bluuebunny/crossref_metadata_2025_split huggingface dataset:
RNF213 vasculopathy manifested in various forms within a family: A case report
Authors: Lim Seong-Soo , Park Sangshin , Oh Byeong Ho , Jung Kiwook , Bae Jang-Whan , Bae Dae-Hwan 
Published: December 2023

Rationale:
The ring finger protein 213 (RNF213) p.R4810K variant has been identified as being associated with Moyamoya disease (MMD), a condition that is more prevalent in East Asians. This association extends beyond cerebral vessels and has been implicated in coronary artery disease.

Patient concerns:
A 36-year-old female was admitted to the emergency room with chest pain. Although the patient had no known underlying conditions or risk factors for atherosclerosis, she was diagnosed with unstable angina and underwent percutaneous coronary intervention. Given her older sister’s ongoing treatment for MMD, it was suspected that the patient’s coronary artery disease might be linked to the MMD-associated gene mutation.

Diagnoses:
Coronary angiography revealed 80% narrowing of the proximal left anterior descending artery. Based on clinical symptoms and coronary angiography, we diagnosed it as unstable angina.

Intervention:
Due to the family history of MMD and detection of the RNF213 p.R4810K heterozygous variant in the patient’s older sister, genetic counseling was recommended. Next-generation sequencing for vascular diseases was performed.

Outcomes:
Genetic testing confirmed the presence of an RNF213 p.R4810K heterozygous variant in the patient, mirroring that in her sister. An RNF213 p.C4397R heterozygous variant was identified concomitantly, although it was categorized as a variant of uncertain significance. Coronary artery disease has been attributed to the RNF213 p.R4810K variant.

Lessons:
Although MMD is rare in Western populations, it is more common in East Asian populations. Traditionally, MMD diagnoses have focused solely on the cerebral vessels without guidelines for the assessment of other vascular involvements. This familial case underscores the fact that a single genetic mutation can manifest in diverse ways in different diseases. Hence, the need and regularity of systemic vessel screening should be thoughtfully considered in such a context.
Metabolic syndrome and the risk of coronary artery disease among the physicians
Authors: Tangjitgamol Siriwan , Udayachalerm Wasan , Preeyanont Piyanart , Kaewwanna Watcharagan , Ativanichayapong Natapon , Wanishsawad Chad 
Published: December 2023

Background:
Physicians, due to their work and lifestyle patterns, can be at risk for metabolic syndrome (MetS). We aimed to evaluate the prevalence of MetS among physicians and its association with coronary artery disease (CAD).

Materials and methods:
This retrospective cross-sectional study collected data on Thai physicians who had medical examination including cardiovascular testing from 14 February to 31 October 2022, in our hospital. Inclusion criteria were those who had complete data for MetS diagnosis per Adult Treatment Panel III criteria and CAD diagnosis information. Outcome measures were prevalence of MetS and CAD prevalence in affected vs non-affected physicians.

Results:
Of 1194 physicians, the median age was 48.0±10.29 years. The authors found 4.5% were obese, 30.6% having high blood pressure, 26.6% high fasting blood sugar (FBS), 12.7% high triglycerides, and 13.7% low high-density lipoprotein (HDL). The prevalence of MetS was 8.9%. Increasing age, systolic blood pressure, body mass index, FBS, triglyceride, and decreasing HDL were identified as independent risk factors of MetS. The prevalence of CAD was 11.4%: 47.2% vs. 7.9% among the physicians with and without MetS respectively (odds ratio 10.41: 95% CI, 6.70–16.16%, P<0.001).

Conclusion:
The prevalence of MetS among Thai physicians in this study was 8.9%. Those physicians with MetS were associated with a 10-fold higher risk of CAD. Physicians who were at risk of developing MetS should consider modifying their health habits and being vigilant about the potential consequences of CAD. Further prospective cohort studies are warranted to validate these results.
Social Determinants of Health in Graduate Nursing Simulation Education
Authors: Murillo Crystal L. , Díaz Desiree A. , Tamanna Nowrin , Worthy Karen , Jenerette Coretta 
Published: December 2023

Background:
This integrative review examined how simulation is being used to teach graduate nursing students about the social determinants of health (SDH).

Methods:
The literature search focused on studies that included a sample of graduate nursing students who participated in an SDH simulation-based education (SBE). The timeframe used was 2013 to 2023 as this is when SBE emerged in graduate nursing education. Databases searched included Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Web of Science.

Results:
Nine studies included a sample of graduate nursing students and were included in this review. Published studies ranged from 2013 to 2023.

Conclusion:
The findings of this review highlight the need for graduate nursing faculty to design, implement, and evaluate transformative SDH-specific SBE that prepares students to understand their role as social justice advocates for health equity.
Quantifying the association of individual-level characteristics with disparities in kidney transplant waitlist addition among people with HIV
Authors: Shelton Brittany A. , Sen Bisakha , Becker David J. , MacLennan Paul A. , Budhwani Henna , Locke Jayme E. 
Published: December 2023

Background:
Over 45% of people with HIV (PWH) in the United States at least 50 years old and are at heightened risk of aging-related comorbidities including end-stage kidney disease (ESKD), for which kidney transplant is the optimal treatment. Among ESKD patients, PWH have lower likelihood of waitlisting, a requisite step in the transplant process, than individuals without HIV. It is unknown what proportion of the inequity by HIV status can be explained by demographics, medical characteristics, substance use history, and geography.

Methods:
The United States Renal Data System, a national database of all individuals ESKD, was used to create a cohort of people with and without HIV through Medicare claims linkage (2007–2017). The primary outcome was waitlisting. Inverse odds ratio weighting was conducted to assess what proportion of the disparity by HIV status could be explained by individual characteristics.

Results:
Six thousand two hundred and fifty PWH were significantly younger at ESKD diagnosis and more commonly Black with fewer comorbidities. PWH were more frequently characterized as using tobacco, alcohol and drugs. Positive HIV-status was associated with 57% lower likelihood of waitlisting [adjusted hazard ratio (aHR): 0.43, 95% confidence interval (CI): 0.46–0.48, P < 0.001]. Controlling for demographics, medical characteristics, substance use and geography explained 39.8% of this observed disparity (aHR: 0.69, 95% CI: 0.59–0.79, P < 0.001).

Conclusion:
PWH were significantly less likely to be waitlisted, and 60.2% of that disparity remained unexplained. HIV characteristics such as CD4+ counts, viral loads, antiretroviral therapy adherence, as well as patient preferences and provider decision-making warrant further study.
BOA
Authors: Haubold Johannes , Baldini Giulia , Parmar Vicky , Schaarschmidt Benedikt Michael , Koitka Sven , Kroll Lennard , van Landeghem Natalie , Umutlu Lale , Forsting Michael , Nensa Felix , Hosch René 
Published: December 2023

Purpose
The study aimed to develop the open-source body and organ analysis (BOA), a comprehensive computed tomography (CT) image segmentation algorithm with a focus on workflow integration.

Methods
The BOA combines 2 segmentation algorithms: body composition analysis (BCA) and TotalSegmentator. The BCA was trained with the nnU-Net framework using a dataset including 300 CT examinations. The CTs were manually annotated with 11 semantic body regions: subcutaneous tissue, muscle, bone, abdominal cavity, thoracic cavity, glands, mediastinum, pericardium, breast implant, brain, and spinal cord. The models were trained using 5-fold cross-validation, and at inference time, an ensemble was used. Afterward, the segmentation efficiency was evaluated on a separate test set comprising 60 CT scans. In a postprocessing step, a tissue segmentation (muscle, subcutaneous adipose tissue, visceral adipose tissue, intermuscular adipose tissue, epicardial adipose tissue, and paracardial adipose tissue) is created by subclassifying the body regions. The BOA combines this algorithm and the open-source segmentation software TotalSegmentator to have an all-in-one comprehensive selection of segmentations. In addition, it integrates into clinical workflows as a DICOM node–triggered service using the open-source Orthanc research PACS (Picture Archiving and Communication System) server to make the automated segmentation algorithms available to clinicians. The BCA model's performance was evaluated using the Sørensen-Dice score. Finally, the segmentations from the 3 different tools (BCA, TotalSegmentator, and BOA) were compared by assessing the overall percentage of the segmented human body on a separate cohort of 150 whole-body CT scans.

Results
The results showed that the BCA outperformed the previous publication, achieving a higher Sørensen-Dice score for the previously existing classes, including subcutaneous tissue (0.971 vs 0.962), muscle (0.959 vs 0.933), abdominal cavity (0.983 vs 0.973), thoracic cavity (0.982 vs 0.965), bone (0.961 vs 0.942), and an overall good segmentation efficiency for newly introduced classes: brain (0.985), breast implant (0.943), glands (0.766), mediastinum (0.880), pericardium (0.964), and spinal cord (0.896). All in all, it achieved a 0.935 average Sørensen-Dice score, which is comparable to the one of the TotalSegmentator (0.94). The TotalSegmentator had a mean voxel body coverage of 31% ± 6%, whereas BCA had a coverage of 75% ± 6% and BOA achieved 93% ± 2%.

Conclusions
The open-source BOA merges different segmentation algorithms with a focus on workflow integration through DICOM node integration, offering a comprehensive body segmentation in CT images with a high coverage of the body volume.
Extracorporeal life support in trauma: Indications and techniques
Authors: Lee Alex , Romano Kali , Tansley Gavin , Al-Khaboori Sadiq , Thiara Sonny , Garraway Naisan , Finlayson Gordon , Kanji Hussein D. , Isac George , Ta Kim Long , Sidhu Amandeep , Carolan Mark , Triana Eleanor , Summers Cara , Joos Emilie , Ball Chad G. , Hameed Syed Morad 
Published: December 2023

BACKGROUND
Clarity about indications and techniques in extracorporeal life support (ECLS) in trauma is essential for timely and effective deployment, and to ensure good stewardship of an important resource. Extracorporeal life support deployments in a tertiary trauma center were reviewed to understand the indications, strategies, and tactics of ECLS in trauma.

METHODS
The provincial trauma registry was used to identify patients who received ECLS at a Level I trauma center and ECLS organization–accredited site between January 2014 and February 2021. Charts were reviewed for indications, technical factors, and outcomes following ECLS deployment. Based on this data, consensus around indications and techniques for ECLS in trauma was reached and refined by a multidisciplinary team discussion.

RESULTS
A total of 25 patients underwent ECLS as part of a comprehensive trauma resuscitation strategy. Eighteen patients underwent venovenous ECLS and seven received venoarterial ECLS. Nineteen patients survived the ECLS run, of which 15 survived to discharge. Four patients developed vascular injuries secondary to cannula insertion while four patients developed circuit clots. On multidisciplinary consensus, three broad indications for ECLS and their respective techniques were described: gas exchange for lung injury, extended damage control for severe injuries associated with the lethal triad, and circulatory support for cardiogenic shock or hypothermia.

CONCLUSION
The three broad indications for ECLS in trauma (gas exchange, extended damage control and circulatory support) require specific advanced planning and standardization of corresponding techniques (cannulation, circuit configuration, anticoagulation, and duration). When appropriately and effectively integrated into the trauma response, ECLS can extend the damage control paradigm to enable the management of complex multisystem injuries.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Maximizing wound coverage in full-thickness skin defects: A randomized-controlled trial of autologous skin cell suspension and widely meshed autograft versus standard autografting
Authors: Henry Sharon , Mapula Steven , Grevious Mark , Foster Kevin N. , Phelan Herbert , Shupp Jeffrey , Chan Rodney , Harrington David , Mashruwala Neil , Brown David A. , Mir Haaris , Singer George , Cordova Alfredo , Rae Lisa , Chin Theresa , Castanon Lourdes , Bell Derek , Hughes William , Molnar Joseph A. 
Published: December 2023

BACKGROUND
Traumatic insults, infection, and surgical procedures can leave skin defects that are not amenable to primary closure. Split-thickness skin grafting (STSG) is frequently used to achieve closure of these wounds. Although effective, STSG can be associated with donor site morbidity, compounding the burden of illness in patients undergoing soft tissue reconstruction procedures. With an expansion ratio of 1:80, autologous skin cell suspension (ASCS) has been demonstrated to significantly decrease donor skin requirements compared with traditional STSG in burn injuries. We hypothesized that the clinical performance of ASCS would be similar for soft tissue reconstruction of nonburn wounds.

METHODS
A multicenter, within-patient, evaluator-blinded, randomized-controlled trial was conducted of 65 patients with acute, nonthermal, full-thickness skin defects requiring autografting. For each patient, two treatment areas were randomly assigned to concurrently receive a predefined standard-of-care meshed STSG (control) or ASCS + more widely meshed STSG (ASCS+STSG). Coprimary endpoints were noninferiority of ASCS+STSG for complete treatment area closure by Week 8, and superiority for relative reduction in donor skin area.

RESULTS
At 8 weeks, complete closure was observed for 58% of control areas compared with 65% of ASCS+STSG areas (p = 0.005), establishing noninferiority of ASCS+STSG. On average, 27.4% less donor skin was required with ASCS+ STSG, establishing superiority over control (p < 0.001). Clinical healing (≥95% reepithelialization) was achieved in 87% and 85% of Control and ASCS+STSG areas, respectively, at 8 weeks. The treatment approaches had similar long-term scarring outcomes and safety profiles, with no unanticipated events and no serious ASCS device-related events.

CONCLUSION
ASCS+STSG represents a clinically effective and safe solution to reduce the amount of skin required to achieve definitive closure of full-thickness defects without compromising healing, scarring, or safety outcomes. This can lead to reduced donor site morbidity and potentially decreased cost associated with patient care.

Clincaltrials.gov identifier: NCT04091672

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level I.
Nephrogenic diabetes insipidus in a geriatric patient affected by SARS-CoV-2: complexity of a diagnosis, complexity of a virus
Authors: Corich Maria Ada , Niero Michele , Corich Lucia , Ferretti Elisabetta , De Colle Paolo , Bernardi Stella , Ceschia Giuliano , Sanson Gianfranco , Zanetti Michela 
Published: December 2023

Background. We describe the alteration of the last part of the nephron induced by Sars-CoV-2. Most previous studies have highlighted lesions caused by this virus in the early segments of the nephron. Starting from the pharmacological complexity and comorbidities of the geriatric patient and tracing a pathophysiological and molecular path, we demonstrate a new etiology of nephrogenic diabetes insipidus compared to those most commonly possible.
Methods. A 71 years old man with a respiratory failure in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pneumonia presented the typical symptoms of diabetes insipidus after about 20 days of hospitalization. The water deprivation test led to the diagnosis of nephrogenic diabetes insipidus.
The etiological study was complex particularly because due to the patient’s previous lithium therapy.
Results. The sequence of pathognomonic events typical of diabetes insipidus associated with anamnestic, clinical and laboratory evidences supported strongly the diagnosis of nephrogenic diabetes insipidus due to SARS-CoV-2, rather than to other etiologies.
Conclusions. The collecting duct could represent a target for SARS-CoV-2 infection, directly or indirectly as a result of lesions of upstream portions of the nephron which would cascade into the distal segment. Other molecules, besides angiotensin 2 converting enzyme, might be involved in facilitating the viral aggression. The complexity of the geriatric patient shows the importance of a comprehensive approach which integrates a careful monitoring of clinical signs and symptoms, laboratory and instrumental tests. This is especially important in the context of SARS-CoV-2 infection and in the management of its unexpected complications.
Revealing the biology behind MRI signatures in high grade glioma
Authors: Lewis Erika M , Mao Lingchao , Wang Lujia , Swanson Kristin R , Barajas Ramon F , Li Jing , Tran Nhan L , Hu Leland S , Plaisier Christopher L 
Published: December 2023

AbstractMagnetic resonance imaging (MRI) measurements are routinely collected during the treatment of high-grade gliomas (HGGs) to characterize tumor boundaries and guide surgical tumor resection. Using spatially matched MRI and transcriptomics we discovered HGG tumor biology captured by MRI measurements. We strategically overlaid the spatially matched omics characterizations onto a pre-existing transcriptional map of glioblastoma multiforme (GBM) to enhance the robustness of our analyses. We discovered that T1+C measurements, designed to capture vasculature and blood brain barrier (BBB) breakdown and subsequent contrast extravasation, also indirectly reveal immune cell infiltration. The disruption of the vasculature and BBB within the tumor creates a permissive infiltrative environment that enables the transmigration of anti-inflammatory macrophages into tumors. These relationships were validated through histology and enrichment of genes associated with immune cell transmigration and proliferation. Additionally, T2-weighted (T2W) and mean diffusivity (MD) measurements were associated with angiogenesis and validated using histology and enrichment of genes involved in neovascularization. Furthermore, we establish an unbiased approach for identifying additional linkages between MRI measurements and tumor biology in future studies, particularly with the integration of novel MRI techniques. Lastly, we illustrated how noninvasive MRI can be used to map HGG biology spatially across a tumor, and this provides a platform to develop diagnostics, prognostics, or treatment efficacy biomarkers to improve patient outcomes.
Time of surgery for aneurysmal subarachnoid hemorrhage in patients ≥70 years
Authors: Zhang Hengrui , Wang Bangyue , Wang Ruyi , Peng Chao , Hou Changkai , Zhao Yan , Huan Linchun , Chai Yanfen , Yang Xinyu , Yu Jianjun 
Published: December 2023

AbstractObjectiveTo establish a time-to-surgery threshold for elderly aneurysmal subarachnoid hemorrhage patients before the risk of mortality increases.MethodsA cohort study using data with consecutive patients 70 years and older(N=743). Risk-adjusted restricted cubic splines modeled the mortality according to wait-time. The inflection point (in hours) when mortality began to increase was used to define early-time, middle-time and late-time surgery. To evaluate the robustness of this definition, outcomes among propensity-score matched non-middle surgical and middle-time surgical patients were compared using percent absolute risk differences.ResultsThere were a total of 535 patients who met inclusion. Their mean age was 74.3 (4.38) years. Cox models with restricted cubic spline showed a statistically significant U shaped association for onset-to-surgery time with two year all cause mortality. 66 patients (12.3%) received middle-time surgery and 469 patients (87.7%) received early-time or late-time surgery. There were 60 (91%) patients in the middle-time surgery group matched to those in the non-middle-time group. Of the 60 matched patients who received surgery after less than 49 hours or more than 68 hours, 23 patients (38.3%) died within 24 months vs 14 patients (23.3%) of 60 who received surgery within 49 to 68 hours, for an absolute risk difference of 15% (95% CI, -2.68% to 31.50%).ConclusionsIn this study, onset-to-treatment time showed a U shaped association with 24 months all cause mortality. Early surgery was superior to delayed surgery in reducing death rate. Elderly patients with poor tolerance to ultra-early surgery in whom operation was probably postponed.
Microplastics are detected in bull and dog sperm and polystyrene microparticles impair sperm fertilization
Authors: Grechi N. , Ferronato G.A. , Devkota S. , Ferraz M.A.M.M. 
Published: December 2023

AbstractThe alarming increase in global infertility rates has coincided with the pervasive accumulation of microplastics (MPs) resulting from the poor management of plastic waste. This concerning trend is particularly troubling because only 10% of male infertility cases can be attributed to identifiable causes, leaving a significant knowledge gap in our understanding of their underlying factors. To bridge this critical gap, it is important to explore the connection between the accumulation of MPs and the observed decline in male fertility. Here, the presence of microplastics in reproductive fluids from bulls and dogs was assessed and used as baseline concentrations for bull sperm exposure. Bovine epididymal sperm (ES) presented a mean of 72.5 MP particles mL-1(0.3691 μg mL−1) while canine seminal plasma had an average of 35.4 MP particles mL-1(0.0066 μg mL−1). Bovine sperm was exposed to three different concentrations of a mixture of 1.1, 0.5, and 0.3 µm polystyrene (PS) beads: (1) 0.7 μg mL−1, blood concentration of PS in cows (bPS); (2) 0.37 μg mL−1, concentration of total MPs in ES (esMP); and (3) 0.026 μg mL−1, concentration of PS in ES (esPS). All sperm samples incubated with PS exhibited reduced motility compared with the CT at 0.5 h. However, PS exposure did not affect acrosome or induced oxidative stress. When used forin vitrofertilization, the sperm exposed to PS had decreased blastocyst rates, in addition to inducing ROS formation and apoptosis on resulting embryos. By employing realistic exposure concentrations, this research sought to shed light on the comprehensive impact of MPs on bovine sperm and the quality of resulting embryos, providing the first evidence of MPs in bovine and dog sperm and demonstrating the detrimental effect of PS MPs on sperm motility and functionality.Graphical AbstractHighlightsMicroplastics were found across the most diverse range of environments and their presence have been shown to affect reproductive parameters within different species.True-to-life concentrations of exposure were used to assess the potential effects of polystyrene in sperm parameters and fertilization.Polystyrene microplastics attach to sperm and decrease motility, also reducing sperm functionality as seen by decreased blastocyst rate and increased oxidative stress in embryos.