bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double Take on Double Vision: Invasive Rhinosinusitis From Blastomyces dermatitidis in an Adolescent With Well-Controlled Diabetes
Authors: Dimo Joana , Hall Jaimee , Parran Krista , Mitchell Michelle , Zhu Frank 
Published: November 2021

Abstract
Blastomyces dermatitidis is a fungus endemic to the Ohio and Mississippi river valley region and great lakes region. Exposure is typically associated with outdoor activities near streams, rivers, or moist soil. Pulmonary disease is the main manifestation, whereas dissemination is more frequently observed in immunosuppressed individuals. We herein report an uncommon case of B. dermatitidis causing invasive fungal sinusitis in a patient with well-controlled type 2 diabetes mellitus in the absence of conventional higher-risk environmental exposures. This case highlights the importance of a broad differential for invasive fungal infections in patients with diabetes, including those in endemic areas without classical exposures.
Embolic MCA Stroke Treated With tPA and TICI-3 Mechanical Thrombectomy Complicated by Hemiballismus: A Case Study and Literature Review
Authors: Tatum Peter S , Kornbluth Joshua , Soroka Andrew 
Published: November 2021

ABSTRACT
This report examines the etiology of hemiballistic movements that began 24 hours after a 63-year-old male with vascular risk factors received tissue plasminogen activator (tPa) and thrombolysis in cerebral ischemia 3 (TICI3) thrombectomy for a left middle cerebral artery (MCA) ischemic stroke. The clinical course was reviewed from an admission at a large academic institution where assessments included physical exams, head and neck computed tomography angiography (CTA), and head magnetic resonance imaging (MRI) without contrast. The patient’s initial physical exam was consistent with a left MCA syndrome and included a National Institute of Health Stroke Scale (NIHSS) of 20. CTA showed an embolic M2 occlusion. After tPA and TICI 3 thrombectomy, NIHSS improved to 3 for dysarthria, facial weakness, and language deficits. MRI showed left insular diffusion restriction. New right-sided hemiballistic movements began 24 hours after treatment. At his six-week follow-up outpatient appointment, the movements were no longer present, and his neurologic exam was unremarkable, including an NIHSS of zero. No prior cases of hemiballism have been reported as a likely complication of treatment with tPa and thrombectomy. The globus pallidus is the suspected origin of the ballistic movements either from a decreased insular signal or embolic event during treatment. As stroke interventions improve, the susceptibility of certain tissues to brief ischemic events during treatment must be assessed.
Development of a Critical Care Air Transport Team “Go Bag”: Slimming Down ICU Capability to Augment Pararescue or Civilian Contract Medical Evacuation Personnel
Authors: Nowadly Craig D , Foley Kyle E , Davis Maxwell L , Hebert Erik J , Corey Gabe A 
Published: November 2021

ABSTRACT

Introduction
Critical Care Air Transport Team (CCATT) is a three-person United States Air Force (USAF) medical asset, typically providing intercontinental medical evacuation on large military aircraft. The CCATT equipment Allowance Standard (AS) weighs approximately 272 kg (600 lbs). In austere locations, CCATT teams may augment contract medical evacuation (CME) personnel or Pararescue (PJ) in small aircraft with limited space for medical equipment. It was unknown what deployed PJ and CME carry within their packouts. We sought to design a packout or “Go Bag,” weighing less than 22.7 kg (50 lbs) and sourced from the CCATT AS, that a CCATT member could use to complement CME or PJ equipment to provide a higher level of care while limiting redundancy.

Materials and Methods
Equipment lists were obtained from a CME and PJs from two separate USAF squadrons. The equipment lists were combined to provide a reference for development of a CCATT Go Bag. Three members of a deployed CCATT team independently generated a list of necessary equipment from the CCATT AS. The list was peer reviewed by a separate, deployed CCATT team.

Results
A Go Bag was developed with the supplies and equipment necessary for video laryngoscopy, ventilation, invasive pressure monitoring, basic laboratory capability, chest tube placement, ultrasound, and advanced pharmacologic interventions. The Go Bag weighed 18.3 kg (40.4 lbs). A separate respiratory bag weighing 1.1 kg (2.4 lbs) was attached directly to a ventilator. Intravenous pumps and cardiac monitoring equipment were notable ICU equipment excluded from the Go Bag.

Conclusion
Major components of the CCATT AS can be reduced into a Go Bag and accompanying Ventilator Accessory Bag. This may benefit CCATT teams required to augment PJs or CME in small aircraft during prolonged field care scenarios.
Vela pulsar: single pulses analysis with machine learning techniques
Authors: Lousto Carlos O , Missel Ryan , Prajapati Harshkumar , Sosa Fiscella Valentina , Armengol Federico G López , Gyawali Prashnna Kumar , Wang Linwei , Cahill Nathan D , Combi Luciano , Palacio Santiago del , Combi Jorge A , Gancio Guillermo , García Federico , Gutiérrez Eduardo M , Hauscarriaga Fernando 
Published: November 2021

ABSTRACT
We study individual pulses of Vela (PSR B0833−45/J0835−4510) from daily observations of over 3 h (around 120 000 pulses per observation), performed simultaneously with the two radio telescopes at the Argentine Institute of Radioastronomy. We select four days of observations in 2021 January to March and study their statistical properties with machine learning techniques. We first use Density-Based Spatial Clustering of Applications with Noise clustering techniques, associating pulses mainly by amplitudes, and find a correlation between higher amplitudes and earlier arrival times. We also find a weaker (polarization dependent) correlation with the mean width of the pulses. We identify clusters of the so-called mini-giant pulses, with ∼10 times the average pulse amplitude. We then perform an independent study, with Self-Organizing Maps (SOM) clustering techniques. We use Variational AutoEncoder (VAE) reconstruction of the pulses to separate them clearly from the noise and select one of the days of observation to train VAE and apply it to the rest of the observations. We use SOM to determine four clusters of pulses per day per radio telescope and conclude that our main results are robust and self-consistent. These results support models for emitting regions at different heights (separated each by roughly a hundred km) in the pulsar magnetosphere. We also model the pulses amplitude distribution with interstellar scintillation patterns at the inter-pulses time-scale finding a characterizing exponent nISS ∼ 7–10. In the appendices, we discuss independent checks of hardware systematics with the simultaneous use of the two radio telescopes in different one-polarization/two-polarizations configurations. We also provide a detailed analysis of the processes of radio-interferences cleaning and individual pulse folding.
Brexit and UK higher education
Authors: Mayhew Ken 
Published: November 2021

Abstract
The Brexit vote in 2016 caused consternation in higher education circles. Financial and reputational questions were raised concerning: the number of students from EU countries coming to study in the UK; the ability of the sector to retain and recruit staff from the EU; the threats to research funding; and the ability of UK students to study abroad. This paper tracks developments since then. Much remains uncertain and the picture has been complicated by the impact of Covid-19. Though enrolments of EU citizens for the 2021–22 academic year have fallen dramatically, this has been more than offset by larger numbers of UK entrants and entrants from non-EU countries. The main immediate threat is to research funding, partly because of restricted access to EU programmes and partly because of constrained government spending. The longer-term threat is to the sector’s relationship with European academia.
P011 Radiological pattern in juvenile onset Spondylarthritis differ from the adult onset spondylarthritis
Authors: Ferjani Hanene , Yasmine Makhlouf , Maatallah Kaouther , Ben Nessib Dorra , Triki Wafa , Kaffel Dhia , Hamdi Wafa 
Published: November 2021

Abstract

Background
Spondylarthritis (SpA) is a chronic inflammatory disease of the axial spine that may be affect the peripheral joints. SpA occurs predominantly in adulthood: Adult onset Ankylosing Spondylitis (AoAS). However, it can occur earlier in childhood (≤16 years old), also termed as juvenile onset Ankylosing Spondylitis (JoAS). In the second group, delay in diagnosis may lead to further structural damage. The aim of our study was to compare the differences in radiographic features between JoAS and AoAS.

Methods
We conducted a retrospective study in our department of rheumatology of Kassab Institute of orthopedics, including patients diagnosed with SpA according to the ASAS criteria (≥17 years at symptom onset) or to the ILAR criteria (≤16 years at symptom onset). Were not included AS patients whose disease onset was ≥ 45 years. Sociodemographic as well as disease characteristics were recorded. The lateral cervical and lumbar spine radiographs were used to assess structural damage by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and The Bath Ankylosing Radiologic Index (BASRI). The total score of mSASSS and BASRI vary between 0–72 and 0–16 respectively with higher scores indicating evolved structural damage. Radiographic features were then compared between AoAS and JoAS. The level of significance was fixed for a P &lt; 0.05.

Results
Of 140 AS patients, 40 had JoAS and 100 had AoAS. The average age at disease onset was 12.4 ± 3 [8–16] and 25.4 ± 10.1 [17–42] respectively (P &lt; 0.001). The disease duration was 10.6 years [1–44]. The average current age was 25.3 ± 10.2 [9–59] and 32.5 ± 7.5 [18–46] (P &lt; 0.001). The JoAS group showed a more frequent onset with peripheral joint involvement than the AoAS group (80% vs 50%,P = 0.001). Similarly, hip involvement was more frequent among JoAS patients (57.7% vs 25%, P = 0.000). There was no significant differences between the two groups regarding the mean mSASSS score, the total BASRI score and the BASRI score for the sacroiliac joints (P = 0.9, P = 0.49, P = 0.06 respectively). Similarly, there was no differences in the mean spine BASRI score between the two groups, although there was a trend of higher scores among AoAS patients (3.2 vs 3.9, P = 0.15 respectively). On the contrary, JoAS patients had a significantly higher BASRI score for the hip than AoAS patients (2.4 vs 1.3, P = 0.000).

Conclusion
Our study showed that JoAS patients are more likely to suffer from early hip damage than AoAS patients. The spine BASRI was similar between the two groups despite the shorter disease duration in the juvenile group. This highlights the need for screening for hip involvement and for a closer monitoring in this subset of children.
P012 An HLA Typing for every JIA?
Authors: Boutrid N , Rahmoune H , Boutrid H , Bioud B , Madani M , Amrane M 
Published: November 2021

Abstract

Background
Among the genetic susceptibility factors of Juvenile Idiopathic Arthritis (JIA), the HLA class I and II genes are the most frequently involved. These HLA genes are extensively investigated, highlighting the role of self/non-self-balance in auto-immune and auto-inflammatory diseases.

Methods
We carried out a retrospective study of HLA class I and/or class II genes (HLA B and HLA DR genes) of 12 children.
Genotyping was performed through microlymphocytotoxicity for class I (HLA B5 and B27) and through indirect immunofluorescence and PCR for class II (HLA DR4)

Results
The summarized results depict:
4 patients have the HLA B27 +
3 patients have the HLA B5+
1 patient had the HLA DR
JIA comprises a broad spectrum influenced by both genetic and environmental factors. The International League of Rheumatology Associations (ILAR) has defined seven categories of JIA consisting of a myriad of pediatric auto-immune and auto-inflammatory diseases.
The HLA genomic region is also associated with a wide range of auto-immune diseases, encoding the HLA-DR, HLA-DQ, and HLA-DP proteins involved in the peptide’s presentations to HLA -class II-restricted CD4 + helper T cells. These mechanisms are involved in the pathogenesis of various diseases such as rheumatoid arthritis.
Juvenile arthritis has also been associated with a single nucleotide polymorphism in the regulatory region of the interleukin-6 gene, close to the HLA coding region.

Conclusion
Genetic exploration of the HLA system in JIA, more accessible and less expensive than other targeted genetic typing, can be a helpful tool. Its usage ought to be encouraged and expanded in clinical practice.
P014 Use of prosthetic surgery in Juvenile Idiopathic Arthritis
Authors: Miladi S , El Mabrouk Y , Fazaa A , Souabni L , Ouenniche K , Kassab S , Chekili S , Ben Abdelghani K , Laatar A 
Published: November 2021

Abstract

Background
Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory rheumatism in childhood characterized by destructive potential. The involvement of weight-bearing joints constitutes an evolutionary turning point in the course of the disease, which may be responsible for a major functional handicap. In this context, arthroplasty constitutes a therapeutic alternative. Through this study, we aimed to determine the prevalence of the prosthetic surgery and its benefits in children with JIA.

Methods
This is a retrospective study of JIA patients. The diagnosis of JIA was selected according to ILAR criteria. All the patients included were followed for a minimum of 1 year. The parameters collected were: pain VAS, HAQ, Lequesnealgofunctional index (AFI), disease activity scores and mobility of the operated joint before and 6 months after surgery.

Results
Forty -four JIA patients were followed over an average period of 14 years (minimum of 1 year). The mean age of disease onset was 9 years [1.5–16 years]. Fifteen cases of coxitis (34%) and 4 cases of destruction of the knees (9%) were noted after an average course of the disease of 8 years [6 months–19 years]. Radiologically, coxofemoral ankylosis is reported in 6 cases, acetabular protrusion in 2 others and total destruction of the knee with misalignment in 2 cases. Eight patients required hip replacement surgery and 2 knee cases. In all cases, the hip prostheses were bilateral. Only one knee prosthesis was placed. The JIA subtype was rheumatoid factor seronegative polyarthritis in 5 cases and enthesitis related arthritis in 3 cases. Six months after surgery, the average AFI dropped from 15.4–4.5; the pain VAS from 73 mm to 50 mm and the HAQ from 2.5–1.06. In the polyarticular JIA, the DAS28 composite score decreased from 4.02–3.8 and in ERA patients the BASDAI decreased from 6.5–4.25 while BASFI remained stable. Recovery of joint mobility was partial in only one case. No immediate or late postoperative complications were noted.

Conclusion
Prosthetic surgery provided improvement in disease activity and recovery of gait pattern in children with severe JIA. However, the decision of an arthroplasty remains delicate in children, especially since this intervention can compromise the stature growth.
P015 Imaging findings in cervical spine in patients with Juvenile Idiopathic Arthritis in Tunisia
Authors: Bettaieb Hiba , Ferjani Hanene , Maatallah Kaouther , Ben Nessib Dorra , Triki Wafa , Kaffel Dhia , Hamdi Wafa 
Published: November 2021

Abstract

Background
Juvenile Idiopathic Arthritis (JIA) is a chronic disease characterized by prolonged synovial inflammation that may cause structural joint damage. However, little is known about cervical spine involvement in JIA. The main objective of this study is to describe radiological findings of the cervical spine in patients with JIA.

Methods
We conduct a retrospective monocentric study. All JIA patients were included (ILAR criteria). Sociodemographic, JIA subtype, and clinical characteristics were collected. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis-related enthesitis form. Cervical spine radiographs including anteroposterior and lateral with flexion views were analyzed. A p-value &lt; 0.05 was considered significant.

Results
We included 25 patients (16 girls and 9 boys) diagnosed with JIA with a mean age at disease onset of 9.9 ± 3.9 [3–16]. The median disease duration was 36 months (IQR 25–75%; 30–84). The JIA subtypes were in decreasing order of frequency: Enthesitis-related Arthritis (n = 9), Oligoarticular (n = 6), Polyarticular RF- (n = 4), Polyarticular RF + (n = 2), Systemic (n = 2), Psoriatic Arthritis (n = 1), and Undifferentiated (n = 1).
Median ESR and CRP were 17 mm/h [2–98] and 15.4 mg/l [0–56] respectively. The Median BASDAI score was 2.8 [1–6.3]. Median JADAS10 score was 5.3 [0–20]. Four patients (16%) were on long-term corticosteroid therapy.
Five patients (20 %) have a cervical spine involvement with the following subtypes: Polyarticular (n = 2), enthesitisenthesitis-related arthritis (n = 2), and systemic (n = 1). Clinical manifestations were neck pain (n = 3) and limited range of motion (n = 4). Neurological examination noted brisk deep tendon reflexes (n = 6), positive Babinski reflex (n = 1) and positive Hoffmann reflex (n = 2). No patient had a neurological deficit.
The conventional radiographs of the cervical spine showed: loss of cervical lordosis (n = 2), diastasis C1-C2 (n = 3), erosion of the odontoid process (n = 1), and anterior ankylosis (n = 3). Subsequent cervical spine MRI confirmed these findings and showed pannus at the craniocervical junction in one case and block vertebra of C6-C7 in another case. Atlanto-axial subluxation was anteroposterior in 3 patients and rotatory in one.

Conclusion
Cervical spine involvement is frequent and underestimated in JIA, and its radiological features are various. Hence, regular radiographic monitoring of the cervical spine is required to prevent the development of this complication.
P017 Complications of Juvenile Idiopathic Arthritis
Authors: Miladi S , Bouzid S , Fazaa A , Souabni L , Sellami M , Ouenniche K , Kassab S , Chekili S , Ben Abdelghani K , Laatar A 
Published: November 2021

Abstract

Background
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by onset before the age of 16. This term encompasses several disease categories, each of which has distinct methods of presentation, clinical signs, and prognosis. The study aimed to determine JIA complications in 51 patients.

Methods
A cross-sectional study including patients diagnosed with JIA according to ILAR criteria was conducted for 26 years [1995– 2021]. Epidemiological, clinical, therapeutic, and evolutive aspects were noted.

Results
Twenty-nine males and 22 females were included. The mean age of the disease onset was 7.6 years [1,5–16]. The mean age of patients at the time of the study was 23.29 years [9–45]. Polyarticular and seronegative form was the most frequent (34.5%). Other subtypes diagnosed were systemic (25%), enthesitis-related arthritis (21.2%), oligoarticular (12.5%), and seropositive polyarticular (5.8%).
Standard X-Ray imaging showed articular damage in 50% of the cases. Hip arthritis was observed in 32% and surgery was needed in 16.9%. One patient presented with atlantoaxial subluxation. Growth retardation was noted in 28.6%. Cardiac manifestations were seen in 3 patients (pericarditis = 2, myocarditis = 1), uveitis in 3 cases, renal manifestation (extra membranous glomerulonephritis) in one patient with polyarticular form. One patient was diagnosed with multiple sclerosis.
Small doses of corticosteroids were prescribed in 71.7%. Methotrexate was prescribed in 70.5% (interrupted for adverse effects in 3 patients), sulfasalazine in 30.6%, hydroxychloroquine in 5.7%, leflunomide in 15.4%. bDMARDs were needed in 16 patients: 14 patients received TNF alpha inhibitors, rituximab was prescribed for one patient with a polyarticular form, and tocilizumab in a patient with a systemic form.
A switch of bDMARDs was conducted in 10 patients: for inefficiency in 4 cases and adverse effects in other 4 cases. Three patients developed uveitis under Etanercept, septicemia under Adalimumab, an allergic reaction, and depression under Infliximab. One patient died from a convulsive seizure at the age of 9.

Conclusion
The presence of complications is an additional burden to JIA patients. A multidisciplinary approach is required for the management of these complications.
P018 Functional impairment in enthesitis related arthritis patients
Authors: Ferjani Hanene , Bettaieb Hiba , Ben Ammar Lobna , Maatallah Kaouther , Ben Nessib Dorra , Triki Wafa , Kaffal Dhia , Hamdi Wafa 
Published: November 2021

Abstract

Background
Enthesitis related arthritis (ERA) is a subgroup of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis and predominately lower limb arthritis and can affect sacroiliac joint and spine. Recent studies showed that ERA is associated with worse physical status and poorer quality of life (1). The main objective of this study was to compare the aspects of functional status in patients (ERA) and patients with spondyloarthritis (SpA).

Methods
A retrospective monocentric study was carried out on patients with ERA (ILAR criteria) or SpA (ASAS Criteria). Demographic data and clinical characteristics were obtained from medical records. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein rate (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional impairment was evaluated by Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of life Questionnaire (ASQoL). Global well-being was assessed by Bath Ankylosing Spondylitis Global Index (BASGI). Population was divided into two groups: group 1 (G1) stands for ERA patients and group 2 (G2) stands for SpA patients. P &lt; 0.05 was considered statistically significant.

Results
A total of 174 patients (40 ERA and 134 SpA) were enrolled. Mean age at disease onset was 12.4 ± 3 years in G1 and 27.8 ± 8 years in G2. Male to female sex ratio was 5.6 in G1 and 3.7 in G2.
Morning stiffness (&gt;60 min) was reported by 37.5% of G1 and 49.3%. G1 patients had longer morning stiffness than G2 (61 [0–90] min vs 30 [0–240] min; P = 0.58). Multiple nocturnal awakenings were reported by 45% of G1 patients and 58.2% of G2 patients. Median BASDAI score was 4.9 [1–44] in G1 and 4.5 in G2 [0–10] (P = 0.48). Median BASGI score was 6 [1.5–9.5] in G1 and 6 [0–10] in G2 (P = 0.58). Median ESR was 35 mm/h [8–90] in G1 and 35 mm/h [2–125] in G2. Median CRP was 18.2 mg/l [1–70] in G1 and 13 mg/l [3–180] in G2. The assessment of functional status revealed that G1 patients had higher BASFI scores than G2 patients (5.2 vs 4.5). The association between G1 and BASFI was statistically significant (P = 0.05). Median ASQoL was 12 [2–17] in G1 and 9 [0–18] in G2. No link was noted between G1 and ASQoL score (P = 0.152).

Conclusion
Our study showed that ERA was associated with higher BASFI scores in comparison with SpA. Treat-to target strategies are mandatory in order to optimize the functional status of children with ERA.