bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Atypical Presentation of Ischemic Stroke in a Middle-Aged Adult
Authors: Buck Martha 
Published: August 2024

Stroke-like symptoms are a common complaint in the emergency department; however, signs of an acute cerebrovascular event in a patient under the age of 50 can be both alarming and unexpected. In this case, a 41-year-old male presented to the emergency department with vague symptoms of intermittent weakness and paresthesias for 4 days. Originally deemed a “stroke code” in the field, the patient was immediately transferred to the computerized tomography scanner. The patient was later found to have a right-sided internal carotid dissection and subsequent right parietal lobe ischemic infarcts. This article highlights the need to maintain a high suspicion for acute cerebrovascular events, even in atypical presentations. The key features of caring for a patient experiencing carotid dissection, as well as their expected prognosis and care course, are also expounded upon. Early recognition of stroke-like symptoms in young, otherwise healthy, patients is critical to providing the needed care in a timely manner and to preserve future function and quality of life.
Emergency Department Length of Stay
Authors: Bennage Johnette K. , Ford Cassandra D. , Ezemenaka Christina J. , Persing Tamara F. 
Published: August 2024

Objective:
This quality improvement initiative was conducted to determine if a provider in triage and split flow model could decrease the length of stay (LOS) of discharged patients seen in a community hospital emergency department (ED).

Background:
Extended LOSs within the ED lead to delays in the care of patients, increase the number of patients who leave without being seen by a provider, decrease patient satisfaction, and cause a loss of revenue for health care organizations. Using a provider in triage and a split flow model, where patients can be seen and dispositioned without delays, can improve ED throughput and decrease the overall LOS.

Methods:
Through a structured, interdisciplinary approach using the Plan-Do-Study-Act Shewhart Cycle of Process Improvement, a provider was placed in triage, and an interior waiting room was used to evaluate emergency severity index level 3 and 4 patients to expedite diagnostic testing and perform procedures. This model allowed lower acuity patients to be cared for separately from higher acuity patients, who were being treated in the main ED. In addition, the median arrival to provider, arrival to bed, and LOS from arrival to departure of discharged patients were compared to the current departmental processes.

Results:
There was a significant improvement in the LOS of discharged patients and the time of arrival to triage, arrival to bed, and arrival to provider using a provider in triage and a split flow model compared to the current intake.

Conclusion:
Implementation of a provider in triage and a split flow model can demonstrate a decrease in the LOS of discharged patients along with other ED metrics and improve efficiencies in patient care within a community hospital.
A case of pleural Mycobacterium tuberculosis infection with reversion of Quantiferon Gold Plus results from positive to negative.
Authors: Goire Namraj , Suchard Melinda , Barling Andrew , Fernando Ruchira , Dreyer Linda , Mahony Andrew 
Published: August 2024

Introduction
Mycobacterium tuberculosis continues to have a high mortality and morbidity burden globally. IGRA such as Quantiferon Gold Plus aid in diagnosis of latent TB but diagnosis of pleural TB remains challenging. We present a case of active pleural MTB infection with reversion of IGRA from positive to negative, and negative Xpert MTB/RIF Ultra PCR results from pleural biopsy tissues.
Case
A 52-year-old male presented in 2022 with a two-week history of pleuritic chest pain associated with modest elevation in inflammatory markers. The patient had had a positive QFG-Plus result in 2018, however QFG-Plus during this admission was negative. CTPA and needle thoracocentesis showed an exudative left pleural effusion with predominant lymphocytes. The patient’s symptoms failed to resolve with empiric antimicrobial therapy for community-acquired pneumonia. Broncho-Alveolar Lavage as well as biopsies of pleural tissues via video-assisted thoracoscopic surgery from the left lower lobe yielded negative results on routine microbiological culture as well as Xpert Ultra PCR. Growth of AFB was noted from mycobacterial cultures of pleural tissues which was identified as MTB.
Conclusion
Despite significant technological advances, microbiological diagnosis of MTB infections remains challenging. We document QFG-Plus reversion during development from latent to active pleural TB. Decline in the ability of CD4+ and CD8+ T cells to produce interferon gamma in response to TB antigens (ESAT-6 and CFP-10) was likely associated with loss of host control of latent MTB. This case serves as a reminder that despite exhaustive testing with state-of-art diagnostic platforms, MTB can still elude discovery.
Whole-genome sequencing of Western Canadian Borrelia spp. collected from diverse tick and animal hosts reveals short-lived local genotypes interspersed with longer-lived continental genotypes
Authors: Russell Jennifer N. , Lee Min-Kuang , Uyaguari-Diaz Miguel I. , Sies Ashton N. , Suchan Danae M. , Hsiao William , Fraser Erin , Morshed Muhammad G. , Cameron Andrew D. S. 
Published: August 2024

Changing climates are allowing the geographic expansion of ticks and their animal hosts, increasing the risk of Borrelia-caused zoonoses in Canada. However, little is known about the genomic diversity of Borrelia from the west of the Canadian Rockies and from the tick vectors Ixodes pacificus, Ixodes auritulus and Ixodes angustus. Here, we report the whole-genome shotgun sequences of 51 Borrelia isolates from multiple tick species collected on a range of animal hosts between 1993 and 2016, located primarily in coastal British Columbia. The bacterial isolates represented three different species from the Lyme disease-causing Borrelia burgdorferi sensu lato genospecies complex [Borrelia burgdorferi sensu stricto (n=47), Borrelia americana (n=3) and Borrelia bissettiae (n=1)]. The traditional eight-gene multi-locus sequence typing (MLST) strategy was applied to facilitate comparisons across studies. This identified 13 known Borrelia sequence types (STs), established 6 new STs, and assigned 5 novel types to the nearest sequence types. B. burgdorferi s. s. isolates were further differentiated into ten ospC types, plus one novel ospC with less than 92 % nucleotide identity to all previously defined ospC types. The MLST types resampled over extended time periods belonged to previously described STs that are distributed across North America. The most geographically widespread ST, ST.12, was isolated from all three tick species. Conversely, new B. burgdorferi s. s. STs from Vancouver Island and the Vancouver region were only detected for short periods, revealing a surprising transience in space, time and host tick species, possibly due to displacement by longer-lived genotypes that expanded across North America.
This article contains data hosted by Microreact.
Distinguishing clinical and genetic risk factors for suicidal ideation and behavior in a diverse hospital population
Authors: Colbert Sarah M.C. , Lepow Lauren , Fennessy Brian , Iwata Nakao , Ikeda Masashi , Saito Takeo , Terao Chikashi , Preuss Michael , Pathak Jyotishman , Mann J. John , Coon Hilary , Mullins Niamh 
Published: August 2024

ABSTRACTSuicidal ideation (SI) and behavior (SB) are major public health concerns, but risk factors for their development and progression are poorly understood. We used ICD codes and a natural language processing algorithm to identify individuals in a hospital biobank with SI-only, SB, and controls without either. We compared the profiles of SB and SI-only patients to controls, and each other, using phenome-wide association studies (PheWAS) and polygenic risk scores (PRS). PheWAS identified many risk factors for SB and SI-only, plus specific psychiatric disorders which may be involved in progression from SI-only to SB. PRS for suicide attempt were only associated with SB, and even after accounting for psychiatric disorder PRS. SI PRS were only associated with SI-only, although not after accounting for psychiatric disorder PRS. These findings advance understanding of distinct genetic and clinical risk factors for SB and SI-only, which will aid in early detection and intervention efforts.
Imaging protocol suggested by large language model depends on language: preliminary experiments using GPT-4
Authors: Suzuki Kazufumi , Abe Kayoko , Sakai Shuji 
Published: August 2024

AbstractPurposeThis study aimed to evaluate the potential of GPT-4, a large language model, in assisting radiologists to determine brain magnetic resonance imaging (MRI) protocols.MethodsWe used brain MRI protocols from a specific hospital, covering 20 diseases or examination purposes, excluding brain tumor protocols. GPT-4 was given system prompts to add one MRI sequence for the basic brain MRI protocol and disease names were input as user prompts. The model’s suggestions were evaluated by two radiologists with over 20 years of relevant experience. Suggestions were scored based on their alignment with the hospital’s protocol as follows: 0 for inappropriate, 1 for acceptable but nonmatching, and 2 for matching the protocol. The experiment was conducted in both Japanese and English to compare GPT-4’s performance in different languages.ResultsGPT-4 scored 27/40 points in English and 28/40 points in Japanese. GPT-4 gave inappropriate suggestions for Moyamoya disease and neuromyelitis optica in both languages and cerebral infarction in Japanese. For the other protocols, the suggested sequences were either appropriate or better. The suggestions in English differed from those in Japanese for seven protocols.ConclusionGPT-4 can suggest appropriate MRI sequences for each disease in addition to the standard brain MRI protocol. GPT-4’s output is language-dependent and suggests brain MRI protocols tailored to specific regions and domains.
LLIN Evaluation in Uganda Project (LLINEUP2) – Effect of long-lasting insecticidal nets (LLINs) treated with pyrethroid plus pyriproxyfen vs LLINs treated with pyrethroid plus piperonyl butoxide in Uganda: a cluster-randomised trial
Authors: Gonahasa Samuel , Namuganga Jane F , Nassali Martha J , Maiteki-Sebuguzi Catherine , Nabende Isaiah , Epstein Adrienne , Snyman Katherine , Nankabirwa Joaniter I , Opigo Jimmy , Donnelly Martin J , Dorsey Grant , Kamya Moses R , Staedke Sarah G 
Published: August 2024

AbstractBackgroundWe embedded a pragmatic, cluster-randomised trial into Uganda’s national campaign to distribute long-lasting insecticidal nets (LLINs) in 2020–2021, comparing LLINs treated with pyrethroids plus the synergist piperonyl butoxide (PBO), to LLINs treated with pyrethroids plus pyriproxyfen, an insect growth regulator.MethodsTarget communities surrounding public health facilities (clusters, n=64), covering 32 high-burden districts not receiving indoor residual spraying, were included. Clusters were randomised 1:1 in blocks of two by district to receive: (1) pyrethroid-PBO LLINs (PermaNet 3.0, n=32) or (2) pyrethroid-pyriproxyfen LLINs (Royal Guard, n=32). LLINs were delivered from 7 November 2020 to 26 March 2021 and malaria outcome data were collected until 31 March 2023. Estimates of malaria incidence in residents of all ages (the primary outcome) were generated for each cluster from enhanced health facility surveillance data. At 12- (24 November 2021 to 1 April 2022) and 24-months (23 November 2022 to 21 March 2023) post-LLIN distribution, cross-sectional community surveys were conducted in randomly selected households (at least 50 per cluster, 3,200 per survey).FindingsIn the two years following LLIN distribution, 186,364 episodes of malaria were diagnosed in cluster residents during 398,931 person-years of follow-up. Malaria incidence after 24-months was lower than at baseline in both arms (pyrethroid-PBO: 465 vs 676 episodes per 1000 person-years; pyrethroid-pyriproxyfen: 469 vs 674 episodes per 1000 person-years); but the difference between the arms was not statistically significant (incidence rate ratio 1.06, 95% confidence interval [CI] 0.91– 1.22, p=0.47). Two years post-distribution, ownership of at least one LLIN for every two household residents was low in both arms (41.1% pyrethroid-PBO vs 38.6% pyrethroid-pyriproxyfen). Parasite prevalence in children aged 2-10 years was no different between the arms in either survey and similar results were observed for prevalence of anaemia in children aged 2-4 years.InterpretationThe effectiveness of pyrethroid-PBO LLINs and pyrethroid-pyriproxyfen LLINs was no different in Uganda, but two years after mass distribution, LLIN coverage was inadequate.FundingUS National Institutes for Health, Bill and Melinda Gates FoundationTrial registrationNCT04566510. Registered 28 September 2020,https://clinicaltrials.gov/ct2/show/NCT04566510
Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study
Authors: Niu Huicong , Wang Yong , Yang Ning , Chu Min , Mao Xueyu , Wang Daosheng , Zhao Jing 
Published: August 2024

AbstractBackgroundAggressive lipid-lowering therapy is recommended for patients with ischemic stroke; however, lipid paradox has been reported in several clinical studies. The mechanism of lipid paradox remains uncertain, and nutrition maybe one explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.Materials and MethodsA total of 5257 patients with ischemic stroke were recruited for analysis. The Controlling Nutritional Status (CONUT) score was utilized to investigate the risk of malnutrition. Individuals were classified into 4 groups based on their CONUT score. Poor outcomes and all-cause mortality were compared among patients with varied nutritional status and RC levels.ResultsPatients with moderate-severe malnutrition had the highest incidences of in-hospital complications, including pulmonary infection, renal dysfunction, and hemorrhagic transformation, and the highest rates of poor outcomes (61.3%,P<0.001) and all-cause mortality (32.8%,P< 0.001) during the 3-month follow-up period. Baseline higher RC level was an independent protective factor of adverse clinical outcomes for patients with any degree of malnutrition, which was not observed in patients without malnutrition. In addition, compared with the moderate-severe malnourished with RC <0.471 mmol/L, the adjusted ORs for poor outcomes and all-cause mortality were 0.805 (0.450–1.438) and 0.898 (0.502-1.607) for participants with 0.471-0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633-0.868 mmol/L, and 0.160 (0.037–0.689) and 0.202 (0.042-0.967) for ≥ 0.869 mmol/L, prospectively.ConclusionLipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients with ischemic stroke and good nutritional status. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial than aggressive lipid control.
Deciphering octoploid strawberry evolution with serial LTR similarity matrices for subgenome partition
Authors: Lyu Haomin , Ou Shujun , Yim Won Cheol , Yu Qingyi 
Published: August 2024

AbstractPolyploidization has been recognized as a major force in plant evolution. With the continuous progress in sequencing technologies and genome assembly algorithms, high-quality chromosome-level assemblies of polyploid genomes have become increasingly attainable. However, accurately delineating these assemblies into subgenomes remains a challenging task, especially in case where known diploid ancestors are absent. In this study, we introduce a novel approach that leverages long terminal repeat retrotransposons (LTR-RTs) coupled with the Serial Similarity Matrix (SSM) method to assign genome assemblies to subgenomes, particularly beneficial for those without known diploid progenitor genomes. The SSM method helps identify subgenome-specific LTRs and facilitates the inference of the timing of allopolyploidization events. We validated the efficacy of the SSM approach using well-studied allopolyploidy genomes,Eragrostis tefandGossypium hirsutum, alongside an artificially created allotetraploid genome by merging two closely related diploid species,Glycine maxandG. soja. Our results demonstrated the robustness of the method and its effectiveness in assigning chromosomes to subgenomes. We then applied the SSM method to the octoploid strawberry genome. Our analysis revealed three allopolyploidization events in the evolutionary trajectory of the octoploid strawberry genome, shedding light on the evolutionary process of the origin of the octoploid strawberry genome and enhancing our understanding of allopolyploidization in this complex species.
Leveraging microtopography to pattern multi-oriented muscle actuators
Authors: Rossy Tamara , Schwendeman Laura , Bawa Maheera , Umashankar Pavankumar , Raman Ritu 
Published: August 2024

AbstractEngineering skeletal muscle tissue with precisely defined alignment is of significant importance for applications ranging from drug screening to biohybrid robotics. Aligning 2D contractile muscle monolayers, which are compatible with high-content imaging and can be deployed in planar soft robots, typically require micropatterned cues. However, current protocols for integrating microscale topographical features in extracellular matrix hydrogels require expensive microfabrication equipment and multi-step procedures involving error-prone manual handling steps. To address this challenge, we present STAMP (Simple Templating of Actuators via Micro-topographical Patterning), an easily accessible and cost-effective one-step method to pattern microtopography of various sizes and configurations on the surface of hydrogels using reusable 3D printed stamps. We demonstrate that STAMP enables precisely controlling the alignment of mouse and human skeletal muscle fibers, and thus their force-generating axes, without impacting their maturation or function. To showcase the versatility of our technique, we designed a planar soft robot inspired by the iris, which leverages spatially segregated regions of concentric and radial muscle fibers to control pupil dilation. Optogenetic skeletal muscle fibers grown on a STAMPed iris substrates formed a multi-oriented actuator, and selective light stimulation of the radial and concentric fibers was used to control the function of the iris, including pupil constriction. Computational modeling of the biohybrid robot as an active bilayer matched experimental outcomes, showcase the robustness of our method of designing, fabricating, and testing planar biohybrid robots capable of complex multi-degree-of-freedom motion.
NXT2 is the key player for nuclear RNA export in the human testis and critical for spermatogenesis
Authors: Dicke Ann-Kristin , Ahmedani Ammar , Ma Lin , van der Heijden Godfried W. , Koser Sophie A. , Krallmann Claudia , Kalyon Oguzhan , Xavier Miguel J. , Veltman Joris A. , Kliesch Sabine , Neuhaus Nina , Kotaja Noora , Tüttelmann Frank , Stallmeyer Birgit 
Published: August 2024

AbstractIn eukaryotes, the nucleocytoplasmic export of bulk poly(A)+-mRNAs through the nuclear pore complex is mediated by the ubiquitously expressed NXT1-NXF1 heterodimer. In humans,NXT1has an X-chromosomal paralog,NXT2,which exhibits testis-enriched expression, suggesting a role in spermatogenesis. Here, we report thein vivointeraction of NXT2 with crucial components of the nuclear export machinery, including NXF1, the testis-specific NXF1 paralogs NXF2 and NXF3, and the nuclear pore complex proteins NUP93 and NUP214. Further, NXT2’s NTF2-like domain mediates binding to NXF2 and NXF3. By identifying infertile men with loss-of-function variants inNXT2andNXF3, we link the impaired NXT2-NXF activity to disturbed germ cell development. The predominant absence of germ cells in men with NXT2 deficiency indicates its critical function already during fetal or first steps of germ cell development. In contrast, loss of NXF3 affects later stages of spermatogenesis resulting in quantitatively and qualitatively impaired sperm production.
Microvascular Metrics on Diabetic Retinopathy: Insights from a Meta-Analysis of Diabetic Eye Images from Real-World Data
Authors: Cuscó Cristina , Esteve Pau , Almazán-Moga Ana , Fernández-Carneado Jimena , Ponsati Berta 
Published: August 2024

AbstractObjectiveTo quantify microvascular lesions in a large Real-World Data (RWD) set, based on single central retinal fundus images from different origins, with the aim of validating its use as a precision tool for classifying Diabetic Retinopathy (DR) severity.DesignRetrospective meta-analysis across multiple fundus image datasets.Sample sizeThe study analyzed 2,340 retinal fundus images from diabetic patients across four diverse RWD international datasets, including populations from Spain, India, China and the US.InterventionThe quantification of specific microvascular lesions: microaneurysms (MAs), hemorrhages (Hmas) and hard exudates (HEs) using advanced automated image analysis techniques on central retinal images to validate reliable metrics for DR severity assessment. The images were pre-classified in the DR severity levels as defined by the International Clinical Diabetic Retinopathy (ICDR) scale.Main Outcome MeasuresThe primary variables measured were the number of MAs, Hmas, red lesions (RLs) and HEs. These counts were related with DR severity levels using statistical methods to validate the relationship between lesion counts and disease severity.ResultsThe analysis revealed a robust and statistically significant increase (p<0.001) in the number of microvascular lesions and the DR severity across all datasets. Tight data distributions were reported for MAs, Hmas and RLs, supporting the reliability of lesion quantification for accurately assessing DR severity. HEs also followed a similar pattern, but with a broader dispersion of data. Data used in this study are consistent with the definition of the DR severity levels established by the ICDR guidelines.ConclusionsThe statistically significant increase in the number of microvascular lesions across DR severity validate the use of lesion quantification in a single central retinal field as a key biomarker for disease classification and assessment. This quantification method demonstrates an improvement over traditional assessment scales, providing a quantitative metric that enhances the precision of disease classification and patient monitoring. The inclusion of a numerical component allows for the detection of subtle variations within the same severity level, offering a deeper understanding of disease progression. The consistency of results across diverse datasets not only confirms the method’s reliability but also its applicability in a global healthcare setting.