bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Little Red Flags”: Barriers to Accessing Health Care as a Sexual or Gender Minority Individual in the Rural Southern United States—A Qualitative Intersectional Approach
Authors: Joudeh Layla , Harris Orlando O. , Johnstone Ethan , Heavner-Sullivan Smith , Propst Shantara K. 
Published: April 2021

Abstract
Sexual and gender minorities (SGMs) experience unique challenges when accessing sexuality and gender-affirming, safe health care services in the rural, southern United States. An identified gap in the literature is an intersectional, community-based approach to assessing the obstacles SGM individuals with intersecting identities experience when navigating comprehensive health services in rural southern communities in the United States; therefore, the present study used qualitative inquiry with an intersectional lens to describe these obstacles. The authors analyzed qualitative data from in-depth, semi-structured individual interviews with SGM individuals (N = 12). Common themes emerged that highlighted the compounding effects of the sociopolitical climate of the geographical area, religious attitudes toward SGMs, and the experience of racism. Findings of this study can inform health professions' academic curriculum, provider and support staff training, and implementation of policy that focuses on creating a diverse and inclusive health care delivery experience.
Myocardial injury in a pediatric patient with diabetic ketoacidosis
Authors: Shim Houn Joe , Yoo Byung Min , Jin Seon Mi , Kang Min Jae 
Published: April 2021

Abstract

Rationale:
Diabetic ketoacidosis (DKA) can cause several complications. Among them, cardiac complications are the most fatal and difficult to detect. Cardiac markers are prognostic factors for morbidity and mortality in adult patients with DKA. But, there have been very few discussed cases in pediatrics. We report a case of severe DKA in child with elevated cardiac enzymes and prolonged QT interval.

Patient concerns:
A 12-year-old girl admitted by nausea, vomiting, and lethargy for 1 day.

Diagnoses:
Her blood sugar level was initially undetectable by the capillary blood glucose meter, and blood gas analysis showed severe DKA with elevated cardiac enzymes and prolonged QT interval.

Interventions:
The patient was admitted to hospital and intensive intravenous fluid and regular insulin infusion were administered.

Outcomes:
After 5 days of supportive care, the patient was fully recovered, discharged, and followed up in an outpatient clinic.

Lessons:
Since the relationship between DKA and myocardial injury has not been clearly elucidated, pediatricians and emergency physicians should remain careful throughout the recovery time as it can lead to life-threatening conditions in various courses.
Clinical significance of apelin in the treatment of type 2 diabetic peripheral neuropathy
Authors: Xu Hua , Wang Qi , Wang Qian , Che Xuan Qiang , Liu Xue , Zhao Shumiao , Wang Shitao 
Published: April 2021

Abstract

Background:
Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes. As apelin is an adipocytokine closely associated with diabetes, this study explored the clinical significance of serum apelin levels in patients with type 2 DPN before and after treatment.

Methods:
In total, 44 patients with T2DM without DPN (non-DPN group), 41 patients with DPN who received antihyperglycemic treatment (DPN-A group), 44 patients with DPN who received antihyperglycemic treatment combined with nutritional neurotherapy (DPN-B group), and 40 healthy control individuals (NC group) were selected continuously enrolled in the present study. Enzyme-linked immunosorbent assays (ELISA) were performed to determine serum levels of apelin and tumor necrosis factor-α (TNF-α). Related apelin, fasting blood glucose (FBG), glycosylated hemoglobin A1c, TNF-α, body mass index, fasting C peptide, and nerve conduction velocity (NCV) were recorded in each group before and after treatment.

Results:
Serum levels of apelin and TNF-α were higher in patients with diabetes than those in the NC group, as well as in the DPN group as compared to the non-DPN group; furthermore, some NCV values were significantly reduced in the DPN group. After treatment, the serum levels of apelin, TNF-α, and FBG reduced in patients with diabetes; moreover, apelin levels were found significantly lower in the DPN-B group as compared to the DPN-A group, while some NCV values significantly increased in the DPN-B group. Apelin was negatively correlated with part of NCV values and positively correlated with TNF-α and FBG (P < .01).

Conclusion:
Our results show that the increase in serum apelin levels is an important clinical reference index for DPN, while a decrease indicates that the DPN treatment is effective.
Serum leptin level as a diagnostic and prognostic marker in infectious diseases and sepsis
Authors: Birlutiu Victoria , Boicean Loredana Camelia 
Published: April 2021

Abstract

Background:
Infections and sepsis are common causes of morbidity and mortality, with an increasing incidence worldwide. Leptin is involved in the inflammatory process and may modulate the cytokine production, immune cell proliferation and endothelial function. There are conflicting results regarding alterations of leptin levels in infectious diseases and the outcome from sepsis.
The aim of the current article is to provide an overview of the medical literature on the correlations between variations of leptin levels and infectious diseases and sepsis.

Methods:
We performed an extensive literature search in PubMed and Google Scholar databases, using keywords to identify articles related to leptin in infectious diseases and sepsis. Searches were referenced using medical subject headings that included “leptin,” “adipokines,” “sepsis,” “infectious diseases,” “leptin deficiency,” “leptin resistance” or “hyperleptinemia.” The language of publication, journal, or country were not included as limitation criteria.
Articles or abstracts containing adequate information, such as age, sex, anthropometric indices, clinical presentation, comorbidities, and management were included in the study, whereas articles with insufficient clinical and demographic data were excluded. We assessed the quality of the studies selected.
The final review of all databases was conducted on June 18, 2020.

Results:
We find the results from the current review to be of great importance due to the possible therapeutic role of leptin analogs in states of leptin deficiency associated with infectious diseases or sepsis.
In hyperleptinemia, a therapeutic plan for obtaining leptin neutralization also needs further investigations. This could lead to the reduction of proinflammatory responses.
There is a need for further studies to demonstrate the specificity and sensitivity of leptin in the early diagnosis of sepsis and the need to measure serum leptin levels in routine evaluation of the critical patient.

Conclusion:
The multiple effects of leptin are of growing interest, but further studies are needed to elucidate the role of leptin signalling in infectious diseases and sepsis. Because very few human studies are reported, we recommend the need for further research.
Better understanding of the pathophysiology of sepsis and the implication of circulating total leptin in this process could help physicians in managing this life-threatening condition.
Postrecurrence Survival After Liver Transplantation for Liver Metastases From Neuroendocrine Tumors
Authors: Sposito Carlo , Rossi Roberta Elisa , Monteleone Michela , Coppa Jorgelina , Bongini Marco , Milione Massimo , Bhoori Sherrie , Mazzaferro Vincenzo 
Published: April 2021

Background.
Liver metastases from neuroendocrine tumors (NETs) are an accepted indication for liver transplantation (LT). Despite strict patient selection, post-LT recurrence is observed in 30%–50% of cases. Postrecurrence survival is poorly investigated as well as factors influencing postrecurrence outcomes.

Methods.
Consecutive patients treated at a single institution for post-LT recurrence of NET between January 1, 2004, and December 31, 2018, were included. Baseline patients’ characteristics, data on the primary tumor, pretransplant therapies, posttransplant recurrence and treatments, and long-term outcomes were prospectively collected and retrospectively analyzed.

Results.
Thirty-two patients presented with post-LT NET recurrence occurring 82.9 mo (interquartile range, 29.4–119.1 mo) from LT, and the most common sites were abdominal lymph nodes (59.4%), peritoneum (6.3%), and lungs (6.3%). Fourteen patients (43.8%) underwent surgery with radical intent. Five- and 10-y survival after recurrence were 76.3% and 45.5%, respectively. Only time from LT to recurrence had a significant impact on postrecurrence survival, being 5-y overall survival 89.5% versus 0% for patients recurring >24 mo after LT versus ≤24 mo, respectively (P = 0.001). Moreover, for patients with Ki-67 monoclonal antibody staining >2% at recurrence, 5 y overall survival was 87.5% versus 0% for those undergoing surgery versus locoregional or systemic treatments (P = 0.011).

Conclusions.
The presented results, although based on a retrospective and relatively small series, show that excellent long-term survival is observed after post-LT NET recurrence, particularly in those patients recurring long after LT (>24 mo). An aggressive surgical treatment might result in a new chance of cure for a selected subgroup of patients.
Transcranial Direct Current Stimulation Electrode Montages May Differentially Impact Variables of Walking Performance in Individuals Poststroke: A Preliminary Study
Authors: Seamon Bryant A. , Bowden Mark G. , Kindred John H. , Embry Aaron E. , Kautz Steven A. 
Published: April 2021

Purpose:
Transcranial direct current stimulation (tDCS) has mixed effects on walking performance in individuals poststroke. This is likely the result of variations in tDCS electrode montages and individualized responses. The purpose of this study was to quantify the effects of a single session of tDCS using various electrode montages on poststroke walking performance.

Methods:
Individuals with chronic stroke (n = 16) participated in a double-blind, randomized cross-over study with sham stimulation and three tDCS electrode montages. Gait speed, paretic step ratio, and paretic propulsion were assessed prestimulation and poststimulation at self-selected and fastest comfortable speeds. Changes in muscle activation patterns with self-selected walking were quantified by the number of modules derived from nonnegative matrix factorization of EMG signals for hypothesis generation.

Results:
There was no significant effect of active stimulation montages compared with sham. Comparisons between each participant's best response to tDCS and sham show personalized tDCS may have a positive effect on fastest comfortable overground gait speed (P = 0.084), paretic step ratio (P = 0.095) and paretic propulsion (P = 0.090), and self-selected paretic step ratio (P = 0.012). Participants with two or three modules at baseline increased module number in response to the all experimental montages and sham, but responses were highly variable.

Conclusions:
A single session of tDCS may affect clinical and biomechanical walking performance, but effects seem to be dependent on individual response variability to different electrode montages. Findings of this study are consistent with responses to various tDCS electrode montages being the result of underlying neuropathology, and the authors recommend examining how individual factors affect responses to tDCS.
Long-Term Risk of Developing Dementia After Electroconvulsive Therapy for Affective Disorders
Authors: Hjerrild Simon , Kahlert Johnny , Buchholtz Poul-Erik , Rosenberg Raben , Videbech Poul 
Published: April 2021

Objectives
Severe depression is associated with an increased risk of developing dementia, however, whether treatment with electroconvulsive therapy (ECT) modify this risk remains unknown.

Methods
In this matched cohort study, 1089 consecutive in-patients with affective disorders, receiving ECT during the period 1982 to 2000, were matched with 3011 in-patients with affective disorders not treated with ECT (non-ECT), and 108,867 individuals randomly selected from the background population. The comparison cohorts were matched on sex, age, and the non-ECT cohort was further matched according to diagnoses and admission period and hospital. Dementia diagnoses were retrieved from the national patient health registry. Analyses were adjusted for disease severity, somatic, and psychiatric comorbidities.

Results
The cumulative incidence of dementia was 13.45% (10.75–16.46%) in the ECT cohort after 34 years of follow-up, 10.53% (8.5–12.81%) in the non-ECT cohort, and 8.43% (8.17–8.7%) in the background cohort. Using the ECT cohort as reference and age as the underlying time scale, the adjusted hazard ratio of developing dementia was 0.73 (0.52–1.04) in the non-ECT cohort and 0.61 (0.49–0.76) in the background cohort. The stratified analysis based on age at index (<65 years; 65–80 years; >80 years) found no age-related difference in the risk of developing dementia between the ECT cohort and non-ECT cohort.

Conclusions
The ECT treatment of affective disorders was not associated with an increased long-term risk of developing dementia compared with in-patients with affective disorders not treated with ECT.
Analysis of fragment ends in plasma DNA from patients with cancer
Authors: Budhraja Karan K. , McDonald Bradon R. , Stephens Michelle D. , Contente-Cuomo Tania , Markus Havell , Farooq Maria , Favaro Patricia F. , Connor Sydney , Byron Sara A. , Egan Jan B. , Ernst Brenda , McDaniel Timothy K. , Sekulic Aleksandar , Tran Nhan L. , Prados Michael D. , Borad Mitesh J. , Berens Michael E. , Pockaj Barbara A. , LoRusso Patricia M. , Bryce Alan , Trent Jeffrey M. , Murtaza Muhammed 
Published: April 2021

AbstractFragmentation patterns observed in plasma DNA reflect chromatin accessibility in contributing cells. Since DNA shed from cancer cells and blood cells may differ in fragmentation patterns, we investigated whether analysis of genomic positioning and nucleotide sequence at fragment ends can reveal the presence of tumor DNA in blood and aid cancer diagnostics. We analyzed whole genome sequencing data from >2700 plasma DNA samples including healthy individuals and patients with 11 different cancer types. We observed higher fractions of fragments with aberrantly positioned ends in patients with cancer, driven by contribution of tumor DNA into plasma. Genomewide analysis of fragment ends using machine learning showed overall area under the receiver operative characteristic curve of 0.96 for detection of cancer. Our findings remained robust with as few as 1 million fragments analyzed per sample, suggesting that analysis of fragment ends can become a cost-effective and accessible approach for cancer detection and monitoring.One-sentence summaryAnalyzing the positioning and nucleotide sequence at fragment ends in plasma DNA may enable cancer diagnostics.
Stimulation of vascular organoids with SARS-CoV-2 antigens increases endothelial permeability and regulates vasculopathy
Authors: Khan Abdullah O. , Reyat Jasmeet S. , Bourne Joshua H. , Colicchia Martina , Newby Maddy L. , Allen Joel D. , Crispin Max , Youd Esther , Murray Paul G. , Taylor Graham , Stamataki Zania , Richter Alex G. , Cunningham Adam F. , Pugh Matthew , Rayes Julie 
Published: April 2021

AbstractObjectiveThrombotic complications and vasculopathy have been extensively associated with severe COVID-19 infection, however the mechanisms by which endotheliitis is induced remain poorly understood. Here we investigate vascular permeability in the context of SARS-CoV-2-mediated endotheliitis in patient samples and a vascular organoid model.Methods and ResultsWe report the presence of the Spike glycoprotein in pericytes associated with pericyte activation and increased endothelial permeability in post-mortem COVID-19 lung autopsies. A pronounced decrease in the expression of the adhesion molecule VE-cadherin is observed in patients with thrombotic complications. Interestingly, fibrin-rich thrombi did not contain platelets, did not colocalize with tissue factor and have heterogenous levels of Von Willebrand factor, suggesting a biomarker-guided therapy might be required to target thrombosis in severe patients. Using a 3D vascular organoid model, we observe that ACE2 is primarily expressed in pericytes adjacent to vascular networks, consistent with patient data, indicating a preferential uptake of the S glycoprotein by these cells. Exposure of vascular organoids to SARS-CoV-2 or its antigens, recombinant trimeric Spike glycoprotein and Nucleocapsid protein, reduced endothelial cell and pericyte viability as well as CD144 expression with no additive effect upon endothelial activation via IL-1β.ConclusionsOur data suggest that pericyte uptake of SARS-CoV-2 or Spike glycoprotein contributes to vasculopathy by altering endothelial permeability increasing the risk of thrombotic complications.
A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL)
Authors: Setianingrum Findra , Rozaliyani Anna , Adawiyah Robiatul , Syam Ridhawati , Tugiran Mulyati , Sari Cut Yulia I. , Nandipinto Finny , Ramnath Johannes , Arifin Arief Riadi , Handayani Diah , Burhan Erlina , Rumende Martin C. , Wahyuningsih Retno , Rautemaa-Richardson Riina , Denning David W. 
Published: April 2021

AbstractObjectivesChronic pulmonary aspergillosis (CPA) can complicate recovery from pulmonary tuberculosis (TB). CPA may also be misdiagnosed as bacteriologically-negative TB. This study aimed to determine the incidence of CPA in patients treated for TB in Indonesia; a country with a high incidence of TB.MethodsIn this prospective, longitudinal cohort study in patients treated for pulmonary TB, clinical, radiological and laboratory findings were analysed. Sputum was collected for fungal culture and TB PCR. Patients were assessed at baseline (0-8 weeks) and at the end (5-6 months) of TB therapy. CPA diagnosis was based on symptoms (>3 months), characteristic radiological features and positive Aspergillus serology, and categorized as proven, probable and possible.ResultsOf the 216 patients recruited, 128 (59%) were followed up until end of TB therapy. At baseline, 91 (42%) had microbiological evidence for TB. Aspergillus-specific IgG was positive in 64 (30%) patients and went from negative to positive in 16 (13%) patients during TB therapy. The incidence of proven and probable CPA at baseline was 6% (n=12) and 2% (n=5) and end of TB therapy 8% (n=10) and 5% (n=7), respectively. Six patients (2 with confirmed TB) developed an aspergilloma. Diabetes mellitus was a significant risk factor for CPA (p=0.040). Persistent cough (n=5, 50%; p=0.005) and fatigue (n=6, 60%; p=0.001) were the most common symptoms in CPA.ConclusionCPA should be considered a relatively frequent differential diagnosis in patients with possible or proven TB in Indonesia. Lack of awareness and limited access to Aspergillus-specific IgG tests and CT imaging are obstacles in establishing a CPA diagnosis.Key messagesWhat is the key question?Do what extent is chronic pulmonary aspergillosis (CPA) both a) mistaken for TB and b) co-exists with TB during the course of 6 months therapyWhat is the bottom line?Features consistent with CPA were present in 6% of patients when starting TB therapy and 8% at the end of therapy, with some resolving and some developing CPA de novo during TB therapy. At the end of B therapy symptoms, cavitations with Aspergillus-specific IgG detectable were the key features of CPA.Why read on?Co-existence of TB and CPA is present in a substantial minority of patients starting and ending TB therapy, and needs addressing in terms of diagnosis, dual therapy and follow up.
Standardized genome-wide function prediction enables comparative functional genomics: a new application area for Gene Ontologies in plants
Authors: Fattel Leila , Psaroudakis Dennis , Yanarella Colleen F. , Chiteri Kevin O. , Dostalik Haley A. , Joshi Parnal , Starr Dollye C. , Vu Ha , Wimalanathan Kokulapalan , Lawrence-Dill Carolyn J. 
Published: April 2021

BackgroundGenome-wide gene function annotations are useful for hypothesis generation and for prioritizing candidate genes potentially responsible for phenotypes of interest. We functionally annotated the genes of 18 crop plant genomes across 14 species using the GOMAP pipeline.ResultsBy comparison to existing GO annotation datasets, GOMAP-generated datasets cover more genes, contain more GO terms, and produce datasets similar in quality (based on precision and recall metrics using existing gold standards as the basis for comparison). From there, we sought to determine whether the datasets across multiple species could be used together to carry out comparative functional genomics analyses in plants. To test the idea and as a proof of concept, we created dendrograms of functional relatedness based on terms assigned for all 18 genomes. These dendrograms were compared to well-established species-level evolutionary phylogenies to determine whether trees derived were in agreement with known evolutionary relationships, which they largely are. Where discrepancies were observed, we determined branch support based on jack-knifing then removed individual annotation sets by genome to identify the annotation sets causing unexpected relationships.ConclusionsGOMAP-derived functional annotations used together across multiple species generally retain sufficient biological signal to recover known phylogenetic relationships based on genome-wide functional similarities, indicating that comparative functional genomics across species based on GO data hold promise for generating novel hypotheses about comparative gene function and traits.
Ensemble of deep masked language models for effective named entity recognition in multi-domain corpora
Authors: Naderi Nona , Knafou Julien , Copara Jenny , Ruch Patrick , Teodoro Douglas 
Published: April 2021

AbstractThe health and life science domains are well known for their wealth of entities. These entities are presented as free text in large corpora, such as biomedical scientific and electronic health records. To enable the secondary use of these corpora and unlock their value, named entity recognition (NER) methods are proposed. Inspired by the success of deep masked language models, we present an ensemble approach for NER using these models. Results show statistically significant improvement of the ensemble models over baselines based on individual models in multiple domains - chemical, clinical and wet lab - and languages - English and French. The ensemble model achieves an overall performance of 79.2% macro F1-score, a 4.6 percentage point increase upon the baseline in multiple domains and languages. These results suggests that ensembles are a more effective strategy for tackling NER. We further perform a detailed analysis of their performance based on a set of entity properties.