bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional changes in intestinal permeability in cirrhosis are associated with mucosal bacteria
Authors: Bloom Patricia P. , Rao Krishna , Bassis Christine , Nojkov Borko , Young Vincent B. , Lok Anna SF 
Published: September 2023

Background:
Several complications of cirrhosis are theorized to result from the translocation of bacteria or their products across the intestinal epithelium. We aimed to assess epithelial permeability and associations with mucosal bacteria in patients with cirrhosis.

Approach and Results:
We collected 247 duodenum, ileum, and colon biopsies from 58 consecutive patients with cirrhosis and 33 controls during clinically indicated endoscopies. Patients with cirrhosis were similarly aged to controls (60 vs. 58 y) and had a median Model for End-stage Liver Disease of 8 (interquartile range 7, 10). Biopsies underwent 16S rRNA-encoding gene amplicon sequencing to determine mucosal bacteria composition and transepithelial electrical resistance (TEER) to determine epithelial permeability. In the entire cohort, there were regional differences in TEER with the lowest TEER (ie, more permeable) in the ileum; duodenum TEER was 43% higher and colon TEER 20% higher than ileum TEER (ANOVA p = 0.0004). When comparing patients with cirrhosis and controls, both TEER (26% lower in cirrhosis, p = 0.006) and alpha diversity differed in the duodenum (27% lower in cirrhosis, p = 0.01) but not ileum or colon. A beta-binomial model found that 26 bacteria were significantly associated with TEER. Bifidobacteriaceae Bifidobacterium in duodenal mucosa was protective of epithelial permeability and future hospitalization for hepatic decompensation.

Conclusions:
Duodenal epithelial permeability was higher, and mucosal bacteria alpha diversity was lower in cirrhosis compared to controls, while no such differences were seen in the ileum or colon. Specific bacteria were associated with epithelial permeability and future hepatic decompensation.
Exercise changes the intrahepatic immune cell profile and inhibits the progression of nonalcoholic steatohepatitis in a mouse model
Authors: Tsutsui Yuriko , Mori Taizo , Yoshio Sachiyo , Sato Miku , Sakata Toshihiro , Yoshida Yuichi , Kawai Hironari , Yoshikawa Shiori , Yamazoe Taiji , Matsuda Michitaka , Kakazu Eiji , Osawa Yosuke , Oyama Chinatsu , Tamura-Nakano Miwa , Kawaguchi Takumi , Yoshizumi Tomoharu , Kanto Tatsuya 
Published: September 2023

Background:
NASH is an increasingly common cause of chronic liver disease and can progress to cirrhosis and HCC. Although exercise suppresses inflammation during acute hepatitis, its impact on the progression of chronic liver disease remains unclear. Here, we investigated the effects of exercise on disease progression and intrahepatic immune cell composition in a mouse model of NASH.

Method:
Mice were assigned to 4 groups: 2 control groups (normal diet) and 2 NASH groups (western diet and low-dose carbon tetrachloride injection). One of each group remained sedentary and one was exercised on a treadmill for 12 weeks (60 min/d, 5 times/wk). All mice were then analyzed for liver histomorphology, steatosis, inflammation, and fibrosis; liver, adipose tissue, and skeletal muscle expression of genes related to metabolism and inflammation; and intrahepatic immune cell composition.

Result:
Compared with the normal diet mice, NASH mice exhibited enhanced liver steatosis, inflammation, and fibrosis; upregulated expression of liver lipogenesis-related and inflammation-related genes; and increased frequencies of intrahepatic F4/80int CD11bhi bone marrow-derived macrophages and programmed death receptor-1 (PD-1)+ CD8+ T cells. Expression of inflammatory cytokines and the frequencies of bone marrow-derived macrophages and PD-1+ CD8+ T cells correlated positively with liver steatosis, inflammation, and fibrosis. Exercise was shown to reduce NASH-induced hepatic steatosis, liver inflammation, and fibrosis; induce alterations in metabolism-related genes and inflammatory cytokines in the liver; and suppress accumulation of liver bone marrow-derived macrophages and PD-1+ CD8+ T cells. In addition, we showed that exercise induced increased expression of IL-15 in muscle and its deficiency exacerbated the pathology of NASH.

Conclusions:
Exercise alters the intrahepatic immune cell profile and protects against disease progression in a mouse model of NASH.
Serum levels of fibrogenesis biomarkers reveal distinct endotypes predictive of response to weight loss in advanced nonalcoholic fatty liver disease
Authors: Karsdal Morten A. , Hallsworth Kate , Scragg Jadine , Leeming Diana J. , Villesen Ida F. , Avery Leah , Haigh Laura , Govaere Olivier , Wichmann Sarah , Taylor Guy , Cassidy Sophie , McPherson Stuart , Anstee Quentin M. 
Published: September 2023

Background:
NAFLD is associated with activation of fibroblasts and hepatic fibrosis. Substantial patient heterogeneity exists, so it remains challenging to risk-stratify patients. We hypothesized that the amount of fibroblast activity, as assessed by circulating biomarkers of collagen formation, can define a “high-risk, high-fibrogenesis” patient endotype that exhibits greater fibroblast activity and potentially more progressive disease, and this endotype may be more amendable to dietary intervention.

Methods:
Patients with clinically confirmed advanced NAFLD were prescribed a very low-calorie diet (VLCD) intervention (∼800 kcal/d) to induce weight loss, achieved using total diet replacement. Serum markers of type III (PRO-C3) and IV collagen (PRO-C4) fibrogenesis were assessed at baseline every second week until the end of the VLCD, and 4 weeks post-VLCD and at 9 months follow-up.

Results:
Twenty-six subjects had a mean weight loss of 9.7% with VLCD. This was associated with significant improvements in liver biochemistry. When stratified by baseline PRO-C3 and PRO-C4 into distinct fibrosis endotypes, these predicted substantial differences in collagen fibrogenesis marker dynamics in response to VLCD. Patients in the high activity group (PRO-C3 >11.4 ng/mL and/or PRO-C4 >236.5 ng/mL) exhibited a marked reduction of collagen fibrogenesis, ranging from a 40%–55% decrease in PRO-C3 and PRO-C4, while fibrogenesis remained unchanged in the low activity group. The biochemical response to weight loss was substantially greater in patients a priori exhibiting a high fibroblast activity endotype in contrast to patients with low activity.

Conclusions:
Thus, the likelihood of treatment response may be predicted at baseline by quantification of fibrogenesis biomarkers.
Management and outcomes after liver transplantation for progressive familial intrahepatic cholestasis: A systematic review and meta-analysis
Authors: Kavallar Anna Maria , Mayerhofer Christoph , Aldrian Denise , Okamoto Tatsuya , Müller Thomas , Vogel Georg Friedrich 
Published: September 2023

Background:
Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous rare congenital cholestatic liver disease. Disease progression might necessitate liver transplantation (LT). The aim of this study was to describe the outcome of PFIC1-4 patients after LT.

Methods:
Electronic databases were searched to identify studies on PFIC and LT. Patients were categorized according to PFIC type, genotype, graft type, age at LT, time of follow-up, and complications and treatment during follow-up.

Results:
Seventy-nine studies with 507 patients met inclusion criteria; most patients were classified as PFIC1-3. The median age at LT was 50 months. The overall 5-year patient survival was 98.5%. PFIC1 patients with diarrhea after LT were at significant risk of developing graft steatosis (p < 0.0001). Meta-analysis showed an efficacy of 100% [95% CI: 73.9%–100%] for surgical biliary diversion to ameliorate steatosis and 94.9% [95% CI: 53.7%–100%] to improve diarrhea (n = 8). PFIC2 patients with bile salt export pump (BSEP)2 or BSEP3-genotype were at significant risk of developing antibody-induced BSEP deficiency (AIBD) (p < 0.0001), which was reported in 16.2% of patients at a median of 36.5 months after LT. Meta-analysis showed an efficacy of 81.1% [95% CI: 47.5%–100%] for rituximab-based treatment regimens to improve AIBD (n = 18). HCC was detected in 3.6% of PFIC2 and 13.8% of PFIC4 patients at LT.

Conclusions:
Fifty percent of PFIC1 patients develop diarrhea and steatosis after LT. Biliary diversion can protect the graft from injury. PFIC2 patients with BSEP2 and BSEP3 genotypes are at significant risk of developing AIBD, and rituximab-based treatment regimens effectively improve AIBD. PFIC3 patients have no PFIC-specific complications following LT.
CORRELATIONS BETWEEN SUSPENDED HYPERREFLECTIVE MATERIAL WITH THE MACULAR MICROSTRUCTURE AND SPONTANEOUS CLOSURE OF FULL-THICKNESS MACULAR HOLES
Authors: Yang Qian , Huang Xin , Peng Rui , Li Ruiwen , Xu Gezhi , Wang Ling , Chang Qing 
Published: September 2023

Abstract

Purpose:
To investigate the characteristics of spontaneously closed full-thickness macular holes (FTMHs) and to seek potential predictors for the spontaneous closure of FTMHs.

Methods:
In this retrospective cohort study, the clinical data and optical coherence tomography (OCT) images were reviewed from 19 eyes with spontaneously closed FTMHs (spontaneous closure group) and 37 control eyes with FTMHs that were delayed for non-medical reasons but ultimately requiring surgery (control group). The term, suspended hyperreflective material (SHM), was defined as hyperreflective material suspended within the FTMHs observed via OCT; the presence of SHM was evaluated in these eyes.

Results:
The median time from diagnosis to spontaneous closure of the FTMHs was 13.7 (range, 2.4-32.4) weeks in the spontaneous closure group. The mean diameter of FTMHs in the spontaneous closure group was significantly smaller than that in the control group (191.68±70.57 μm vs 401.68±162.19 μm, P<0.0001). The incidence of vitreomacular traction (VMT) was higher in the spontaneous closure group compared to the control group (9/19 vs 5/37, P=0.009, OR [95% CI], 5.76 [1.56–21.21]); in 7 of the 9 eyes with VMT from the spontaneous closure group, spontaneous VMT separation and subsequent FTMH closure was observed. SHM was observed in 9 eyes (47%) from the spontaneous closure group and 3 eyes (8%) from the control group (P=0.001, OR [95% CI], 10.20[2.31‒45.02]).

Conclusions:
Smaller diameters, VMT, and presence of SHM might be suggestive of the potential for spontaneous closure of FTMHs.
Evaluation of a new device to treat negative dysphotopsia
Authors: Roop Prakhyat , Nayak Shreya , Kittur Amogh , Roop Roop , Sharma Namrata 
Published: September 2023

Purpose:
To evaluate the efficacy and safety of Negative Dysphotopsia (ND) Ring implantation for treating and preventing ND.

Setting:
Multicentric tertiary eye hospitals.

Design:
Prospective interventional cohort study.

Methods:
22 patients with ND were enrolled. Eyes with other ocular structural pathologies (corneal, macular, optic nerve head, retinal, neuro-ophthalmological) were excluded. In 15 eyes, the ring was implanted to treat ND (therapeutic group), and in 7 eyes, it was implanted during cataract surgery of the fellow eye as a prophylactic measure (prophylactic group) to prevent the occurrence of ND. Preoperative evaluation included video recording of the patients' complaints aside complete eye examination. Postoperatively, patients were interviewed to confirm resolution of complaints related to ND. The intraoperative difficulties and postoperative adverse events were recorded. A minimum follow-up of 1 year was completed for all eyes.

Results:
In the therapeutic group, 14 of 15 eyes (93.3%) patients reported complete resolution of ND on the first postoperative day while 1 patient reported persistence of a smaller and lighter temporal shadow. No ND was reported by any patient in any of the 7 eyes treated prophylactically. No significant adverse intraoperative event was recorded; however, vitreous upthrust was noted in 2 of 22 eyes (9.0%). No permanent drop in visual acuity was recorded in the therapeutic group.

Conclusions:
ND Ring implantation was an easy, safe, and effective approach for both treating and preventing ND.
Overview of the economic burden of musculoskeletal pain in children and adolescents: a systematic review with meta-analysis
Authors: Espirito Santo Caique de Melo , Santos Verônica S. , Kamper Steven J. , Williams Christopher M. , Miyamoto Gisela C. , Yamato Tiê P. 
Published: September 2023

Abstract
Studies suggest a high economic burden among children and adolescents with musculoskeletal pain. There is no summary in the literature on the overall economic burden of musculoskeletal pain in children and adolescents. The aim of this systematic review of cost-of-illness studies was to synthesize the economic burden of musculoskeletal pain in children and adolescents. We conducted electronic searches on MEDLINE, EMBASE, CINAHL, EconLit, NHSEED, and HTA databases. We included cost-of-illness studies that estimated healthcare, patient/family, lost productivity, and/or societal costs in children and adolescents with musculoskeletal pain. The risk of bias was assessed with the Consolidated Health Economic Evaluation Reporting Standards checklist. All values were adjusted to the same reference year (2021) and converted to American Dollar. We included 45 cost-of-illness studies (n = 665,623). Twenty-two studies estimated the annual healthcare costs that ranged from $143 to $41,379 per patient. Nine studies estimated the annual patient/family costs that ranged from $287 to $27,972 per patient. Seven studies estimated the annual lost productivity costs that ranged from $124 to $4671 per patient. Nine studies estimated the annual societal costs that ranged from $1095 to $69,351 per patient. Children and adolescents with juvenile idiopathic arthritis and musculoskeletal pain had higher annual incremental healthcare costs than those without these conditions (mean difference: $3800 higher, 95% confidence interval [CI]: 50-7550; mean difference: $740 higher, 95% CI: 470-1,010, respectively). In conclusion, the estimated annual economic burden of children and adolescents with musculoskeletal pain ranged from $124 to $69,351.
The Role and Value of Corporate Medical Directors in Employer Benefits Management
Authors: Stave Gregg M. , Burton Wayne N. 
Published: September 2023

Objective
Knowledge of health-related employer benefits is considered a core competency by the American College of Occupational and Environmental Medicine. This study seeks to understand how this translates into practice.

Methods
An electronic survey was e-mailed to members of American College of Occupational and Environmental Medicine Corporate Medicine and Health and Human Performance Sections; Integrated Benefits Institute; and Employer Health Innovation Roundtable.

Results
One hundred nineteen responses were received, including 54 from corporate medical directors (CMDs) and 43 from employee benefits professionals, from a variety of industries. Fifty percent of CMDs reported expertise in designing benefits, but only 25% are engaged with health benefits. The majority of CMDs thought that their involvement was important, while the majority of benefits professionals thought that it was not important.

Conclusions
Many CMDs report having benefits expertise but being underutilized while others report not having expertise.
The benefits of R anastomotic technique for Billroth-II reconstruction with Braun anastomosis during totally laparoscopic distal gastrectomy: a propensity score matching analysis
Authors: Zhou Jiajie , Zhang Qi , Wang Wei , Sun Longhe , Li Ruiqi , Zhao Shuai , Wang Daorong 
Published: September 2023

Background:
Currently, there is no consensus on the most appropriate anastomotic site, anastomotic line, and direction for Billroth-II reconstruction with Braun anastomosis (B-II-B anastomosis) during totally laparoscopic distal gastrectomy (TLDG). Herein, the authors presented a novel anastomotic technique called R anastomosis for B-II-B anastomosis and compared it with the conventional B-II-B anastomosis technique to assess its feasibility, safety, and effectiveness.

Methods:
Between March 2019 and September 2022 in our centre, R anastomosis was performed on 123 patients undergoing TLDG for distal gastric cancer. A retrospective review of a prospectively collected database identified patients who underwent TLDG between January 2010 and September 2022. Patients who underwent R anastomosis were matched in a 1:1 ratio with patients who underwent conventional anastomosis using a propensity score based on age, sex, preoperative BMI, American Society of Anesthesiologists (ASA) score, and the history of abdominal surgery. Surgical and postoperative outcomes and clinicopathological data were analyzed for both groups.

Results:
During the study period, 246 patients were included, 123 in each group. No intraoperative complications associated with digestive tract reconstruction and no cases of conversion to open surgery were reported in either group; furthermore, no incidences of perioperative mortality were noted in either group. The R group had a significantly reduced anastomotic time compared to the control group (30 ± 4.1 vs. 36 ± 5.3 min, P < 0.001). Perioperatively, the incidences of Clavien–Dindo grade II or higher complications were 6.5% (8/123) and 12.2% (15/123) in the R and control groups with no significant difference between the two groups. Postoperative gastric emptying dysfunction was found in five and one patient in the control and R groups, respectively.

Conclusion:
R anastomosis is a safe and effective technique for B-II-B anastomosis following TLDG. This novel technique enhances the convenience of performing anastomosis and can reduce postoperative gastric emptying dysfunction.
Quantifying time from last dose: do direct oral anticoagulant assays correlate with patient's reported last dose
Authors: Stretton Brandon , Kovoor Joshua , Bacchi Stephen , Gupta Aashray , Edwards Suzanne , Boey Jir Ping , Gluck Samuel , Reddi Benjamin , Maddern Guy , Boyd Mark 
Published: September 2023

Introduction
In the absence of a patient's last direct oral anticoagulant (DOAC) dose time, best practice regarding preoperative DOAC cessation remains unclear. The aim of this study was to investigate, in a real-life patient cohort, if there was an association between subjective patient recall and objective DOAC assay titre.

Methods/Materials
A multicentre cohort study of consecutive surgical inpatients was conducted. DOAC assays were ‘expected’ if they satisfied both time and titre-based guidelines.

Results
Patient-recalled last dose and DOAC assay was available in 285 individuals. DOAC assay titres correlated strongly with the expected levels based on a patient's reported last dose time(rho = 0.70, P value < 0.0001). However, underweight (<50 kg; P = 0.0339) and elderly (>80 years; P = 0.0134) were more likely to have an unexpectedly high assay titre.

Conclusions
A significant portion (∼25%) of patients had unexpected DOAC titres. DOAC levels can be clinically impactful in a significant percentage of patients, particularly in elderly and/or underweight.
Current opinion in quantitative lung ultrasound for the nephrologist
Authors: Reisinger Nathaniel , Koratala Abhilash 
Published: September 2023

Purpose of review
Volume overload mediates worse cardiovascular outcomes in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), leading to increased acute care utilization. Understanding the presence of pulmonary congestion, which is often clinically silent, could be instrumental in predicting acute care needs and mitigating risks through appropriate therapy. This review provides an overview of the existing literature on lung ultrasound in ESKD patients.

Recent findings
Quantitative lung ultrasound predicts adverse cardiovascular outcomes in ESKD patients on HD. The largest randomized controlled trial of a lung ultrasound-guided ultrafiltration strategy demonstrated control of pulmonary congestion without an increased risk of intradialytic hypotension, arrhythmia, or access thrombosis. Despite this, the study was negative in the incidence of the primary composite endpoint of all-cause death, nonfatal myocardial infarction, and decompensated heart failure. A post hoc analysis showed promise with reductions in recurrent acute care utilization and cardiovascular events. Recent research has focused on simplification of the 28-zone lung ultrasound, and abbreviated protocols have been shown to retain prognostic ability.

Summary
Lung ultrasound is a valuable tool for nephrologists to diagnose and manage pulmonary congestion. However, its optimal integration with other hemodynamic parameters to formulate effective management strategies remains elusive. Future studies should address these gaps and find solutions to the training inadequacies in clinician-performed ultrasound.
Proximal and Distal Factors Distinguishing Between Individuals With Suicidal Ideation Only and Suicide Attempters
Authors: Serebriakova Jana , Kemmler Georg , Deisenhammer Eberhard A. 
Published: September 2023

Abstract
Prior studies identifying variables that may differentiate suicide attempters from suicidal ideators mostly focused on distal risk factors and have not included the severity of suicidal ideation. The aim of this study was to consider the extent to which proximal (consumption of alcohol and psychotropic substances, intake of medication, interpersonal contact during the suicidal phase) and distal (resilience, sense of coherence, reasons for living) factors differ among nonideators, suicidal ideators (graded with regard to each individual's self-assessed mental distance to a suicidal act), and suicide attempters. A sample of 464 individuals recruited via an online link were compared by using RS-13, SOC-13, RFLI, and questions concerning the suicidal phase. There was a gradual decrease respectively increase in proximal and distal factors, as well as significant differences among the groups. Sense of coherence and reasons for living were independent protective factors, whereas consumption of alcohol and intake of medication were independent risk factors.