bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distinguishing thymic cysts from low-risk thymomas via [18F]FDG PET/CT
Authors: Choi Sunju , Kim Yong-il , Han Sangwon , Yun Jae Kwang , Lee Geun Dong , Choi Sehoon , Kim Hyeong Ryul , Kim Yong-Hee , Kim Dong Kwan , Park Seung-Il , Ryu Jin-Sook 
Published: May 2024

Abstract
Background
Thymic cysts are a rare benign disease that needs to be distinguished from low-risk thymoma. [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a non-invasive imaging technique used in the differential diagnosis of thymic epithelial tumours, but its usefulness for thymic cysts remains unclear. Our study evaluated the utility of visual findings and quantitative parameters of [18F]FDG PET/CT for differentiating between thymic cysts and low-risk thymomas.

Methods
Patients who underwent preoperative [18F]FDG PET/CT followed by thymectomy for a thymic mass were retrospectively analyzed. The visual [18F]FDG PET/CT findings evaluated were PET visual grade, PET central metabolic defect, and CT shape. The quantitative [18F]FDG PET/CT parameters evaluated were PET maximum standardized uptake value (SUVmax), CT diameter (cm), and CT attenuation in Hounsfield units (HU). Findings and parameters for differentiating thymic cysts from low-risk thymomas were assessed using Pearson’s chi-square test, the Mann-Whitney U-test, and receiver operating characteristics (ROC) curve analysis.

Results
Seventy patients (18 thymic cysts and 52 low-risk thymomas) were finally included. Visual findings of PET visual grade (P < 0.001) and PET central metabolic defect (P < 0.001) showed significant differences between thymic cysts and low-risk thymomas, but CT shape did not. Among the quantitative parameters, PET SUVmax (P < 0.001), CT diameter (P < 0.001), and CT HU (P = 0.004) showed significant differences. In ROC analysis, PET SUVmax demonstrated the highest area under the curve (AUC) of 0.996 (P < 0.001), with a cut-off of equal to or less than 2.1 having a sensitivity of 100.0% and specificity of 94.2%. The AUC of PET SUVmax was significantly larger than that of CT diameter (P = 0.009) and CT HU (P = 0.004).

Conclusions
Among the [18F]FDG PET/CT parameters examined, low FDG uptake (SUVmax ≤ 2.1, equal to or less than the mediastinum) is a strong diagnostic marker for a thymic cyst. PET visual grade and central metabolic defect are easily accessible findings.
Exploring the nexus between fatigue, body composition, and muscle strength in hemodialysis patients
Authors: Shi Rui , Zhu Jia-xin , Zhu Li , Zhao Wen-man , Li Huai , Chen Qi-chun , Pan Hai-feng , Wang De-guang 
Published: May 2024

Abstract
Background
Fatigue is a relatively prevalent condition among hemodialysis patients, resulting in diminished health-related quality of life and decreased survival rates. The purpose of this study was to investigate the relationship between fatigue and body composition in hemodialysis patients.

Methods
This cross-sectional study included 92 patients in total. Fatigue was measured by Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) (cut-off ≤ 34). Body composition was measured based on quantitative computed tomography (QCT), parameters including skeletal muscle index (SMI), intermuscular adipose tissue (IMAT), and bone mineral density (BMD). Handgrip strength was also collected. To explore the relationship between fatigue and body composition parameters, we conducted correlation analyses and binary logistic regression.

Results
The prevalence of fatigue was 37% (n = 34), abnormal bone density was 43.4% (n = 40). There was a positive correlation between handgrip strength and FACIT-F score (r = 0.448, p < 0.001). Age (r = − 0.411, p < 0.001), IMAT % (r = − 0.424, p < 0.001), negatively associated with FACIT-F score. Multivariate logistic regression analysis shows that older age, lower serum phosphorus, higher IMAT% are associated with a high risk of fatigue.

Conclusion
The significantly increased incidence and degree of fatigue in hemodialysis patients is associated with more intermuscular adipose tissue in paraspinal muscle.
Tensile strength of adhesives in peripheral nerve anastomoses: an in vitro biomechanical evaluation of four different neurorrhaphies
Authors: Heitzer Marius , Kilic Konrad , Merfort Ricarda , Winnand Philipp , Emonts Caroline , Bock Anna , Ooms Mark , Steiner Timm , Hölzle Frank , Modabber Ali 
Published: May 2024

Abstract
Background
The fundamental prerequisite for prognostically favorable postoperative results of peripheral nerve repair is stable neurorrhaphy without interruption and gap formation.

Methods
This study evaluates 60 neurorrhaphies on femoral chicken nerves in terms of the procedure and the biomechanical properties. Sutured neurorrhaphies (n = 15) served as control and three sutureless adhesive-based nerve repair techniques: Fibrin glue (n = 15), Histoacryl glue (n = 15), and the novel polyurethane adhesive VIVO (n = 15). Tensile and elongation tests of neurorrhaphies were performed on a tensile testing machine at a displacement rate of 20 mm/min until failure. The maximum tensile force and elongation were recorded.

Results
All adhesive-based neurorrhaphies were significant faster in preparation compared to sutured anastomoses (p < 0.001). Neurorrhaphies by sutured (102.8 [cN]; p < 0.001), Histoacryl (91.5 [cN]; p < 0.001) and VIVO (45.47 [cN]; p < 0.05) withstood significant higher longitudinal tensile forces compared to fibrin glue (10.55 [cN]). VIVO, with △L/L0 of 6.96 [%], showed significantly higher elongation (p < 0.001) compared to neurorrhaphy using fibrin glue.

Conclusion
Within the limitations of an in vitro study the adhesive-based neurorrhaphy technique with VIVO and Histoacryl have the biomechanical potential to offer alternatives to sutured neuroanastomosis because of their stability, and faster handling. Further in vivo studies are required to evaluate functional outcomes and confirm safety.
Digital financial inclusion, international remittances, and poverty reduction
Authors: Inoue Takeshi 
Published: May 2024

AbstractEnsuring access to and usage of formal financial services through digital devices can be referred to as “digital financial inclusion” (DFI). In recent years, there has been a growing trend in the use of financial services, including money transfers through mobile phones. This study applies mobile phone subscriptions as a proxy to measure the degree of DFI and explores the individual effects of DFI and remittances and their interaction effects on poverty conditions in developing countries. Using panel data from 2000 to 2020 for 123 countries and employing the dynamic generalized method of moments estimation, the results reveal that DFI and remittance inflows help ameliorate poverty in developing countries. Furthermore, we find that the coefficient of the interaction term between DFI and remittances is statistically significant and positive, suggesting that the impact of DFI on poverty alleviation could weaken as remittance inflows increase in the remittance-receiving country and vice versa.
Evaluating habitat-specific interference in automated radio telemetry systems: implications for animal movement studies
Authors: Tran Vinh T. , Vitz Andrew C. , Bakermans Marja H. 
Published: May 2024

AbstractAutomated radio telemetry systems have become a popular and invaluable tool in tracking the activity and movement of wild animals. However, many environmental conditions can hinder accuracy when tracking with this technology. For instance, study sites may contain multiple habitat types, each habitat uniquely affecting the signal strength received from tagged species. To investigate the influence of a structurally diverse study site on an automated radio telemetry system, we conducted this project at a restored and managed pine barren habitat that consisted of a mix of mature pitch pine, treated pitch pine, scrub oak, and hardwood forests. This site, Montague Plains Wildlife Management Area, Montague, Massachusetts, is also a known breeding ground for Eastern whip-poor-will (Antrostomus vociferus). To measure the relationship of radio signal strength with distance across each habitat, we used radio telemetry equipment manufactured by Cellular Tracking Technologies. We produced negative exponential decay functions measuring radio signal strength over distance and tested for differences among habitat types on radio signal strength (RSS). We found that decay function parameters significantly differed by habitat type, prompting us to investigate if accounting for these differences improved location estimate accuracy. To test this, we estimated known locations using trilateration methods with and without habitat calibration. Comparing these tests indicates that habitat-specific adjustments significantly improved location accuracy. Lastly, we visualized estimated RSS-based locations of 1 week of whip-poor-will data and compared them to GPS data generated from the same individual. Previous studies have accounted for types of environmental interference (like elevation) in the field but have avoided incorporating habitat-specific factors by working with node networks covering a relatively small area, but in this study, we examined the potential to scale up for larger areas and in more complex habitats.
Severe hypoglycemia with reduced liver volume as an indicator of end-stage malnutrition in patients with anorexia nervosa: a retrospective observational study
Authors: Matsunaga Hidenori , Riku Keisen , Shimizu Kentaro , Fujimi Satoshi 
Published: May 2024

Abstract
Background
Hypophosphatemia due to excessive carbohydrate administration is considered the primary pathogenesis of refeeding syndrome. However, its association with liver injury and hypoglycemia, often seen in severe malnutrition before re-nutrition, remains unclear. Autophagy reportedly occurs in the liver of patients with severe malnutrition. This study aimed to clarify the pathophysiology of liver injury and hypoglycemia by focusing on liver volume.

Methods
Forty-eight patients with anorexia nervosa with a body mass index (BMI) of < 13 kg/m2 were included (median BMI: 10.51 kg/m2 on admission). Liver volume was measured in 36 patients who underwent abdominal computed tomography (CT), and the “estimated liver weight/ideal body weight” was used as the liver volume index. Seventeen blood test items were analyzed during the first 60 days.

Results
Liver volume significantly decreased when abdominal CTs were conducted shortly before or after hypoglycemia compared to when the scans were performed during periods without hypoglycemia. Five patients with severe hypoglycemia on days 13–18 after admission had a very low nutritional intake; of them, four showed a marked decrease in liver volume. Severe hypoglycemia was accompanied by low serum triglycerides and liver dysfunction. Patients experiencing hypoglycemia of blood glucose levels < 55 mg/dL (< 3.05 mmol/L) (32 patients; median lowest BMI: 9.45 kg/m2) exhibited significantly poorer blood findings for most of the 17 items, except serum phosphorus and potassium, than did those not experiencing hypoglycemia (16 patients; median lowest BMI: 11.2 kg/m2). All patients with a poor prognosis belonged to the hypoglycemia group. Empirically, initiating re-nutrition at 500 kcal/day (20–25 kcal/kg/day), increasing to 700–800 kcal/day after a week, and then gradually escalating can reduce serious complications following severe hypoglycemia.

Conclusions
Liver volume reduction accompanied by hypoglycemia, low serum triglyceride levels, and liver dysfunction occurs when the body's stored energy sources are depleted and external nutritional intake is inadequate, suggesting that the liver was consumed as a last resort to obtain energy essential for daily survival. This pathophysiology, distinct from refeeding syndrome, indicates the terminal stage of malnutrition and is a risk factor for complications and poor prognosis. In treatment, extremely low nutrient levels should be avoided.
Phenomic landscape and pharmacogenomic implications for HLA region in a Taiwan Han Chinese population
Authors: Chou Wan-Hsuan , Chen Lu-Chun , Wong Henry Sung-Ching , Chao Ching-Hsuan , Chu Hou-Wei , Chang Wei-Chiao 
Published: May 2024

Abstract
Background
The human leukocyte antigen (HLA) genes, exhibiting significant genetic diversity, are associated with susceptibility to various clinical diseases and diverse in drug responses. High costs of HLA sequencing and the population-specific architecture of this genetic region necessitate the establishment of a population-specific HLA imputation reference panel. Moreover, there is a lack of understanding about the genetic and phenotypic landscape of HLA variations within the Taiwanese population.

Methods
We created models for a Taiwanese-specific HLA imputation reference panel. These models were trained with the array genotype data and HLA sequencing data from 845 Taiwanese subjects. HLA imputation was applied for 59,448 Taiwanese subjects to characterize the HLA allele and haplotype frequencies. Additionally, a phenome-wide association study (PheWAS) was conducted to identify the phenotypes associated with HLA variations. The association of the biallelic HLA variants with the binary and quantitative traits were evaluated with additive logistic and linear regression models, respectively. Furthermore, an omnibus test with likelihood-ratio test was applied for each HLA amino acid position in the multiallelic HLA amino acid polymorphisms to compare the difference between a fitted model and a null model following a χ2 distribution of n-1 degree of freedom at a position with n residues. Finally, we estimated the prevalence of adverse drug reactions (ADR)-related HLA alleles in the Taiwanese population.

Results
In this study, the reference panel models displayed remarkable accuracy, with averages of 99.3%, 98.9%, and 99.1% for 2-, 4-, 6-digit alleles of the eight classical HLA genes, respectively. For PheWAS, a total of 18,136 significant associations with HLA variants across 26 phenotypes are identified (p < 5×10-8), highlighting the pleiotropy feature of the HLA region. Among the independent signals, 15 are novel, including the association of HLA-B pos 138 variation with ankylosing spondylitis (AS), and rs9266290 and rs9266292 with allergy. Through an analysis spanning the entire HLA region, we identified clusters of phenotype correlations. Finally, the carriers of pharmacogenomic related HLA alleles, including HLA-C*01:02 (35.86%), HLA-B*58:01 (20.9%), and HLA-B*15:02 (8.38%), were characterized in the Taiwanese general population.

Conclusions
We successfully delivered the HLA imputation for 59,448 Taiwanese subjects and characterized the genetic and phenotypic landscapes of the HLA variations. In addition, we quantified the estimated prevalence of the ADR-related HLA alleles in the Taiwanese population. The developed HLA imputation reference panel could be used for estimation of population HLA allele frequencies, which can facilitate further studies in the role of HLA variants in a wider range of phenotypes in the population.
Neuropathological assessment of the olfactory bulb and tract in individuals with COVID-19
Authors: Lengacher Nathalie A. , Tomlinson Julianna J. , Jochum Ann-Kristin , Franz Jonas , Hasan Ali Omar , Flatz Lukas , Jochum Wolfram , Penninger Josef ,   aSCENT-PD Investigators, Arenkiel Benjamin , Liu Zhandong , Mollenhauer Brit , Penninger Josef , Rousseaux Maxime , Saghatelyan Armen , Salmaso Natalina , Stadelmann Christine , Schlossmacher Michael G. , Tomlinson Julianna J. , Woulfe John M. , Stadelmann Christine , Woulfe John M. , Schlossmacher Michael G. 
Published: May 2024

AbstractThe majority of patients with Parkinson disease (PD) experience a loss in their sense of smell and accumulate insoluble α-synuclein aggregates in their olfactory bulbs (OB). Subjects affected by a SARS-CoV-2-linked illness (COVID-19) also frequently experience hyposmia. We previously postulated that microglial activation as well as α-synuclein and tau misprocessing can occur during host responses following microbial encounters. Using semiquantitative measurements of immunohistochemical signals, we examined OB and olfactory tract specimens collected serially at autopsies between 2020 and 2023. Deceased subjects comprised 50 adults, which included COVID19 + patients (n = 22), individuals with Lewy body disease (e.g., PD; dementia with Lewy bodies (n = 6)), Alzheimer disease (AD; n = 3), and other neurodegenerative disorders (e.g., progressive supranuclear palsy (n = 2); multisystem atrophy (n = 1)). Further, we included neurologically healthy controls (n = 9), and added subjects with an inflammation-rich brain disorder as neurological controls (NCO; n = 7). When probing for microglial and histiocytic reactivity in the anterior olfactory nuclei (AON) by anti-CD68 immunostaining, scores were consistently elevated in NCO and AD cases. In contrast, microglial signals on average were not significantly altered in COVID19 + patients relative to healthy controls, although anti-CD68 reactivity in their OB and tracts declined with progression in age. Mild-to-moderate increases in phospho-α-synuclein and phospho-tau signals were detected in the AON of tauopathy- and synucleinopathy-afflicted brains, respectively, consistent with mixed pathology, as described by others. Lastly, when both sides were available for comparison in our case series, we saw no asymmetry in the degree of pathology of the left versus right OB and tracts. We concluded from our autopsy series that after a fatal course of COVID-19, microscopic changes in the rostral, intracranial portion of the olfactory circuitry -when present- reflected neurodegenerative processes seen elsewhere in the brain. In general, microglial reactivity correlated best with the degree of Alzheimer’s-linked tauopathy and declined with progression of age in COVID19 + patients.
An evaluation of the adequacy of Lévy and extreme value tail risk estimates
Authors: Mozumder Sharif , Hassan M. Kabir , Kabir M. Humayun 
Published: May 2024

AbstractThis study investigates the simplicity and adequacy of tail-based risk measures—value-at-risk (VaR) and expected shortfall (ES)—when applied to tail targeting of the extreme value (EV) model. We implement Lévy–VaR and ES risk measures as full density-based alternatives to the generalized Pareto VaR and the generalized Pareto ES of the tail-targeting EV model. Using data on futures contracts of S&P500, FTSE100, DAX, Hang Seng, and Nikkei 225 during the Global Financial Crisis of 2007–2008, we find that the simplicity of tail-based risk management with a tail-targeting EV model is more attractive. However, the performance of EV risk estimates is not necessarily superior to that of full density-based relatively complex Lévy risk estimates, which may not always give us more robust VaR and ES results, making the model inadequate from a practical perspective. There is randomness in the estimation performances under both approaches for different data ranges and coverage levels. Such mixed results imply that banks, financial institutions, and policymakers should find a way to compromise or trade-off between “simplicity” and user-defined “adequacy”.
Learning and Balancing Unknown Loads in Large-Scale Systems
Authors: Goldsztajn Diego , Borst Sem C. , van Leeuwaarden Johan S. H. 
Published: May 2024

Consider a system of identical server pools where tasks with exponentially distributed service times arrive as a time-inhomogeneous Poisson process. An admission threshold is used in an inner control loop to assign incoming tasks to server pools, while in an outer control loop, a learning scheme adjusts this threshold over time to keep it aligned with the unknown offered load of the system. In a many-server regime, we prove that the learning scheme reaches an equilibrium along intervals of time when the normalized offered load per server pool is suitably bounded and that this results in a balanced distribution of the load. Furthermore, we establish a similar result when tasks with Coxian distributed service times arrive at a constant rate and the threshold is adjusted using only the total number of tasks in the system. The novel proof technique developed in this paper, which differs from a traditional fluid limit analysis, allows us to handle rapid variations of the first learning scheme, triggered by excursions of the occupancy process that have vanishing size. Moreover, our approach allows us to characterize the asymptotic behavior of the system with Coxian distributed service times without relying on a fluid limit of a detailed state descriptor. Funding: The work in this paper was supported by the Nederlandse Organisatie voor Wetenschappelijk Onderzoek [Gravitation Grant NETWORKS-024.002.003 and Vici Grant 202.068].
Introducing an ultrasound-guided longer length peripheral IV catheter for patients with difficult venous access
Authors: Godfrey Julie , Gallipoli Luigi 
Published: May 2024

Aim: Insertion of a peripheral intravenous catheter (PIVC) is one of the most common procedures carried out in hospitals worldwide, but failure rates are unacceptably high. This local quality improvement project aimed to assess improvements in first-stick success rate, dwell time and overall catheter success rate when implementing a longer-length peripheral intravenous catheter (LPIVC) under ultrasound guidance for patients with difficult venous access (DVA). Methods: Data were collected from 386 DVA patients requiring a PIVC at one hospital. Number of catheter insertion attempts, catheter dwell time and reason for catheter removal were recorded for each patient. To implement the new DVA catheterisation pathway, registered nurses undertook a training programme comprising workshops and ultrasound-guided cannulation technique practice on phantoms. Costs and waste weights associated with LPIVC insertion, compared with midline insertion, were calculated. Results: First-stick success rate was 95.0% using the LPIVC under ultrasound guidance. Dwell time ranged from 1 to 80 days, with a large proportion of those dwelling <1 day being placed in day-case patients. Treatment success rate with the LPIVCs was 83.6%. Equipment costs for an LPIVC insertion were £89.22 lower than for a midline insertion, and the weight of waste generated per procedure was 1 kg lower for LPIVCs. Conclusions: First-stick success rate of LPIVCs, aided by improved purchase in the vein and visualisation with ultrasound guidance, was very high, superior to rates reported in other studies. The procedure provides a better patient experience as successful first attempts avoid unnecessary further insertion attempts. Other benefits are increased nursing time efficiency, a reduction in clinical waste and the lower cost of the equipment required.