bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy – making the right diagnosis
Authors: Liampas Andreas , Markoula Sofia , Zis Panagiotis , Reuber Markus 
Published: September 2021

AbstractEpilepsy is a risk factor for the development of psychogenic non-epileptic seizures (PNES) and comorbid epilepsy is recognized as a comorbidity in about 10–30% of patients with PNES. The combination of epileptic and nonepileptic seizures poses a particular diagnostic challenge. In patients with epilepsy, additional PNES may be suspected on the basis of their typical semiology. The possibility of additional PNES should also be considered if seizures fail to respond to antiepileptic drug treatment, in patients with frequent emergency admissions with seizures and in those who develop new types of seizures. The description of semiological details by patients and witnesses can suggest additional PNES. Home video recordings can support an initial diagnosis, however, especially in patients with mixed seizure disorders it is advisable to seek further diagnostic confirmation by capturing all habitual seizure types with video-EEG. The clinical features of PNES associated with epilepsy are similar to those in isolated PNES disorders and include longer duration, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, persistently closed eyes and mouth, ictal crying, recall of ictal experiences and absence of postictal confusion. PNES can also present as syncope-like episodes with unresponsiveness and reduced muscle tone. There is no unique epileptological or brain pathology profile putting patients with epilepsy at risk of additional PNES. However, patients with epilepsy and PNES typically have lower educational achievements and higher levels of psychiatric comorbidities than patients with epilepsy alone. Psychological trauma, including sexual abuse, appears to be a less relevant aetiological factor in patients with mixed seizure disorders than those with isolated PNES, and the gender imbalance (i.e. the greater prevalence in women) is less marked in patients with PNES and additional epilepsy than those with PNES alone. PNES sometimes develop after epilepsy surgery. A diagnosis of ‘known epilepsy’ should never be accepted without (at least brief) critical review. This narrative review summarises clinical, electrophysiological and historical features that can help identify patients with epilepsy and additional PNES.
Swyer syndrome with malignant germ cell tumor: a case report
Authors: Hamed Soha Talaat , Hanafy MennatAllah Mohamed 
Published: September 2021

Abstract
Background
Swyer syndrome (Pure gonadal dysgenesis, 46 XY) is a rare form of disorder of sexual development. These patients presented with external female phenotype, normal Mullerian structures and streak gonads. Pure gonadal dysgenesis, XY patients are more likely to develop germ cell tumors due to the presence of the Y chromosome.

Case presentation
A 19-year-old patient with a female external phenotype presented with primary amenorrhea. Clinical examination, Karyotyping, imaging, and histopathological assessment revealed Swyer syndrome. On imaging, a right adnexal mass with calcification was detected. Laparoscopic surgery with histopathology revealed a malignant germ cell tumor.

Conclusions
Swyer syndrome represents a rare form of sexual development that necessitates a meticulous clinical, laboratory and radiological evaluation. Clinically, the patients have a female external phenotype with 46xy Karyotyping. Imaging, Ultrasound is the primary imaging modality Imaging and MRI helps in detection of the exact site of streak gonads and characterization of lesions. CT is useful in detecting calcification, which is a hallmark in the diagnosis of gonadoblastoma. Early diagnosis of Swyer syndrome is crucial as prophylactic gonadectomy in these cases reduces the risk of developing germ cell tumors.
Multidetector computed tomography: a corner stone imaging modality in evaluation of acute small bowel diseases
Authors: Emara Doaa M. , Moghazy Khaled M. , Abouelnagah Galal M. , Amer Ahmed H. 
Published: September 2021

Abstract
Background
The diagnosis of acute small bowel diseases is one of the challenging issues that confronted by the radiologists so accurate diagnosis is essential to determine the appropriate way of management. CT has become the preferred imaging tool to evaluate acute small bowel diseases. Our study aimed to assess the role of MDCT in evaluation of acute abdomen secondary to small bowel origin by identification and differentiation between different acute small bowel pathologies.

Results
Thirty-eight patients presented with acute abdomen of small bowel origin from June 2019 to September 2019. The mean age of incidence was 48 ± 19 years ranged from 4 to 88 years. Males represented by 23 patients (60.5%). Acute exacerbation of inflammatory bowel diseases (Crohn’s disease) represented by (34.2%), small bowel obstruction (31.6%), ischemic bowel diseases (21.1%), small bowel perforation (10.5%) and infectious (TB enteritis) small bowel disease (2.6%). MDCT had an overall high sensitivity (97.3%) in assessment of acute small bowel diseases in correlation with post-operative data and follow-up response to management.

Conclusions
MDCT is a reliable diagnostic imaging tool for assessment of patients with acute abdomen secondary to small bowel origin with high-efficiency in differentiation between different pathological entities that causing acute abdomen.
Aqueous fruit pulp extract of Adansonia digitata (L) protects against lead-acetate-induced hepato-renal damage in rat model
Authors: Makena Wusa , Otong Eduitem Sunday , Dibal Nathan Isaac , Ishaku Barka , Bazabang Sebastine Anthony 
Published: September 2021

Abstract
Background
Adansonia digitata (L) fruit has a multi-purpose function one among many, is the antioxidant activities of the fruit by preventing oxidative stress. The effect of Adansonia digitata (L) fruit on lead-induced liver and kidney damage is not clear. Hence, the study was aimed to assessed the protective role of Adansonia digitata (L) fruits against lead acetate induced changes in the liver and kidney function test parameters and the histology of both organ in experimental rats. The rats were divided into five groups with five rats each. All the rats were administered with respective assigned treatment once daily for 6 weeks. Rats in groups I were administered with just distil water (2 ml/kg). Rats in groups II were administered with lead acetate (30 mg/kg) while rats in groups III–V were administered Adansonia digitatata (L) fruit extract (250 mg/kg and 500 mg/kg) and Succimer (5 mg/kg) respectively, then additionally challenged with lead acetate (30 mg/kg) immediately after. At the end of the administration, the blood serum from the experimental rats were used for biochemical analysis. Then, the the organs such as the liver and kidney collected for histological study.

Results
Rats administered with Lead acetate showed an increase in AST, ALP and ALT as well as increase in urea and creatinine level (p < 0.001), when compared with the control group (group I), where as Adansonia digitatata (L) fruit prevented the effect (upsurge of serum, Urea, Creatinine, AST, ALP and ALT) of lead acetate. Rats administer with only Lead acetate revealed marked liver steatosis and the degeneration of the kidney glomerulus. The Adansonia digitatata (L) fruit extract and Succimer prevented the histological liver steatosis, as well as the degeneration of the glomerulus of the kidney cytoarchitecture.

Conclusion
The findings in this study suggest that Adansonia digitata fruits extract has a protective potentials against lead acetate induced liver and kidney toxicity by preventing the upsurge of liver function enzymes and kidney function parameters. Hence, Adansonia digitata fruits can serve as a natural plant agent that can prevent hepato-renal toxicity. Therefore, Adansonia digitata holds future prospects in preclinical framework to ameliorate organs toxicity for oral therapeutic applications.
Qualitative and quantitative phytochemical composition, antimicrobial activity, and brine shrimp cytotoxicity of different solvent extracts of Acanthus polystachyus, Keetia gueinzii, and Rhynchosia elegans
Authors: Mailu James Kiamba , Nguta Joseph Mwanzia , Mbaria James Mucunu , Okumu Mitchel Otieno 
Published: September 2021

Abstract
Background
The root, root bark, and root tubers of Acanthus polystachyus, Keetia gueinzii, and Rhynchosia elegans are used for managing bacterial and fungal infections among the Luo community of Kisumu East Sub County in Kenya. However, data on the efficacy of these plants against common bacterial and fungal pathogens is not available. The safety of these plants is also not known. This study aimed to investigate the phytochemical composition, antimicrobial properties, and safety of different solvent extracts of the roots, root barks, and root tubers of Acanthus polystachyus, Keetia gueinzii, and Rhynchosia elegans. The broth microdilution method evaluated the antimicrobial activities of the root, root bark, and root tuber extracts (water, acetone, and methanol) of Acanthus polystachyus, Keetia gueinzii, and Rhynchosia elegans. Gram-positive (Bacillus cereus, Staphylococcus aureus), gram-negative (Escherichia coli), and fungal (Candida albicans) microorganisms were used in the evaluation. The safety of the extracts was evaluated in Artemia salina. The phytochemical composition of the extracts was determined using qualitative and quantitative assays.

Results
In general, the extracts of Acanthus polystachyus, Keetia gueinzii, and Rhynchosia elegans displayed poor antimicrobial properties relative to conventional antimicrobial agents including Amoxicillin, Gentamicin, and Nystatin. The aqueous extract of Acanthus polystachyus and the aqueous, acetone, and methanol extracts of Keetia gueinzii were safe in Artemia salina but all other extracts were cytotoxic to Artemia salina.

Conclusions
These findings suggest that the use of the roots, root barks, and root tubers of Acanthus polystachyus, Keetia gueinzii, and Rhynchosia elegans is limited by poor antimicrobial efficacy and cytotoxicity.
The use of a score-based protocol in pediatric appendicitis decreases CT scan utilization when evaluating children in a community hospital
Authors: Hulka Frieda , Morris Bryn , Elliott Paige , Targonska Bogna 
Published: September 2021

Abstract
Background
The Pediatric Appendicitis Score (PAS) is a validated scoring system assessing children with abdominal pain. Prior to 2016, children with abdominal pain in our community hospital were evaluated primarily using CT scans. A protocol using PAS and ultrasound (US) as the primary radiologic modality was adopted in 2016 for evaluating children with abdominal pain. The protocol consisted of three tiers with low PAS requiring no radiologic evaluation; moderate PAS requiring US and high PAS requiring initial surgical consultation. Retrospective chart review of children presenting with clinically suspected appendicitis was performed from January 2015 through December 2017, representing 1 year before and 2 years after implementation of PAS protocol. PAS scoring was assigned retrospectively to patients not scored in the emergency physician’s note, and statistical analysis of the patient cohorts was performed using SPSS, version 17. This study was approved by the University of Nevada Institutional Review Board.

Results
Application of PAS scoring system increased use of US as the primary radiologic test from 59% pre-protocol to 91% post protocol and decreased use of CT scans from 41 to 8% (p < .05). Physician adherence to protocol improved from 59 to 71%, increasing further to 81% in the 2nd year post-protocol (p < .05). The highest rate of non-compliance was noted when providers ordered an US in patients with a low PAS, followed by ordering any radiologic tests in patients with a high PAS.

Conclusion
Implementation of PAS-based protocol altered clinician behavior in a community hospital when evaluating children with clinically suspected appendicitis. Improved adherence to the protocol over time with significant decrease of CT scans ordered thereby reducing radiation exposure in the pediatric population. Future improvements will be aimed at decreasing radiologic testing in patients with a low PAS and involving surgeons earlier with patients who have a high PAS as clinical acceptance to the protocol matures.
Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial
Authors: Elsayed Ahmed Mahrous , Salem Elham Elsayed , Eldin Sahar Mohamed Nour , Abbass Mai Elsayed 
Published: September 2021

Abstract
Background
Adaptive seating is commonly used as an intervention method to enhance postural control. The aim of this study is to investigate the effect of using therapy ball as a seat alternative to using typical chair on grasping and visual motor integration in the children with hemiparetic cerebral palsy. For this aim, thirty children with hemiparetic cerebral palsy from both sexes were included in this study. The children ages ranged from 3 to 6 years old. The degree of spasticity was 1 to 1+ according to modified Ashworth scale. The children were able to sit independently and follow instructions. Children were randomly assigned into two groups (experimental group and control group). Each child was evaluated before and after 3 successive months of selected occupational therapy exercises program. All the children of both groups received the same selected occupational therapy exercises program, but the children in the experimental group performed the exercises while sitting on therapy ball, and the children in the control group performed the exercises while sitting on typical chair.

Results
There was a significant improvement in the measured variables for both groups after treatment. The post-treatment results of the two groups of grasping and visual motor integration for age equivalent scores revealed significant difference (p=0.008 and p=0.011 respectively) in favor of the experimental group.

Conclusions
Therapy ball could be used as a seat alternative to using typical chair to facilitate visual motor integration and grasping in the children with hemiparetic cerebral palsy.
The epidemiology of swine influenza
Authors: Li Yin , Robertson Ian 
Published: September 2021

AbstractGlobally swine influenza is one of the most important diseases of the pig industry, with various subtypes of swine influenza virus co-circulating in the field. Swine influenza can not only cause large economic losses for the pig industry but can also lead to epidemics or pandemics in the human population. We provide an overview of the pathogenic characteristics of the disease, diagnosis, risk factors for the occurrence on pig farms, impact on pigs and humans and methods to control it. This review is designed to promote understanding of the epidemiology of swine influenza which will benefit the control of the disease in both pigs and humans.
Cyp17a1 is Required for Female Sex Determination and Male Fertility by Regulating Sex Steroid Biosynthesis in Fish
Authors: Yang Lanying , Zhang Xuefeng , Liu Shujun , Zhao Chenhua , Miao Yiyang , Jin Li , Wang Deshou , Zhou Linyan 
Published: September 2021

Abstract
In teleost fish, sex steroids are involved in sex determination, sex differentiation, and fertility. Cyp17a1 (Cytochrome P450 family 17 subfamily A member 1) is thought to play essential roles in fish steroidogenesis. Therefore, to further understand its roles in steroidogenesis, sex determination, and fertility in fish, we constructed a cyp17a1 gene mutant in Nile tilapia (Oreochromis niloticus). In XX fish, mutation of the cyp17a1 gene led to a female-to-male sex reversal with a significant decline in 17β-estradiol (E2) and testosterone (T) production, and ectopic expression of male-biased markers (Dmrt1 and Gsdf) in gonads from the critical window of sex determination. Sex reversal was successfully rescued via T or E2 administration, and ovarian characteristics were maintained after termination of E2 supplementation in the absence of endogenous estrogen production in cyp17a1–/– XX fish. Likewise, deficiencies in T and 11-ketotestosterone (11-KT) production in both cyp17a1–/– XX sex-reversed males and cyp17a1–/– XY mutants resulted in meiotic initiation delays, vas deferens obstruction and sterility due to excessive apoptosis and abnormal mitochondrial morphology. However, 11-KT treatment successfully rescued the dysspermia to produce normal sperm in cyp17a1–/– male fish. Significant increases in gonadotropic hormone (gth) and gth receptors in cyp17a1–/– mutants may excessively upregulate steroidogenic gene expression in Leydig cells through a feedback loop. Taken together, our findings demonstrate that Cyp17a1 is indispensable for E2 production, which is fundamental for female sex determination and differentiation in XX tilapia. Additionally, Cyp17a1 is essential for T and 11-KT production, which further promotes spermatogenesis and fertility in XY males.
Vacuum-Assisted Breast Biopsy After Neoadjuvant Systemic Treatment for Reliable Exclusion of Residual Cancer in Breast Cancer Patients
Authors: Koelbel Vivian , Pfob André , Schaefgen Benedikt , Sinn Peter , Feisst Manuel , Golatta Michael , Gomez Christina , Stieber Anne , Bach Paul , Rauch Geraldine , Heil Joerg 
Published: September 2021

AbstractBackgroundAbout 40 % of women with breast cancer achieve a pathologic complete response in the breast after neoadjuvant systemic treatment (NST). To identify these women, vacuum-assisted biopsy (VAB) was evaluated to facilitate risk-adaptive surgery. In confirmatory trials, the rates of missed residual cancer [false-negative rates (FNRs)] were unacceptably high (> 10%). This analysis aimed to improve the ability of VAB to exclude residual cancer in the breast reliably by identifying key characteristics of false-negative cases.MethodsUni- and multivariable logistic regressions were performed using data of a prospective multicenter trial (n= 398) to identify patient and VAB characteristics associated with false-negative cases (no residual cancer in the VAB but in the surgical specimen). Based on these findings FNR was exploratively re-calculated.ResultsIn the multivariable analysis, a false-negative VAB result was significantly associated with accompanying ductal carcinoma in situ (DCIS) in the initial diagnostic biopsy [odds ratio (OR), 3.94;p < 0.001], multicentric disease on imaging before NST (OR, 2.74;p = 0.066), and age (OR, 1.03;p = 0.034). Exclusion of women with DCIS or multicentric disease (n = 114) and classication of VABs that did not remove the clip marker as uncertain representative VABs decreased the FNR to 2.9% (3/104).ConclusionFor patients without accompanying DCIS or multicentric disease, performing a distinct representative VAB (i.e., removing a well-placed clip marker) after NST suggests that VAB might reliably exclude residual cancer in the breast without surgery. This evidence will inform the design of future trials evaluating risk-adaptive surgery for exceptional responders to NST.
Unmet healthcare needs in adults with childhood-onset neurodisabilities: a protocol for a systematic review
Authors: Meehan Elaine , Gallagher Aoife L. , Ryan Jennifer , Kerr Claire , O' Sullivan Rory , Galvin Rose , Manikandan Manjula , Wormald Andrew , Robinson Katie 
Published: September 2021

Background Many adults with childhood-onset neurodisabilities, such as those with intellectual disability or cerebral palsy, report difficulties accessing the healthcare that they require when they are no longer eligible for paediatric services. Compared to the general population, this population is at greater risk of developing many ageing-related diseases and has higher rates of preventable deaths and premature mortality. Addressing unmet healthcare needs is essential to ensuring equitable access in a quality healthcare system. The aim of this systematic review is to synthesise the current available evidence related to unmet healthcare needs in adults with a range of childhood-onset neurodisabilities. Methods A systematic review of quantitative research studies of adults with a range of diagnoses that fall under the neurodisability umbrella and outcomes related to unmet healthcare needs will be undertaken. The Conducting Systematic Reviews and Meta-Analyses of Observational Studies (COSMOS-E) guidelines will be adhered to. Searches of key databases will be undertaken, and a two-phase screening process carried out by pairs of independent reviewers to select studies that meet the inclusion criteria. Data will be extracted using a purposefully designed form. Risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Tools. If it is possible to pool prevalence data, a meta-analysis will be undertaken. Where pooling of data is not possible, a structured synthesis approach will be used, and results will be presented in tables and summarised narratively. Conclusions In recent years, there has been increased emphasis placed on promoting positive ageing and improving the healthcare experiences throughout the lifespan for people with neurodisabilities. Findings of this systematic review can inform decision-making related to healthcare for this vulnerable population and has the potential to contribute to reducing preventable deaths and premature mortality and promoting positive and healthy ageing for this group.
Using self-supervised feature learning to improve the use of pulse oximeter signals to predict paediatric hospitalization
Authors: Mwaniki Paul , Kamanu Timothy , Akech Samuel , Dunsmuir Dustin , Ansermino J. Mark , Eijkemans M.J.C 
Published: September 2021

Background: The success of many machine learning applications depends on knowledge about the relationship between the input data and the task of interest (output), hindering the application of machine learning to novel tasks. End-to-end deep learning, which does not require intermediate feature engineering, has been recommended to overcome this challenge but end-to-end deep learning models require large labelled training data sets often unavailable in many medical applications. In this study, we trained machine learning models to predict paediatric hospitalization given raw photoplethysmography (PPG) signals obtained from a pulse oximeter. We trained self-supervised learning (SSL) for automatic feature extraction from PPG signals and assessed the utility of SSL in initializing end-to-end deep learning models trained on a small labelled data set with the aim of predicting paediatric hospitalization.Methods: We compared logistic regression models fitted using features extracted using SSL with end-to-end deep learning models initialized either randomly or using weights from the SSL model. We also compared the performance of SSL models trained on labelled data alone (n=1,031) with SSL trained using both labelled and unlabelled signals (n=7,578). Results: The SSL model trained on both labelled and unlabelled PPG signals produced features that were more predictive of hospitalization compared to the SSL model trained on labelled PPG only (AUC of logistic regression model: 0.78 vs 0.74). The end-to-end deep learning model had an AUC of 0.80 when initialized using the SSL model trained on all PPG signals, 0.77 when initialized using SSL trained on labelled data only, and 0.73 when initialized randomly. Conclusions: This study shows that SSL can improve the classification of PPG signals by either extracting features required by logistic regression models or initializing end-to-end deep learning models. Furthermore, SSL can leverage larger unlabelled data sets to improve performance of models fitted using small labelled data sets.