bluuebunny/crossref_metadata_2025_split huggingface dataset:
P683 Patients with newly diagnosed fistulizing perianal Crohn’s disease have a distinct microbial signature
Authors: Goren I , Ian W , Reshef L , Sharar Fischler T , Pauker M , Silverman J , Dotan I , Yanai H 
Published: May 2021

Abstract

Background
Alterations in gut bacterial microbiota are strongly associated with the pathogenesis of Crohn’s disease (CD). Up to 1/3 of patients with CD have perianal involvement (P-CD), either fistulizing (f-P-CD) or non-fistulizing (nf-P-CD). We hypothesized that alterations in fecal microbiota might drive perianal CD phenotypes.

Methods
Patients with newly diagnosed treatment naive CD were consecutively recruited. Patients were stratified into f-P-CD and nf-P-CD, and compared with CD without perianal involvement (non-P-CD). Bacterial 16S rRNA gene sequencing was performed. Microbial dysbiosis index (MDI), Shannon diversity score (H) and log ratio between anaerobic and aerobic bacteria (anaerobic index, AI) were calculated. Linear discriminant analysis effect size (LEfSe) was used to identify specific taxa discriminating between different patient groups. Fecal calprotectin (FC) was measured.

Results
We included 97 CD patients (50 males, median age 28 [IQR 22–41] years). Other than perianal involvement patients in both groups had comparable distribution of CD location and phenotype. The microbial indices MDI, H and AI as well as FC levels, did not differ between the P-CD (n=25) and non-P-CD (n=72) groups. When compared to non-P-CD, the P-CD exhibited significantly lower relative abundance in the Streptococci genera (p=0.01) and in the Ruminiclostridium_5 genera (p=0.02). Within the P-CD group, patients with f-P-CD (n=12) had significantly lower H than those with nf-P-CD (means: 2.0 vs 2.45, p=0.045), while FC levels were comparable between f-P-CD and nf-P-CD. Moreover, proportions of Coprococcus_3 and Lacnoclostridium were reduced in patients with f-P-CD vs nf-P-CD (p= 0.008, p=0.05, respectively), while Streptococcus was elevated (p=0.03).

Conclusion
Perianal CD is a spectrum with distinct microbial alterations in different phenotypes. Microbial alterations correspond to the severity of perianal involvement. This finding may suggest that the microbiome has a mechanistic role in complicated perianal CD.
Toxicity of pathogenic ataxin-2 inDrosophilashows dependence on a pure CAG repeat sequence
Authors: McGurk Leeanne , Rifai Olivia M , Shcherbakova Oksana , Perlegos Alexandra E , Byrns China N , Carranza Faith R , Zhou Henry W , Kim Hyung-Jun , Zhu Yongqing , Bonini Nancy M 
Published: May 2021

AbstractSpinocerebellar ataxia type 2 is a polyglutamine (polyQ) disease associated with an expanded polyQ domain within the protein product of the ATXN2 gene. Interestingly, polyQ repeat expansions in ATXN2 are also associated with amyotrophic lateral sclerosis (ALS) and parkinsonism depending upon the length of the polyQ repeat expansion. The sequence encoding the polyQ repeat also varies with disease presentation: a pure CAG repeat is associated with SCA2, whereas the CAG repeat in ALS and parkinsonism is typically interrupted with the glutamine encoding CAA codon. Here, we asked if the purity of the CAG sequence encoding the polyQ repeat in ATXN2 could impact the toxicity of the ataxin-2 protein in vivo in Drosophila. We found that ataxin-2 encoded by a pure CAG repeat conferred toxicity in the retina and nervous system, whereas ataxin-2 encoded by a CAA-interrupted repeat or CAA-only repeat failed to confer toxicity, despite expression of the protein at similar levels. Furthermore, the CAG-encoded ataxin-2 protein aggregated in the fly eye, while ataxin-2 encoded by either a CAA/G or CAA repeat remained diffuse. The toxicity of the CAG-encoded ataxin-2 protein was also sensitive to the translation factor eIF4H, a known modifier of the toxic GGGGCC repeat in flies. These data indicate that ataxin-2 encoded by a pure CAG versus interrupted CAA/G polyQ repeat domain is associated with differential toxicity, indicating that mechanisms associated with the purity of the sequence of the polyQ domain contribute to disease.
Developing machine learning models to personalize care levels among emergency room patients for hospital admission
Authors: Nguyen Minh , Corbin Conor K , Eulalio Tiffany , Ostberg Nicolai P , Machiraju Gautam , Marafino Ben J , Baiocchi Michael , Rose Christian , Chen Jonathan H 
Published: May 2021

Abstract

Objective
To develop prediction models for intensive care unit (ICU) vs non-ICU level-of-care need within 24 hours of inpatient admission for emergency department (ED) patients using electronic health record data.

Materials and Methods
Using records of 41 654 ED visits to a tertiary academic center from 2015 to 2019, we tested 4 algorithms—feed-forward neural networks, regularized regression, random forests, and gradient-boosted trees—to predict ICU vs non-ICU level-of-care within 24 hours and at the 24th hour following admission. Simple-feature models included patient demographics, Emergency Severity Index (ESI), and vital sign summary. Complex-feature models added all vital signs, lab results, and counts of diagnosis, imaging, procedures, medications, and lab orders.

Results
The best-performing model, a gradient-boosted tree using a full feature set, achieved an AUROC of 0.88 (95%CI: 0.87–0.89) and AUPRC of 0.65 (95%CI: 0.63–0.68) for predicting ICU care need within 24 hours of admission. The logistic regression model using ESI achieved an AUROC of 0.67 (95%CI: 0.65–0.70) and AUPRC of 0.37 (95%CI: 0.35–0.40). Using a discrimination threshold, such as 0.6, the positive predictive value, negative predictive value, sensitivity, and specificity were 85%, 89%, 30%, and 99%, respectively. Vital signs were the most important predictors.

Discussion and Conclusions
Undertriaging admitted ED patients who subsequently require ICU care is common and associated with poorer outcomes. Machine learning models using readily available electronic health record data predict subsequent need for ICU admission with good discrimination, substantially better than the benchmarking ESI system. The results could be used in a multitiered clinical decision-support system to improve ED triage.
Daśanāmīsamādhisin West Bengal: Preliminary Observations
Authors: Hatcher Brian A 
Published: May 2021

AbstractThis essay provides a summary of research on the history and material legacy of a Daśanāmī monastic network established in modern Bengal. Centred on the pilgrimage centre of Tārakeśvar, at its peak this network area covered much of southwestern Bengal, integrating disparate temples and economic centres. The essay calls special attention to the role of samādhis (burial monuments) in anchoring Daśanāmī monasteries (maṭhas) in the local landscape and also illustrates the challenge of documenting sites when these material markers have deteriorated, vanished, or been renovated.
Dark Energy Survey Year 3 results: Curved-sky weak lensing mass map reconstruction
Authors: Jeffrey N , Gatti M , Chang C , Whiteway L , Demirbozan U , Kovacs A , Pollina G , Bacon D , Hamaus N , Kacprzak T , Lahav O , Lanusse F , Mawdsley B , Nadathur S , Starck J L , Vielzeuf P , Zeurcher D , Alarcon A , Amon A , Bechtol K , Bernstein G M , Campos A , Rosell A Carnero , Kind M Carrasco , Cawthon R , Chen R , Choi A , Cordero J , Davis C , DeRose J , Doux C , Drlica-Wagner A , Eckert K , Elsner F , Elvin-Poole J , Everett S , Ferté A , Giannini G , Gruen D , Gruendl R A , Harrison I , Hartley W G , Herner K , Huff E M , Huterer D , Kuropatkin N , Jarvis M , Leget P F , MacCrann N , McCullough J , Muir J , Myles J , Navarro-Alsina A , Pandey S , Prat J , Raveri M , Rollins R P , Ross A J , Rykoff E S , Sánchez C , Secco L F , Sevilla-Noarbe I , Sheldon E , Shin T , Troxel M A , Tutusaus I , Varga T N , Yanny B , Yin B , Zhang Y , Zuntz J , Abbott T M C , Aguena M , Allam S , Andrade-Oliveira F , Becker M R , Bertin E , Bhargava S , Brooks D , Burke D L , Carretero J , Castander F J , Conselice C , Costanzi M , Crocce M , da Costa L N , Pereira M E S , De Vicente J , Desai S , Diehl H T , Dietrich J P , Doel P , Ferrero I , Flaugher B , Fosalba P , García-Bellido J , Gaztanaga E , Gerdes D W , Giannantonio T , Gschwend J , Gutierrez G , Hinton S R , Hollowood D L , Hoyle B , Jain B , James D J , Lima M , Maia M A G , March M , Marshall J L , Melchior P , Menanteau F , Miquel R , Mohr J J , Morgan R , Ogando R L C , Palmese A , Paz-Chinchón F , Plazas A A , Rodriguez-Monroy M , Roodman A , Sanchez E , Scarpine V , Serrano S , Smith M , Soares-Santos M , Suchyta E , Tarle G , Thomas D , To C , Weller J ,   DES Collaboration
Published: May 2021

ABSTRACT
We present reconstructed convergence maps, mass maps, from the Dark Energy Survey (DES) third year (Y3) weak gravitational lensing data set. The mass maps are weighted projections of the density field (primarily dark matter) in the foreground of the observed galaxies. We use four reconstruction methods, each is a maximum a posteriori estimate with a different model for the prior probability of the map: Kaiser–Squires, null B-mode prior, Gaussian prior, and a sparsity prior. All methods are implemented on the celestial sphere to accommodate the large sky coverage of the DES Y3 data. We compare the methods using realistic ΛCDM simulations with mock data that are closely matched to the DES Y3 data. We quantify the performance of the methods at the map level and then apply the reconstruction methods to the DES Y3 data, performing tests for systematic error effects. The maps are compared with optical foreground cosmic-web structures and are used to evaluate the lensing signal from cosmic-void profiles. The recovered dark matter map covers the largest sky fraction of any galaxy weak lensing map to date.
Insights into xanthine riboswitch structure and metal ion-mediated ligand recognition
Authors: Xu Xiaochen , Egger Michaela , Chen Hao , Bartosik Karolina , Micura Ronald , Ren Aiming 
Published: May 2021

Abstract
Riboswitches are conserved functional domains in mRNA that mostly exist in bacteria. They regulate gene expression in response to varying concentrations of metabolites or metal ions. Recently, the NMT1 RNA motif has been identified to selectively bind xanthine and uric acid, respectively, both are involved in the metabolic pathway of purine degradation. Here, we report a crystal structure of this RNA bound to xanthine. Overall, the riboswitch exhibits a rod-like, continuously stacked fold composed of three stems and two internal junctions. The binding-pocket is determined by the highly conserved junctional sequence J1 between stem P1 and P2a, and engages a long-distance Watson–Crick base pair to junction J2. Xanthine inserts between a G–U pair from the major groove side and is sandwiched between base triples. Strikingly, a Mg2+ ion is inner-sphere coordinated to O6 of xanthine and a non-bridging oxygen of a backbone phosphate. Two further hydrated Mg2+ ions participate in extensive interactions between xanthine and the pocket. Our structure model is verified by ligand binding analysis to selected riboswitch mutants using isothermal titration calorimetry, and by fluorescence spectroscopic analysis of RNA folding using 2-aminopurine-modified variants. Together, our study highlights the principles of metal ion-mediated ligand recognition by the xanthine riboswitch.
U–Pb Dating of Apatite, Titanite and Zircon of the Kingash Mafic–Ultramafic Massif, Kan Terrane, Siberia: from Rodinia Break-up to the Reunion with the Siberian Craton
Authors: Marfin Alexander E , Radomskaya Tatiana A , Ivanov Alexei V , Kamenetsky Vadim S , Kamenetsky Maya B , Yakich Tamara Yu , Gertner Igor F , Kamo Sandra L , Ernst Richard E , Bryanskiy Nikolay V , Glazunov Oleg M , Belozerova Olga Yu 
Published: May 2021

Abstract
The initial stage of Rodinia supercontinent break-up occurred at about 750 Ma. It preceded formation of the Irkutsk and Franklin large igneous provinces (LIPs) at 712 ± 2 to 739 ± 8 Ma. These LIPs were emplaced within the formerly connected Laurentian and Siberian cratons. The Kingash massif is located in the Precambrian Kan terrane in direct contact with the Siberian Craton at its southwestern boundary. It has been linked to an important suite of mafic–ultramafic intrusions that border the southern margin of the Siberian craton, and that have been inferred to belong to the Irkutsk LIP. The massif is also significant, because it hosts platinum group element (PGE)–Cu–Ni-rich mineralization and is the only large deposit in the region. However, despite numerous dating attempts, the age of the massif had not been resolved. A significant difficulty is post-magmatic recrystallization at amphibolite facies that affected the rocks of the massif. In this study we used U–Pb dating of zircon, titanite and apatite from rocks of the Kingash massif and cross-cutting granite and monzonite veins. The oldest igneous zircon grain of the Kingash massif analysed by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) yields an age of c. 750 Ma, taken as a tentative age of magmatism. Dating of multiple grains of metamorphic zircon by chemical abrasion isotope dilution thermal ionization mass spectrometry yielded 564·8 ± 2·2 Ma, which is in agreement with LA-ICP-MS titanite ages of 557 ± 19, 565 ± 35 and 551 ± 17 Ma. Apatite of two different samples showed ages of 496·4 ± 7·9 and 497·0 ± 1·8 Ma (LA-ICP-MS), which are interpreted as the time when the terrane cooled below the closure temperature of apatite. Using our new data we suggest that at the time of the Irkutsk–Franklin LIP event the Kan terrane was a part of Rodinia, then it separated from either Siberia or Laurentia during the break-up of Rodinia and finally collided with Siberia at 560 Ma, the time of regional amphibole-facies metamorphism.
Reliability of Trigger Point Evaluation in the Lower Leg Muscles
Authors: Rozenfeld Evgeni , Strinkovsky Asia , Finestone Aharon S , Kalichman Leonid 
Published: May 2021

Abstract

Background
Myofascial trigger point diagnosis is a clinical palpatory skill dependent on the patient’s subjective response. The inter- and intra-rater reliability of trigger point physical evaluation in the lower leg muscles has rarely been reported. Previous reliability studies suffered from the Kappa paradox.

Objective
To evaluate the inter- and intra-rater reliability of trigger point recognition in the lower leg muscles implying a specific method to overcome the first Kappa paradox.

Design
A reliability study with pre-second examiner exclusion to correct prevalence index.

Setting
Physical therapy outpatient clinic, Beer-Sheva, Israel.

Subjects
In sum, 86 soldiers aged 18–30 referred for physical therapy with a diagnosis of musculoskeletal pain consented to take part in this study; 26 were excluded for lacking trigger points, leaving 60 subjects for analysis (31 women, 29 men).

Methods
Both legs were evaluated, and the results were analyzed separately for symptomatic (N = 87) and asymptomatic legs (N = 31). Each subject was evaluated three times, twice by one examiner, and once by a second examiner. Dichotomous findings including palpable taut-band, tenderness, referred pain, and relevance of referred pain were recorded.

Results
Inter-rater reliability for active trigger points ranged from 0.49 to 0.75 (median: 0.52) and intra-rater reliability ranged from 0.41 to 0.84 (median: 0.65) and. For total trigger points intra-rater reliability ranged from 0.52 to 0.79 (median: 0.67), and inter-rater reliability ranged from 0.44 to 0.77 (median: 0.66).

Conclusions
Physical examination is a reliable method of trigger point evaluation in lower leg muscles, and it can be used as a diagnostic method for trigger point evaluation.
The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence
Authors: Brondfield Sam , Blum Alexander Mario , Lee Kewchang , Linn Marcia C. , O’Sullivan Patricia S. 
Published: May 2021

Purpose
Fellows and residents provide inpatient consultations. Though consults vary considerably, measuring the associated cognitive load (CL) is key to guiding faculty on how to optimize learning during consults. However, existing CL instruments, such as the unidimensional Paas scale, cannot separate the 3 components of CL and may miss the nuances of consult CL. Therefore, the authors developed the Consult Cognitive Load (CCL) instrument to measure the 3 CL components during consults.

Method
In 2018–2019, the authors developed the CCL at the University of California, San Francisco, using Wilson’s constructive approach to measurement. To generate content and response process validity evidence, the authors consulted the literature and experts to generate construct maps, items, and a scoring rubric and conducted cognitive interviews. They administered the CCL to internal medicine and psychiatry trainees across 5 University of California campuses and used Rasch family and linear regression models to assess internal structure validity and relationships to key predictor variables. They compared the CCL with the Paas scale using Wright maps and used latent correlations to support separating CL into 3 components.

Results
Analysis revealed appropriate fit statistics, appropriate mean respondent location increases across all levels, threshold banding, and expected relationships with key predictor variables. The CCL provided more coverage of the 3 CL components compared with the Paas scale. Correlations among the 3 CL components were not strong, suggesting that the CCL offers more nuance than a unidimensional measure of CL in the context of consults.

Conclusions
This study generated initial validity evidence to support the CCL’s use as a measure of consult CL and supports measuring the 3 CL components separately rather than as a single construct in the context of consults. Learners and faculty could compare learner CCL scores with reference scores to promote reflection, metacognition, and coaching.
Efficacy and Safety of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Metabolic Associated Fatty Liver Disease
Authors: Jianping Wu , Xuelian Zheng , Anjiang Wang , Haiying Xiao 
Published: May 2021

Background:
Clinical trials examining the therapeutic benefits of glucagon-like peptide-1 receptor agonists (GLP-1RA) on patients with metabolic associated fatty liver disease (MAFLD) have reported inconsistent results. The aim of this meta-analysis was to verify the role of GLP-1RA in the treatment of MAFLD patients.

Materials and Methods:
We searched PubMed, Embase, Medline, and the Cochrane Library for randomized controlled trials published that compared GLP-1RA with the control treatment in patients with MAFLD till to July 30, 2020. The effects of GLP-1RA on liver histology, body mass index, waist circumference (WC), aspartate aminotransferase, total cholesterol, triglycerides (TG), low-density lipoprotein and high-density lipoprotein were evaluated.

Results:
Thirteen trials involving 704 patients were included in the meta-analysis. Compared with the control treatment, GLP-1RA treatment induced a greater resolution of steatohepatitis [RR=2.87; 95% confidence interval (CI): 0.89 to 9.23], delayed the progression of liver fibrosis (RR=3.83, 95% CI: 0.91 to 16.07) and reduced liver fat deposition (MD: −1.40; 95% CI: −2.75 to −0.05). In addition, it reduced the body mass index (MD: −1.15; 95% CI: −2.26 to −0.04), WC (MD: −3.33; 95% CI: −6.31 to −0.35) and improved serum aspartate aminotransferase (MD: −3.04; 95% CI: −5.93 to −0.16) and total cholesterol (MD: −0.20; 95% CI: −0.28 to −0.13).

Conclusion:
GLP-1RA improves liver steatosis and fibrosis. It is also beneficial to metabolic syndrome as it reduces BMI, WC, and hyperlipidemia.
Treatment options for managing obesity in chronic kidney disease
Authors: Parvathareddy Vishnu P. , Ella Krishiv M. , Shah Maulin , Navaneethan Sankar D. 
Published: May 2021

Purpose of review
Obesity is a risk factor for the development and progression of chronic kidney disease (CKD). In this review, we provide a comprehensive overview of various management options (lifestyle intervention, medications, and bariatric surgery) to address obesity in those with CKD.

Recent findings
Few clinical trials have examined the benefits of lifestyle modifications in those with preexisting CKD and suggest potential renal and cardiovascular benefits in this population. Yet, superiority of different dietary regimen to facilitate weight loss in CKD is unclear. Although medications could offer short-term benefits and assist weight loss, their safety and long-term benefits warrant further studies in this high-risk population. Observational studies report that bariatric procedures are associated with lower risk of end stage kidney disease. Clinicians should also recognize the higher risk of acute kidney injury, nephrolithiasis, and other complications noted with bariatric surgical procedures.

Summary
Lifestyle modifications and some weight loss medications may be recommended for facilitating weight loss in CKD. Referral to bariatric centers should be considered among morbidly obese adults with CKD.
Case Report: Management of Refractory Filamentary Keratitis with N-acetylcysteine
Authors: Crist Andrew J. 
Published: May 2021

SIGNIFICANCE
Filamentary keratitis is frequently a recurrent corneal condition characterized by the presence of filaments attached to the cornea. This condition can be challenging to manage because the clinician must treat the underlying cause and filament formation. N-acetylcysteine, a mucolytic agent, should be considered as adjunctive therapy to manage refractory cases.

PURPOSE
This case demonstrates the utility of a mucolytic agent, N-acetylcysteine, to treat and manage filamentary keratitis when conventional therapies failed to provide long-term symptomatic relief and reduction of further filament formation.

CASE REPORT
A 70-year-old man with recurrent filamentary keratitis (first occurrence 8 years prior) presented to the clinic with worsening red and painful eyes for 2 days. Prior treatment and management included artificial tears and ointments, punctal plugs, topical corticosteroids, contact lenses, and eyelid hygiene. Slit-lamp examination revealed multiple corneal filaments that were removed with forceps. He was diagnosed with recurrent filamentary keratitis secondary to dry eye disease and treated with preservative-free ophthalmic ointment, oral doxycycline, and 10% N-acetylcysteine ophthalmic solution. The patient had complete resolution of corneal filaments with significant relief of symptoms at 3-week, 5-month, and 10-month follow-up examinations.

CONCLUSIONS

N-acetylcysteine is not commercially available in an ophthalmic solution and must be compounded by a local pharmacist for patient use. Because filamentary keratitis can be challenging to manage because of frequent recurrences, addition of N-acetylcysteine to the treatment regimen should be considered a viable option in refractory cases when other therapies have failed to provide sustained symptomatic relief and resolution of filaments.