bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of the CCL20/CCR6 axis in tubular epithelial cell injury: Kidney‐specific translational insights from acute kidney injury to chronic kidney disease
Authors: Yoo Kyung Don , Yu Mi‐yeon , Kim Kyu Hong , Lee Seongmin , Park EunHee , Kang Seongmin , Lim Doo‐Ho , Lee Yeonhee , Song Jeongin , Kown Soie , Kim Yong Chul , Kim Dong Ki , Lee Jong Soo , Kim Yon Su , Yang Seung Hee 
Published: January 2024

AbstractThis study investigated the role of the axis involving chemokine receptor 6 (CCR6) and its ligand chemokine (C–C motif) ligand 20 (CCL20) in acute kidney disease (AKD) using an ischemia–reperfusion injury (IRI) model. The model was established by clamping the unilateral renal artery pedicle of C57BL/6 mice for 30 min, followed by evaluation of CCL20/CCR6 expression at 4 weeks post‐IRI. In vitro studies were conducted to examine the effects of hypoxia and H2O2‐induced oxidative stress on CCL20/CCR6 expression in kidney tissues of patients with AKD and chronic kidney disease (CKD). Tubular epithelial cell apoptosis was more severe in C57BL/6 mice than in CCL20 antibody‐treated mice, and CCR6, NGAL mRNA, and IL‐8 levels were higher under hypoxic conditions. CCL20 blockade ameliorated apoptotic damage in a dose‐dependent manner under hypoxia and reactive oxygen species injury. CCR6 expression in IRI mice indicated that the disease severity was similar to that in patients with the AKD phenotype. Morphometry of CCL20/CCR6 expression revealed a higher likelihood of CCR6+ cell presence in CKD stage 3 patients than in stage 1–2 patients. Kidney tissues of patients with CKD frequently contained CCL20+ cells, which were positively correlated with interstitial inflammation. CCL20/CCR6 levels were increased in fibrotic kidneys at 4 and 8 weeks after 5/6 nephrectomy. These findings suggest that modulating the CCL20/CCR6 pathway is a potential therapeutic strategy for managing the progression of AKD to CKD.
Adolescent Tobacco/Nicotine Use and the Potential Role of Contingency Management-based Interventions
Authors: Shirazi Anaheed , Radgoudarzi Niloofar , Brody Arthur L. 
Published: January 2024

Abstract
The high prevalence of tobacco/nicotine use among youth, including e-cigarettes, is a public health problem in the United States. Early exposure leads to an increased risk of dependence and health consequences in adulthood. We reviewed the literature on current treatment approaches for nicotine/tobacco use in adolescents/young adults and highlighted underexplored areas of treatment research. There are no current Food and Drug Administration–approved medications for treatment of nicotine/tobacco use disorders in adolescents. However, in research settings and on a case-to-case basis, clinical practice medications (including nicotine replacement therapy, bupropion, and varenicline) have been prescribed to this population with consideration of risk-benefit analysis when behavioral treatments are not sufficient to address dependence. Among the nonpharmacological interventions, there is evidence to support the potential for expanded use of contingency management in youth. Neural differences predisposing adolescents to substance use, along with higher attentiveness to value of options in decision making (flexible reward system) may enhance the effectiveness of reward-based approaches for treatment of substance use disorders in this population. The overall high rates of nonresponders across psychosocial and pharmacological treatments highlight the importance of considering novel strategies to improve existing interventions. We suggest that future research be done that considers unique characteristics of today's adolescents, such as high social activism and engagement with digital rewards to tailor contingency management for this age group and assess its effectiveness. Adolescents could potentially benefit from rewards administered through digital media (eg, video games, computer-based apps, and social media influencers).
Development and External Validation of Models to Predict Persistent Hypoxemic Respiratory Failure for Clinical Trial Enrichment*
Authors: Sathe Neha A. , Zelnick Leila R. , Morrell Eric D. , Bhatraju Pavan K. , Kerchberger V. Eric , Hough Catherine L. , Ware Lorraine B. , Fohner Alison E. , Wurfel Mark M. 
Published: January 2024

OBJECTIVES:
Improving the efficiency of clinical trials in acute hypoxemic respiratory failure (HRF) depends on enrichment strategies that minimize enrollment of patients who quickly resolve with existing care and focus on patients at high risk for persistent HRF. We aimed to develop parsimonious models predicting risk of persistent HRF using routine data from ICU admission and select research immune biomarkers.

DESIGN:
Prospective cohorts for derivation (n = 630) and external validation (n = 511).

SETTING:
Medical and surgical ICUs at two U.S. medical centers.

PATIENTS:
Adults with acute HRF defined as new invasive mechanical ventilation (IMV) and hypoxemia on the first calendar day after ICU admission.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We evaluated discrimination, calibration, and practical utility of models predicting persistent HRF risk (defined as ongoing IMV and hypoxemia on the third calendar day after admission): 1) a clinical model with least absolute shrinkage and selection operator (LASSO) selecting Pao
2/Fio
2, vasopressors, mean arterial pressure, bicarbonate, and acute respiratory distress syndrome as predictors; 2) a model adding interleukin-6 (IL-6) to clinical predictors; and 3) a comparator model with Pao
2/Fio
2 alone, representing an existing strategy for enrichment. Forty-nine percent and 69% of patients had persistent HRF in derivation and validation sets, respectively. In validation, both LASSO (area under the receiver operating characteristic curve, 0.68; 95% CI, 0.64–0.73) and LASSO + IL-6 (0.71; 95% CI, 0.66–0.76) models had better discrimination than Pao
2/Fio
2 (0.64; 95% CI, 0.59–0.69). Both models underestimated risk in lower risk deciles, but exhibited better calibration at relevant risk thresholds. Evaluating practical utility, both LASSO and LASSO + IL-6 models exhibited greater net benefit in decision curve analysis, and greater sample size savings in enrichment analysis, compared with Pao
2/Fio
2. The added utility of LASSO + IL-6 model over LASSO was modest.

CONCLUSIONS:
Parsimonious, interpretable models that predict persistent HRF may improve enrichment of trials testing HRF-targeted therapies and warrant future validation.
Ultrasonic- and Ultrasound-assisted Improvement of Silhouette of the Torso: Bone Structure High-definition Remodeling (Part I)
Authors: Oñate Valdivieso Carlos , Oñate Valdivieso Daniel , Hoyos Alfredo E. , Perez Pachon Mauricio E. , Aguilar Villa Hugo , Michels Paulo Jr Alberton , Viera Andres , Benavides Jorge E. , Villabona Silvia J. , Ramirez Brian 
Published: January 2024

Background:
High-definition liposculpture allowed plastic surgeons to achieve better aesthetic results by carving the underlying muscles and contours in a new way. Several authors have improved the original technique by adding other procedures and new technologies. We designed a new improvement by incorporating bone transformation surgery to overcome the lack of silhouette at the waist and, as a result, optimize the breast-waist-hip ratios.

Methods:
We carried out a prospective multicenter study, with five different surgeons performing the same rib remodeling technique for waist definition. We used an ultrasonic piece for costal corticotomy and real-time ultrasound imaging to perform green-stick fractures over the last two or three floating ribs. Ours is a new technique based on the prior one described by Kudzaev.

Results:
We reported 131 consecutive patients who were enrolled in this study. Waistline diameter decreased an average of 8 cm after surgery (P < 0.05). Most patients were women (n = 125, 95.4%). No major complications were reported. Most common complication was prolonged pain, with only three cases of contour asymmetry, all of which were attributable to noncompliance of constantly wearing the corset + compressive garments. Patients reported a high satisfaction rate and fast recovery (Body-QoL survey).

Conclusions:
Ultrasonic- and ultrasound- assisted indentation surgery of the thorax is a safe and reliable technique for waistline definition, with a high satisfaction rate, almost-invisible scars, and minimal risk for complications. Incorporation of high-definition liposculpture to rib remodeling opens up a new horizon for bone structure modification surgery (S-high-definition remodeling) that can be safely performed for patients who seek better aesthetic outcomes in body contouring.
5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review
Authors: Chang Chao-Yuan , Chen Chun-Chung 
Published: January 2024

Rationale:
Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor for which maximal tumor resection plays an important role in the treatment strategy. 5-aminolevulinic (5-ALA) is a powerful tool in fluorescence-guided surgery for GBM. However, 5-ALA- enhancing lesion can also be observed with different etiologies.

Patients concerns:
Three cases of 5-ALA-enhancing lesions with etiologies different from glioma

Diagnoses:
The final diagnosis was abscess in 1 patient and diffuse large B-cell in the other 2 patients.

Interventions:
Three patients received 5-aminolevulinic acid-guided tumor resection under microscope with intraoperative neuromonitoring.

Outcomes:
All of our patients showed improvement or stable neurological function outcomes. The final pathology revealed etiologies different from GBM.

Lessons:
The 5-aminolevulinic acid fluorescence-guided surgery has demonstrated its maximal extent of resection and safety profile in patients with high-grade glioma. Non-glioma etiologies may also mimic GBM in 5-ALA-guided surgeries. Therefore, patient history taking and consideration of brain images are necessary for the interpretation of 5-ALA-enhanced lesions.
Prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in a middle-aged population with overweight and normal liver enzymes, and diagnostic accuracy of noninvasive proxies
Authors: van Son K.C. , te Nijenhuis-Noort L.C. , Boone S.C. , Mook-Kanamori D.O. , Holleboom A.G. , Roos P.R. , Lamb H.J. , Alblas G. , Coenraad M.J. , Rosendaal F.R. , de Mutsert R. , Tushuizen M.E. 
Published: January 2024

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing at an alarming rate. Elevated liver enzymes are a primary reason to refer patients for further testing. However, liver enzymes within the normal range do not exclude the presence of MASLD. We examined the prevalence of MASLD in a middle-aged population with overweight and normal liver enzymes. In addition, we examined the accuracy of 4 sets of noninvasive proxies for MASLD.
We included 1017 participants from the Netherlands epidemiology of obesity cohort study with body mass index ≥25 kg/m2 and liver enzymes (asparate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase) within normal range. The diagnostic accuracy of biomarker scores (fatty liver index, liver fat score [LFS], STEATO-ELSA, and hepatic steatosis index) was determined against elevated hepatic triglyceride content measured by 1proton magnetic resonance spectroscopy.
Participants (mean age 56 years, 49% women), had a median body mass index of 29.6 kg/m2 and a median hepatic triglyceride content of 4.4%. MASLD was present in 42% of participants and was more common in men than women, with respectively 47% and 36% being affected. The LFS showed the highest accuracy with an area under the curve of 0.72. We identified metabolic syndrome as the prime predictor for MASLD with an odds ratio of 2.95 (95% confidence interval 2.20–3.98).
The prevalence of MASLD in middle-aged men and women with overweight and liver enzymes within the normal range is over 40%. LFS showed the highest accuracy to detect MASLD, but, overall, biomarker scores performed relatively poor. The presence of metabolic syndrome was the prime predictor of MASLD.
The green bad omen in blood smear and the potential of blood purification therapy: A case report
Authors: Chen Yanhui , Ni Wenpeng , Gu Guanghong 
Published: January 2024

Rationale:
Green inclusions (GI) are distinct morphological features found in phagocytic cells like neutrophils and monocytes. These intracellular structures exhibit bright green color with unclear boundaries, and their origin and clinical significance are still not fully understood. GI carriers, often middle-aged to elderly with liver dysfunction, face higher mortality rates, earning them the nickname “inclusions of death.” This report presents a rare GI-related pediatric case, demonstrating a favorable response to blood purification therapy.

Patient concerns:
A 10-year-old girl was admitted with recurrent fever, abdominal pain, and neurological symptoms, culminating in a transient cardiac arrest. Blood tests revealed multi-organ injury and a high risk of disseminated intravascular coagulation, while peripheral blood smear detected GI within neutrophil cytoplasm.

Diagnosis:
The patient was diagnosed with acute necrotizing encephalopathy, severe sepsis, and multiple organ failure.

Interventions and outcomes:
After receiving multiple sessions of blood purification therapy, peripheral blood GI levels markedly decreased, accompanied by improvements in various laboratory parameters and signs of neurological recovery. Unfortunately, due to financial constraints, the family opted to transfer the patient back to their local hospital, where she succumbed shortly after discharge.

Lessons:
This case underscores the complexities in managing GI-related pediatric cases. Moreover, it emphasizes the potential benefits of blood purification therapy in such scenarios. Notably, this study highlights a potential correlation between the level of GI in peripheral blood and disease severity, particularly in pediatric cases. While these findings hold clinical significance for the treatment and management of GI-related patients, further research focusing on middle-aged and elderly individuals is imperative to elucidate the fundamental relationship between peripheral blood GI quantity and clinical presentation and to evaluate the efficacy of blood purification in GI-related cases.
Interstitial pneumonia disease induced by osimertinib combined with savolitinib targeted therapy in a lung cancer patient: A case report
Authors: Shen Yikuan , Lou Songgao , Zhang Jiansong 
Published: January 2024

Rationale:
MET-TKI is a late-stage treatment for drug-resistant NSCLC that has been marketed in recent years, and interstitial lung disease may be a rare adverse reaction. This case reports the development of interstitial lung disease in a patient with advanced lung cancer who developed during treatment with savolitinib after resistance to osimertinib.

Patient concerns:
A 74-year-old female diagnosed with lung adenocarcinoma was referred to our hospital with chest tightness and shortness of breath following treatment with osimertinib plus savolitinib.

Diagnose:
Chest CT of the patient shows interstitial changes in both lungs, and drug-related interstitial lung disease is considered in the context of the patient previous condition.

Interventions:
The patient is treated with methods such as glucocorticoids, anti-infection, and mechanical ventilation.

Outcomes:
At the 1-year follow-up visit, the patient condition of interstitial lung disease was relatively stable. The patient has passed away due to tumor progression.

Lessons:
This case reported interstitial lung disease following osimertinib plus savolitinib. This suggests that healthcare providers should be aware of early symptoms of interstitial lung disease during treatment and treat them appropriately to prevent symptoms from worsening.
Atrial flutter complicating acute respiratory distress syndrome (ARDS): A rare case report
Authors: Elendu Chukwuka , Amaechi Dependable C. 
Published: January 2024

Rationale:
This case report addresses a unique instance of atrial flutter complicating acute respiratory distress syndrome (ARDS), contributing a novel addition to the medical literature. The co-occurrence of these conditions sheds light on a rare clinical scenario that requires careful consideration.

Patient Concerns:
The patient exhibited symptoms of pronounced dyspnea, tachypnea, and hypoxemia. Clinical assessment revealed irregular heart rhythms, notably atrial flutter, alongside characteristic signs of ARDS, including bilateral pulmonary infiltrates and reduced lung compliance.

Diagnoses and Interventions:
After a comprehensive evaluation, the patient was diagnosed with atrial flutter complicating ARDS. Therapeutic measures encompassed antiarrhythmic agents, mechanical ventilation, and targeted ARDS management protocols. The intricate interplay between cardiac and respiratory factors necessitated a multidisciplinary approach.

Outcomes:
Throughout treatment, the patient’s respiratory distress gradually improved. Control of the atrial flutter was achieved, and oxygenation levels were restored within acceptable limits. This successful outcome underscores the significance of a well-coordinated treatment strategy in addressing complex cases like this.

Lessons:
This case highlights the importance of recognizing and managing the intricate relationship between cardiac arrhythmias such as atrial flutter and respiratory complications like ARDS. The successful management of this patient underscores the value of multidisciplinary collaboration and tailored therapeutic interventions. Practitioners should remain vigilant for such rare complications and consider this case a reminder of the potential complexities that can arise in critical care scenarios.
Fatal intracerebral hemorrhage following endovascular Onyx embolization of an arteriovenous malformation: A case report
Authors: Park Geo-Seong , Park Jung-Soo 
Published: January 2024

Introduction:
Patients with cerebral arteriovenous malformation (AVM) have a lifetime risk of hemorrhagic stroke. Although identified asymptomatic cases can be monitored with imaging follow-up, treatment is considered in cases of AVM rupture or hemodynamic instability.

Patient concerns:
A 43-year-old man who had been taking antihypertensive drugs for the past 5 years visited our hospital 3 days after the abrupt onset of headache. The patient also complained of progressive ptosis in the left eye.

Diagnoses:
Brain computed tomography (CT) showed a small intraventricular hemorrhage with obstructive hydrocephalus. Subsequent brain CT angiography and magnetic resonance imaging confirmed the presence of an AVM in the cerebellar vermis.

Interventions:
Endovascular embolization was performed directly through the right femoral artery. Near-total obliteration of the AVM nidus was achieved by using multiple Onyx castings.

Outcomes:
The patient developed an altered mental status and right hemiparesis after the procedure. CT performed after the procedure revealed intraventricular hemorrhage in all ventricles, with a left thalamic intracerebral hemorrhage. Despite emergency external ventricular drainage and aggressive treatment for intracranial pressure control, the patient expired on the 14th day after the embolization procedure.

Lessons:
When treating AVMs, especially those with a large nidus of high flow, it is necessary to consider possible hemorrhagic complications and preventive measures.
The double whammy: Advanced medical training and parenting
Authors: Alkhawashki Samah , Alasiri Rahaf , Ruetalo Mariela , Maggi Julie 
Published: January 2024

Clinicians may become parents during their clinical training and may be exposed to several challenges in career development, burnout and work-life balance. Previous research findings have reported that stressors facing trainees with children warrant greater attention from graduate medical institutions. Additionally, parenting-related information and considerations about the needs of trainees with children across clinical specialties are needed to inform institutional and national policies. A quantitative approach was used to examine clinical trainees’ perceptions and experiences of parenting in relation to different specialties, sociodemographic traits, levels of support, and other potential factors influencing their residency and fellowship training and well-being. We used a survey that was distributed to all University of Toronto medical trainees (2214) via email correspondence and social media platforms. The trainees were asked to base their answers on their experience during the academic year of 2019 to 2020 (before the Coronavirus Disease 2019-related shutdown). Our study revealed that clearly, burnout is a concern for physicians who are raising children while in training. Notably, it was higher among younger aged trainees and those beginning their training journey including, first-year fellows and second-year residents, in addition to parents with toddlers. Moreover, female residents and male fellows showed higher burnout than their counterparts. Institutional support was associated with lower rates of burnout, evidenced by access to opportunities, allowing time to breastfeed/express milk and having access to medical care. We found multiple independent and significant factors affecting their rate of burnout including limited access to opportunities, lack of a self-care routine and absence of social community outside of work.
The results show the importance of creating a positive learning experience for trainees juggling parenting and training needs, especially those starting their training both as residents and as fellows and those with younger children. Interventions can be categorized into those targeted at the individual and family levels, and institutional levels, with the overarching goal of balancing training and parenting. This can be achieved by fostering learning environments that prevent and decrease burnout and enhance the well-being of trainees and their families, which can start with ensuring trainees are aware of available resources and possible accommodations.
Accuracy of dual-energy computed tomography for bone marrow edema in the sacroiliac joint: A systematic review and meta-analysis
Authors: Li Xin , Wang Jianguo , Li Ping , Zhuang Shunda , Jiang Shun , Liu Wenqian 
Published: January 2024

Background:
This systematic literature review and meta-analysis aimed to assess the accuracy, sensitivity, and specificity of dual-energy computed tomography (DECT) of the sacroiliac joint. Bone marrow edema (BME) of the sacroiliac joint is an early manifestation of some diseases, such as ankylosing spondylitis, and is usually examined by nuclear magnetic resonance imaging (MRI); however, MRI can be intolerable for some patients; hence, numerous studies have analyzed DECT examinations.

Methods:
We searched PUBMED, CNKI, and EMBASE in 2023 for articles containing the following terms (DECT) or (DE-CT) or (dual-energy CT) or “dual-energy CT” or (dual-energy computed tomography) and ((sacroiliac joint) or (ankylosing spondylitis) or (sacroiliac arthritis) or (sacroiliitis)). An initial search identified 444 articles, of which 7 met the criteria. Data were extracted to calculate the sensitivity, specificity, and diagnostic odds for analysis using R software.

Results:
Out of 291 patients and 577 sacroiliac joints, 429 (74.35%) exhibited BME. All studies used magnetic resonance as the control group. The overall sensitivity and specificity of DECT were 79%, and 92%, respectively, with positive prediction rate of 92.55% and negative prediction rate of 83.73%.

Conclusion:
DECT appears to be a promising diagnostic tool for detecting BME in the sacroiliac joint and can be used as an alternative examination method for patients in whom MRI is contraindicated.