bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-Intensity Focused Ultrasound Combined With Gonadotropin-Releasing Hormone Agonist or Levonorgestrel-Releasing Intrauterine System in Treating Dysmenorrhea of Severe Adenomyosis
Authors: Xu Yaping , Zhou Zhan , Wang Haili , Shao Lin , Liu Guoyan 
Published: March 2021

Objective
The objective of this study was to investigate the efficacy of high-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone agonist or levonorgestrel-releasing intrauterine system (LNG-IUS) in treating dysmenorrhea in patients with severe adenomyosis.

Methods
A retrospective analysis was performed on 243 patients diagnosed with severe adenomyosis. Patients were divided into H (received HIFU alone), H-G (received HIFU combined with gonadotropin-releasing hormone agonist), and H-L (received HIFU combined with LNG-IUS) groups. Their clinical results were compared at 3 months, 6 months, and 12 months after treatment.

Results
The effective rates of dysmenorrhea relief in the 3 groups after 3 months were 95.24% in the H group, 98.8% in the H-G group, and 94.74% in the H-L group; those after 6 months were 88.10% in the H group, 95.18% in the H-G group, and 84.21% in the H-L group; those after 12 months were 77.38% in the H group, 79.52% in the H-G group, and 96.05% in the H-L group. There was significant difference in effective rates of dysmenorrhea relief among 3 groups after 12 months of treatment, but not 3 or 6 months. In addition, at 12 months after treatment, there were significant differences in the efficacy of dysmenorrhea between patients of different ages or different ablation rates in group H. However, there was no significant difference in the H-G group and the H-L group.

Conclusions
High-intensity focused ultrasound alone is effective in alleviating the symptoms of dysmenorrhea in short term. However, HIFU combined with LNG-IUS improves the therapeutic effect for a longer period.
Revisiting DCE-MRI
Authors: Breit Hanns C. , Block Tobias K. , Winkel David J. , Gehweiler Julian E. , Glessgen Carl G. , Seifert Helge , Wetterauer Christian , Boll Daniel T. , Heye Tobias J. 
Published: March 2021

Purpose
The aim of this study was to investigate the diagnostic value of descriptive prostate perfusion parameters derived from signal enhancement curves acquired using golden-angle radial sparse parallel dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with high spatiotemporal resolution in advanced, quantitative evaluation of prostate cancer compared with the usage of apparent diffusion coefficient (ADC) values.

Methods
A retrospective study (from January 2016 to July 2019) including 75 subjects (mean, 65 years; 46–80 years) with 2.5-second temporal resolution DCE-MRI and PIRADS 4 or 5 lesions was performed. Fifty-four subjects had biopsy-proven prostate cancer (Gleason 6, 15; Gleason 7, 20; Gleason 8, 13; Gleason 9, 6), whereas 21 subjects had negative MRI/ultrasound fusion-guided biopsies. Voxel-wise analysis of contrast signal enhancement was performed for all time points using custom-developed software, including automatic arterial input function detection. Seven descriptive parameter maps were calculated: normalized maximum signal intensity, time to start, time to maximum, time-to-maximum slope, and maximum slope with normalization on maximum signal and the arterial input function (SMN1, SMN2). The parameters were compared with ADC using multiparametric machine-learning models to determine classification accuracy. A Wilcoxon test was used for the hypothesis test and the Spearman coefficient for correlation.

Results
There were significant differences (P < 0.05) for all 7 DCE-derived parameters between the normal peripheral zone versus PIRADS 4 or 5 lesions and the biopsy-positive versus biopsy-negative lesions. Multiparametric analysis showed better performance when combining ADC + DCE as input (accuracy/sensitivity/specificity, 97%/93%/100%) relative to ADC alone (accuracy/sensitivity/specificity, 94%/95%/95%) and to DCE alone (accuracy/sensitivity/specificity, 78%/79%/77%) in differentiating the normal peripheral zone from PIRADS lesions, biopsy-positive versus biopsy-negative lesions (accuracy/sensitivity/specificity, 68%/33%/81%), and Gleason 6 versus ≥7 prostate cancer (accuracy/sensitivity/specificity, 69%/60%/72%).

Conclusions
Descriptive perfusion characteristics derived from high-resolution DCE-MRI using model-free computations show significant differences between normal and cancerous tissue but do not reach the accuracy achieved with solely ADC-based classification. Combining ADC with DCE-based input features improved classification accuracy for PIRADS lesions, discrimination of biopsy-positive versus biopsy-negative lesions, and differentiation between Gleason 6 versus Gleason ≥7 lesions.
Photon-Counting Multienergy Computed Tomography With Spectrally Optimized Contrast Media for Plaque Removal and Stenosis Assessment
Authors: Sartoretti Thomas , Eberhard Matthias , Nowak Tristan , Gutjahr Ralf , Jost Gregor , Pietsch Hubertus , Schmidt Bernhard , Flohr Thomas , Alkadhi Hatem , Euler André 
Published: March 2021

Purpose
The aim of this study was to systematically evaluate the potential to combine investigational contrast media with spectrally optimized energy-thresholding of photon-counting detector computed tomography (PCCT) for subtraction of calcified plaques in a coronary artery stenosis phantom.

Methods
A small vessel phantom containing 3 fillable tubes (diameter, 3 mm each) with calcified plaques was placed into an anthropomorphic chest phantom. The plaques had incremental thicknesses ranging from 0.3 to 2.7 mm, simulating vessel stenoses ranging from 10% to 90% of the lumen diameter. The phantom was filled with 5 different investigational contrast media (iodine, bismuth, hafnium, holmium, and tungsten) at equal mass concentrations (15 mg/mL) and was imaged on a prototype PCCT at 140 kVp using optimized, contrast media–dependent energy thresholds. Contrast maps (CMs) were reconstructed for each contrast medium by applying a linear 2-material decomposition algorithm. Image noise magnitude and noise texture of CM were compared among the contrast media using the noise power spectrum. Two blinded readers independently rated the vessel lumen visualization on short-axis and the overall subjective image quality on long-axis CM relative to iodine as the reference standard. Four readers determined the highest degree of stenosis that could be assessed with high diagnostic confidence on long-axis CM.

Results
Average image noise on CM was lower for tungsten (49 HU) and hafnium (62 HU) and higher for bismuth (81 HU) and holmium (165 HU) compared with iodine (78 HU). Noise texture of CM was similar among the contrast media. Interreader agreement for vessel lumen visualization on short-axis CM ranged from moderate to excellent (k = 0.567–0.814). Compared with iodine, lumen visualization of each reader was improved using tungsten (P < 0.001 for both readers), similar to improved using hafnium (P = 0.008, P = 0.29), similar using bismuth (P = 0.38, P = 0.69), and decreased using holmium (both, P < 0.001). Overall subjective image quality was similar for holmium and superior for tungsten, hafnium, and bismuth as compared with iodine. Higher-degree stenoses were evaluable with high confidence using tungsten (mean, 70%; interquartile range, 70%–70%), bismuth (70%; 60%–70%), and hafnium (75%; 70%–80%) compared with iodine (50%; 50%–60%) and holmium (50%; 50%–60%).

Conclusions
Spectral optimization in PCCT combined with investigational contrast media can improve calcium subtraction and stenosis assessment in small vessels. Contrast maps of tungsten and, to a lesser extent, hafnium as contrast media yielded superior image noise properties and improved vessel lumen visualization, along with a higher subjective image quality compared with the reference standard iodine.
Surgical Outcome of Pharyngocutaneous Fistula After Total Laryngectomy
Authors: Higashino Takuya , Oshima Azusa , Fukunaga Yutaka , Hayashi Ryuichi 
Published: March 2021

Background
The management of pharyngocutaneous fistula is challenging. We typically treat postlaryngectomy pharyngocutaneous fistulas with a pedicled pectoralis major flap transfer. This study analyzed the outcomes of our surgical treatments for pharyngocutaneous fistula to propose considerations for surgical strategies.

Methods
This retrospective review included all patients who underwent surgical repair of a postlaryngectomy pharyngocutaneous fistula at the National Cancer Center Hospital East in Kashiwa, Japan, from January 2005 to December 2019.

Results
The final analysis included 33 cases (median age, 71 years). Twenty-two cases had a history of radiotherapy to the head and neck region. Wound closures were performed with a pedicled pectoralis major musculocutaneous flap (n = 26) or pedicled pectoralis major muscle flap (n = 7). In 1 case, a deltopectoral flap was combined with the pectoralis major musculocutaneous flap. The median total operation time was 236 minutes, the median blood loss during surgery was 144 mL, and the median hospital stay after the reconstructive surgery was 39 days. Minor leakage occurred in 19 cases, and major leakage occurred in 2 cases. The fistula was finally cured successfully in 31 cases. We compared the outcomes in patients with leakage after surgical repair to those in patients without leakage after surgical repair to determine the risk factors for leakage after surgical repair of a pharyngocutaneous fistula. Five patients in the nonleakage group and 17 in the leakage group had a history of preoperative radiation (P = 0.052). The median preoperative blood values in the nonleakage and leakage groups were as follows: albumin, 3.6 and 3.2 g/dL (P = 0.061), and C-reactive protein, 2.36 and 6.77 mg/dL (P = 0.031), respectively. The time between the occurrence of the fistula and reconstructive surgery was 32 and 9 days in the nonleakage and leakage groups, respectively (P = 0.009).

Conclusions
Our surgical treatment for postlaryngectomy pharyngocutaneous fistula succeeded in 31 of 33 cases (94%). This study demonstrated that pedicled pectoralis major flap transfer is useful for the treatment of postlaryngectomy pharyngocutaneous fistula.
Evaluating thunderclap headache
Authors: Chen Chun-Yu , Fuh Jong-Ling 
Published: March 2021

Purpose of review
Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH.

Recent findings
The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. Additionally, the updated guideline recommends that after a negative brain CT, CT angiogram is a reasonable alternative to lumbar puncture if clinical suspicion of an intracranial source of SAH is high. An important update of reversible vasoconstriction syndrome (RCVS), the second most common etiology of TCH, is the RCVS2 score development based on clinical and radiological features, providing high specificity and sensitivity for distinguishing RCVS from other intracranial arteriopathies.

Summary
Although the evaluation of TCH is exhaustive, the potentially catastrophic consequence of a missed diagnosis of sentinel headache justifies the efforts. Awareness of the clinical features and application of diagnostic tools specific for different pathological conditions can facilitate the diagnostic workup.
Early multiple sclerosis: diagnostic challenges in clinically and radiologically isolated syndrome patients
Authors: Calabrese Massimiliano , Marastoni Damiano , Crescenzo Francesco , Scalfari Antonio 
Published: March 2021

Purpose of review
With the introduction of new diagnostic criteria, the sensibility for multiple sclerosis (MS) diagnosis increased and the number of cases with the clinically isolated syndrome (CIS) decreased. Nevertheless, a misdiagnosis might always be around the corner, and the exclusion of a ‘better explanation’ is mandatory.
There is a pressing need to provide an update on the main prognostic factors that increase the risk of conversion from CIS or from radiologically isolated syndrome (RIS) to MS, and on the potential ‘red flags’ to consider during the diagnostic workup.

Recent findings
We discuss diagnostic challenges when facing patients presenting with a first demyelinating attack or with a RIS, with a focus on recently revised diagnostic criteria, on other neuroinflammatory conditions to be considered in the differential diagnosis and on factors distinguishing patients at risk of developing MS.
A correct definition of a ‘typical’ demyelinating attack, as well as a correct interpretation of MRI findings, remains crucial in the diagnostic process. The cerebrospinal fluid examination is warmly recommended to confirm the dissemination in time of the demyelinating process and to increase the diagnostic accuracy.

Summary
An early and accurate diagnosis of MS requires careful consideration of all clinical, paraclinical and radiological data, as well the reliable exclusion of other mimicking pathological conditions. This is advocated to promptly initiate an appropriate disease-modifying therapy, which can impact positively on the long-term outcome of the disease.
Facial pain beyond trigeminal neuralgia
Authors: May Arne , Hoffmann Jan 
Published: March 2021

Purpose of review
Trigeminal neuralgia is a well-known facial pain syndrome with several treatment options. In contrast, non-neuralgiform idiopathic facial pain syndromes are relatively rare, reflected by the fact that, until 2020, no internationally accepted diagnostic classification existed. Like trigeminal neuralgia, these non-dental facial pain syndromes need to be managed by neurologists and pain specialists, but the lack of pathophysiological understanding has resulted in an underrepresented and undertreated patient group.

Recent findings
This work provides a brief overview of the most common primary facial pain syndromes, namely, the facial attack-like facial pain, which corresponds to attack-like headache, the persistent idiopathic facial pain (formerly ‘atypical facial pain’), and trigeminal neuropathy. What these disorders have in common is that they should all be treated conservatively.

Summary
On the basis of pragmatic classifications, permanent and attack-like primary facial pain can be relatively easily differentiated from one another. The introduction of the new International Classification of Orofacial Pain offers the opportunity to better coordinate and concentrate scientific efforts, so that in the future the therapy strategies that are still inadequate, can be optimized.
Electroconvulsive Therapy Use in Psychiatric Hospitalizations in Portugal
Authors: Mota Pedro , Gonçalves-Pinho Manuel , Ribeiro João Pedro , Macedo Silvério , Freitas Alberto , Mota Jorge 
Published: March 2021

Objectives
The primary aim of this study was to describe a Portuguese nationwide epidemiological perspective on the use of electroconvulsive therapy (ECT) in hospitalized psychiatric patients. The secondary aims of the study were to characterize clinical and sociodemographic trends of hospitalized patients treated with ECT.

Methods
A retrospective-observational study was conducted using an administrative database gathering every registered Portuguese public hospital hospitalizations from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 (Other electroshock therapy) defined by the International Classification of Diseases version 9, Clinical Modification. Variables included birth date, sex, address, primary and secondary diagnoses, admission/discharge date, length of stay, and discharge status from each single hospitalization episode. We also calculated Portugal's inpatient ECT prevalence rate (iP%).

Results
There were a total of 879 registered hospitalizations with ECT within the 8-year period of this study. Most occurred in female patients (53.4%), belonging to the age group of 51 to 70 years old, with a mean age of 50.5 years. The median length of stay was 43.0 days with an interquartile range of 27.0 to 68.0. The most frequent primary diagnosis was major depressive disorder, recurrent episode, representing 19.6% of all hospitalizations. The iP% for the study period was 0.71%.

Conclusions
In Portugal, most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. Portugal's iP% represents a low rate when compared with other European countries, which might indicate an underutilization of ECT in Portuguese psychiatric hospitals.
De novoassembly of 64 haplotype-resolved human genomes of diverse ancestry and integrated analysis of structural variation
Authors: Ebert Peter , Audano Peter A. , Zhu Qihui , Rodriguez-Martin Bernardo , Porubsky David , Bonder Marc Jan , Sulovari Arvis , Ebler Jana , Zhou Weichen , Mari Rebecca Serra , Yilmaz Feyza , Zhao Xuefang , Hsieh PingHsun , Lee Joyce , Kumar Sushant , Lin Jiadong , Rausch Tobias , Chen Yu , Ren Jingwen , Santamarina Martin , Höps Wolfram , Ashraf Hufsah , Chuang Nelson T. , Yang Xiaofei , Munson Katherine M. , Lewis Alexandra P. , Fairley Susan , Tallon Luke J. , Clarke Wayne E. , Basile Anna O. , Byrska-Bishop Marta , Corvelo André , Chaisson Mark J.P. , Chen Junjie , Li Chong , Brand Harrison , Wenger Aaron M. , Ghareghani Maryam , Harvey William T. , Raeder Benjamin , Hasenfeld Patrick , Regier Allison , Abel Haley , Hall Ira , Flicek Paul , Stegle Oliver , Gerstein Mark B. , Tubio Jose M.C. , Mu Zepeng , Li Yang I. , Shi Xinghua , Hastie Alex R. , Ye Kai , Chong Zechen , Sanders Ashley D. , Zody Michael C. , Talkowski Michael E. , Mills Ryan E. , Devine Scott E. , Lee Charles , Korbel Jan O. , Marschall Tobias , Eichler Evan E. 
Published: March 2021

AbstractLong-read and strand-specific sequencing technologies together facilitate thede novoassembly of high-quality haplotype-resolved human genomes without parent–child trio data. We present 64 assembled haplotypes from 32 diverse human genomes. These highly contiguous haplotype assemblies (average contig N50: 26 Mbp) integrate all forms of genetic variation across even complex loci such as the major histocompatibility complex. We focus on 107,590 structural variants (SVs), of which 68% are inaccessible by short-read sequencing. We identify new SV hotspots (spanning megabases of gene-rich sequence), characterize 130 of the most active mobile element source elements, and find that 63% of all SVs arise by homology-mediated mechanisms—a twofold increase from previous studies. Our resource now enables reliable graph-based genotyping from short reads of up to 50,340 SVs, resulting in the identification of 1,525 expression quantitative trait loci (SV-eQTLs) as well as SV candidates for adaptive selection within the human population.
Resilience through diversity: Loss of neuronal heterogeneity in epileptogenic human tissue impairs network resilience to sudden changes in synchrony
Authors: Rich Scott , Chameh Homeira Moradi , Lefebvre Jeremie , Valiante Taufik A 
Published: March 2021

AbstractA myriad of pathological changes associated with epilepsy can be recast as decreases in cell and circuit heterogeneity. We thus propose recontextualizing epileptogenesis as a process where reduction in cellular heterogeneity in part, renders neural circuits less resilient to seizure. By comparing patch clamp recordings from human layer 5 (L5) cortical pyramidal neurons from epileptogenic and non-epileptogenic tissue, we demonstrate significantly decreased biophysical heterogeneity in seizure generating areas. Implemented computationally, this renders model neural circuits prone to sudden transitions into synchronous states with increased firing activity, paralleling ictogenesis. This computational work also explains the surprising finding of significantly decreased excitability in the population activation functions of neurons from epileptogenic tissue. Finally, mathematical analyses reveal a unique bifurcation structure arising only with low heterogeneity and associated with seizure-like dynamics. Taken together, this work provides experimental, computational, and mathematical support for the theory that ictogenic dynamics accompany a reduction in biophysical heterogeneity.
Exploring bacterial diversity via a curated and searchable snapshot of archived DNA sequences
Authors: Blackwell Grace A. , Hunt Martin , Malone Kerri M. , Lima Leandro , Horesh Gal , Alako Blaise T.F. , Thomson Nicholas R , Iqbal Zamin 
Published: March 2021

ABSTRACTThe open sharing of genomic data provides an incredibly rich resource for the study of bacterial evolution and function, and even anthropogenic activities such as the widespread use of antimicrobials. Whilst these archives are rich in data, considerable processing is required before biological questions can be addressed. Here, we assembled and characterised 661,405 bacterial genomes using a uniform standardised approach, retrieved from the European Nucleotide Archive (ENA) in November of 2018. A searchable COBS index has been produced, facilitating the easy interrogation of the entire dataset for a specific gene or mutation. Additional MinHash and pp-sketch indices support genome-wide comparisons and estimations of genomic distance. An analysis on this scale revealed the uneven species composition in the ENA/public databases, with just 20 of the total 2,336 species making up 90% of the genomes. The over-represented species tend to be acute/common human pathogens. This aligns with research priorities at different levels from individuals with targeted but focused research questions, areas of focus for the funding bodies or national public health agencies, to those identified globally as priority pathogens by the WHO for their resistance to front and last line antimicrobials. Understanding the actual and potential biases in bacterial diversity depicted in this snapshot, and hence within the data being submitted to the public sequencing archives, is essential if we are to target and fill gaps in our understanding of the bacterial kingdom.