bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic retinal biopsy in the management of secondary non-CNS vitreoretinal lymphoma masquerading as viral retinitis: a case report
Authors: Rali Aditya , Xu Lucy T. , Craven Caroline , Cohen Jonathon B. , Yeh Steven , Grossniklaus Hans E. , O’Keefe Ghazala D. 
Published: October 2021

Abstract
Background
Intraocular lymphoma accounts for fewer than 1% of intraocular tumors. When the posterior segment is involved, it can be further classified as vitreoretinal or choroidal lymphoma. Vitreoretinal lymphoma (VRL) can rarely masquerade as an infectious retinitis making diagnosis and management challenging.

Results
A 73-year-old woman with a history of non-central nervous system (CNS) involving diffuse large B-cell lymphoma (DLBCL) was referred for worsening blurry vision—visual acuity of count figures at 2 ft—in her right eye for 8 months. Dilated fundus examination of the right eye was significant for retinal whitening and dot-blot hemorrhages, which was concerning for a viral retinitis and guided initial management. Secondary intraocular lymphoma was also considered. The retinal disease continued to progress despite intravitreal and systemic antiviral therapy, and a diagnostic vitrectomy was inconclusive. A retinal biopsy was then performed, which showed DLBCL, confirming a diagnosis of secondary VRL. Three subsequent treatments with intravitreal methotrexate led to regression of the VRL.

Conclusions
Our case highlights the utility of a retinal biopsy after an inconclusive diagnostic vitrectomy in a challenging scenario of VRL to establish a diagnosis and initiate successful treatment. A multidisciplinary team of providers was essential for diagnosis, comprehensive workup, medical and surgical management of the patient.
Post-COVID depression among a sample of Egyptian patients and its associated factors
Authors: Ezzelregal Hieba Gamal , Hassan Azza Mohammed , Mohamed Rehab Serag , Ahmed Noha Othman 
Published: October 2021

Abstract
Background
Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities. Nowadays, we are in COVID-19 pandemic. From practice after COVID-19 illness resolves, some of the recovering patients return back smoothly to their pre-illness life. Others experience different mood changes. Anxiety and depression are the most common. Those patients with improving general health, radiology, and oxygenation have different somatic complaints such as sensation of dyspnoea. Psychological support and psychiatric evaluation can help them to overcome this situation and get rid of dyspnoea sensation. This work aimed to evaluate the relation between COVID-19 survivors and depression and to how extent this could affect functional status of the study participants.

Results
This work recruited 102 adult patients as a sample of Egyptians who were positive PCR for SARS-COV2, turned negative and free of symptoms for 1 month or more which include physicians, nurses, employees, and literate health care workers of Ain Shams University hospitals attending chest outpatient clinic for follow-up. The majority were 47.1% in age group (35–55 years), sixty two (60.8%) participants were females, 74.5% had high education, and 24.5% were smokers. The most frequent symptom reported by study participants as the most annoying COVID-19 symptom was fever (32.4%). Beck depression inventory score showed that 59 (57.8%) participants had no depression, 24 (23.5%) had mild depression, 16 (15.7%) had moderate depression, and only 3 (2.9%) participants had severe depression. Logistic regression analysis was done to measure effect of steroid use and grade of dyspnoea on development of moderate or severe post-COVID depression and showed that higher grades of dyspnoea were associated with higher probability of development of moderate or severe post-COVID depression (p value < 0.05).

Conclusion
As predicted, COVID-19 survivors presented a high prevalence of psychiatric sequelae. Age, sex, and education level were important association factors. Higher educational level was associated with higher score of depression due to increased awareness of the current pandemic issue. Steroids’ use was proposed as a cause of depression since the majority of moderate or severe depression group were on steroids. Higher grades of dyspnoea were associated with higher probability of development of moderate or severe post-COVID depression. It is suggested that COVID-19 survivors should be assessed, to properly diagnose and treat any psychiatric conditions, to reduce the disease burden.
Management of Cerebral Edema, Brain Compression, and Intracranial Pressure
Authors: Liotta Eric M. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
This article reviews the pathophysiology and management of cerebral edema, brain compression, and elevated intracranial pressure (ICP). It also provides a brief introduction to the concept of the glymphatic system and select cellular contributors to cerebral edema.

RECENT FINDINGS
Cerebral edema and brain compression should be treated in a tiered approach after the patient demonstrates a symptomatic indication to start treatment. All patients with acute brain injury should be treated with standard measures to optimize intracranial compliance and minimize risk of ICP elevation. When ICP monitors are used, therapies should target maintaining ICP at 22 mm Hg or less. Evidence exists that serial clinical examination and neuroimaging may be a reasonable alternative to ICP monitoring; however, clinical trials in progress may demonstrate advantages to advanced monitoring techniques. Early decompressive craniectomy and hypothermia are not neuroprotective in traumatic brain injury and should be reserved for situations refractory to initial medical interventions. Medical therapies that acutely lower plasma osmolality may lead to neurologic deterioration from osmotic cerebral edema, and patients with acute brain injury and renal or liver failure are at elevated risk.

SUMMARY
A tiered approach to the management of cerebral edema and brain compression can reduce secondary brain injury when implemented according to core physiologic principles. However, our knowledge of the pathophysiology of acute brain injury is incomplete, and the conceptual framework underlying decades of clinical management may need to be revised in response to currently evolving discoveries regarding the pathophysiology of acute brain injury.
Acute Neurologic Manifestations of Respiratory Viruses
Authors: Pizzi Michael A. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
Understanding the pathophysiology of COVID-19 and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes the disease has demonstrated the complexity of acute respiratory viruses that can cause neurologic manifestations. This article describes the most common respiratory viruses that have neurologic manifestations, with a focus on SARS-CoV-2 and COVID-19.

RECENT FINDINGS
In vitro and in vivo studies have better elucidated the neurotropism of various respiratory viruses. Understanding host cell receptors that mediate viral binding and entry not only demonstrates how viruses enter host cells but also provides possible mechanisms for therapeutic interventions. Elucidation of SARS-CoV-2 binding and fusion with host cells expressing the angiotensin-converting enzyme 2 (ACE2) receptor may also provide greater insights into its systemic and neurologic sequelae. Respiratory virus neurotropism and collateral injury due to concurrent inflammatory cascades result in various neurologic pathologies, including Guillain-Barré syndrome, encephalopathy, encephalitis, ischemic stroke, intracerebral hemorrhage, and seizures.

SUMMARY
Numerous respiratory viruses can infect the cells of the peripheral and central nervous systems, elicit inflammatory cascades, and directly and indirectly cause various neurologic manifestations. Patients with neurologic manifestations from respiratory viruses are often critically ill and require mechanical ventilation. Neurologists and neurointensivists should be familiar with the common neurologic manifestations of respiratory viruses and the unique and still-evolving sequelae associated with COVID-19.
Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome as Syndromes of Cerebrovascular Dysregulation
Authors: Singhal Aneesh B. 
Published: October 2021

ABSTRACT

PURPOSE OF REVIEW
This article describes the causes, clinical and imaging features, management, and prognosis of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS), in which the underlying pathophysiology is related to reversible dysregulation of the cerebral vasculature.

RECENT FINDINGS
PRES and RCVS are descriptive terms, each bringing together conditions with similar clinical-imaging manifestations. Headache, visual symptoms, seizures, and confusion occur in both syndromes. RCVS is usually heralded by recurrent thunderclap headaches, whereas encephalopathy and seizures are typical in PRES. In PRES, brain imaging shows reversible vasogenic edema that is typically symmetric and located in subcortical regions (mostly posterior predominant). In RCVS, brain imaging is often normal; cerebral angiography shows segmental vasoconstriction-vasodilatation affecting the circle of Willis arteries and their branches. Aside from shared clinical features, significant imaging overlap exists. Both PRES and RCVS can be complicated by ischemic and hemorrhagic brain lesions; angiographic abnormalities frequently occur in PRES and vasogenic edematous lesions in RCVS. Common triggers (eg, eclampsia, vasoconstrictive and chemotherapeutic agents) have been identified. Abnormal cerebrovascular tone and endothelial dysfunction may explain both syndromes. Management of these syndromes includes the removal of identified triggers, symptomatic treatment of headache or seizures, and moderate blood pressure control. Both syndromes are self-limited, with clinical recovery occurring within days to weeks. Long-term deficits and mortality are uncommon.

SUMMARY
PRES and RCVS have been well characterized and acknowledged to have significant overlap. Advances in our understanding of pathophysiology and risk factors for poor outcome are expected to optimize the management of these not uncommon syndromes.
After Sexology
Authors: Lubin Joan , Vaccaro Jeanne 
Published: October 2021

AbstractIs sexology over? What does one do with its history, at once a seemingly remote relic and a persistent logic of biopolitics today? “Sexology and Its Afterlives” begins from the premise that the history of sexology lives in the infrastructures of the present. Locating the afterlives of sexology in material and aesthetic form, this introduction to the special issue engages the largely unmarked detritus of a disaggregated sexological project, whose components have found renewed life in the biopolitical apparatus. The contributors to this issue identify not only familiar sites of sexological persistence (the sex-segregated public toilet) but also less immediately obvious ones (the Moynihan report, redlining, the army base) as executing the unfinished business of the sexological project. This breadth of sexological diffusion makes its analysis a necessarily interdisciplinary prospect, and the contributors call on disability studies, trans studies, Black studies, women-of-color feminism, visual culture, and the history of sexuality, generating emergent concepts, including crip-of-color critique (Kim), binary-abolitionist praxis (Stryker), a “trans-mad” aesthetic (Crawford), and a shift toward expressivity as a framework (Musser). Across the issue, newly imagined sites of collective politics come into view as a payoff for working through the stalled-out imaginaries of sexological binarisms.
Queering the Moment of Hypospadias “Repair”
Authors: Griffiths David Andrew 
Published: October 2021

AbstractHeteronormativity structures biomedical justifications for continuing surgical interventions on infants’ genitals that are cosmetic and medically unnecessary. It would seem, then, that queer theory is uniquely suited to challenge this continuing practice. This article takes up the question of what queer theory can do for intersex, with particular focus on queer temporality. I consider the example of “hypospadias repair,” a surgical intervention justified by invoking restrictive norms of what the penis should look like and be able to do at some point in the future. In contrast, intersex activists invoke post-medical futures, structured by norms of consent and bodily integrity. While queer approaches to temporality might challenge the notion of intervening surgically on an infant for the sake of the future adult the child will become, might this queer critique also disrupt the ability of activist individuals and organizations to invoke other narratives of the future, including ones where adults have not had irreversible surgeries as infants? I will ask whether queer theories of temporality and futurity can challenge medical practices that compromise consent and bodily integrity. Can queer theory question surgery as a queer moment and help us to conceptualize all bodily differences within a more expansive frame, without reinstating heteronormative narratives of futurity?
Making Cardiopulmonary Exercise Testing Interpretable for Clinicians
Authors: Andonian Brian J. , Hardy Nicolas , Bendelac Alon , Polys Nicholas , Kraus William E. 
Published: October 2021

Abstract
Cardiopulmonary exercise testing (CPET) is a dynamic clinical tool for determining the cause for a person's exercise limitation. CPET provides clinicians with fundamental knowledge of the coupling of external to internal respiration (oxygen and carbon dioxide) during exercise. Subtle perturbations in CPET parameters can differentiate exercise responses among individual patients and disease states. However, perhaps because of the challenges in interpretation given the amount and complexity of data obtained, CPET is underused. In this article, we review fundamental concepts in CPET data interpretation and visualization. We also discuss future directions for how to best use CPET results to guide clinical care. Finally, we share a novel three-dimensional graphical platform for CPET data that simplifies conceptualization of organ system-specific (cardiac, pulmonary, and skeletal muscle) exercise limitations. Our goal is to make CPET testing more accessible to the general medical provider and make the test of greater use in the medical toolbox.
Experimental demonstration of flexible information rate PON beyond 100  Gb/s with probabilistic and geometric shaping
Authors: Kaneda Noriaki , Zhang Rui , Lefevre Yannick , Mahadevan Amitkumar , van Veen Doutje , Houtsma Vincent 
Published: October 2021

The application of pairwise probabilistic shaping combined with geometric shaping is investigated for a pulse-amplitude-modulation-based intensity modulated and direct detection (IMDD) system. With probabilistically shaped signals, we experimentally demonstrate the flexible information rate beyond 100 Gb/s in a practical passive optical network (PON) link. Similar to the G.hsp 50 Gb/s PON standard, the PON link assumes the existence of a semiconductor optical amplifier (SOA), which boosts the transmitter power to achieve a high link budget. While the optimal signal distributions for the IMDD link with a SOA tend to be unipolar distributions, we consider a practical methodology of accommodating forward error correction (FEC) parity bits using pairwise probabilistic distribution. Since pairwise signaling causes performance degradation when the optimal signal would be strongly shaped, we propose to combine geometric shaping (GS) with probabilistic shaping (PS) to overcome the shortcomings of the pairwise signaling. We present experimental demonstrations of the various achievable rate measurements using PS

+

GS modulations with flexible FEC assumption. We also propose a novel descrambling-based decoding technique to evaluate the post-FEC performance based on transmission data that is agnostic of the FEC code. The post-FEC performances are then presented using a fixed and practical low-density parity check code.
Detection of obstructive sleep apnea using Belun Sleep Platform wearable with neural network-based algorithm and its combined use with STOP-Bang questionnaire
Authors: Yeh Eric , Wong Eileen , Tsai Chih-Wei , Gu Wenbo , Chen Pai-Lien , Leung Lydia , Wu I-Chen , Strohl Kingman P. , Folz Rodney J. , Yar Wail , Chiang Ambrose A. 
Published: October 2021

Many wearables allow physiological data acquisition in sleep and enable clinicians to assess sleep outside of sleep labs. Belun Sleep Platform (BSP) is a novel neural network-based home sleep apnea testing system utilizing a wearable ring device to detect obstructive sleep apnea (OSA). The objective of the study is to assess the performance of BSP for the evaluation of OSA. Subjects who take heart rate-affecting medications and those with non-arrhythmic comorbidities were included in this cohort. Polysomnography (PSG) studies were performed simultaneously with the Belun Ring in individuals who were referred to the sleep lab for an overnight sleep study. The sleep studies were manually scored using the American Academy of Sleep Medicine Scoring Manual (version 2.4) with 4% desaturation hypopnea criteria. A total of 78 subjects were recruited. Of these, 45% had AHI < 5; 18% had AHI 5–15; 19% had AHI 15–30; 18% had AHI ≥ 30. The Belun apnea-hypopnea index (bAHI) correlated well with the PSG-AHI (r = 0.888, P < 0.001). The Belun total sleep time (bTST) and PSG-TST had a high correlation coefficient (r = 0.967, P < 0.001). The accuracy, sensitivity, specificity in categorizing AHI ≥ 15 were 0.808 [95% CI, 0.703–0.888], 0.931 [95% CI, 0.772–0.992], and 0.735 [95% CI, 0.589–0.850], respectively. The use of beta-blocker/calcium-receptor antagonist and the presence of comorbidities did not negatively affect the sensitivity and specificity of BSP in predicting OSA. A diagnostic algorithm combining STOP-Bang cutoff of 5 and bAHI cutoff of 15 events/h demonstrated an accuracy, sensitivity, specificity of 0.938 [95% CI, 0.828–0.987], 0.944 [95% CI, 0.727–0.999], and 0.933 [95% CI, 0.779–0.992], respectively, for the diagnosis of moderate to severe OSA. BSP is a promising testing tool for OSA assessment and can potentially be incorporated into clinical practices for the identification of OSA.
Trial registration: ClinicalTrial.org NCT03997916 https://clinicaltrials.gov/ct2/show/NCT03997916?term=belun+ring&draw=2&rank=1
Association between Epstein-Barr virus and periodontitis: A meta-analysis
Authors: Maulani Chaerita , Auerkari Elza Ibrahim , C. Masulili Sri Lelyati , Soeroso Yuniarti , Djoko Santoso Widayat , S. Kusdhany Lindawati 
Published: October 2021

PurposePrevious studies have found that Epstein-Barr virus (EBV) is associated with periodontitis, though some controversy remains. This meta-analysis aimed to clarify and update the relationship between EBV and periodontitis as well as clinical parameters.MethodsA comprehensive search was conducted in the PubMed and Scopus databases in December 2020. Original data were extracted according to defined inclusion and exclusion criteria. Outcomes were analyzed, including overall odds ratios (ORs) and 95% confidence intervals (CIs). A random-effects model was used, and publication bias was assessed by Egger’s and Begg’s tests. Sensitivity analysis was used to evaluate the stability of the outcome.ResultsTwenty-six studies were included in the present meta-analysis, involving 1354 periodontitis patients and 819 healthy controls. The included studies mostly showed high quality. The overall quantitative synthesis for the association between EBV and periodontitis was an increased odds ratio when subgingival EBV was detected OR = 7.069, 95% CI = 4.197–11.905, P<0.001). The results of subgroup analysis suggested that the association of EBV with periodontitis was significant in Asian, European, and American populations (P<0.001; P = 0.04; P = 0.003, respectively) but not in African populations (P = 0.29). Subgroup analysis by sample type showed that subgingival plaque (SgP), tissue and gingival crevicular fluid GCF were useful for EBV detection (P<0.001). EBV detection amplification methods included nested PCR, multiplex PCR and PCR (P<0.001; P = 0.05, P<0.001, respectively), but EBV detection by real-time PCR and loop-mediated isothermal amplification presented no significant result (P = 0.06; P = 0.3, respectively). For the clinical parameters of periodontitis, pocket depth (PD) and bleeding of probing (BOP) percentages were higher in the EBV-positive sites than in the EBV-negative sites (MD 0.47 [0.08, 0.85], P = 0.02; MD 19.45 [4.47, 34.43], P = 0.01).ConclusionsA high frequency of EBV detection is associated with an increased risk of periodontitis. The EBV association was particularly significant in all populations except in African populations. Subgigival plaque (SgP), tissue and GCF were not significantly different useful material for detecting EBV in periodontitis. Nested PCR and multiplex PCR are reliable methods for this purpose. In the presence of EBV, PD and BOP are reliable clinical parameters for gingival inflammation. However, some caution in such interpretation is justified due to heterogeneity among studies. A suggested extension could assess the parallel influence of other human herpesviruses.
Pain drawing as a screening tool for anxiety, depression and reduced health-related quality of life in back pain patients: A cohort study
Authors: Weßollek Katharina , Kowark Ana , Czaplik Michael , Rossaint Rolf , Kowark Pascal 
Published: October 2021

Background
Back pain patients are more likely to suffer from depression, anxiety and reduced quality of life. Pain drawing is a simple, frequently used anamnesis tool that facilitates communication between physicians and patients. This study analysed pain drawings to examine whether pain drawing is suitable as a screening tool for signs of anxiety, depression or reduced quality of life, as the detection of these symptoms is essential for successful treatment.

Methods
Pain drawings of 219 patients with lower back pain were evaluated retrospectively. Pain drawings are a schematic drawing of a human being. Six variables of the pain drawing were analysed. Subscales of the Hospital Anxiety and Depression Scale (HADS) and the Mental Component Summary (MCS) of the Short Form 12 (SF-12) were used to measure anxiety, depression and quality of life, respectively. Descriptive statistics, uni- and multivariate linear regression analyses and analysis of variance were performed. Logistic regression analyses were conducted for suitable variables.

Results
We revealed significant positive correlations between the variables "filled body surface" and "number of pain sites" and the anxiety (HADS-A) and depression subscales (HADS-D) of the HADS (p<0.01). The same predictors had significant negative correlations with the MCS (p<0.01). However, the sensitivity and specificity of the variable "number of pain sites" were too low compared to those for existing screening tests to consider it as a screening tool for anxiety, depression and quality of life (HADS-A: sensitivity: 45.2%, specificity: 83.3%; HADS-D: sensitivity: 61.1%, specificity: 51%; MCS: sensitivity: 21.2%, specificity: 85.7%).

Conclusions
There were significant correlations between the amount of filled body surface and the number of pain sites in the pain drawing and anxiety, depression and quality of life. Although useful in routine clinical practice, pain drawing cannot be used as a screening tool based on our results.