bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic comparison of machine learning algorithms to develop and validate prediction model to predict heart failure risk in middle-aged and elderly patients with periodontitis (NHANES 2009 to 2014)
Authors: Wang Yicheng , Xiao Yuan , Zhang Yan
Published: August 2023

Periodontitis is increasingly associated with heart failure, and the goal of this study was to develop and validate a prediction model based on machine learning algorithms for the risk of heart failure in middle-aged and elderly participants with periodontitis. We analyzed data from a total of 2876 participants with a history of periodontitis from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014, with a training set of 1980 subjects with periodontitis from the NHANES 2009 to 2012 and an external validation set of 896 subjects from the NHANES 2013 to 2014. The independent risk factors for heart failure were identified using univariate and multivariate logistic regression analysis. Machine learning algorithms such as logistic regression, k-nearest neighbor, support vector machine, random forest, gradient boosting machine, and multilayer perceptron were used on the training set to construct the models. The performance of the machine learning models was evaluated using 10-fold cross-validation on the training set and receiver operating characteristic curve (ROC) analysis in the validation set. Based on the results of univariate logistic regression and multivariate logistic regression, it was found that age, race, myocardial infarction, and diabetes mellitus status were independent predictors of the risk of heart failure in participants with periodontitis. Six machine learning models, including logistic regression, K-nearest neighbor, support vector machine, random forest, gradient boosting machine, and multilayer perceptron, were built on the training set, respectively. The area under the ROC for the 6 models was obtained using 10-fold cross-validation with values of 0 848, 0.936, 0.859, 0.889, 0.927, and 0.666, respectively. The areas under the ROC on the external validation set were 0.854, 0.949, 0.647, 0.933, 0.855, and 0.74, respectively. K-nearest neighbor model got the best prediction performance across all models. Out of 6 machine learning models, the K-nearest neighbor algorithm model performed the best. The prediction model offers early, individualized diagnosis and treatment plans and assists in identifying the risk of heart failure occurrence in middle-aged and elderly patients with periodontitis.
Microsurgical clipping and endovascular intervention for middle cerebral artery aneurysm: A meta-analysis
Authors: Zhang Zheng , Liu Jing Yi , Xing Hong Shun , Ma Jin Yuan , Li Ai Jun
Published: August 2023

Background:

The purpose of this study is to compare the prognosis and effective rate of interventional embolization and surgical clipping in the treatment of middle cerebral artery aneurysms, to provide evidence-based basis for the selection of clinical treatment.

Methods:

By searching PubMed, Cochrane library, Medline, Embase and other databases, we collected the related studies interventional embolization and surgical clipping in the treatment of middle cerebral artery aneurysms, whether it was a randomized controlled trial or not. According to the relevant inclusion and exclusion criteria, 2 researchers independently screened and extracted the relevant data. Quality of life, residual neck and recurrence rate, incidence of ischemic cerebral infarction, intracranial infection rate, incidence of vasospasm and rebleeding rate were measured. Revman5.4 software was used for Meta-analysis.

Results:

There were 3658 patients included in 30 literatures, including 1478 patients treated with interventional embolization and 2180 patients treated with surgical clipping. The rate of low quality of life (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.36–2.07, P < .00001) and intracranial infection rate (OR = 8.79,95% CI: 4.47–17.27, P < .00001) in the interventional embolization group were lower than those in the surgical clipping group. The postoperative rebleeding rate (OR = 0.46, 95% CI: 0.29–0.73, P = .0009), residual neck and recurrence rate (OR = 0.32, 95% CI: 0.24–0.43, P < .00001) in the interventional embolization group were higher than those in the surgical clipping group. The heterogeneity of residual neck and recurrence rate were high, so subgroup analysis was performed. We divide them into short-term group (OR = 0.68, 95% CI: 0.40–1.13, P = .13) and long-term group (OR = 0.23, 95% CI: 0.16–0.33, P < .00001). The results showed that the residual neck and recurrence rate in the interventional embolization group were higher than those in the surgical clipping group. There was no significant difference in the incidence of cerebral vasospasm (OR = 1.09, 95% CI: 0.64–1.86, P = .74) and ischemic stroke (OR = 0.87, 95% CI: 0.63–1.19, P = .37) between the 2 treatments.

Conclusion:

According to the current clinical research evidence, compared with interventional embolization in the treatment of middle cerebral artery aneurysms, the quality of life of patients after clipping is lower, the incidence of intracranial infection is higher, but the residual neck, and recurrence rate are reduced. The risk of rebleeding is also reduced. There was no significant difference in the incidence of vasospasm and ischemic stroke between the 2 groups.
Group A Streptococcus dysgalactiae subspecies equisimilis vertebral osteomyelitis accompanied by progressive atlantoaxial subluxation: A case report and literature review
Authors: Toyoshima Hirokazu , Tanigawa Motoaki , Ishiguro Chiaki , Tanaka Hiroyuki , Nakanishi Yuki , Sakabe Shigetoshi
Published: August 2023

Rationale:

Clinically, vertebral osteomyelitis commonly occurs in immunocompromised individuals, such as people with diabetes, immunosuppression, chronic liver disease, and malignancy. Microbiologically, vertebral osteomyelitis is commonly caused by Staphylococcus aureus; however, Streptococcus dysgalactiae subspecies equisimilis (SDSE) may also potentially cause vertebral osteomyelitis, albeit rarely. Since no case reports have documented the occurrence of SDSE cervical osteomyelitis accompanied by progressive atlantoaxial subluxation, its clinical characteristics remain uncertain. Herein, we report the first case of progressive atlantoaxial subluxation in addition to cervical osteomyelitis due to septic atlantoaxial arthritis caused by SDSE in an immunocompetent individual, and provide a review of the relevant literature.

Patient concerns:

A 63-year-old man with hypertension but no history of trauma or musculoskeletal disorders presented with worsening neck pain for 1 month without fever. Physical examination revealed neck pain due to neck retroflexion and tenderness with swelling of the upper cervical spine. No neurological deficit was observed. Magnetic resonance imaging revealed low-intensity areas on a T1-weighted image and high-intensity areas on a short tau inversion recovery image at the C2, C5, and C6 vertebral bodies with atlantoaxial subluxation. Two sets of blood culture tests (aerobic and anaerobic) were performed.

Diagnoses:

The anaerobic blood culture bottle showed the presence of beta-hemolytic pyrrolidonyl arylamidase-negative SDSE expressing Lancefield group A antiserum. Hence, the patient was diagnosed with SDSE cervical osteomyelitis with atlantoaxial subluxation; intensive intravenous ampicillin (2 g every 6 hours) – which is effective against SDSE – was administered.

Interventions:

Posterior fusion (occipital bone, C4) was performed on day 33 because a follow-up magnetic resonance imaging on day 31 revealed progression of atlantoaxial subluxation with thickened atlantodental soft tissue.

Outcomes:

The patient’s neck pain was completely relieved after treatment with intravenous ampicillin for 6 weeks, followed by oral amoxicillin (1500 mg) daily for an additional 4 weeks. The patient did not experience recurrence or sequelae during the 2-year follow-up period.

Lessons:

SDSE expressing Lancefield group A antiserum can cause afebrile vertebral osteomyelitis and progressive atlantoaxial subluxation due to the occurrence of septic atlantoaxial arthritis in immunocompetent individuals. Spinal instrumentation for vertebral osteomyelitis may be acceptable after 6 weeks of antimicrobial therapy.
Serum CXCL8 and CXCR2 as diagnostic biomarkers for noninvasive screening of cervical cancer
Authors: Zhang Nianzhu , Pang Chunsong , Li Zhenguo , Xu Fang , Zhao Lifen
Published: August 2023

Background:

Cervical cancer (CC) is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer-related death in women. Identifying new biomarkers for the early detection of CC is an essential requirement in this field. CXCL8 was originally discovered because of its role in inflammation by binding to CXCR1 and CXCR2; however, it is now known to play an important role in cancer. In this study, we aimed to evaluate the expression levels of potential biomarkers (CXCL8, CXCR1, and CXCR2) and to explore their diagnostic potential in CC.

Methods:

The expression levels of serum CXCL8, CXCR1, and CXCR2 were investigated by kit method on Immulite-1000 in 30 healthy volunteers, 30 precancerous patients and 70 CC patients.

Results:

The results indicated that the expression of CXCL8 and CXCR2 was significantly higher in the serum of CC patients than in healthy volunteers, similar to the well-established tumor marker (squamous-cell cancerantigen [SCC]). Receiver operating characteristic analyses showed that the combination of CXCL8, CXCR2, and SCC had the highest diagnostic sensitivity and area under the curve value. Meanwhile, the positive predictive value and negative predictive value were not very low. Moreover, high concentrations of CXCL8 and CXCR2 are associated with an increased risk of CC.

Conclusions:

In conclusion, our data demonstrated that combined serum CXCL8, CXCR2, and SCC measurements are helpful for CC diagnosis and can be used as potential biomarkers for the early detection of CC. Cytokines, such as CXCL8 and CXCR2, can be easily measured in most university hospital laboratories and in some private laboratories with a routine test.
Four differentially expressed exosomal miRNAs as prognostic biomarkers and therapy targets in endometrial cancer: Bioinformatic analysis
Authors: Yao Yingsha , Shi Liujing , Zhu Xiaoming
Published: August 2023

Endometrial cancer (EC) is one of the most common gynecological malignancies worldwide. Accumulated evidence has demonstrated exosomes of cancer cells carry microRNAs (miRNAs) to nonmalignant cells to induce metastasis. Our study aimed to find possible biomarkers of EC. Data for miRNA expression related with exosome from EC patients were downloaded from The Cancer Genome Atlas database, and the miRNA expression profiles associated with exosomes of EC were downloaded from the National Center for Biotechnology Information. We used different algorithms to analyze the differential miRNA expression, infer the relative proportion of immune infiltrating cells, predict chemotherapy sensitivity, and comprehensively score each gene set to evaluate the potential biological function changes of different samples. The gene ontology analysis and Kyoto encyclopedia of genome genomics pathway analysis were performed for specific genes. A total of 13 differential miRNAs were identified, of which 4 were up-regulated. The 4 miRNAs, that is hsa-miR-17-3p, hsa-miR-99b-3p, hsa-miR-193a-5p, and hsa-miR-320d, were the hub exosomal miRNAs that were all closely related to the clinic phenotypes and prognosis of patients. This study preliminarily indicates that the 4 hub exosomal miRNAs (hsa-miR-17-3p, hsa-miR-99b-3p, hsa-miR-193a-5p, and hsa-miR-320d) could be used as prognostic biomarkers or therapy targets in EC. Further studies are required to make sure of their real feasibility and values in the EC clinic and the relative research.
Comparison between pressure-controlled and manual ventilation during anesthetic induction in patients with expected difficult airway: A prospective randomized controlled trial
Authors: Park Jeong Jun , Seong Hyunyoung , Huh Hyub , Kwak Ji Soo , Park Heechan , Yoon Seung Zhoo , Cho Jang Eun
Published: August 2023

Background:

Gastric insufflation can cause gastric regurgitation, which may be exacerbated in patients who are expected to have difficult airways. The purpose of this study was to investigate the difference in respiratory parameters and the frequency of gastric insufflation according to the ventilation mode during the anesthestic induction on patients who were predicted to have difficult facemask ventilation.

Methods:

A total of eighty patients with expected airway difficulties were included. Patient were allocated to 2 groups (n = 40 each). In the manual ventilation group, ventilation was performed by putting a mask on the patient’s face with 1-hand and adjusting the pressure limiting valve to 15 cm H2O. In the pressure-controlled ventilation group, a mask was held in place using 2-handed jaw-thrust maneuver. The pressure-controlled ventilation was applied and peak inspiration pressure was adjusted to achieve a tidal volume of 6 to 8 mL/kg. The primary outcome was the difference of the peak airway pressure between 2 groups every 30 seconds for 120 seconds duration of mask ventilation. We also evaluated respiratory variables including peak airway pressure, End-tidal carbon dioxide and also gastric insufflation using ultrasonography.

Results:

The pressure-controlled ventilation group demonstrated lower peak airway pressure than the manual ventilation group (P = .005). End-tidal carbon dioxide was higher in the pressure-controlled ventilation group (P = .012). The incidence of gastric insufflation assessed by real-time ultrasonography of the gastric antrum was higher in the manual ventilation group than in the pressure-controlled ventilation group [3 (7.5%) vs 17 (42.5%), risk ratio (95% confidence interval): 0.06 to 0.56, P = .003].

Conclusions:

Pressure-controlled ventilation during facemask ventilation in patients who were expected to have difficult airways showed a lower gastric insufflation rate with low peak airway pressure compared to manual ventilation.
A review of recent evidence on androgen abuse from interviews with users
Authors: Grant Bonnie , Minhas Suks , Jayasena Channa N.
Published: August 2023

Purpose of review

Androgens (also known as anabolic–androgenic steroids; AAS) are increasingly being abused worldwide to enhance body physique or athletic performance. Qualitative studies including interviews provide a wider understanding of androgen abuse and focus specific support needs to this group. This narrative review summarizes recent studies (2021–2023) using interviews with individuals abusing androgens.

Recent findings

Motivations for androgen abuse in men include desires to achieve certain physicality, enhance self-confidence and improve libido. The risks of androgen abuse are justified to achieve these outcomes and men may use other illicit substances as postcycle-therapy to lessen the risks. Some adverse effects may be more pronounced with certain substances. The therapeutic relationship with healthcare professionals is often described negatively by androgen abusers due to stigma and a perceived lack of knowledge. Both healthcare professionals and androgen abusers agree that development of guidelines are needed. Androgen abuse in women is rare however body dissatisfaction and desires for improve appearance and strength are motivators.

Recent qualitative studies have helped further our understanding of men and women who abuse androgens, however the small number of recently published studies confirms there is still a paucity of evidence in the literature. Further research is needed to develop specific harm minimization strategies in those abusing androgens.
Recovery fulminant hepatitis A in systemic juvenile idiopathic arthritis patient treated with tocilizumab: a case report
Authors: Kudsi Maysoun , Alghawe Fatima , Hamsho Suaad
Published: August 2023

Introduction:

Systemic juvenile idiopathic arthritis (sJIA) is a rare systemic immune disorder that affects patients before 16 years of age. Several viruses have been reported to trigger this disease. Increased use of biologics, such as tocilizumab and anakinra, and decreased use of glucocorticoid may lead to improved outcomes in patients with sJIA. Serious liver injuries induced by tocilizumab include acute liver failure, hepatitis, and jaundice.

Hepatitis A remains a highly prevalent disease in low-income countries.

Case presentation:

A 14-year-old Syrian child was diagnosed with sJIA and treated with different DMARDs, including MTX. Tocilizumab was then added as monotherapy and stopped after 12 doses after full diseases remission and normal laboratory tests. He presented with a very high alanine transferase, aspartate transferase, a spiked fever, and fatigue. He was infected with hepatitis A.

Discussion:

Liver abnormalities are uncommon in sJIA. Acute liver failure may develop a few months after the onset of sJIA.

Although acute infections with the hepatitis A virus in children are self-limited, 0.1% of patients progress to fulminant hepatic failure, which spontaneously recovers in 40% of cases. No data are available concerning the coexistence of hepatitis A and sJIA. Our case was the first case presenting fulminant Hepatitis A in a sJIA patient treated with tocilizumab, which had recovered, and the authors initiated Anakinra as a treatment.

Conclusion:

Further follow-up and cohort studies are needed to find the exact prevalence and coexistence of Fulminant Hepatitis A in the coarse of sJIA treated with tocilizumab.
Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study
Authors: Paudel Sharma , Regmi Pradeep R. , Kayastha Prakash , Katuwal Shailendra , Ghimire Prasoon , Shrestha Suraj , Gurung Urmila
Published: August 2023

Background:

Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease.

Materials and methods:

This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel’s cave, and the brain parenchyma.

Results:

The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients.

Conclusion:

The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.
Portal vein thrombosis in a 10-month-old infant as a complication of neonatal umbilical catheterization: a case report
Authors: Haddad Sultaneh , Haddad Salim , Swaid Komait , Martini Nafiza , Mansour Marah , Alkouri Lina
Published: August 2023

Introduction:

Esophageal varices bleeding after portal hypertension is a rare condition in children but is associated with significant morbidity and mortality. Neonatal umbilical catheterization is one of the risk factors for the development of portal vein thrombosis (PVT) and portal hypertension.

Case presentation:

Neonatal umbilical catheterization was used here to provide appropriate treatment for postpartum sepsis. Color Doppler revealed an approximate total obstruction of the portal vein, and endoscopy showed esophageal varices. The patient was sequentially managed with endoscopic sclerotherapy.

Discussion:

The manifestations associated with PVT (like splenomegaly and bleeding esophageal varices) have been detected in a 10-month-old, which is considered a relatively young age according to the medical literature review.

Conclusion:

Using umbilical vein catheterization in neonates may be associated with several complications, including PVT. This case report describes a rare instance of portal hypertension complicated by bleeding esophageal varices in a 10-month-old infant who had undergone newborn umbilical catheterization.
What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments
Authors: Yeager Valerie A. , Burns Ashlyn B. , Lang Britt , Kronstadt Jessica , Hughes Monica J. , Gutta Jyotsna , Kirkland Chelsey , Orr Jason , Leider Jonathon P.
Published: August 2023

Objective:

Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans).

Design:

This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021.

Main Outcome Measures:

Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme.

Results:

The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18).

Conclusion:

While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.
A Clinical-Community Partnership to Address Food Insecurity and Reduce Emergency Department Utilization Among Medicaid-Insured Patients in North Carolina
Authors: Mayfield Carlene A. , Robinson-Taylor Tanya , Rifkin Danielle , Harris Mamie-Eleanor
Published: August 2023

Context:

Socioeconomic risk factors have the greatest impact on overall health trajectory. Patients with Medicaid insurance are more likely to experience food insecurity, in addition to poor health and increased health care utilization. Targeted food and produce prescription programs can reduce food insecurity, but sustainable implementation is challenging and evidence demonstrating the impact on clinical utilization outcomes is lacking.

Program:

In 2021, a cross-sector collaboration between Mecklenburg County Public Health, Reinvestment Partners, and Atrium Health initiated a food prescription program in urban North Carolina. A low-cost mass text message campaign was used to identify and enroll Medicaid-insured patients with a history of emergency department (ED) utilization.

Methods:

A nonrandomized before/after evaluation design was used with a 12-month data collection window (6 months before/after program enrollment) for 711 patients enrolled between June 2021 and 2022. Changes in the odds of nonadmission ED utilization were modeled using logistic regression, adjusting for race/ethnicity, gender, age, comorbidity, and dose, along with interaction by comorbidity.

Results:

A majority of the sample was non-Hispanic Black (61%; n = 436), female (90%; n = 643), with “none to mild” chronic disease comorbidity (81%; n = 573). The unadjusted and adjusted odds of nonadmission ED utilization significantly reduced between time periods, along with significant interaction by comorbidity. Among the subsamples, patients with “none to mild” comorbidity showed 34% reduction in odds of nonadmission ED utilization (OR = 0.64; 95% CI, 0.47-0.86).

Discussion:

Food prescription programming targeting Medicaid-insured patients may reduce ED utilization, particularly among those without severe comorbidity. Retrospective data collection and sample homogeneity reduced the quality of evidence, but results offer a pragmatic example that can be replicated for further study. Additional research is needed to strengthen the body of evidence and support cross-sector investment in food and produce prescription programming.
Decompression of Axillary Vein: An Essential Adjunct for Advanced Lymphedema
Authors: Jeong Hyung Hwa , Yoon In Ah , Al-Shomer Feras M. , Suh HyunSuk Peter , Pak ChangSik John , Neligan Peter , Hong Joon Pio
Published: August 2023

Background:

In advanced lymphedema, lymphovenous anastomosis (LVA) can be a solution based on using the pressure gradient between the high-pressure lymphatics and the low-pressure veins. If the vein pressure is high, the effect of surgery will be less optimal. This study evaluated the effect of axillary vein perivascular scar release on LVA.

Methods:

This is a retrospective study of 40 upper limb stage 2 and 3 lymphedema patients divided into 2 groups with an average follow-up of 33 months (minimum of at least 12 months): the scar release group (n = 25) and the control group (n = 15). All patients underwent LVA with or without lymph node transfer. Demographic data, outcome (volumetric change and bioimpedence analysis [BIA]), and major vein (axillary, basilic, and cephalic) diameter changes were evaluated.

Results:

Both groups showed significant reduction in volume and BIA parameters after LVA. The scar release group (24 of 25 with lymph node transfer and 1 without) showed statistically higher reduction of BIA analysis compared with the control group at 1, 6, and 12 months after LVA. The changes in the major veins after axilla scar release showed significant changes in all 3 veins. There was a significant correlation between cephalic vein diameter reduction and BIA measurement.

Conclusions:

The release of perivascular scar in the axillary vein may result in better outcome after LVA. This is based on the finding that scar release shows correlation between cephalic vein diameter reduction and BIA measurement suggesting reduction of venous pressure in the peripheral vein increasing the pressure gradient between the lymphatic and venous system allowing better outflow after LVA.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Barriers and Solutions for Pediatric Rheumatology Referrals in a Rural Area
Authors: Campbell Julie A. , Wilson Lauren , Shenoi Susan
Published: August 2023

Background

Currently, there are 9 states across the United States that do not have a pediatric rheumatologist, including the state of Montana. Patients in these states are often cared for by outreach clinics staffed by pediatric rheumatology (PR) providers from other states or looked after by in-state adult rheumatologists or in-state primary care providers.

Methods

Using a web-based survey, we determined barriers and potential solutions to PR referrals from referring providers (including primary care providers and subspecialists) in Montana state.

Results

Eighty-five Montana referring providers responded, with 44% being pediatric physicians and 33% being family medicine physicians. Other respondents were adult rheumatologists, pediatric and family medicine advanced practice providers, orthopedic surgeons, and pediatric subspecialists. Eighty-five percent of providers had previously referred a patient to PR. Referring providers rated difficulty referring MT patients to PR as 27 (on a linear numeric scale of 0–100, with 0 being very difficult) and noted lack of access to local pediatric rheumatologist as the most significant barrier to referral. The top patient barrier as perceived by 95% of providers was travel time. Potential solutions to improve care included presence of local pediatric rheumatologist with 50 miles, development of algorithms for common PR complaints, and outreach clinics.

Conclusion

Referring providers in Montana report difficulty in referring to PR, with lack of access and travel time being key barriers. Improving access through expanding local PR workforce and increasing access through outreach clinics may help reduce these barriers.
Severity of Mandibular Dysmorphology in Treacher Collins Syndrome for Stratification of Perioperative Airway Risk
Authors: Barrero Carlos E. , Wietlisbach Larissa E. , Pontell Matthew E. , Salinero Lauren K. , Wagner Connor S. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: August 2023

Background:

Patients with Treacher Collins syndrome (TCS) and attendant airway dysmorphology may be predisposed to airway complications in the perioperative period. However, limited data correlates severity of mandibular hypoplasia and airway status. This study aims to improve risk stratification for perioperative airway insufficiency in TCS by using a previously proposed mandibular severity index.

Methods:

Patient demographics, perioperative airway status, difficulty of intubation, and Cormack Lehane grade were collected and compared using a TCS mandibular hypoplasia severity grading scale in patients with TCS treated between 2000 and 2022.

Results:

Twenty-six patients underwent 222 procedures with institutional mandibular severity gradings as follows: 23% Grade I, 31% Grade II, 39% Grade III, 8% Grade IV. Our severity index was associated with intubation difficulty (P<0.001) and difficult airway status (P<0.001), with 72% of difficult airways found in grade III and grade IV patients. Mandibular retrusion and ramal hypoplasia subscores were positively correlated with measures of airway severity (P<0.001), whereas the gonial angle was negatively correlated (P<0.001). Age was negatively correlated with difficult visualization for endotracheal intubation (P=0.02) but had no association with difficult airway status (P=0.2).

Conclusions:

This study found a positive correlation between severity of maxillomandibular dysmorphology and perioperative airway difficulty in TCS patients. Our findings suggest that severely affected patients require heightened vigilance throughout life, as difficult airways may not completely resolve with aging. Given the risk of morbidity and mortality associated with airway complications, proper identification and preparation for challenging airways is critical for TCS patients.
Misdiagnosis of Chronic Subdural Hematoma in Children
Authors: Peng Zeyu , Xue Yan , Wang Fei
Published: August 2023

Chronic subdural hematoma is a common intracranial disease in elderly individuals, but in very rare cases, it can also develop in children. Some subdural hematomas are prone to misdiagnosis as epidural hematomas, which can affect the surgical approach and patient prognosis. We report a case of a 12-year-old male child with a misdiagnosed subdural hematoma as an epidural hematoma. We reviewed the data of this misdiagnosed patient with chronic subdural hematoma, analyzed relevant imaging information, identified the reasons for misdiagnosis, and summarized our experience to enhance our understanding of this condition.
Drainage Pattern of Craniofacial Veins With Emphasis on its Influence on Facial Reconstruction Procedures
Authors: Ranade Anu V. , Rai Rajalakshmi , Rai Ashwin R. , Joy Teresa , Janardhanan Jiji P. , Dass Prameela M.
Published: August 2023

As the facial transplantation procedures are becoming more popular and frequent in recent years, for repairing facial trauma, variations in the veins of head and neck needs to be reported time and again. This study was undertaken to examine the course and drainage pattern of the facial vein and external jugular vein on this context and emphasize its surgical implications. The authors studied the head and neck region of 50 embalmed cadavers of both sexes to document normal and variant anatomy of facial, retromandibular, and external jugular veins. In 30% of the head and neck regions, different draining pattern of the above-mentioned veins were observed. One of the rare variation discovered was the splitting of the retromandibular vein to embrace the external carotid artery within the parotid gland. The data about variations in the termination of facial vein, retromandibular vein, and external jugular vein, as observed in the present study might be useful in avoiding accidental injury to these vessels during any surgical intervention in the face as well as neck.

Level of Evidence: IV.
The multipolar elastic fields of ellipsoidal and polytopal plastic inclusions
Authors: Gurrutxaga-Lerma B.
Published: August 2023

The article offers a general formulation for the multipolar field expansion of an inclusion. The multipolar moments of arbitrary order for the ellipsoidal inclusion are derived, showing known features of their elastic fields in both the far and near field. Using integer point enumeration theory, the same formulation is extended to all polytopal inclusions, which serve to model faceted inclusions found in, e.g. igneous and metamorphic rocks, particle reinforced composite materials, or as intermetallic precipitates in alloys. A general algorithm for the calculation of the multipolar moments of polytopes of any number of vertices is derived. A number of examples for tetrahedral, cuboidal and dodecahedral inclusions are given. It is shown that the parity of the axial moment function of a polytopal inclusion mirrors the symmetry of the inclusion. This represents the main properties of their elastic fields, including the long- and near-field decay. If the inclusion is symmetric with respect to a given axes, the fields will decay with

1

/

r
2

in the far field and

1

/

r
4

in the near field. If symmetry along that direction is lost, as is expected in most real inclusions, the decay rate progresses with

1

/

r
2

but the near field with

1

/

r
3

.
A low molecular weight dextran sulphate, ILB®, for the treatment of amyotrophic lateral sclerosis (ALS): an open-label, single-arm, single-centre, phase II trial
Authors: Srinivasan Venkataramanan , Homer Victoria , Barton Darren , Clutterbuck-James Abigail , Jenkins Siân , Potter Claire , Brock Kristian , Logan Ann , Smith Donna , Bruce Lars , Nagy Zsuzsanna , Bach Simon P
Published: August 2023

Background

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehriǵs disease, is a rare neurological disease and is the most common motor neurone disease. It is a fatal disease with specific loss of motor neurons in the spinal cord, brain stem, and motor cortex leading to progressive paralysis and usually death within five years of diagnosis. There remains no cure for ALS, and management is focused on a combination of neuroprotective medication, respiratory support, and management by multidisciplinary clinics.

Patients and Methods

This prospective, single-arm, open-label phase II clinical trial of sustained weekly administration of 2 mg/kg ILB® (a low-molecular weight dextran sulphate) was conducted in a single UK hospital. Eligible patients were at least 18 years and had a definite diagnosis of ALS according to El Escorial Criteria. The co-primary outcomes were safety, tolerability, and quantity of ILB® administered. All evaluable patients were analysed in a modified intention-to-treat analysis.

EudraCT number. 2018-000668-28

Findings

Between 18-Apr-2019 and 27-Mar-2020, 11 patients were recruited and treated for up to 38 weeks. There were no treatment terminations or withdrawals. One serious adverse event was reported, which was not related to ILB® and resolved without sequalae. 270 mild/moderate adverse events were reported with no intolerable events occurring during the trial. The total number of ILB® treatments administered per patient ranged from 4 to 38, with a cumulative dose ranging from 745 to 6668 mg. As a result of the COVID-19 pandemic and the high-risk status of study participants, recruitment and treatment was suspended early in Mar-2020. At the long-term follow-up, three patients had died after the trial was halted, between 53 and 62 weeks after their final ILB® injection.

Interpretation

Long-term weekly ILB® injections of 2 mg/kg was well tolerated and had an acceptable safety profile in patients with ALS.
Comparison of the Diagnostic Performance from Patient’s Medical History and Imaging Findings between GPT-4 based ChatGPT and Radiologists in Challenging Neuroradiology Cases
Authors: Horiuchi Daisuke , Tatekawa Hiroyuki , Oura Tatsushi , Oue Satoshi , Walston Shannon L , Takita Hirotaka , Matsushita Shu , Mitsuyama Yasuhito , Shimono Taro , Miki Yukio , Ueda Daiju
Published: August 2023

Purpose

To compare the diagnostic performance between Chat Generative Pre-trained Transformer (ChatGPT), based on the GPT-4 architecture, and radiologists from patient’s medical history and imaging findings in challenging neuroradiology cases.

Methods

We collected 30 consecutive “Freiburg Neuropathology Case Conference” cases from the journal Clinical Neuroradiology between March 2016 and June 2023. GPT-4 based ChatGPT generated diagnoses from the patient’s provided medical history and imaging findings for each case, and the diagnostic accuracy rate was determined based on the published ground truth. Three radiologists with different levels of experience (2, 4, and 7 years of experience, respectively) independently reviewed all the cases based on the patient’s provided medical history and imaging findings, and the diagnostic accuracy rates were evaluated. The Chi-square tests were performed to compare the diagnostic accuracy rates between ChatGPT and each radiologist.

Results

ChatGPT achieved an accuracy rate of 23% (7/30 cases). Radiologists achieved the following accuracy rates: a junior radiology resident had 27% (8/30) accuracy, a senior radiology resident had 30% (9/30) accuracy, and a board-certified radiologist had 47% (14/30) accuracy. ChatGPT’s diagnostic accuracy rate was lower than that of each radiologist, although the difference was not significant (p= 0.99, 0.77, and 0.10, respectively).

Conclusion

The diagnostic performance of GPT-4 based ChatGPT did not reach the performance level of either junior/senior radiology residents or board-certified radiologists in challenging neuroradiology cases. While ChatGPT holds great promise in the field of neuroradiology, radiologists should be aware of its current performance and limitations for optimal utilization.
Pharmacokinetics-based identification of antiviral compounds ofRheum palmatumrhizomes and roots (Dahuang)
Authors: Tian Nan-Nan , Ren Ling-Ling , Zhu Ya-Xuan , Sun Jing-Ya , Lu Jun-Lan , Zeng Jia-Kai , Wang Feng-Qing , Du Fei-Fei , Yang Xi-He , Ge Shu-Ning , Huang Rui-Min , Jia Wei-Wei , Li Chuan
Published: August 2023

The potential of Dahuang to eliminate lung pathogens was often highlighted inWenyi Lun. This investigation aimed to identify potential antiviral compounds of herbal component Dahuang (Rheum palmatumrhizomes and roots) of LianhuaQingwen capsule, with respect to their systemic exposure and lung reachability. Circulating Dahuang compounds were identified in human volunteers receiving LianhuaQingwen. The reachability of these compounds to SARS-CoV-2 3CLprowas assessed byin vitrotransport, metabolism, immunohistochemistry, and 3CLpro-biochemical studies. LianhuaQingwen contained 55 Dahuang constituents (0.01–2.08 μmol/day), categorized into eight classes. Only three compounds rhein (3), methylisorhein (10; a new Dahuang anthraquinone), and 4-O-methylgallic acid (M42M2) exhibited significant systemic exposure in humans. Two intestinal absorption mechanisms for3and10were proposed: active intestinal uptake of3/10by human TAUT/ASBT and human MRP1/3/4, and intestinal lacate-phlorizin hrdrolyase-mediated hydrolysis of rhein-8-O-β-D-glucoside (9), followed by the transporter-mediated absorption of released3. Targeted reachability of circulating3/10could be achieved as rat orthologues of human ASBT/TAUT was observed in alveolar and bronchial epithelia. These compounds exhibited potential ability to inhibit the 3CLproenzyme responsible for coronaviral replication. Notably, Dahuang anthraquinones and tannins varied greatly in pharmacokinetics between humans and rats after dosing LianhuaQingwen. This investigation, along with such investigations of other components, has implications for precisely defining the therapeutic benefits of Dahuang-containing medicines.
A neuronal circuit driven by GLP-1 in the olfactory bulb regulates insulin secretion
Authors: Montaner Mireia , Denom Jessica , Simon Vincent , Jiang Wanqing , Holt Marie K , Brierley Dan , Rouch Claude , Foppen Ewout , Kassis Nadim , Jarriault David , Khan Dawood , Eygret Louise , Mifsud Francois , Hodson David J , Broichhagen Johannes , Van Oudenhove Lukas , Fioramonti Xavier , Gault Victor , Cota Daniela , Reimann Frank , Gribble Fiona M , Migrenne-Li Stephanie , Trapp Stefan , Gurden Hirac , Magnan Christophe
Published: August 2023

Glucagon-like peptide 1 (GLP-1) stimulates insulin secretion and holds significant pharmacological potential. Nevertheless, the regulation of energy homeostasis by centrally-produced GLP-1 remains partially understood. Preproglucagon cells, known to release GLP-1, are found in the olfactory bulb (OB). We demonstrate that activating GLP-1 receptors (GLP-1R) in the OB stimulates insulin secretion in response to oral glucose in lean and diet-induced obese mice. This is associated with reduced noradrenaline content in the pancreas and blocked by an α2-adrenergic receptor agonist, highlighting the functional implication of the sympathetic nervous system (SNS). Inhibiting GABAA receptors in the paraventricular nucleus of the hypothalamus (PVN), the control centre of the SNS, abolishes the enhancing effect on insulin secretion induced by OB GLP-1R. Therefore, OB GLP-1-dependent regulation of insulin secretion relies on a relay within the PVN. These findings identify a novel top-down neural mechanism engaged by OB GLP-1 signaling to control insulin secretion via the SNS.
A Dimensionality Reduction Approach for Motor Imagery BCI using Functional Clustering, Graph Signal Processing, and Differential Evolution
Authors: Khalili Mohammad Davood , Abootalebi Vahid , Saeedi-Sourck Hamid
Published: August 2023

This paper aims to address the dimension reduction and classification of electroencephalogram (EEG) signals within the context of motor imagery brain-computer interface (MI-BCI). By leveraging modern brain signal processing tools, specifically Graph Signal Processing (GSP) and meta-heuristic techniques, we introduce the K-GLR-DE approach. This methodology encompasses functional clustering, Kron reduction, regularized common spatial patterns with generic learning (GLRCSP), and differential evolution (DE). Our approach is underpinned by a comprehensive structural-functional framework that carefully shapes the architecture of the brain graph. Edge weights are assigned based on geometric distance and correlation, imbuing the model with physiologically meaningful connectivity patterns. Graph reduction involves strategically employing physiological regions of interest (ROIs) and Kron reduction to select informative subgraphs while preserving vital information from all graph vertices. Feature extraction integrates total variation calculation and the GLRCSP method, followed by dimension reduction using the DE algorithm. The extracted features are then evaluated using well-established machine-learning classifiers. The validation process is carried out using Dataset IVa from BCI Competition III, providing a tangible benchmark for the performance of the K-GLR-DE approach. Significantly, the SVM-RBF classifier stands out as the top performer, achieving a remarkable average accuracy of 96.46±0.83. Noteworthy is our approach’s capacity to notably augment MI-BCI classification performance across diverse training trial scenarios, encompassing limited, small, and conventional settings.
Mental Tasks for Controlling Cursor Movements in a Brain Computer Interface
Authors: Sakkaff Zahmeeth , Freiburger Andrew P. , Henry Christopher , Nanayakkara A.
Published: August 2023

Traumatic brain injury and neuro-degenerative diseases leave people dependent and with a low quality of life. Several technologies have been proposed to connect the central nervous system to silicon circuitry and thereby circumvent the damaged nervous tissue that is impairing normal function. These technologies rely upon a language of subtle movements within a patient’s capability to direct computer operations, however, selecting the proper abstraction for even a task as simple as moving a computer cursor can be challenging. Involuntary movements can create noise and false positives for the brain-computer-interface (BCI) receptors, and non-intuitive abstractions can be a barrier for adoption by neurologically damaged patients. We therefore introduce Visualization of Arrow Movements (VAM) as a set of mental tasks for controlling cursor movements in a BCI system. The performance of VAM was evaluated by six untrained subjects via 10-fold cross validation using band power and k-Nearest Neighbor classification methods as well as linear discriminant analysis (LDA) after spatial filtering. The binary classification accuracy in recognizing VAM tasks from each other was between 92% and 100% for four subjects and between 66% and 72% for the other two participants, which suggests that the tasks are most intuitive for even untrained persons. Non-EEG analysis revealed that this performance does not originate from ocular or other facial movements, but from cerebral electrical activity. The high classification accuracy and intuitive abstraction suggest that VAM is a promising abstraction for BCI systems.