bluuebunny/crossref_metadata_2025_split huggingface dataset:
Air pollution mixture complexity and its effect on PM2.5-related mortality: A multicountry time-series study in 264 cities
Authors: Masselot Pierre , Kan Haidong , Kharol Shailesh K. , Bell Michelle L. , Sera Francesco , Lavigne Eric , Breitner Susanne , das Neves Pereira da Silva Susana , Burnett Richard T. , Gasparrini Antonio , Brook Jeffrey R. ,   on behalf of the MCC Collaborative Research Network
Published: October 2024

Background:
Fine particulate matter (PM2.5) occurs within a mixture of other pollutant gases that interact and impact its composition and toxicity. To characterize the local toxicity of PM2.5, it is useful to have an index that accounts for the whole pollutant mix, including gaseous pollutants. We consider a recently proposed pollutant mixture complexity index (PMCI) to evaluate to which extent it relates to PM2.5 toxicity.

Methods:
The PMCI is constructed as an index spanning seven different pollutants, relative to the PM2.5 levels. We consider a standard two-stage analysis using data from 264 cities in the Northern Hemisphere. The first stage estimates the city-specific relative risks between daily PM2.5 and all-cause mortality, which are then pooled into a second-stage meta-regression model with which we estimate the effect modification from the PMCI.

Results:
We estimate a relative excess risk of 1.0042 (95% confidence interval: 1.0023, 1.0061) for an interquartile range increase (from 1.09 to 1.95) of the PMCI. The PMCI predicts a substantial part of within-country relative risk heterogeneity with much less between-country heterogeneity explained. The Akaike information criterion and Bayesian information criterion of the main model are lower than those of alternative meta-regression models considering the oxidative capacity of PM2.5 or its composition.

Conclusions:
The PMCI represents an efficient and simple predictor of local PM2.5-related mortality, providing evidence that PM2.5 toxicity depends on the surrounding gaseous pollutant mix. With the advent of remote sensing for pollutants, the PMCI can provide a useful index to track air quality.
Short-term, lagged association of airway inflammation, lung function, and asthma symptom score with PM2.5 exposure among schoolchildren within a high air pollution region in South Africa
Authors: Buthelezi Minenhle S. , Mentz Graciela , Wright Caradee Y. , Phaswana Shumani , Garland Rebecca M. , Naidoo Rajen N. 
Published: October 2024

Background:
Asthma affects millions of people globally, and high levels of air pollution aggravate asthma occurrence. This study aimed to determine the association between short-term lagged PM2.5 exposure and airway inflammation, lung function, and asthma symptom scores among schoolchildren in communities in the Highveld high-pollution region in South Africa.

Methods:
A cross-sectional study was conducted among schoolchildren aged 9–14 years in six communities in the Highveld region in South Africa, between October 2018 and February 2019. A NIOX 200 instrument was used to measure fractional exhaled nitric oxide (FeNO). Lung function indices (forced expiratory volume in one second [FEV1]; forced vital capacity [FVC] and FEV1/FVC) were collected using spirometry and the percent of predicted of these was based on the reference equations from the Global Lung Initiative, without ethnic correction. These values were further analyzed as binary outcomes following relevant thresholds (lower limits of normal for lung function and a cutoff of 35 ppb for FeNO). Asthma symptoms were used to create the asthma symptom score. Daily averages of PM2.5 data for the nearest monitoring station located in each community, were collected from the South African Air Quality Information System and created short-term 5-day lag PM2.5 concentrations. Additional reported environmental exposures were collected using standardized instruments.

Results:
Of the 706 participating schoolchildren, only 1.13% of the participants had doctor-diagnosed asthma, compared to a prevalence of 6.94% with an asthma symptom score suggestive of asthma. Lag 1 (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00, 1.02, P = 0.039) and 5-day average lagged PM2.5 (OR: 1.02; 95% CI: 0.99, 1.04, P = 0.050) showed increased odds of the FeNO > 35 ppb. Lung function parameters (FEV1 < lower limit of normal [LLN] [OR: 1.02, 95% CI: 1.00, 1.03, P = 0.018], and FEV1/FVC < LLN [OR: 1.01; 95% CI: 1.00, 1.02, P < 0.001]) and asthma symptom score ≥ 2 (OR: 1.02; 95% CI: 1.00, 1.04, P = 0.039) also showed significant associations with lag 2, lag 4 and lag 1 of PM2.5, respectively.

Conclusion:
Lagged PM2.5 exposure was associated with an increased odds of airway inflammation and an increased odds of lung function parameters below the LLN particularly for the later lags, but a significant dose–response relationship across the entire sample was not consistent.
Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery
Authors: Petit Ludivine , Pastene Bruno , Dupont Guillaume , Baffeleuf Bruno , Goulevant Pierre-Alain , Fellahi Jean-Luc , Gricourt Yann , Lebuffe Gilles , Ouattara Alexandre , Fischer Marc-Olivier , Mertes Paul-Michel , Eyraud Daniel , Bouhemad Belaid , Gomola Alexandra , Montravers Philippe , Alingrin Julie , Flory Laura , Incagnoli Pascal , Boisson Matthieu , Leone Marc , Monneret Guillaume , Lukaszewicz Anne Claire , Pereira Bruno , Molliex Serge 
Published: October 2024

BACKGROUND
Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).

OBJECTIVES
We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence.

STUDY DESIGN
The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up. Multivariate analyses were performed to determine the risk factors for PIs and for postoperative lymphopaenia.

SETTING
Patients were included from January 2016 to September 2017 in 25 French centres.

PATIENTS
Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion.

MAIN OUTCOME MEASURE
PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy).

RESULTS
Of 1207 patients included, 273 (22.6%) developed at least one infection within 30 days after surgery, with a median [IQR] time to onset of 8 [5 to 11] days. An increased risk of PI was significantly associated with an ASA score of IV: hazard ratio (HR) 4.27 (95% confidence interval (CI), 1.87 to 9.72), surgery > 200 min (HR 1.58 (1.15 to 2.17) and lymphopaenia on postoperative day 1 (POD1) (HR 1.56 (1.08 to 2.25). This risk was associated with changes in postoperative LC over time (P = 0.001) but not with preoperative LC (P = 0.536).
POD1 lymphopenia was related to patient characteristics and duration of surgery but not to potentially modifiable other surgical or anaesthetics factors.

CONCLUSIONS
POD1 lymphopaenia was associated with PIs in patients undergoing thoracic or gastrointestinal cancer surgery. To individualise care, patient characteristics and surgery duration should be taken into account.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02799251
A new method of non-ultrasound monitoring of ovarian stimulation (NUMOS): Mission possible!—A pilot study
Authors: Vladimirov Iavor K. , Tacheva Desislava , Gatev Evan , Rangelova Magdalena , Vladimirov Martin 
Published: October 2024

Purpose:
This study aims to establish the viability of monitoring an appropriate and safe ovarian stimulation without the use of ultrasound and serum hormone testing.

Method:
As a primary marker for monitoring the ovarian response, we used urinary estrone-3-glucuronide (E1-3G) growth rate, which was self-measured by patients daily at home, with a portable analyzer, during the stimulation. For an adequate ovarian response, an average daily rate of increase of E1-3G was estimated to be within 25%–77%. Ovulation trigger day was determined based on the length of the menstrual cycle.
The study included 24 women. Inclusion criteria were age below 41 years and AMH >1 ng/mL. A progestin-primed ovarian stimulation protocol (PPOS) with fixed doses of gonadotropins was used.

Results:
The average female age was 32.9 years (±4.4), BMI 22.7 kg/m2 (±4.3), AMH 3.7 ng/mL (±2.6), stimulation days 10.6 (±1.1), collected oocytes 12.5 (±8.5), MII oocytes 10.6 (±7.8), fertilization rate 83.6% (±22.5), blastocyst 66.4% (±28.6), good quality blastocysts 31.6% (±16.9).
Absence of oocyte aspiration was found in one of the cases. There were no cases of OHSS and ovarian stimulation cancellation.

Conclusions:
This is the first pilot study to successfully apply a new marker for ovarian stimulation monitoring.
Examining Risk Factors Related to Cardiac Rehabilitation Cessation Among Patients With Advanced Heart Failure
Authors: Sidhu Sharnendra K. , Kadosh Bernard S. , Tang Ying , Sweeney Greg , Pierre Alicia , Whiteson Jonathan , Katz Edward , Reyentovich Alex , Dodson John A. 
Published: October 2024

Purpose:
Cardiac rehabilitation (CR) is beneficial in heart transplant and left ventricular assist device (LVAD) recipients, but patterns of attendance remain poorly understood. We describe CR adherence and cessation in this population.

Methods:
We performed a retrospective review of heart transplant and LVAD recipients who attended ≥1 CR session at a tertiary medical center (2013-2022). Complete adherence was defined as attending 36 sessions. Primary reasons for cessation before 36 sessions were recorded. We compared post-operative complications, duration of hospitalization, and readmissions between participants with and without complete adherence using logistic and linear regressions. Among participants with complete adherence, we compared changes in metabolic equivalent of task (MET), exercise time, and peak oxygen uptake using paired sample t tests.

Results:
There were 137 heart transplant and LVAD recipients (median age 56.9 years, 74% male) who attended CR. Among them, 91% either completed 36 CR sessions or <24 sessions. Among those without complete adherence (n = 74), 72% reported medical reasons, and 15% reported personal reasons for cessation. Compared to those who completed CR, those without complete adherence experienced more post-operative complications (44% vs 24%, P = .02) and major bleeding (23% vs 7%, P = .02) prior to CR. Participants with complete adherence experienced significant improvements in exercise time (142.5 seconds), MET (0.4), and peak oxygen uptake (1.4 mL/kg/min).

Conclusions:
Nearly half of heart transplant and LVAD recipients in CR completed all 36 sessions. Those with complete adherence experienced significant improvements in exercise measures, underscoring the important benefits of CR in this population.
Delays in Treatment for Temporal Encephaloceles and Cerebrospinal Fluid Leaks
Authors: Mouzourakis Maggie , Steinwald Peter , Maxwell Anne K. , Saravia Ari , Master Adam , Mankowski Nicholas , Saunders James E. , Materne Grace M. , Noonan Kathryn 
Published: October 2024

Objective
Lateral skull base defects (LSBD) pose a diagnostic challenge; however, early recognition and treatment are important to avoid sequelae. This study examines the impact of health care disparities associated with time to diagnosis and treatment for patients with LSBD.

Study Design, Setting, Patients, Intervention, Outcome Measures
Multi-institutional retrospective cohort study at four U.S. tertiary centers from 2000 to 2022. Adult patients with a primary diagnosis of CSF leak or encephalocele were included. Multivariate regressions used to analyze how age, sex, race/ethnicity, insurance, language, zip code, distance to medical center, referral patterns, diagnostic workup, and clinical course affected time to diagnosis and treatment.

Results
In 127 patients with LSBD, mean time to treatment of CSF leak or encephalocele was 13.9 months. On average, patients waited 10.6 months from initial assessment to diagnosis and saw 2 providers prior to diagnosis. Approximately 91% (115) of patients had a CT scan, and 75% (95) had an MRI. Imaging did not influence time to treatment. Older age, public insurance, and number of providers seen were associated with delays. Non-English speakers (5% of 127) encountered treatment delays, although this was not statistically significant. Fifty-eight (46%) people had private insurance. The average traveled distance for care was 62.6 miles. Clinical presentation, race, zip code, imaging, myringotomy, beta-2 transferrin, and ED workup were not found to be associated with delays to care.

Conclusion
There are significant delays in diagnosis and management of LSBD. Referral patterns did influence care. Health care disparities did not impact care; however, disparities and language barriers need to be studied further to determine contributions to delays in care.
Periprosthetic Joint Infection in Patients With Inflammatory Arthritis
Authors: Goodman Susan M. , Mannstadt Insa , Tam Kathleen , Mehta Bella , Kochen Alejandro , Shakib Lorien , Sculco Peter , Carli Alberto , Batter Stephen , Rodriguez Jose , Bass Anne R. , Blevins Jason L. , Miller Andy O. , Russell Linda , Donlin Laura , Nocon Allina , Figgie Mark 
Published: October 2024

Objective
Diagnosis of periprosthetic joint infection (PJI) in patients with inflammatory arthritis (IA) is challenging, as features of IA flares can mimic infection. We aimed to cross-sectionally determine if the optimal tests to diagnose PJI in osteoarthritis were present in patients with IA flares.

Methods
We enrolled patients from October 2020 to July 2022 in 3 groups: (a) PJI—total joint arthroplasty patients undergoing revision for infection, (b) IA Flare—IA patients with a flaring native joint, and (c) IA Aseptic—total joint arthroplasty patients with IA undergoing aseptic arthroplasty revision. We compared blood and synovial fluid markers between the cohorts using Kruskal-Wallis and Fisher exact tests to assess marker sensitivity and specificity.

Results
Of 52 cases overall, 40% had rheumatoid arthritis, 20% psoriatic arthritis, and 11% osteoarthritis (in PJI group). PJI cases had higher C-reactive protein (CRP) and synovial fluid polymorphonuclear neutrophil percentage (%PMN). Alpha-defensin tested positive in 93% of PJI cases, 20% of IA Flares, and 6% of IA Aseptic (p < 0.01). Synovial white blood cell count >3000/μL and positive alpha-defensin were highly sensitive (100%) in diagnosing infection; however, specificity was 50% for white blood cell counts and 79% for alpha-defensin. PJI diagnosis was nearly 5 times more likely with positive alpha-defensin and almost 6 times more likely with %PMNs >80. Blood markers interleukin-6, procalcitonin, and d-dimer were neither sensitive nor specific, whereas erythrocyte sedimentation rate and CRP showed 80% sensitivity, but 47% and 58% respective specificities.

Conclusions
Although synovial %PMNs, CRP, and alpha-defensin are sensitive tests for diagnosing PJI, they are less specific and may be positive in IA flares.
When an underestimated zoonosis and antimicrobial resistance collide: Corynebacterium ulcerans
Authors: Mori giovanni , Errico Giulia , Giancristofaro Sara , Visentin Donatella , Castagna Antonella , Viel Laura , Dellamaria Debora , Lorenzin Giovanni , Ortalli Gaia , Scarparo Claudio , Lanzafame Massimiliano 
Published: October 2024

In the European region, diphtheria is now rarely suspected in patients presenting with upper respiratory tract symptoms. C. ulcerans is the underestimated zoonosis that is replacing C. diphtheria infections in industrialised countries, but extensive human and animal prevalence studies are lacking. The range of hosts that can act as reservoirs for C. ulcerans is very broad, companion pets currently being the main source of human infection. We report a case of macrolide-resistant C. ulcerans infection with no apparent zoonotic transmission and outline the efforts required for public and zooprophylactic management of these cases. We describe the main critical issues to be addressed to comprehensively tackle this zoonosis in the future.
Pancreatic Tuberculosis Revealed by a Mass with Neoplastic Appearance: A Case Report
Authors: Hachimi Idrissi Mariam , Benass Jihane , Zegmout Adil , Tazi Imane , Ben Lahlou Yassine , Benaissa Elmostafa , Seddik Hassan , Chadli Mariama 
Published: October 2024

Introduction : Pancreatic tuberculosis is an extremely rare form of extrapulmonary tuberculosis. This condition can be challenging to diagnose due to its rarity, nonspecific symptoms, and radiological features that may mimic a neoplastic origin.
Case report: A 46-year-old immunocompetent patient with no past history of tuberculosis exposure, presented with spontaneously resolving jaundice over the past month, accompanied by non specific fever episodes and general fatigue with no other associated digestive symptoms. Abdominal CT and MRI scans revealed a poorly defined, partially necrotic mass in the pancreatic head with heterogeneous hypodensity and enhancement after contrast injection. Additionally, there were nodal and hilar macro-nodal lesions with necrotic appearances, as well as peripancreatic lymphadenopathy. The patient was scheduled for an Endoscopic ultrasound (EUS) examination which revealed the presence of a heterogeneous lesion with areas of necrosis in the posterosuperior aspect of the head and isthmus of the pancreas, accompanied by perilesional and celiac lymphadenopathies with necrotic centers. EUS-guided tissue sampling allowed the diagnosis of pancreatic tuberculosis, with both histological examination and GeneXpert MTB/RIF testing rapidly positive for Mycobacterium tuberculosis, followed by culture on solid Loewenstein-Jensen medium. The patient responded well to antitubercular chemotherapy .
Conclusion: Pancreatic tuberculosis, though rare, should be considered in cases of pancreatic masses, especially in endemic regions. Tissue samples with necrosis should be tested for Mycobacterium tuberculosis using GeneXpert and Loewenstein-Jensen culture. This work highlights the GeneXpert MTB/RIF test as highly sensitive, specific, and fast, making it ideal for diagnosing extra-pulmonary tuberculosis, particularly when smear results are negative.
Detecting Incipient Heart Failure in Asymptomatic Patients with Normal Ejection Fraction and comparisons with patients with heart failure and preserved ejection fraction using TimeSformer for classifying Echocardiography videos
Authors: Adhyapak Srilakshmi M , Menon Prahlad G 
Published: October 2024

AbstractBackgroundRecently deep learning models have helped differentiate echocardiography images of patients with heart failure with preserved ejection fraction (HFpEF) from normal controls. Our aim was to develop a model capable of detecting early signs of heart failure in asymptomatic patients with a normal ejection fraction.MethodsWe employed the TimeSformer, a video transformer model that classifies video data using a novel attentionbased mechanism. This self-attention mechanism that diverges from traditional convolutional neural networks (CNNs). It focuses on relevant parts of the video across both space and time, split into spatial attention, which processes each frame individually, and temporal attention, which integrates information across different frames. The training and validation of the TimeSformer model were conducted on the same dataset of echocardiography videos from 50 normal controls and 80 patients diagnosed with HFpEF, employing 5-fold cross-validation to ensure robust performance evaluation.ResultsThe TimeSformer model effectively identified HFpEF in patients, as all diagnosed with HFpEF were flagged as abnormal. The echocardiography assessment, along with NT pro BNP levels, supported the diagnoses, with patients showing NT pro BNP levels of 1016±32 pg/ml. Conversely, 26 out of 50 normal controls were correctly identified. While 24 normal controls were identified as abnormal. Their NT pro BNP levels were 52±12 pg/ml. At 2 years 8 (33.3%) controls identified as abnormal developed symptoms of heart failure with NT pro BNP levels of 800±41 pg/ml.ConclusionsThe TimeSformer model demonstrated capability in identifying subtle deviations indicative of incipient heart failure in videos of normal controls, despite normal NT pro BNP levels. A significant number of these controls developed heart failure with elevated NT pro BNP levels at 2 years.
Extinction vortices are driven more by a shortage of beneficial mutations than by deleterious mutation accumulation
Authors: Mawass Walid , Matheson Joseph , Hernández Ulises , Berg Jeremy , Masel Joanna 
Published: October 2024

AbstractNatural populations are increasingly at risk of extinction due to climate change and habitat loss or fragmentation. The long-term viability of small populations can be threatened by an “extinction vortex” — a positive feedback loop between declining fitness and declining population size. Two distinct mechanisms can drive an extinction vortex: i) ineffective selection in small populations allows deleterious mutations to fix, driving “mutational meltdown”, and ii) fewer individuals produce fewer of the novel beneficial mutations essential for long-term adaptation, a mechanism we term “mutational drought”. We measure the relative importance of each mechanism, on the basis of how sensitive beneficial vs. deleterious components of fitness flux are to changes in census population size near the critical population size at which fitness is stable. We derive analytical results given linkage equilibrium, complemented by simulations that capture the complex linkage disequilibria that emerge under high deleterious mutation rates. Even in the absence of environmental change, mutational drought can be nearly as important as mutational meltdown. Real populations must also adapt to a changing environment, making mutational drought more important. A partial exception is that mutational drought is somewhat less important when the beneficial mutation rate is high, although its contribution remains substantial. Linkage between deleterious and beneficial mutations drives the critical population size substantially higher and increase (albeit modestly) the importance of mutational drought.