bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circulating cell-free messenger RNA secretome characterization of primary sclerosing cholangitis
Authors: Chalasani Naga , Vuppalanchi Raj , Lammert Craig , Gawrieh Samer , Braun Jerome V. , Zhuang Jiali , Ibarra Arkaitz , Ross David A. , Nerenberg Michael , Quake Stephen R. , Sninsky John J. , Toden Shusuke 
Published: May 2023

Background:
Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease characterized by multifocal bile duct strictures. To date, underlying molecular mechanisms of PSC remain unclear, and therapeutic options are limited.

Methods:
We performed cell-free messenger RNA (cf-mRNA) sequencing to characterize the circulating transcriptome of PSC and noninvasively investigate potentially bioactive signals that are associated with PSC. Serum cf-mRNA profiles were compared among 50 individuals with PSC, 20 healthy controls, and 235 individuals with NAFLD. Tissue and cell type-of-origin genes that are dysregulated in subjects with PSC were evaluated. Subsequently, diagnostic classifiers were developed using PSC dysregulated cf-mRNA genes.

Results:
Differential expression analysis of the cf-mRNA transcriptomes of PSC and healthy controls resulted in identification of 1407 dysregulated genes. Furthermore, differentially expressed genes between PSC and healthy controls or NAFLD shared common genes known to be involved in liver pathophysiology. In particular, genes from liver- and specific cell type-origin, including hepatocyte, HSCs, and KCs, were highly abundant in cf-mRNA of subjects with PSC. Gene cluster analysis revealed that liver-specific genes dysregulated in PSC form a distinct cluster, which corresponded to a subset of the PSC subject population. Finally, we developed a cf-mRNA diagnostic classifier using liver-specific genes that discriminated PSC from healthy control subjects using gene transcripts of liver origin.

Conclusions:
Blood-based whole-transcriptome cf-mRNA profiling revealed high abundance of liver-specific genes in sera of subjects with PSC, which may be used to diagnose patients with PSC. We identified several unique cf-mRNA profiles of subjects with PSC. These findings may also have utility for noninvasive molecular stratification of subjects with PSC for pharmacotherapy safety and response studies.
Impact of body composition in advanced hepatocellular carcinoma: A subanalysis of the SORAMIC trial
Authors: Surov Alexey , Thormann Maximilian , Hinnerichs Mattes , Seidensticker Max , Seidensticker Ricarda , Öcal Osman , Schütte Kerstin , Zech Christoph J. , Loewe Christian , van Delden Otto , Vandecaveye Vincent , Verslype Chris , Gebauer Bernhard , Sengel Christian , Bargellini Irene , Iezzi Roberto , Berg Thomas , Klümpen Heinz J. , Benckert Julia , Gasbarrini Antonio , Amthauer Holger , Sangro Bruno , Malfertheiner Peter , Omari Jazan , Wienke Andreas , Ricke Jens , Pech Maciej 
Published: May 2023

Background:
Body composition parameters have been reported to be prognostic factors in patients with oncologic diseases. However, the available data on patients with HCC are conflicting. The aim of this study was to assess the impact of body composition on survival in patients with HCC treated with sorafenib or selective internal radioembolization (SIRT) and sorafenib.

Methods:
This is an exploratory subanalysis of the prospective, randomized controlled SORAMIC trial. Within the palliative arm of the study, patients were selected if a baseline abdominal CT was available. A broad set of skeletal muscle and adipose tissue parameters were measured at the L3 level. Low skeletal muscle mass (LSMM) and density parameters were defined using published cutoffs. The parameters were correlated with overall survival.

Results:
Of 424 patients in the palliative study arm, 369 patients were included in the analysis. There were 192 patients in the combined sorafenib/SIRT and 177 patients in the sorafenib group. Median overall survival was 9.9 months for the entire cohort and 10.8 and 9.2 months for the SIRT/sorafenib and sorafenib groups, respectively. There was no relevant association of either body composition parameter with overall survival in either the overall cohort or in the SIRT/sorafenib or sorafenib subgroups.

Conclusions:
This subanalysis of the prospective SORAMIC trial does not suggest a relevant influence of body composition parameters of survival in patients with advanced HCC. Body composition parameters therefore do not serve in patient allocation in this palliative treatment cohort.
Home-Based Cardiac Rehabilitation Among Patients Unwilling to Participate in Hospital-Based Programs
Authors: Nabutovsky Irene , Breitner Daniel , Heller Alexis , Levine Yoav , Moreno Merav , Scheinowitz Mickey , Levin Chedva , Klempfner Robert 
Published: May 2023

Purpose:
Asynchronous home-based cardiac rehabilitation (HBCR) is a viable alternative to center-based cardiac rehabilitation (CBCR). However, to achieve significant functional improvement, a high level of adherence and activity must be achieved. The effectiveness of HBCR among patients who actively avoid CBCR has not been effectively investigated. This study aimed to investigate the effectiveness of the HBCR program among patients unwilling to participate in CBCR.

Methods:
A randomized prospective study enrolled 45 participants to a 6-mo HBCR program and the remaining 24 were allocated to regular care. Both groups were digitally monitored for physical activity (PA) and self-reported outcomes. Change in peak oxygen uptake (VO2peak), the primary study outcome, was measured by the cardiopulmonary exercise test, immediately before program start and 4 mo thereafter.

Results:
The study included 69 patients, 81% men, aged 55.9 ±12 yr, enrolled in a 6-mo HBCR program to follow a myocardial infarction (25.4%) or coronary interventions (41.3%), heart failure hospitalization (29%), or heart transplantation (10%). Weekly aerobic exercise totaled a median of 193.2 (110.2-251.5) min (129% of set exercise goal), of which 112 (70-150) min was in the heart rate zone recommended by the exercise physiologist.
After 4 mo, VO2peak improved by 10.2% in the intervention group versus −2.7% in the control group (+2.46 ± 2.67 vs −0.72 ± 3.02 mL/kg/min; P < .001).

Conclusion:
The monthly PA of patients in the HBCR versus conventional CBCR group were well within guideline recommendations, showing a significant improvement in cardiorespiratory fitness. Risk level, age, and lack of motivation at the beginning of the program did not prevent achieving goals and maintaining adherence.
Effects of Lifestyle Modification on Psychosocial Function in Patients With Resistant Hypertension
Authors: Blumenthal James A. , Smith Patrick J. , Mabe Stephanie , Hinderliter Alan , Craighead Linda , Watkins Lana L. , Ingle Krista , Tyson Crystal C. , Lin Pao-Hwa , Kraus William E. , Liao Lawrence , Sherwood Andrew 
Published: May 2023

Purpose:
In a secondary analysis of the TRIUMPH clinical trial, psychological outcomes in patients with resistant hypertension (RH) receiving a diet and exercise intervention delivered in a cardiac rehabilitation setting were compared with those receiving a similar prescription of diet and exercise provided in a single counseling session by a health educator.

Methods:
One hundred forty patients with RH were randomly assigned to a 4-mo program of dietary counseling, behavioral weight management, and exercise (C-LIFE) or a single counseling session providing standardized education and physician advice (SEPA). Participants completed a battery of questionnaires to assess psychological functioning before and after the intervention. A global measure of psychological functioning was derived from the General Health Questionnaire (GHQ), Perceived Stress Scale (PSS), Medical Outcomes Study 36-item Short Form Health Survey, Spielberger State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory-II, and Patient-Reported Outcomes Measurement Information System (PROMIS) Anger scale.

Results:
Participants in the C-LIFE intervention achieved greater improvements in psychological functioning compared with SEPA (C-LIFE: 58.9 [56.1, 61.8] vs SEPA: 66.5 [62.1, 70.9]; P = .024). Greater improvements were especially evident for the GHQ, PSS, and HADS. Examination of mediation revealed that greater weight loss (B =−0.17, P = .004) and improved oxygen uptake (B =−0.12, P = .044) were associated with improved psychological functioning.

Conclusion:
Compared with standard education and physician advice, a structured program of diet and exercise not only reduced blood pressure but also improved psychological functioning in patients with RH.
Deep Morphea in an Immunosuppressed Patient With Anti-U1RNP Myositis: A Case Report
Authors: Berjawi Ahmad , Irani Laure L. , El Khoury Jinane R. 
Published: May 2023

Introduction:
Morphea is an inflammatory skin disease characterized by skin thickening due to increased collagen deposition in the dermis or subcutaneous tissues. Anti-U1RNP myositis is a newly described entity characterized by myositis, arthritis, interstitial lung disease, and Raynaud phenomenon.
We present a case of a unique combination of deep morphea in a patient with anti-U1RNP myositis.

Case presentation:
A 64-year-old male with 5-year history of proximal muscle weakness, polyarthritis, Raynaud phenomenon, and dyspnea on multiple immunosuppressives presented with localized infiltrated, tight, and hyperpigmented plaques over the posterior thighs and mid-to-lower back developing over the last 2 years and limiting his movement. Autoimmune workup revealed a positive ANA, anti-U1RNP antibody, anti-Jo1 antibody, and anti-Ro52 antibody. Further workup showed restrictive lung disease, kidney disease, and arthritis. Patient was diagnosed with anti-U1RNP myositis. Skin biopsy of the back lesion showed deep morphea.

Discussion:
Association of deep morphea with anti-U1RNP myositis is not described prior in the literature. Treatment of morphea is challenging since the patient is already on immunosuppressive medications. The patient failed methotrexate prior and is currently on Mycophenolate mofetil and Deflazacort which are reported as potential treatment for morphea. Therefore, physical therapy plus topical Tacrolimus were suggested as an initial measure to preserve the range of motion of his posterior thighs and back. This is a case of progressive deep morphea developing in a patient with a unique autoimmune profile on immunosuppressive drugs.

Conclusion:
Anti-U1RNP myositis is a challenging diagnosis and should be always thought of in patients with positive anti-U1RNP, myositis, interstitial lung disease, arthritis, kidney disease, and Raynaud phenomenon. Moreover, deep morphea treatment in immunosuppressed patients is challenging and different measures should be considered.
The use of multiple daily injections versus insulin pump therapy for HgbA1c reduction in patients with insulin-dependent type 2 diabetes
Authors: Stallings Dana E. , Higgins Karen J. 
Published: May 2023

ABSTRACT

Background:
More than 35 million Americans live with type 2 diabetes (T2D), resulting in the need for newer strategies and technologies to manage the disease. Insulin pump therapy (IPT) has historically been reserved for type 1 diabetes, although emerging data demonstrates improved glucose outcomes for patients with T2D using IPT.

Purpose:
To measure the change in HgbA1c in patients with T2D after changing therapy from multiple daily injections (MDI) to continuous subcutaneous insulin infusion through IPT.

Methodology:
A retrospective comparison study was conducted by reviewing the electronic medical record of patients with T2D, older than 18 years, who had been on multiple daily insulin injections for at least 1 year, followed by IPT for at least 1 year.

Results:
One hundred seventy-one patients met the inclusion criteria. There was a statistically significant reduction in mean HgbA1c from 9.6% to 7.6%.

Conclusion:
Insulin pump therapy may result in lower HgbA1c levels for T2D not at goal on MDI.

Implications:
Patients on multiple daily insulin injections who are not at goal should be considered for IPT.
HLA-DQ antibodies in alloimmunity, what makes them different?
Authors: Meneghini Maria , Tambur Anat R. 
Published: May 2023

Purpose of review
De novo HLA-DQ antibodies are the most frequently observed after solid-organ allotransplantation; and are associated with the worse adverse graft outcomes compared with all other HLA antibodies. However, the biological explanation for this observation is not yet known. Herein, we examine unique characteristics of alloimmunity directed specifically against HLA-DQ molecules.

Recent findings
While investigators attempted to decipher functional properties of HLA class II antigens that may explain their immunogenicity and pathogenicity, most early studies focused on the more expressed molecule – HLA-DR. We here summarize up-to-date literature documenting specific features of HLA-DQ, as compared to other class II HLA antigens. Structural and cell-surface expression differences have been noted on various cell types. Some evidence suggests variations in antigen-presenting function and intracellular activation pathways after antigen/antibody interaction.

Summary
The clinical effects of donor-recipient incompatibility at HLA-DQ, the risk of generating de novo antibodies leading to rejection, and the inferior graft outcomes indicate increased immunogenicity and pathogenicity that is unique to this HLA antigen. Clearly, knowledge generated for HLA-DR cannot be applied interchangeably. Deeper understanding of features unique to HLA-DQ may support the generation of targeted preventive-therapeutic strategies and ultimately improve solid-organ transplant outcomes.
Visiting Policies and Parental Presence During PICU Admission: A Survey in French Units
Authors: Bergerat Manon , De Saint Blanquat Laure , Milesi Christophe , Grimaud Marion , Le Bourgeois Fleur , Renolleau Sylvain , Pouletty Marie , Oualha Mehdi , Leteurtre Stéphane , Recher Morgan , Béranger Agathe 
Published: May 2023

OBJECTIVES:
To describe the policies about parent visiting and involvement in care during admission to French PICUs.

DESIGN:
A structured questionnaire was emailed to the chief of each of 35 French PICUs. Data about visiting policies, involvement in care, evolution of policies, and general characteristics were collected from April 2021 to May 2021. A descriptive analysis was conducted.

SETTING:
Thirty-five PICUs in France.

PATIENTS:
None.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Twenty-nine of 35 (83%) PICUs replied. Twenty-four-hour access for parents was reported for all PICUs responding. Other allowed visitors were grandparents (21/29, 72%) and siblings (19/29, 66%) with professional support. Simultaneous visits were restricted to two visitors in 83% (24/29) of PICUs. Family presence was always permitted during medical rounds for 20 of 29 (69%) PICUs. Most of the units rarely or never allowed parental presence during the most invasive procedures, such as central venous catheter placement (18/29, 62%) and intubation (22/29, 76%).

CONCLUSIONS:
Unrestricted access to the PICU, for both parents, was available in all responding French units. There were, however, restrictions on the number of visitors and the presence of other family members at the bedside. Moreover, permission for parental presence during care procedures was heterogenous, and mainly restricted. National guidelines and educational programs are needed to support family wishes and promote acceptance by healthcare providers in French PICUs.
Point-of-Care Ultrasound, an Unexpected Cardiac Mass in a Neonate
Authors: Barbera Nicole L. , Ekpenyong Atim , Nguyen Mylinh T. , Pade Kathryn H. 
Published: May 2023

Abstract
Neonatal cardiac masses are uncommon and often not obvious based on physical examination or plain radiography. The objective of this clinical case report is to demonstrate how cardiac point-of-care ultrasound was pivotal in the clinical course of a seemingly well neonate with vague symptoms. A 6-week-old male infant presented to the emergency department with fatigue and pallor that was reported to have resolved before arrival. In the emergency department, he had a normal physical examination and stable vital signs. Cardiac point-of-care ultrasound was performed and demonstrated a mass near the mitral valve. These ultrasound findings prompted additional evaluation, cardiology consultation, admission, and subsequent diagnosis of a rhabdomyoma due to tuberous sclerosis.
Scarless Donor Site for Breast Reconstruction by Endoscopically Assisted Extended Latissimus Dorsi Flap plus Lipofilling
Authors: Akita Shinsuke , Tokumoto Hideki , Yamaji Yoshihisa , Kosaka Kentaro , Arai Minami , Ando Nobuhiro , Maei Haruka , Kubota Yoshitaka , Fujimoto Hiroshi , Mitsukawa Nobuyuki 
Published: May 2023

Background:
Breast reconstruction using endoscopically assisted latissimus dorsi (LD) flap leaves no scar on the back; however, the small amount of tissue obtained makes this procedure less practical. This study aimed to propose a new technique of endoscopically assisted extended LD (eeLD) flap plus lipofilling, which could secure a large breast volume.

Methods:
Lateral thoracic adipose tissues supplied by the thoracodorsal artery branches and the LD muscle were elevated as a single unit only through the mastectomy scar and three ports through the lateral chest. Furthermore, fat was simultaneously injected to support the volume and shape of the breast. Changes in the volume of the reconstructed breast over time were measured using three-dimensional stereophotogrammetry.

Results:
Overall, 15 breasts of 14 patients who underwent breast reconstruction using an eeLD flap exhibited no serious complications. On average, 281.9 ± 32.4 g of flap and 74.7 ± 19.4 mL of lipofilling were used. Within 8 weeks after the procedure, the volume of the reconstructed breast decreased to 69.5 ± 7.5% and then plateaued. Seven patients needed a subsequent session of lipofilling to acquire adequate breast volume and projection. Notably, according to the BREAST-Q back scores, patients who underwent eeLD flap surgery were significantly more satisfied than those who underwent conventional LD musculocutaneous flap surgery using a skin paddle on the back at the same institution (82.8 ± 9.2 versus 62.6 ± 6.3; P < 0.0001).

Conclusion:
Despite the limitations in volume, eeLD flap plus lipofilling is advantageous because it does not leave a noticeable donor-site scar.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Effect of Calf Subcutaneous Fat Thickness on Patient Satisfaction after Calf Contouring with Botulinum Toxin A
Authors: Xu Xiangwen , Liu Dandan , Wu Mengfan , Luo Lin , Feng Jun , Ou Yanting , Kang Yixing , Panayi Adriana C. , Long Yun , Cui Yongyan 
Published: May 2023

Background:
As a minimally invasive therapy, botulinum toxin A (BTXA) treatment effectively reduces the hypertrophy of the gastrocnemius muscle (GM). Patient satisfaction is, however, reported to be low after treatment, with a possible correlation between high satisfaction and thinner subcutaneous fat. The goal of this study was to classify the subcutaneous fat of calves to understand the relation between fat thickness and patient satisfaction after BTXA treatment.

Methods:
The maximal leg circumference was measured, and B-mode ultrasound was used to measure the thickness of the medial head of the GM and of the subcutaneous fat. Patients were followed up at 1 and 6 months after BTXA treatment.

Results:
A total of 50 cases were classified into the following levels of fat thickness: slim (<0.55 cm), moderate (0.55 to 0.85 cm), and bulge (>0.85 cm). All patients were treated with 300 units of BTXA. Patients in the slim and bulge groups reported higher satisfaction rate than patients in the moderate group, with patients in the slim and bulge groups reporting complete satisfaction (100%) with calf contour at the 6-month follow-up. The satisfaction rate with the improvement in total leg circumference was low in all 3 groups. No severe complications were encountered in this study.

Conclusions:
This study identified a U-shaped correlation between calf subcutaneous fat thickness and patient satisfaction rate after treatment. The authors’ results provide a theoretical basis for BTXA treatment and suggest the importance of preprocedure conversations in GM hypertrophy treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Refinements in the Preexpanded Distant Flap for Giant Melanocytic Nevi of the Upper Extremity in Pediatric Patients
Authors: Kim Ji-Young , Choi Tae Hyun , Kim Byung Jun 
Published: May 2023

Background:
Surgical treatment of large and giant congenital melanocytic nevi (GCMN) of the upper extremity is challenging because of limited options for reconstruction. A preexpanded distant flap is considered an important option in upper extremity reconstruction, where the soft tissue available for use is limited. The authors aimed to refine the preexpanded distant flap after excision of the GCMN in the upper extremity.

Methods:
Large (>10 cm) and giant (>20 cm) congenital melanocytic nevi of the upper extremities treated with tissue expansion and distant flaps over 10 years were retrospectively reviewed, and the authors describe in detail the surgical strategies for reconstruction of the upper extremity with a distant flap.

Results:
From March of 2010 to February of 2020, 13 patients (mean age, 2.87 years) treated with 17 preextended distant flaps were included. The mean flap dimension was 154.87 cm2, ranging from 15 × 5 to 26.5 × 11 cm. All procedures were successfully completed except for one, in which partial flap necrosis occurred. Preconditioning was performed before flap transfer in 5 patients with larger rotation arcs and flap dimensions. The mean duration of postoperative follow-up was 51.85 months. A new reconstructive protocol was proposed that combined the 3 elements, including a distant flap, tissue expander, and preconditioning.

Conclusions:
In the treatment of GCMN in the upper extremities, careful planning and multiple stages are required. For pediatric patients, the preextended distant flap with preconditioning is useful and effective for reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.