bluuebunny/crossref_metadata_2025_split huggingface dataset:
An 84-Year-Old Man With Chronic Obstructive Pulmonary Disease and Cirrhosis
Authors: Vashistha Kirtivardhan , Kashyap Rahul , Patel Ashokakumar M. 
Published: February 2024

Abstract
α1-Antitrypsin deficiency is an underdiagnosed, widely prevalent systemic disease, and clinicians should maintain a high degree of awareness during evaluation of patients with chronic obstructive pulmonary disease, unexplained liver disease, or specific skin manifestations. Early identification helps provide specific therapy for patients, improve prognosis, and decrease associated morbidity and mortality. Therapy should be based on the patient’s candidacy and comorbidities and on the risks, benefits, and cost of treatment.
A 66-Year-Old Man With Fatigue, Dyspnea, and Hypoxemia
Authors: Bourne Michael , Diedrich Daniel A. 
Published: February 2024

Abstract
Methemoglobinemia can be congenital or acquired. Congenital methemoglobinemia is secondary to enzymatic deficiencies that result in decreased reduction of methemoglobin. Acquired methemoglobinemia is most commonly caused by drugs, but other sources of oxidative stress, such as surgical procedures, have been implicated. The diagnosis of methemoglobinemia requires a high degree of clinical awareness and corresponding ABG and co-oximetry results.
A 45-Year-Old Man With Worsening Dyspnea and Hypoxemia
Authors: Myers Melissa K. , Wylam Mark E. , Rishi Muhammad A. 
Published: February 2024

Abstract
Pulmonary alveolar proteinosis is caused by excess accumulation of surfactant within alveoli and results in a crazy-paving pattern on computed tomography. Pulmonary alveolar proteinosis may be categorized as congenital, autoimmune (most commonly), or secondary. Diagnosis is made with positive periodic acid–Schiff staining of bronchoalveolar lavage fluid, transbronchial biopsy, or surgical lung biopsy. Whole-lung lavage improves gas exchange immediately. Established alternatives are granulocyte-macrophage colony-stimulating factor supplementation or granulocyte-macrophage colony-stimulating factor antibody depletion.
A 59-Year-Old Woman With Progressive Dyspnea Undergoing Evaluation for Lung Transplant
Authors: Zhang Zhenmei , Peters Steve G. 
Published: February 2024

Abstract
Pulmonary alveolar microlithiasis is a rare autosomal recessive disorder that is characterized by intra-alveolar accumulation of microliths and a sandstorm appearance on chest radiography. The only currently available and effective therapy for pulmonary alveolar microlithiasis is lung transplant. Appropriate patients with progressive, chronic lung disease should be referred to transplant centers in a timely manner to complete the comprehensive multidisciplinary evaluation.
A 52-Year-Old Woman With Arthralgias, Hair Loss, and Skin Ulcers
Authors: Varghese Cyril , Ryu Jay H. 
Published: February 2024

Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease related to smoking in adults. The disease may coexist with other smoking-related conditions, including respiratory bronchiolitis, DIP, and emphysema. Decreased Dlco is the most common finding on pulmonary function testing. Extrapulmonary involvement, mainly with bone and pituitary involvement, occurs in 10% to 15% of adults with smoking-related PLCH. Treatment of PLCH is mainly smoking cessation; rarely, corticosteroids and cladribine are used if the disease continues to progress despite smoking cessation. Complications of PLCH include spontaneous pneumothorax, pulmonary hypertension, and increased risk of malignancies.
A 68-Year-Old Man With Dyspnea and Multiple Pulmonary Nodules
Authors: Canepa Scott M. , Stroh Gregory R. , Ryu Jay H. 
Published: February 2024

Abstract
The differential diagnosis of pulmonary nodules is broad and encompasses various systemic and lung-limited diseases. An organized and algorithmic diagnostic approach is necessary to formulate and narrow an accurate differential diagnosis. The present case demonstrates how the use of such an approach with key features of the clinical history can direct a focused and successful diagnostic investigation.
A 71-Year-Old Woman With a Nodule in the Right Lung
Authors: Veerabattini Naresh K. , Aragon Pinto Catarina N. , Hoskote Sumedh S. 
Published: February 2024

Abstract
Oligometastatic adenocarcinoma of the lung is a distinct subset of stage IV oligometastatic non–small cell lung cancer that potentially carries a better prognosis. In the early course of the disease, surgery or radiotherapy for local control therapy should be considered before systemic therapy. Guidelines recommend performing molecular testing and PD-L1 testing for all patients with metastatic adenocarcinomas.
A 60-Year-Old Man With Fever, Cough, and Fatigue 2 Months After Bilateral Lung Transplant
Authors: Cecchini Matthew J. , Roden Anja C. 
Published: February 2024

Abstract
Acute cellular rejection is a common and important cause of graft dysfunction and failure after lung transplant. It is graded histologically according to the degree of inflammation surrounding the vessels and small airways. Patients with high-grade A4 rejection also have features of acute lung injury. Even mild rejection is often treated with increased immunosuppression. Infectious causes and other mimics of rejection should always be considered.
A 57-Year-Old Man With a History of Recurrent Epistaxis and Arteriovenous Malformations
Authors: Iyer Vivek N. , Ahluwalia Vaibhav 
Published: February 2024

Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by epistaxis, mucocutaneous telangiectasias, and visceral arteriovenous malformations. Spontaneous and recurrent epistaxis is a cardinal symptom of HHT, and its presence should alert the clinician to the possibility of HHT. Antiangiogenic therapies have been very effective for the management of HHT-related epistaxis and gastrointestinal tract bleeding. Patients and their family members with HHT should seek care at an accredited HHT Center of Excellence, where a comprehensive plan for screening diagnostic tests and discussions about therapeutic options can be undertaken without delay.
Early Versus Late Antipseudomonal β-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study
Authors: Aldardeer Namareq F , Alshreef Maram M , Alharbi Emad A , Aljabri Ahmad K , Aljawadi Mohammad H , Almangour Thamer A , Alobaili Saad , Alarifi Mohammed I , Alomari Awad , Alhammad Abdullah M 
Published: February 2024

Abstract

Background
Acute kidney injury (AKI) is a common complication of sepsis, contributing to an increased mortality rate. However, some studies have demonstrated that renal function improves in sepsis patients with AKI within 48 hours, raising questions about the necessity for early antibiotic adjustment. This study evaluates the association between the timing of antipseudomonal β-lactam dose adjustment and the outcomes of critically ill sepsis patients with AKI.

Methods
A prospective, multicenter observational study of critically ill patients aged ≥18 years admitted to the intensive care unit with sepsis and AKI and started on antipseudomonal β-lactam therapy. After the initial dose, eligible patients were grouped as early β-lactam antibiotic (E-BLA) or late β-lactam antibiotic (L-BLA) dose adjustments based on the administration of subsequent renally adjusted doses within 24 hours and after 24 hours of sepsis recognition, respectively. The main outcome of interest was in-hospital mortality.

Results
Among 1185 patients screened, 224 (mean age, 62.7 ± 16.8 years; 62% were male) met inclusion criteria. Eighty-four and 140 patients were included in the E-BLA and L-BLA groups, respectively. Approximately half of the cohort presented with AKI stage II, and piperacillin-tazobactam was prescribed as initial empirical therapy in more than 50% of the cohort. In the multivariable Cox proportional hazards model, L-BLA was associated with a significant reduction in in-hospital mortality compared to E-BLA (hazard ratio, 0.588 [95% confidence interval, .355–.974]).

Conclusions
In sepsis patients with AKI, L-BLA was associated with in-hospital mortality benefits.
Landscape and Saturation Analysis of Mutations Associated With Race in Cancer Genomes by Clinical Sequencing
Authors: Muquith Maishara , Hsiehchen David 
Published: February 2024

Abstract
Differences in cancer genomes between racial groups may impact tumor biology and health disparities. However, the discovery of race-associated mutations is constrained by the limited representation and sample size of different racial groups in prior genomic studies. We evaluated the influence of race on the frequency of gene mutations using the Genomics, Evidence, Neoplasia, Information, Exchange database, a large genomic dataset aggregated from clinical sequencing. Matched cohort analyses were used to identify histology-specific race-associated mutations including increased TERT promoter mutations in Black and Asian patients with gliomas and bladder cancers, and a decreased frequency of mutations in DNA repair pathway genes and subunits of the SWI/SNF chromatin complex in Asian and Black patients across multiple cancer types. The distribution of actionable mutations in oncogenes was also race-specific, demonstrating how targeted therapies may have a disparate impact on racial groups. Down-sampling analyses indicate that larger sample sizes are likely to discover more race-associated mutations. These results provide a resource to understand differences in cancer genomes between racial groups which may inform the design of clinical studies and patient recruitment strategies in biomarker trials.
Endocrinology’s early historians (1889-1914) and the forgotten prehistory of testosterone
Authors: Janssen Diederik F 
Published: February 2024

Abstract

Introduction
An often-retold historical outline of endocrinology was established over a century ago. An exhaustive history of sexual physiology remains forthcoming, however.

Objectives
To explore and contextualize the remarkable medical-historical and medical-anthropologic frenzy triggered by Brown-Séquard’s 1889 self-injections with testicular juice, which ultimately settled down into an early history of endocrinology.

Methods
Pertinent primary sources were selected from a broader study, primarily between 1889 and 1914, as well as selected older texts identified and unidentified by these sources.

Results
Endocrinology’s early historians in a short space of time moved from the history of testicular opotherapy to that of glandular typology and physiology and to increasingly encompassing medical-historical accounts of internal secretion as an epochal idea. Early historians nominated “precursors” to Brown-Séquard but underestimated physiologic continuities—specifically, early modern protoendocrinologic notions concerning semen as a “recrement,” notions still recited by Brown-Séquard and early Brown-Séquardists as well their detractors. Brown-Séquard himself worked through this old (recremental) concept of semen between 1889 and 1892 but was later identified with it, by among others Ancel and Bouin.

Conclusion
Western sexual physiology is a medical palimpsest, the undertexts of which remain to be studied in detail.
Kinesin light chain 1 stabilizes insulin receptor substrate 1 to regulate the IGF‐1‐AKT signaling pathway during myoblast differentiation
Authors: Qu Zihao , Shi Linjing , Wu Zhen , Lin Peng , Zhang Guangan , Cong Xiaoxia , Zhao Xiang , Ge Huiqing , Yan Shigui , Jiang Liangjun , Wu Haobo 
Published: February 2024

AbstractThe IGF signaling pathway plays critical role in regulating skeletal myogenesis. We have demonstrated that KIF5B, the heavy chain of kinesin‐1 motor, promotes myoblast differentiation through regulating IGF‐p38MAPK activation. However, the roles of the kinesin light chain (Klc) in IGF pathway and myoblast differentiation remain elusive. In this study, we found that Klc1 was upregulated during muscle regeneration and downregulated in senescence mouse muscles and dystrophic muscles from mdx (X‐linked muscular dystrophic) mice. Gain‐ and loss‐of‐function experiments further displayed that Klc1 promotes AKT–mTOR activity and positively regulates myogenic differentiation. We further identified that the expression levels of IRS1, the critical node of IGF‐1 signaling, are downregulated in Klc1‐depleted myoblasts. Coimmunoprecipitation study revealed that IRS1 interacted with the 88‐154 amino acid sequence of Klc1 via its PTB domain. Notably, the reduced Klc1 levels were found in senescence and osteoporosis skeletal muscle samples from both mice and human. Taken together, our findings suggested a crucial role of Klc1 in the regulation of IGF‐AKT pathway during myogenesis through stabilizing IRS1, which might ultimately influence the development of muscle‐related disorders.
Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People
Authors: Guglielminotti Jean , Lee Allison , Landau Ruth , Samari Goleen , Li Guohua 
Published: February 2024

OBJECTIVE:To assess the association between structural racism and labor neuraxial analgesia use.METHODS:This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black–White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index.RESULTS:Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9–19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9–29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5–14.4%) in the second tercile and 15.6% (95% CI, 14.7–16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles.CONCLUSION:A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.
Effect of Increasing Blood Pressure on Brain Tissue Oxygenation in Adults After Severe Traumatic Brain Injury*
Authors: Kunapaisal Thitikan , Lele Abhijit V. , Gomez Courtney , Moore Anne , Theard Marie Angele , Vavilala Monica S. 
Published: February 2024

OBJECTIVES:
To examine if increasing blood pressure improves brain tissue oxygenation (PbtO2) in adults with severe traumatic brain injury (TBI).

DESIGN:
Retrospective review of prospectively collected data.

SETTING:
Level-I trauma center teaching hospital.

PATIENTS:
Included patients greater than or equal to 18 years of age and with severe (admission Glasgow Coma Scale [GCS] score < 9) TBI who had advanced neuromonitoring (intracranial blood pressure [ICP], PbtO2, and cerebral autoregulation testing).

INTERVENTIONS:
The exposure was mean arterial pressure (MAP) augmentation with a vasopressor, and the primary outcome was a PbtO2 response. Cerebral hypoxia was defined as PbtO2 less than 20 mm Hg (low).

MAIN RESULTS:
MAP challenge test results conducted between ICU admission days 1–3 from 93 patients (median age 31; interquartile range [IQR], 24–44 yr), 69.9% male, White (n = 69, 74.2%), median head abbreviated injury score 5 (IQR 4–5), and median admission GCS 3 (IQR 3–5) were examined. Across all 93 tests, a MAP increase of 25.7% resulted in a 34.2% cerebral perfusion pressure (CPP) increase and 16.3% PbtO2 increase (no MAP or CPP correlation with PbtO2 [both R
2 = 0.00]). MAP augmentation increased ICP when cerebral autoregulation was impaired (8.9% vs. 3.8%, p = 0.06). MAP augmentation resulted in four PbtO2 responses (normal and maintained [group 1: 58.5%], normal and deteriorated [group 2: 2.2%; average 45.2% PbtO2 decrease], low and improved [group 3: 12.8%; average 44% PbtO2 increase], and low and not improved [group 4: 25.8%]). The average end-tidal carbon dioxide (ETCO2) increase of 5.9% was associated with group 2 when cerebral autoregulation was impaired (p = 0.02).

CONCLUSIONS:
MAP augmentation after severe TBI resulted in four distinct PbtO2 response patterns, including PbtO2 improvement and cerebral hypoxia. Traditionally considered clinical factors were not significant, but cerebral autoregulation status and ICP responses may have moderated MAP and ETCO2 effects on PbtO2 response. Further study is needed to examine the role of MAP augmentation as a strategy to improve PbtO2 in some patients.
Ustekinumab Drug Levels and Outcomes in Inflammatory Bowel Disease
Authors: Petrov Jessica , Fine Sean , Alzahrani Raneem , Mohamed Gamal , Al-Bawardy Badr 
Published: February 2024

Background:
Data regarding the utility of therapeutic drug monitoring with ustekinumab (UST) are sparse. Our aim was to determine the correlation of UST levels with outcomes in a cohort of patients with inflammatory bowel disease (IBD).

Methods:
This was a multicenter, retrospective study of all patients with IBD who received UST from January 1, 2014 to March 1, 2022. The primary outcomes were the correlation of UST level with clinical remission (per physician global assessment), endoscopic healing [the absence of ulcers/erosions in Crohn’s disease (CD) and Mayo endoscopic score ≤1 for ulcerative colitis (UC)], and normal serum C-reactive protein (CRP) (≤5 mg/L). Secondary outcomes included defining optimal UST trough levels associated with favorable outcomes.

Results:
A total of 71 patients (74.6% with CD; 57.7% female) were included. The median age was 39.5 years [interquartile range (IQR): 26 to 52] and 12.6% were on combination therapy with immunomodulators. Median UST trough levels were significantly higher in patients who achieved endoscopic healing at 5.4 µg/mL versus 3.5 µg/mL (P=0.035) and normal CRP at 5.5 µg/mL versus. 3.1 µg/mL (P=0.002). A cutoff UST level of 4.8 µg/mL yielded the highest area under the curve (AUC) of 0.73 (95% CI: 0.61-0.80) to predict a normal CRP followed by a cutoff of 3.5 µg/mL which yielded an AUC of 0.66 (95% CI: 0.52-0.81) to predict endoscopic healing.

Conclusions:
UST trough levels were significantly higher in patients who achieved a normal CRP and endoscopic healing. A cutoff UST level of 4.8 µg/mL reliably predicted CRP normalization.
Bibliometric and visual analysis of intestinal flora and immunity
Authors: Nie Kaidi , Deng Tingting , Wang Jie , Qi Luming , Liu Nannan , Chen Zhixuan , Xia Lina 
Published: February 2024

Background:
The gut microbiota and its stability have important relationships with immunity. However, bibliometric analysis in this field is underdeveloped. This study aims to visualize publications related to the gut microbiota and immunity to identify research frontiers and hotspots, providing references and guidance for further research.

Methods:
Gut microbiota and immunity data were retrieved from the Web of Science Core Collection database, and Microsoft Excel, Scimago Graphica and VOSviewer software were used to analyze publication output trends, the most productive countries/regions, journals, authors, co-cited references, and keywords.

Results:
This study analyzed 16,611 publications, including 10,865 articles and 5746 reviews, and found a continuous increase in publications related to gut microbiota and immunity since 2013. We identified 62,872 authors contributing to this field from 2144 journals and 9965 organizations/institutions in 145 countries/regions. The top publisher with the highest output is University of California System with 525 papers. Among these journals, the top 3 most prolific journals are Frontiers in Immunology, Frontiers in Microbiology, and PLOS ONE. The literature with the highest citation frequency is published in Science and has been cited 3006 times by Patrick M. Smith and others.
Gut microbiota research hotspots include gut microbiota inflammation, immune response, inflammatory bowel diseases (IBDs), and microbiota tumors. The gut microbiota and its microbial homeostasis play critical roles in immune reactions, inflammation, and even tumors and IBDs.
Current research on gut microbiota and immunity is a popular field. Previous studies have shown that the gut microbiota and its microbial species have important effects on maintaining human health, immune function, inflammation, tumorigenesis, and IBDs. Understanding the roles of microbial communities and specific bacterial species as well as their interactions with humans has led to numerous discoveries that provide unique opportunities for exploring human health and future research.

Conclusion:
This study used bibliometric and visualization analysis to identify the development trends and hotspots of publications related to the gut microbiota and immunity. The findings of this study provide valuable insights into the emerging trends and future directions in this field.
Adalimumab induced exacerbation of psoriasis in patients with combined pemphigus: A case report
Authors: Yao Limin , Cai Xiaoli , Du Xiaoqing , Ma Yuxin 
Published: February 2024

Rationale:
Psoriasis is an immune-related disease caused by genetic factors, abnormalities in the immune system and environmental factors, while pemphigus is an autoimmune disease caused by the autoimmune system attacking the skin and mucosal tissues. Herein, we aimed to report a rare case of adalimumab induced exacerbation of psoriasis patients with pemphigus. The rare disease causes considerable challenges for clinical diagnosis and treatment.

Patient concerns:
The patient was a 43-year-old man with intermittent erythema and scaling all over the body for more than 20 years, and blisters and vesicles on the trunk and limbs for 1 month. Half a year ago, the patient had blisters on the limbs, and was diagnosed with deciduous pemphigus in a hospital, and the blisters subsided after being given traditional Chinese medicine orally. Half a month ago, the erythema area was enlarged, and adalimumab 80 mg intramuscular injection was given for 1 time after consultation in the hospital. On the following day, the area of erythema and scales was suddenly enlarged obviously compared with the previous 1, and obvious blisters and vesicles appeared on the limbs, neck, and trunk, which were aggravated progressively and accompanied by obvious itching and pain.

Diagnoses:
The patient was diagnosed with psoriasis in patients with combined pemphigus.

Intervention:
After combined treatment with methylprednisolone and cyclosporine, the skin lesions have basically recovered.

Outcomes:
The skin lesions have basically healed. Follow up for 6 months without recurrence.

Lessons:
Methylprednisolone combined with cyclosporine may be an option in treating patients with psoriasis patients with pemphigus.