bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative analysis of INTERGROWTH-21st and Fenton growth charts for birthweight classification in a multiethnic Asian cohort: a cross-sectional study
Authors: Chan Daniel , Zheng Ruther Teo , Beh Eirena , Heng Thurston Yan Jia , Chandran Suresh , Yap Fabian 
Published: November 2024

ObjectiveThe objective of this study is to evaluate the impact of using International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) (IG-21) growth standards compared with Fenton growth charts on birthweight classification in a multiethnic newborn cohort in Singapore.DesignCross-sectional study.SettingKK Women’s and Children’s Hospital, Singapore.PatientsStudy population included 2541 babies born between 16 December 2019 and 16 March 2020.InterventionsNone.Main outcome measuresBirthweight classifications of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) were assessed using IG-21 and Fenton growth charts. The level of agreement between the two charts was measured using Cohen’s kappa coefficient (K).ResultsOf 2541 neonates, 171 (6.7%) had discordant birthweight classifications. The kappa coefficient indicated moderate overall agreement (K=0.79) between the charts, with decreasing agreement from preterm (K=0.88) to full-term categories (K=0.71). The largest discordance was observed in 98 (60.5%) neonates classified as LGA by IG-21 but AGA by Fenton. In comparison, 60 (2.9%) neonates classified as AGA by IG-21 were SGA by Fenton, while 13 (4.6%) were SGA by IG-21 but AGA by Fenton.ConclusionsThe study found discrepancies in birthweight classification between IG-21 and Fenton growth charts, with Fenton charts overclassifying SGA and underclassifying LGA in our study population. These findings suggest the potential need to integrate IG-21 growth standards into local practice to improve accuracy in neonatal growth assessment. Further research is necessary to evaluate the clinical implications of these discordant classifications on neonatal outcomes.
Agreement and comparative accuracy of instability criteria at discharge for predicting adverse events in patients with community-acquired pneumonia
Authors: Danjou Anne , Bouisse Magali , Boussat Bastien , Blaise Sophie , Gaillat Jacques , Francois Patrice , Courtois Xavier , Sellier Elodie , Toffart Anne-Claire , Schwebel Carole , Halm Ethan A , Labarere José 
Published: November 2024

ObjectiveFive definitions of clinical instability have been published to assess the appropriateness and safety of discharging patients hospitalised for pneumonia. This study aimed to quantify the level of agreement between these definitions and estimate their discriminatory accuracy in predicting post-discharge adverse events.Study design and settingWe conducted a retrospective cohort study involving 1038 adult patients discharged alive following hospitalisation for pneumonia.ResultsThe prevalence of unstable criteria within 24 hours before discharge was 4.5% for temperature >37.8°C, 13.8% for heart rate >100/min, 1.0% for respiratory rate >24/min, 2.6% for systolic blood pressure <90 mm Hg, 3.3% for oxygen saturation <90%, 5.4% for inability to maintain oral intake and 6.4% for altered mental status. The percentage of patients classified as unstable at discharge ranged 12.8%–41.0% across different definitions (Fleiss Kappa coefficient, 0.47; 95% CI 0.44 to 0.50). Overall, 140 (13.5 %) patients experienced adverse events within 30 days of discharge, including 108 unplanned readmissions (10.4%) and 32 deaths (3.1%). Clinical instability was associated with a 1.3-fold to 2.0-fold increase in the odds of postdischarge adverse events, depending on the definition, withc-statistics ranging 0.54–0.59 (p=0.31).ConclusionClinical instability was associated with higher odds of 30-day postdischarge adverse events according to all but one of the published definitions. This study supports the validity of definitions that combine vital signs, mental status and the ability to maintain oral intake within 24 hours prior to discharge to identify patients at a higher risk of postdischarge adverse events.
TMED inhibition suppresses cell surface PD-1 expression and overcomes T cell dysfunction
Authors: Vredevoogd David W , Apriamashvili Georgi , Levy Pierre L , Sinha Sanju , Huinen Zowi R , Visser Nils L , de Bruijn Beaunelle , Boshuizen Julia , van Hal-van Veen Susan E , Ligtenberg Maarten A , Bleijerveld Onno B , Lin Chun-Pu , Díaz-Gómez Judit , Sánchez Santiago Duro , Markovits Ettai , Simon Nieto Juan , van Vliet Alex , Krijgsman Oscar , Markel Gal , Besser Michal J , Altelaar Maarten , Ruppin Eytan , Peeper Daniel S 
Published: November 2024

BackgroundBlockade of the programmed cell death protein 1 (PD-1) immune checkpoint (ICB) is revolutionizing cancer therapy, but little is known about the mechanisms governing its expression on CD8 T cells. Because PD-1 is induced during activation of T cells, we set out to uncover regulators whose inhibition suppresses PD-1 abundance without adversely impacting on T cell activation.MethodsTo identify PD-1 regulators in an unbiased fashion, we performed a whole-genome, fluorescence-activated cell sorting (FACS)-based CRISPR-Cas9 screen in primary murine CD8 T cells. A dual-readout design using the activation marker CD137 allowed us to uncouple genes involved in PD-1 regulation from those governing general T cell activation.ResultsWe found that the inactivation of one of several members of the TMED/EMP24/GP25L/p24 family of transport proteins, most prominently TMED10, reduced PD-1 cell surface abundance, thereby augmenting T cell activity. Another client protein was cytotoxic T lymphocyte-associated protein 4 (CTLA-4), which was also suppressed by TMED inactivation. Treatment with TMED inhibitor AGN192403 led to lysosomal degradation of the TMED-PD-1 complex and reduced PD-1 abundance in tumor-infiltrating CD8 T cells (TIL) in mice, thus reversing T cell dysfunction. Clinically corroborating these findings, single-cell RNA analyses revealed a positive correlation between TMED expression in CD8 TIL, and both a T cell dysfunction signature and lack of ICB response. Similarly, patients receiving a TIL product with high TMED expression had a shorter overall survival.ConclusionOur results uncover a novel mechanism of PD-1 regulation, and identify a pharmacologically tractable target whose inhibition suppresses PD-1 abundance and T cell dysfunction.
Adjunctive intravascular lithotripsy for heavily calcified carotid stenosis: a dual-center experience and technical case series
Authors: Hanel Ricardo A , Jaikumar Vinay , Gutierrez-Aguirre Salvador F , Khan Hamid Sharif , De Toledo Otavio F , Lim Jaims , Scullen Tyler A , Rodriguez-Erazú Fernanda , Okai Bernard , McPheeters Matthew J , Bouslama Mehdi , Raygor Kunal P , Siddiqui Adnan H 
Published: November 2024

BackgroundHeavily calcified carotid stenosis (HCCS) is considered an exclusion for carotid angioplasty and/or stenting (CAS), amenable only to carotid endarterectomy. This study presents preliminary retrospective dual-center experience utilizing the Shockwave S4intravascular lithotripsy (IVL) system (Shockwave Medical) as an adjunct to CAS for HCCS.MethodsPatients with symptomatic or asymptomatic HCCS (de novo stenosis or in-stent restenosis (ISR)) undergoing IVL+CAS were included. Charts were reviewed for demographic, imaging, procedural, and outcome data. The primary endpoint was composite major adverse event (MAE) rate: death, ipsilateral stroke, or myocardial infarction (MI) within 30 days of IVL+CAS. Secondary endpoints included technical and procedural success, residual stenosis, and ISR postprocedure.ResultsFifteen patients underwent 17 IVL+CAS procedures: de novo HCCS=13, heavily calcified ISR=4; symptomatic disease was addressed in seven cases. Procedures were performed transfemorally under conscious sedation with dual protection; flow reversal through a balloon guide catheter, and distal embolic protection system (EPS) use. Median pre-IVL+CAS stenosis was 73% (IQR 60–80%). Technical success (IVL+CAS+ EPS use) was achieved in all cases. Median post-IVL+CAS residual stenosis was 27% (IQR 12–33%), achieving <50% residual stenosis and procedural success in all. Five patients required dopamine infusion for postprocedural hypotension. No periprocedural ipsilateral strokes occurred. MAE rate was 6.7% (95% CI 0.2% to 32%), including one MI resulting in death. Additionally, one ISR (6.3%; 95% CI 0.2% to 30.2%) identified 160 days after IVL+CAS was retreated with angioplasty.ConclusionsIVL+CAS was safe and effective for treating symptomatic and asymptomatic HCCS, achieving high rates of freedom from MAE. IVL has potential to expand the role of CAS in difficult to treat HCCS.
Development and validation of prediction models for prehospital triage of military trauma patients
Authors: Lokerman Robin D , van der Sluijs R , Waalwijk J F , Verleisdonk E J M M , Haasdijk R A , van Deemter M M , Leenen L P H , van Heijl M 
Published: November 2024

IntroductionThe introduction of wireless sensors will enable military care providers to continuously and remotely assess/monitor vital signs. Prediction models are needed to use such data adequately and aid military care providers in their on-scene decision-making to optimise prehospital triage and improve patient outcomes.MethodsA prospective cohort comprising data from eight Emergency Medical Services and seven inclusive trauma regions was used to develop and validate prediction models that could aid military care providers in their prehospital triage decisions. Healthy (American Society of Anesthesiologists physical status classification 1 or 2) admitted adult trauma patients (aged ≥16 and ≤50 years), who suffered from a trauma mechanism that could occur to military personnel and were transported by ambulance from the scene of injury to a hospital, were included. A full model strategy was used, including prehospital predictors that are expected to be automaticly collectible by wireless sensors or to be incorporated in a personalised device that could run the models. Models were developed to predict early critical-resource use (ECRU), severe head injury (Abbreviated Injury Scale (AIS) ≥4), serious thoracic injury (AIS ≥3) and severe internal bleeding (>20% blood loss). Model performance was evaluated in terms of discrimination and calibration.ResultsPrediction models were developed with data from 4625 patients (80.0%) and validated with data from 1157 patients (20.0%). The models had good to excellent discriminative performance for the predicted outcomes in the validation cohort, with an area under the curve of 0.80 (95% CI 0.76 to 0.84) for ECRU, 0.83 (0.76 to 0.91) for severe head injury, 0.75 (0.70 to 0.80) for serious thoracic injury and 0.85 (0.78 to 0.93) for severe internal bleeding. All models showed satisfactory calibration in the validation cohort.ConclusionThe developed models could reliably predict outcomes in a simulated military trauma population and potentially support prehospital care providers in their triage decisions.
Obturator canal block: an anatomical study
Authors: Labandeyra Hipolito , Goffin Pierre , Riera Rita , Vallejo Andrea , Prats-Galino Alberto , Sala-Blanch Xavier 
Published: November 2024

BackgroundDifferent approaches to the obturator nerve have been described. However, few have focused on the injection point inferior the iliopubic ramus, specifically at the exit of the obturator canal. This study aims to anatomically evaluate the ultrasound-guided obturator nerve block at the exit of the obturator canal, detailing anatomical landmarks and solution distribution.MethodsThis anatomical study was conducted using 10 cadavers to generate 20 hemipelvis samples. Ultrasound references were utilized to identify the obturator canal, iliopubic ramus, pectineus and external obturator muscles, and the obturator membrane. An ultrasound-guided obturator nerve block was performed using a low-frequency convex probe for initial identification and a high-frequency linear transducer for the injection of a methylene blue solution. Subsequent dissections were performed to evaluate the distribution of the dye within the obturator nerve.ResultsThe injection of methylene blue consistently stained the common trunk and anterior branch of the obturator nerve in 100% of the cases and the posterior branch in 80% of the samples. Intrapelvic staining was observed in 65% of the specimens, indicating effective diffusion of the dye. Key anatomical landmarks, such as the iliopubic ramus and the obturator membrane, were crucial for accurate identification and injection.ConclusionIn conclusion, sagittal approaches using the iliopubic ramus as an anatomical reference achieve the most complete obturator nerve block. Our anatomical study details the structures of the obturator canal and access to the obturator nerve at its exit. Future studies are needed to confirm its safety and efficacy.
Methotrexate inhibits glucocorticoids-induced osteoclastogenesis via activating IFN-γR/STAT1 pathway in the treatment of rheumatoid arthritis
Authors: Teng Yao , Yin Haifeng , Feng Ruizhi , Jiang Lijuan , Qiu Wenlin , Duan Xiaoru , Wang Xuefei , Deng Guo-Min 
Published: November 2024

ObjectivesRheumatoid arthritis (RA) is a chronic autoimmune disease characterised by the synovitis and bone erosion. The combination therapy of glucocorticoids (GCs) and methotrexate (MTX) is recommended in early RA management, although the precise underlying mechanism of action remains unclear. This study is aimed to clarify the mechanism of MTX in combined with GC in treating RA.MethodsGC-induced osteoporosis (GIOP) mouse model was used to investigate the bone-protective role of MTX. Lipopolysaccharide-induced arthritis mouse model was used to evaluate the anti-inflammatory effects of GCs and MTX. Functional role of MTX on osteoclastogenesis was assessed by trap staining and micro-computer tomography. Western blot, RT-qPCR and coimmunoprecipitation were used to explore the underlying mechanisms.ResultsWe demonstrate that GCs, but not MTX, rapidly inhibited synovitis in arthritis model. MTX treatment was observed to inhibit osteoclastogenesis induced by GC in vitro and mitigate bone loss attributed by GIOP. GCs were found to augment the interaction between the membrane GC receptor (mGR) and signal transducer and activator of transcription 1 (STAT1), leading to the suppression of IFN-γR/STAT1 signalling pathways. Interestingly, MTX was found to inhibit osteoclastogenesis induced by GCs through the enhancement of the A2AR and IFN-γR interaction, thereby activating the IFN-γR/STAT1 signalling cascade. Consequently, this process results in a reduction in the mGR and STAT1 interaction.ConclusionsOur study provides compelling evidence that MTX can make GCs effectively to suppress synovitis and reduce bone loss induced by GCs. This sheds light on the potential mechanistic insights underlying the efficacy of GCs in conjunction with MTX for treating RA.
Caregiver burden in advanced cancer in tertiary care palliative medicine
Authors: Quadir Sayeda Sharmin , Alam Afroja , Bhuiyan A K M Motiur Rahman , Islam Nashid , Sarker Mridul , Rabin Farzana 
Published: November 2024

ObjectiveDuring the period of caregiving, informal caregivers of incurably ill patients experience caregiving burden that is often overlooked since the focus is on the suffering of the care receiver. In Bangladesh, informal caregivers often cannot express their suffering as they are culturally obliged to take responsibility for sick family members. This cross-sectional study was conducted among 156 informal caregivers of patients with advanced cancer attending the Department of Palliative Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.MethodsThe sample was chosen consecutively based on the inclusion and exclusion criteria. Face-to-face interviews were conducted using a well-designed questionnaire. A previously translated and validated Bangla version of the Zarit Burden Interview (ZBI) was used to assess the burden of the informal caregivers.ResultsThe mean ZBI score of the informal caregivers was 28±11. The study found that caregiver burden was significantly associated with the relationship between the informal caregiver and the patient, as well as the caregiver’s awareness of the patient’s prognosis.ConclusionCurrently, no facilities for informal caregivers are available in Bangladesh. As extended members of the patient’s care team, the burden experienced by the caregivers needs to be given more attention and should be taken into account in healthcare.
Complex Event Recognition meets Hierarchical Conjunctive Queries
Authors: Pinto Dante , Riveros Cristian 
Published: November 2024

Hierarchical conjunctive queries (HCQ) are a subclass of conjunctive queries (CQ) with robust algorithmic properties. Among others, Berkholz, Keppeler, and Schweikardt have shown that HCQ is the subclass of CQ (without projection) that admits dynamic query evaluation with constant update time and constant delay enumeration. On a different but related setting stands Complex Event Recognition (CER), a prominent technology for evaluating sequence patterns over streams. Since one can interpret a data stream as an unbounded sequence of inserts in dynamic query evaluation, it is natural to ask to which extent CER can take advantage of HCQ to find a robust class of queries that can be evaluated efficiently.
In this paper, we search to combine HCQ with sequence patterns to find a class of CER queries that can get the best of both worlds. To reach this goal, we propose a class of complex event automata model called Parallelized Complex Event Automata (PCEA) for evaluating CER queries with correlation (i.e., joins) over streams. This model allows us to express sequence patterns and compare values among tuples, but it also allows us to express conjunctions by incorporating a novel form of non-determinism that we call parallelization. We show that for every HCQ (under bag semantics), we can construct an equivalent PCEA. Further, we show that HCQ is the biggest class of full CQ that this automata model can define. Then, PCEA stands as a sweet spot that precisely expresses HCQ (i.e., among full CQ) and extends them with sequence patterns. Finally, we show that PCEA also inherits the good algorithmic properties of HCQ by presenting a streaming evaluation algorithm under sliding windows with logarithmic update time and output-linear delay for the class of PCEA with equality predicates.
Acute Limb Ischemia in a Nephrotic Syndrome Patient: A Rare and Unpredictable Complication
Authors: Erickatulistiawan Gallusena , Tjahjono Cholid , Kurnianingsih Novi 
Published: November 2024

Pendahuluan: Iskemia tungkai akut (ALI) adalah kondisi medis kritis yang membutuhkan tindakan segera untuk mencegah kerusakan jaringan yang tidak dapat disembuhkan. Penanganannya menjadi semakin rumit pada pasien dengan kondisi penyerta seperti sindrom nefrotik.

Ilustrasi kasus: Seorang wanita berusia 23 tahun dengan riwayat sindrom nefrotik datang dengan nyeri kaki kanan akut yang timbul dalam kurun 24 jam. Pemeriksaan menunjukkan eritema yang mencolok dan sensasi dingin distal hingga pergelangan kaki kanan. Ultrasonografi duplex menunjukkan tidak adanya aliran darah di arteri dorsalis pedis pada kaki yang terkena. Meskipun telah dilakukan beberapa percobaan trombektomi dan pemberian heparin, status vaskularnya hanya menunjukkan sedikit perbaikan. Amputasi di bawah lutut dilakukan setelah upaya pemulihan aliran darah tidak berhasil. Kondisi pasien semakin memburuk dengan oklusi vaskular baru, sehingga diperlukan Trombolisis Kateter Langsung (CDT). Namun, pasca-CDT, pasien mengalami pendarahan hebat yang menyebabkan syok hemoragik, henti jantung, dan komplikasi multi-organ berikutnya, yang berujung pada kematiannya pada hari ke-35 pengobatan.

Ringkasan: Dalam studi kasus ini, seorang wanita berusia 23 tahun dengan iskemia Tungkai Akut (ALI) dan riwayat Sindrom Nefrotik yang membuat tantangan pengobatan yang signifikan. Meskipun telah dilakukan beberapa intervensi, termasuk trombektomi dan Trombolisis Langsung Kateter, pasien mengalami komplikasi serius hingga pasien meninggal dunia. Kasus ini menekankan kebutuhan pendekatan komprehensif bagaimana penanganan penyakit Iskemia tungkai akut pada sindrom nefrotik

Kata Kunci: Iskemia Tungkai Akut, Sindrom Nefrotik, Thrombektomi
BRAZILIAN SCIENTIFIC PRODUCTION ABOUT JAPAN: PERSPECTIVES FROM THE FIELD OF PSYCHOLOGY
Authors: Cambur Arthur , Almeida Igor de 
Published: November 2024

O Japão é um país muito influente no mundo, tanto econômica quanto culturalmente. Apesar da influência cultural, econômica e da imigração japonesa no Brasil, o Japão parece não atrair tanta atenção dentro da academia brasileira, quando comparado às potências ocidentais. A academia brasileira teve e tem como principais influências as academias europeias e estadunidense. Isso se reflete na produção científica brasileira em diversas áreas, incluindo na psicologia. O objetivo desde estudo foi quantificar e analisar a produção brasileira sobre o Japão dentro do campo da psicologia. 142 publicações foram analisadas e classificadas nos temas: cultura, imigração, psicologia e áreas relacionadas, e outros. A influência de autores com ascendência japonesa também foi analisada. Apesar da quantidade razoável de publicações sobre o Japão, o número ainda é baixo comparado a publicações sobre países europeus, latino-americanos ou EUA.
ApoE Receptor-2 R952Q Variant in Macrophages Elevates Soluble LRP1 to Potentiate Hyperlipidemia and Accelerate Atherosclerosis in Mice
Authors: Turkson Vanessa , Haller April , Jaeschke Anja , Hui David Y. 
Published: November 2024

BACKGROUND:
apoER2 (apolipoprotein E receptor-2) is a transmembrane receptor in the low-density lipoprotein receptor (LDLR) family with unique tissue expression. A single-nucleotide polymorphism that encodes the R952Q sequence variant has been associated with elevated plasma cholesterol levels and increased myocardial infarction risk in humans. The objective of this study was to delineate the mechanism underlying the association between the apoER2 variant with arginine-to-glutamine substitution at residue 952 (R952Q) and increased atherosclerosis risk.

METHODS:
An apoER2 R952Q mouse model was generated and intercrossed with LDLR knockout mice, followed by feeding a Western-type high-fat high-cholesterol diet for 16 weeks. Atherosclerosis was investigated by immunohistology. Plasma lipids and lipid distributions among the various lipoprotein classes were analyzed by colorimetric assay. Tissue-specific effects of the R952Q sequence variant on atherosclerosis were analyzed by bone marrow transplant studies. sLRP1 (soluble low-density lipoprotein receptor-related protein 1) was measured in plasma and conditioned media from bone marrow–derived macrophages by ELISA and GST-RAP (glutathione S-transferase-receptor-associated protein) pull-down, respectively. P38 MAPK (mitogen-activated protein kinase) phosphorylation in VLDL (very-low-density lipoprotein)–treated macrophages was determined by Western blot analysis.

RESULTS:
Consistent with observations in humans with this sequence variant, the apoER2 R952Q mutation exacerbated diet-induced hypercholesterolemia, via impediment of plasma triglyceride-rich lipoprotein clearance, to accelerate atherosclerosis in Western diet–fed LDLR knockout mice. Reciprocal bone marrow transplant experiments revealed that the apoER2 R952Q mutation in bone marrow–derived cells instead of non-bone marrow–derived cells was responsible for the increase in hypercholesterolemia and atherosclerosis. Additional data showed that the apoER2 R952Q mutation in macrophages promotes VLDL-induced LRP1 (low-density lipoprotein receptor-related protein 1) shedding in a p38 MAPK–dependent manner.

CONCLUSIONS:
The apoER2 R952Q mouse model recapitulates characteristics observed in human disease. The underlying mechanism is that the apoER2 R952Q mutation in macrophages exacerbates VLDL-stimulated sLRP1 production in a p38 MAPK–dependent manner, resulting in its competition with cell surface LRP1 to impede triglyceride-rich lipoprotein clearance, thereby resulting in increased hypercholesterolemia and accelerated atherosclerosis.