bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Bacteremia and Serious Bacterial Infections in Hyperpyrexic Infants Offered Universal Pneumococcal Conjugate Vaccine 13 and Haemophilus influenzae B Immunization
Authors: Be'er Moria , Rimon Ayelet , Segev Or , Huber Adi , Scolnik Dennis , Glatstein Miguel 
Published: May 2024

Background
High fevers, especially in young children, often alarm clinicians and prompt extensive evaluation based on perceptions of increased risk of serious bacterial infection (SBI), and even brain damage or seizure disorders.

Objective
The aim of this study was to determine the prevalence of SBI in infants aged 3–36 months with fever ≥40.5°C in a population of infants offered universal pneumococcal conjugate vaccine 13 and Haemophilus influenzae B immunization.

Methods
This study is a retrospective review of all infants aged 3–36 months with temperature ≥40.5°C presenting to a tertiary care pediatric emergency department over a 30-month period in an era of universal pneumococcal conjugate 13 and H. influenzae B immunization.

Results
SBI was recorded in 54 (21.8%) of 247 study infants, most commonly pneumonia 30 patients (12.1%) and urinary tract infection 16 patients (6.5%). Two patients had positive blood cultures, yielding a bacteremia rate of 0.8%. Patients with SBI had a significantly higher WBC count (P < 0.0001) and C-reactive protein levels (P < 0.0001), and were significantly more likely to be hospitalized (P < 0.0001).

Discussion
Although SBI was common (21.8%) in our cohort of hyperpyrexic infants universally offered vaccination with pneumococcal conjugate 13 and H. influenzae B vaccines, bacteremia was a rare finding (0.8%).
Whole Spinal Cord FDG Uptake at PET/CT Caused by H3K27-Altered Diffuse Midline Glioma in an Adult Patient
Authors: Morin Léo , Godard François , Aubriot-Lorton Marie-Hélène , Drouet Clément 
Published: May 2024

Abstract
Diffuse midline glioma, H3K27-altered, is a relatively new entity, characterized by H3K27M histone mutation. This rare pediatric disease with severe prognosis has recently been identified as a new subtype of diffuse astrocytoma due to major breakthrough in histopathological and molecular characterization of gliomas. We report a case of H3K27-altered diffuse midline glioma in a 30-year-old woman.
Research Advances in Vascular Remodeling in Choke Vessels of Perforator Flap
Authors: Ji Jiahao , Chen Dondli , Ni Jiamin , Chang Fei 
Published: May 2024

Background
As a significant bridge between perforasomes, choke vessels are the key structure of blood supply expansion, also a prerequisite for preventing distal ischemic necrosis of the multiterritory perforator flap, where the remodeling of choke vessels after flap elevation plays an essential role. This systematic review highlights the underlying mechanisms and clinical ways to promote remodeling of choke vessels, as well as experimental observation approaches to further guide researchers.

Methods
A systematic review was conducted from 1975 to 2023 through PubMed, EMBASE, Web of Science, and Cochrane database with the key words “choke vessels” and “perforator flap” to investigate the mechanisms and ways to promote remodeling of choke vessels as well as observation approaches. The inclusion criteria and exclusion criteria were set to screen the literature.

Results
A total of 94 literatures were obtained through database retrieval. After removing the duplicate literature, reading the title and abstract, and reviewing the full text finally, 33 articles were included in the final study.

Conclusions
The underlying remodeling of choke vessels may be related to fluid shear stress, hypoxia, and inflammation. The clinical ways to promote remodeling of choke vessels include surgical delay, arterial supercharge, venous superdrainage, drugs, and stem cells. Various experimental methods of observing microvascular morphology allow for a comprehensive research of choke vessels.
The difficult airway in trauma: What you need to know
Authors: Eugene Vadine , Hutzler Jason , Kempema James , Bradford James , Brown Carlos V.R. 
Published: May 2024

ABSTRACT
Airway evaluation and management are generally the first priority for treatment of trauma patients from the prehospital setting throughout their hospital stay. Delay in recognition of an airway problem, or inability to oxygenate or ventilate because of an inadequate airway, will lead to rapid death. Therefore, all clinicians involved in the care of trauma patients should have adequate knowledge of current best practices for airway evaluation and management. In addition, trauma providers should develop and maintain the skills needed to perform various airway maneuvers to establish and maintain an adequate airway. While elective airway management has the luxury of time for thorough airway evaluation, the airway management in the trauma setting does not allow this same opportunity. For this reason, all trauma airways should be presumed to be a difficult airway, and teams should prepare accordingly. This review will summarize the best practices for airway evaluation and management for trauma patients from the prehospital setting through the emergency department.
Isavuconazole Versus Voriconazole as the First-line Therapy for Solid Organ Transplant Recipients With Invasive Aspergillosis: Comparative Analysis of 2 Multicenter Cohort Studies
Authors: Fernández-Ruiz Mario , Gioia Francesca , Bodro Marta , Gutiérrez Martín Isabel , Sabé Núria , Rodriguez-Álvarez Regino , Corbella Laura , López-Viñau Teresa , Valerio Maricela , Illaro Aitziber , Salto-Alejandre Sonsoles , Cordero Elisa , Arnaiz de Las Revillas Francisco , Fariñas María Carmen , Muñoz Patricia , Vidal Elisa , Carratalà Jordi , Goikoetxea Josune , Ramos-Martínez Antonio , Moreno Asunción , Martín-Dávila Pilar , Fortún Jesús , Aguado José María ,   For the SOTIS and DiasperSOT Study Groups
Published: May 2024

Background.
Isavuconazole (ISA) and voriconazole (VORI) are recommended as the first-line treatment for invasive aspergillosis (IA). Despite theoretical advantages of ISA, both triazole agents have not been compared in solid organ transplant recipients.

Methods.
We performed a post hoc analysis of 2 retrospective multicenter cohorts of solid organ transplant recipients with invasive fungal disease (the SOTIS [Solid Organ Transplantation and ISavuconazole] and DiasperSOT [DIagnosis of ASPERgillosis in Solid Organ Transplantation] studies). We selected adult patients with proven/probable IA that were treated for ≥48 h with ISA (n = 57) or VORI (n = 77) as first-line therapy, either in monotherapy or combination regimen. The primary outcome was the rate of clinical response at 12 wk from the initiation of therapy. Secondary outcomes comprised 12-wk all-cause and IA-attributable mortality and the rates of treatment-emergent adverse events and premature treatment discontinuation.

Results.
Both groups were comparable in their demographics and major clinical and treatment-related variables. There were no differences in the rate of 12-wk clinical response between the ISA and VORI groups (59.6% versus 59.7%, respectively; odds ratio [OR], 0.99; 95% confidence interval [CI], 0.49-2.00). This result was confirmed after propensity score adjustment (OR, 0.81; 95% CI, 0.32-2.05) and matching (OR, 0.79; 95% CI, 0.31-2.04). All-cause and IA-attributable mortality were also similar. Patients in the ISA group were less likely to experience treatment-emergent adverse events (17.5% versus 37.7%; P = 0.011) and premature treatment discontinuation (8.8% versus 23.4%; P = 0.027).

Conclusions.
Front-line treatment with ISA for posttransplant IA led to similar clinical outcomes than VORI, with better tolerability and higher treatment completion.
Neuroinflammation in amyotrophic lateral sclerosis: pathogenic insights and therapeutic implications
Authors: Calma Aicee D. , Pavey Nathan , Menon Parvathi , Vucic Steve 
Published: May 2024

Purpose of review
Neuroinflammation appears to be an important pathogenic process in amyotrophic lateral sclerosis (ALS). Dysfunction of central immune pathways, including activation of microglia and astrocytes, and peripherally derived immune cells, initiate noncell autonomous inflammatory mechanisms leading to degeneration. Cell autonomous pathways linked to ALS genetic mutations have been recently identified as contributing mechanism for neurodegeneration. The current review provides insights into the pathogenic importance of central and peripheral inflammatory processes in ALS pathogenesis and appraises their potential as therapeutic targets.

Recent findings
ALS is a multistep process mediated by a complex interaction of genetic, epigenetic, and environmental factors. Noncell autonomous inflammatory pathways contribute to neurodegeneration in ALS. Activation of microglia and astrocytes, along with central nervous system infiltration of peripherally derived pro-inflammatory innate (NK-cells/monocytes) and adaptive (cell-mediated/humoral) immune cells, are characteristic of ALS. Dysfunction of regulatory T-cells, elevation of pro-inflammatory cytokines and dysbiosis of gut microbiome towards a pro-inflammatory phenotype, have been reported as pathogenic mechanisms in ALS.

Summary
Dysregulation of adaptive and innate immunity is pathogenic in ALS, being associated with greater disease burden, more rapid disease course and reduced survival. Strategies aimed at modulating the pro-inflammatory immune components could be of therapeutic utility.
Topological Structures in the Space of Treatment-Naïve Patients With Chronic Lymphocytic Leukemia
Authors: McGee Reginald L. , Reed Jake , Coombes Caitlin E. , Herling Carmen D. , Keating Michael J. , Abruzzo Lynne V. , Coombes Kevin R. 
Published: May 2024

AbstractPatients are complex and heterogeneous; clinical data sets are complicated by noise, missing data, and the presence of mixed-type data. Using such data sets requires understanding the high-dimensional “space of patients”, composed of all measurements that define all relevant phenotypes. The current state-of-the-art merely defines spatial groupings of patients using cluster analyses. Our goal is to apply topological data analysis (TDA), a new unsupervised technique, to obtain a more complete understanding of patient space. We applied TDA to a space of 266 previously untreated patients with Chronic Lymphocytic Leukemia (CLL), using the “daisy” metric to compute distances between clinical records. We found clear evidence for both loops and voids in the CLL data. To interpret these structures, we developed novel computational and graphical methods. The most persistent loop and the most persistent void can be explained using three dichotomized, prognostically important factors in CLL:IGHVsomatic mutation status, beta-2 microglobulin, and Rai stage. In conclusion, patient space turns out to be richer and more complex than current models suggest. TDA could become a powerful tool in a researchers arsenal for interpreting high-dimensional data by providing novel insights into biological processes and improving our understanding of clinical and biological data sets.Simple SummaryClinical data sets incorporate continuous data like blood pressure or sodium levels, categorical data like cancer grade or stage, and binary data like sex or marital status. Measurements on an individual patient define a point in a high-dimensional space; data from many patients defines a “point cloud”. The “shape” of the point cloud influences experimental design by describing patient variability. Topological data analysis (TDA) is a mathematical technique for understanding the shape of point clouds by finding “holes” that correspond to combinations of patient characteristics that are never observed. TDA results are stratified by dimension. Zero-dimensional features define patient subtypes. One-dimensional features (“loops”) are analogs of the inside of a circle or a donut hole. Two-dimensional features (“voids”) are analogs of the inside of a balloon. Here, we apply TDA to a clinical data set of previously untreated patients with Chronic Lymphocytic Leukemia to find loops and voids.
Prognostic Factors for Mortality in Patients Infected with Hantavirus: A Systematic Review with GRADE Certainty Assessment
Authors: Tortosa Fernando , Perré Fernando , Neumann Ignacio , Ragusa Martín Alberto , Lossetti Lucia , Guaresti Germán , Izcovich Ariel 
Published: May 2024

AbstractIntroductionOne of the challenges in managing patients with hantavirus infection is accurately identifying individuals who are at risk of developing severe disease. Prompt identification of these patients can facilitate critical decisions, such as early referral to an intensive care unit. The identified prognostic factors could be incorporated into predictive models to enhance the management of hantavirus infection.ObjectiveTo identify and evaluate prognostic factors associated with mortality in hantavirus infection, providing a basis for a risk assessment model for hantavirus mortalityMethodsWe conducted a systematic review following the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) guidelines. We conducted a comprehensive search in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from their inception to January 2024. Furthermore, we included studies evaluating individual prognostic factors or risk assessment models of hantavirus infections, with no restrictions on study design, publication status, or language. When feasible, we conducted meta-analyses for prognostic factors using the inverse variance-based method with random effect model. We assessed the certainty of the evidence using the GRADE approach,ResultsWe included 30 studies with a total of 92,183 participants. We identified the following key prognostic factors which predicted and increased mortality and disease severity: over 15 years, female gender, elevated creatinine levels (>1.4 mg/dL), increased hematocrit (>42%), and presence of infiltrates on chest radiographs.DiscussionOur systematic review not only sheds light on the pivotal prognostic factors for hantavirus infection but also sets the stage for the development of comprehensive management strategies that are informed by robust empirical evidence. These strategies, underpinned by predictive modeling and regional customization, can significantly enhance outcomes for individuals at risk of severe hantavirus disease, aligning with global health objectives aimed at zoonotic disease control and prevention.PROSPERO Registration NumberCRD42021225823
The impact of chronic pain on brain gene expression
Authors: Collier Lily , Seah Carina , Hicks Emily M. ,   Traumatic Stress Brain Research Group, Holtzheimer Paul E. , Krystal John H. , Girgenti Matthew J. , Huckins Laura M. , Johnston Keira J.A. 
Published: May 2024

AbstractBackgroundChronic pain affects one fifth of American adults, contributing significant public health burden. Chronic pain mechanisms can be further understood through investigating brain gene expression.MethodsWe tested differentially expressed genes (DEGs) in chronic pain, migraine, lifetime fentanyl and oxymorphone use, and with chronic pain genetic risk in four brain regions (dACC, DLPFC, MeA, BLA) and imputed cell type expression data from 304 postmortem donors. We compared findings across traits and with independent transcriptomics resources, and performed gene-set enrichment.ResultsWe identified two chronic pain DEGs: B4GALT and VEGFB in bulk dACC. We found over 2000 (primarily BLA microglia) chronic pain cell type DEGs. Findings were enriched for mouse microglia pain genes, and for hypoxia and immune response. Cross-trait DEG overlap was minimal.ConclusionsChronic pain-associated gene expression is heterogeneous across cell type, largely distinct from that in pain-related traits, and shows BLA microglia are a key cell type.
Automated quantitative analysis of peri-articular bone microarchitecture in HR-pQCT knee images
Authors: Neeteson Nathan J. , Hasick Sasha M. , Souza Roberto , Boyd Steven K. 
Published: May 2024

ABSTRACTThere is growing interest in applying HR-pQCT to image the knee, particularly in the study of osteoarthritis, which necessitates the development and validation of novel image analysis workflows. In this work, we present and validate the first fully automated workflow forin vivoquantitative assessment of peri-articular bone density and microarchitecture in the human knee. Bone segmentation models were trained by transfer learning with a large dataset of radius and tibia images (N=2,598) and fine-tuned on a knee image dataset (N=131), atlas-based registration was used to identify medial and lateral contact surfaces, and morphological operations combined these intermediate outputs to generate peri-articular regions of interest (ROIs) for morphological analysis. Accuracy was assessed with an external validation dataset (N=131), where predicted and reference morphological parameters showed excellent correspondence (0.86≤R2≤0.99), with moderate bias present in predictions of subchondral bone plate density (-80 mg HA/cm3) and thickness (+0.15 mm). Precision was assessed with a triple-repeat measures dataset (N=29), where the short-term precision RMS%CV estimates ranged from 0.7% to 3.5% when rigid registration was used to synchronize ROI generation across images.
When two communication differences intersect: Comparing inpatient rehabilitation care and outcomes for people with post-stroke aphasia who do and do not require an interpreter
Authors: Mellahn Kathleen , Kilkenny Monique , Siyambalapitiya Samantha , Lakhani Ali , Burns Catherine , Cadilhac Dominique A. , Rose Miranda L. 
Published: May 2024

ABSTRACTBackgroundCommunicative ability after stroke influences patient outcomes. Limited research has explored the impact of aphasia when it intersects with cultural or linguistic differences on receiving stroke care and patient outcomes. We investigated associations between requiring an interpreter and the provision of evidence-based stroke care and outcomes for people with aphasia in the inpatient rehabilitation setting.MethodsPatient-level data from people with aphasia were aggregated from the Australian Stroke Foundation National Stroke Audit - Rehabilitation Services (2016-2020). Multivariable regression models compared adherence to processes of care (e.g. home assessment complete, type of aphasia management) and in-hospital outcomes (e.g. length of stay, discharge destination) by requirement of an interpreter. Outcome models were adjusted for sex, stroke type, hospital size, year, and stroke severity factors.ResultsAmong 3160 people with aphasia (median age 76, 56% male), 208 (7%) required an interpreter (median age 77, 52% male). The interpreter group had more severe disability on admission, reflected by reduced cognitive (6% vs 12%, p<0.0000) and motor FIM scores (6% vs 12%, p<0.009). The interpreter group were less likely to have phonological and semantic interventions for their aphasia (OR 0.56, 95% CI 0.40, 0.78) compared to people not requiring an interpreter. They more often had a carer (OR 2.03, 95% CI 1.41, 2.96) and were less likely to have a home assessment prior to discharge (OR 0.34, 95% CI 0.12, 0.95) despite increased likelihood of discharging home with supports (OR 1.49, 95% CI 1.08, 2.05). The interpreter group had longer lengths of stay (median 31 vs 26 days, p=0.005).ConclusionSome processes of care and outcomes differed in inpatient rehabilitation for people with post-stroke aphasia who required an interpreter compared with those who did not. Equitable access to therapy is imperative and greater support for cultural/linguistic minorities during rehabilitation is indicated.
Prevalence and Clinical Outcomes of Acute Noncardiac Organ Failure among Non-Acute Myocardial Infarction Cardiogenic Shock: A Nationwide Cohort Analysis
Authors: Majmundar Monil , Faisaluddin Mohammed , Alarfaj Mohammad , Ahmed Asmaa , Patel Kunal N , Majmundar Vidit , Doshi Rajkumar , Shah Hirak , Gupta Kamal , Shah Zubair , Dalia Tarun 
Published: May 2024

AbstractBackgroundNoncardiac organ failure often complicates cardiogenic shock (CS). The results of cardiogenic shock caused by noncardiac organ failures in patients without acute myocardial infarction (AMI) are not well documented.MethodsWe examined the National Inpatient Sample (NIS) data from 2016 to 2020 to identify cases of CS and non-AMI CS-related hospitalizations. We divided both cohorts based on the number of acute noncardiac organ failures and evaluated the influence of organ failure on the primary outcome, which was in-hospital mortality.ResultsA total of 599,210 (100%) cardiogenic shock and 366,905 (61.2%) non-AMI CS hospitalizations were identified. Among those with non-AMI CS, 58,965 (16.07%) had no organ failure, 121,845 (33.21%) had a single organ failure, and 186,095 (50.72%) had a multiorgan failure. Acute Kidney Injury (AKI) was the most common non-cardiac organ failure (38.1%). Multiorgan failure was associated with an increased risk of in-hospital mortality (aOR: 4.91, 95% CI: 4.72-5.06, p <0.001) compared to no organ failure. A notable increase in mortality rates was observed in correlation with the number of organ involvement. The highest mortality rates were seen in cases where five or more organs were affected. Neurological failure exhibited a significant association with mortality when compared to other organ failures. Similar trends were seen among the CS cohort.ConclusionsIn non-acute myocardial infarction and all cardiogenic shock patients, AKI is the most common type of organ failure, and neurological failure was associated with the highest mortality rate. The presence of noncardiac multiorgan failure was found to be strongly associated with a higher mortality rate. This risk increased as more organs were affected.Clinical PerspectiveWhat Is New?● Non-AMI patients bear a considerable load of non-cardiac organ failure, where AKI is the most prevalent form of organ failure. Additionally, neurological failure has the highest in-hospital mortality rate.● A predictor model for calculating the probability of in-hospital mortality in all CS patients.● Non-AMI cardiogenic shock and all cardiogenic shock patients are associated with higher morbidity, mortality, and resource utilization, as well as advanced circulatory support therapies, which increase as the number of affected organs increases.What are the Clinical Implications?● Multi-organ failure in non-AMI CS can have worse cardiovascular outcomes.● A multidisciplinary team’s involvement in managing these complex CS patients should be considered.