bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges in Diagnosing Gallbladder Tuberculosis Mimicking Acute Calculus Cholecystitis: A Case Report of an Uncommon Presentation
Authors: Munira Sirajam , Hasan Mehedi , Jalil Rukshana , Sa Jahangir Md. 
Published: August 2024

Abstract

Introduction
: Gall bladder tuberculosis (TB) represents a highly uncommon form of extra-pulmonary TB, even within endemic regions, presenting a considerable diagnostic challenge. Limited pre-operative diagnostic tools lead to cholecystectomy and tissue analysis to initiate definitive treatment, thereby prolonging patient suffering and delaying diagnosis.
Case Presentation
: A 50-year-old menopausal lady presented with history of prolonged fever, significant weight loss, and subsequent upper abdominal pain. Serological and blood biochemistry tests revealed normal findings, except for moderate anemia. Abdominal ultrasound detected cystitis, while MRCP revealed a distal common bile duct stricture concomitant with gallstones. However, ERCP failed to confirm the biliary stricture, instead revealing papillary stenosis. The initial diagnosis was cholelithiasis, leading to laparoscopic cholecystectomy. The histopathological examination of the specimen indicated the presence of granulomas consisting of epithelioid cells and multinucleated giant cells. Additionally, areas of necrosis and chronic inflammatory cell infiltration were observed within the gallbladder wall. Histopathology of Lymph node biopsy showed granulomas, multinucleated giant cells, and areas of necrosis confirmed the diagnosis as gallbladder Tuberculosis. Category-1 Anti-Tubercular Therapy was initiated postoperatively, resulting in favorable clinical and operative outcomes.
Conclusion
Although gall bladder TB is a rare entity, clinicians should raise a high index of suspicion for TB in patients presenting with prolonged fever, weight loss, and features suggestive of calculus cholecystitis in endemic areas, aiming to mitigate unnecessary investigations and treatments, particularly in resource-limited settings such as Bangladesh.
The Use of Artificial Intelligence Based Chat Bots in Ophthalmology Triage
Authors: David Daniel , ZLOTO OFIRA , Katz Gabriel , Baron Ruth Huna , Vishnevskia-Dai Vicktoria , Armanik Sharon , Avni-Zauberman Noa , Megiddo Elinor , Singer Reut , Hostovsky Avner , Klang Eyal 
Published: August 2024

Abstract

Purpose - To evaluate AI-based chat bots ability to accurately answer common patient's questions in the field of ophthalmology.
Methods - An experienced ophthalmologist curated a set of 20 representative questions and responses were sought from two AI generative models: OpenAI's ChatGPT and Google's Bard (Gemini Pro). Eight expert ophthalmologists from different sub-specialties assessed each response, blinded to the source, and ranked them by three metrics – accuracy, comprehensiveness, and clarity, on a 1-5 scale.
Results - For accuracy, ChatGPT scored a median of 4.0, whereas Bard scored a median of 3.0. In terms of comprehensiveness, ChatGPT achieved a median score of 4.5, compared to Bard which scored a median of 3.0. Regarding clarity, ChatGPT maintained a higher score with a median of 5.0, compared to Bard's median score of 4.0. All comparisons were statistically significant (p<0.001).
Conclusion - AI-based chat bots can provide relatively accurate and clear responses for addressing common ophthalmological inquiries. ChatGPT surpassed Bard in all measured metrics. While these AI models exhibit promise, further research is indicated to improve their performance and allow them to be used as a reliable medical tool.
A method for in silico exploration of potential Glioblastoma Multiforme attractors using single-cell RNA sequencing
Authors: Junior Marcos Guilherme Vieira , Côrtes Adriano Maurício de Almeida , Carneiro Flávia Raquel Gonçalves , Carels Nicolas , Silva Fabrício Alves Barbosa da 
Published: August 2024

Abstract

We presented a method to find potential cancer attractors using single-cell RNA sequencing (scRNA-seq) data. We tested our method in a Glioblastoma Multiforme (GBM) dataset, an aggressive brain tumor presenting high heterogeneity. Using the cancer attractor concept, we argued that the GBM's underlying dynamics could partially explain the observed heterogeneity, with the dataset covering a representative region around the attractor. Exploratory data analysis revealed promising GBM's cellular clusters within a 3-dimensional marker space. We approximated the clusters’ centroid as stable states and each cluster covariance matrix as defining confidence regions. To investigate the presence of attractors inside the confidence regions, we constructed a GBM gene regulatory network, defined a model for the dynamics, and prepared a framework for parameter estimation. An exploration of hyperparameter space allowed us to sample time series intending to simulate myriad variations of the tumor microenvironment. We obtained different densities of stable states across gene expression space and parameters displaying multistability across different clusters. Although we used our methodological approach in studying GBM, we would like to highlight its generality to other types of cancer. Therefore, this report contributes to an advance in the simulation of cancer dynamics and opens avenues to investigate potential therapeutic targets.
Condition Monitoring of Railway Infrastructure a Case Study of a Light Rail System
Authors: Aseer Sajid , Onsy Ahmed , Varley Martin Roy 
Published: August 2024

Abstract

Railway infrastructure includes complex, integrated, multi-disciplinary systems requiring regular inspections and maintenance. Track and Overhead Line Equipment (OLE) are the main railway infrastructure systems. These systems deteriorate over time due to operations and environmental factors. Monitoring technologies are used to replace manual measurements, to gather data relating to the condition of railway infrastructure assets. Engineers and experts review and make decisions. There is a collective interest to replace the current reactive and preventative maintenance with Predictive Maintenance (PdM) which means maintaining or renewing assets before they fail. This is achieved by condition monitoring of assets. The research data is collected using a Remote Condition Monitoring (RCM) system mounted on a tram on the UK’s biggest light rail network. Data is processed by analytical software. The research aims to introduce Artificial Intelligence (AI), specifically a Machine learning (ML) algorithm, to inform PdM of railway infrastructure focusing on OLE and Track systems.
Unapproved and unproven cancer treatments in patients admitted to palliative care units
Authors: Akagi Hideko , Katsumata Noriyuki , Suzuki Kozue , Masukawa Kento , Morita Tatsuya , Kizawa Yoshiyuki , Tsuneto Satoru , Shima Yasuo , Miyashita Mitsunori 
Published: August 2024

Abstract

Purpose
To clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physicians’.
Methods
This study was conducted as part of a cross-sectional, anonymous nationwide survey of the bereaved family members of patients with cancer in Japan.
Results
Questionnaires were sent to 1,039 bereaved family members, and responses were received from 661 (64%). Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. A total of 7.3% (41 of 558) of patients received UUCT. Of these, 34% (14 of 41) of patients were formed that the treatment was in the research phase, and 49% (20 of 41) were informed that the efficacy of the treatment was unknown. Regarding expectations for UUCT, 61% (25/41) expected to be cured, and 80% (33/41) expected it to slow disease progression. In multivariate logistic regression analysis, more patients received complementary and alternative medicine (CAM) than UUCT (p = 0.024), and patients who could discuss CAM with their doctors tended to receive UUCT (p = 0.054).
Conclusion
Patients with cancer want to be cured and improve their condition, no matter what it takes. These results highlight the challenge of telling patients that UUCT is ineffective and informing them of their prognosis and severe medical conditions.
LLM Doc: An Assessment of ChatGPT’s Ability to Consent Patients for IR Procedures
Authors: Hofmann Hayden , Vairavamurthy Jenanan 
Published: August 2024

Abstract

Purpose: The study aims to evaluate how current interventional radiologists view ChatGPT in the context of informed consent for interventional radiology (IR) procedures.
Methods: ChatGPT-4 was instructed to outline the risks, benefits, and alternatives for IR procedures. The outputs were reviewed by IR physicians to assess if outputs were 1) accurate, 2) comprehensive, 3) easy to understand, 4) written in a conversational tone, and 5) if they were comfortable providing the output to the patient. For each criterion, outputs were measured on a 5-point scale. Mean scores and percentage of physicians rating output as sufficient (4 or 5 on 5-point scale) were measured. A linear regression correlated mean rating with number of years in practice. Intraclass correlation coefficient(ICC) measured agreement among physicians.
Results: The mean rating of the ChatGPT responses was 4.29, 3.85, 4.15, 4.24, 3.82 for accuracy, comprehensiveness, readability, conversational tone, and physician comfort level, respectively. Percentage of physicians rating outputs as sufficient was 84%, 71%, 85%, 85%, and 67% for accuracy, comprehensiveness, readability, conversational tone, and physician comfort level, respectively. There was an inverse relationship between years in training and output score (coeff = -0.03413, p=0.0128); ICC measured 0.39 (p=0.003).
Conclusions: GPT-4 produced outputs that were accurate, understandable, and in a conversational tone. However, GPT-4 had a decreased capacity to produce a comprehensive output leading some physicians to be uncomfortable providing the output to patients. Practicing IRs should be aware of these limitations when counseling patients as ChatGPT-4 continues to develop into a clinically usable AI tool.
Analyzing the Relationship Between Cerebral Aneurysms and Non- Oculomotor Cranial Nerve Palsies: A Systematic Review
Authors: Badary Amr , Helal Amer , Azab Mohammed A. , Almealawy Yasser F. , Alibraheemi Mohammed Q. , Jawed Noyan , Abdulbaki Arif , Brandes Santiago Pastrana , Awuah Wireko Andrew , Omer Mazin , Atallah Oday 
Published: August 2024

Abstract

Objectives
This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function.
Methodology:
Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27.
Results
The analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%).
Conclusion
Intracerebral aneurysms are significantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.
Comparison of cerebral blood flow during general anesthesia in elderly patients with and without dementia: a prospective controlled clinical trial
Authors: Morimoto Yoshinari , Hayashi Megumi , Tanaka Yohei , Nishizaki Hitomi , Mikuzuki Lou 
Published: August 2024

Abstract

Maintenance of cerebral blood flow (CBF) by maintaining blood pressure and brain cell activity and avoiding hypocapnia is important when administering anesthesia in patients with dementia. This study aimed to evaluate CBF during general anesthesia in elderly patients with severe dementia while maintaining their physiological parameters in the adequate range. The patients were anesthetized under a setting range of parameters without affecting CBF (mean arterial pressure [MAP] > 50 mmHg; bispectral index [BIS] > 20; percutaneous arterial oxygen saturation [SpO2] > 95%; end-tidal CO2 [etCO2] 35–40 mmHg). The normalized tissue hemoglobin index (nTHI), which reflects CBF, was measured using near-infrared spectroscopy. The parameters were compared between patients with severe dementia (n = 13) and those without cognitive impairment (n = 12). There were no differences in patient background. A similar decline in MAP and BIS values was observed in both groups, but the values remained within the setting range. The nTHI decreased significantly to 0.60 in the dementia group and to 0.75 in the non-dementia group after the start of treatment (P = 0.047). Even when the MAP, BIS, SpO2, and etCO2 values were maintained in their adequate ranges during general anesthesia, the nTHI decreased by 40% in the dementia group.
Barriers and Facilitators to High-Volume Evidence-Based Innovation and Implementation in a Large, Community-Based Learning Health System
Authors: Durojaiye Cimone , Prausnitz Stephanie , Schneider Jennifer L. , Lieu Tracy A. , Schmittdiel Julie A. , Rouillard Smita , Chen Yi-Fen , Lee Kristine , Corley Douglas A. 
Published: August 2024

Abstract

Background
Broad-scale, rapid health care change is critically needed to improve value-based, effective health care. Health care providers and systems need to address common barriers and facilitators across the evidence to implementation pathway, across diverse specialties. However, most evidence translation / implementation research evaluates single topic areas, and may be of limited value for informing comprehensive efforts. This project’s objective was to identify, characterize, and illustrate common trans-topic facilitators and barriers of translating new health care evidence results to clinical implementation across multiple medical specialties.
Methods
This study was an evaluation of all evidence-based innovation projects completed during 2019–2021. Each project was created with medical group clinical leaders and was intended to inform clinical care. The evaluation took place in a large community-based integrated health care system, and an embedded delivery science and applied research program. Clinical investigators, scientific investigators, and clinical operational leaders received structured questionnaires regarding barriers and facilitators for the operational implementation of new research findings for each project. Responses were mapped to the Consolidated Framework for Implementation Research to identify perceived implementation barriers and facilitators.
Results
All 48 projects completed between 2019–2021 were evaluated; responses were received for 45 (94%) and 34 had comments mappable to framework domains. Potential barriers and facilitators to clinical implementation of new research results were identified across all five framework domains and, within these, the 38 constructs or sub-constructs. Among 245 total comments, the most commonly cited facilitators were how the new research evidence generated compelled change (n = 29), specialty communication networks for disseminating results and initiating change (n = 20), leadership engagement in the project (n = 19), and the innovation’s relative advantage over existing practices (n = 11). The most commonly cited barriers were inadequate resource commitment for next-step implementation (n = 15), insufficient learning/implementation culture (n = 5), and insufficient individual-level willingness/ability for change (n = 5).
Conclusions
A novel large-scale evaluation of barriers and facilitators across the evidence to implementation pathway identified common factors across multiple topic areas and specialties. These common potentially replicable facilitators and modifiable barriers can focus health systems and leaders pursuing large-volume evidence-to-implementation initiatives on those areas with the likely greatest benefit-for-effort, for accelerating health care change.
Downregulation of polygalacturonase (PG) gene expression caused significant changes in gene expression in sesame (Sesamum indicum L.) false septa tissues.
Authors: Sultan Esraa A. A. , Oweda Mariam , Elarabi Nagwa I. , El-Hadidi Mohamed , Abdelhadi Abdelhadi A. , Abdallah Naglaa A. , Tawfik Mohamed S. 
Published: August 2024

Abstract

Sesame (Sesamum indicum L.) is one of the oldest cultivated oil crops worldwide and struggles with low yield, which could be attributed to capsule dehiscence and seed shattering just before and during full maturation. The present study addresses the seed-shattering in sesame via downregulating the endo-polygalacturonase (endo-PG) gene activity “known as the ripening enzyme”. Five lines of sesame plants using an RNAi transformation strategy via a non-tissue culture-based transformation technique. Individual transformants were tested using BASTA leave-painting and spraying over mature plants, as well as conducting PCR, RT-PCR, and real-time PCR tests on T1 plants. The transgenics exhibited a significant reduction in endo-PG levels and showed delays in leaves, organ senescence, and a delay in capsule opening. A transcriptome profiling study was conducted to understand the effect of downregulating the endo-PG expression levels on the genetic expression profile of false septa tissues excised from sesame capsules. Different comparisons between the expression profile of the false septa in transgenic vs non-transgenic control were conducted, yet we are reporting one of the comparisons in this study. A total of 24,468 unigenes were annotated, and 514 differentially expressed genes (DEGs) were detected in the selected comparison, including 349 up-regulated and 165 down-regulated unigenes. Nineteen DEGs for genes directly involved in plant hormones, cell wall modification, and capsule shattering were selected. Our results indicate that silencing the endo-PG gene caused changes in the expression of a wide range of genes, eventually leading to a dramatic reduction in seed-shattering in transgenic sesame capsules.
WITHDRAWN: Development and Validation of an Integrated Traditional Chinese Medicine and Western Medicine Early Screening Model for Coronary Heart Disease in the Community of Tianjin, China: A Simple and Practical Risk Model for Community Physicians
Authors: yang ji , ZHANG Yao , GAO Shengwei , zhao Yingqiang 
Published: August 2024

Abstract

Objective
To explore the influencing factors of coronary heart disease in Tianjin and construct a suitable early screening model for coronary heart disease in the Tianjin community population that integrates traditional Chinese and Western medicine.
Methods
Utilizing annual physical examination data from the electronic health records of community residents participating in the national basic public health service project as the data source and modeling index. The propensity score matching method (PSM) was applied to match age and gender, establishing a standard database. Data were randomly divided into training (8:2 ratio) and test sets using R 4.1.3 software. The training set was used to build the model, and the test set was used to verify the model's discrimination and calibration. Univariate and multivariate Logistic analysis methods were employed to screen predictors and build the model. The model was evaluated through internal and external validation, including goodness of fit, ROC curve analysis, sensitivity, specificity, accuracy, likelihood ratios, and AUC. The "caret" package in R software was used for internal validation via the Bootstrap method, and clinical decision curve analysis (DCA) was applied to assess clinical efficacy.
Results
A total of 24,792 community individuals with complete archives were screened, including 3,487 cases of coronary heart disease. After propensity matching, 3,487 cases each for the coronary heart disease and non-coronary heart disease groups were matched. The training set consisted of 5,580 cases, and the test set of 1,394 cases, with no significant baseline data differences (P > 0.05). A joint early screening model of traditional Chinese and Western medicine was established, incorporating variables such as residential area, waist circumference, diastolic blood pressure, auscultation murmur, dietary salt preference, coexisting conditions like stroke and anemia, and TCM constitution types. The Hosmer-Lemeshow test indicated a good model fit (χ²=14.519, P = 0.065 > 0.05), with an AUC of 0.796. The model demonstrated predictive efficacy and clinical value, suggesting its potential for quantitatively evaluating the risk of coronary heart disease in community residents without reliance on biochemical indicators.
Conclusions
The early screening model for coronary heart disease, based on annual physical examination data of the community population, shows good clinical predictive efficiency. It can quantitatively evaluate the risk of coronary heart disease in community residents, assist community doctors in screening high-risk populations, and is valuable for early diagnosis.
Relapsed/refractory classical Hodgkin lymphoma treated with pulsed Boom-Boom radiotherapy combined with a PD-1 inhibitor and decitabine: Two case reports
Authors: Wang Chen , Xue Zhuang , Zou Benkui , Shi Pengyue , Yue Jinbo 
Published: August 2024

Abstract

Hodgkin lymphoma (HL), characterized by cancerous Reed-Sternberg cells within an inflammatory milieu, poses challenges in relapsed or refractory cases. Current standard treatments, including salvage chemotherapy and autologous stem cell transplantation (ASCT), have limitations in achieving long-term remission. Herein, we present two cases of nodular sclerosing relapsed/refractory Hodgkin's lymphoma treated with personalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR) in combination with a PD-1 inhibitor and Decitabine. Patients underwent PULSAR (2Gy/dose x 2f D1-2 q3w) for recurrent lesions along with PD-1 monoclonal antibody (200mg D0 q3w) and Decitabine (10mg D1-5 q3w) for six cycles. Both patients achieved complete remission (CR) post-treatment, enabling subsequent ASCT and PD-1 maintenance therapy. Follow-up revealed prolonged survival without recurrence. PULSAR, by delivering radiation pulses at longer intervals, allows for tumor adaptation and immune response, potentially enhancing treatment efficacy and minimizing toxicity. Combined with immunotherapy and Decitabine, PULSAR shows promise in managing relapsed/refractory HL, warranting further investigation through clinical trials. This approach signifies a paradigm shift towards precision tumor therapy and immunomodulation in HL management.