bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bile acid diarrhea – as bad as it gets?
Authors: BouSaba Joelle , Camilleri Michael 
Published: May 2023

Purpose of review
Bile acid diarrhea (BAD) is a common but under-recognized gastrointestinal condition that manifests with increased stool frequency and urgency, and a looser stool consistency. The aim of this review is to present recent advances in the pathophysiology, mechanisms, manifestations, diagnosis, and treatment of BAD.

Recent findings
Patients with BAD have evidence of accelerated colonic transit, increased gut mucosal permeability, altered stool microbiome composition, and decreased quality of life. Single, random stool measurements of bile acids, alone or in combination with fasting serum 7-alpha-hydroxy-4-cholesten-3-one, have shown good sensitivity and specificity for the diagnosis of BAD. Novel therapeutic approaches include farnesoid X receptor agonists and glucagon-like peptide 1 agonists.

Summary
Recent research has led to a better understanding of the pathophysiology and mechanisms of BAD, which might pave the way towards more targeted treatment strategies for BAD. Newer, more affordable, and easier diagnostic methods facilitate the diagnosis of BAD.
Retention of small bowel capsule endoscopy
Authors: Rosa Bruno , Dray Xavier , Koulaouzidis Anastasios 
Published: May 2023

Purpose of review
Capsule endoscopy is widely recognized as a safe and effective procedure to evaluate the small bowel and/or the colon noninvasively. Although infrequent, capsule retention is the most feared adverse event related to this technique. A better knowledge of risk factors, improvement of patients’ selection and precapsule patency assessment may further contribute to reducing the incidence of capsule retention, even in patients at increased risk for this complication.

Recent findings
This review addresses the main risk factors for capsule retention, strategies for risk reduction such as patients’ selection, dedicated cross-sectional imaging and rational use of the patency capsule, as well as management options and outcomes in the case of capsule retention.

Summary
Capsule retention is infrequent, and it is usually manageable conservatively with favorable clinical outcomes. Patency capsules and dedicated small-bowel cross-sectional techniques such as CT or MR enterography should be used selectively and are both effective in decreasing the rate of capsule retention. However, none of them can completely eliminate the risk of retention.
The evaluation of liver abnormalities in inflammatory bowel disease patients
Authors: McHenry Scott 
Published: May 2023

Purpose of Review
Develop a clinical presentation-based approach for common liver abnormalities encountered by providers caring for patients with inflammatory bowel disease (IBD). Develop a treatment pathway for those with nonalcoholic fatty liver disease (NAFLD) arising in IBD. Discuss recent studies of prevalence, incidence, risk factors, and prognosis NAFLD in the IBD population.

Recent Findings
The work-up for liver abnormalities should be approached systematically in IBD patients, similar to the general population, while still appreciating the differing prevalence of underlying liver diagnoses. Although immune mediated liver diseases occur commonly in patients with IBD, NAFLD is still the most common liver disease in patients with IBD paralleling its expanding prevalence in the general population. IBD is also an independent risk factor for NAFLD, developing in many patients with lower degrees of adiposity. Furthermore, the more severe histologic subtype, nonalcoholic steatohepatitis, is both more common and difficult to treat considering the lower effectiveness of weight loss interventions.

Summary
Having a standard approach to the most common liver disease presentations and care pathway for NAFLD will improve the quality of care provided and ease the medical decision making complexity for IBD patients. The early identification of these patients should prevent the development of irreversible complications like cirrhosis or hepatocellular carcinoma.
Assessing incidence and risk factors of laparoscopic cholecystectomy complications in Jeddah: a retrospective study
Authors: AlKhalifah Zainab , Alzahrani Amal , Abdu Shahad , Kabbarah Ammar , Kamal Omar , Althoubaity Fatma 
Published: May 2023

Context:
Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. However, it is associated with several complications. No previous studies have investigated LC complications and their associated risk factors in the western region of Saudi Arabia.

Aims:
We aimed to identify the risk factors for postoperative complications (POCs) of LC at a tertiary institute in Jeddah, Western Saudi Arabia.

Settings and design:
This retrospective study was conducted between June 2021 and August 2021 among patients who underwent LC at a tertiary centre in Jeddah, Saudi Arabia.

Materials and methods:
Records of 596 patients were reviewed, and 510 patients were included in the final analysis after applying the exclusion criteria. Data were collected from hospital medical records. χ
2 tests and independent t tests were used to analyse categorical and continuous variables, respectively. The Mann–Whitney U test was used for nonparametric data. Multivariate regression analysis was used to adjust the P values to determine the most strongly and independently associated risk factors.

Results:
Our data showed that the overall incidence of intraoperative complications (IOCs) was 10.8%. The most common complications were gallbladder perforation (n=28, 5.5%), bile leakage (n=25, 4.9%), and bleeding (n=15, 2.9%). POCs occurred in 11% of the patients; the majority complained of abdominal pain (n=36, 6.9%), had elevated liver function tests (n=14, 2.7%), and retained stones (n=11, 2.2%). Acute cholecystitis, overweight, diabetes, and male sex were significant predictors of IOC, POC, and conversion to open cholecystectomy (P<0.05).

Conclusions:
LC complications have a multifactorial aetiology. Patient awareness of all possible IOCs is fundamental. The improved skill and experience of the surgical team can mitigate serious complications.
Ultrasound vs. clinical diagnosis—which is better in diagnosing acute appendicitis?: a cohort study
Authors: Kam Cheuk Tung , Alsahaf Mahdi , Chongbang Kul , Taki Mona , Yusob Jamal , Alexander Santhosh , Rait Jaideep 
Published: May 2023

Background:
Acute appendicitis is one of the most common causes of right iliac fossa pain which often warrants surgical management. In many cases, abdominal ultrasonography (USS) is done to confirm the diagnosis however negative appendicectomy is common due to atypical presentations and different visualisation rate. The unnecessary operative intervention can result in complications. The aim of this study was to compare the efficacy between clinical diagnosis and USS in diagnosing acute appendicitis to avoid negative appendicectomy and prevent further complications.

Method:
A retrospective cohort study was conducted in a district general hospital which 1046 cases of laparoscopic appendicectomy were included and examined for the use of USS or clinical diagnosis. The sensitivity, specificity, negative and positive predictive value in USS and data in clinical evaluation were analysed for their accuracy in the diagnosis of acute appendicitis based on the histology results post appendicectomy.

Results:
Clinical diagnosis without preoperative imaging was found to have a significantly lower negative appendicectomy rate of 27.20% compared with 42.67% in those who underwent ultrasound. 44.64% of the patients were misdiagnosed with a normal USS result who had a subsequent positive histology of appendicitis.

Conclusions:
USS has been shown to be less sensitive for diagnosing acute appendicitis which results in high negative appendicectomy and misdiagnosis rate. With an increasing burden of health budget and resources, cautious and appropriate use of USS would avoid the misdiagnosis and prevent further complications. Thorough clinical evaluation remains an important first step and role in the diagnosis of acute appendicitis.
Intraosseous angiolipoma of the humerus: a second case report
Authors: Khana Firas K. , Khabbak Sina , Shaikh Torab Sana , Arslan Mohammed W. , Mouhandes Mohamed I.E. 
Published: May 2023

Introduction and Importance:
To document a case of an intraosseous angiolipoma (IOAL) of the humerus.

Case presentation:
A 52-year-old woman presented with gradually increasing pain in her right arm. A X-ray series of the right elbow and computed tomography revealed a nonexpanding radiolucent lesion in the distal end of the right humerus. The fatty nature of the lesion was further verified using fat-suppression techniques on magnetic resonance imaging sequences.

Clinical discussion:
The tumor was surgically excised, and the patient has experienced no symptoms for 2 years now. Histopathological findings confirmed the presence of an IOAL, which is an extremely rare intraosseous tumor that consists of thin blood vessels and mature adipose tissue.

Conclusion:
Accurate diagnosis of an IOAL is challenging; therefore, careful planning and assessment are paramount in the management of such lesions, with histological findings being essential for a conclusive diagnosis and surgery is the most suitable treatment choice in most cases.
Utility of neutrophil to lymphocyte ratio to predict acute respiratory distress syndrome in COVID-19: short communication
Authors: Bano Mehdi Kulsoom , Jehan Shahzeeba , Akhter Madiha , Angez Meher , Nasir Nosheen 
Published: May 2023

Background:
Acute respiratory distress syndrome (ARDS) is the most severe and devastating form of acute lung injury. Neutrophil to lymphocyte ratio (NLR) and C-reactive protein have been used to predict severity and prognosis of certain viral illnesses.

Methods:
A retrospective cohort study was conducted in hospitalized COVID-19 patients. Serial measurements of NLR and C-reactive protein were recorded and patients were followed for development of ARDS.

Results:
Out of 388 patients admitted with COVID-19, 43 patients developed ARDS compared with 345 patients who did not develop ARDS. The median NLR at presentation was significantly higher in patients who developed ARDS (8.89 vs. 4.25) compared with those who did not develop ARDS (P<0.001). Moreover, serial measurement of NLR at presentation, day 3, day 5 and day 7 was significantly associated with development of ARDS (P<0.001). In multivariable analysis, age of greater than or equal to 50 years (adsjusted odds ratio=3.28; 95% CI=1.40–7.69) and unit increase in NLR at presentation (adsjusted odds ratio=1.07; 95% CI=1.03–1.11) were independently associated with development of ARDS.

Conclusion:
Serial measurement of NLR can predict patients who are at a greater risk for developing ARDS in COVID-19.
Degree of kidney injury due to artificial pelvic-ureteric junction obstruction with level of neutrophil gelatinase-associated lipocalin, interleukin 18, and histopathological descriptions in Wistar: experimental research
Authors: Sigumonrong Yacobda Hamonangan , Dharmajaya Ridha , Warli Syah Mirsya , Eyanoer Putri Chairani , Wahyudi Irfan , Sembiring Rosita Juwita , Alferraly Tengku Ibnu , Rusda Muhammad 
Published: May 2023

Background:
Pelvic-ureteric junction obstruction (PUJO) is considered the most common pathology for hydronephrosis in neonates. Full recovery of kidney impairment due to PUJO is possible, especially when pyeloplasty is indicated as surgery is mostly conducted when deterioration is identified, early detection should be considered to prevent further complications. Commonly used kidney damage biomarkers are not sensitive enough to predict kidney damage. Neutrophil gelatinase-associated lipocalin (NGAL) and urinary interleukin 18 (IL-18) are markers of early kidney damage with different characteristics. This study aimed to evaluate the relationship between these two markers with the degree of histopathological kidney damage in Wistar rats induced by PUJO.

Methods:
A total of thirty male Wistar rats, 200–250 g, were divided into three groups: (1) control, (2) sham, (3) PUJO (4th, 7th, 14th, and 21st days). Urine NGAL, IL-18 levels, and renal histopathology were observed on day 0, 4, 7, 14, and 21. Statistical analysis was performed using the Kruskal–Wallis and Mann–Whitney test with P less than 0.05 considered significant.

Results:
There was no significant difference in urine NGAL levels between groups, while IL-18 levels were significantly different based on the Kruskal–Wallis test (P 0.031). The results of the Mann–Whitney test showed a significant difference in IL-18 levels between the control group and the PUJO group on day 4 (P=0.028); the Sham surgery group with the PUJO group on day 4 (P=0.014); the PUJO group on day 4 with the PUJO group on the 7th day (P=0.008); and the PUJO group on the 7th day with the PUJO group on the 14th day (P=0.033).

Conclusion:
Urinary IL-18 levels can be used as a predictor of kidney damage in acute-subacute PUJO cases.
67Ga-PSMA I&T for Radioguided Surgery of Lymph Node Metastases in Patients With Biochemical Recurrence of Prostate Cancer
Authors: Winkens Thomas , Berger Frank Peter , Foller Susan , Greiser Julia , Groeber Sebastian , Grimm Marc-Oliver , Freesmeyer Martin , Kuehnel Christian 
Published: May 2023

Purpose
Radioguided lymph node dissection in patients with prostate cancer, and suffering from biochemical recurrence has been described thoroughly during the past few years. Several prostate-specific membrane antigen (PSMA)–directed ligands labeled with 111In, 99mTc, and 68Ga have been published; however, limitations regarding availability, short half-life, high costs, and unfavorable high energy might restrict frequent use. This study aims at introducing 67Ga as a promising radionuclide for radioguided surgery.

Methods
Retrospective analysis was performed on 6 patients with 7 PSMA-positive lymph node metastases. 67Ga-PSMA I&T (imaging and therapy) was synthesized in-house and intravenously applied according to §13 2b of the German Medicinal Products Act. Radioguided surgery was performed 24 hours after injection of 67Ga-PSMA I&T using a gamma probe. Patient urine samples were collected. Occupational and waste dosimetry was performed to describe hazards arising from radiation.

Results

67Ga-PSMA application was tolerated without adverse effects. Five of 7 lymph nodes were detected on 22-hour SPECT/CT in 4 of 6 patients. During surgery, all 7 lymph node metastases were identified by positive gamma probe signal. Relevant accumulation of 67Ga was observed in lymph node metastases (32.1 ± 15.1 kBq). Histology analysis of near-field lymph node dissection revealed more lymph node metastases than PET/CT (and gamma probe measurements) identified. Waste produced during inpatient stay required decay time of up to 11 days before reaching exemption limits according to German regulations.

Conclusions
Radioguided surgery using 67Ga-PSMA I&T is a safe and feasible option for patients suffering from biochemical recurrence of prostate cancer. 67Ga-PSMA I&T was successfully synthesized according to Good Manufacturing Practice guidelines. Radioguided surgery with 67Ga-PSMA I&T does not lead to relevant radiation burden to urology surgeons and represents a novel interdisciplinary approach in nuclear medicine and urology.
Stem Cell–Enriched Fat Grafts Versus Autologous Fat Grafts for Facial Reconstruction
Authors: Karam Mohammad , Abul Ahmad , Wood Benjamin , Kahlar Narvair , Naik Anish , Tay Jing , Rahman Shafiq , Matteucci Paolo 
Published: May 2023

Objective
The aim of the study is to compare the outcomes of stem cell-enrichment fat grafting versus routine fat grafting for facial reconstruction purposes.

Methods
A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines and a search of electronic information was conducted to identify all randomized controlled trials, case control studies, and cohort studies comparing the outcomes of stem cell enrichment fat grafting versus routine fat grafting for facial reconstruction purposes. Volume retention and infection rate were primary outcome measures. Secondary outcome measures included patient satisfaction postsurgery, redness and swelling, fat necrosis, cysts, as well as operation time. Fixed and random effects modeling was used for the analysis.

Results
Eight studies enrolling 275 subjects were selected. There was a significant difference between the stem cell enrichment fat grafting and routine grafting groups in terms of mean volume retention (standardized mean difference, 2.49; P < 0.00001). However, there was no significant difference between the 2 groups in the rate of infection (odds ratio, 0.36; P = 0.30). For all secondary outcomes, the intervention group had similar results compared with the control group except for the operation time, which was shorter in the latter.

Conclusions
Stem cell–enriched fat grafting is a superior option when compared with the routine fat grafting for facial reconstruction surgery because it improves the mean volume retention and does not worsen patient satisfaction and surgical complications.
Single-Use Negative Pressure Wound Therapy Applied on Various Wound Types
Authors: Amin Neha , Homsombath Bounthavy , Rumbaugh John , Craft-Coffman Beretta , Fagan Shawn P. , Chowdhry Tayseer , Wilson Joan , Paglinawan Rey , Lussi Karin , Hassan Zaheed 
Published: May 2023

PURPOSE:
The purpose of this study was to determine whether a single-use negative pressure wound therapy (NPWT) system achieves individualized goals of therapy when used to treat patients with a variety of wound types.

DESIGN:
Multiple case series.

SUBJECTS AND SETTING:
The same comprised 25 participants; their mean age was 51.2 years (SD: 18.2; range: 19-79 years); 14 were male (56%) and 11 were female (44%). Seven study participants withdrew from study participation. Wound etiologies vary; 4 had diabetic foot ulcers; 1 had a full-thickness pressure injury; 7 were treated for management of an abscess or cyst; 4 had necrotizing fasciitis, 5 had nonhealing postsurgical wounds, and 4 had wounds of other etiologies. Data were collected at 2 ambulatory wound care clinics located in the Southeastern United States (Augusta and Austell, Georgia).

METHODS:
A single-outcome measure was selected for each participant by his or her attending physician at a baseline visit. Selected end points were (1) decrease in wound volume, (2) decrease in size of the tunneling area, (3) decrease in size of the undermining, (4) decrease in the amount of slough, (5) increase in granulation tissue formation, (6) decrease in periwound swelling, and (7) wound bed progression toward transition to another treatment modality (such as standard dressing, surgical closure, flap, or graft). Progress toward the individualized goal was monitored until the goal was achieved (study end point) or a maximum of 4 weeks following initiation of treatment.

RESULTS:
The most common primary treatment goal was to achieve a decrease in wound volume (22 of 25 study participants), and the goal to increase granulation tissue was chosen for the remaining 3 study participants. A majority of participants (18 of 23, 78.3%) reached their individualized treatment outcome. The remaining 5 participants (21.7%) were withdrawn during the study (for reasons not related to the therapy). The median (interquartile range [IQR]) duration of NPWT therapy was 19 days (IQR: 14-21 days). Between baseline and the final assessment, median reductions in wound area and volume were 42.7% (IQR: 25.7-71.5) and 87.5% (IQR: 30.7-94.6).

CONCLUSIONS:
The single-use NPWT system achieved multiple individualized treatment objectives in a variety of wound types. Individually selected goals of therapy were met by all study participants who completed the study.
Hospital-Acquired Pressure Injuries in Adults With Prone Positioning Using Manual Method Versus Specialty Bed
Authors: DeMellow Jacqueline M. , Dhillon Harbir , Bhattacharyya Mouchumi , Pacitto Daniel , Kozik Teri M. 
Published: May 2023

PURPOSE:
The purpose of this study was to compare the incidence of hospital-acquired pressure injuries (HAPIs) in patients with acute respiratory distress syndrome (ARDS) and placed in a prone position manually or using a specialty bed designed to facilitate prone positioning. A secondary aim was to compare mortality rates between these groups.

DESIGN:
Retrospective review of electronic medical records.

SUBJECTS AND SETTING:
The sample comprised 160 patients with ARDS managed by prone positioning. Their mean age was 61.08 years (SD = 12.73); 58% (n = 96) were male. The study setting was a 355-bed community hospital in the Western United States (Stockton, California). Data were collected from July 2019 to January 2021.

METHODS:
Data from electronic medical records were retrospectively searched for the development of pressure injuries, mortality, hospital length of stay, oxygenation status when placed in a prone position, and the presence of a COVID-19 infection.

RESULTS:
A majority of patients with ARDS were manually placed in a prone position (n = 106; 64.2%), and 54 of these patients (50.1%) were placed using a specialty care bed. Slightly more than half (n = 81; 50.1%) developed HAPIs. Chi-square analyses showed no association with the incidence of HAPIs using manual prone positioning versus the specialty bed (P = .9567). Analysis found no difference in HAPI occurrences between those with COVID-19 and patients without a coronavirus infection (P = .8462). Deep-tissue pressure injuries were the most common type of pressure injury. More patients (n = 85; 80.19%) who were manually placed in a prone position died compared to 58.18% of patients (n = 32) positioned using the specialty bed (P = .003).

CONCLUSIONS:
No differences in HAPI rates were found when placing patients manually in a prone position versus positioning using a specialty bed designed for this purpose.
Gramella oceanisediminis sp. nov., isolated from deep-sea sediment of the Indian Ocean
Authors: Yang Lin , Shi Haolei , Li Qian , Zheng Minggang , Lai Qiliang , Zheng Li 
Published: May 2023

A taxonomic study was carried out on strain GC03-9T, which was isolated from deep-sea sediment of the Indian Ocean. The bacterium was Gram-stain-negative, catalase-positive, oxidase-negative, rod-shaped and gliding motile. Growth was observed at salinities of 0–9 % and at temperatures of 10–42 °C. The isolate could degrade gelatin and aesculin. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain GC03-9T belonged to the genus

Gramella

, with the highest sequence similarity to

Gramella bathymodioli

JCM 33424T (97.9 %), followed by

Gramella jeungdoensis

KCTC 23123T (97.2 %) and other species of the genus

Gramella

(93.4–96.3 %). The average nucleotide identity and the digital DNA–DNA hybridization estimate values between strain GC03-9T and

G. bathymodioli

JCM 33424T and

G. jeungdoensis

KCTC 23123T were 25.1 and 18.7 % and 82.47 and 75.69 %, respectively. The principal fatty acids were iso-C15 : 0 (28.0 %), iso-C17 : 0 3OH (13.4 %), summed feature 9 (iso-C17 : 1
ω9c and/or 10-methyl C16 : 0; 13.3 %) and summed feature 3 (C16 : 1
ω7c and/or C16 : 1
ω6c; 11.0 %). The G+C content of the chromosomal DNA was 41.17 mol%. The respiratory quinone was determined to be menaquinone-6 (100 %). Phosphatidylethanolamine, one unknown phospholipid, three unknown aminolipids and two unknown polar lipids were present. The combined genotypic and phenotypic data showed that strain GC03-9T represents a novel species within the genus

Gramella

, for which the name Gramella oceanisediminis sp. nov. is proposed, with the type strain GC03-9T (=MCCC M25440T=KCTC 92235T).