bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated visceral manifestation of Buerger’s disease presenting as intestinal obstruction: a case report
Authors: Rana Ramesh , Bhattacharya Satyadeep , Bhattacharya Baishali , Ghimire Ram K. , Joshi Neeraj 
Published: June 2024

Introduction and importance:
Buerger’s disease is an uncommon segmental nonatherosclerotic vasculitis essentially affecting small to medium-sized arteries and veins of upper and lower extremities and can lead to limb amputation. Visceral vessel involvement is quite rare accounting for 2% of cases presenting with acute abdomen due to mesenteric ischemia. Moreover, isolated visceral involvement is even rare.

Case presentation:
A 42-year-old gentleman, a chronic smoker, presented with abdominal pain associated with nausea and vomiting and loose stool of 2 months duration. Magnetic resonance enterography revealed segmental circumferential wall thickening with stricture in the mid part of the jejunum with lymphadenopathy features of possible inflammatory bowel disease (Crohn’s disease). Furthermore, intraoperative surgical findings were also suggestive of Crohn’s disease. However, histologic findings were consistent with thromboangiitis obliterans.

Discussion:
Thromboangiitis obliterans can present with inflammatory vascular lesions without necrosis in the early stage to varying degrees of recanalisation, gangrene, and amputation in the late stage. It rarely involves the brain, heart, and abdominal viscera. The visceral involvement may be in the form of intestinal obstruction or mesenteric ischemia or can mimic Crohn’s in a background of smoking.

Conclusion:
This case report will help to learn more about the rarer intestinal presentation of intestinal Buerger’s disease. It can present with features of bowel ischemia, obstruction or Crohn’s. So, histology would play a pivotal role in differentiating the diagnostic dilemma.
Fentanyl Deaths in Infants and Children
Authors: Monday Katrina , Shattuck Brandy , Barba Kristie , Revercomb Carolyn H. 
Published: June 2024

Abstract
Death due to fentanyl and its various analogs has resulted in an exponential rise in deaths throughout the United States, overwhelming many medical examiner offices for over a decade. Its potency and prevalence have caused fentanyl to become the most reported substance in overdose fatalities, with an accompanying increase in exposure of the most vulnerable, infants and children. This report provides information about fentanyl in the pediatric population, including case examples, proposed investigative practices, published therapeutic and lethal blood concentrations, and available resources for future cases. Nine cases of pediatric death between 2013 and 2023 due to fentanyl were reviewed. Five case summaries are presented that highlight classic features of fentanyl deaths in infants, children, and teenagers. Deaths due to fentanyl have continued to rise year after year. Infants and children, most of whom are opioid naive, are at ever increased risk for exposure to high levels of fentanyl. The legal ramifications of a positive fentanyl level in a child increase the need for caution on the part of the forensic pathologist. Understanding what can and cannot be proven by autopsy as well as what resources are available to strengthen one's justification for fentanyl being the primary cause of death is critical.
Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019–2020*
Authors: Azamfirei Razvan , Behrens Deanna , Padilla Sofia , Madden Kate , Goldberg Sarah , Geno Megan , Manning Mary-Jeanne , Piole Michelle , Madsen Erik , Maue Danielle , Abu-Sultaneh Samer , Awojoodu Ronke , Wang Nae-Yuh , Needham Dale M. , Neufeld Karin , Kudchadkar Sapna R. 
Published: June 2024

OBJECTIVES:
To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices.

DESIGN:
A secondary analysis of 2019–2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168).

SETTING:
Six PICUs in the United States.

PATIENTS:
One thousand sixty-four patients who were admitted to a PICU for 3 or more days.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 1064 patients, 74% (95% CI, 71–76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1–3 days (aOR 3.36 [95% CI, 2.62–4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32–2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04–1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08–2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63–0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63–0.90]) or ketamine (aOR 0.48 [95% CI, 0.29–0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates.

CONCLUSIONS:
In the 2019–2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.
A predictive model for HIV-related lymphoma
Authors: Kurosawa Shuhei , Yoshimura Yukihiro , Takada Yusuke , Yokota Takako , Hibi Masaki , Hirahara Ayumi , Yoshida Tsutomu , Okubo So , Masuda Moe , So Yuna , Miyata Nobuyuki , Nakayama Hitomi , Sakurai Aki , Sato Kosuke , Ito Chisako , Aisa Yoshinobu , Nakazato Tomonori 
Published: June 2024

Objectives:
To address the paucity of HIV-related lymphoma (HRL)–specific prognostic scores for the Japanese population by analyzing domestic cases of HRL and constructing a predictive model.

Design:
A single-center retrospective study coupled with a review of case reports of HRL.

Methods:
We reviewed all patients with HRL treated at our hospital between 2007 and 2023 and conducted a comprehensive search for case reports of HRL from Japan using public databases. A multivariate analysis for overall survival (OS) was performed using clinical parameters, leading to the formulation of the HIV-Japanese Prognostic Index (HIV-JPI).

Results:
A total of 19 patients with HRL were identified in our institution, whereas the literature review yielded 44 cases. In the HIV-JPI, a weighted score of 1 was assigned to the following factors: age at least 45 years, HIV-RNA at least 8.0×104 copies/ml, Epstein–Barr virus-encoded small RNA positivity, and Ann Arbor classification stage IV. The overall score ranged from 0 to 4. We defined the low-risk group as scores ranging from 0 to 2 and the high-risk group as scores ranging from 3 to 4. The 3-year OS probability of the high-risk group [30.8%; 95% confidence interval (CI): 9.5–55.4%) was significantly poorer than that of the low-risk group (76.8%; 95% CI: 52.8–89.7%; P < 0.01).

Conclusion:
This retrospective analysis established pivotal prognostic factors for HRL in Japanese patients. The HIV-JPI, derived exclusively from Japanese patients, highlights the potential for stratified treatments and emphasizes the need for broader studies to further refine this clinical prediction model.
Predicting Reduction Mammaplasty Total Resection Weight With Machine Learning
Authors: Seu Michelle Y. , Rezania Nikki , Murray Carolyn E. , Qiao Mark T. , Arnold Sydney , Siotos Charalampos , Ferraro Jennifer , Jazayeri Hossein E. , Hood Keith , Shenaq Deana , Kokosis George 
Published: June 2024

Background
Machine learning (ML) is a form of artificial intelligence that has been used to create better predictive models in medicine. Using ML algorithms, we sought to create a predictive model for breast resection weight based on anthropometric measurements.

Methods
We analyzed 237 patients (474 individual breasts) who underwent reduction mammoplasty at our institution. Anthropometric variables included body surface area (BSA), body mass index, sternal notch–to–nipple (SN-N), and nipple–to–inframammary fold values. Four different ML algorithms (linear regression, ridge regression, support vector regression, and random forest regression) either including or excluding the Schnur Scale prediction for the same data were trained and tested on their ability to recognize the relationship between the anthropometric variables and total resection weights. Resection weight prediction accuracy for each model and the Schnur scale alone were evaluated based on using mean absolute error (MAE).

Results
In our cohort, mean age was 40.36 years. Most patients (71.61%) were African American. Mean BSA was 2.0 m2, mean body mass index was 33.045 kg/m2, mean SN-N was 35.0 cm, and mean nipple–to–inframammary fold was 16.0 cm. Mean SN-N was found to have the greatest variable importance. All 4 models made resection weight predictions with MAE lower than that of the Schnur Scale alone in both the training and testing datasets. Overall, the random forest regression model without Schnur scale weight had the lowest MAE at 186.20.

Conclusion
Our ML resection weight prediction model represents an accurate and promising alternative to the Schnur Scale in the setting of reduction mammaplasty consultations.
Effects of the March 2021 Allocation Policy Change on Key Deceased-donor Kidney Transplant Metrics
Authors: Cutrone Alissa M. , Rega Scott A. , Feurer Irene D. , Karp Seth J. 
Published: June 2024

Background.
A major change to deceased-donor kidney allocation in the United States, Kidney Allocation System 250 (KAS250), was implemented on March 15, 2021. Evaluating the consequences of this policy on critical system performance metrics is critical to determining its success.

Methods.
We performed a retrospective analysis of critical performance measures of the kidney transplant system by reviewing all organs procured during a 4-y period in the United States. To mitigate against possible effects of the COVID-19 pandemic, Scientific Registry of Transplant Recipients records were stratified into 2 pre- and 2 post-KAS250 eras: (1) 2019; (2) January 1, 2020–March14, 2021; (3) March 15, 2021–December 31, 2021; and (4) 2022. Between-era differences in rates of key metrics were analyzed using chi-square tests with pairwise z-tests. Multivariable logistic regression and analysis of variations methods were used to evaluate the effects of the policy on rural and urban centers.

Results.
Over the period examined, among kidneys recovered for transplant, nonuse increased from 19.7% to 26.4% (all between-era P < 0.05) and among all Kidney Donor Profile Index strata. Cold ischemia times increased (P < 0.001); however, the distance between donor and recipient hospitals decreased (P < 0.05). Kidneys from small-metropolitan or nonmetropolitan hospitals were more likely to not be used over all times (P < 0.05).

Conclusions.
Implementation of KAS250 was associated with increased nonuse rates across all Kidney Donor Profile Index strata, increased cold ischemic times, and shorter distance traveled.
Expanding Selection Criteria in Deceased Donor Liver Transplantation for Hepatocellular Carcinoma: Long-term Follow-up of a National Registry and 2 Transplant Centers
Authors: Wehrle Chase J. , Kusakabe Jiro , Akabane Miho , Maspero Marianna , Zervos Bobby , Modaresi Esfeh Jamak , Whitsett Linganna Maureen , Imaoka Yuki , Khalil Mazhar , Pita Alejandro , Kim Jaekeun , Diago-Uso Teresa , Fujiki Masato , Eghtesad Bijan , Quintini Cristiano , Kwon Choon David , Pinna Antonio , Aucejo Federico , Miller Charles , Mazzaferro Vincenzo , Schlegel Andrea , Sasaki Kazunari , Hashimoto Koji 
Published: June 2024

Background.
This study compares selection criteria for liver transplant (LT) for hepatocellular carcinoma (HCC) for inclusivity and predictive ability to identify the most permissive criteria that maintain patient outcomes.

Methods.
The Scientific Registry of Transplant Recipients (SRTR) database was queried for deceased donor LT’s for HCC (2003–2020) with 3-y follow-up; these data were compared with a 2-center experience. Milan, University of California, San Francisco (UCSF), 5-5-500, Up-to-seven (U7), HALT-HCC, and Metroticket 2.0 scores were calculated.

Results.
Nationally, 26 409 patients were included, and 547 at the 2 institutions. Median SRTR-follow-up was 6.8 y (interquartile range 3.9–10.1). Three criteria allowed the expansion of candidacy versus Milan: UCSF (7.7%, n = 1898), Metroticket 2.0 (4.2%, n = 1037), and U7 (3.5%, n = 828). The absolute difference in 3-y overall survival (OS) between scores was 1.5%. HALT-HCC (area under the curve [AUC] = 0.559, 0.551–0.567) best predicted 3-y OS although AUC was notably similar between criteria (0.506 < AUC < 0.527, Mila n = 0.513, UCSF = 0.506, 5-5-500 = 0.522, U7 = 0.511, HALT-HCC = 0.559, and Metroticket 2.0 = 0.520), as was Harrall’s c-statistic (0.507 < c-statistic < 0.532). All scores predicted survival to P < 0.001 on competing risk analysis. Median follow-up in our enterprise was 9.8 y (interquartile range 7.1–13.3). U7 (13.0%, n = 58), UCSF (11.1%, n = 50), HALT-HCC (6.4%, n = 29), and Metroticket 2.0 (6.3%, n = 28) allowed candidate expansion. HALT-HCC (AUC = 0.768, 0.713–0.823) and Metroticket 2.0 (AUC = 0.739, 0.677–0.801) were the most predictive of recurrence. All scores predicted recurrence and survival to P < 0.001 using competing risk analysis.

Conclusions.
Less restrictive criteria such as Metroticket 2.0, UCSF, or U7 allow broader application of transplants for HCC without sacrificing outcomes. Thus, the criteria for Model for End-stage Liver Disease-exception points for HCC should be expanded to allow more patients to receive life-saving transplantation.
Systematic search for new HLA alleles in 4195 human 30x WGS samples
Authors: Albert EA , Deviatkin AA , Smirnova DI , Woroncow M. , Zobkova G.Y , Smirnova A.V , Volchkov PY 
Published: June 2024

AbstractHLA (Human Leukocyte Antigens) is a highly polymorphic locus in the human genome which also has a high clinical significance. New alleles of HLA genes are constantly being discovered but mostly through the efforts of laboratories which primarily focus on HLA typing and are using field-specific experimental and data processing techniques, like enrichment of HLA region in high-throughput sequencing data. Nevertheless, a vast amount of whole genome sequencing (WGS) data was accumulated over the past years and continues to expand rapidly. Therefore it is an appealing possibility to identify new HLA alleles and refine the information on known alleles from already available WGS data. Currently there are many tools designed for HLA typing, e.g. assigning known alleles, from non HLA enriched WGS data, but none of them specifically tailored towards identification and immediate thorough description of new HLA alleles. Here we are presenting a pipeline HLAchecker, which is specifically designed to identify potentially new HLA alleles based on discrepancies between predicted HLA types, made by any other dedicated tool, and underlying raw 30x WGS data. HLAchecker reports structured in a way which simplifies further validation of potentially new HLA alleles and streamlines submission of alleles to appropriate databases. We validated this tool on 4195 30x WGS samples typed by HLA-HD, discovered 17 potentially new HLA alleles with substitutions in exonic regions and validated five randomly chosen alleles by Sanger sequencing.
Respiratory mucosal administration of DNA aptamer nanomaterials protects against antigenically diverse SARS-CoV-2 variants
Authors: D’Agostino Michael R. , Li Jiuxing , Zhang Zijie , Gu Jimmy , Marzok Art , Ang Jann , Bujold Katherine E. , Afkhami Sam , Xia Xiaohu , Li Yingfu , Miller Matthew S. 
Published: June 2024

AbstractThe ongoing COVID-19 pandemic has highlighted the need for innovative therapeutic strategies to combat rapidly evolving pathogens that challenge the efficacy of traditional vaccines and monoclonal antibody treatments. Here, we explored the potential of TMSA52, a previously described homotrimeric DNA aptamer as a universal prophylactic and therapeutic agent against SARS-CoV-2. TMSA52 demonstrates exceptional binding affinities and broad neutralization against diverse SARS-CoV-2 variant spike proteins that are further enhanced through multimerization onto lamellar iridium nanoplates. Respiratory mucosal delivery of TMSA52 nanomaterials was well-tolerated. Surprisingly, TMSA52 offered potent protection from infection with ancestral SARS-CoV-2 on-par with monoclonal antibodies, and superior protection against antigenically distant SARS-CoV-2 variants. These findings establish DNA aptamers as a promising, cost-effective, and scalable alternative to traditional monoclonal antibody therapies. This study underscores the potential of aptamer-based platforms as a next-generation strategy to enhance global pandemic preparedness and expand our arsenal of infectious disease countermeasures.
Three families of CD4-induced antibodies are associated with the capacity of plasma from people living with HIV to mediate ADCC in presence of CD4-mimetics
Authors: Tauzin Alexandra , Marchitto Lorie , Bélanger Étienne , Benlarbi Mehdi , Beaudoin-Bussières Guillaume , Prévost Jérémie , Yang Derek , Chiu Ta-Jung , Chen Hung-Ching , Bourassa Catherine , Medjahed Halima , Korzeniowski Marek K , Gottumukkala Suneetha , Tolbert William D. , Richard Jonathan , Smith Amos B , Pazgier Marzena , Finzi Andrés 
Published: June 2024

ABSTRACTCD4-mimetics (CD4mcs) are small molecule compounds that mimic the interaction of the CD4 receptor with HIV-1 envelope glycoproteins (Env). Env from primary viruses normally samples a “closed” conformation which occludes epitopes recognized by CD4-induced (CD4i) non-neutralizing antibodies (nnAbs). CD4mcs induce conformational changes on Env resulting in the exposure of these otherwise inaccessible epitopes. Here we evaluated the capacity of plasma from a cohort of 50 people living with HIV to recognize HIV-1-infected cells and eliminate them by antibody-dependent cellular cytotoxicity (ADCC) in the presence of a potent indoline CD4mc. We observed a marked heterogeneity among plasma samples. By measuring the levels of different families of CD4i Abs, we found that the levels of anti-cluster A, anti-coreceptor binding site and anti-gp41 cluster I antibodies are responsible for plasma-mediated ADCC in presence of CD4mc.IMPORTANCEThere are several reasons that make it difficult to target the HIV reservoir. One of them, is the capacity of infected cells to prevent the recognition of HIV-1 envelope glycoproteins (Env) by commonly-elicited antibodies in people living with HIV. Small CD4-mimetic compounds expose otherwise occluded Env epitopes, thus enabling their recognition by non-neutralizing antibodies. A better understanding of the contribution of these antibodies to eliminate infected cells in presence of CD4mc could lead to the development of therapeutic cure strategies.
Hepatic Macrophage Migration Inhibitory Factor Promotes Pancreatic Cancer Liver Metastasis in NAFLD
Authors: Yu Qian , Song Hui , Zhu Liang , Shi Xiao-ya , Wang Hai-zhen , Wang Ying-luo , Gong Rui-ning , Cui Jiu-fa , Yang Xiao-nan , Wang Ji-gang , Liang Yu , Chen Ying , Dong Xiao-wu , Lu Guo-tao , Li Chang , Zhang Huan , Tian Yan-tao , Hu Hai-tao , Shao Xin-xin , Hu Ya-bin , Saluja Ashok K. , Li Yue , Mo Ming-guang , Ren He 
Published: June 2024

AbstractHow pathological livers shape tumors, thereby driving pancreatic ductal adenocarcinoma (PDAC) metastasis to the liver, is poorly understood. In the present study, we focus on examining key molecules implicated in this process and assessing their translational significance. We demonstrated that patients with combined non-alcoholic fatty liver disease (NAFLD) have approximately a ninefold increased risk of developing liver metastasis compared to those without NAFLD. In mice model, NAFLD fosters an immunosuppressive microenvironment with increased tumor cell pluripotency and focal adhesion. Mechanistically, NAFLD-induced MIF mediated the progression of PDAC liver metastasis by attracting CD44 positive pancreatic cells. Hepatic MIF knockdown significantly reduced metastases burden with decreased stem-like cancer cells, tumor associated macrophages (TAMs) infiltration and focal adhesion. Targeting the MIF-CD44 axis by either a MIF tautomerase inhibitor, IPG1576, or by CD44 knockdown in tumor cells significantly attenuate liver metastasis of PDAC within the NAFLD context. Patients with PDAC liver metastasis and NAFLD had elevated hepatic MIF expression and increased number of stem-cell like cancer cells. Collectively, our study highlights a pivotal role for MIF-CD44 axis in cancer stemness and offer novel avenues for tailoring therapeutic strategies to individual patients with NAFLD as an underlying condition.
Unraveling Alzheimer’s Disease: Investigating Dynamic Functional Connectivity in the Default Mode Network through DCC-GARCH Modeling
Authors: Yue Kun , Webster Jason , Grabowski Thomas , Jahanian Hesamoddin , Shojaie Ali 
Published: June 2024

AbstractAlzheimer’s disease (AD) has a prolonged latent phase. Sensitive biomarkers of amyloid beta (Aβ), in the absence of clinical symptoms, offer opportunities for early detection and identification of patients at risk. CurrentAβbiomarkers, such as CSF and PET biomarkers, are effective but face practical limitations due to high cost and limited availability. Recent blood plasma biomarkers, though accessible, still incur high costs and lack physiological significance in the Alzheimer’s process. This study explores the potential of brain functional connectivity (FC) alterations associated with AD pathology as a non-invasive avenue forAβdetection. While current stationary FC measurements lack sensitivity at the single-subject level, our investigation focuses on dynamic FC using resting-state functional MRI (rs-fMRI) and introduces the Generalized Auto-Regressive Conditional Heteroscedastic Dynamic Conditional Correlation (DCC-GARCH) model. Our findings demonstrate the superior sensitivity of DCC-GARCH to CSFAβstatus, and offer key insights into dynamic functional connectivity analysis in AD.
Assessment of Ontario-purchased commercially available milk products for the presence of influenza A viral RNA
Authors: Blais-Savoie Juliette , Yim Winfield , Kotwa Jonathon D. , Yip Lily , Kozak Robert , McGeer Allison , Mubareka Samira 
Published: June 2024

AbstractGiven the widespread presence of influenza A(H5N1) viral RNA in pasteurized milk in the United States, we tested 117 samples of pasteurized cow’s milk purchased from retail outlets in Ontario, Canada in April 2024 for the presence of influenza A viral RNA. No influenza A viral RNA was detected.