bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defective natriuresis contributes to hyperkalemia in db/db mice during potassium supplementation
Authors: Shu Ting-Ting , Gao Zhong-Xiuzi , Mao Zi-Hui , Yang Yuan-Yuan , Fu Wen-Jia , Pan Shao-Kang , Zhao Qian-Qian , Liu Dong-Wei , Liu Zhang-Suo , Wu Peng 
Published: May 2024

Objectives:
Potassium supplementation reduces blood pressure and the occurrence of cardiovascular diseases, with K+-induced natriuresis playing a potential key role in this process. However, whether these beneficial effects occur in diabetes remains unknown.

Methods:
In this study, we examined the impact of high-K+ intake on renal Na+/K+ transport by determining the expression of major apical Na+ transporters, diuretics responses (as a proxy for specific Na+ transporter function), urinary Na+/K+ excretion, and plasma Na+/K+ concentrations in db/db mice, a model of type 2 diabetes mellitus.

Results:
Although db/m mice exhibited increased fractional excretion of sodium (FENa) and fractional excretion of potassium (FEK) under high-K+ intake, these responses were largely blunted in db/db mice, suggesting impaired K+-induced natriuresis and kaliuresis in diabetes. Consequently, high-K+ intake increased plasma K+ levels in db/db mice, which could be attributed to the abnormal activity of sodium-hydrogen exchanger 3 (NHE3), sodium-chloride cotransporter (NCC), and epithelial Na+ channel (ENaC), as high-K+ intake could not effectively decrease NHE3 and NCC and increase ENaC expression and activity in the diabetic group. Inhibition of NCC by hydrochlorothiazide could correct the hyperkalemia in db/db mice fed a high-K+ diet, indicating a key role for NCC in K+-loaded diabetic mice. Treatment with metformin enhanced urinary Na+/K+ excretion and normalized plasma K+ levels in db/db mice with a high-K+ diet, at least partially, by suppressing NCC activity.

Conclusion:
Collectively, the impaired K+-induced natriuresis in diabetic mice under high-K+ intake may be primarily attributed to impaired NCC-mediated renal K+ excretion, despite the role of NHE3.
RETINAL TOXICITY SECONDARY TO INADVERTENT SUBRETINAL MITOMYCIN C INJECTION
Authors: Alsberge Joseph B. , Hoffelt Zakary 
Published: May 2024

Purpose:
To report a patient who developed retinal toxicity after inadvertent subretinal mitomycin C injection during glaucoma surgery.

Methods:
Case report and review of the literature.

Results:
A 73-year-old man underwent glaucoma tube shunt surgery with sub-Tenon mitomycin C injection. Postoperatively, he developed retinal edema, hemorrhages, and occlusive vasculopathy localized to the quadrant of the mitomycin C injection. It was determined that the sclera had been inadvertently punctured during mitomycin C injection, resulting in subretinal placement of the medication and resultant retinal toxicity. At postoperative month 1, there was diffuse chorioretinal atrophy in the area of the injection. The macula was spared and he retained his preoperative visual acuity.

Conclusion:
Inadvertent subretinal mitomycin C injection may occur when attempting to inject the drug into the sub-Tenon space and can result in localized retinal toxicity.
Clinical Efficacy of 2% Rebamipide in Patients With Video Display Terminal–Associated Dry Eye Disease: A Prospective, Randomized, Double-Blinded Study
Authors: Lee Yong Woo , Han Sang Beom 
Published: May 2024

Purpose:
To compare the effects of 2% rebamipide clear solution and 0.1% sodium hyaluronate eye drops in patients with visual display terminal (VDT)-related dry eye disease (DED).

Design:
Prospective, randomized, double-blinded Study.

Methods:
This was a prospective, double-blind, and randomized controlled study. Patients with VDT-related DED were randomly allocated to a 2% rebamipide (REB) group or a 0.1% sodium hyaluronate (HYA) group (4 times/day for 4 weeks). The ocular surface disease index (OSDI), dry eye questionnaire-5 (DEQ-5), Placido disk-tear film analyzer, fluorescein-stained tear break-up time (FBUT), ocular surface staining score, and Schirmer 1 test were examined before and after the instillation of drug.

Results:
A total of 56 eyes of 28 patients (28 eyes of 14 patients in each group) were included. There were no significant differences in the baseline data. The OSDI, DEQ-5, FBUT, and conjunctival erosion scores improved significantly in both groups after treatment. In the REB group, corneal staining and bulbar nasal redness scores also improved significantly after treatment (P<0.001 and 0.036, respectively), whereas no significant differences were found in these parameters in the HYA group (P=0.326 and 0.118, respectively). The REB group showed a significantly larger decrease in the corneal staining score than the HYA group (P=0.016). No adverse reactions were observed.

Conclusions:
A 2% rebamipide clear solution effectively improved the symptoms and signs in patients with VDT-related DED and was superior to 0.1% sodium hyaluronate ophthalmic solution in improving corneal epithelial damage, making it a safe and effective treatment option for VDT-related DED.
Myopic Regression After FS-LASIK and SMILE
Authors: Lin Meng-Yin , Tan Hsin-Yuan , Chang Chao-Kai 
Published: May 2024

Purpose:
To compare the degree of myopic regression after myopia correction with either femtosecond laser-assisted in situ keratomileusis (FS-LASIK) or small-incision lenticule extraction (SMILE) over 18 months.

Methods:
Patients undergoing FS-LASIK or SMILE surgery for myopia correction were retrospectively recruited. The propensity scores were used to match patients by age and preoperative manifest spherical equivalent (SEQ) from these 2 groups. Myopic regression was analyzed using the Cox proportional hazard model.

Results:
A total of 416 eyes of 416 patients undergoing FS-LASIK and 416 eyes of 416 patients undergoing SMILE were matched. Using 1-month SEQ as baseline, the SEQ regression values after FS-LASIK were 0D, −0.17 ± 0.69D, −0.24 ± 0.65D, −0.31 ± 0.65D, −0.32 ± 0.63D, and −0.33 ± 0.62D and the SEQ regression values after SMILE were 0D, −0.07 ± 0.75D, −0.18 ± 0.77D, −0.23 ± 0.82 D, −0.21 ± 0.77D, and −0.24 ± 0.68D at 1, 3, 6, 9, 12, and 18 months, respectively. The Cox proportional hazard model showed that preoperative manifest SEQ (P = 0.021) and designed optical zone (P = 0.048) are significant predictors. The selected surgical procedure had no significant effect on predicting myopic regression (P = 0.470). The cumulative survival rates of myopic regression were 54.74% and 42.10% in the FS-LASIK group and 58.66% and 43.83% in the SMILE group, at 12 and 18 months, respectively (log-rank test, P = 0.11).

Conclusions:
After matching based on age and preoperative manifest SEQ, we found that higher myopia and a smaller optical zone contribute significantly to the development of myopic regression after undergoing FS-LASIK or SMILE surgery at 18 months. The selected surgical procedure, however, does not affect the likelihood of myopic regression.
Diagnostic Abilities of Three-Dimensional Anterior Segment Optical Coherence Tomography in Detecting Angle Closure
Authors: Chansangpetch Sunee , Phinyo Phichayut , Patumanond Jayanton , Choovuthayakorn Janejit , Lin Shan C. 
Published: May 2024

Précis:
Three-dimensional (3D) angle parameters and cutoff values for detecting angle closure were proposed. The 3D parameters demonstrated excellent diagnostic performance. Certain horizontal two-dimensional (2D) parameters [ie, trabecular iris space area (TISA)-750, angle opening distance (AOD)-750, and AOD-500] can attain similar performance to their high-performing 3D counterparts.

Objective:
To investigate the diagnostic performance of single horizontal 2D versus 3D angle parameters from swept-source anterior segment optical coherence tomography (CASIA2) in detecting angle closure.

Materials and Methods:
The cross-sectional study included 118 phakic patients (59 open angles, 59 closed angles). AOD, angle recess area (ARA), and TISA at 250, 500, and 750 μm from scleral spur were measured in 360-degree radial-scan images. The 3D information of each measurement was analyzed in 2 patterns: (1) average 3D parameter—the averaged value from 360-degree angle values and (2) estimate 3D parameter—the estimation of surface area of circumferential angle inlet (using AOD) or circumferential angle volume (using ARA and TISA). The areas under the receiver operating characteristic curve [areas under the curve (AUCs)] of eighteen 3D parameters were compared with 2D horizontal parameters.

Results:
Among 3D parameters, AOD-500 estimate 3D gave the highest AUC (AUC: 0.950, cutoff: 6.09 mm2), followed by AOD-750 estimate 3D (AUC: 0.948, cutoff: 8.26 mm2). 3D parameters significantly increased the AUC of ARA-250 and TISA-250 (all P < 0.02) compared with the 2D parameters. No significant improvement in AUC was demonstrated for AOD-250 and all parameters at 500 and 750 μm. No significant difference in AUC was found among the 6 maximum AUC parameters, which were AOD-750 horizontal 2D, AOD-500 estimate 3D, TISA-750 horizontal 2D, AOD-500 horizontal 2D, AOD-750 estimate 3D, and TISA-750 average 3D.

Conclusions:
The 3D-angle parameters had high performance in detecting angle closure. However, comparing a horizontal measurement to 3D parameters, the AUC improvement was mostly insignificant.
Examining Acute Symptoms After Sport-Related Concussion in Collegiate Athletes With Preinjury Migraines
Authors: Jo Jacob , Berkner Paul D. , Stephenson Katie , Maxwell Bruce A. , Iverson Grant L. , Zuckerman Scott L. , Terry Douglas P. 
Published: May 2024

Objective:
To examine whether a personal history of migraines is associated with worse acute symptom burden after sport-related concussion (SRC).

Design:
Retrospective cohort study.

Setting:
National Collegiate Athletic Association Division III collegiate programs.

Participants:
Collegiate athletes from a prospective concussion surveillance system between 09, 2014, and 01, 2023.

Intervention:
Preinjury migraines (yes/no) were self-reported by athletes.

Main Outcome Measures:
Post-Concussion Symptom Scale (PCSS) were collected within 3 days postinjury. Mann–Whitney U tests compared total PCSS scores and individual symptom scores between athletes with and without preinjury migraines. Chi-squared tests were used to compare proportions of athletes endorsing individual symptoms (ie, item score ≥1) between 2 groups. Multivariable regression analyzed potential predictors of PCSS scores.

Results:
Of 1190 athletes with SRC, 93 (7.8%) reported a preinjury history of migraines. No significant difference in total PCSS scores was found between athletes with and without preinjury migraines (22.0 ± 16.4 vs 20.5 ± 15.8, U = 48 719.0, P = 0.471). Athletes with preinjury migraines reported greater severity of “sensitivity to light” (1.59 ± 1.59 vs 1.23 ± 1.41, P = 0.040) and “feeling more emotional” (0.91 ± 1.27 vs 0.70 ± 1.30; P = 0.008) and were more likely to endorse “feeling more emotional” (45.2% vs 29.5%, P = 0.002). No differences were found across all other symptoms, including headaches (migraine = 87.1% vs no migraine = 86.3%, P = 0.835). In a multivariable model, a history of migraine was not a significant predictor of acute PCSS scores, but those with a history of psychological disorders (β = 0.12, P <0 .001) and greater number of days to symptom evaluation (β = 0.08, P = 0.005) had higher PCSS scores.

Conclusions:
Collegiate athletes with a pre-existing history of migraines did not have higher acute symptom burden after SRC.
Process and Impact of Development of an Adolescent Emergency Psychiatry Unit at a Large Urban Hospital
Authors: Claudius Ilene , Tolles Juliana , Fleischman Ross , Muller Vikram , Padlipsky Patricia , Kelly Patrick , Saidinejad Mohsen 
Published: May 2024

Objectives
Boarding of adolescent patients with mental health concerns requiring ongoing observation and treatment is of increasing concern across US emergency departments. The objective was a proof of concept of developing an adolescent psychiatric emergency unit and assessment of the impact of this unit on lengths of stay (LOS).

Methods
We describe the creation of the unit designed to allow safe assessment and boarding of patients, and appropriate interventions and services, while arranging transfer to inpatient facility or safe discharge home. Using a precreation and postcreation analysis and comparison with a similar facility that did not create such a unit, we utilized linear regression to investigate the primary outcome of total length of stay and secondary outcomes of psychiatric emergency department and pediatric emergency department length of stay for both unit-eligible patients and all patients.

Results
The overall length of stay was not associated with a statistically significant change for unit-eligible patients; however, there was a significant decrease in the pediatric emergency department LOS for unit-eligible patients. This was associated with a decrease in beds lost to boarding in the pediatric emergency department of 544 hours per month.

Conclusions
Creation of an adolescent psychiatric emergency unit without allotment of significant additional resources is an option to decrease pediatric emergency department boarding times for adolescent patients requiring ongoing emergent therapy for mental health concerns.
Age Impacts Clinical and Patient-Reported Outcomes following Postmastectomy Breast Reconstruction
Authors: Kim Minji , Ali Barkat , Zhang Kevin , Vingan Perri , Boe Lillian , Ly Catherine L. , Allen Robert J. , Stern Carrie S. , Matros Evan , Cordeiro Peter G. , Mehrara Babak , Nelson Jonas A. 
Published: May 2024

Background:
Although the current literature indicates that age should not be a deterring factor in postmastectomy breast reconstruction, the true impact of increasing age on postoperative outcomes remains unknown. The purpose of this study is to understand the impact of age on complications and patient-reported outcomes (PROs) using the BREAST-Q longitudinally 5 years after postmastectomy breast reconstruction.

Methods:
The authors conducted a retrospective analysis of patients who underwent autologous (ABR) or implant-based reconstruction (IBR). Age was studied as both a categorical and a continuous variable. Outcome measures included complications and BREAST-Q scores preoperatively, at 6 months, and 1 to 5 years postoperatively.

Results:
A total of 4730 patients were included, of which 1536 (32.5%) underwent ABR and 3194 (67.5%) underwent IBR. Older age was significantly associated with increased risk of developing mastectomy skin flap/nipple necrosis, infection, and seroma. Older age was negatively correlated with Satisfaction with Breasts (β = −0.06 [95% CI, −0.12 to −0.01]; P = 0.033) and positively correlated with Psychosocial Well-being (β = 0.14 [95% CI, 0.09 to 0.20]; P < 0.001). Older age was not correlated with Physical Well-being of the Chest (β = −0.03 [95% CI, 0.08 to 0.02]; P = 0.2) or Sexual Well-being (β = −0.04 [95% CI, −0.12 to 0.02]; P = 0.2). Subgroup analyses of ABR and IBR patients demonstrated different complications and PRO profiles.

Conclusions:
The authors’ analysis of the impact of age on surgical outcomes and PROs suggests that complication rates increase with age, and older age is negatively correlated with Satisfaction with Breasts but positively correlated with Psychosocial Well-being. Overall, older patients should be informed about the potential associated risks and anticipated PROs.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Pleural Spindle Cell Sarcoma on 68Ga-DOTA-FAPI-04 PET/CT and 18F-FDG PET/CT
Authors: Cui Yan , Zhou Xin , Li Nan 
Published: May 2024

Abstract
A 67-year-old woman with pleural mass underwent 18F-FDG PET/CT, suspected of malignant pleural tumor with intense 18F-FDG uptake. Then she underwent 68Ga-DOTA-FAPI-04 PET/CT for staging, which showed similar uptake in pleural lesions and opposite uptake pattern in mediastinal and hilar lymph nodes. Finally, she was diagnosed with spindle cell sarcoma (G2) by histopathology. After 1 cycle chemotherapy, the pleural lesions progressed, while mediastinal lymph nodes shrunk. Half a month later, the patient died due to rapid disease progression. This case indicates that 68Ga-FAPI PET/CT might be a promising new tool in diagnosis and staging of pleural spindle cell sarcoma.
Inheritance of somatic mutations can affect fitness in monkeyflowers
Authors: Streisfeld Matthew A. , Crown Jessie C. , McLean Jack J. , Short Aidan W. , Cruzan Mitchell B. 
Published: May 2024

AbstractPlants possess the unique ability to transmit mutations to progeny that arise both through meiotic and mitotic (somatic) cell divisions. This is because the same meristem cells responsible for vegetative growth also generate gametes for sexual reproduction. Despite the potential for somatic mutations to be an additional source of genetic variation for adaptation, their role in plant evolution remains largely unexplored. We performed multiple experiments in the bush monkeyflower (Mimulus aurantiacus) to determine the fitness effects of somatic mutations inherited across generations. We tracked somatic mutations transmitted to progeny by generating self-pollinations within a flower (autogamy) or between stems of the same plant (geitonogamy). Autogamy and geitonogamy lead to different segregation patterns of somatic mutations among stems, making it possible to compare average fitness due to somatic variants. We found increased fecundity following autogamy, as well as significant impacts on drought tolerance, survival, and biomass. The variance in fitness was also greater following autogamy, consistent with the effects of somatic mutations impacting fitness. Effect sizes were small, but predictable, given thatM. aurantiacusis a long-lived, drought-adapted shrub. These results reveal the importance of inherited somatic mutations as a source of genetic variation that can be relevant for plant adaptation.
Determinants of Prevalence and Stages of Undiagnosed Hypertension
Authors: Zuzunaga-Montoya Fiorella E. , Vásquez-Romero Luisa Erika Milagros , Loayza-Castro Joan A. , Vigil-Ventura Enrique , Gutierrez De Carrillo Carmen Inés , Vera-Ponce Víctor Juan 
Published: May 2024

AbstractIntroductionHypertension (HTN) has been classified into stages according to elevated blood pressure levels. It has been detailed that higher levels correlate with an increased risk of long-term complications.ObjectiveTo determine the prevalence and trends of different hypertension stages among Peruvians and to identify factors associated with these stages.MethodsData from the Demographic and Family Health Survey from 2014 to 2022 were analyzed. Blood pressure levels were categorized into normotension, high blood pressure (HBP), and HTN stages I, II, and III. The study included individuals aged 18 years and older, excluding those who had not had their blood pressure measured or had known histories of hypertension.ResultsThe prevalences of HBP, HTN stage I, II, and III were 14.73%, 9.64%, 2.16%, and 0.64%, respectively. Factors such as gender, age, wealth index, alcohol consumption, daily smoking, and health conditions like obesity and diabetes significantly influenced the prevalence of the various stages.ConclusionsThe prevalence of HTN varies significantly depending on the stage. These findings underscore the necessity for public health strategies that are personalized and differentiated according to the specific stage of HTN to enhance effectiveness.
Large Language Models for Social Determinants of Health Information Extraction from Clinical Notes – A Generalizable Approach across Institutions
Authors: Keloth Vipina K. , Selek Salih , Chen Qingyu , Gilman Christopher , Fu Sunyang , Dang Yifang , Chen Xinghan , Hu Xinyue , Zhou Yujia , He Huan , Fan Jungwei W. , Wang Karen , Brandt Cynthia , Tao Cui , Liu Hongfang , Xu Hua 
Published: May 2024

AbstractThe consistent and persuasive evidence illustrating the influence of social determinants on health has prompted a growing realization throughout the health care sector that enhancing health and health equity will likely depend, at least to some extent, on addressing detrimental social determinants. However, detailed social determinants of health (SDoH) information is often buried within clinical narrative text in electronic health records (EHRs), necessitating natural language processing (NLP) methods to automatically extract these details. Most current NLP efforts for SDoH extraction have been limited, investigating on limited types of SDoH elements, deriving data from a single institution, focusing on specific patient cohorts or note types, with reduced focus on generalizability. This study aims to address these issues by creating cross-institutional corpora spanning different note types and healthcare systems, and developing and evaluating the generalizability of classification models, including novel large language models (LLMs), for detecting SDoH factors from diverse types of notes from four institutions: Harris County Psychiatric Center, University of Texas Physician Practice, Beth Israel Deaconess Medical Center, and Mayo Clinic. Four corpora of deidentified clinical notes were annotated with 21 SDoH factors at two levels: level 1 with SDoH factor types only and level 2 with SDoH factors along with associated values. Three traditional classification algorithms (XGBoost, TextCNN, Sentence BERT) and an instruction tuned LLM-based approach (LLaMA) were developed to identify multiple SDoH factors. Substantial variation was noted in SDoH documentation practices and label distributions based on patient cohorts, note types, and hospitals. The LLM achieved top performance with micro-averaged F1 scores over 0.9 on level 1 annotated corpora and an F1 over 0.84 on level 2 annotated corpora. While models performed well when trained and tested on individual datasets, cross-dataset generalization highlighted remaining obstacles. To foster collaboration, access to partial annotated corpora and models trained by merging all annotated datasets will be made available on the PhysioNet repository.
Radiation dermatitis in the hairless mouse model mimics human radiation dermatitis
Authors: Lawrence Jessica , Seelig Davis , Demos-Davies Kimberly , Ferreira Clara , Ren Yanan , Wang Li , Alam Sk. Kayum , Yang Rendong , Guedes Alonso , Craig Angela , Hoeppner Luke H. 
Published: May 2024

AbstractOver half of all people diagnosed with cancer receive radiation therapy. Moderate to severe radiation dermatitis occurs in most human radiation patients, causing pain, aesthetic distress, and a negative impact on tumor control. No effective prevention or treatment for radiation dermatitis exists. The lack of well-characterized, clinically relevant animal models of human radiation dermatitis contributes to the absence of strategies to mitigate radiation dermatitis. Here, we establish and characterize a hairless SKH-1 mouse model of human radiation dermatitis by correlating temporal stages of clinical and pathological skin injury. We demonstrate that a single ionizing radiation treatment of 30 Gy using 6 MeV electrons induces severe clinical grade 3 peak toxicity at 12 days, defined by marked erythema, desquamation and partial ulceration, with resolution occurring by 25 days. Histopathology reveals that radiation-induced skin injury features temporally unique inflammatory changes. Upregulation of epidermal and dermal TGF-ß1 and COX-2 protein expression occurs at peak dermatitis, with sustained epidermal TGF-ß1 expression beyond resolution. Specific histopathological variables that remain substantially high at peak toxicity and early clinical resolution, including epidermal thickening, hyperkeratosis and dermal fibroplasia/fibrosis, serve as specific measurable parameters for in vivo interventional preclinical studies that seek to mitigate radiation-induced skin injury.