bluuebunny/crossref_metadata_2025_split huggingface dataset:
A neural circuit for spatial orientation derived from brain lesions
Authors: Roseman Moshe , Elias Uri , Kletenik Isaiah , Ferguson Michael A , Fox Michael D , Horowitz Zalman , Marshall Gad A , Spiers Hugo J , Arzy Shahar 
Published: December 2023

Abstract
There is disagreement regarding the major components of the brain network supporting spatial cognition. To address this issue, we applied a lesion mapping approach to the clinical phenomenon of topographical disorientation. Topographical disorientation is the inability to maintain accurate knowledge about the physical environment and use it for navigation. A review of published topographical disorientation cases identified 65 different lesion sites. Our lesion mapping analysis yielded a topographical disorientation brain map encompassing the classic regions of the navigation network: medial parietal, medial temporal, and temporo-parietal cortices. We also identified a ventromedial region of the prefrontal cortex, which has been absent from prior descriptions of this network. Moreover, we revealed that the regions mapped are correlated with the Default Mode Network sub-network C. Taken together, this study provides causal evidence for the distribution of the spatial cognitive system, demarking the major components and identifying novel regions.
Effectiveness and safety of stag beetle knife (SB knife) in management of Zenker’s diverticulum: a systematic review and meta-analysis
Authors: Dahiya Dushyant Singh , Deliwala Smit , Chandan Saurabh , Ramai Daryl , Ali Hassam , Kassab Lena L , Facciorusso Antonio , Kochhar Gursimran S 
Published: December 2023

Summary
Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3–99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6–92.3; I219) and 13.5% (95% CI: 9.6–18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91–98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6–8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6–17.8; I20) and 9.3% (95% CI: 5.7–14.9; I2 &lt; 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.
Implementation of climate adaptation in the public health sector in Europe: qualitative thematic analysis
Authors: Turner Grace A , de’Donato Francesca , Hoeben Annechien D , Nordeng Zuzana , Coleman Samantha , Otto Ilona M , Hajat Shakoor , Kovats Sari 
Published: December 2023

Abstract

Background
Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood.

Aim
To identify key issues in climate change adaptation implementation for public health in Europe.

Methods
Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation.

Interviews addressed
Barriers and levers for adaptation, policy alignment, networks and evidence needs.

Results
Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation.

Conclusions
Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health.
An unbiased approach of molecular characterization of the endometrium: toward defining endometrial-based infertility
Authors: Bui Bich Ngoc , Ardisasmita Arif Ibrahim , Kuijk Ewart , Altmäe Signe , Steba Gaby , Mackens Shari , Fuchs Sabine , Broekmans Frank , Nieuwenhuis Edward 
Published: December 2023

Abstract
Infertility is a complex condition affecting millions of couples worldwide. The current definition of infertility, based on clinical criteria, fails to account for the molecular and cellular changes that may occur during the development of infertility. Recent advancements in sequencing technology and single-cell analysis offer new opportunities to gain a deeper understanding of these changes. The endometrium has a potential role in infertility and has been extensively studied to identify gene expression profiles associated with (impaired) endometrial receptivity. However, limited overlap among studies hampers the identification of relevant downstream pathways that could play a role in the development of endometrial-related infertility. To address these challenges, we propose sequencing the endometrial transcriptome of healthy and infertile women at the single-cell level to consistently identify molecular signatures. Establishing consensus on physiological patterns in endometrial samples can aid in identifying deviations in infertile patients. A similar strategy has been used with great success in cancer research. However, large collaborative initiatives, international uniform protocols of sample collection and processing are crucial to ensure reliability and reproducibility. Overall, the proposed approach holds promise for an objective and accurate classification of endometrial-based infertility and has the potential to improve diagnosis and treatment outcomes.
tRNA shape is an identity element for an archaeal pyrrolysyl-tRNA synthetase from the human gut
Authors: Krahn Natalie , Zhang Jingji , Melnikov Sergey V , Tharp Jeffery M , Villa Alessandra , Patel Armaan , Howard Rebecca J , Gabir Haben , Patel Trushar R , Stetefeld Jörg , Puglisi Joseph , Söll Dieter 
Published: December 2023

Abstract
Protein translation is orchestrated through tRNA aminoacylation and ribosomal elongation. Among the highly conserved structure of tRNAs, they have distinguishing features which promote interaction with their cognate aminoacyl tRNA synthetase (aaRS). These key features are referred to as identity elements. In our study, we investigated the tRNA:aaRS pair that installs the 22nd amino acid, pyrrolysine (tRNAPyl:PylRS). Pyrrolysyl-tRNA synthetases (PylRSs) are naturally encoded in some archaeal and bacterial genomes to acylate tRNAPyl with pyrrolysine. Their large amino acid binding pocket and poor recognition of the tRNA anticodon have been instrumental in incorporating &gt;200 noncanonical amino acids. PylRS enzymes can be divided into three classes based on their genomic structure. Two classes contain both an N-terminal and C-terminal domain, however the third class (ΔpylSn) lacks the N-terminal domain. In this study we explored the tRNA identity elements for a ΔpylSn tRNAPyl from Candidatus Methanomethylophilus alvus which drives the orthogonality seen with its cognate PylRS (MaPylRS). From aminoacylation and translation assays we identified five key elements in ΔpylSn tRNAPyl necessary for MaPylRS activity. The absence of a base (position 8) and a G–U wobble pair (G28:U42) were found to affect the high-resolution structure of the tRNA, while molecular dynamic simulations led us to acknowledge the rigidity imparted from the G–C base pairs (G3:C70 and G5:C68).
A Case of Sustained Viral Shedding of Mpox With Ocular Involvement Resulting in Vision Loss
Authors: Speiser Lisa J , Wonnaparhown Alex M , Blair Janis , Shah Ami , Patel Dharmendra R , McCullough Ann E , Nicolasora Nelson , Khalsa Ann M , Orenstein Robert , Vikram Holenarasipur R , Huang Vivian , Seville Maria Teresa 
Published: December 2023

Abstract
Mpox, caused by infection with Monkeypox virus, usually presents as a mild, self-limited illness in immunocompetent persons that resolves within 2–4 weeks. Serious complications have been reported when mpox lesions involve vulnerable anatomic sites, such as the eye, and in those with substantial immunosuppression. We describe a patient with advanced human immunodeficiency virus infection and sustained viral shedding of mpox with ocular involvement, which resulted in vision loss.
Common variable immunodeficiency disorder-related liver disease is common and results in portal hypertension and an increased risk of death
Authors: Halliday Neil , Eden Nadia , Somers Henry , Burke Niall , Silva Hiroshi , Brito Camila GX , Hall Andrew , Quaglia Alberto , Burns Siobhan O. , Lowe David M. , Thorburn Douglas 
Published: December 2023

Background:
Common variable immunodeficiency disorder (CVID) manifests with recurrent infections and inflammatory complications, including liver disease. We report the clinical features, natural history, and outcomes of patients with CVID-related liver disease (CVID-rLD) from a tertiary immunology and hepatology center.

Methods:
Two hundred eighteen patients were identified; CVID-rLD was defined by persistently abnormal liver function tests or evidence of chronic liver disease (CLD) or portal hypertension (PHTN) by radiological or endoscopic investigation, after exclusion of other causes. Patients with CVID-rLD were investigated and managed following a joint pathway between immunology and hepatology services. Data, including clinical parameters, investigations, and outcomes, were retrospectively collected.

Results:
A total of 91/218 (42%) patients had evidence of CVID-rLD, and 40/91 (44%) had PHTN. Patients with CVID-rLD were more likely to have other noninfectious complications of CVID (85/91, 93.4% vs. 75/127, 59.1%, p<0.001) including interstitial lung disease, gut disease, and autoimmune cytopenias. Nodular regenerative hyperplasia (NRH) was identified in 63.8% of liver biopsies, and fibrosis in 95.3%. Liver stiffness measurements (LSMs) were frequently elevated (median 9.95 kPa), and elevated LSM was associated with PHTN. All-cause mortality was higher in those with CVID-rLD (24/91, 26.4% vs. 14/127, 11%, p=0.003), which was the only organ complication associated with mortality (HR 2.24, 1.06–4.74, p=0.04). Factors predicting mortality in CVID-rLD included PHTN, increasing fibrosis, and LSM.

Conclusions:
Liver disease is a common complication of CVID as part of complex, multi-organ involvement and is associated with high rates of PHTN and an increased hazard of mortality.
Recurrent stroke shortly after mechanical thrombectomy secondary to carotid web: A case report
Authors: Yang Guo-Mei , Zhang Ren-Wei , Li Hua-Gang , Liu Yu-Min 
Published: December 2023

Rationale:
Carotid web, a known source of thrombus for embolic stroke, presents a considerable risk of stroke recurrence. While case reports have demonstrated the safety and effectiveness of mechanical thrombectomy in treating carotid web-related stroke, the need for concurrent carotid artery stenting to prevent recurrent stroke immediately after thrombectomy remains unclear. This study aims to underscore the importance of immediate carotid artery stenting in preventing recurrent stroke following mechanical thrombectomy in patients with carotid web-related stroke.

Patient concerns:
A 43-year-old woman with acute onset of left limb weakness and slurred speech within 3 hours was admitted to the emergency department.

Diagnoses:
Computed tomographic angiography confirmed the M1 segment occlusion of the right middle cerebral artery.

Interventions:
The patient received intravenous thrombolysis in the local hospital and mechanical thrombectomy in our stroke center.

Outcomes:
Three days post-mechanical thrombectomy, there was a sudden exacerbation of her neurological deficit symptoms. A reexamination via computed tomographic angiography revealed a re-occlusion in M1 segment of the right middle cerebral artery, despite the implementation of stringent anticoagulation therapy for carotid web-related stroke.

Lessons:
Stroke patients with carotid web had a high risk of stroke recurrence and it was necessary to conduct carotid artery stenting to prevent stroke recurrence secondary to the carotid web immediately after mechanical thrombectomy.
Primary hepatic lymphoma a case report and literature review
Authors: Jiang Minzhi , Jiang Shudian , Yang Yu , Yao Rucheng , Hu Mingzheng 
Published: December 2023

Rationale:
Primary hepatic lymphoma is a rare extranodal non-Hodgkin lymphoma that is primarily localized in the liver. It predominantly affects elderly males and presents with nonspecific laboratory findings, imaging results, and clinical symptoms, making diagnosis challenging. Histopathological examination serves as the gold standard for diagnosis, and treatment options include chemotherapy or surgical intervention combined with chemotherapy.

Patient concerns:
A 50-year-old male patient came to our hospital for treatment after finding a mass in his liver.

Diagnoses:
Laboratory tests and clinical symptoms lack specificity for primary hepatic lymphoma, and imaging findings can be difficult to differentiate. Pathology is the gold standard.

Outcomes:
The patient was dead.

Conclusion:
A definitive diagnosis primarily relies on histopathological examination, and surgical resection combined with chemotherapy yields better treatment outcomes.
Chronic kidney disease on the background of bardet–biedl syndrome: a case report and review of literature
Authors: Pokharel Pashupati , Pandey Uday , Sedai Samir , Khanal Kapil , Shrestha Midhan 
Published: December 2023

Introduction:
Bardet–Biedl syndrome (BBS) is a rare autosomal recessive multisystem disorder characterized by retinal dystrophy, obesity, postaxial polydactyly, renal dysfunction, learning difficulties, and hypogonadism. In this case report, the authors present the clinical course and management of a patient with BBS who developed chronic kidney disease (CKD).

Case presentation:
An 18-year-old male presented to the emergency department with chief complaints of fever, cough, vomiting, and decreased urine output for 7 days. Parents complained that the child had a delay in development compared to other children of the same age group. On examination, the patient had tachypnea, periorbital and pedal edema, expiratory wheeze with bilateral basal crackles, polydactyly, central obesity, microtestes, and delayed developmental milestones. Ultrasonography revealed bilateral small kidneys with increased cortical echotexture and loss of corticomedullary differentiation. Based on clinical features, the patient was diagnosed with CKD in the background of BBS. Hemodialysis was initiated after the diagnosis.

Discussion:
The management of CKD in the background of BBS poses unique challenges due to the complex multisystem involvement of this genetic disorder. There should be early reorganization and management of this condition so that the patient can have a better quality of life. Moreover, in developing countries like Nepal, genetic testing and diagnosis should be made easily accessible for better patient outcome.

Conclusion:
Multidisciplinary approach involving nephrologists, ophthalmologists, endocrinologists, and geneticists is important to optimize the treatment and long-term management of Badet Biedel patients.
Usefulness of the hybrid technique of interventional radiology and endoscopic treatment for intestinal bleeding after pancreaticoduodenectomy: a case report
Authors: Chiba Nobutaka , Nomura Yuri , Mizuochi Minori , Sato Jun , Saito Takeshi , Sakurai Atsushi , Kinoshita Kosaku 
Published: December 2023

Introduction and importance:
In endovascular treatment of ruptured pseudoaneurysm after pancreaticoduodenectomy (PD) with gastrointestinal bleeding, treatment for vasospasm of the culprit vessel from haemorrhagic shock and subsequent reperfusion has not been determined before.

Case presentation:
The authors hereby present you with a case of a 59-year-old man with unknown operative method upon arrival at the Emergecy room and who had hematemesis and collapse 6 months post-PD surgery.

Clinical discussion:
An initial contrast-enhanced computed tomography (CT) revealed no obvious source of bleeding, so an upper gastrointestinal endoscope was performed. Rebleeding occurred during the examination, and interventional radiology was performed because haemostasis was difficult. Coil embolization was performed for leakage of contrast material from the gastroduodenal artery stump into the gastrointestinal tract. However, because the embolization was uncertain due to vasospasm of the common hepatic artery, endoscopic clipping of the perforation site was also performed to prevent rebleeding due to reperfusion after improvement of vasospasm. A CT scan 5 days later showed reperfusion of the coil-implanted vessel. No rebleeding or hepatic infarction occurred postoperatively.

Conclusion:
In this case, the haemostasis by coil embolization was uncertain due to the presence of vasospasm, and clipping was used in combination with the procedure to prevent rebleeding.
Clustering of >145,000 Symptom Logs Reveals Distinct Pre, Peri, and Post Menopausal Phenotypes
Authors: Aras Shravan G. , Grant Azure D. , Konhilas John P. 
Published: December 2023

AbstractBackground and ObjectivesThe transition to menopause is commonly associated with disappearance of menstrual cycle symptoms and emergence of vasomotor symptoms. Although menopausal women report a variety of mood, digestive, and pain symptoms, it remains unclear what symptoms emerge prior to menopause, if symptoms occur in predictable clusters, how these clusters change from across the premenopause-perimenopause-menopause transition, or if distinct phenotypes are present within each life stage.MethodsWe present analysis of self-reported symptom presentation in premenopausal to menopausal women using the MenoLife app, which includes 4,789 (n=1,115(23%) premenopausal, n=1,388(29%) perimenopausal, n=2,286(48%) menopausal) individuals and 147,501 (n=27,371(19%) premenopausal, n=57,964(39%) perimenopausal, n=61,806(42%) menopausal) symptom logs. Clusters generated from logs of 45 different symptoms were assessed for similarities across methods: hierarchical clustering analysis (HCA), K-Means clustering of principal components of symptom reporting, and binomial network analysis. Participants were further evaluated based on menstrual cycle regularity or type of menopause.ResultsMenstrual cycle-associated symptoms (e.g., cramps, breast swelling), digestive, mood, and integumentary symptoms were characteristic of premenopausal women. Vasomotor symptoms, pain, mood, and cognitive symptoms were characteristic of menopause. Perimenopausal women exhibited both menstrual cycle-associated and vasomotor symptoms. Subpopulations across life stages presented with additional correlated mood and cognitive symptoms, integumentary complaints, digestive, nervous, or sexual symptoms. Symptoms also differed among women depending on the reported regularity of their menstrual cycles or the way in which they entered menopause. Notably, we identified a set of symptoms that were very common across life stages: fatigue, headache, anxiety, and brain fog. We consistently identified the lack of predictive power of hot flashes for other symptoms except night sweats.ConclusionsTogether, premenopausal women exhibit menstrual cycle-associated symptoms and menopausal women reported vasomotor symptoms, perimenopausal women report both; and all report high rates of fatigue, headache, anxiety, and brain fog. Limiting focus of menopausal treatment to vasomotor symptoms, or to premenstrual syndrome in premenopausal women, neglects a large proportion of overall symptom burden. Future research and interventions targeting mood and cognitive, digestive, and integumentary symptoms are needed across stages of female reproductive life.
Real-World Performance of the Alinity m STI Assay for the simultaneous detection of Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis in Clinical Specimens at a Large Tertiary Hospital System in the United States
Authors: Rexroth Karen C. , Kostera Joshua 
Published: December 2023

AbstractBackgroundIn the US, sexually transmitted infections (STI) are reported for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) but not Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG). TV and MG surveillance data in the US remains inadequate. We evaluated the performance of the fully automated, multi-plex PCR-based Alinity m STI assay, to simultaneously detect CT, NG, TV, and MG, at a large Veterans Affairs hospital system.Methods260 urine, urogenital, and extragenital clinical specimens were tested with the Alinity m STI assay and the results were compared to those from the Abbott RealTime CT/NG assay in our lab and TV and MG assays run at an external reference laboratory.ResultsAlinity m STI assay results for urine specimens had an overall percent agreement (OPA) with the RealTime comparator assay of 187/187 (100.0%) for CT and 186/187 (99.5%) for NG. For 20 rectal specimens, the OPA for CT was 95% and for NG was 100%; for 13 oral specimens, OPA was 100% for CT and 92.3% for NG. Of the urine specimens sent for TV and MG testing, 100% agreement was observed between the Alinity m STI assay and TV (n=104) and MG (n=30) comparator assay results.ConclusionsThe Alinity m STI assay is an easy-to-use, sensitive and specific assay that allows high-throughput testing for common and undertested STI pathogens to facilitate surveillance efforts.KEY MESSAGESWhat is already known on this topicMycoplasma genitalium and Trichomonas vaginalis are sexually transmitted infections, however, global prevalence data vary between geographical regions, as these sexually transmitted infections are not included in routine screening.What this study addsThis study aimed at assessing Trichomonas and Mycoplasma prevalence and association with a positive Chlamydia and/or Gonorrhoeae result.How this study might affect research, practice, or policyIncluding Mycoplasma genitalium and Trichomonas vaginalis testing in a routine screening STI diagnostic algorithm, with cost-effective and accurate multiplex assays can improve diagnosis to initiation of appropriate treatment.