bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent strokes in an occult case of recurrent Cutibacterium acnes prosthetic valve infective endocarditis: a case report
Authors: Fry Charles , Primus Christopher P , Serafino-Wani Robert , Woldman Simon 
Published: May 2021

Abstract

Background
Infective endocarditis (IE) is a known but uncommon cause of cardioembolic stroke and there are rare but recognized cases of IE without an inflammatory response. Cutibacterium acnes is an increasingly recognized source of invasive infections, including IE, but diagnosis is challenging due to its low virulence and fastidious nature.

Case summary
A 47-year-old man presented with a multi-focal stroke suggestive of a cardioembolic source. Outpatient transoesophageal echocardiography (TOE) was concerning for vegetation or thrombus associated with his previous mitral valve repair. He remained clinically well, with no evidence of an inflammatory response and sterile blood cultures. Computed tomography–positron emission tomography (CT-PET) corroborated the TOE findings, however, given the atypical presentation, he was treated for valvular thrombus. Following discharge, he quickly re-presented with further embolic phenomena and underwent emergency mitral valve replacement. Intraoperative findings were consistent with prosthetic valve IE (PVE) and a 6-week course of antibiotics commenced. C. acnes was identified on molecular testing. Eighteen months later, he re-presented with further neurological symptoms. Early TOE and CT–PET were consistent with IE. Blood cultures grew C. acnes after prolonged incubation. Given the absence of surgical indications, he was managed medically, and the vegetation resolved without valvular dysfunction. He continues to be followed up in an outpatient setting.

Discussion
In patients presenting with multi-territory stroke, IE should be considered despite sterile blood cultures and absent inflammatory response. C. acnes is an increasingly recognized cause of PVE in this context, often requiring surgical intervention. A high index of suspicion and collaboration with an Endocarditis Team is therefore essential to diagnose and treat.
Persisting and reoccurring cyanosis after Fontan operation is associated with increased late mortality
Authors: Schafstedde Marie , Nordmeyer Sarah , Schleiger Anastasia , Nordmeyer Johannes , Berger Felix , Kramer Peter , Ovroutski Stanislav 
Published: May 2021

Abstract

OBJECTIVES
The Fontan operation aims at reducing cyanosis and cardiac volume overload in patients with complex univentricular heart malformations. However, persisting or reoccurring cyanosis is frequently observed. We sought to systematically determine the prevalence and clinical consequences of persisting and secondary cyanosis after Fontan operation.

METHODS
A total of 331 Fontan patients, operated between 1984 and 2016 with a median postoperative follow-up of 7.9 (interquartile range 2.6–15.8) years, were studied retrospectively. Cyanosis was defined as transcutaneous oxygen saturation ≤93% at rest measured by pulse oximetry. Prevalence of cyanosis was analysed at 3 different time points (t1 = post-Fontan operation, t2 = post-Fontan cardiac catheterization, t3 = last follow-up) and the association of cyanosis with mortality was examined.

RESULTS
Prevalence of cyanosis was 50% at t1 and 39% at t3. Fenestration was patent in 71% and 33% of all cyanotic patients at t1 and t3, respectively. In patients with clinical indication for catheterization (t2; n = 178/331), prevalence of cyanosis was 72%. At t2, patent fenestration (33%), veno-venous collaterals (24%) or both (32%) were present. Thirty-six (11%) patients died during follow-up. In a time-varying multivariable Cox regression analysis, cyanosis was the strongest predictor for late mortality (P &lt; 0.001, hazard ratio 12.2, 95% confidence interval 3.7–40.5).

CONCLUSIONS
Prevalence of cyanosis was considerable during long-term follow-up after Fontan operation and—as a surrogate parameter for unfavourable Fontan haemodynamics—is associated with increased late mortality. Accordingly, particular attention should be directed towards the persistence or reoccurrence of cyanosis during follow-up since it may indicate haemodynamic attrition and development of Fontan failure.
Full-length transcriptome analysis of pecan (Carya illinoinensis) kernels
Authors: Zhang Chengcai , Ren Huadong , Yao Xiaohua , Wang Kailiang , Chang Jun 
Published: May 2021

Abstract
Pecan is rich in bioactive components such as fatty acids (FAs) and flavonoids and is an important nut type worldwide. Therefore, the molecular mechanisms of phytochemical biosynthesis in pecan are a focus of research. Recently, a draft genome and several transcriptomes have been published. However, the full-length mRNA transcripts remain unclear, and the regulatory mechanisms behind the quality components biosynthesis and accumulation have not been fully investigated. In this study, single-molecule long-read sequencing technology was used to obtain full-length transcripts of pecan kernels. In total, 37,504 isoforms of 16,702 genes were mapped to the reference genome. The numbers of known isoforms, new isoforms, and novel isoforms were 9013 (24.03%), 26,080 (69.54%), and 2411 (6.51%), respectively. Over 80% of the transcripts (30,751, 81.99%) had functional annotations. A total of 15,465 alternative splicing (AS) events and 65,761 alternative polyadenylation events were detected; wherein, the retained intron was the predominant type (5652, 36.55%) of AS. Furthermore, 1894 long noncoding RNAs and 1643 transcription factors were predicted using bioinformatics methods. Finally, the structural genes associated with FA and flavonoid biosynthesis were characterized. A high frequency of AS accuracy (70.31%) was observed in FA synthesis-associated genes. This study provides a full-length transcriptome data set of pecan kernels, which will significantly enhance the understanding of the regulatory basis of phytochemical biosynthesis during pecan kernel maturation.
Genomics-based discrimination of 2n gamete formation mechanisms in polyploids: a case study in nonaploid Diospyros kaki ‘Akiou’
Authors: Sun Peng , Nishiyama Soichiro , Asakuma Hideaki , Voorrips Roeland E , Fu Jianmin , Tao Ryutaro 
Published: May 2021

Abstract
Unreduced gametes (2n gametes), possessing double the haploid genome, whatever ploidy that happens to be, are a common source of ploidy variation in plant populations. First and second division restitution (FDR and SDR) are the dominant mechanisms of 2n gamete production; all else being equal, FDR gametes have a higher degree of heterozygosity, thus they are advantageous in breeding. The discrimination of these mechanisms from the consequence of hybridization is challenging, especially in higher polyploids, and usually requires information on centromere location. In this study, we propose a genotyping-based strategy to uncover the mechanisms of 2n gamete formation in progeny that has a higher ploidy than its parents. Simulation of 2n gamete production revealed that FDR and SDR pathways can be discriminated based on allele transmission patterns alone without information on centromere location. We applied this strategy to study the formation mechanism of a nonaploid Diospyros kaki ‘Akiou', which was bred via hybridization between D. kaki hexaploid cultivars. The result demonstrated that ‘Akiou' was derived from the fertilization of a normal female gamete by a 2n male gamete and that this 2n gamete was produced through FDR. Consequently, the distinct duplex transmission pattern in the FDR gamete enabled us to infer the genomic characteristics of polyploid persimmon. The method could be tested only for the plant being polypoid, which allows for the ability to discriminate causes of 2n gamete formation using allele dosage in progeny, and will be useful in future studies of polyploid genomics.
Wartime Is Peacetime: Undeclared Armed Conflict in the Late Twentieth and Early Twenty-First Centuries
Authors: Teles Fazendeiro Bernardo 
Published: May 2021

Abstract
War has increasingly concealed itself by way of euphemism and undeclared armed conflict, a practice that has unsettled the distinction between wartime and peacetime. Each of the four books reviewed herein touches upon this topic, either directly or indirectly. Carson addresses the features of and reasons for covert operations over the course of the twentieth century, focusing on concerted concerns over the risk of escalation. Hoffman and Weiss investigate the evolution of the mainstay commitment to humanitarianism in the international arena, and the extent to which it has become increasingly attached to security. Fazal largely agrees with this conclusion, but takes it one step further. She persuasively shows how the proliferation of international humanitarian law led to a decrease in formal declarations of war among states, a practice that contributed to semantic confusion as well as to the growing use of euphemism to account for armed conflict. Schadlow argues consistently for greater conceptual and practical links between war and postconflict governance, pointing, among other things, to how ill-conceived strategy regarding the broader meaning of war leads to unsuccessful military operations. The review essay subsequently links this common thread—particularly the concealed types of warfare, the use of euphemism, and limited conceptions of armed conflict—to ongoing debates on wartime and peacetime and their relationship to the international order. Overall, the international order's specific setup in conjunction with how war is no longer explicitly recognized or declared has resulted in a division of labor among the military, technocrats, and the police. This division of labor has in turn unsettled the traditional distinction between peacetime and wartime to the effect that the latter is no longer explicitly acknowledged.
Effect of microbial and chemical additives on the fermentation and aerobic stability of alfalfa silage ensiled at 2 dry matters and subjected to air stress during storage
Authors: Li Yanbing , da Silva Erica B , Novinski Charles O , Kung Limin 
Published: May 2021

Abstract
We evaluated the effects of different types of additives on the fermentation and aerobic stability of alfalfa (Medicago sativa) ensiled at 2 dry matters (DM). Alfalfa was untreated (CTRL) or treated with sodium benzoate, potassium sorbate, and sodium nitrite (SFE), or microbial inoculants (Lactobacillus plantarum MTD1 [LP] or L. buchneri 40788 and Pediococcus pentocaseus 12455 [LBPP]) at a moderate (38%) and high (46%) DM using a completely randomized design with a 2 × 4 factorial arrangement of treatments. High DM silage was higher (P &lt; 0.01) in pH, had less lactic and acetic acid (P &lt; 0.01) and had more yeasts (P &lt; 0.05) and molds (P &lt; 0.01) than moderate DM silage. Recovery of DM declined (P &lt; 0.01) for CTRL and LP treated silages with increasing DM but was not different between LBPP and SFE treatments. Compared to CTRL, LBPP had a lower (P &lt; 0.01) DM recovery at the moderate DM, but SFE had the greatest (P &lt; 0.01) recovery of all treatments at the high DM. Treatment with LBPP increased (P &lt; 0.05) the concentrations of acetic acid and 1,2 propanediol (PD) compared with other treatments (P &lt; 0.01). Numerically, fewer yeasts were found in additive treated silages compared with CTRL, but they were statistically (P &lt; 0.01) lower only when treated with SFE. Treatment with LP resulted in a small improvement in aerobic stability at the moderate but not high DM. In contrast, treatment with SFE and LBPP markedly improved (P &lt; 0.01) the aerobic stability of alfalfa silage at both DM. Whereas SFE and LBPP were similar in their improvements in aerobic stability at the DM, LBPP was better (P &lt; 0.01) than SFE at the high DM. A higher (P &lt; 0.01) concentration of acetic acid in LBPP compared with other treatments was most likely responsible for better stability. This study showed that LBPP and SFE resulted in increases in the aerobic stability of alfalfa silage and it is the first study showing SFE, can markedly improve the aerobic stability of alfalfa silage.
Increasing Prevalence of Ketamine in Drivers in New York City Including the Identification of 2-Fluoro-Deschloroketamine
Authors: Arango Elba , Toriello Allison , Rosario Zoila , Cooper Gail 
Published: May 2021

Abstract
Ketamine is a dissociative anesthetic used in veterinary and human medicine since the 1970s. Its clinical use has expanded to control of seizures, by pre-hospital emergency medical services (EMS), and is finding new purpose as an analgesic alternative and antidepressant. Ketamine brings hope for effective management of chronic pain in the absence of opioids and decreasing suicidal ideations; however, its persistence as a recreational drug for its hallucinogenic properties remains. In the wake of expanding medicinal purposes, the diversity of New York City’s population was explored to better understand its misuse. This retrospective study looks at the prevalence of ketamine in driver fatalities over a period of 18 years (2003–2020) and cases involving suspected driving under the influence of drugs (DUID) over a period of 6 years (2015–2020). Ketamine was identified in 6 driver fatalities and in 47 DUID cases. None of the driver fatalities were suspected of ketamine misuse, due to administration either in hospital or by EMS. In the DUID cases, an increasing trend was observed over the 6-year study period with 100% (n = 47) of the cases confirmed as non-hospital/non-EMS administered ketamine. Of the DUID cases, 94% were male with the majority between the age of 21 and 39 years (85%) and were predominantly Hispanic (36%) and Asian (34%). Blood concentrations of ketamine ranged from 27 to &gt;2000 ng/mL with polydrug use prevalent. The most common drug classes detected in addition to ketamine were cannabinoids (38%), ethanol (32%), benzodiazepines (26%), cocaine (19%) and amphetamines/3,4-methylenedioxymethamphetamine (15%). In 2019, 2-fluoro-deschloroketamine was identified in two cases for the first time. Despite its increased acceptance for mental health disorders, ketamine’s persistence and misuse as a recreational drug remains and should continue to be monitored by relevant toxicological, clinical and law enforcement communities along with emerging illicit ketamine analogs.
Sublethal Effects of the Microbial-Derived Insecticide Spinetoram on the Growth and Fecundity of the Fall Armyworm (Lepidoptera: Noctuidae)
Authors: Gao Zupeng , Chen Yu , He Kanglai , Guo Jingfei , Wang Zhenying 
Published: May 2021

Abstract
The fall armyworm, Spodoptera frugiperda (J. E. Smith), is one of the most important pests in tropical and subtropical regions of American. S. frugiperda was first detected in Southern China in January 2019, and then subsequently invaded in 26 provinces. Spinetoram widely used for pest management is recommended for S. frugiperda control. The sublethal effects of spinetoram on S. frugiperda were investigated in the present study. The toxicity of spinetoram against S. frugiperda larvae was determined after one oral dose of spinetoram at sublethal concentration. The results showed that spinetoram LC10 and LC30 were 0.011 and 0.044 mg/liter for the larvae, respectively. Spinetoram at sublethal concentration significantly increased developmental time but reduced larval body weight. In addition, spinetoram had a post-exposure effect on pupal weight, but not on pupal duration, pupation rate, emergence rate, eggs number, or adults longevity. In conclusion, the sublethal effects of spinetoram could negatively affect the growth and development of S. frugiperda that have important implications for pest management.
Targeted eHealth Intervention to Reduce Breast Cancer Survivors’ Fear of Recurrence: Results From the FoRtitude Randomized Trial
Authors: Wagner Lynne I , Tooze Janet A , Hall Daniel L , Levine Beverly J , Beaumont Jennifer , Duffecy Jenna , Victorson David , Gradishar William , Leach Joseph , Saphner Thomas , Sturtz Keren , Smith Mary Lou , Penedo Frank , Mohr David C , Cella David 
Published: May 2021

Abstract

Background
Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching.

Methods
BCS (N  = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided.

Results
FCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P &lt; .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P &lt; .001).

Conclusions
BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
Prevalence of Polytrauma Clinical Triad Among Active Duty Service Members
Authors: Laughter Sharon , Khan Munziba , Banaag Amanda , Madsen Cathaleen , Koehlmoos Tracey Perez 
Published: May 2021

ABSTRACT

Introduction
The polytrauma clinical triad (PCT), encompassing traumatic brain injury, PTSD, and chronic pain, has been identified as a significant concern in the Military Health System (MHS). Conditions in this triad mutually reinforce one another and can pose a significant challenge to treatment for patients and providers. Polytrauma clinical triad has previously been studied in deployed veterans but remains understudied in the active duty military population. Therefore, this novel study seeks to determine the prevalence of PCT among active duty service members and to identify the subpopulations most at risk for PCT.

Materials and Methods
This cross-section study used the MHS Data Repository in order to retrospectively review all administrative claim data for active duty service members within the Army, Navy, Air Force, and Marine Corps from fiscal years 2010 to 2015. Specific ICD-9 codes were extracted that correlated with traumatic brain injury, PTSD, and chronic pain to determine the risk of PCT. We used logistic regression to compare individuals presenting with the PCT conditions to those service members without any of the PCT diagnoses codes.

Results
The study identified 2,441,698 active duty service members eligible for inclusion. The prevalence of all three conditions of PCT was 5.99 per 1,000 patients. Patients with PCT were most likely to be 20–29 years old (52.15%), male (89.83%), White (59.07%), married (64.18%), Junior Enlisted (55.27%), and serving in the Army (74.71%).

Conclusion
This study is the first to identify the risk of PCT in the active duty military population. Awareness of the risk and subsequent prompt identification of the triad will enable treatment through an integrated, team approach, which should alleviate potential patient suffering and improve the efficiency of care and readiness of service members.
Rectal Bleeding in the Clinic
Authors: Mangalindan Kristin E , Bush Allison , Nguyen Nhu An 
Published: May 2021

ABSTRACTAnal cancer is a rare malignancy with an estimated 8,580 new cases each year in the USA where hematochezia, a common condition, is often the initial presenting sign. We describe a 51-year-old woman who presented with painful hematochezia, with a delayed diagnosis of anal cancer in the setting of missed and misdiagnosed digital rectal exams in an otherwise low-risk patient. This case highlights the importance of maintaining a broad differential diagnosis for hematochezia and the utility of thorough physical exams.
Impact of Oral Health Status on Perceived Dental Problems Among Japan Maritime Self-Defense Force Personnel
Authors: Sonoda Chikanobu , Sakurai Yutaka , Okoda Manabu , Ebisawa Masato , Nakashima Hiroshi , Tsunoda Masashi 
Published: May 2021

ABSTRACT

Introduction
Dental problems may have a great impact on military mission effectiveness, as such, evidence-based dental classification guidelines are required for minimizing the occurrence of dental problems. The aim of this study is to elucidate the independent contribution of each oral disease to the perception of dental problems among Japan Maritime Self-Defense Force (JMSDF) personnel in order to make the dental classification guidelines more precise for the prediction of future dental problems.

Materials and Methods
Japan Maritime Self-Defense Force personnel who were examined during the annual dental checkup in 2013 answered questions about the experience of dental problems within the last 12 months in 2014. The associations between the items of a dental checkup and the perception of dental problems were examined using multiple logistic regression analysis with a stepwise procedure to calculate odds ratios (ORs) and 95% CIs.

Results
The data of a total of 22,441 subjects were included in the analysis. Those who declared to have perceived dental problems within the last 12 months were 5,088 (22.7%). The multiple logistic regression analysis showed that personnel who had decayed teeth had a higher chance of experiencing dental problems than those who had no dental caries. Personnel whose periodontal disease was judged to be more severe in a dental examination had a greater OR for the perception of dental problems.

Conclusion
These results may become recommendations for operations in the JMSDF dental classification system.