bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knockout of the circadian gene, Per2, disrupts corticosterone secretion and results in depressive‐like behaviors and deficits in startle responses
Authors: Russell Ashley L. , Miller Lauren , Yi Hannah , Keil Rita , Handa Robert J. , Wu T. John 
Published: January 2021

AbstractBackgroundThe Period Circadian Regulator 2 (Per2) gene is important for the modulation of circadian rhythms that influence biological processes. Circadian control of the hypothalamus-pituitary-adrenal (HPA) axis is critical for regulation of hormones involved in the stress response. Dysregulation of the HPA axis is associated with neuropsychiatric disorders. Therefore, it is important to understand how disruption of the circadian rhythm alters the HPA axis. One way to address this question is to delete a gene involved in regulating a central circadian gene such asPer2in an animal model and to determine how this deletion may affect the HPA axis and behaviors that are altered when the HPA axis is dysregulated. To study this, corticosterone (CORT) levels were measured through the transition from light (inactive phase) to dark (active phase). Additionally, CORT levels as well as pituitary and adrenal mRNA expression were measured following a mild restraint stress. Mice were tested for depressive-like behaviors (forced swim test (FST)), acoustic startle response (ASR), and pre-pulse inhibition (PPI).ResultsThe present results showed thatPer2knockout impacted CORT levels, mRNA expression, depressive-like behaviors, ASR and PPI. Unlike wild-type (WT) mice,Per2knockout (Per2) mice showed no diurnal rise in CORT levels at the onset of the dark cycle.Per2−/−mice had enhanced CORT levels and adrenal melanocortin receptor 2 (Mc2R) mRNA expression following restraint. There were no changes in expression of any other pituitary or adrenal gene. In the FST,Per2−/−mice spent more time floating (less time struggling) than WT mice, suggesting increased depressive-like behaviors.Per2−/−mice had deficits in ASR and PPI startle responses compared to WT mice.ConclusionsIn summary, these findings showed that disruption of the circadian system viaPer2gene deletion dysregulated the HPA stress axis and is subsequently correlated with increased depressive-like behaviors and deficits in startle response.
A rare case of thymic carcinoid presenting with gastrointestinal symptoms and pericardium effusion
Authors: Xiang Qun-yan , Xu Jin , Liu Ling 
Published: January 2021

Abstract
Background
Thymic carcinoid is one of an extremely rare type of malignant neuroendocrine tumor with a poor prognosis. Invasion of thymic carcinoid to other organs could lead to devastating consequences. It has been reported that thymic carcinoid mainly invaded to the pleura, lungs, liver, pancreas and bone, while rarely to the cardiac, especially to the ventricle.

Case presentation
A 53-year-old man presented with gastrointestinal symptoms and persistent pericardial effusion. Multiple imaging tools, including chest computed tomography (CT), magnetic resonance imaging (MRI), 18F-Fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) showed a malignant neoplasm arising from the thymus invading into the biventricular myocardium, pericardium, and left superior pulmonary veins. The tumor was finally diagnosed as a thymic carcinoid through pathological examination.

Conclusion
This is a rare case of thymic carcinoid invading the ventricular myocardium, which presented as subacute heart failure. The observations in this case would be useful for differential diagnosis of primary heart disease and invasion of heart due to thymic carcinoid.
Obesity interacts with hyperuricemia on the severity of non-alcoholic fatty liver disease
Authors: Zhou Mimi , Yang Nan , Xing Xin , Chang Danyan , Li Juan , Deng Jiang , Chen Yi , Hu Chunhua , Zhang Rou , Lu Xiaolan , Zhao Yingren , He Yingli 
Published: January 2021

Abstract
Background
A series of evidence revealed that body mass index was an important confounding factor in the research of uric acid and ischemic heart disease/hypertension. The objective of this study was to investigate whether obesity status can modify the association between serum uric acid and the severity of liver damage in NAFLD, and the possible interactive effect of hyperuricemia and obesity.

Methods
We conducted a cross-sectional study in a total of 557 ultrasound diagnosed-NAFLD. The hepatic steatosis and liver fibrosis were quantitatively evaluated by transient elastography. Hyperuricemia was defined as serum uric acid > 420 μmol/L in men, > 360 μmol/L in women and obesity was defined as body mass index ≥ 25 kg/m2. The adjusted OR values of hyperuricemia and obesity were analyzed by multivariate logistic regression analysis, and the additive model was used to investigate the possible interactive effect.

Results
Multivariate regression analysis showed that hyperuricemia was associated with serious hepatic steatosis (1.74[1.09–2.79]) and elevated ALT (2.17[1.38–3.41]), but not with advanced fibrosis (1.61[0.91–2.85]). The association was further investigated in different BMI group. Hyperuricemia was associated with higher odds of serious hepatic steatosis (2.02[1.14–3.57]) and elevated ALT (2.27[1.37–3.76]) only in obese NAFLD, not in non-obese subjects. Similarly, patients with hyperuricemia had higher odds of advanced fibrosis in obese subjects (2.17[1.13–4.18]), not in non-obese subjects (0.60[0.14–2.70]). Furthermore, there was an additive interaction between hyperuricemia and obesity on the odds of serious hepatic steatosis (AP: 0.39[0.01–0.77]) and advanced fibrosis. (AP: 0.60[0.26–0.95]).

Conclusions
Hyperuricemia and obesity had a significantly synergistic effect on the hepatic steatosis and fibrosis. Thus, management of uric acid may need to be targeted in obese NAFLD.
Percutaneous direct pancreatic duct intervention in management of pancreatic fistulas: a primary treatment or temporizing therapy to prepare for elective surgery
Authors: Li Xi , Paz-Fumagalli Ricardo , Wang Weiping , Toskich Beau B. , Stauffer John A. , Frey Gregory T. , McKinney J. Mark , Nguyen Justin H. 
Published: January 2021

Abstract
Background
This study evaluates preliminary results of image-guided percutaneous direct pancreatic duct intervention in the management of pancreatic fistula after surgery or pancreatitis when initially ineligible for surgical or endoscopic therapy.

Methods
Between 2001 and 2018 the medical records of all patients that underwent percutaneous pancreatic duct intervention for radiographically confirmed pancreatic fistula initially ineligible for surgical or endoscopic repair were reviewed for demographics, clinical history, procedure details, adverse events, procedure related imaging and laboratory results, ability to directly catheterized the main pancreatic duct, and whether desired clinical objectives were met.

Results
In 10 of 11patients (6 male and 5 female with mean age 60.5, range 39–89) percutaneous pancreatic duct cannulation was possible. The 10 duct interventions included direct ductal suction drainage in 7, percutaneous duct closure in 3 and stent placement in 1. Pancreatic fistulas closed in 7 of 10, 2 were temporized until elective surgery, and 1 palliated until death from malignancy. The single patient with failed duct cannulation resolved the fistula with prolonged catheter drainage of the peri-pancreatic cavity. There were no major adverse events related to intervention.

Conclusion
In patients with pancreatic fistulas initially ineligible for endoscopic therapy or elective surgery, direct percutaneous pancreatic duct interventions are possible, can achieve improvement without major morbidity or mortality, and can improve and maintain the medical condition of patients in preparation for definitive surgery.
Use of a technology-based system to motivate older adults in performing physical activity: a feasibility study
Authors: Knippenberg Els , Timmermans Annick , Palmaers Steven , Spooren Annemie 
Published: January 2021

AbstractBackgroundMaintaining or initiating regular physical activity (PA) is important for successful aging. Technology-based systems may support and stimulate older adults to initiate and persevere in performing PA. The aim of the current study was to assess to which extent a customised Kinect system is 1) a credible tool to increase PA in older adults, 2) motivating to perform PA by older adults, and 3) easy to be used in older adults.MethodsA mixed-method cross-sectional feasibility study was performed in 5 aged care facilities in Flanders, Belgium. Aged participants were asked to perform a 20–30 min test with the intelligent Activity-based Client-centred Training (i-ACT) system. After the test, the ‘Credibility and Expectancy Questionnaire’ (CEQ), the ‘Intrinsic Motivation Inventory’(IMI), the System Usability Scale (SUS), and semi-structured interviews were conducted in the older adults. Feedback was gathered using the thinking aloud method in both aged participants and healthcare professionals.ResultsA total of 48 older adults (20 males and 28 females, mean age = 81.19 (SD = 8.10)), were included. The scores pertaining to system credibility and expectancy, system usability, and motivation towards use were moderate to good. Participants reported that they liked using the i-ACT system, but that the context could be more attractive by adding more visualisations. Twelve professionals stated that they observed involvement in older adults but think that i-ACT is better used in day care centres.ConclusionsThis study indicates that i-ACT is a usable and motivational system to engage older adults to perform PA and therefore supports successful aging. Future research is necessary to investigate the efficacy of i-ACT to perform PA and the transfer to regain and/or maintain engagement in ADLs that older adults find meaningful and purposeful at an older age. Also, further development of i-ACT is advisable to adapt the i-ACT system towards implementation at the home of older adults.Trial registrationClinicalTrial.govIDNCT04489563, 23 July 2020 - Retrospectively registered.
Severe Candida glabrata pancolitis and fatal Aspergillus fumigatus pulmonary infection in the setting of bone marrow aplasia after CD19-directed CAR T-cell therapy – a case report
Authors: Rejeski Kai , Kunz Wolfgang G. , Rudelius Martina , Bücklein Veit , Blumenberg Viktoria , Schmidt Christian , Karschnia Philipp , Schöberl Florian , Dimitriadis Konstantin , von Baumgarten Louisa , Stemmler Joachim , Weigert Oliver , Dreyling Martin , von Bergwelt-Baildon Michael , Subklewe Marion 
Published: January 2021

Abstract
Background
Prolonged myelosuppression following CD19-directed CAR T-cell transfusion represents an important, yet underreported, adverse event. The resulting neutropenia and multifactorial immunosuppression can facilitate severe infectious complications.

Case presentation
We describe the clinical course of a 59-year-old patient with relapsed/refractory DLBCL who received Axicabtagene-Ciloleucel (Axi-cel). The patient developed ASTCT grade I CRS and grade IV ICANS, necessitating admission to the neurological ICU and prolonged application of high-dose corticosteroids and other immunosuppressive agents. Importantly, neutropenia was profound (ANC < 100/μl), G-CSF-refractory, and prolonged, lasting more than 50 days. The patient developed severe septic shock 3 weeks after CAR transfusion while receiving anti-fungal prophylaxis with micafungin. His clinical status stabilized with broad anti-infective treatment and intensive supportive measures. An autologous stem cell backup was employed on day 46 to support hematopoietic recovery. Although the counts of the patient eventually started to recover, he developed an invasive pulmonary aspergillosis, which ultimately lead to respiratory failure and death. Postmortem examination revealed signs of Candida glabrata pancolitis.

Conclusions
This case highlights the increased risk for fatal infectious complications in patients who present with profound and prolonged cytopenia after CAR T-cell therapy. We describe a rare case of C. glabrata pancolitis associated with multifactorial immunosuppression. Although our patient succumbed to a fatal fungal infection, autologous stem cell boost was able to spur hematopoiesis and may represent an important therapeutic strategy for DLBCL patients with CAR T-cell associated bone marrow aplasia who have underwent prior stem cell harvest.
Analysis of virulence factors and antibiotic resistance genes in group B streptococcus from clinical samples
Authors: Mudzana Raymond , Mavenyengwa Rooyen T. , Gudza-Mugabe Muchaneta 
Published: January 2021

Abstract
Background
Streptococcus agalacticae (Group B Streptococcus, GBS) is one of the most important causative agents of serious infections among neonates. This study was carried out to identify antibiotic resistance and virulence genes associated with GBS isolated from pregnant women.

Methods
A total of 43 GBS isolates were obtained from 420 vaginal samples collected from HIV positive and negative women who were 13–35 weeks pregnant attending Antenatal Care at Chitungwiza and Harare Central Hospitals in Zimbabwe. Identification tests of GBS isolates was done using standard bacteriological methods and molecular identification testing. Antibiotic susceptibility testing was done using the modified Kirby-Bauer method and E-test strips. The boiling method was used to extract DNA and Polymerase Chain Reaction (PCR) was used to screen for 13 genes. Data was fed into SPSS 24.0.

Results
Nine distinct virulence gene profiles were identified and hly-scpB-bca-rib 37.2% (16/43) was common. The virulence genes identified were namely hly 97.8% (42/43), scpB 90.1% (39/43), bca 86.0% (37/43), rib 69.8% (30/43) and bac 11.6% (5/43). High resistance to tetracycline 97.7% (42/43) was reported followed by 72.1% (31/43) cefazolin, 69.8% (30/43) penicillin G, 58.1% (25/43) ampicillin, 55.8% (24/43) clindamycin, 46.5% (20/43) ceftriaxone, 34.9% (15/43) chloramphenicol, and 30.2% (13/43) for both erythromycin and vancomycin using disk diffusion. Antibiotic resistance genes among the resistant and intermediate-resistant isolates showed high frequencies for tetM 97.6% (41/42) and low frequencies for ermB 34.5% (10/29), ermTR 10.3% (3/29), mefA 3.4% (1/29), tetO 2.4% (1/42) and linB 0% (0/35). The atr housekeeping gene yielded 100% (43/43) positive results, whilst the mobile genetic element IS1548 yielded 9.3% (4/43).

Conclusion
The study showed high prevalence of hly, scpB, bca and rib virulence genes in S. agalactiae strains isolated from pregnant women. Tetracycline resistance was predominantly caused by the tetM gene, whilst macrolide resistance was predominantly due to the presence of erm methylase, with the ermB gene being more prevalent. Multi-drug resistance coupled with the recovery of resistant isolates to antimicrobial agents such as penicillins indicates the importance of GBS surveillance and susceptibility tests. It was also observed that in vitro phenotypic resistance is not always accurately predicted by resistance genotypes.
Clinical characteristics of refractory mycoplasma pneumoniae pneumonia in children treated with glucocorticoid pulse therapy
Authors: Zhu Zhenli , Zhang Tongqiang , Guo Wei , Ling Yaoyao , Tian Jiao , Xu Yongsheng 
Published: January 2021

Abstract
Background
To observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) under different doses, to summarize the clinical features of children treated with glucocorticoid pulse therapy.

Methods
The clinical data of 125 children with RMPP hospitalized in Tianjin Children’s Hospital from September 2018 to October 2019 were retrospectively analyzed. They were divided into two groups according to the dose of hormone. Compare the clinical features, laboratory findings, and imaging between the two groups, and use meaningful related indicators as ROC curves to find reference indicators for pulse therapy.

Results
(1) The median age of the group II was older than that of the group I(P < 0.05). (2) We found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in group II, which needed oxygen more often, higher the hormone, higher usage rate of gamma globulin, higher usage rate of bronchoscopy, and higher incidence of plastic bronchitis(P < 0.05). (3) WBC, CRP, LDH, FER, D-D dimer, APTT, TT, PCT, IL-6 and the percentage of neutrophils in peripheral blood in Group II were higher than those in Group I(P < 0.05). (4) In ROC curve analysis, CRP, LDH, FER, and neutrophils of leukocyte classification were independent related factors that could be used as valuable predictors of methylprednisolone pulse therapy for RMPP in children. The cut-off values were CRP44.45 mg/L, LDH590IU/L, FER411ng/L, and neutrophils in leukocyte classification were 73.75%, respectively.

Conclusion
CRP ≥ 44.45 mg/L, LDH ≥ 590 IU/L, FER ≥ 411 ng/L, neutrophil≥73.75%, lung consolidation, and pleural effusion may be predictors that guide the treatment of RMPP with pulse dose of GC.
Joint optic disc and cup segmentation based on densely connected depthwise separable convolution deep network
Authors: Liu Bingyan , Pan Daru , Song Hui 
Published: January 2021

Abstract
Background
Glaucoma is an eye disease that causes vision loss and even blindness. The cup to disc ratio (CDR) is an important indicator for glaucoma screening and diagnosis. Accurate segmentation for the optic disc and cup helps obtain CDR. Although many deep learning-based methods have been proposed to segment the disc and cup for fundus image, achieving highly accurate segmentation performance is still a great challenge due to the heavy overlap between the optic disc and cup.

Methods
In this paper, we propose a two-stage method where the optic disc is firstly located and then the optic disc and cup are segmented jointly according to the interesting areas. Also, we consider the joint optic disc and cup segmentation task as a multi-category semantic segmentation task for which a deep learning-based model named DDSC-Net (densely connected depthwise separable convolution network) is proposed. Specifically, we employ depthwise separable convolutional layer and image pyramid input to form a deeper and wider network to improve segmentation performance. Finally, we evaluate our method on two publicly available datasets, Drishti-GS and REFUGE dataset.

Results
The experiment results show that the proposed method outperforms state-of-the-art methods, such as pOSAL, GL-Net, M-Net and Stack-U-Net in terms of disc coefficients, with the scores of 0.9780 (optic disc) and 0.9123 (optic cup) on the DRISHTI-GS dataset, and the scores of 0.9601 (optic disc) and 0.8903 (optic cup) on the REFUGE dataset. Particularly, in the more challenging optic cup segmentation task, our method outperforms GL-Net by 0.7$$\%$$
%
in terms of disc coefficients on the Drishti-GS dataset and outperforms pOSAL by 0.79$$\%$$
%
on the REFUGE dataset, respectively.

Conclusions
The promising segmentation performances reveal that our method has the potential in assisting the screening and diagnosis of glaucoma.
Two kinds of rare light chain cast nephropathy caused by multiple myeloma: case reports and literature review
Authors: Sun Li-Jun , Dong Hong-Rui , Xu Xiao-Yi , Wang Guo-Qin , Cheng Hong , Chen Yi-Pu 
Published: January 2021

AbstractBackgroundLight chain cast nephropathy (LCCN) is the most common renal disease caused by multiple myeloma (MM). In addition to ordinary light chain protein casts, there are a few rare casts with unique shapes, including light chain amyloid casts (LCAC) and light chain crystal casts (LCCC).Case presentationsHere, we report two patients. Patient 1 is a 72-year-old man who was clinically diagnosed with MM and acute kidney injury (AKI). Pathological examination of a renal biopsy revealed that there were many amyloid casts in the distal tubules that had a lightly-stained central area and a deeply-stained burr-like edge. The marginal zone of the cast was positive for Congo red staining and contained numerous amyloid fibers, as observed by electron microscopy. No systemic amyloidosis was found. The patient received 4 courses of bortezomib-based chemotherapy, and then, his MM achieved partial remission. Patient 2 is a 57-year-old man who was also clinically diagnosed with MM and AKI. Pathological examination of a renal biopsy showed that there were many crystalline casts in the distal tubules that were fully or partially composed of crystals with different shapes, including rhomboid, needle, triangle, rectangle and other geometric shapes. Congo red staining was negative. Crystals were also detected in the urine of this patient. After 9 courses of treatment with a bortezomib-based regimen, his MM obtained complete remission and his renal function returned to normal.ConclusionsLCAC and LCCC nephropathy caused by MM are two rare types of LCCN, and both have their own unique morphological manifestations. LCAC nephropathy may not be accompanied by systemic amyloidosis. The diagnosis of these two unique LCCNs must rely on renal biopsy pathology, and the discovery of urine crystals is of great significance for indicating LCCC nephropathy.
Guillain-Barré syndrome triggered by surgery in a Chinese population: a multicenter retrospective study
Authors: Gong Qiaoyu , Liu Shuping , Liu Yin , Yao Jiajia , Fu Xiujuan , Xiao Zheman , Lu Zuneng 
Published: January 2021

Abstract
Background
Surgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery.

Methods
The medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS.

Results
Among the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001).

Conclusion
Surgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored.

Trial registration
chicTR-RRc-17,014,152.