bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dissecting Epileptic and Cognitive Network Dysfunction in Epilepsy
Authors: Lenck-Santini Pierre-Pascal , Holmes Gregory 
Published: July 2024

Abstract
Cognitive and behavioral impairment can drastically affect the quality of life of patients with epilepsy, particularly when seizures appear in early childhood. Treating such deficits is therefore critical, and understanding the mechanisms involved is an important step toward this goal. Although seizures are believed to play a critical role in these deficits, the underlying etiology of the epilepsy may also directly affect brain function. Unfortunately, dissociating the impact of seizure activity from the impact of etiology is complex. Experimental strategies developed to make this dissociation consist of three levels of investigation: behavioral performance analysis, neural coding properties of epileptic networks, and organization of neuronal dynamics through brain rhythms and oscillations. From this strategy, evidence suggests that both seizures and cognitive deficits take their origin in a discoordination of epileptic networks, caused by GABAergic dysfunction and/or the abnormal presence of excitatory loops. Such network discoordination manifests itself in the form of abnormal rhythmical activity or of epileptiform activity. Restoring such rhythmopathies might be the focus of future therapeutic perspectives.
Management of Febrile Status Epilepticus
Authors: Garcia-Curran Megan M. , Baram Tallie Z. 
Published: July 2024

Abstract
The majority of seizures that arise with fever in infants and children are brief and cause few long-term consequences. A subset of the seizures is prolonged and, when lasting &gt;30 minutes, are termed febrile status epilepticus (FSE). Human and experimental animal data indicate that FSE may be associated with injury to the hippocampus and subsequent temporal lobe epilepsy (TLE) and cognitive problems. Current clinical approaches in the treatment of febrile seizures recommend administration of benzodiazepines to abort the seizure and prevent the evolution of FSE. However, the minimal duration of FSE that leads to epilepsy and memory deficits is unclear, and the first FSE in a child—which is sufficient to provoke long-term consequences—is often difficult to anticipate and abort. Ongoing human and experimental animal studies are beginning to uncover the mechanisms by which FSE can lead to injury, epilepsy, and cognitive deficits in both normal and predisposed individuals. These mechanisms include neuroinflammation and large-scale changes in neuronal gene expression and synaptic connectivity within hippocampal circuits. Future therapy will focus on aborting adverse FSE-induced consequences using mechanism-based interventions.
Ionic Mechanisms of Ictogenic Disinhibition
Authors: Staley Kevin J. 
Published: July 2024

Abstract
Seizures are a consequence of an imbalance between excitation and inhibition. Of course, most of the time the brain does not generate seizure activity, even in severely epileptic patients. So there must be a way for the balance of excitation and inhibition to shift to engender seizure activity. Here two types of shifts are considered. The first is a temporal shift in the efficacy of inhibition. The neurotransmitter GABA, released from interneurons and acting on postsynaptic GABAA receptors, is the principal mechanism of synaptic inhibition in the brain. The GABAA receptor is unique in that it gates an anionic membrane current that can change direction under both physiological and pathological circumstances. Some of the pathological shifts can lead to seizure activity. The second shift in the efficacy of inhibition is anatomical. Some GABAA synapses that were meant to gate anion flow in the inhibitory direction instead gate anion flux in the opposite direction. This can occur as a consequence of either dysgenesis or the effects of injury and recovery from injury. This chapter reviews the basis for the direction of GABAA currents, and then discusses how they can be altered in time and space to increase the probability of seizure activity. Finally, therapeutic interventions are discussed.
First deep X-ray observations of the Fermi-detected steep-spectrum source and radio-loud NLS1 galaxy 3C 286
Authors: Yao Su , Komossa S , Kraus A , Grupe D 
Published: July 2024

ABSTRACT
A well-known calibrator source in radio astronomy, 3C 286 ($z=0.85$), is a compact steep-spectrum (CSS) radio source and spectroscopically classified as a narrow-line Seyfert 1 (NLS1) galaxy. It is also known for its damped Ly $\alpha$ system from an intervening galaxy at $z=0.692$ detected in both ultraviolet (UV) and radio spectra. In addition, despite being a misaligned active galactic nuclei (AGN), 3C 286 is also detected in $\gamma$-rays by Fermi. Thus, this unique object combines the characteristics of CSS sources, NLS1 galaxies, and $\gamma$-ray emitters with misaligned jets, providing an excellent laboratory for extending our knowledge of AGN disc–jet coupling. Despite its significance, 3C 286 has been rarely observed in X-rays. In this study, we present our deep XMM–Newton and Chandra observations of 3C 286. The results reveal that the X-ray spectrum can be well-described by models including an intervening absorber with redshift and column density consistent with previous UV and radio observations. The most important finding is that the spectrum cannot be described by a single power law, but a soft excess is required which is parametrized by a blackbody. Furthermore, we find evidence suggesting the presence of off-nuclear X-ray emission at a radius that corresponds to the location of the radio lobes. While further theoretical work is still needed, our findings offer new clues to understand the specific mechanism for $\gamma$-ray emission from this unique object.
A Cross-Sectional Evaluation of the Virtual Outpatient Management of People With Mpox
Authors: Warrell Clare E , Chaudhry Zain , Shawe-Taylor Marianne , Mastoraki Evanthia , Delmonte Sen Ashwin , Rafferty Hannah , De Wilton Angus , Mescall Naomi , Houlihan Catherine , Gothard Philip , Jungmann Eva , Logan Sarah , Rampling Tommy , Waters Laura , Browne Rita , Marks Michael , Shaw Emily 
Published: July 2024

Abstract

Background
To report on the implementation and outcomes of a virtual ward established for the management of mpox during the 2022 outbreak, we conducted a 2-center, observational, cross-sectional study over a 3-month period.

Methods
All patients aged ≥17 years with laboratory polymerase chain reaction–confirmed monkeypox virus managed between 14 May and 15 August 2022, at the Hospital for Tropical Diseases at University College London Hospitals National Health Service (NHS) Foundation Trust and sexual health services at Central North and West London NHS Foundation Trust, were included. Main outcomes included the proportion of patients managed exclusively on the virtual ward, proportion of patients requiring inpatient admission, proportion of patients with human immunodeficiency virus, and duration of lesion reepithelialization.

Results
Among confirmed cases (N = 221), 86% (191/221) were managed exclusively on the virtual ward, while 14% (30/221) required admission. Treatment for concomitant sexually transmitted infections was provided to 25% (55/221) of patients, antibiotics for other infective complications to 16% (35/221), and symptomatic relief to 27% (60/221). The median time from onset to complete lesion reepithelialization and de-isolation was 18 days (range, 8–56 days). Eleven percent (24/221) of individuals disengaged from services within 4 days of testing.

Conclusions
The virtual ward model facilitated safe and holistic outpatient management of mpox, while minimizing admissions. This approach could serve as a model for future outbreak responses.
Timeframe for Conversion to Psychosis From Individuals at Clinical High-Risk: A Quantile Regression
Authors: Zhang TianHong , Wei YanYan , Tang XiaoChen , Xu LiHua , Hu YeGang , Liu HaiChun , Wang ZiXuan , Chen Tao , Li ChunBo , Wang JiJun 
Published: July 2024

Abstract

Background and Hypothesis
The time taken for an individual who is at the clinical high-risk (CHR) stage to transition to full-blown psychosis may vary from months to years. This temporal aspect, known as the timeframe for conversion to psychosis (TCP), is a crucial but relatively underexplored dimension of psychosis development.

Study Design
The sample consisted of 145 individuals with CHR who completed a 5-year follow-up with a confirmed transition to psychosis within this period. Clinical variables along with functional variables such as the Global Assessment of Function (GAF) score at baseline (GAF baseline) and GAF-drop from the highest score in the past year. The TCP was defined as the duration from CHR identification to psychosis conversion. Participants were categorized into 3 groups based on TCP: “short” (≤6 months, ≤33.3%), “median” (7–17 months, 33.3%–66.6%), and “long” (≥18 months, ≥66.6%). The quantile regression analysis was applied.

Study Results
The overall sample had a median TCP of 11 months. Significant differences among the three TCP groups were observed, particularly in GAF-drop (χ2 = 8.806, P = .012), disorganized symptoms (χ2 = 7.071, P = .029), and general symptoms (χ2 = 6.586, P = .037). Greater disorganized symptoms (odds ratio [OR] = 0.824, P = .009) and GAF-drop (OR = 0.867, P = .011) were significantly associated with a shorter TCP, whereas greater general symptoms (OR = 1.198, P = .012) predicted a longer TCP. Quantile regression analysis demonstrated a positive association between TCP and GAF baseline above the 0.7 quantile and a negative association between TCP rank and GAF drop below the 0.5 quantile.

Conclusions
This study underscores the pivotal role of functional characteristics in shaping TCP among individuals with CHR, emphasizing the necessity for a comprehensive consideration of temporal aspects in early prevention efforts.
The Great Flood: Race-Moderated Associations between Social Work Students’ Protective Mechanisms and Adaptive Coping
Authors: Lemieux Catherine M , Kim Youn Kyoung 
Published: July 2024

Abstract
The postdisaster experiences of 167 social work students in the aftermath of the Great Flood of 2016 were examined. Using a cross-sectional survey design and validated self-report measures, the current study examined the association between students’ protective factors (hope, altruism, spiritual support; at 8, 20, and 12 items, respectively) and six adaptive coping mechanisms, and further sought to determine whether such associations varied according to students’ race (white vs. African American). Six hierarchical multiple linear regression analyses were conducted using each of the adaptive coping strategies (acceptance, active coping, positive reframing, self-distraction, planning, and venting). Results showed that students’ race moderated the associations between altruism and active coping, spiritual support and active coping, spiritual support and self-distraction, altruism and planning, spiritual support and planning, and altruism and venting. The decomposition of the significant interactions indicated that the effect of altruism on active coping, planning, and venting was greater among white than among African American participants; the effect of spiritual support on active coping, self-distraction, and planning was greater among African American than among white participants. Recommendations include educating all students about risks incurred when working with traumatized populations. Research examining postdisaster coping responses of social workers can inform culturally responsive supervision approaches.
GLP-1 RAs
Authors: Drake Evan S. , Marino Adriane B. , Theroux Jenna D. , Roberts Kaitlin 
Published: July 2024

ABSTRACT
In the last decade, the glucagon-like peptide-1 (GLP-1) receptor agonist (RA) drug class has revolutionized treatment for type 2 diabetes mellitus and some of its comorbidities, including obesity and cardiovascular disease. Continued advancements in the GLP-1 RA space show clinical promise for patients, though challenges—including barriers to care such as drug expense and availability—exist. This article provides an overview of available GLP-1 RAs and their mechanisms of action, indications, adverse reactions, and risks, providing practical pearls for providers along the way.
Evidence-based data support strategies for the prevention of Hymenoptera venom anaphylaxis
Authors: Kamga Audrey , Bourrain Jean Luc , Demoly Pascal , Tanno Luciana Kase 
Published: July 2024

Purpose of review
This review aims to identify phenotypes at-risk of Hymenoptera venom-induced anaphylaxis (HVA), focusing on different perspectives (epidemiological, clinical, and therapeutic) in order to adapt future preventive strategies.

Recent findings
HVA remains one of the leading causes of anaphylaxis, with a broad pattern of symptoms. Although most cases occur outside healthcare settings, data indicate a high emergency admission rate due to insect stings. Mortality is often underestimated because of the lack of witnesses and difficulties in recognizing the signs and the culprit. Targeting risk factors could be a clue to improve these statistics and the prognosis of the disease.
Potential risk factors for severe HVA in the European population are basal serum tryptase (BST) above 8 μg, mast cell disorders, the absence of skin symptoms, and cardiovascular conditions requiring the use of beta blockers and ACE inhibitors. Identifying these criteria, mainly based on clinical patterns, helps to develop personalized strategies for management and prevention.

Summary
With a personalized medicine approach, phenotypes must be characterized to adapt to the management of patients suffering from Hymenoptera venom anaphylaxis (HVA), including venom immunotherapy (VIT). In this systematic review, all articles mentioned systemic reactions with heterogeneous severity degrees. Half of those reported grade III–IV systemic reactions (Ring and Messmer). HVA clinical patterns could be worsened by one Hymenoptera sting, a patient's history with mast cell disorders, or cardiovascular diseases. VIT failure was attributed to bee venom extract and monotherapy in two-thirds of publications. Findings stress the difficulty of having uniform epidemiological data on HVA and the lack of financial support in some world regions to support appropriate management of these conditions. Although observing a heterogeneity of data, we were able to identify potential risk factors, in particular for the severe cases. We believe our work will support allergists and health professionals to implement improved personalized management of patients suffering from severe HVA.
The SMILE study: Study of long-term methotrexate and iguratimod combination therapy in early rheumatoid arthritis
Authors: Du Fang , Dai Qing , Teng Jialin , Lu Liangjing , Ye Shuang , Ye Ping , Lin Zhiqian , Ding Hong , Dai Min , Bao Chunde ,   on behalf of the SMILE Group
Published: July 2024

Abstract

Background:
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and joint destruction. Iguratimod (IGU) is a novel conventional synthetic disease-modifying antirheumatic drugs (csDMARD) with good efficacy and safety for the treatment of active RA in China and Japan. However, the long-term effects of IGU on the progression of bone destruction or radiographic progression in patients with active RA remain unknown. We aimed to investigate the efficacy and safety of iguratimod (IGU), a combination of methotrexate (MTX) and IGU, and IGU in patients with active rheumatoid arthritis (RA) who were naïve to MTX.

Methods:
This multicenter, double-blind, randomized, non-inferiority clinical trial was conducted at 28 centers for over 52 weeks in China. In total, 911 patients were randomized (1:1:1) to receive MTX monotherapy (10–15 mg weekly, n = 293), IGU monotherapy (25 mg twice daily, n = 297), or IGU + MTX (10–15 mg weekly for MTX and 25 mg twice daily for IGU, n = 305) for 52 weeks. The patients’ clinical characteristics, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), disease activity score in 28 joints-C-reactive protein (DAS28-CRP) level, and erythrocyte sedimentation rate (DAS28-ESR) were assessed at baseline. The primary endpoints were the proportion of patients with ≥20% improvement according to the American College of Rheumatology (ACR20) response and changes in the van der Heijde-modified total Sharp score (vdH-mTSS) at week 52.

Results:
The proportions of patients achieving an ACR20 response at week 52 were 77.44%, 77.05 %, and 65.87% for IGU monotherapy, IGU + MTX, and MTX monotherapy, respectively. The non-inferiority of IGU monotherapy to MTX monotherapy was established with the ACR20 (11.57%; 95% confidence interval [CI], 4.35–18.79%; P <0.001) and vdH-mTSS (−0.37; 95% CI, −1.22–0.47; P = 0.022). IGU monotherapy was also superior to MTX monotherapy in terms of ACR20 (P = 0.002) but not the vdH-mTSS. The superiority of IGU + MTX over MTX monotherapy was confirmed in terms of the ACR20 (11.18%; 95% CI, 3.99–18.37%; P = 0.003), but not in the vdH-mTSS (−0.68; 95% CI, −1.46–0.11; P = 0.091). However, the difference in the incidence rates of adverse events was not statistically significant.

Conclusions:
IGU monotherapy/IGU + MTX showed a more favorable clinical response than did MTX monotherapy. IGU may have some clinical benefits over MTX in terms of radiographic progression, implying that IGU may be considered as an initial therapeutic option for patients with active RA.

Trial Registration:

https://classic.clinicaltrials.gov/, NCT01548001.
Perfusion Mapping of Flaps Using Indocyanine Green Fluorescence Angiography and Laser Speckle Contrast Imaging
Authors: Zötterman Johan , Tesselaar Erik , Elawa Sherif , Elmasry Moustafa , Farnebo Simon 
Published: July 2024

Background:
Indocyanine green fluorescence angiography (ICG-FA) is often used for assessing tissue circulation in reconstructive surgery. Indocyanine green (ICG) is injected intravenously and visualized in the tissue with an infrared camera. The information is used to plan the surgery, for example, in free flap breast reconstructions. Laser speckle contrast imaging (LSCI) is another method that uses laser to assess tissue perfusion in the skin. Unlike ICG-FA, LSCI is noninvasive and may therefore have an advantaged compared with ICG-FA. The aim of this study was to evaluate the correlation between information obtained from these two techniques.

Methods:
Five deep inferior epigastric perforator patients were included. The flaps were assessed with LSCI and ICG-FA. For LSCI, the perfusion was calculated in 32 regions of interest. For ICG-FA, the maximum slope and area under curve (AUC) were calculated based on average pixel intensity data.

Results:
Large variations in maximum slope values could be seen between flaps, whereas AUC had lower variability within the same flap and between flaps. Pearson rank correlation comparing average perfusion (LSCI) and AUC (ICG-FA) showed a correlation between the values (r = 0.55, P < 0.0001). No significant correlation was observed between perfusion and maximum slope (r = 0.11, P = 0.18).

Conclusions:
There is a significant correlation between data obtained using LSCI and ICG-FA, when ICG-FA data are presented as AUC of the ICG-FA intensity curve. Maximum slope lacks significant correlation with flap data obtained with LSCI. The study indicates that LSCI may be used in reconstructive surgery to assess tissue circulation in a way similar to ICG-FA.
A case of AZOOR under immunomodulatory treatment
Authors: Merle David A. , Wolfram Lasse , Nasyrov Emil , Reith Milda , Kowalski Martin , Kempf Melanie , Strudel Lisa , Doycheva Deshka , Deuter Christoph , Stingl Katarina , Kühlewein Laura 
Published: July 2024

Purpose:
To describe the clinical course and treatment response of a case of Acute Zonal Occult Outer Retinopathy (AZOOR).

Methods:
This is an observational case report. The examinations included ophthalmic examination, longitudinal multimodal imaging, visual field testing, electrophysiological recordings, serologic analyses and whole genome sequencing.

Results:
In this report, the authors present the case of an otherwise healthy 33-year-old female with bilateral AZOOR manifestation. Other possible causes of the observed retinal lesions were ruled out by extensive diagnostic work-up. Treatment with oral prednisolone therapy led to temporal disease control but progression was observed after prednisolone discontinuation. A tapered oral prednisolone therapy in combination with adalimumab initiation prevented further progression for at least 21 months.

Conclusion:
Diagnosis of AZOOR is frequently complicated by the unspecific symptoms of the disease and significant number of differential diagnoses. Complete diagnostic work-up is important to rule out other etiologies. Due to the lack of randomized controlled trials, therapeutic decisions obligatorily rely on empiric treatment decisions in combination with frequent follow-up examinations.
Impact of Biopsychosocial Pain Education on Physician Assistant Students' Pain Knowledge, Pain Attitudes, and Recommendations for Lower Back Pain
Authors: Kiesel John D. , Stevens Douglas , Elwood Chelsea 
Published: July 2024

Introduction
Physician assistants treat patients with chronic musculoskeletal pain on a regular basis. This pilot study implemented a pain education module in the first semester of didactic training and evaluated changes in knowledge, attitudes, and recommendations for lower back pain.

Methods
The biopsychosocial pain education module, focused on the social, cultural, psychological, and biological complexities of pain and incorporated online training and in-person case based discussions. Students completed surveys on pain knowledge, attitudes, and recommendations for a case scenario before and after the module and at a one-year follow-up.

Results
Physician assistant students' pain attitudes and beliefs demonstrated statistically significant shifts toward a biopsychosocial perspective immediately after the educational module (P < 0.001) and at one-year follow-up compared with pretest levels (P = .034). Pain knowledge demonstrated statistically significant improvements immediately after the module (P = .006). At one-year follow-up, pain knowledge was not statistically significantly different from pretest levels (P = .530). Clinical recommendations for the case-based scenario trended toward increased agreement with clinical practice guideline recommendations after the module and persisted at the one-year follow-up.

Discussion
Implementing a pain education module with emphasis on the multidimensional nature of pain using a case-based approach can improve pain knowledge, attitudes, and recommendations for care.