bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Lagenidium deciduum infection in a patient with relapsed acute myeloid leukemia
Authors: Theophilopoulos Joanna , King Rebekah , Citta Autumn , Alford Constance , Dotson Natalie , Cañete-Gibas Connie , Sanders Carmita , Wiederhold Nathan , Ligon John A. , Trieu Connie 
Published: May 2024

Abstract
Background
Lagenidium deciduum is an oomycete that can cause infections in mammals that present similarly to pythiosis and mucormycosis. Most of the existing case reports have occurred in canines and have been fatal. In animals, medical therapy has not been successful, so surgical excision is the mainstay of treatment. Lagenidium sp. infections in humans are rare. There is only one case of a human Lagenidium sp. infection in the literature, and it presented as an ocular infection. The human ocular infection was resistant to medical therapy and required a penetrating keratoplasty for cure. Additional reports of effective therapy are needed to guide management of this emerging pathogen. We present the first case of a cutaneous Lagenidium deciduum infection in a human patient, which is also the first documented case of a Lagenidium deciduum infection in an immunocompromised host of any species.

Case presentation
An 18-year-old female with relapsed acute myeloid leukemia, awaiting a haploidentical stem cell transplant, presented with erythematous cutaneous lesions on her left hip and bilateral buttocks that enlarged and blackened over several days. About 1 week later, boil-like lesions appeared on her bilateral buttocks. The skin lesions were initially presumed to be bacterial in origin, so the patient was treated with clindamycin and cefepime with little improvement. Upon further investigation, fungal cultures and skin biopsies revealed aseptate hyphae, so the patient was switched to isavuconazole and amphotericin B due to concern for mucormycosis. Phenotypic characterization and DNA sequencing were performed by the Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, which identified the causal fungal organism as Lagenidium deciduum. All of her cutaneous lesions were surgically excised, and the patient was treated with micafungin, terbinafine, doxycycline, and azithromycin. Micafungin and terbinafine were continued until she achieved engraftment post-transplant.

Conclusions
We report the first successful treatment of a human Lagenidium infection in an immunocompromised host through a combination of aggressive surgical excision and prolonged antifungal therapy during the prolonged neutropenia associated with allogeneic stem cell transplant. Prompt diagnosis and management may prevent disseminated oomycosis.
Incidence and mortality of community-acquired and nosocomial infections in Japan: a nationwide medical claims database study
Authors: Takahashi Nozomi , Imaeda Taro , Oami Takehiko , Abe Toshikazu , Shime Nobuaki , Komiya Kosaku , Kawamura Hideki , Yamao Yasuo , Fushimi Kiyohide , Nakada Taka‑aki 
Published: May 2024

Abstract
Background
It is important to determine the prevalence and prognosis of community-acquired infection (CAI) and nosocomial infection (NI) to develop treatment strategies and appropriate medical policies in aging society.

Methods
Patients hospitalized between January 2010 and December 2019, for whom culture tests were performed and antibiotics were administered, were selected using a national claims-based database. The annual trends in incidence and in-hospital mortality were calculated and evaluated by dividing the patients into four age groups.

Results
Of the 73,962,409 inpatients registered in the database, 9.7% and 4.7% had CAI and NI, respectively. These incidences tended to increase across the years in both the groups. Among the patients hospitalized with infectious diseases, there was a significant increase in patients aged ≥ 85 years (CAI: + 1.04%/year and NI: + 0.94%/year, P < 0.001), while there was a significant decrease in hospitalization of patients aged ≤ 64 years (CAI: -1.63%/year and NI: -0.94%/year, P < 0.001). In-hospital mortality was significantly higher in the NI than in the CAI group (CAI: 8.3%; NI: 14.5%, adjusted mean difference 4.7%). The NI group had higher organ support, medical cost per patient, and longer duration of hospital stay. A decreasing trend in mortality was observed in both the groups (CAI: -0.53%/year and NI: -0.72%/year, P < 0.001).

Conclusion
The present analysis of a large Japanese claims database showed that NI is a significant burden on hospitalized patients in aging societies, emphasizing the need to address particularly on NI.
Ectopic cervical thymoma in myasthenia gravis: a case report
Authors: Zargar Shima , Hosseini Farahabadi Maryam , Reynolds Samuel J. 
Published: May 2024

Abstract
Background
Ectopic cervical thymoma (ECT) is an extremely rare tumor, especially in association with myasthenia gravis (MG).

Case presentation
We report a case of myasthenia gravis with an ectopic thymoma in the neck, whose myasthenic symptoms significantly improved after complete removal of the mass. A 55-year-old woman with generalized myasthenia gravis (MG) experienced worsening neuromuscular weakness after abruptly discontinuing pyridostigmine. Testing revealed acetylcholine receptor-antibody (AChR-Ab) positivity and a cervical mass initially thought to be thyroid or parathyroid was identified as a thymoma, type A. Post-surgery and radiation therapy, her myasthenic symptoms improved significantly with less prednisone and pyridostigmine requirements over time and no need for additional immunotherapies.

Conclusions
Diagnosing ECTs is challenging due to rarity, atypical locations, and inconclusive fine needle aspiration cytology (FNAC) results, often misinterpreted as thyroid or parathyroid lesions. As proper management of patients with MG, including thymectomy, offers favorable clinical outcomes such as significant improvement in myasthenic complaints and reduced immunosuppressive medication requirements, clinicians should be vigilant of the ectopic locations of thymomas to ensure timely diagnosis and intervention.
PD-L1 knockdown suppresses vasculogenic mimicry of non-small cell lung cancer by modulating ZEB1-triggered EMT
Authors: Li Wenjuan , Wu Jiatao , Jia Qianhao , Shi Yuqi , Li Fan , Zhang Linxiang , Shi Fan , Wang Xiaojing , Wu Shiwu 
Published: May 2024

Abstract
Background
PD-L1 overexpression is commonly observed in various malignancies and is strongly correlated with poor prognoses for cancer patients. Moreover, PD-L1 has been shown to play a significant role in promoting angiogenesis and epithelial-mesenchymal transition (EMT) processes across different cancer types.

Methods
The relationship between PD-L1 and vasculogenic mimicry as well as epithelial-mesenchymal transition (EMT) was explored by bioinformatics approach and immunohistochemistry. The functions of PD-L1 in regulating the expression of ZEB1 and the EMT process were assessed by Western blotting and q-PCR assays. The impact of PD-L1 on the migratory and proliferative capabilities of A549 and H1299 cells was evaluated through wound healing, cell invasion, and CCK8 assays following siRNA-mediated PD-L1 knockdown. Tube formation assay was utilized to evaluate the presence of VM structures.

Results
In this study, increased PD-L1 expression was observed in A549 and H1299 cells compared to normal lung epithelial cells. Immunohistochemical analysis revealed a higher prevalence of VM structures in the PD-L1-positive group compared to the PD-L1-negative group. Additionally, high PD-L1 expression was also found to be significantly associated with advanced TNM stage and increased metastasis. Following PD-L1 knockdown, NSCLC cells exhibited a notable reduction in their ability to form tube-like structures. Moreover, the levels of key EMT and VM-related markers, including N-cadherin, MMP9, VE-cadherin, and VEGFA, were significantly decreased, while E-cadherin expression was upregulated. In addition, the migration and proliferation capacities of both cell lines were significantly inhibited after PD-L1 or ZEB1 knockdown.

Conclusions
Knockdown PD-L1 can inhibit ZEB1-mediated EMT, thereby hindering the formation of VM in NSCLC.
Prevalence of insulin resistance and its associated factors in drug-naïve patients with bipolar disorder among Han Chinese population
Authors: Li Kanglai , Li Tong , Yang Ting , Lin Youzhen , Liao Yingtao , Gan Zhaoyu 
Published: May 2024

Abstract
Background
Metabolic syndrome (Mets) is commonly seen in bipolar disorder (BD). As the key component and early biological index of Mets, insulin resistance (IR) among BD has received more and more attention. However, little is known about the prevalence of IR and its associated factors in drug-naïve patients with (BD), especially among Han Chinese population.

Methods
A cross-sectional study was conducted on 125 drug-naïve patients with bipolar disorder (BD) and 85 healthy controls (HC). The Homeostatic Model Assessment of insulin resistance (HOMA-IR) was calculated, and IR was defined as HOMA-IR greater than the 75th percentile value for health controls (2.35). Clinical characteristics of BD were collected through semi-structural interview performed by a trained interviewer with background of psychiatric education.

Results
Among the measured anthropocentric variables including BMI, waist circumference, abdomen circumference, hipline, and hip-waist ratio, waist circumference was found to be the most closely related to IR (0R = 1.070, 95%CI = 1.031–1.110, P < 0.001). Male was another factor that was associated with IR (OR = 2.281, 95%CI = 1.107–4.702, P = 0.025). After adjusted for gender and waist circumference, the risk of IR was significantly higher in bipolar disorder than in healthy controls (OR = 2.66, 95%CI = 1.364–5.214, P = 0.004). No significant association was found between IR and any of the observed physical and mental comorbidities, any characteristic of illness course including age onset, number of mixed episodes, types of current state, duration of current episode, duration of illness course, rapid cycling, number of mood episodes, and subgroup of BD. Hypersomnia was the only symptomatic feature that was significantly associated with IR (OR = 0.316, 95%CI = 0.124–0.803, P = 0.016).

Conclusions
Bipolar disorder increases two-to-three-fold risk of IR, both circumference and male are the risk factors of IR but hypersomnia act as a protective factor.
Multi-level analysis of intimate partner violence and its determinants among reproductive age group women in Ethiopia: evidence from Ethiopian Demographic Health Survey, 2016
Authors: Mulatu Teshale , Dessie Yadeta , Abera Muluemebet 
Published: May 2024

Abstract
Background
Intimate partner violence (IPV) is recognized as a main public health challenge, with serious consequences for women’s physical, mental, sexual, and reproductive health. Despite its public health importance, most studies of IPV in Ethiopia mainly focused on individual characteristics and didn’t identify how factors operating at different levels affect IPV. Thus, there is limited evidence regarding the hierarchical-level factors of IPV and the effect of individual and community-level determinants of IPV. The aim of this study is to assess the individual and community-level factors associated with violence against women among ever-married reproductive-age women in Ethiopia.

Methods
A retrospective analysis of secondary data retrieved from the Ethiopia Demographic and Health Survey was conducted among reproductive age group women (15–49 years of age) who reported ever being married within the available data set for the domestic violence module. STATA 14 was used to conduct the analysis. A two-level mixed-effects logistic regression analysis was used to determine associations between IPV and individual- and community-level factors. IPV variability across the community was assessed using ICC and PCV. The model’s fitness was assessed using the Akaike information criterion (AIC), the Bayesian information criterion (BIC), and the likelihood ratio test.

Result
The life time prevalence of IPV in this study was 33% [95% CI: 30.74, 34.25]. Women’s age 20–24 (AOR = 5.85, 95% CI: 201 3.10, 11.04), 25–29 age group (AOR = 6.41, 95% CI; 3.34, 12.32), 30–34 age group (AOR = 9.48, 95% CI: 4.71, 19.06), 35–39 age group (AOR = 9.88, 95% CI: 4.79, 20.39), 40–44 age group (AOR = 11.10, 95% CI: 5.16, 23.89), and 45–49, (AOR = 14.15, 95% CI: 6.01, 32.80), early marriage (AOR = 1.21, 95% CI: 1.08, 1.47), witnessing inter-parental violence during childhood (AOR = 2.80, 95% CI: 2.16, 3.96), having a lot of living children (AOR = 0.45, 95% CI: 0.26, 0.74), having a partner who drank alcohol (AOR = 3.00, 95% CI: 2.42–3.67), decision-making autonomy of the women (AOR = 0.77, 95% CI: 0.62, 0.97), Poor wealth index (AOR = 1.64, 95% CI: 1.23, 2.18), middle wealth index (AOR = 1.86, 95% CI: 1.36, 2.54) and exposure to media (AOR = 1.47, 95% CI: 1.06, 2.00) were all significantly associated with IPV.

Conclusion and recommendation
This study showed that one-third of the women experienced IPV in their lifetime. The finding suggested that community based interventions and multi-sectorial collaborations are needed to reduce the IPV and its adverse consequences.
Evaluation of a digitally enhanced cardiac auscultation learning method in Cameroon: results of a controlled study
Authors: Bediang Georges , Baran à Zock Agnès , Doualla Fred-Cyrille Goethe , Nganou-Gnindjio Chris 
Published: May 2024

Summary
Background
Cardiac auscultation is an efficient and effective diagnostic tool, especially in low-income countries where access to modern diagnostic methods remains difficult. This study aimed to evaluate the effect of a digitally enhanced cardiac auscultation learning method on medical students’ performance and satisfaction.

Methods
We conducted a double-arm parallel controlled trial, including newly admitted 4th -year medical students enrolled in two medical schools in Yaoundé, Cameroon and allocated into two groups: the intervention group (benefiting from theoretical lessons, clinical internship and the listening sessions of audio recordings of heart sounds) and the control group (benefiting from theoretical lessons and clinical internship). All the participants were subjected to a pretest before the beginning of the training, evaluating theoretical knowledge and recognition of cardiac sounds, and a post-test at the eighth week of clinical training associated with the evaluation of satisfaction. The endpoints were the progression of knowledge score, skills score, total (knowledge and skills) score and participant satisfaction.

Results
Forty-nine participants (27 in the intervention group and 22 in the control group) completed the study. The knowledge progression (+ 26.7 versus + 7.5; p ˂0.01) and the total progression (+ 22.5 versus + 14.6; p ˂ 0.01) were higher in the intervention group with a statistically significant difference compared to the control group. There was no significant difference between the two groups regarding skills progression (+ 25 versus + 17.5; p = 0.27). Satisfaction was higher in general in the intervention group (p ˂ 0.01), which recommended this method compared to the control group.

Conclusion
The learning method of cardiac auscultation reinforced by the listening sessions of audio recordings of heart sounds improves medical students’ performances (knowledge and global – knowledge and skills) who find it satisfactory and recommendable.

Trial Registration
This trial has been registered the 29/11/2019 in the Pan African Clinical Trials Registry (http://www.pactr.org) under unique identification number PACTR202001504666847 and the protocol has been published in BMC Medical Education.
Clinicians’ perceptions of “enhanced recovery after surgery” (ERAS) protocols to improve patient safety in surgery: a national survey from Australia
Authors: Lovegrove Josephine , Tobiano Georgia , Chaboyer Wendy , Carlini Joan , Liang Rhea , Addy Keith , Gillespie Brigid M. 
Published: May 2024

Abstract
Background
Surgical patients are at risk of postoperative complications, which may lead to increased morbidity, mortality, hospital length-of-stay and healthcare costs. Enhanced Recovery After Surgery (ERAS®) protocols are evidence-based and have demonstrated effectiveness in decreasing complications and associated consequences. However, their adoption in Australia has been limited and the reason for this is unclear. This study aimed to describe clinicians’ perceptions of ERAS protocols in Australia.

Methods
A national online survey of anaesthetists, surgeons and nurses was undertaken. Invitations to participate were distributed via emails from professional colleges. The 30-item survey captured respondent characteristics, ERAS perceptions, beliefs, education and learning preferences and future planning considerations. The final question was open-ended for elaboration of perceptions of ERAS. Descriptive and inferential statistics were used to describe and compare group differences across disciplines relative to perceptions of ERAS.

Results
The sample included 178 responses (116 nurses, 65.2%; 36 surgeons, 20.2%; 26 anaesthetists, 14.6%) across six states and two territories. More than half (n = 104; 58.8%) had used ERAS protocols in patient care, and most perceived they were ‘very knowledgeable’ (n = 24; 13.6%) or ‘knowledgeable’ (n = 71; 40.3%) of ERAS. However, fewer nurses had cared for a patient using ERAS (p <.01) and nurses reported lower levels of knowledge (p <.001) than their medical counterparts. Most respondents agreed ERAS protocols improved patient care and financial efficiency and were a reasonable time investment (overall Md 3–5), but nurses generally recorded lower levels of agreement (p.013 to < 0.001). Lack of information was the greatest barrier to ERAS knowledge (n = 97; 62.6%), while seminars/lectures from international and national leaders were the preferred learning method (n = 59; 41.3%). Most supported broad implementation of ERAS (n = 130; 87.8%).

Conclusion
There is a need to promote ERAS and provide education, which may be nuanced based on the results, to improve implementation in Australia. Nurses particularly need to be engaged in ERAS protocols given their significant presence throughout the surgical journey. There is also a need to co-design implementation strategies with stakeholders that target identified facilitators and barriers, including lack of support from senior administration, managers and clinicians and resource constraints.
Cytogenomic characterization of pediatric T-cell acute lymphoblastic leukemia reveals TCR rearrangements as predictive factors for exceptional prognosis
Authors: Lizcova Libuse , Prihodova Eva , Pavlistova Lenka , Svobodova Karla , Mejstrikova Ester , Hrusak Ondrej , Luknarova Pavla , Janotova Iveta , Sramkova Lucie , Stary Jan , Zemanova Zuzana 
Published: May 2024

Abstract
Background
T-cell acute lymphoblastic leukemia (T-ALL) represents a rare and clinically and genetically heterogeneous disease that constitutes 10–15% of newly diagnosed pediatric ALL cases. Despite improved outcomes of these children, the survival rate after relapse is extremely poor. Moreover, the survivors must also endure the acute and long-term effects of intensive therapy. Although recent studies have identified a number of recurrent genomic aberrations in pediatric T-ALL, none of the changes is known to have prognostic significance. The aim of our study was to analyze the cytogenomic changes and their various combinations in bone marrow cells of children with T-ALL and to correlate our findings with the clinical features of the subjects and their treatment responses.

Results
We performed a retrospective and prospective comprehensive cytogenomic analysis of consecutive cohort of 66 children (46 boys and 20 girls) with T-ALL treated according to BFM-based protocols and centrally investigated cytogenetics and immunophenotypes. Using combinations of cytogenomic methods (conventional cytogenetics, FISH, mFISH/mBAND, arrayCGH/SNP and MLPA), we identified chromosomal aberrations in vast majority of patients (91%). The most frequent findings involved the deletion of CDKN2A/CDKN2B genes (71%), T-cell receptor (TCR) loci translocations (27%), and TLX3 gene rearrangements (23%). All chromosomal changes occurred in various combinations and were rarely found as a single abnormality. Children with aberrations of TCR loci had a significantly better event free (p = 0.0034) and overall survival (p = 0.0074), all these patients are living in the first complete remission. None of the abnormalities was an independent predictor of an increased risk of relapse.

Conclusions
We identified a subgroup of patients with TCR aberrations (both TRA/TRD and TRB), who had an excellent prognosis in our cohort with 5-year EFS and OS of 100%, regardless of the presence of other abnormality or the translocation partner. Our data suggest that escalation of treatment intensity, which may be considered in subsets of T-ALL is not needed for nonHR (non-high risk) patients with TCR aberrations.
A robust acid-resistant chelating polymer for enhanced stabilization of lead ions in fly ash
Authors: Wang Qi , Yan Huiyu , Yao Linyan , Guo Ying , Xiao Jianxi 
Published: May 2024

AbstractFly ash derived from municipal solid waste incinerators (MSWIs) harbors significant quantities of heavy metals with high leaching toxicity, resulting in detrimental environmental effects. Pb2+ in fly ash is the ion most likely to exceed permissible levels. However, chemical stabilization methods demonstrate poor efficacy in stabilizing Pb2+ under acidic conditions. Herein, we have developed a robust acid-resistant chelating polymer (25DTF) for enhanced stabilization of Pb2+ in fly ash. 25DTF was synthesized through the reaction of formaldehyde with 2,5-dithiourea. 25DTF exhibited remarkable chelation efficiency, nearing 100%, for Pb2+ in fly ash. 25DTF demonstrated exceptional chelation efficiency, surpassing 99.9%, when interacting with Pb2+ in fly ash at pH ≤ 7. Even under acidic conditions, 25DTF effectively prevented the secondary dissolution of Pb2+. Additionally, it indicated outstanding Pb2+ chelation efficiency across diverse regions of China. The 25DTF chelating agent shows considerable potential in alleviating metal ion contamination in soil, wastewater, and urban environmental management, thereby fostering advancements in environmental stewardship.