bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial infarction with nonobstructive coronary arteries
Authors: Barnes Jonathan 
Published: February 2025

ABSTRACT
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an important, often underrecognized working diagnosis. MINOCA is defined as an acute MI in a patient whose coronary angiography reveals no significant obstructive coronary artery disease. A comprehensive diagnostic approach beyond the initial coronary angiogram is essential for identifying this heterogeneous infarction pathophysiology. Distinguishing disease-specific causes affects patient management and prognosis, especially in female patients. This article provides an evidence-based overview of the tailored management strategies and ongoing clinical research likely to shape future guidelines.
Caring for youth in foster care
Authors: Quick Christina , Halasz Tracy W. 
Published: February 2025

ABSTRACT
Providing comprehensive healthcare to children in foster care can be challenging. Youth placed in foster care are a vulnerable population of patients who often have complex trauma histories and chronic healthcare needs that are further compounded by fragmented and transient healthcare. With an estimated 368,000 children in foster care in the US in 2022 based on the most recently available national data, it is critical for providers to understand the challenges associated with providing care to this population and to know how to address them. This discussion provides healthcare providers with a practical, trauma-informed guide to caring for youth in foster care rooted in evidence-based practice and current guidelines.
Adopting national recommendations for clinical management of pediatric obesity in primary care
Authors: Davila Natalia , Garcia Julia , Reneau Marcelaine G. , Smith Whitney 
Published: February 2025

ABSTRACT
The World Health Organization reports that more than 390 million children and adolescents have obesity, with the US facing a prevalence of 14 million among this population and incurring an annual medical cost of $1.3 billion. Childhood and adolescent obesity stems from genetic, environmental, and socioecological factors, indicating the need for an evolving approach to pediatric obesity management. The updated 2023 American Academy of Pediatrics guideline for evaluation and treatment of pediatric obesity advocates for a child-centric strategy, considering health equity, racism, weight bias stigmatism, and adverse childhood experiences. Management includes intensive health behavior and lifestyle treatment, partnership with communities to build comprehensive treatment programs, promotion of early intervention, consideration of pharmacotherapy for children age 12 years and older, selective use of bariatric surgery, screening for and treatment of comorbidities, integration of mental health treatment, and use of motivational interviewing to engage patients in their care. Pediatric primary care providers play a key role in identification of obesity and encouragement of obesity treatment. Proactive management of childhood obesity benefits individuals, families, and the nation. Early intervention holds the promise of substantial cost savings on obesity-related healthcare. Healthcare providers wield significant influence in reducing childhood morbidity and enhancing the overall health of US children and adolescents.
Prognostic Impact of Diabetes Mellitus and Extended Hepatectomy on Perihilar Cholangiocarcinoma
Authors: Shibamoto Jun , Otsuka Shimpei , Okawa Yuta , Ashida Ryo , Ohgi Katsuhisa , Kato Yoshiyasu , Dei Hideyuki , Uesaka Katsuhiko , Sugiura Teiichi 
Published: February 2025

Objective:
To evaluate the prognostic impact of diabetes mellitus (DM) in patients who underwent resection for perihilar cholangiocarcinoma (PHCC) and the influence of remnant liver volumes on postoperative glycemic profiles and survival outcomes.

Background:
The impact of DM and extended hepatectomy on survival outcomes of patients with PHCC remains unclear.

Methods:
A total of 184 patients who underwent hepatectomy with extrahepatic bile duct resection for PHCC between 2002 and 2020 were retrospectively analyzed and divided into groups based on DM and future liver remnant (FLR) ≥40% or <40%. Survival outcomes and glycemic profiles were analyzed.

Results:
Patients with DM (n = 34) had significantly worse overall survival compared with those without DM (n = 150; median survival time: 23.3 vs 46.7 months; P = 0.003) although cancer-specific survival was comparable (P = 0.894). Patients with DM had a higher incidence of death from infections (P < 0.001). Multivariate analysis identified DM as an independent prognostic factor (hazard ratio, 1.742; P = 0.021). DM with FLR <40% (n = 11) exhibited worse survival (median survival time: 13.7 vs 35.0 months; P = 0.026) and a higher incidence of death from infections (P = 0.016) compared with those with FLR ≥40% (n = 23). The median glucose fluctuation was larger in patients with DM and FLR <40% (80 vs 39 mg/dL; P = 0.023).

Conclusions:
DM was an independent prognostic factor in patients with PHCC undergoing hepatectomy. DM and FLR <40% were associated with worse survival and larger glucose fluctuation postoperatively.
The ability of shock index to predict refractory postpartum haemorrhage
Authors: Daghmouri Mohamed Aziz , Repplinger Sébastien , Weiss Emmanuel , Bonnet Marie-Pierre , Le Guen Morgan , Dahmani Souhayl , Ducloy Bouthors Anne Sophie , Mebazaa Alexandre , Gayat Etienne , Deniau Benjamin 
Published: February 2025

BACKGROUND
The predictability of severe and refractory postpartum haemorrhage (PPH) remains a challenge for clinicians and researchers.

OBJECTIVE
We aimed to evaluate the ability of the shock index to predict refractory PPH.

DESIGN
This study was a secondary analysis of a multicentre, prospective, observational study investigating the association between severe postpartum haemorrhage (PPH) and the subsequent development of mental disorders.

SETTING
Participants were patients who experienced severe PPH, characterised by blood loss of at least 1500 ml requiring the administration of sulprostone. The shock index, defined as the ratio of heart rate to SBP, was recorded at two time points: at the start of sulprostone infusion (T0) and at the time of the most severe symptoms after enrolment but before the occurrence of refractory PPH (T1). Refractory PPH was defined by the need for four or more blood products, interventional radiology, or laparotomy (excluding caesarean section).

THE MAIN OUTCOME
The predictive ability of the shock index was assessed using univariate and multivariate logistic regression and area under the receiver operating characteristic curve (AUROC).

RESULTS
From November 2014 to November 2016, 332 patients experienced severe PPH, of which 316 were included in the final analysis. The prevalence of refractory PPH was 35.4% (112/316). We found that high shock index levels at T0 were independently associated with the occurrence of refractory PPH: odds ratio (OR) 3.07 [95% confidence interval (CI), 1.22 to 7.89, P = 0.017]. In addition, high shock index levels at T1 were also independently associated with the occurrence of refractory PPH: OR 5.28 (95% CI, 2.25 to 12.8), P < 0.001. The AUROC of shock index levels measured at T0 and T1 were 0.614 (95% CI, 0.549 to 0.678) and 0.681 (95% CI, 0.616 to 0.746), respectively.

CONCLUSION
The shock index measured at the start of sulprostone infusion and at the worst time after enrolment, has poor discriminative power to predict this event.
Spatial single-cell proteomics landscape decodes the tumor microenvironmental ecosystem of intrahepatic cholangiocarcinoma
Authors: Hong Libing , Mei Jie , Sun Xuqi , Wu Yifan , Dong Zhen , Jin Yuzhi , Gao Liaoliao , Cheng Jinlin , Tian Weihong , Liu Chuan , Li Bin , Hu Pingping , Liu Lulu , Xin Shan , Dai Xiaomeng , Zhao Peng , Guo Rongping , Chen Minshan , Yun Jingping , Lin Bo , Wei Wei , Fang Weijia , Bao Xuanwen 
Published: February 2025

Background & Aims
The prognoses and therapeutic responses of patients with intrahepatic cholangiocarcinoma (iCCA) depend on spatial interactions among tumor microenvironment (TME) components. However, the spatial TME characteristics of iCCA remain poorly understood. The aim of this study was to generate a comprehensive spatial atlas of iCCA using artificial intelligence-assisted spatial multiomics patterns and to identify spatial features associated with prognosis and immunotherapy.

Approach & Results:
Spatial multiomics, including imaging mass cytometry (IMC, n=155 in-house), spatial proteomics (n=155 in-house), spatial transcriptomics (n=4 in-house), multiplex immunofluorescence (mIF, n=20 in-house), single-cell RNA sequencing (scRNA-seq, n=9 in-house and n=34 public), bulk RNA-seq (n=244 public), and bulk proteomics (n=110 in-house and n=214 public), were employed to elucidate the spatial TME of iCCA. More than 1.06 million cells were resolved, and the findings revealed that spatial topology, including cellular deposition patterns, cellular communities, and intercellular communications, profoundly correlates with the prognosis of iCCA patients. Specifically, CD163hi M2-like resident-tissue macrophages suppress anti-tumor immunity by directly interacting with CD8+ T cells, resulting in poorer patient survival. Additionally, five spatial subtypes with distinct prognoses were identified, and potential therapeutic options were generated for these subtypes. Furthermore, a spatial TME deep learning system was developed to predict the prognosis of iCCA patients with high accuracy from a single 1-mm2 tumor sample.

Conclusions:
This study offers preliminary insights into the spatial TME ecosystem of iCCA, providing valuable foundations for precise patient classification and the development of personalized treatment strategies.
Traumatic Encephalopathy Syndrome: Head Impact Exposure and Blood Biomarkers in Professional Combat Athletes
Authors: Kleven Brooke D. Conway , Chien Lung-Chang , Cross Chad L. , Labus Brian , Bernick Charles 
Published: February 2025

Objective: This study aimed to (1) determine whether there was an association between a diagnosis of traumatic encephalopathy syndrome (TES) and changes in three specific serum biomarkers, and (2) determine head impact exposure thresholds among both TES+ and TES− groups. Setting: Data were collected from Cleveland Clinic’s Professional Athletes Brain Health Study (PABHS). Participants: This study included 192 professional combat athletes, 35 years of age and older. Athletes must be actively fighting or retired with a minimum of 10 professional fights over their careers. Design/Intervention: This was a retrospective observational study of the PABHS longitudinal cohort. Main Measures: The generalized linear model with the generalized estimating equation for repeated measurements was used to compare various biomarkers between both active and retired TES− and TES+ groups. Results: The odds ratio for TES diagnosis was 5.44 (95% CI = 2.48, 11.94; P < .0001) among active fighters and 10.75 (95% CI = 3.52, 32.85; P < .0001) among retired fighters, indicating the odds for a TES diagnosis were over 5 times greater for active fighters with every fight completed at or beyond 30 professional fights. Retired fighters had 10 times greater odds of TES diagnosis with every fight completed at or beyond 15 professional fights. Likewise, the odds of a TES diagnosis were 2.0% (95% CI = 0.3, 3.1; P = 0.0039) greater with each pg/mL increase of glial fibrillary acidic protein (GFAP). No relationship was observed between a TES diagnosis and neurofilament light chain or P-tau231. Conclusion: This study provides preliminary evidence that progressively elevated levels of the GFAP blood biomarker increase the odds of a TES diagnosis among retired professional fighters. Further evaluation is required to improve clarity and understanding of the relationship between progressive changes in the GFAP blood biomarker and a TES diagnosis, specifically evaluating the duration of chronicity and exposure thresholds.
Plasma Microbial Cell-free DNA Sequencing for the Detection of Kingella kingae Pediatric Spinal Infections
Authors: Ahmed Asim A. , Park Sarah Y. , Smollin Matthew J. , Lindner Martin S. , Sarmiento Clemente Adriana , Del Valle Penella Ana , Laufer P. Marcelo , Sanchez-Vegas Carolina , Cotilla Manuel R. , Melish Marian E. , Trieu Connie , Kabani Nazia A. , Cooper Joshua , Lloyd Audrey R. , Kimberlin David W. , Arnold John C. , Jordan-Villegas Alejandro , Patterson Lori E. , Foster Catherine E. , Yagupsky Pablo 
Published: February 2025

Background:
Diagnosis of Kingella kingae skeletal system infections is made challenging by the microbe’s fastidious nature. Detection and quantification of circulating microbial cell-free DNA (mcfDNA) in plasma by the Karius Test, a commercial metagenomic sequencing test, may offer promise in diagnosing pediatric spinal infections caused by difficult-to-culture organisms such as K. kingae.

Methods:
Plasma mcfDNA sequencing detections of K. kingae from April 2018 to December 2020 were reviewed to identify pediatric (age <18 years) patients. Medical charts of those with spinal infections were reviewed, and mcfDNA sequencing diagnostic performance was compared with usual care tests (ie, cultures, polymerase chain reaction).

Results:
Ten children with K. kingae spinal infections were identified across 7 institutions. The median age was 16.5 months (range 11–23 months). All case-patients had vertebral osteomyelitis with 9 having spondylodiscitis. Compared with usual care tests, mcfDNA sequencing was significantly more sensitive (McNemar’s test 6.25, 2-tailed P = 0.0133). It was the only method of microbiological diagnosis in 9 patients, providing results in a median of 2.5 days (range 2–5 days) from sample collection. K. kingae mcfDNA was detected despite antibiotic pretreatment in 5/5 case-patients. Pathogen-tailoring of antimicrobial coverage was undertaken in 9 children.

Conclusion:
Plasma mcfDNA sequencing offers a rapid, noninvasive method of detecting K. kingae causing pediatric spinal infections. This culture-independent approach may facilitate diagnosis, despite antibiotic pretreatment and subsequently targeted therapy and potentially obviate the need for biopsy.
Comparative evaluation of clinical results and patient-reported outcomes of enhanced monofocal and conventional monofocal intraocular lenses
Authors: Kabura Ryota , Takeshita Tetsuji , Furushima Kyoka , Iwasaki Rumi , Fukuda Rikako , Amikawa Hinako , Oshika Tetsuro 
Published: February 2025

Purpose:
To evaluate and compare visual performance of two enhanced monofocal intraocular lenses (IOLs), XY1-EM (Vivinex Impress, Hoya) and DIB00V (TECNIS Eyhance, Johnson & Johnson) with that of a conventional monofocal IOL, XY-1 (Vivinex, Hoya).

Setting:
Kamiamakusa General Hospital, Kumamoto, Japan.

Methods:
A retrospective analysis was conducted on 130 eyes from 75 patients, including 46 eyes (27 patients) implanted with XY1-EM, 47 eyes (26 patients) with DIB00V, and 37 eyes (22 patients) with XY-1.

Results:
Corrected-distance visual acuity was comparable across all three groups. Both enhanced monofocal IOLs (XY1-EM and DIB00V) demonstrated significantly superior distance-corrected visual acuity at 70 cm and 50 cm compared to the conventional monofocal IOL (XY1). The rates of spectacle independence were also significantly higher in the enhanced monofocal IOL groups. In a direct comparison between the two enhanced monofocal IOLs, XY1-EM exhibited a significantly better defocus curve at -1.5D than DIB00V. Patients reported higher subjective satisfaction for "reading a newspaper" and "speed of adaptation to daily vision" in the XY-1 group compared to the DIB00V group.

Conclusions:
The new enhanced monofocal IOL, Vivinex Impress XY1-EM, demonstrated significantly improved intermediate visual acuity compared to the conventional monofocal IOL. It also showed slightly superior intermediate visual acuity and higher subjective satisfaction compared to the other enhanced monofocal IOL evaluated in this study.
Females Have a Higher Prevalence of Severe and Dysplastic Fundic Gland Polyposis
Authors: Altfillisch Charles , Meyer Chase , Yuquimpo Kyle , Jackson Katy , Saha Souvik , Montgomery Robert , Madan Rashna , Buckles Daniel , Bansal Ajay 
Published: February 2025

Goals:
The purpose of this study was to determine risk factors associated with the development of Fundic Gland Polyps (FGP) and its association with gastric cancer.

Background:
Gastric cancer incidence is increasing and may be linked to PPIs. FGP﻿ are ﻿ common and a possible intermediary between PPI use and the risk of gastric cancer.

Study:
This single-center retrospective case-control study compared multiple risk factors between cases with FGP﻿ and controls between January 1, 2021 and December 31, 2021. Severe FGP was defined by innumerable, diffuse, or >50 polyps by endoscopic reporting and dysplasia by histopathology. Patient outcomes with severe polyposis and dysplasia were reviewed. Gastrectomy specimens and endoscopic reports were reviewed for FGP in an independent cohort of patients with known gastric cancer. Univariate and multivariate models using logistic regression were constructed.

Results:
The main logistic regression model included 591 participants (330 cases and 261 controls). Increasing age [OR: 1.02 (1.01 to 1.03)] and >2 years of PPI use [OR: 2.76 (1.72 to 4.47)] were associated with increased risk of FGP whereas smoking was protective [OR: 5.41 (2.58 to 12.24)]. Most patients with severe FGP (87.5%), low-grade (77%), and high-grade dysplasia (80%) were females. No patients developed gastric cancer on follow-up (mean: 13.9 mo). None of the patients within an independent cohort of gastric cancers diagnosed between January 1, 2021 and December 31, 2021 had FGP.

Conclusions:
Although FGP are equally common among sexes, severe and dysplastic FGP are more common among females, but none progressed to cancer. These data could be useful to counsel patients with FGP.
The Role of Artificial Intelligence Combined With Digital Cholangioscopy for Indeterminant and Malignant Biliary Strictures
Authors: McCarty Thomas R. , Shah Raj , Allencherril Ronan P. , Moon Nabeel , Njei Basile 
Published: February 2025

Background:
Current endoscopic retrograde cholangiopancreatography (ERCP) and cholangioscopic-based diagnostic sampling for indeterminant biliary strictures remain suboptimal. Artificial intelligence (AI)-based algorithms by means of computer vision in machine learning have been applied to cholangioscopy in an effort to improve diagnostic yield. The aim of this study was to perform a systematic review and meta-analysis to evaluate the diagnostic performance of AI-based diagnostic performance of AI-associated cholangioscopic diagnosis of indeterminant or malignant biliary strictures.

Methods:
Individualized searches were developed in accordance with PRISMA and MOOSE guidelines, and meta-analysis according to Cochrane Diagnostic Test Accuracy working group methodology. A bivariate model was used to compute pooled sensitivity and specificity, likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristics curve (SROC).

Results:
Five studies (n=675 lesions; a total of 2,685,674 cholangioscopic images) were included. All but one study analyzed a deep learning AI-based system using a convoluted neural network (CNN) with an average image processing speed of 30 to 60 frames per second. The pooled sensitivity and specificity were 95% (95% CI: 85-98) and 88% (95% CI: 76-94), with a diagnostic accuracy (SROC) of 97% (95% CI: 95-98). Sensitivity analysis of CNN studies (4 studies, 538 patients) demonstrated a pooled sensitivity, specificity, and accuracy (SROC) of 95% (95% CI: 82-99), 88% (95% CI: 72-95), and 97% (95% CI: 95-98), respectively.

Conclusions:
Artificial intelligence-based machine learning of cholangioscopy images appears to be a promising modality for the diagnosis of indeterminant and malignant biliary strictures.
Taking the Guess Work Out of Endoscopic Polyp Measurement
Authors: Kerbage Anthony , Souaid Tarek , Singh Kailash , Burke Carol A. 
Published: February 2025

Colonoscopy is a crucial tool for evaluating lower gastrointestinal disease, monitoring high-risk patients for colorectal neoplasia, and screening for colorectal cancer. In the United States, over 14 million colonoscopies are performed annually, with a significant portion dedicated to post-polypectomy follow-up. Accurate measurement of colorectal polyp size during colonoscopy is essential, as it influences patient management, including the determination of surveillance intervals, resection strategies, and the assessment of malignancy risk. Despite its importance, many endoscopists typically rely on visual estimation alone, which is often imprecise due to technological and human biases, frequently leading to overestimations of polyp size and unnecessarily shortened surveillance intervals. To address these challenges, multiple tools and technologies have been developed to enhance the accuracy of polyp size estimation.
The review examines the evolution of polyp measurement techniques, ranging from through-the-scope tools to computer-based and artificial intelligence-assisted technologies.
Glucagon like peptide-1 receptor agonists as a promising therapeutic option of metabolic dysfunction associated steatotic liver disease and obesity: hitting two targets with one shot
Authors: Kaya Eda , Syn Wing-Kin , Manka Paul 
Published: February 2025

Purpose of review
Obesity and type 2 diabetes mellitus (T2DM) are significant global health challenges, closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown promise in treating T2DM and obesity, but their potential for managing MASLD is still being explored. This review aims to examine the current progress in using GLP-1RAs for MASLD treatment and evaluate emerging dual and triple hormonal agonists as future therapeutic options.

Recent findings
GLP-1RAs have been effective in controlling blood sugar levels, promoting weight loss, and improving cardiovascular and kidney function. Furthermore, they have shown potential benefits for liver function in patients with MASLD. GLP-1, a key incretin hormone, influences glucose metabolism, appetite, and insulin sensitivity while affecting gastric emptying and potentially reducing fat deposition in the liver. Recent developments in GLP-1RAs include various formulations with different administration and dosing options, expanding their therapeutic use.

Summary
GLP-1RAs have become central to the management of T2DM, obesity, and possibly MASLD due to their ability to lower HbA1c, aid in weight reduction, and provide cardiovascular protection. As research continues, dual and triple hormonal agonists are emerging as the next evolution of incretin-based therapies, offering promising new strategies for addressing MASLD in the future.