bluuebunny/crossref_metadata_2025_split huggingface dataset:
Graph Convolutional Network for AD and MCI Diagnosis Utilizing Peripheral DNA Methylation: Réseau de neurones en graphes pour le diagnostic de la MA et du TCL à l’aide de la méthylation de l’ADN périphérique
Authors: Qian Yuqin , Tang Xinlu , Shen Ruinan , Lu Yong , Ding Jianqing , Qian Xiaohua , Zhang Chencheng 
Published: November 2024

Objective Blood DNA methylation (DNAm) alterations have been widely reported in the onset and progression of mild cognitive impairment (MCI) and Alzheimer's disease (AD); however, DNAm is underutilized as a diagnostic biomarker for these diseases. We aimed to evaluate the diagnostic performance of DNAm for MCI and AD, both individually and in combination with well-established AD biosignatures. Methods A total of 1,891 blood samples from Alzheimer's Disease Neuroimaging Initiative (ADNI) studies were used to identify potential candidate DNAm biomarkers. Multimodal clinical data from 635 samples (normal control (NC), n = 193; MCI, n = 352; AD, n = 90) in the TADPOLE dataset were utilized to construct eight different classification models using a graph convolutional network, a machine learning framework. Results After feature selection, 17 DNAm sites were selected for subsequent analysis. Remarkable differences in DNAm levels were observed at the screened DNAm loci in all three cohorts. Adopting DNAm features into multimodal models significantly improved the classification performance for three dichotomous subtasks (NC vs. non-NC, MCI vs. non-MCI, and AD vs. non-AD), especially when combined with cerebrospinal fluid (CSF) features for NC (area under the curve (AUC): 0.8534) and MCI classification (AUC: 0.7675). A weak correlation between DNAm and both magnetic resonance imaging and CSF features in the NC and MCI cohorts suggests good complementarity between modalities (correlation coefficient ≤0.2). Conclusions Our study offers new insights into peripheral DNAm in MCI and AD and suggests promising diagnostic performance of models integrating epigenomics, imaging, or CSF biomarkers. Plain Language Summary Title Using Machine Learning and Blood-Based Genetic Markers to Help Diagnose Mild Cognitive Impairment and Alzheimer's Disease
Exploring Rapid Response Team Activation Impact in Patients with Cirrhosis with Acute Decompensation
Authors: Friesen Joelle N. , Maberry Mackenzie , Olson Jody C. , Gallo de Moraes Alice 
Published: November 2024

Background Cirrhosis is associated with significant healthcare utilization, yet data about in-hospital decompensations remain sparse. Additionally, the impact of liver transplant candidacy status on resuscitation and outcomes is largely unknown. Aims We aimed to evaluate the characteristics of resuscitation events for patients with cirrhosis with acute decompensation, analyzing liver transplant candidacy and intensive care unit (ICU) transfer parameters. Methods Retrospective single-center review of adult patients with liver cirrhosis who had a rapid response team (RRT) activation during hospitalization and no prior liver transplantation. Results Patients with cirrhosis who were liver transplant candidates were more likely to be younger ( p = .003), have a higher serum total bilirubin ( p = .015), higher INR ( p < .001), and higher MELD 3.0 ( p = .006). There was no significant difference in ICU transfer ( p = .170) after RRT activation. Liver transplant candidates had a lower 30- and 60-day mortality ( p = .008, p = .014) and were less likely to have a code status discussion after decompensation ( p = .001). Lower serum albumin was associated with ICU transfer ( p = .001). Patients who transferred to the ICU were more likely to have a code status discussion within 24 h after RRT ( p = .011) without significant difference in 30- or 60-day mortality ( p = .059, p = .277). Conclusions Liver transplant candidacy in patients with cirrhosis with acute decompensation is not clearly correlated with ICU transfer. Liver transplant candidates are more likely to be younger, have higher MELD 3.0 scores, less likely to have code status discussed after RRT, and have lower 30- and 60-day mortality rates. Patients who transfer to the ICU are more likely to have a code status discussion without any significant difference in 30- or 60-day mortality.
The problem of pain in systemic lupus erythematosus: A comprehensive analysis of pain distribution using the CHOIR body map and PROMIS measures
Authors: Jiang Tiffany En , Mackey Sean , Darnall Beth D , Simard Julia F , Falasinnu Titilola 
Published: November 2024

Background Our study investigates the associations between pain distribution, biopsychosocial factors, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures in patients with systemic lupus erythematosus (SLE). Employing self-reported pain body maps, we aim to characterize the distribution of pain and its impact on biopsychosocial measures. Methods We retrospectively analyzed the electronic health records (EHR) of 332 adult patients with SLE attending pain clinics at an academic medical center. The study included demographics, pain distribution assessed via self-reported body maps, and PROMIS assessments of biopsychosocial experiences. We used linear regression models adjusted for age and sex to investigate associations between pain distribution and PROMIS outcomes. Results Men, on average, indicated pain in 3.2 regions, whereas women reported pain in 5.6 regions. Women predominantly highlighted the hip, buttock, and leg region, whereas men primarily emphasized the shoulder and arm region. We found a positive correlation between pain widespreadness and worse PROMIS measures, including pain interference, behavior, fatigue, depression, anxiety, sleep disturbance, and social isolation. Additionally, widespread pain was associated with lower physical function, emotional support, and satisfaction in roles and activities. Female patients reported higher levels of pain and PROMIS measures compared to males. Conclusion Our findings highlight the multidimensional impact of pain on SLE patients’ lives underscoring the need for holistic pain management approaches. The intricate associations between pain distribution and biopsychosocial factors emphasize the importance of considering spatial dimensions of pain in clinical interventions. Further research is warranted to explore effective interventions addressing psychosocial aspects of pain in SLE, aiming to enhance patient symptom management and quality of life.
Qualitative discrimination of low-dose oral contraceptives and identification of environmentally stressed tablets: Comparing a handheld near infrared spectrometer to a benchtop spectrometer
Authors: Eady Matthew , Peters Noah , Jenkins David 
Published: November 2024

Levonorgestrel – ethinyl estradiol tablets (Levo-EE) are an essential medication provided through global health supply chains for family planning purposes. Ensuring the quality of Levo-EE and other essential medications in a global supply chain is a primary concern. Portable and handheld diffuse reflectance spectrometers have become more approachable from a cost and usability perspective in recent years. A discriminatory screening method with a handheld near infrared (NIR) spectrometer (900 – 1700 nm) differentiating between brands of Levo-EE and placebos has been constructed. Additionally, the handheld spectrometer was used to determine if environmentally stressed tablets could be identified and differentiated in a qualitative screening method. The same samples were scanned on a benchtop diffuse reflectance NIR spectrometer as well (350 – 2500 nm) for comparison. Brands of oral contraceptives were able to be discriminated by applying a Mahalanobis distance-based classification approach to the handheld spectrometer, though be it at a slightly lower level of discernability due to the reduced spectral range collected. Environmentally stressed samples were applied to the classification model, which were flagged as unlike the reference dataset. Spectra from the environmentally stressed tablets saw an increase in absorbance for water associated peaks with the benchtop spectrometer at approximately 1450 nm and 1949 nm for tablets stored at 30, 40, and 50°C–54°C. Data collected by the handheld showed that the spectrometer offers a low-cost screening approach to oral contraceptive tablets containing two low-dose active ingredients. The handheld spectrometer was also able to flag environmentally stressed samples. The total model accuracy for the target product (brand “A”; N = 560) was above 98% for both benchtop and handheld spectrometers. While these results focus on oral contraceptives, a similar approach could be conducted for other solid dosage tablets for more approachable quality compliance screening.
GLA-loaded Liposome Albumin Particles-mediated p53 Targets Cervical Cancer Cell Transplant Tumors
Authors: Du Yanzi , Liu Chengyun 
Published: November 2024

Background p53 is a phosphorylated glycoprotein whose expression is abnormally elevated in various human tumors. p53 also regulates a variety of tumor cells, but research on cervical cancer has not yet been reported. Purpose This study intends to investigate the role of targeting p53 in cervical cancer. Methods Electron microscopy was used to assess the size of protein particles, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2 H-tetrazolium bromide (MTT) was used to detect the OD value of nanocomposites at different concentrations using a UV spectrophotometer, MTT and cell cloning were used to detect cell proliferation expression ability, and reverse transcriptase polymerase chain reaction (RT-PCR) to detect p53 expression. Immunofluorescence measured nuclear factor kappa B (NF-κB) expression in cells, and western blotting assessed the relative expression of p53 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) proteins. The detection mechanism was further explored through in vivo studies. Results Glutaraldehyde (GLA)-loaded liposomal albumin particles showed a positive zeta value, indicating that the CS coating process of GLA was successful. Our data show that the experimental group showed a concentration-dose-dependent growth relationship, indicating that GLA-loaded liposome albumin particles have better antitumor activity in cervical cancer cell lines. Compared with most GLA-loaded liposomal albumin particle groups, P53 expression was inhibited, and the expression of P53 was downregulated in GLA-loaded liposomal albumin particle cervical cancer. In vivo results showed that the measured tumor volume decreased after treatment with GLA-loaded liposomal albumin particles, and mice treated with GLA-loaded liposomal albumin particles had longer survival times. Induction of NF-κB in tumors may be a powerful strategy allowing GLA-loaded liposomal albumin particles to avoid apoptosis and possibly after cytotoxic chemotherapy. Conclusion This study demonstrates that GLA-loaded liposomal albumin particles may participate in the development and progression of human cervical cancer cells by targeted regulation of NF-κB activity.
Blockades in the Pathway of Speciality Care in Systemic Lupus Erythematosus: A Report Based on Indian Rheumatology Association Database
Authors: Ghosh Alakendu , Chandrashekara S , Shenoy Padmanabha , Kumar Uma , Pandya Sapan , Khare Apurva , Dudam Rajkiran , Goswami Rudra Prosad 
Published: November 2024

Aim: The lack of knowledge among primary care physicians about autoimmune rheumatic diseases can contribute to referral delays by impeding early recognition, accurate diagnosis and timely referral to specialists. The present study is aimed at analysing the factors influencing the diagnostic and referral delay in patients with systemic lupus erythematosus (SLE) to the rheumatology speciality in India. Materials and methods: The independent, multi-centre, database-based, cross-sectional study collected data from seven centres across India through the Indian Rheumatology Association database. The patient-related factors and the referral factors were determined based on the patient narration. Based on the patient’s income, a modified version of the Prasad scale was employed to classify them according to socioeconomic status. The analysis also included the clinical presentation and system involvement. Logistic regression analysis was used to identify significant predictors of early referral based on initial symptoms. Results: The study considered 786 out of 833 patients fulfilling the Systemic Lupus International Collaborating Clinics criteria. The median delay in referral to a specialist was 1 month, with an interquartile range of 11 months, but the delay ranged from 1 to 192 months. The major causes of referral delay were the management of SLE by other specialists instead of rheumatologists (93%) and a lack of awareness of speciality care (89%). Additionally, more than 25% of primary care practitioners were unaware of rheumatology as a speciality, and a similar percentage of patients received incorrect diagnoses from their general care physician. Early referral within 6 months was associated with a lower prevalence of systemic complications, including pulmonary, gastrointestinal, peripheral vascular, central nervous system and ophthalmic involvement. Significant predictors for early referral included joint pain (49.51% vs. 19.64%; P = .013; odds ratio [OR] = 0.655), hair loss (12.76% vs. 4.76%; P = .279; OR = 0.789) and weight loss (5.05% vs. 1.12%; P = .053; OR = 0.469). Conversely, symptoms such as lung involvement (0.56% vs. 0.98%; P = .042; OR = 3.938), Raynaud’s phenomenon (0.14% vs. 0.98%; P = .002; OR = 15.847) and thrombocytopenia (0.84% vs. 1.12%; P = .035; OR = 3.002) were more likely to lead to referrals to other specialities. Conclusion: The delay in patient referral to the rheumatology speciality is primarily attributed to referrals to other specialities and a lack of knowledge about rheumatology. Educating primary care physicians and facilitating direct referrals to specialists could significantly contribute to reducing these delays.
Functional Units Analysis of Mandibular Morphology in Patients With Parry-Romberg Syndrome
Authors: Li Xiyuan , Zhang Zhiyong 
Published: November 2024

Objective To characterize mandibular morphology in patients with Parry-Romberg syndrome (PRS). Design Retrospective study. Setting A craniofacial center. Patients Thirty-three patients with PRS affecting mandible. Interventions Preoperative computed tomography data were analyzed using Mimics 26.0 (Materialise Inc.). Distances between landmarks—condyle process (Con), coronoid process (Cor), mandibular foramen (IAF), gonion (Go), and mental foramen—were measured to represent the sizes of skeletal units. Positional asymmetry was reflected by angles between lines connecting bilateral landmarks and the occlusal plane. Main outcome measure(s) Bilateral differences in unit sizes were compared. Absolute difference (Δ) > 5 mm and relative size (RS) < 80% were set to evaluate the severity of hypoplasia. Angular measurements were compared to 0° using one-sample t tests. Pearson correlation analysis was conducted to examine the relationship between onset ages and both RS and angular measurements. Results The affected side's skeletal units were smaller. Severe hypoplasia was more common in the angular unit. Angles between Con-Con’, Cor-Cor’, IAF-IAF’, and the occlusal plane were less than 0°, whereas the angle with Go-Go’ was greater than 0°. Age of onset was positively correlated with the condylar unit size and the Con-Con’ to occlusal plane angle. Conclusions Patients with PRS affecting mandible exhibit smaller skeletal units on the affected side, particularly in the angular unit. Most landmarks on affected side tend to cluster toward the occlusal plane. Earlier onset of PRS correlates with more pronounced condylar asymmetry. Evaluating the severity of functional units involvement and implementing appropriate treatment should be considered.
Climate Change Impact on Outdoor Organizations Today
Authors: Jackson Jeff S. , Slay Stuart L. , Tarter Shana L. 
Published: November 2024

Introduction Outdoor recreation and tourism providers, education programs, and outdoor recreation facilities are experiencing the effects of climate change and severe weather firsthand. This research assessed the impact that climate change was having on these operations in 2023. Methods Respondents from 127 outdoor organizations completed an online survey assessing the impacts of climate change and severe weather. Any outdoor operation that owed a duty of care to clients who they take outdoors or host at their facilities was invited to participate. This included outdoor tourism and recreation providers, outdoor education programs (both school and expedition based), groups involved in conservation work, and facilities such as parks, ski areas, and other outdoor recreation facilities. Respondents were from Canada's far north to Mexico, with 14% from further international locations. Results Climate change is having moderate to serious impacts on outdoor operations. Extreme heat and air quality were of primary concern, with storm event flooding, wildfires, snowpack, and changes in the ranges of disease-carrying insects top concerns. Fewer than half the operations have established criteria to aid in decision making, yet most had to revise operational plans in 2023 due to extreme weather. Conclusions There was pervasive uncertainty regarding decisions involving extreme heat and air quality, particularly the short-term health impacts on clients and the long-term health impacts on workers. There was uncertainty regarding trusted sources for guidance and the many overlapping or contradictory jurisdictional recommendations. Practical direction is required for operations and decision makers, as is further research specific to this sector's needs.
Tele-Ultrasound in the Wilderness: A Tutorial Experience for Medical Students
Authors: Kurek Julie , King Samantha A. , Felipe Naillid , Philip Jobin , Haines Caver , Lareu Stephanie , Clinton Michelle , Sward Doug , Euerle Brian , Salerno Alexis 
Published: November 2024

Introduction Providers can evaluate patients who sustain trauma during outdoor activities by using the extended focused assessment with sonography for trauma (FAST) and the limited knee ultrasound. Remote tele-mentored ultrasound (RTMUS) can help minimally trained providers in the wilderness if they have difficulty obtaining a view or have questions about the interpretation of an image. The goal of our study was to determine the feasibility of using RTMUS to teach the FAST exam and knee ultrasound exam to ultrasound-naive medical students during a wilderness medicine outdoor activity. Methods Medical students from two large academic institutions were randomized to receive either in-person or RTMUS education during a wilderness activity 1 d before completion of FAST and knee ultrasound exams. All students received limited ultrasound instruction before the event. The images obtained by the students were compared. Two ultrasound-trained emergency physicians evaluated the images for their ability to identify structures and support a diagnosis from the images. Simple descriptive statistics were performed. Results There was a statistically significant difference between the RTMUS group and the in-person group. The images captured by the in-person group were more likely to identify structures and support a diagnosis than those captured by the RTMUS group. Conclusions In this study, ultrasound-naive medical students who received in-person education on conducting the knee exam and FAST exam obtained higher-quality images than students who received RTMUS education. This study suggests that if RTMUS is used for medical purposes, increased ultrasound training may be needed prior to initiation of RTMUS.
Assessment of percutaneous closure for decannulation of veno-arterial extracorporeal membrane oxygenation: A retrospective study
Authors: Martins-Fernandes Diana , Rocha-Neves João , Ferreira Ana Rita , Martins Hélio , Gaião Sérgio , Paiva José Artur 
Published: November 2024

Background: Despite the evidence supporting the use of Perclose Proglide® (PP) suture-mediated vascular closure devices in various clinical scenarios, limited evidence exists regarding its role in percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation (VA-ECMO). Compared to conventional methods, this study evaluates the effectiveness and complications of bedside percutaneous femoral artery closure using Perclose ProGlide (PP) for VA-ECMO decannulation. Methods: Retrospective cohort of consecutive patients managed with mechanical circulatory support VA-ECMO for refractory cardiogenic shock, who survived decannulation between January 2017 and August 2023. A comparison between PP and other decannulation strategies was established to evaluate the effectiveness and procedure-related complications of bedside percutaneous femoral artery closure using a PP with a post-closure technique compared to conventional approaches of surgical and manual decannulation. Results: Among 122 patients decannulated from VA-ECMO with a mean age of 48.6 ± 13.1 and 78 (63.9) males, 49.2% comprised the PP group. Despite the older age ( p = 0.021) and higher prevalence of arterial hypertension ( p = 0.045), the PP group had a larger number of patients free from decannulation-related adverse events. Additionally, a higher haemoglobin level 24 h post decannulation ( p = 0.047), with no difference in terms of transfusion of red blood cells between groups ( p = 0.263) was found. The pseudoaneurysm was the most frequently reported complication, while the arterial cannulation surgical wound site infection was only documented in the open repair subgroup. A trend towards reduced Intensive Care (ICU) and hospital length of stay after decannulation was noted, although it did not reach statistical significance. There was no difference in mortality between both groups and no procedure-related deaths occurred. A mean of 2.7 PP devices were required to achieve complete haemostasis in the PP cohort, where technical failure was documented in four cases (6.7%). Conclusions: Bedside Percutaneous decannulation of VA-ECMO using a PP device with a post-closure technique is safe and reliable for achieving effective haemostasis, with fewer vascular complications than conventional approaches and a low device failure rate.