bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Spigelian Hernia and Spigelian-Cryptorchidism Syndrome: an Integrating Review
Authors: Arredondo Montero Javier , Rico-Jiménez María 
Published: January 2025

AbstractIntroductionSpigelian hernia (SH) is an aponeurotic defect, either acquired or congenital, in Spiegel’s semilunar line. SH is exceptional in pediatric patients.MethodsA comprehensive non-systematic review of the previous literature was conducted. Eligible studies were identified by searching the primary existing medical bibliography databases. Median and interquartile range or mean and standard deviation were used to describe quantitative variables and proportions for categorical variables. The Kruskal-Wallis, Mann-Whitney U, and Fisher’s exact tests were used to compare group variables. The Spearman, Pearson and Cramér’s V correlation analyses were used to assess the degree of correlation between the study variables. A p-value <0.05 (two tails) was considered statistically significant.ResultsEighty-two publications reporting 123 patients were included. Of these, 105 were male (85.4%). The age range was from 0 to 21 years. Forty-seven patients (38.2%) had a left-sided SH, and 13 (10.6%) had a bilateral SH. Forty-five cases (36.6%) were classified as traumatic, the majority attributable to bicycle-related injuries. Forty-one patients (33.3%) presented with a SH associated with undescended testis (UDT). A peak incidence around 7-9 years was identified for traumatic SH, and a concentration of cases before one year of age for SH associated with UDT. Fifteen patients (12.2%) were reported to have hernia incarceration/strangulation (I/S). These patients were significantly younger than those without I/S (p=0.02), but no gender differences were seen (p=0.63). In 95 patients (77.2%), surgical correction of the defect was reported. Fourteen were approached laparoscopically, with a 35.7% conversion rate. Eight (6.5%) were managed conservatively. Overall, the reported evolution has been favorable.ConclusionsHS is an uncommon condition in pediatric populations, predominantly affecting males. It can present congenitally, with a significant association with ipsilateral UDT, or it can be acquired, typically related to bicycle trauma involving the SL. The risk of incarceration is relatively high, particularly during early childhood. Most reported cases have been treated surgically, with favorable outcomes. Evidence regarding conservative management is limited.
Aflatoxin M1 exposure and nutritional status of breastfeeding children 0-6 months in Makueni County, Kenya
Authors: Ogallo Isaac O. , Kaindi Dasel W. M. , Abong’ George O. , Mwangi Alice M. 
Published: January 2025

AbstractAflatoxin exposure in breastfeeding children has yet to be extensively explored in the southeastern region of Kenya, which is prone to aflatoxin outbreaks, and the assessment of potential risks may be underestimated. We determined the aflatoxin exposure of children 0-6 months and the outcome of weight-for-age z-scores as part of a larger cross-sectional study involving 170 randomly selected mother-child dyads. A semi-structured questionnaire was used to collect information on breastfeeding practices. Children’s weights were also measured. Breast milk samples of 48 lactating mothers and their children’s urine were collected from households whose food samples were collected for aflatoxin analysis. Aflatoxin levels were determined using enzyme-linked immunosorbent assays. The Statistical Package Software for Social Sciences (version 27) and Palisade’s @Risk software were used for analysis.Exclusively breastfeeding children were 44.1% (75/170). The prevalence of aflatoxin M1 in breast milk was 77.1% (37/48) (concentration 35 ng/l;SD, 0.0), and the mean intake was 0.47 mg/kg b.w.t/day. All urine (100%) had aflatoxin M1 (mean 0.39 ng/ml (SD, 0.16). The exposure levels through breast milk were alarmingly high (margin of exposure < 10000) regardless of breastfeeding status, with complementary feeding potentially increasing the risks. Mothers’ diets significantly contributed to aflatoxin M1 in breast milk and urine (p= 0.01). Socioeconomic status, household size, and age of lactating mothers were not significant predictors of aflatoxin M1 exposure (p> 0.05). Aflatoxin M1 exposure did not influence the weight-for-age z-scores (pall> 0.05). The results indicate high exposure levels among children 0-6 months, and breastfeeding practices could be one of the under-evaluated risk factors.
Development of a Claims-Based Computable Phenotype for Ulcerative Colitis Flares
Authors: Copeland Daniel , Marwaha Jayson S. , Wong Daniel , Yuan William , Fakler Michelle N. , Kennedy Chris J. , Beaulieu-Jones Brendin , Poylin Vitaliy , Feuerstein Joseph , Brat Gabriel A. 
Published: January 2025

AbstractBackground and AimsSeveral conditions exist that do not have their own unique diagnosis code in widely-used clinical terminologies, making them difficult to track and study. Acute severe ulcerative colitis (ASUC) is one such condition. There is no automated method to identify patients admitted for ASUC from observational data, nor any specific billing or diagnosis code for ASUC. Accurate, automated, large-scale identification of hospital admissions for non-coded conditions like ASUC may enable further research into them.MethodsWe performed a retrospective cohort study of patients with a history of ulcerative colitis (UC) admitted to a single academic institution from 2014-2019. Clinicians at our institution performed a chart review of these admissions to determine if each was due to a true episode of ASUC or not. Logistic regression, random forest (RF), and support vector machine (SVM) models were trained upon administrative claims data for all admissions.Results268 ASUC admissions and 3,725 non-ASUC admissions among UC patients were included. Our RF model exhibited the best performance, correctly classifying 95.5% of admissions as either ASUC or non-ASUC, with a validation AUROC of 0.96 (95% CI 0.94-0.98; AUPRC 0.73). The model had a sensitivity of 81.5% and specificity of 96.5%. The five most important features in the model were endoscopy of sigmoid colon, length of stay, age, endoscopy of rectum, and abdominal x-ray.ConclusionsThere is currently no modality by which ASUC, which does not have its own unique diagnosis code, can be identified from claims databases in a scalable fashion for research or clinical purposes. We have developed a machine learning-based model that identifies clinically significant ASUC and reliably distinguishes them from admissions for non-ASUC reasons among UC patients. The ability to automatically curate large, accurate datasets of non-coded conditions like ASUC episodes can serve as the basis of large-scale analyses to maximize our ability to learn from real-world data, enable future research, and better understand these diseases.SummaryThere is currently no accurate way to identify, track, or study acute severe ulcerative colitis (ASUC) using administrative claims datasets. We have built a machine learning model to identify ASUC from claims data to enable large-scale studies on this condition.
Knowledge, Attitude and Practices (KAP) of Antimicrobial Usage in in Kisii County, Kenya
Authors: Babafemi Emmanuel O , Omasaki Simion K , Mogoko Edward , McCabe Philippa G 
Published: January 2025

AbstractBackgroundAntimicrobial stewardship (AMS) policy is critical in tackling antimicrobial resistance (AMR). The information is available at the national level in Kenya about AMS policy but needed to be strengthened among the health workers and facilities at the county level. The aim of this study was to conduct a baseline assessment of the Knowledge, Attitude and Practices (KAP) on Antimicrobial Prescription and its Resistance Among Health Care Providers in Resource Poor Settings using Kisii County, Kenya as case study.MethodsA paper-based survey was conducted among Public, Private Health facilities and Community Pharmacies in Kisii County between October and December 2023. The data collected from the respondents were put into Microsoft Excel spreadsheet for coding before being imported to RStudio for analysis.ResultsA total of 154 facilities across the 45 wards in Kisii County were included in the study. Most participants 111 (72%) agreed they have not received training and education on AMR and its implications on public health. Similarly,75 (49%) of the respondents said they have no formal procedures for all prescribers to conduct daily reviews of antibiotic selection until a definitive diagnosis and treatment duration are established. And that, they were not aware of AMS policy. However, they would be interested in workshops to educate them on AMR/AMS. Finally, on the level of awareness of the diagnosis and surveillance of AMR mechanisms, 248 (40%) responses said they were not or not very familiar with Methicillin-resistantStaphylococcus aureus(MRSA), Vancomycin-resistant Enterococci (VRE), Extended-Spectrum Beta-Lactamases (ESBLs), Carbapenemase-producing enterobacterales (CPE), Multidrug-resistant tuberculosis (MDR-TB) etc.ConclusionThis study found limited level of AMS implementation/uptake across all the facilities studied in Kisii County, Kenya. The study identified challenges that require urgent action in strengthening AMS policy. AMS training and education would be more effective if they are designed to specific healthcare specialties and communities/facilities in Kisii County.
Prevalence of Hyperglycemia in Pregnancy using early, standard and late screening: a study in the Primary Care Health in Lima, Peru
Authors: Seclén S.N. , Damas-Casani Lucy Nelly , Motta-Montoya Vicky Delia Cecilia , Jiménez-Martel Sandra Lesly , Yovera-Aldana Marlon 
Published: January 2025

AbstractObjectiveTo determine the prevalence of hyperglycemia in pregnancy (HIP) based on the timing of screening in pregnant women.Materials and MethodsA cross-sectional study was conducted on pregnant women recruited from February 2019 to August 2022 in four primary care centers in Lima, excluding those with known diabetes. Screening involved an Oral Glucose Tolerance Test with 75 g of glucose at the first contact. It was classified as early if performed before 24 weeks, standard between 24-28 weeks, and late if after 29 weeks. For gestational diabetes mellitus (GDM), we used the IADPSG diagnostic criteria for any gestational age. For diabetes in pregnancy (DIP), glucose levels over 126 mg/dl fasting or over 200 mg/dl at 2 hours post-load were used. We calculated prevalence ratios for GDM and DIP based on the type of screening.ResultsWe included 4,495 pregnant women with an average age of 29 years. The prevalence of HIP was 14.9%, GDM was 14.2%, and DIP was 0.7%. Early GDM screening showed a 23% higher prevalence compared to GDM screening at 24-28 weeks, adjusted for age (PR 1.23; 95% CI 1.01 – 1.49; p=0.036). No differences were found for DIP across screening types.ConclusionIn pregnant women at four primary centers in Lima, one in seven pregnant women (14.9%) had HIP, GDM was 14.2%, and DIP was 0.7%.. Early screening showed the highest proportion of GDM compared to standard or late screening. Longitudinal studies are needed to validate whether this higher early prevalence impacts maternal-perinatal complications.
A Randomized Controlled Trial Evaluating the Effect of Adalimumab Upon Pre-Clinical Biomarkers of Cardiovascular Disease in ACPA-Positive Rheumatoid Arthritis
Authors: Oakley Stephen P , Gibberd Alison J , Oldmeadow Christopher , Thomas Ranjeny , Nel Hanno , Esmaili Niloofar , Weston Lyanne 
Published: January 2025

ABSTRACTObjectivesRheumatoid arthritis (RA) is associated with elevated risk of cardiovascular (CV) events that has been attributed to inflammation although this is not well supported by randomised controlled trial (RCT) data. This RCT evaluated the effect of adalimumab upon endothelial function and arterial stiffness in ACPA-positive RA.MethodsSixty subjects with active ACPA-positive RA stratified as Early (<12 months n=30) or Established (>12 months n=30) were enrolled and randomised 1:1 within each group to receive 40 mg adalimumab or placebo. They were assessed by DAS28-CRP, Reactive Hyperaemic Index (RHI) and Carotid-Femoral Pulse Wave Velocity (CF-PWV) twice prior to treatment and then at 1, 4, 12 and 24 weeks with one final open-label at 36 weeks. Secondary analysis evaluated the effects of disease duration, Shared Epitope (SE) and smoking status.ResultsThere were significant treatment effects upon DAS28-CRP at weeks 1, 4 and 12 in Early RA with transient effects upon RHI at week 1 in Established RA and CF-PWV in Early RA at week 4. Area-under-the-curve analysis found positive treatment effects in subjects expressing one SE (DAS28-CRP p 0.031, CF-PWV p 0.034) and in non-smokers (DAS28-CRP p 0.096, CF-PWV p 0.033).ConclusionsThis RCT appeared to show positive treatment effects upon CV risk. However, the effect of adalimumab upon RHI may be type 1 statistical error and the effect upon CF-PWV more likely represents physiologic pain-driven mechanisms rather than structural effects. This study highlights the challenges, the limitations, strengths of and opportunities for CV biomarker research in this complex field.
Epigenetic attenuation of interferon signaling drives aging-related improvements in systemic lupus
Authors: Narendra Rithwik , Phan Hoang Van , Patterson Sarah L. , Almonte Loya Ana Laura , Lanata Cristina , Love Christina , Park Joonsuk , Lydon Emily C. , Shimoda Michiko Ametani , Barcellos Lisa , Mekonen Honey , Detweiler Angela , Deosthale Padmini , Neff Norma , Criswell Lindsey A. , Maliskova Lenka , Eckalbar Walter , Fragiadakis Gabriella , Yazdany Jinoos , Dall’Era Maria , Katz Patricia , Ye Chun Jimmie , Sirota Marina , Langelier Charles R. 
Published: January 2025

AbstractIn the general human population, aging is associated with a rise in systemic inflammation, primarily involving innate immune pathways related to interferon (IFN), toll-like receptor, and cytokine signaling. In systemic lupus erythematosus (SLE), a prototypical systemic autoimmune disease, aging is distinctly associated with improvements in disease activity, suggesting a unique relationship between aging and inflammation in this disease. Using a multi-omic approach incorporating transcriptional profiling, single cell RNA sequencing, proteomics and methylation analysis, we studied age-related changes in the immune profiles of 287 SLE patients between 20 and 83 years old, and compared the results against 928 healthy controls aged between 21 and 89 years old. In contrast to the increase in inflammatory gene expression that occurs with aging in most healthy adults, SLE patients exhibited the opposite. Most notable was a decrease in type I IFN signaling that was evident across multiple cell types, with CD56-dim natural killer (NK) cells, CD4+effector memory T cells, and naïve B cells exhibiting the most significant differences. We found that aging in SLE patients was also associated with decreased IFN-α2 and IFN-λ1 levels, and differential methylation of the genome. Notably, of the genes both downregulated and hypermethylated with older age, IFN-related genes were disproportionately represented, suggesting that age-related decreases in IFN signaling were driven in part by epigenetic silencing. Both SLE patients and healthy controls demonstrated age-related declines in naïve T cells and lymphoid progenitor cells, but only SLE patients demonstrated age-related increases in CD56-dim NK cells. Taken together, our work provides new insight into the phenomenon of inflammaging and the unique clinical improvement in disease activity that occurs in SLE patients as they age.
Knowledge and Awareness of Bovine Tuberculosis Associated with Raw Milk and Under-Cooked Meat Contamination Among Cattle Farmers in Selected Parts of Zambia
Authors: Phiri Anthony , Likulunga Emmanuel , Chauwa Adriace , Zulu Mildred , Kankhuni Beatrice , Monde Ngula , Malama Sydney 
Published: January 2025

ABSTRACTBackgroundBovine tuberculosis (bTB) is a disease of cattle that is transmitted through direct contact with an infected animal or ingestion of contaminated food.MethodsA mixed methods study was conducted in two districts of Zambia Lundazi and Monze from December 2021 to June 2022. A cross-sectional survey was conducted with 280 respondents, five focus group discussions, and five key informant interviews. Descriptive statistics were used to analyze quantitative data using R software while qualitative data was analyzed using Nvivo® and content analysis.ResultsSocial and cultural practices were reported to significantly contribute to bTB transmission with risky behaviors including the consumption of undercooked meat and unpasteurised milk, and inadequate protective measures during cattle slaughtering. Overall, 75.3% of male and 70.3% of female respondents expressed a poor level of awareness of bTB transmission. Among cattle farmers, 85.7% lacked formal education, resulting in low knowledge levels, with 99.5% expressing poor awareness. Additionally, findings revealed that 99.5% of cattle farmers had poor awareness of bTB, human doctors/clinicians, and veterinary/para-veterinarians had 100% excellent knowledge. Abattoir workers had good knowledge at 78.3% and cattle businessmen had a fair knowledge level at 96.4%. Overall, bTB awareness varied across occupations, with human and animal healthcare professionals being the most knowledgeable.ConclusionsOur study found low levels of awareness and misperception about bTB among cattle farmers. Awareness varied across professionals with educated individuals being more knowledgeable. The consumption of undercooked meat and raw milk highlighted these knowledge gaps. Therefore, it is crucial to conduct public health campaigns to raise awareness about bTB causes, sources of infection, and control measures.
Comparative Evaluation of Advanced AI Reasoning Models in Pediatric Clinical Decision Support: ChatGPT O1 vs. DeepSeek-R1
Authors: Mondillo Gianluca , Colosimo Simone , Perrotta Alessandra , Frattolillo Vittoria , Masino Mariapia 
Published: January 2025

AbstractIntroductionThe adoption of advanced reasoning models, such as ChatGPT O1 and DeepSeek-R1, represents a pivotal step forward in clinical decision support, particularly in pediatrics. ChatGPT O1 employs “chain-of-thought reasoning” (CoT) to enhance structured problem-solving, while DeepSeek-R1 introduces self-reflection capabilities through reinforcement learning. This study aimed to evaluate the diagnostic accuracy and clinical utility of these models in pediatric scenarios using the MedQA dataset.Materials and MethodsA total of 500 multiple-choice pediatric questions from the MedQA dataset were presented to ChatGPT O1 and DeepSeek-R1. Each question included four or more options, with one correct answer. The models were evaluated under uniform conditions, with performance metrics including accuracy, Cohen’s Kappa, and chi-square tests applied to assess agreement and statistical significance. Responses were analyzed to determine the models effectiveness in addressing clinical questions.ResultsChatGPT O1 achieved a diagnostic accuracy of 92.8%, significantly outperforming DeepSeek-R1, which scored 87.0% (p <0.00001). The CoT reasoning technique used by ChatGPT O1 allowed for more structured and reliable responses, reducing the risk of errors. Conversely, DeepSeek-R1, while slightly less accurate, demonstrated superior accessibility and adaptability due to its open-source nature and emerging self-reflection capabilities. Cohen’s Kappa (K=0.20) indicated low agreement between the models, reflecting their distinct reasoning strategies.ConclusionsThis study highlights the strengths of ChatGPT O1 in providing accurate and coherent clinical reasoning, making it highly suitable for critical pediatric scenarios.DeepSeek-R1, with its flexibility and accessibility, remains a valuable tool in resource-limited settings. Combining these models in an ensemble system could leverage their complementary strengths, optimizing decision support in diverse clinical contexts. Further research is warranted to explore their integration into multidisciplinary care teams and their application in real-world clinical settings.
Personalized circulating tumor DNA dynamics predict survival and response to immune checkpoint blockade in recurrent/metastatic head and neck cancer
Authors: Ruiz-Torres Daniel A. , Merkin Ross D. , Bryan Michael , Mendel Julia , Efthymiou Vasileios , Roberts Thomas , Patel Manisha , Park Jong C. , Chevalier Amber , Murray Clodagh , Gates Lisa , Pipinikas Christodoulos , Stott Shannon L. , Fisch Adam S. , Wirth Lori J. , Faden Daniel L. 
Published: January 2025

AbstractBackgroundRecurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is an aggressive cancer with a median overall survival of only 12 months. Existing biomarkers have limited ability to predict treatment response or survival, exposing many patients to the potential toxicity of treatment without certain clinical benefit. Circulating tumor DNA (ctDNA) has emerged as a non-invasive, real-time biomarker that could address these challenges.MethodsWe analyzed 137 plasma samples from 16 patients with R/M HNSCC undergoing immune checkpoint blockade (ICB)-based therapy. A tumor-informed, highly sensitive next-generation sequencing liquid biopsy assay (RaDaR, NeoGenomics Laboratories, Inc.) was applied to track ctDNA changes at baseline and throughout treatment. Univariable and multivariable analyses were used to assess the association between ctDNA negativity and key clinical outcomes: disease control (best objective response of stable disease, partial response, or complete response), three-year overall survival (OS), and three-year progression-free survival (PFS). We also assessed a machine learning model to predict disease progression based on ctDNA dynamics.ResultsMultivariable analysis revealed that ctDNA negativity during treatment was significantly associated with improved disease control (OR 21.7, 95% CI 1.86-754.88, p=0.0317), three-year OS (HR 0.04, 95% CI 0.00-0.47, p=0.0103), and three-year PFS (HR 0.03, 95% CI 0.00-0.37, p=0.0057). The machine learning model predicted disease progression with 88% accuracy (AUC 0.89).ConclusionSerial ctDNA monitoring predicted disease control, survival, and progression in patients with R/M HNSCC receiving treatment with ICB, suggesting that incorporation of ctDNA into clinical practice could enhance treatment decision-making for clinicians and improve patient outcomes.
Dementia risk factors and cognitive decline: Results from the 2023 Behavioral Risk Factor Surveillance System (BRFSS)
Authors: Adams Mary L. 
Published: January 2025

AbstractBackgroundThe potentially modifiable risk factors of obesity, diabetes, hypertension, smoking, physical inactivity, depression, hearing impairment, and excessive alcohol consumption, have been found to be associated with cognitive decline and dementia.ObjectiveTo study the association between subjective cognitive decline (SCD) among survey respondents and the 8 risk factors compared with other potential risks.MethodsUsing 2023 Behavioral Risk Factor Surveillance data from 155,112 respondents ages 45+ in 35 states with data on SCD the associations between the 8 dementia risk factors, separately and in a composite measure, plus other demographic and health measures were studied using Stata.ResultsSCD rates were 17.2% overall ranging from 11.0% to 23.9% across states while 81.9% of adults 45+ reported any of the 8 dementia risk factors. Adults with each of the risk factors had higher SCD rates compared with those without the risk factor, with SCD rates ranging from 8.4% for adults with 0 risks, 19.2% for any of the 8 risks, and 45.3% for those with 5 or more. Logistic regression confirmed most results with adjusted odds ratios (AORs) up to 6.0 for 5 or more risk factors, >3.1 for current long COVID and >1.2 for low education. Obesity was not confirmed as a separate risk and highest AOR for age was 1.2 for ages 75+ with 8 risk factors entered separately.ConclusionsResults suggest that prevention efforts for SCD, which can be a step toward dementia, should focus on 8 common potentially modifiable risk factors plus long COVID.