bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study
Authors: Ryan BL , Allen B , Zwarenstein M , Stewart M , Glazier RH , Fortin M , Wetmore SJ , Shariff SZ 
Published: August 2020

Objective: To examine the relationship between multimorbidity and mortality, and whether relationship varied by material deprivation/rural location and by age. Methods: Retrospective population-based cohort study conducted using 2013–14 data from previously created cohort of Ontario, Canada residents classified according to whether or not they had multimorbidity, defined as having 3+ of 17 chronic conditions. Adjusted rate ratios were calculated to compare mortality rates for those with and without multimorbidity, comparing rates by material deprivation/rural location, and by age group. Results: There were 13,581,191 people in the cohort ages 0 to 105 years; 15.2% had multimorbidity. Median length of observation was 365 days. Adjusted mortality rate ratios did not vary by material deprivation/rural location; overall adjusted mortality rate ratio was 2.41 (95% CI 2.37–2.45). Adjusted mortality rate ratios varied by age with ratios decreasing as age increased. Overall rate ratio was 14.7 (95% CI 14.48–14.91). Children (0–17 years) had highest ratio, 40.06 (95% CI 26.21–61.22). Youngest adult age group (18–24 years) had rate ratio of 9.96 (95% CI 7.18–13.84); oldest age group (80+ years) had rate ratio of 1.97 (95% CI 1.94–2.04). Conclusion: Compared to people without multimorbidity, multimorbidity conferred higher risk of death in this study at all age groups. Risk was greater in early and middle adulthood than in older ages. Results reinforce the fact multimorbidity is not just a problem of aging, and multimorbidity leads not only to poorer health and higher health care utilization, but also to a higher risk of death at a younger age.
Effect of Targeted Curricular Reform on the Learning Environment, Student Empathy, and Hidden Curriculum in a Medical School: A 7-Year Longitudinal Study
Authors: Zgheib Nathalie K , Dimassi Zakia , Arawi Thalia , Badr Kamal F , Sabra Ramzi 
Published: August 2020

Objective: The American University of Beirut Faculty of Medicine follows the American model of medical education. In 2013-2014, a carefully designed new curriculum replaced the previous, largely traditional curriculum, and aimed to improve student wellbeing, upgrade the learning environment, enhance student empathy, and counter the negative influences of the hidden curriculum. This longitudinal study assessed the effectiveness of the new curriculum in those domains over a period of 7 years. Methods: Three cohorts of medical students anonymously filled a paper-based survey at the end of years 1, 2, 3, and 4 of the 4-year curriculum. These included the Class of 2016, the last batch of students who followed the old curriculum, and 2 cohorts that followed the new curriculum (Class of 2017 and Class of 2019). The perceived learning environment was assessed by the Dundee Ready Education Environment Measurement survey; the student’s empathy was assessed by the Jefferson Scale of Physician Empathy-Student version; and the hidden curriculum was examined using a locally developed survey. Results: The scores on the learning environment survey were significantly higher among the cohorts following the new curriculum relative to those following the old curriculum. Similar significant results appeared when looking at each of the subscales for the learning environment. The students’ empathy scores were also significantly higher in both cohorts of the new curriculum when compared with the old curriculum. Nevertheless, there was a significant decrease in empathy in both third and fourth years relative to second year. The new curriculum also improved aspects of the students’ perceptions and responses to the hidden curriculum. Conclusion: In conclusion, a well-planned and well-researched curricular intervention, based on sound educational theories, practices, and standards can indeed transform the learning environment, as well as the attitudes, values, and experiences of medical students.
Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty
Authors: MacAskill Micah L , Thomas Rachel J , Barnes Leslie A 
Published: August 2020

Introduction: Reverse shoulder arthroplasty is a useful procedure with broadening applications, but it has the best outcomes when used for rotator cuff tear arthropathy. However, this procedure is not without complications. While scapular notching and aseptic loosening are more common complications that have been extensively studied in the literature, dissociation of the glenoid component and incomplete glenosphere seating has not received much attention. Specifically, little research has explored appropriate management of incomplete seating of the glenosphere component, and no gold standard for treatment of this complication has emerged. Methods: In the case described here, an elderly patient with an incompletely seated glenosphere component post-operatively opted to pursue conservative management in order to avoid revision surgery if possible. Results: The partially engaged, superiorly directed components in this case exhibited spontaneous complete and symmetric seating of the glenosphere between six and twelve months post-operatively, indicating that conservative management of this complication in low-demand patients may be a viable option to avoid the risks associated with revision surgery. Conclusion: Further research should be pursued to explore what patient and prosthesis design factors may be suited to observation with serial radiographs when incomplete seating of the glenosphere component occurs.
Optical Coherence Tomography Angiography Findings in Patients With Acute Syphilitic Posterior Placoid Chorioretinopathy
Authors: Farley Nathan , Pellegrini Marco , Marlow Elizabeth , Ruby Alan , Randhawa Sandeep 
Published: August 2020

Purpose: Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is an uncommon and distinct manifestation of ocular syphilis necessitating immediate treatment. ASPPC is attributed to disruption of the choriocapillaris, retinal pigment epithelium, and photoreceptors. Optical coherence tomography angiography (OCTA) can evaluate choriocapillaris vascular flow and may provide further information about ASPPC’s disease process. Methods: OCTA images from 7 eyes of 4 patients with ASPPC were compared before and after treatment when available. Results: All eyes demonstrated increased choriocapillaris vascular flow voids in the distribution of the ASPPC lesions at initial testing. Following treatment, decreased placoid lesion size was associated with decreased flow voids on OCTA along with improved ellipsoid zone integrity in 2 patients. Conclusions: Disruption of choriocapillaris vascular flow in ASPPC that causes outer retinal changes can improve following treatment as suggested by OCTA imaging. Some cases may continue to demonstrate decreased flow even after appropriate therapy.
Assessing the Effect of Demographic Background on Barriers to Seek Medical Attention for Psoriasis
Authors: Bray Jeremy K. , Feldman Steven R. 
Published: August 2020

Background: Lack of treatment or undertreatment of psoriasis is a major issue. Demographics might be related to specific barriers to health care. Objective: To assess the association between demographic background and barriers to seek medical attention for individuals with psoriasis. Methods: A total of 152 subjects with self-reported psoriasis were recruited through Amazon Mechanical Turk and surveyed via Qualtrics to assess the impact of demographics on health care barriers. Subjects were presented with an image of a psoriatic plaque on an elbow and asked to rate how large of a barrier they would face to seek care on a 1 to 10 scale. Outcome measures were compared using multiple linear regression. Results: Demographics were correlated with high cost of care (F(6,107) = 3.38, P < .01, R 2 = 0.16), lack of availability of services (F(6,60) = 2.84, P = .01, R 2 = 0.22), and lack of understanding treatment options (F(6,61) = 2.18, P = .05, R 2 = 0.18). Conclusion: Some demographic groups face higher rates of barriers to seek medical attention. These barriers may contribute to undertreatment of psoriasis.
Oxidized Lipids and Lipoprotein Dysfunction in Psoriasis
Authors: Sorokin Alexander V. , Remaley Alan T. , Mehta Nehal N. 
Published: August 2020

Background: Psoriasis is a chronic immune-mediated inflammatory skin disease associated with increased development of metabolic abnormalities including obesity and dyslipidemia, as well as increased cardiovascular disease (CVD) risk. Shared pathophysiological mechanisms linking psoriasis to CVD include altered immune activation, elevated chronic systemic inflammation, and lipoprotein dysfunction characterized by oxidative damage to lipids and apolipoproteins. Objective: This review aims to provide evidence-based proof for existing relationships between psoriatic inflammation, lipid oxidation, and increased CVD risk. Methods: We included review articles and original research papers, published between 1980 and 2020, using the following key words: psoriasis, oxidized lipids, oxidation, dyslipidemia, and inflammation. Results: Systemic inflammation underlying psoriasis leads to increased skin accumulation of pro-inflammatory oxidized lipids, derived from the omega-6 fatty acids, along with counteracting anti-inflammatory lipid mediators, products of the omega-3 polyunsaturated fatty acids. Imbalance in these metabolites culminates in impaired inflammation resolution and results in multisystemic biological alterations. Sustained systemic inflammation results in excessive lipid oxidation, generating proatherogenic oxidized low- and high-density lipoproteins. Together, these pathophysiological mechanisms contribute to increased CVD risk associated with psoriasis disease. Conclusion: Available anti-inflammatory treatment showed promising clinical results in treating psoriasis, although further research is warranted on managing associated dyslipidemia and establishing novel cardiometabolic markers specific for both skin and vascular pathology.
Tildrakizumab Shows Significant Efficacy in Psoriasis Treatment With Comorbid Immunoglobulin A Nephropathy: A Case Report
Authors: Song Eingun James 
Published: August 2020

Background: Chronic kidney disease is a relative contraindication for conventional systemic therapy in patients with psoriasis. Although biologic agents may be suitable in these patients due to their elimination via endogenous metabolism and protein degradation, no dedicated studies have evaluated the safety of biologics in patients with psoriasis and chronic kidney disease. Tildrakizumab—an anti-interleukin-23p19 monoclonal antibody—is approved for treatment of moderate-to-severe plaque psoriasis. Objective: To evaluate efficacy and safety of tildrakizumab in a 56-year-old woman with moderate-to-severe plaque psoriasis and comorbid immunoglobulin A nephropathy. Methods: Subcutaneous tildrakizumab 100 mg was administered at weeks 0, 4, 20, 33, and 48. Assessments included body surface area affected, physician’s global assessment score, and laboratory assessments. Results: At initial presentation, patient had predominantly plaque-type psoriasis involving 5% body surface area with a static physician’s global assessment score of 3. Patient failed an adequate trial of ultrapotent topical steroids. Baseline laboratory tests confirmed renal impairment with blood creatinine level of 2.0 mg/dL and an estimated glomerular filtration rate of 27.0 mL/min/1.73 m2. Administration of subcutaneous tildrakizumab 100 mg led to near-complete skin clearance by week 33, with a durable response to week 48. No treatment-related adverse events were reported through 48 weeks. Metabolic and hematological parameters remained grossly unchanged. Conclusion: Tildrakizumab was well tolerated and effective for treatment of moderate-to-severe plaque psoriasis in a patient with comorbid immunoglobulin A nephropathy.
Evaluation of the latent tuberculosis screening and treatment strategy for asylum seekers in Stockholm, Sweden 2015–2018: a record linkage study of the care cascade
Authors: Nederby Öhd Joanna , Hergens Maria-Pia , Luksha Yauheni , Buxbaum Charlotte , Shedrawy Jad , Jonsson Jerker , Bruchfeld Judith , Lönnroth Knut 
Published: August 2020

IntroductionAbout 90% of active tuberculosis (TB) cases in Sweden are foreign born and are mainly due to latent TB infection (LTBI) reactivation. The aim of this study was to assess the current migrant LTBI screening programme with regards to test results and completion of the care cascade.MethodA retrospective cohort of all 14173 individuals attending a health examination was established for the Stockholm Region 2015–2018 through record-linkage of data extracted from the Swedish Migration Authority and medical records. Screening results, referrals to specialist care and treatment initiation were ascertained through automated data extraction for the entire cohort. Detailed cascade steps, including treatment completion, were analysed through manual data extraction for a subsample of all persons referred to specialist care in the period 2016–2017.ResultsOf 5470 patients screened with an interferon-gamma release assay (IGRA), 1364 (25%) were positive, of whom 358 (26%) initiated LTBI treatment. An increased trend in IGRA-positivity was seen for increased age and TB-incidence in country of origin. Among the IGRA positive patients, 604 (44%) were referred to specialist care. Lower age was the main referral predictor. In the subsample of 443 patients referred to specialist care in 2016–2017, 386 (87%) were invited, of whom 366 (95%) attended. Of 251 patients (69%) recommended for LTBI treatment, 244 (97%) started such treatment and of those 221 (91%) completed it.ConclusionThe low attrition in patient-dependent cascade steps shows that the voluntary approach works well. Low LTBI treatment attainment is due to the current conservative local treatment policy, which means the vast majority are IGRA-tested without an intention to treat for LTBI.
Type2 diabetes mellitus prediction using data mining algorithms based on the long-noncoding RNAs expression: a comparison of four data mining approaches
Authors: Kazerouni Faranak , Bayani Azadeh , Asadi Farkhondeh , Saeidi Leyla , Parvizi Nasrin , Mansoori Zahra 
Published: August 2020

Abstract
Background
About 90% of patients who have diabetes suffer from Type 2 DM (T2DM). Many studies suggest using the significant role of lncRNAs to improve the diagnosis of T2DM. Machine learning and Data Mining techniques are tools that can improve the analysis and interpretation or extraction of knowledge from the data. These techniques may enhance the prognosis and diagnosis associated with reducing diseases such as T2DM. We applied four classification models, including K-nearest neighbor (KNN), support vector machine (SVM), logistic regression, and artificial neural networks (ANN) for diagnosing T2DM, and we compared the diagnostic power of these algorithms with each other. We performed the algorithms on six LncRNA variables (LINC00523, LINC00995, HCG27_201, TPT1-AS1, LY86-AS1, DKFZP) and demographic data.

Results
To select the best performance, we considered the AUC, sensitivity, specificity, plotted the ROC curve, and showed the average curve and range. The mean AUC for the KNN algorithm was 91% with 0.09 standard deviation (SD); the mean sensitivity and specificity were 96 and 85%, respectively. After applying the SVM algorithm, the mean AUC obtained 95% after stratified 10-fold cross-validation, and the SD obtained 0.05. The mean sensitivity and specificity were 95 and 86%, respectively. The mean AUC for ANN and the SD were 93% and 0.03, also the mean sensitivity and specificity were 78 and 85%. At last, for the logistic regression algorithm, our results showed 95% of mean AUC, and the SD of 0.05, the mean sensitivity and specificity were 92 and 85%, respectively. According to the ROCs, the Logistic Regression and SVM had a better area under the curve compared to the others.

Conclusion
We aimed to find the best data mining approach for the prediction of T2DM using six lncRNA expression. According to the finding, the maximum AUC dedicated to SVM and logistic regression, among others, KNN and ANN also had the high mean AUC and small standard deviations of AUC scores among the approaches, KNN had the highest mean sensitivity and the highest specificity belonged to SVM. This study’s result could improve our knowledge about the early detection and diagnosis of T2DM using the lncRNAs as biomarkers.
Saving time maintaining reliability: a new method for quantification of Tetranychus urticae damage in Arabidopsis whole rosettes
Authors: Ojeda-Martinez Dairon , Martinez Manuel , Diaz Isabel , Santamaria M. Estrella 
Published: August 2020

Abstract
Background
The model species Tetranychus urticae produces important plant injury and economic losses in the field. The current accepted method for the quantification of the spider mite damage in Arabidopsis whole rosettes is time consuming and entails a bottleneck for large-scale studies such as mutant screening or quantitative genetic analyses. Here, we describe an improved version of the existing method by designing an automatic protocol. The accuracy, precision, reproducibility and concordance of the new enhanced approach are validated in two Arabidopsis accessions with opposite damage phenotypes. Results are compared to the currently available manual method.

Results
Image acquisition experiments revealed that the automatic settings plus 10 values of brightness and the black background are the optimal conditions for a specific recognition of spider mite damage by software programs. Among the different tested methods, the Ilastik-Fiji tandem based on machine learning was the best procedure able to quantify the damage maintaining the differential range of damage between accessions. In addition, the Ilastik-Fiji tandem method showed the lowest variability within a set of conditions and the highest stability under different lighting or background surroundings. Bland-Altman concordance results pointed out a negative value for Ilastik-Fiji, which implies a minor estimation of the damage when compared to the manual standard method.

Conclusions
The novel approach using Ilastik and Fiji programs entails a great improvement for the quantification of the specific spider mite damage in Arabidopsis whole rosettes. The automation of the proposed method based on interactive machine learning eliminates the subjectivity and inter-rater-variability of the previous manual protocol. Besides, this method offers a robust tool for time saving and to avoid the damage overestimation observed with other methods.
Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report
Authors: Jang Albert Youngwoo , Oh Young Jun , Lee Seok In , Lim Oh Kyung , Suh Soon Yong 
Published: August 2020

Abstract
Background
Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life.

Case presentation
A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling.

Conclusion
The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.
Metastatic pancreatic adenocarcinomas could be classified into M1a and M1b category by the number of metastatic organs
Authors: Feng Fang , Cai Wei , Wang Gaoming , Chen Weigang , Yang Haochang , Sun Mingyu , Zhou Li 
Published: August 2020

Abstract
Background
With the improvement of treatment and prognosis for patients with late malignant diseases, certain malignancies with distant metastasis (M1 category) have been further classified into M1a (single metastatic site) and M1b (multiple metastatic sites) category in the staging system. We aimed to assess the feasibility of sub-classifying metastatic pancreatic adenocarcinoma (mPA) into M1a and M1b category depending on the number of metastatic organs.

Methods
Patient records were collected from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). Univariable and multivariable analyses were performed using the Cox regression model. Then survival analysis was determined using the Kaplan–Meier method.

Results
A total of 11,885 patients were included in this analysis, including 9425 patients with single metastasis and 2460 patients with multiple metastases. Multivariable analysis showed that gender, age, marital status, grade, surgery, chemotherapy, and radiotherapy were independent prognostic factors for patients with single metastasis; gender, age, marital status, grade, chemotherapy and radiotherapy were independent prognostic factors for patients with multiple metastases. Notably, surgery was an independent prognostic factor for patients with single metastasis (P < 0.001) but not for patients with multiple metastases (P = 0.134). Kaplan–Meier analysis showed that patients with single metastasis (M1a) had better survival outcomes than patients with multiple metastases (M1b) (P < 0.001).

Conclusions
PA patients with M1 diseases could be divided into M1a (single metastasis) category and M1b (multiple metastases) category by the number of metastatic organs. The subclassification would facilitate individualized treatment for late PA patients. Surgery was associated with lower mortality in M1a patients but not significantly in M1b patients.