of hearing loss. We also compared the accuracy between different ensemble learning models based on the boosting, bagging, AdaBoost, and stacking algorithms.

Results
We enrolled 1,572 patients with SSNHL; 73.5% of them showed improving and 26.5% did not. Significant between-group differences were noted in terms of age (p = 0.011), days after onset of hearing loss (p < 0.001), and concurrent vertigo (p < 0.001), indicating that the patients who showed improving to treatment were younger and had fewer days after onset and fewer vertigo symptoms. Among ensemble learning models, the AdaBoost algorithm, compared with the other algorithms, achieved higher accuracy (82.89%), higher precision (86.66%), a higher F1 score (89.20), and a larger area under the receiver operating characteristics curve (0.79), as indicated by test results of a dataset with 10 independent runs. Furthermore, Gini scores indicated that age and days after onset are two key parameters of the predictive model.

Conclusions
The AdaBoost model is an effective model for predicting SSNHL. The use of simple parameters can increase its practicality and applicability in remote medical care. Moreover, age may be a key factor influencing prognosis.
Female Adnexal Tumor of Probable Wolffian Origin (Wolffian Tumor)
Authors: Keyhanian Kianoosh , Mack Tanner , Forgo Erna , Tazelaar Henry , Longacre Teri A. 
Published: June 2024

Wolffian tumor and its nosologic relative, the recently defined STK11 adnexal tumor are rare neoplasms thought to arise from mesonephric remnants. These tumors typically arise in the broad ligament, fallopian tube, and ovarian hilum and although most are associated with a good prognosis, up to 50% of STK11 adnexal tumors demonstrate aggressive clinical behavior. The chief differential diagnoses include endometrioid adenocarcinoma and sex cord stromal tumors. However, the morphologic and immunohistochemical features of these tumors exhibit considerable overlap with peritoneal mesothelioma. To fully characterize their immunophenotypic signature, we examined a total of 21 cases (18 Wolffian and 3 STK11 adnexal tumors) with standard markers used in the diagnosis of mesothelioma. Morphologic and immunohistochemical (IHC) features were reviewed and additional IHC performed for cases with available material. Patient age ranged from 25 to 73 (mean: 51) years. Sites included adnexa/broad ligament (6, 28%), paratubal (5, 24%), ovary/paraovarian (5, 24%), tubal (intraluminal) (2, 9.5%), pelvis (2, 9.5%), and liver (1, 5%). The mean tumor size was 9.3 cm (range: 0.2 to 22 cm). The histomorphology in most cases (14/21, 66%) consisted of tubular to solid sheets of neoplastic cells lined by columnar to cuboidal cells containing uniform round to oval nuclei. Compressed tubules with slit-like lumens and sieve-like pattern were also seen in at least 7 (33%) cases. Three cases demonstrated interanastomosing cords and trabeculae of epithelioid cells with cribriform and microacinar patterns growing within prominent myxoid stroma as described in STK11 adnexal tumors. In the cases with available IHC for 3 mesothelial markers (calretinin, WT1, D2-40), 55.5% (5 of 9) showed reactivity with all 3 markers. In cases with at least 2 available mesothelial markers, 69% (11/16) were positive for 2 markers (mostly calretinin and WT1). Claudin-4, MOC31, and BER-EP4 were negative in most cases tested (78% [7/9], 71.4% [5/7], and 100% [6/6], respectively). Given the resemblance to mesothelioma, there was initial strong consideration and/or actual misdiagnosis of mesothelioma in 3 cases (14%). In summary, the morphologic and immunohistochemical features of Wolffian tumor and its recently defined relative, STK11 adnexal tumor, can lead to misdiagnosis of mesothelioma, particularly when encountered in the disseminated or metastatic setting. Wolffian tumor and STK11 adnexal tumor should be considered in the differential diagnosis of all pelvic and peritoneal mesotheliomas.
Characteristics, Treatment, and Prognosis of Pediatric Symphyseal/Parasymphyseal–Condylar Fractures
Authors: Zhu Yanfei , Du Changxin , Tang Yanmei , Wu Yanqi , Zhang Bojun , Zhang Shilei , Zhu Min 
Published: June 2024

Background:
Pediatric condylar fractures combined with symphyseal or parasymphyseal fractures are common but challenging to manage. The authors present fracture characteristics, propose a treatment algorithm, and evaluate the treatment prognosis of pediatric symphyseal/parasymphyseal–condylar fractures.

Methods:
A retrospective review was conducted on pediatric patients who underwent treatment for symphyseal/parasymphyseal–condylar fractures in a trauma center between January of 2006 and January of 2021. Demographic and fracture characteristics were recorded. Complications and functional evaluations, including maximum interincisal opening, Helkimo anamnestic index, and clinical dysfunction index, were assessed after at least 1 year of follow-up.

Results:
After screening, 104 participants met the inclusion criteria. Among them, 50.96% received open reduction and internal fixation for symphyseal/parasymphyseal fractures and closed treatment for condylar fractures, 45.19% were treated by liquid diet and functional exercise, and the remaining 3.85% with severe malocclusion were treated with the assistance of orthodontic appliances. During follow-up, the average maximum interincisal opening of the patients increased from 17 ± 6.29 mm to 41.64 ± 6.33 mm. No subjective symptoms were observed in 86.54% of the patients and 79.81% showed no or mild clinical symptoms. Except for 1 patient who developed temporomandibular joint ankylosis, no other severe complication was reported. Postfracture remodeling of the nonfractured condyle was noted in 3 cases.

Conclusions:
Pediatric symphyseal/parasymphyseal–condylar fractures present unique biomechanical and anatomic challenges that require special consideration during management. In this study, satisfactory functional prognosis was achieved following implementation of the treatment algorithm.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Beyond the Signature: Informed Consent from a Legal Perspective and Its Implications for Plastic Surgery
Authors: Shaheen Mohammed S. , Lane Megan , Chung Kevin C. 
Published: June 2024

Summary:
Informed consent is the principal tool that bridges the gap between clinical practice and our society’s ethical ideals. The intricacies of informed consent, however, are frequently misunderstood, and its effective implementation can be challenging in practice. The continuous stream of innovations, wide array of procedures, and other characteristics inherent to the practice of plastic surgery compound the challenges of implementing informed consent. Unfortunately, there remains a dearth of literature to provide a comprehensive overview of informed consent as it relates to plastic surgery. In this article, the authors highlight the history, legal components, and challenges of informed consent within plastic surgery and offer recommendations on how to approach them. A deeper understanding of informed consent helps enhance patient care, mitigates unnecessary malpractice risk, and leads to better physician-patient relationships.
Predicting Outcome of Patients With Cerebral Hemorrhage Using a Computed Tomography–Based Interpretable Radiomics Model: A Multicenter Study
Authors: Yang Yun-Feng , Zhang Hao , Song Xue-Lin , Yang Chao , Hu Hai-Jian , Fang Tian-Shu , Zhang Zi-Hao , Zhu Xia , Yang Yuan-Yuan 
Published: June 2024

Objective
The aim of this study was to develop and validate an interpretable and highly generalizable multimodal radiomics model for predicting the prognosis of patients with cerebral hemorrhage.

Methods
This retrospective study involved 237 patients with cerebral hemorrhage from 3 medical centers, of which a training cohort of 186 patients (medical center 1) was selected and 51 patients from medical center 2 and medical center 3 were used as an external testing cohort. A total of 1762 radiomics features were extracted from nonenhanced computed tomography using Pyradiomics, and the relevant macroscopic imaging features and clinical factors were evaluated by 2 experienced radiologists. A radiomics model was established based on radiomics features using the random forest algorithm, and a radiomics-clinical model was further trained by combining radiomics features, clinical factors, and macroscopic imaging features. The performance of the models was evaluated using area under the curve (AUC), sensitivity, specificity, and calibration curves. Additionally, a novel SHAP (SHAPley Additive exPlanations) method was used to provide quantitative interpretability analysis for the optimal model.

Results
The radiomics-clinical model demonstrated superior predictive performance overall, with an AUC of 0.88 (95% confidence interval, 0.76–0.95; P < 0.01). Compared with the radiomics model (AUC, 0.85; 95% confidence interval, 0.72–0.94; P < 0.01), there was a 0.03 improvement in AUC. Furthermore, SHAP analysis revealed that the fusion features, rad score and clinical rad score, made significant contributions to the model's decision-making process.

Conclusion
Both proposed prognostic models for cerebral hemorrhage demonstrated high predictive levels, and the addition of macroscopic imaging features effectively improved the prognostic ability of the radiomics-clinical model. The radiomics-clinical model provides a higher level of predictive performance and model decision-making basis for the risk prognosis of cerebral hemorrhage.
Can Machine Learning Models Based on Computed Tomography Radiomics and Clinical Characteristics Provide Diagnostic Value for Epstein-Barr Virus–Associated Gastric Cancer?
Authors: Zong Ruilong , Ma Xijuan , Shi Yibing , Geng Li 
Published: June 2024

Objective
The aim of this study was to explore whether machine learning model based on computed tomography (CT) radiomics and clinical characteristics can differentiate Epstein-Barr virus–associated gastric cancer (EBVaGC) from non-EBVaGC.

Methods
Contrast-enhanced CT images were collected from 158 patients with GC (46 EBV-positive, 112 EBV-negative) between April 2018 and February 2023. Radiomics features were extracted from the volumes of interest. A radiomics signature was built based on radiomics features by the least absolute shrinkage and selection operator logistic regression algorithm. Multivariate analyses were used to identify significant clinicoradiological variables. We developed 6 ML models for EBVaGC, including logistic regression, Extreme Gradient Boosting, random forest (RF), support vector machine, Gaussian Naive Bayes, and K-nearest neighbor algorithm. The area under the receiver operating characteristic curve (AUC), the area under the precision-recall curves (AP), calibration plots, and decision curve analysis were applied to assess the effectiveness of each model.

Results
Six ML models achieved AUC of 0.706–0.854 and AP of 0.480–0.793 for predicting EBV status in GC. With an AUC of 0.854 and an AP of 0.793, the RF model performed the best. The forest plot of the AUC score revealed that the RF model had the most stable performance, with a standard deviation of 0.003 for AUC score. RF also performed well in the testing dataset, with an AUC of 0.832 (95% confidence interval: 0.679–0.951), accuracy of 0.833, sensitivity of 0.857, and specificity of 0.824, respectively.

Conclusions
The RF model based on clinical variables and Rad_score can serve as a noninvasive tool to evaluate the EBV status of gastric cancer.
GDF11 OVEREXPRESSION ALLEVIATES SEPSIS-INDUCED LUNG MICROVASCULAR ENDOTHELIAL BARRIER DAMAGE BY ACTIVATING SIRT1/NOX4 SIGNALING TO INHIBIT FERROPTOSIS
Authors: Wu Zhixiang , Xi Qiong , Zhao Qin , Zhu Shan 
Published: June 2024

ABSTRACT
Sepsis is a lethal clinical syndrome, and acute lung injury (ALI) is the earliest and most serious complication. We aimed to explore the role of growth differentiation factor 11 (GDF11) in sepsis-induced dysfunction of lung microvascular endothelial barrier in vivo and in vitro to elucidate its potential mechanism related to sirtuin 1 (SIRT1)/NADPH oxidase 4 (NOX4) signaling. Cecal ligation and puncture (CLP)-induced sepsis mice and lipopolysaccharide (LPS)-induced pulmonary microvascular endothelial cells (PMECs) were used in this study. Histopathological changes in lung tissues were tested by hematoxylin-eosin staining. Lung wet-to-dry weight ratio and inflammatory factors contents in bronchoalveolar lavage fluid were assessed. Evens blue index, trans-epithelial electrical resistance, and expression of zona occludens 1 (ZO-1), occludin-1, and claudin-1 were used to evaluate alveolar barrier integrity. Reactive oxygen species, lipid peroxidation, and ferroptosis markers were analyzed. Iron deposition in the lung tissues was assessed using Prussian blue staining. Intracellular Fe2+ level was detected using FerroOrange staining. Additionally, expression of GDF11, SIRT1, and NOX4 was estimated with western blot. Then, EX527, a SIRT1 inhibitor, was employed to treat GDF11-overexpressed PMECs with LPS stimulation to clarify the regulatory mechanism. Results showed that GDF11 overexpression attenuated sepsis-induced pathological changes and inflammation and maintained alveolar barrier integrity. Moreover, GDF11 overexpression inhibited ferroptosis, upregulated SIRT1 expression and downregulated NOX4 expression. Additionally, EX527 treatment relieved the impacts of GDF11 overexpression on ferroptosis and destruction of integrity of human pulmonary microvascular endothelial cells exposed to LPS. Taken together, GDF11 overexpression could alleviate sepsis-induced lung microvascular endothelial barrier damage by activating SIRT1/NOX4 signaling to inhibit ferroptosis. Our findings potentially provide new molecular target for clinical therapy of ALI.
Early Detection of Ventilator-associated Pneumonia From Exhaled Breath in Intensive Care Unit Patients
Authors: Bakali Umer , Killawala Chitvan , Monteagudo Evelise , Cobler-Lichter Michael D. , Tito Luciana , Delamater Jessica , Shagabayeva Larisa , Collie Brianna L. , Lyons Nicole B. , Dikici Emre , Deo Sapna K. , Daunert Sylvia , Schulman Carl I. 
Published: June 2024

Objective:
Evaluate associations between volatile organic compounds (VOCs) in heat and moisture exchange (HME) filters and the presence of ventilator-associated pneumonia (VAP).

Background:
Clinical diagnostic criteria for VAP have poor interobserver reliability, and cultures are slow to result. Exhaled breath contains VOCs related to gram-negative bacterial proliferation, the most identified organisms in VAP. We hypothesized that exhaled VOCs on HME filters can predict nascent VAP in mechanically ventilated intensive care unit patients.

Methods:
Gas chromatography-mass spectrometry was used to analyze 111 HME filters from 12 intubated patients who developed VAP. Identities and relative amounts of VOCs were associated with dates of clinical suspicion and culture confirmation of VAP. Matched pairs t tests were performed to compare VOC abundances in HME filters collected within 3 days pre and postclinical suspicion of VAP (pneumonia days), versus outside of these days (non-pneumonia days). A receiver operating characteristic curve was generated to determine the diagnostic potential of VOCs.

Results:
Carbon disulfide, associated with the proliferation of certain gram-negative bacteria, was found in samples collected during pneumonia days for 11 of 12 patients. Carbon disulfide levels were significantly greater (P = 0.0163) for filters on pneumonia days. The Area Under the Curve of the Reciever Operating Characteristic curve (AUC ROC) for carbon disulfide was 0.649 (95% CI: 0.419–0.88).

Conclusions:
Carbon disulfide associated with gram-negative VAP can be identified on HME filters up to 3 days before the initial clinical suspicion, and approximately a week before culture confirmation. This suggests VOC sensors may have potential as an adjunctive method for early detection of VAP.