bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intratumoral microbial heterogeneity affected tumor immune microenvironment and determined clinical outcome of HBV-related HCC
Authors: Li Shengnan , Xia Han , Wang Zeyu , Zhang Xiehua , Song Tianqiang , Li Jia , Xu Liang , Zhang Ningning , Fan Shu , Li Qian , Zhang Qiaoling , Ye Yingnan , Lv Jiayu , Yue Xiaofen , Lv Hongcheng , Yu Jinpu , Lu Wei 
Published: April 2023

Background and Aims:
The intratumoral microbiome has been reported to regulate the development and progression of cancers. We aimed to characterize intratumoral microbial heterogeneity (IMH) and establish microbiome-based molecular subtyping of HBV-related HCC to elucidate the correlation between IMH and HCC tumorigenesis.

Approach and Results:
A case-control study was designed to investigate microbial landscape and characteristic microbial signatures of HBV-related HCC tissues adopting metagenomics next-generation sequencing. Microbiome-based molecular subtyping of HCC tissues was established by nonmetric multidimensional scaling. The tumor immune microenvironment of 2 molecular subtypes was characterized by EPIC and CIBERSORT based on RNA-seq and verified by immunohistochemistry. The gene set variation analysis was adopted to explore the crosstalk between the immune and metabolism microenvironment. A prognosis-related gene risk signature between 2 subtypes was constructed by the weighted gene coexpression network analysis and the Cox regression analysis and then verified by the Kaplan-Meier survival curve.
IMH demonstrated in HBV-related HCC tissues was comparably lower than that in chronic hepatitis tissues. Two microbiome-based HCC molecular subtypes, defined as bacteria- and virus-dominant subtypes, were established and significantly correlated with discrepant clinical-pathologic features. Higher infiltration of M2 macrophage was detected in the bacteria-dominant subtype with to the virus-dominant subtype, accompanied by multiple upregulated metabolism pathways. Furthermore, a 3-gene risk signature containing CSAG4, PIP4P2, and TOMM5 was filtered out, which could predict the clinical prognosis of HCC patients accurately using the Cancer Genome Atlas data.

Conclusions:
Microbiome-based molecular subtyping demonstrated IMH of HBV-related HCC was correlated with a disparity in clinical-pathologic features and tumor microenvironment (TME), which might be proposed as a biomarker for prognosis prediction of HCC.
ROK and RSK2-kinase pathways differ between senescent human renal and mesenteric arteries
Authors: Lubomirov Lubomir T. , Mantke René , Enzmann Thomas , Metzler Doris , Korotkova Tatiana , Hescheler Jürgen , Pfitzer Gabriele , Grisk Olaf 
Published: April 2023

Objective:
Small arteries from different organs vary with regard to the mechanisms that regulate vasoconstriction. This study investigated the impact of advanced age on the regulation of vasoconstriction in isolated human small arteries from kidney cortex and periintestinal mesenteric tissue.

Methods:
Renal and mesenteric tissues were obtained from patients (mean age 71 ± 9 years) undergoing elective surgery. Furthermore, intrarenal and mesenteric arteries from young and aged mice were studied. Arteries were investigated by small vessel myography and western blot.

Results:
Human intrarenal arteries (h-RA) showed higher stretch-induced tone and higher reactivity to α1 adrenergic receptor stimulation than human mesenteric arteries (h-MA). Rho-kinase (ROK) inhibition resulted in a greater decrease in Ca2+ and depolarization-induced tone in h-RA than in h-MA. Basal and α1 adrenergic receptor stimulation-induced phosphorylation of the regulatory light chain of myosin (MLC20) was higher in h-RA than in h-MA. This was associated with higher ROK-dependent phosphorylation of the regulatory subunit of myosin light-chain-phosphatase (MLCP), MYPT1-T853. In h-RA phosphorylation of ribosomal S6-kinase II (RSK2-S227) was significantly higher than in h-MA. Stretch-induced tone and RSK2 phosphorylation was also higher in interlobar arteries (m-IAs) from aged mice than in respective vessels from young mice and in murine mesenteric arteries (m-MA) from both age groups.

Conclusion:
Vasoconstriction in human intrarenal arteries shows a greater ROK-dependence than in mesenteric arteries. Activation of RSK2 may contribute to intrarenal artery tone dysregulation associated with aging. Compared with h-RA, h-MA undergo age-related remodeling leading to a reduction of the contractile response to α1 adrenergic stimulation.
The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit
Authors: Vuu Sally , Barr Christopher J. , Killington Maggie , Howie Joanne , Hutchins Selena , van den Berg Maayken E. L. 
Published: April 2023

Objective:
To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury.

Setting:
An outpatient rehabilitation clinic.

Participants:
Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care.

Design:
A retrospective clinical audit.

Main Measures:
Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test.

Results:
Forty-nine patients (mean age: 33.7 ± 13.0 years), on average 56.2 ± 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 ± 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% ± 12.4% and reporting a rating of perceived exertion of 13.4 ± 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 ± 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% ± 12.8%, P = .01) and rating of perceived exertion (17.0 ± 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons (r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression (r = −0.41, P < .01) and late postconcussion symptoms (r = −0.40, P < .01).

Conclusion:
The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.
THE ROLE OF GENETIC TESTING IN AVOIDING DIAGNOSTIC DELAYS IN INHERITED RETINAL DISEASE
Authors: Shah Arth H. , Park Elisse , Luke Tamara , Xu Qingguo , Jewell Ann , Couser Natario L. 
Published: April 2023

Purpose:
To identify and highlight potential delays in diagnosis and improve the characterization of the providers referring individuals affected with suspected inherited retinal diseases for specialty care, the authors performed an analysis of the patients with inherited retinal diseases seen by an ophthalmic genetics specialty service. In addition, the authors analyzed the diagnostic yield of genetic testing in patients with inherited retinal disease in our series and compared this information with other previous studies.

Methods:
The authors analyzed 131 consecutive patients with suspected inherited retinal diseases referred to an ophthalmic genetics specialty service at a tertiary hospital. Provider referral patterns, delays in diagnosis, and the diagnostic yield of genetic testing were evaluated.

Results:
Mean age in the cohort was 24 years. From the 51 patients who underwent genetic testing, the diagnostic yield was 69%. Of these, genetic testing revealed that 51% of patients had an incorrect initial referral clinical diagnosis. The average delay to reach a correct diagnosis was 15 years. Ophthalmologists represented the largest referral base at 80%, followed by neurologists representing 5% of referrals. Pediatric and retinal specialists were the largest referral of ophthalmic subspecialties at 44% and 35%, respectively.

Conclusion:
A significant number of patients experienced a prolonged delay in reaching a correct diagnosis largely because of a delay in initiating the genetic evaluation and testing process. The initial suspected clinical diagnosis was incorrect in a significant number of cases, revealing that affected patients were potentially denied from appropriate recurrence risk counseling, relevant educational resources, specialty referrals in syndromic cases, and clinical trial eligibility in a timely manner.
Wellens syndrome during chemotherapy for cholangiocarcinoma: A case report of cardiovascular toxicity associated with gemcitabine-containing regimen
Authors: Liang Xufei , Geng Xuhong , Gong Xiaohong , Yin Xi , Chen Yongzhen 
Published: April 2023

Rationale:
Wellens syndrome is a comprehensive electrocardiographic (ECG) diagnosis that combines medical history with characteristic ECG changes. These changes, characterized by biphasic T-wave inversions or symmetric and deep T-wave inversions in the anterior precordial leads, often indicate that the left anterior descending coronary artery is at a high risk of severe stenosis. Chemotherapy-related cardiovascular toxicity refers to damage to the cardiovascular system caused by chemotherapeutic drugs, which is unpredictable and may occur during or after chemotherapy.

Patient concerns:
In this case report, a 41-year-old male patient with cholangiocarcinoma received sequential adjuvant chemotherapy with gemcitabine/nanoparticle albumin–bound paclitaxel and gemcitabine/cisplatin. This patient presented with recurrent brief chest pain episodes after the third dose of gemcitabine/cisplatin, and the characteristic T-wave morphological changes were captured in routine ECG monitoring prior to the 6th dose.

Diagnoses:
Acute coronary syndrome due to chemotherapy-related cardiovascular toxicity was diagnosed on the basis of characteristic ECG changes.

Interventions:
The patient underwent coronary angiography, which revealed diffuse stenosis of up to 95% in the middle segment of the left anterior descending coronary artery. Stents were implanted in the stenotic segment for vascular reconstruction.

Outcomes:
The patient’s chest pain was completely resolved, and electrocardiography returned to normal.

Lessons:
Cardiovascular toxicity during chemotherapy in patients with cancer may be life threatening. This rare case highlights the importance of identifying the characteristic ECG pattern of the Wellens syndrome by monitoring electrocardiography during chemotherapy. Immediate and accurate identification of the morphological ECG features of Wellens syndrome with a slight elevation of the ST-segment is related to patient prognosis.
MicroRNA profiling reveals effects of Erzhi Tiangui granules on kidney deficiency diminished ovarian reserve: A randomized trial
Authors: Liu Dan-Qi , Wei Chao-Feng , Zhang Xing , Xiang Shan , Lian Fang 
Published: April 2023

Background:
Diminished ovarian reserve (DOR) is a danger signal of reduced fertility. The clinical incidence is increasing yearly, exhibiting a gradual low-age trend. Traditional Chinese medicine theory suggests that kidney deficiency is the basic pathogenesis. Erzhi Tiangui granules (ETG), a kidney-tonifying prescription, have been clinically shown to improve ovarian reserve function. The purpose of this study was to investigate the microRNA (miRNA) markers of kidney deficiency DOR and the potential mechanism of ETG on in vitro fertilization outcomes in DOR patients.

Methods:
Experiment 1: Granulosa cells from 5 normal ovarian reserves and 5 kidney deficiency DOR patients were subjected to miRNA sequencing. Experiment 2: Eighty DOR patients were randomly divided into treatment and control groups (40 subjects each), then treated with ETG and placebo, respectively. granulosa cells were collected and subjected to quantitative polymerase chain reaction for analyzing the expression of specific miRNA found in experiment 1. We also compared fertilization rates, high-quality embryos, and clinical pregnancy rates between the 2 groups.

Results:
miRNA sequencing revealed differential expression of 81 miRNAs, of which 39 were downregulated, specially miR-214-3p and miR-193a-5p, whereas 42 were upregulated, specially let-7e-5p and miR-140-3p. In the second experiment, we found that miR-214-3p was significantly upregulated whereas let-7e-5p and miR-140-3p were significantly downregulated in the treatment group, relative to the control group (P < .05). Patients in the ETG treatment group exhibited a significantly higher fertilization rate than those in the control group (P < .05).

Conclusion:
ETG significantly increased fertilization rates in DOR patients with kidney deficiency syndrome and affected the expression of miR-214-3p, let-7e-5p, and miR-140-3p, the potential biomarkers.
Case report on intervention of sedative drug dependence with “simple and quick reconstruction method” in psychological crisis assistance
Authors: Liang Yi-qun , Yu Bao-dong 
Published: April 2023

Introduction:
In the past, the problem of sedation drug dependence has been reported in psychological counseling cases, but it is rare to use the rapid reconstruction method for psychological emergency intervention. This article reports the applying of rapid reconstruction method in the intervention of sedation drug dependence during psychological emergency in the context of the Corona Virus Disease-2019 public health events.

The main therapeutic interventions:
Firstly present the problem including presenting experiences related to psychological stress, troubles of events, core problems and self-assessment based on a score of 0 to 10, secondly transfer information including normalizing relevant reactions and providing useful knowledge, thirdly cope with strategies of seeking internal and external resources, reassessing and making improvement plans, at last improve the summary which includes reviewing the process to summarize gains, initiate actions and commit.

Outcomes:
The author discussed the current psychological crisis with the patient, scored the tense and anxious situation, normalized the response to the patient and passed on the knowledge about controlling Corona Virus Disease-2019 prevention and sedative drugs, helped him find the method to adjust himself and the social resources he confided to his friends during the similar period, scored again, put forward the plan, reviewed the conversation process and made a commitment to not use sedative drugs.

Conclusions:
Through the “simple and quick reconstruction method,” the patient was able to solve the problem of dependence on sedative drugs, relieve tension and anxiety, find resources, and keep living.
Accuracy of ultrasonographic fatty liver index using point-of-care ultrasound in stratifying non-alcoholic fatty liver disease patients
Authors: Sourianarayanane Achuthan , McCullough Arthur J 
Published: April 2023

Background
The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in the USA. Some of these patients develop non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis. Ultrasound imaging is one of the most used modalities for diagnosing hepatic steatosis. Primary care providers are increasingly using point-of-care ultrasound (POCUS), which could increase the number of subjects diagnosed with NAFLD. This study evaluates the accuracy of POCUS in identifying patients with NASH.

Methods
Patients with hepatic steatosis without excess alcohol intake or other liver diseases undergoing liver biopsy were included in this study. These patients underwent POCUS and vibration-controlled transient elastography (VCTE) evaluations within 3 months of a liver biopsy. A comparison of POCUS data with liver histology and VCTE were made to assess the validity of POCUS evaluation in diagnosing NAFLD and NASH.

Results
The steatosis score from the liver histology had a low correlation with the controlled attenuation parameter score from VCTE (r = 0.27) and a moderate correlation with the grade of steatosis detected by the POCUS exam (r = 0.57). The NAFLD activity score on histology was found to correlate with the ultrasonographic fatty liver index (USFLI) from the POCUS exam (r = 0.59). A USFLI ≥ 6 diagnosed NASH with a sensitivity of 81%, and a value of ≤3 ruled out the diagnosis of NASH with a sensitivity of 100%.

Conclusion
The provider can use the POCUS exam in clinical practice to diagnose NAFLD and reliably stratify patients who have NASH.
Outcome of pharmacological thromboprophylaxis in hospitalized patients with cirrhosis – a systematic review and meta-analysis
Authors: Giri Suprabhat , Singh Ankita , Varghese Jijo , Ingawale Sushrut , Roy Akash 
Published: April 2023

Background
Portal hypertension in cirrhosis brings about a complex interplay in the risks of bleeding and thrombosis. It is unclear whether hospitalized patients with cirrhosis need pharmacological prophylaxis for venous thromboembolism (VTE), as it may increase the risk of bleeding. We aimed to compare the outcome of hospitalized patients with cirrhosis with and without pharmacological thromboprophylaxis.

Methods
A comprehensive search of three databases was conducted from inception to August 2022 for studies comparing the outcome of hospitalized patients with cirrhosis with and without pharmacological prophylaxis for VTE. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for the outcomes of VTE or bleeding.

Results
Overall, 12 studies were included in the final analysis. The pooled incidence of VTE in patients with and without thromboprophylaxis was 1.9% (95% CI: 0.8–2.9) and 1.9% (95% CI: 0.9–2.9), respectively. The odds of VTE were comparable between the groups with OR 1.11 (95% CI: 0.76–1.62). The pooled incidence of bleeding events in patients with and without thromboprophylaxis was 6.7% (95% CI: 3.6–9.8) and 10.4% (95% CI: 6.6–14.1), respectively. There was no significant difference in the odds of overall bleeding (OR 0.68; 95% CI: 0.30–1.52) or major bleeding (OR 1.18; 95% CI: 0.55–2.56) between the groups. There was no significant difference in the relative effects on sensitivity analysis.

Conclusion
The present analysis could not demonstrate the benefit of pharmacological thromboprophylaxis in reducing in-hospital VTE in patients with cirrhosis. Future studies are required to assess the role of risk prediction models in hospitalized patients with cirrhosis.
Correlation between individual autoantibodies and clinical features in primary biliary cholangitis: results of a retrospective longitudinal study
Authors: Dias Beatriz , Aguiar Ana , Morais Cátia Iracema , Nery Filipe Gaio 
Published: April 2023

Background and aims
Primary biliary cholangitis (PBC) is an immune-mediated liver disease. The immunological profile seems to relate to clinical prognosis. This study aims to determine the role of autoantibodies in the course of liver disease and in the response to ursodeoxycholic acid.

Methods
Between January 2016 and December 2020, 143 patients with PBC who underwent immunological liver profile evaluation were enrolled. All data were extracted retrospectively from electronic clinical records. Chi-square test, Fisher’s exact test and Mann–Whitney test were used to evaluate the relationship between autoantibodies and biochemical parameters, clinical outcomes and therapeutic response scores. A significance level of 0.05 was used.

Results
Antimitochondrial antibodies were present in 91.6%, antiglycoprotein-210 antibody (anti-gp210) in 18.2% and anti-Sp100 in 19.6% of patients. The incidence of liver-related death was higher in patients with autoimmune hepatitis variants. The occurrence of cirrhosis or portal hypertension was not linked to the presence of any of the autoantibodies tested. No relationship was found with the probability of dying or being transplanted. Patients with anti-Sp100 antibodies had higher baseline levels of aspartate aminotransferase and alanine aminotransferase and lower immunoglobulin M levels. Patients with anti-gp210 were more likely to have a lower median transplant-free survival rate and higher median risk of liver transplant or liver-related death using the GLOBE and UK-PBC scores.

Conclusion
Our findings confirm a strong association between anti-gp210 antibodies and a worse outcome. The association between anti-Sp100 and hepatic lesions requires further elucidation.
Outpatient Treatment of Lyme Disease
Authors: Fuchs Susan 
Published: April 2023

Abstract
Lyme disease, also called Lyme borreliosis, is caused by the spirochete Borrelia burgdorferi sensu stricto (B burgdorferi) in the Upper Atlantic Coast and Borrelia mayonii in the Upper Midwest and West Coast. It can cause a range of manifestations including erythema migrans, cranial nerve palsies, meningitis, carditis, and arthritis. Recent guidelines advocate for outpatient treatment for many of these conditions. Scenarios will be presented that outline treatment of these manifestations.
Where Have All the Rhinoplasties Gone? A Call to Action for Academic Plastic Surgeons to Focus on Increasing Rhinoplasty Procedures Before It Is Too Late
Authors: Jordan Ashley , Tashmia Alexis , Wang Shengxuan , Cederna Paul S. , Kauffman Christian A. 
Published: April 2023

Background
The armamentarium of a plastic surgeon is vast, consisting of an array of surgical procedures from head to toe. Unfortunately, plastic surgeons have been losing portions of their operative domain to other surgical subspecialties for years. The number of subspecialties invading our niche is bothersome, but more concerning is the fact that losing the reins of these core procedures results in less surgical exposure and competency for plastic surgery residents.
Lately, in academic institutions, otolaryngologists seem to be performing most rhinoplasty procedures, resulting in fewer surgeries performed by plastic surgeons. Trainees must perform 10 rhinoplasties to fulfill graduation requirements but, more importantly, residents should graduate feeling competent and confident performing rhinoplasties. The aims of this study are to determine the number of rhinoplasties being performed at academic centers each year and to evaluate the trend with regard to which specialties are performing these procedures.

Methods
Three academic institutions with plastic surgery and otolaryngology residency programs searched medical records for rhinoplasty Current Procedural Terminology codes from January 1, 2009, to December 31, 2019. The total numbers of rhinoplasties performed each year, by each specialty, were tallied.

Results
Growth rate in rhinoplasty volume among participating institutions ranged from 27% to 149%. At these institutions, plastic surgeons performed less than one third of all rhinoplasties. In 2009, 10% of rhinoplasties were performed by plastic surgeons at institution 1, 22% at institution 2, and 18% at institution 3. In 2019, the volume of rhinoplasties performed by plastic surgeons was 5%, 12%, and 27%, respectively. The 3 ENT departments had statistically significant increasing trends in rhinoplasty volume. Institutions 1 and 2's plastic surgery departments showed that negative volume trends, however, were not statistically significant. Institution 3's plastic surgery department has had an increasing trend, which was statistically significant.

Conclusions
Otolaryngology is performing most rhinoplasties at several academic institutions. This is concerning for the education of plastic surgery trainees. Academic plastic surgeons must focus on increasing the number of rhinoplasties performed to adequately train residents this core procedure. If rhinoplasties are not made a priority now, this surgery may become a historic operation instead of a vital skill in plastic surgeons' armamentarium.