bluuebunny/crossref_metadata_2025_split huggingface dataset:
Should Patients Hospitalized for Community-Acquired Pneumonia Be Treated With Additional Antimicrobial Agents Directed Against Anaerobes?
Authors: Smith Miriam A. , Varghese Shawn , Kluger Courtney , Doan Thien-Ly 
Published: February 2025

BACKGROUND:
The revised 2019 American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) clinical practice guidelines for treatment of community-acquired pneumonia (CAP) in newly hospitalized patients with no immunocompromising condition do not recommend addition of focused anaerobic coverage in the absence of lung abscess or empyema. However, many clinicians still prescribe antimicrobial treatment of anaerobes. Our article reviews the basis for the ATS/IDSA guidelines and provides recommendations based on more recent evidence.

AREAS OF UNCERTAINTY:
Despite the ATS/IDSA 2019 guidelines for treatment of newly hospitalized patients with CAP, clinicians still prescribe directed anaerobic treatment. We include newer data since the publication of the CAP guidelines to determine if the recommendations should be revised.

DATA SOURCES:
The databases searched for this review included PubMed/MEDLINE, Google Scholar, CINAHL, Embase, and Cochrane Library, using controlled vocabulary including the following medical subject headings keywords: aspiration, pneumonia, anaerobe, and anaerobic coverage. Studies and reviews from January 2019 to June 2024 were evaluated. Articles were selected if the content involved treatment, including clinical outcomes and microbiology.

THERAPEUTIC ADVANCES:
We found 4 articles between 2019 and 2024 addressing the 2019 ATS/IDSA CAP guidelines. One Canadian study comparing patients receiving limited or extended anaerobic coverage found no significant mortality benefit and a significantly higher rate of Clostridioides difficile colitis with extended coverage. Another study demonstrated a longer intensive care unit length of stay in patients receiving additional anaerobic coverage. A systematic review and meta-analysis also demonstrated no mortality benefit in patients with aspiration pneumonia who received directed anaerobic coverage versus those who did not. In another study, the prevalence of anaerobic bacteria isolated from respiratory samples was similar in patients with aspiration community–acquired pneumonia versus patients with CAP with or without aspiration risk factors.

CONCLUSIONS:
Based on review of newer evidence, we continue to support the 2019 ATS/IDSA treatment guidelines for CAP.
Urinary tract infections and other associated factors in two Syrian hospitals: a cross-sectional study
Authors: Alkailani Ali , Soqia Jameel , Kakaje Ameer , Daher Nizar 
Published: February 2025

Introduction:
Urinary tract infections (UTIs) cause a major burden in hospitals, mainly among the elderly, where they can increase morbidity and mortality and are a common cause of delirium. We aim to study UTIs, their inflammatory markers, and microbiology cultures in Syria.

Methods:
This is a cross-sectional study conducted in two major hospitals in Damascus, Syria, on patients admitted for UTIs and urosepsis who had positive urine cultures. Our study included comorbidities such as diabetes and high blood pressure. Urine culture, symptoms, and presentation were used to determine the diagnosis of UTI/urosepsis. Having an indwelling catheter or other abnormalities was also included.

Results:
This study included 120 patients, 66 (55%) being females. The mean age of the sample was 59.5 years (SD = 11.4), with 52.2% being above 60 years of age. Urine cultures yielded 64 (53.3%) Escherichia coli, of which extended-spectrum beta-lactamases (ESBL) 16 (13.3%), and 23 (19.2%) yielded Klebsiella pneumoniae. Diabetes was significantly associated with having sepsis with the UTI (P < 0.049). Older ages, higher C-reactive protein and neutrophils ratio were significantly associated with urosepsis compared to having just a UTI. However, having an indwelling catheter, urological anatomical abnormalities and recurrent UTIs were not associated with a higher chance of urosepsis.

Conclusion:
UTIs are a major problem and the ESBL burden is high. We need better early indicators to face this growing resistance and to improve outcomes.
Uncommon manifestation of MRSA-related deep vein thrombosis and lung abscesses in a young child: a case report
Authors: Roumi Jamal Bakri , Tarsha Kurdi Hala , Kalaji Rawan , Fustuk Mohamad Omar , Tarsha Kurdi Khalil , Awad Hebatullah 
Published: February 2025

Introduction and importance:
Cellulitis, a common skin and soft tissue infection, can lead to complications such as deep vein thrombosis (DVT), presenting with unilateral limb swelling, erythema, and pain. Methicillin-resistant Staphylococcus aureus (MRSA) is a notable causative pathogen for severe cases and complications.

Case presentation:
We report a rare case of MRSA-induced DVT and lung abscesses in a 5-year-old male following a knee injury. The child initially presented with fever, vomiting, abdominal pain, and restricted movement in the right leg. Laboratory tests confirmed DVT, and chest imaging subsequently revealed multiple lung abscesses. Septic arthritis was ruled out based on a knee synovial fluid test showing no growth of pathogenic bacteria. The patient received initial treatment with intravenous (IV) fluids, subcutaneous enoxaparin sodium (clexane), and IV antibiotics (teicoplanin and ceftazidime). Treatment was later modified to include vancomycin, metronidazole, and finally, linezolid due to its superior lung penetration and clinical response. Endocarditis was ruled out via transthoracic echocardiography. The patient showed marked improvement and was successfully discharged after 2 months.

Clinical discussion:
This case underscores the importance of considering DVT as a potential complication of cellulitis in pediatric patients, particularly with MRSA involvement. The pathophysiology of MRSA-induced DVT involves bacterial toxins that promote platelet aggregation, thrombin activation, and endothelial dysfunction, creating a procoagulant milieu. This case adds to the limited literature on pediatric MRSA infections leading to such severe complications and emphasizes the need for early recognition and targeted therapy.

Conclusion:
MRSA-related infections can lead to rare but severe complications in pediatric patients. Clinicians should maintain a high index of suspicion for DVT and lung abscesses in cases of MRSA cellulitis, particularly following trauma. Early diagnosis and aggressive treatment are essential for better outcomes.
Comparative evaluation of modified frenectomy with papilla preservation flap versus conventional technique in upper labial frenectomy: a randomized controlled trial
Authors: Sayegh Wadie , Khalil Ali , Sleman Nadim 
Published: February 2025

Introduction:
Cosmetic concerns among patients have led to an increased demand for dental treatments aimed at achieving a perfect smile. One of the main cosmetic issues in adults is the gap between the upper incisors, known as diastema, and the upper lip frenulum is often a contributing factor to this condition. Therefore, it is imaportant to focus on this aspect.

Objective:
To explore a new technique for cutting the upper lip frenulum in patients with a gap between the central incisors while avoiding the negative effects of the traditional technique.

Materials and methods:
This randomized controlled clinical trial included 20 patients diagnosed with abnormal upper lip frenal attachment and diastema between the central incisors. The study compared the modified frenectomy technique with a papilla preservation flap against the traditional “Archer” technique. Each technique was performed on 10 patients, and outcomes such as scar formation, gingival inflammation, and post-surgical pain were evaluated.

Results:
The “modified frenectomy with papilla preservation flap” technique prevented scar formation in the papilla area between the upper incisors in nine cases, while scar formation occurred in seven cases using the traditional technique. There were no statistically significant differences in gingival inflammation post-surgery. Pain levels were lower with the modified technique: on the first day, the average pain score was 1.5 for the modified technique and 2.8 for the traditional technique. By the third day, the average pain was 4.3 for the modified technique and 6.9 for the traditional technique, with pain decreasing by the seventh day to an average of 0.7 for the modified technique and 1.6 for the traditional technique.

Conclusion:
The modified frenectomy with a papilla protection flap effectively reduces scarring, enhances healing, and minimizes postoperative pain, offering a more comfortable and aesthetically better result than conventional methods.
Bardet–Biedl syndrome in a Syrian adolescent: a rare case report
Authors: Alabed Ammer , Alhallak Shaghaf , Dakkak Tala , Alhaj Ali Ahmad Jamal , Beiruty Noel , Alwannous Kamal 
Published: February 2025

Introduction:
Bardet–Biedl Syndrome (BBS) is a rare genetic disorder that affects multiple organs and presents with a variety of characteristics. It was found that a dysfunction in the cilia causes it, in addition to mutations in the genes involved in the composition of these cilia. We present a unique case of BBS in a 13-year-old male from Syria, characterized by a significant family history of scleroderma and a distinct clinical presentation.

Case presentation:
The patient presented with intellectual disabilities, post-axial polydactyly, and a history of delayed developmental milestones. The patient’s BMI was within the normal range. Laboratory investigations revealed increased TSH and positive calcium oxalate, without evidence of central obesity or blindness. The diagnosis of BBS was made with a moderate level of confidence. The patient was undergoing treatment with thyroxine, showing improvement in thyroid function and communication skills.

Clinical discussion:
This case highlights the manifestations of BBS and the importance of recognizing atypical presentations. Diagnostic criteria traditionally emphasize a combination of primary and secondary features. We discuss the challenges of diagnosing BBS without genetic testing and the implications for treatment in resource-limited settings. Additionally, we explore therapeutics in managing the patient’s condition.

Conclusion:
This case represents a unique presentation of BBS, expanding the understanding of its clinical variability in different populations. The findings underscore the necessity for individualized diagnostic approaches and comprehensive management strategies in patients with limited access to genetic testing. By documenting this case, we contribute to the growing body of literature on BBS, particularly in the Syrian context, highlighting the need for increased awareness and research into this challenging disorder.
Impact of Lymphedema Duration on Lymphatic Vessel Quality and Outcomes After Supermicrosurgical Lymphaticovenous Anastomosis
Authors: Taliat George , Ou Yu-Che , Wang Yu-Ming , Chang Chad , Wu Shao-Chun , Lin Wei-Che , Chien Peng-Chen , Hsieh Ching-Hua , Yang Johnson Chia-Shen 
Published: February 2025

Background:
Inferior lymphatic vessel (LV) quality was thought to be associated with prolonged lymphedema duration (LD), which can lead to unfavorable lymphaticovenous anastomosis (LVA) outcomes. However, increasing evidence supports the use of LVA in the treatment of advanced lymphedema. Hence, this study aimed to determine the impact of LD on LV quality and outcomes after LVA in patients with secondary lower limb lymphedema.

Patients and Methods:
A total of 189 patients who underwent supermicrosurgical LVA were retrospectively reviewed and enrolled. The study group (LD>3.6 years) and the control group (LD≤3.6 years) consisted of 94 and 95 patients, respectively. Patients with previous LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters and volume changes were recorded and the parameters except LD were matched using propensity-score-matching. The primary endpoint was volume change at 6 and 12 months after LVA.

Results:
Before matching, the study group had significantly higher ratios of indocyanine green-enhanced, lymph flow-positive, and Normal+Ectatic LVs (p=0.016, 0.035, and 0.002, respectively) than the control group. After all parameters except LD were matched, 64 patients were included in each group, with higher median LD in the study group (7.8 vs. 1.1 years, p<0.001) than the control group. However, no significant intergroup differences were found in postoperative percentage volume reduction at the 6- and 12-month follow-up (p=0.813 and 0.627, respectively).

Conclusion:
Contrary to common beliefs, longer LD did not negatively affect LV quality and outcomes after LVA. Therefore, LVA remains a viable treatment option for patients with long-standing lymphedema.
Photon-Counting Detector CT Iodine Maps Versus SPECT/CT
Authors: Kerber Bjarne , Hüllner Martin , Maurer Alexander , Flohr Thomas , Ulrich Silvia , Lichtblau Mona , Frauenfelder Thomas , Franckenberg Sabine 
Published: February 2025

Objectives
The aim of this study was to compare the accuracy of photon-counting detector computed tomography (PCD-CT) iodine maps of the lung parenchyma with perfusion scintigraphy for detection and extent estimation of pulmonary perfusion defects.

Materials and Methods
This institutional review board–approved retrospective study included 26 subjects (11 male, aged 57.2 ± 15.8 years; 15 female, aged 55.2 ± 15.7 years) who underwent clinically indicated PCD-CT and perfusion SPECT/CT to assess for chronic thromboembolic pulmonary hypertension (CTEPH). Two blinded radiologists used CT iodine maps and corresponding sharp-kernel CT reconstructions in lung window to evaluate presence and extent of lobar perfusion defects and detect patients with CTEPH (or CTEPH overlap with other causes of PH). Accordingly, 2 blinded nuclear medicine physicians/radiologists evaluated perfusion SPECT/CT scans. The clinical diagnosis was reviewed in an interdisciplinary clinical setting. Quantitative analyses were calculated for both modalities. Perfusion defect estimation was compared with right heart catheter measurements.

Results
Of the 26 subjects included, 10 were diagnosed with CTEPH or CTEPH overlap, 12 were diagnosed with PH associated with other pathologic mechanisms, 3 had no PH, and 1 had previous acute pulmonary embolism, which resolved. Radiation dose was greatly reduced for PCD-CT compared with SPECT/CT (1.19 [±0.33] mSv; 6.34 [±1.68] mSv, respectively, P < 0.001). Both PCD-CT readers (R1, R2) showed a trend toward higher accuracy, sensitivity, and specificity for CTEPH diagnosis compared with the scintigraphy consensus (SC) (accuracy: R1 0.85, R2 0.88, SC 0.73; sensitivity: R1 0.90, R2 0.90, SC 0.80; specificity: R1 0.81, R2 0.88, SC 0.69), although there was no significant difference observed (P > 0.688). There was good to excellent agreement between both PCD-CT readers for perfusion defect estimation. Moderate intermodality agreement was observed for CTEPH diagnosis certainty and perfusion defect estimation. The quantitative evaluation showed strong to excellent correlation between PCD-CT and SPECT/CT relative perfusion. There was a significant moderate correlation between PCD-CT perfusion defect estimations and mean pulmonary artery pressure (R1: r = 0.49, P = 0.020; R2: r = 0.49, P = 0.021), pulmonary vascular resistance (R1: r = 0.60, P = 0.003; R2: r = 0.52, P = 0.013), and cardiac index (R1: r = −0.45, P = 0.042).

Conclusions
PCD-CT iodine maps allow for accurate CTEPH detection and are comparable to perfusion SPECT/CT with good quantitative correlation, but only moderate qualitative agreement, at greatly reduced radiation dose. Furthermore, visual PCD-CT perfusion defect extent was associated with prognostic right heart catheter measurements.
Pros and Cons of High-Performance Gradient Enabled Short-TE Prostate DWI
Authors: Bachl Maximilian , Skwierawska Dominika , Hadler Dominique , Schreiter Hannes , Uder Michael , Janka Rolf , Laun Frederik B. , Bickelhaupt Sebastian 
Published: February 2025

Objectives
Recent advances in high-performance gradient technology have enabled shorter echo times (TEs) for diffusion-weighted prostate MRI. Short TE may improve the conspicuity of the usually T2 hypointense lesions but may also influence the diagnostic performance of the apparent diffusion coefficient (ADC) due to a changed weighting of subcompartments, including prostate fluid and tissues. The purpose of this study was to evaluate the influence of TE on prostate diffusion-weighted images with respect to lesion conspicuity and diagnostic performance of the ADC.

Materials and Methods
This institutional review board–approved prospective monocentric study included n = 55 (mean age 69 ± 9 years) patients undergoing clinically indicated prostate MRI on two 3 T MRI scanners with high-performance gradients. Diffusion-weighted imaging (DWI) was performed with an echo-planar sequence at 2 different TEs, 41 ms and 70 ms, with b-values of 50 s/mm2 and 800 s/mm2. Computed DWI was generated for a b-value of 1400 s/mm2. The lesion conspicuity and image quality were rated by 3 independent readers with a 5-point Likert scale and tested with the Wilcoxon rank sum test. Lesion ADCs were recorded, and their ability to detect significant lesions (Gleason score >6) was assessed with a receiver operator curve analysis.

Results
Among the participants, n = 24 had clinically significant prostate cancer. The image quality at b = 1400 s/mm2 was rated significantly higher at TE = 41 ms than at TE = 70 ms (mean Likert score ± standard deviation for TE = 41 ms vs TE = 70 ms: R1: 4.06 ± 0.68 vs 3.02 ± 0.59; R2: 4.09 ± 0.82 vs 3.26 ± 0.67; R3: 4.16 ± 0.71 vs 3.18 ± 0.70; for all P’s < 0.001). The lesion conspicuity at b = 1400 s/mm2 was rated higher at TE = 41 ms than at TE = 70 ms (mean Likert score ± standard deviation for TE = 41 ms vs TE = 70 ms: R1: 4.55 ± 0.66 vs 4.46 ± 0.72, P = 0.17; R2: 4.64 ± 0.59 vs 4.53 ± 0.63, P = 0.03; R3: 4.53 ± 0.66 vs 4.28 ± 0.80, P = 0.01). However, the ADC-based area under the curve for lesion characterization decreased from 0.80 at TE = 70 ms to 0.70 at TE = 41 ms (P = 0.07).

Conclusions
Shortening TE to 41 ms in prostate DWI increases lesion conspicuity on high b-value images; however, it negatively impacts the diagnostic performance of the ADC.
Artificial Intelligence Iterative Reconstruction for Dose Reduction in Pediatric Chest CT
Authors: Zhang Feifei , Peng Liying , Zhang Guozhi , Xie Ruigang , Sun Minghua , Su Tao , Ge Yinghui 
Published: February 2025

Purpose:
To assess the performance of a newly introduced deep learning-based reconstruction algorithm, namely the artificial intelligence iterative reconstruction (AIIR), in reducing the dose of pediatric chest CT by using the image data of below 3-year-old patients with congenital heart disease (CHD).

Materials and Methods:
The lung image available from routine-dose cardiac CT angiography (CTA) on below 3 years patients with CHD was employed as a reference for evaluating the paired low-dose chest CT. A total of 191 subjects were prospectively enrolled, where the dose for chest CT was reduced to ~0.1 mSv while the cardiac CTA protocol was kept unchanged. The low-dose chest CT images, obtained with the AIIR and the hybrid iterative reconstruction (HIR), were compared in image quality, ie, overall image quality and lung structure depiction, and in diagnostic performance, ie, severity assessment of pneumonia and airway stenosis.

Results:
Compared with the reference, lung image quality was not found significantly different on low-dose AIIR images (all P>0.05) but obviously inferior with the HIR (all P<0.05). Compared with the HIR, low-dose AIIR images also achieved a closer pneumonia severity index (AIIR 4.32±3.82 vs. Ref 4.37±3.84, P>0.05; HIR 5.12±4.06 vs. Ref 4.37±3.84, P<0.05) and airway stenosis grading (consistently graded: AIIR 88.5% vs. HIR 56.5% ) to the reference.

Conclusions:
AIIR has the potential for large dose reduction in chest CT of patients below 3 years of age while preserving image quality and achieving diagnostic results nearly equivalent to routine dose scans.
Occultation constraints on solar system formation models
Authors: Buie Marc W. , Keller John M. , Nesvorný David , Porter Simon B. 
Published: February 2025

The process by which a system of non-luminous bodies form around a star is fundamental to understanding the origins of our own solar system and how it fits into the context of other systems we have begun to study around other stars. Some basics of solar system formation have emerged to describe the process by which dust and gas around a newly formed star evolve into what we see today. The combination of occultation observations and the flyby observations by New Horizons of the Cold-Classical Kuiper Belt Object (CCKBO), (498958) Arrokoth, has provided essential new constraints on formation models through its three-dimensional shape. We present a case that an occultation-driven survey of CCKBOs would provide fundamental new insight into solar system formation processes by measuring population-wide distributions of shape, binarity, and spin-pole orientation as a function of size in this primordial and undisturbed reservoir.
This article is part of the theme issue ‘Major advances in planetary sciences thanks to stellar occultations’.
Avian air sacs and neopulmo: their evolution, form and function
Authors: Klein Wilfried , Pereira Ribeiro Vinícius , Bueno de Souza Ray Brasil 
Published: February 2025

The avian respiratory system is composed of an exchange structure (parabronchi) and a pump (air sacs) to perform gas exchange. While there are many studies dealing with the morphology and function of the palaeopulmonic parabronchi, the air sacs and the neopulmo have been somewhat neglected from a comparative and functional point of view, not always receiving a closer examination that they deserve. While a decent amount of data are available regarding air sac and neopulmo morphology on a family level or for domestic species, several orders of birds have yet to be investigated. Owing to the lack of detailed specific data, we did not perform a comparative phylogenetic analysis but compiled data regarding air sac and neopulmo morphology and analysed them from the viewpoint of current phylogenetic relations while also discussing aspects of these structures regarding avian physiology.
This article is part of the theme issue ‘The biology of the avian respiratory system’.