bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals
Authors: Razimoghadam Mahya , Yaseri Mehdi , Effatpanah Mohammad , Daroudi Rajabali 
Published: January 2024

Abstract
Background
During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic.

Methods
The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR).

Results
1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals’ EDs.

Conclusion
In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.
Prediction of clinical progression in nervous system diseases: plasma glial fibrillary acidic protein (GFAP)
Authors: Zheng Xiaoxiao , Yang Jingyao , Hou Yiwei , Shi Xinye , Liu Kangding 
Published: January 2024

AbstractGlial fibrillary acidic protein (GFAP), an intracellular type III intermediate filament protein, provides structural support and maintains the mechanical integrity of astrocytes. It is predominantly found in the astrocytes which are the most abundant subtypes of glial cells in the brain and spinal cord. As a marker protein of astrocytes, GFAP may exert a variety of physiological effects in neurological diseases. For example, previous published literatures showed that autoimmune GFAP astrocytopathy is an inflammatory disease of the central nervous system (CNS). Moreover, the studies of GFAP in brain tumors mainly focus on the predictive value of tumor volume. Furthermore, using biomarkers in the early setting will lead to a simplified and standardized way to estimate the poor outcome in traumatic brain injury (TBI) and ischemic stroke. Recently, observational studies revealed that cerebrospinal fluid (CSF) GFAP, as a valuable potential diagnostic biomarker for neurosyphilis, had a sensitivity of 76.60% and specificity of 85.56%. The reason plasma GFAP could serve as a promising biomarker for diagnosis and prediction of Alzheimer's disease (AD) is that it effectively distinguished AD dementia from multiple neurodegenerative diseases and predicted the individual risk of AD progression. In addition, GFAP can be helpful in differentiating relapsing–remitting multiple sclerosis (RRMS) versus progressive MS (PMS). This review article aims to provide an overview of GFAP in the prediction of clinical progression in neuroinflammation, brain tumors, TBI, ischemic stroke, genetic disorders, neurodegeneration and other diseases in the CNS and to explore the potential therapeutic methods.
Treatment and prevention of epilepsy in onchocerciasis-endemic areas is urgently needed
Authors: Colebunders Robert , Siewe Fodjo Joseph Nelson , Kamoen Olivia , Amaral Luís-Jorge , Hadermann Amber , Trevisan Chiara , Taylor Mark J. , Gauglitz Julia , Hoerauf Achim , Sato Yasuaki , Polman Katja , Basáñez María-Gloria , Bhwana Dan , Lakwo Thomson , Abd-Elfarag Gasim , Pion Sébastien D. 
Published: January 2024

Abstract
Background
There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to provide an update on the new knowledge about OAE and to propose recommendations to the World Health Organization how to address this public health problem.

Main text
During the 2nd International Workshop on OAE held on 19–21 September, 2023, in Antwerp, Belgium, participants recognised OAE as a substantial yet neglected public health problem, particularly in areas of sub-Saharan Africa where onchocerciasis remains hyperendemic. Evidence from prospective population-based studies suggest that strengthening onchocerciasis elimination efforts leads to a significant reduction of OAE incidence. There is a need to validate an OAE case definition to estimate the burden of disease and identify onchocerciasis-endemic areas requiring intensification of onchocerciasis elimination programmes and integration of epilepsy care. It is expected that raising awareness about OAE will boost the population uptake of ivermectin. The implementation of a community-based epilepsy treatment programme offering free anti-seizure medications (ASMs) has shown high effectiveness in reducing the frequency of seizures and improving the overall quality of life of people with epilepsy.

Conclusions
To reduce OAE burden, enhanced collaboration between onchocerciasis and mental health programmes at community, national, and international levels is required. Urgent efforts are needed to ensure the uninterrupted provision of free ASMs in onchocerciasis-endemic areas. Furthermore, OAE should be included in the quantification of the onchocerciasis disease burden.

Graphical Abstract
A case series of sage: a new couple-based intervention for borderline personality disorder
Authors: Fitzpatrick Skye , Varma Sonya , Chafe David , Norouzian Nikoo , Traynor Jenna , Goss Sophie , Earle Elizabeth , Di Bartolomeo Alyssa , Siegel Ashley , Fulham Lindsay , Monson Candice M. , Liebman Rachel E. 
Published: January 2024

Abstract
Background
Research suggests that interpersonal dysfunction may be central to borderline personality disorder (BPD), and that the relationships of people with BPD are particularly impaired. Further, the significant others of people with BPD exhibit elevated psychological problems but little access to mental healthcare. Despite this, most BPD interventions are delivered individually and do not routinely incorporate significant others. This manuscript presents the first case series of Sage, a 12-session manualized intervention for people with borderline personality disorder (BPD) and their intimate partners with three targets: a) BPD severity, b) relationship conflict, and c) intimate partner mental health.

Findings
Five couples of people with BPD with frequent suicidal/self-injurious behavior or high suicidal ideation and their intimate partners received Sage. Measures of Sage targets as well as tertiary outcomes were administered at pre-, mid-, and post-intervention. Four out of five dyads completed Sage, with high intervention satisfaction ratings. Improvements were generally demonstrated in BPD severity, suicidal ideation, and suicidal behavior/self-injury. Half of dyads exhibited improvements in conflict, and additional improvements in mental health outcomes for dyad members were demonstrated. One dyad exhibited poor outcomes and speculations regarding this are offered.

Conclusions
Findings provide proof of concept of Sage as an intervention that can improve BPD and other mental health outcomes in those with BPD and their intimate partners. Incorporating intimate partners into BPD treatment may optimize and expedite its outcomes. However, further testing is needed.

Trial registration
This project was pre-registered at Clinicaltrials.gov (Identifier: [NCT04737252]).
Corrosion of aircraft heritage: a comparison between modern and historic Duralumin alloys
Authors: Martini Carla , Bernardi Elena , Velino Cecilia , Lorenzetti Luca , Balbo Andrea , Zanotto Federica , Brunet Magali , Robbiola Luc , Guilminot Elodie , Chiavari Cristina 
Published: January 2024

Abstract
The development of innovative solutions for the conservation and the protection of historic aircraft is a recent and important issue raised in the cultural heritage field and represents the goal of the PROCRAFT (Protection and Conservation of Heritage Aircraft) project. Assessing and documenting the constituent materials as well as their degradation state is necessary to determine and understand factors inducing aluminium alloy corrosion, in order to develop tailored conservation treatments and identify effective protective coatings. The first step of the project was the identification of the constituent materials of aircraft wrecks. Al-Cu-Mg alloys—Duralumin and Super Duralumin, with a higher content of Mg—were the most employed alloys for structural and non-structural parts. These materials undergo a wide range of alterations, amongst which pitting, exfoliation and galvanic corrosion.
In the present work, results of the characterisation of wrecks from a North American Republic P-47D Thunderbolt, crashed in Italy in 1945, are reported and compared to wrecks from a French Breguet 765 Sahara n°504 64-PH, built in 1958. The constituent alloys resulted to be similar to the modern 2024 and 2017A alloy.
In order to assess the representativeness of these modern alloys in simulating the corrosion behaviour of the historic ones, exfoliation susceptibility (ASTM G34) as well as non-destructive and destructive electrochemical tests in 0.1 M NaCl were carried out on both historic and modern alloys. These results contributed to the selection of representative substrates for the development of protective coatings as well as to the expansion of the dataset on composition and microstructure of historic Al alloys for aircraft.
Predicting occult lymph node metastasis in solid-predominantly invasive lung adenocarcinoma across multiple centers using radiomics-deep learning fusion model
Authors: Tian Weiwei , Yan Qinqin , Huang Xinyu , Feng Rui , Shan Fei , Geng Daoying , Zhang Zhiyong 
Published: January 2024

Abstract
Background
In solid-predominantly invasive lung adenocarcinoma (SPILAC), occult lymph node metastasis (OLNM) is pivotal for determining treatment strategies. This study seeks to develop and validate a fusion model combining radiomics and deep learning to predict OLNM preoperatively in SPILAC patients across multiple centers.

Methods
In this study, 1325 cT1a-bN0M0 SPILAC patients from six hospitals were retrospectively analyzed and divided into pathological nodal positive (pN+) and negative (pN-) groups. Three predictive models for OLNM were developed: a radiomics model employing decision trees and support vector machines; a deep learning model using ResNet-18, ResNet-34, ResNet-50, DenseNet-121, and Swin Transformer, initialized randomly or pre-trained on large-scale medical data; and a fusion model integrating both approaches using addition and concatenation techniques. The model performance was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC).

Results
All patients were assigned to four groups: training set (n = 470), internal validation set (n = 202), and independent test set 1 (n = 227) and 2 (n = 426). Among the 1325 patients, 478 (36%) had OLNM (pN+). The fusion model, combining radiomics with pre-trained ResNet-18 features via concatenation, outperformed others with an average AUC (aAUC) of 0.754 across validation and test sets, compared to aAUCs of 0.715 for the radiomics model and 0.676 for the deep learning model.

Conclusion
The radiomics-deep learning fusion model showed promising ability to generalize in predicting OLNM from CT scans, potentially aiding personalized treatment for SPILAC patients across multiple centers.
Ventriculo-atrial shunt with occlusion of the internal jugular vein: operative experience and surgical technique
Authors: Quintero Silvia Tatiana , Ramirez-Velandia Felipe , Hortua Moreno Andres Felipe , Vera Lina , Rugeles Paula , Azuero Gonzalez Rafael Augusto 
Published: January 2024

Abstract
Background
Ventricular shunts are one of the most frequent techniques used for the management of hydrocephalus. The ventriculoperitoneal shunt (VPS) is the most commonly performed procedure, and the ventriculoatrial shunt (VAS) is the second option in most medical centers. The main objective of this study is to introduce and describe a surgical approach for VAS outlining our experience and comparing it with traditional shunting techniques.

Methods
In this retrospective cohort comparison study, we included patients with hydrocephalus treated with a surgical procedure between January 2010 and February 2021 at a single academic institution. We categorized the procedures into two groups: patients with VPS and conventional VAS grouped together into the conventional technique (CT) group, and the second group was patients with whom we performed VAS with complete internal jugular vein occlusion (IJVOT). We compared the surgical time, postoperative complications, and occurrence of shunt failure among the groups by performing univariate analysis using the Fisher exact test.

Results
Out of the 106 patients included in the analysis, IJVOT was performed in 66 patients, and CT in 40 patients. The median surgical time was 60 min (IQR 60–90) for IJVOT versus 100 min (IQR 60–120) for CT (p < 0.01). In the follow-up a month after the procedure, 83.3% of patients with IJVOT and 62.5% of patients with CT did not require shunt removal or shunt revision (p < 0.01). Shunt revision rates were 12.5% and 1.5% for CT while 1.5% and 2.5% for IJVOT at 1 and 6 months after the procedure.

Conclusion
Our findings demonstrate that VAS with IJVOT is a safe method that exhibited shorter surgical times and outcomes comparable to CT. However, since the present study represents the first cohort evaluating IJVOT, it is imperative to conduct larger prospective studies, along with clinical trials, to fully explore and establish efficacy, long-term outcomes, and an in-depth comparison among shunting techniques.
P-39 Fictitious hyperestrogenism in perimenopause: Difficulties in diagnosis by laboratory pitfalls
Authors: Lopes Valentim , Brito Patrícia , Machado Catarina , De Sousa Lages Adriana 
Published: January 2024

Abstract

Introduction
Laboratory errors related to interfering substances can cause significant morbidity related to unnecessary investigations and interventions and patient anxiety. Estradiol (E2) is quantified mainly with competitive immunoassays. The prevalence of analytical interference can be up to 6% and is due to the impairment of the interaction between test antibody and analyte, causing falsely elevated levels. Nevertheless, interference due to heterophile antibody is extremely rare.

Clinical Case
A 51-year-old woman, normal weight, nulliparous, irrelevant previous medical history, menarche at 12 years old and regular menstrual cycles, was referred to the Endocrinology Department due to elevated E2 level. She was followed 4 years before in another institution with no formal diagnosis complaining of severe vasomotor symptoms, vaginal dryness and menometrorrhagias. She was on combined oral contraceptives for 10 years as a method of contraception, which she stopped two years ago. The first two E2 random values were 2362 and 3121 pmol/L, respectively when she had 47 and 49 years old. During our evaluation in January 2021, at the age of 51 years old, in the 4th day of her menstrual cycle, the laboratory evaluation revealed: FSH 9.56 mUI/mL (2.5-10.2), LH 5.43 mUI/mL (1.9-12.5), Prolactin 18.12 ng/mL (2.8-29.2), E2 3530.51 pmol/L (71.6-529.2), 17-Hydroxiprogesterone 0.52 ng/mL (0.32-1.47), DHEA-SO4 75.9 ug/dL (35-430), 4-Androstenedione 1 ng/mL (0.3-3.3) and SHBG 137 nmol/L (18-144). Transvaginal pelvic ultrasonography performed 15 days after menstrual period revealed 2 subserous leiomyomas, a 12 mm endometrial line and a right ovary with a pre-ovulatory follicle. CT scan of adrenal glands was unremarkable and a sellar MRI revealed a 4mm area of hypocaptation in the left region of the adenohypophysis. During this period the patient was treated with escitalopram 10 mg od, with vasomotor symptoms improvement. Two years later, after a 6-month period of amenorrhea, she repeated the analytical evaluation that revealed raised gonadotropins levels (FSH 102.12 mUI/mL, LH 25.37 mUI/mL), low progesterone 0.91 mUI/mL (&lt; 4.45) but maintained a largely elevated estradiol level (1128.01 pmol/L) with undetectable free Estriol (&lt; 0.10 ng/mL). This pattern motivated laboratorial review of blood samples by mass spectrometry and not by chemiluminescence as before. The value was substantially lower (447 pmol/L) hypothesizing the presence of heterophilic antibodies.

Conclusion
Although false E2 elevation due to analytical interference is rare, it must be suspected when results are discordant with the clinical picture and there is no evidence of neoplastic disease. Here, we report a case of falsely elevated E2 that led to prolonged investigation and major impact on a female's quality of life during the challenging period of perimenopause.
P-49 Unexpected spontaneous evolution of a symptomatic Rathke's cleft cyst
Authors: Elfekih Hamza , Gorchane Asma , Ach Taieb , Bnina Molka Ben , Abdessalem Fatma Ben , Ach Koussay , Maaroufi Amel , Abdelkrim Asma Ben , Chaieb Molka 
Published: January 2024

Abstract

Introduction
Rathke's cleft cysts (RCCs) are relatively rare sellar and suprasellar lesions that arise from remnants of Rathke's pouch, an embryonic precursor to the anterior pituitary gland. These cysts are often found incidentally during neuroimaging studies for unrelated issues. Despite their non-neoplastic nature, RCCs can lead to a spectrum of clinical manifestations due to their potential to compress surrounding structures, including the pituitary gland, optic chiasm, and adjacent neurovascular structures. However, the majority of Rathke's cysts will remain asymptomatic and typically do not necessitate any medical intervention. Instances of spontaneous regression of these cysts are infrequent, and cases of regression occurring after a recurrence are exceptionally rare.

Clinical Case
The patient is a 57-year-old individual with a medical history of well-controlled type 2 diabetes and high blood pressure. Additionally, the patient had a history of right ocular trauma in 1989 resulting in a decrease of visual acuity.
The patient presented with persistent chronic headaches, leading to the detection of a Rathke's cleft cyst as revealed by a pituitary MRI showing a cystic structure measuring 15×11 mm in the sellar region. The cyst displayed a predominant left-sided lateralization and was characterized by T1 hypointensity as well as T2 hyperintensity. No enhancement was observed on post-gadolinium contrast injection. The cyst exerted a mass effect on the optic chiasm. Hypophyseal axis assessment revealed intact function. Notably, the patient exhibited significant visual field impairment in the right eye, marked by loss of the superior, nasal, and inferior fields, while the right visual field remained unaffected. The patient was managed conservatively based on the rationale that the visual disturbances were attributed to the ocular trauma and not linked to the RCC. Follow-up hypothalamo-hypophysial MRI conducted in April 2023 demonstrated complete spontaneous regression of the Rathke's cleft cyst, with an improvement of his chronic headache.

Conclusion
The natural history of RCCs is multifaceted leading to heterogenous outcomes ranging from volume progression with hormonal deficiencies and/or visual disturbances to stability over time to even spontaneous involution. The precise mechanism underlying the latter remains unclear. One possible explanation could involve disruptions in the equilibrium between the secretion and absorption of the cystic fluid, or even the potential occurrence of cyst rupture.
The potential for involution or stability of the cyst is influenced by the cyst size. The likelihood of spontaneous involution advocates for a conservative strategy in cases of symptomatic RCCs where headaches are the sole presenting symptom.
P-68 Misdiagnosed calcitonin negative Medullary thyroid carcinoma as Hurthle cell thyroid adenoma with fine needle aspiration biopsy
Authors: Mucha Argjent , Stojkoska Ivana Mladenovska , Limani Valbon , Stefanoska Marija Toshevska , Amzai Gazmend , Bogatinoska Milena Srbinoska , Prosheva Tatjana Bajraktarova 
Published: January 2024

Abstract

Introduction
Medullary carcinoma is a rare thyroid carcinoma, that originates from the malignant proliferation of parafollicular C cells. Medullary thyroid cancer produces calcitonin, and elevated calcitonin level is an essential feature of this tumor, so, most of them are associated with high levels of calcitonin. Calcitonin-negative medullary carcinoma of the thyroid gland is an extremely rare entity and poorly understood primary neuroendocrine carcinoma that is characterized by classic medullary carcinoma of the thyroid morphology without raised serum calcitonin levels. Fine needle biopsy (FNAB) is a diagnostic test done in people with suspected thyroid cancer and it is very important for timely diagnosis and treatment of medullar thyroid cancer, especially when calcitonin levels are in normal range.

Clinical Case
A 35-year-old woman visited an endocrinologist due to swelling on the left side of the neck. Thyroid ultrasound showed hypoechogenic, heterogenous nodule in the left lobe with dimensions 29×28×35 mm and calcifications. Laboratory tests were normal: thyroid stimulating hormone (TSH) 3,0 mlU/ml; free T4 14,3 pmol/l; anti –thyroid peroxidase antibody (ATPO) 20IU/ml; human thyroglobulin 35IU/ml; calcitonin &lt;2 pg/ml; carcinoembryonic acid (CEA) 0.742ng/ml. The FNAB were performed, with cytological finding for classification group I. Four months after the first biopsy, the FNAB was repeated and Hürthle cells were found, with pronounced degenerative changes as well as pronounced cytological atypia, cytological findings correspond to classification group III. Computed tomography of the neck was performed preoperatively and it showed hypodense nodule (slightly smaller than 4 cm) with numerous calcifications, and no significantly enlarged lymph nodes. Left lobectomy was performed with histopathological findings for Medullary thyroid carcinoma. Immunohistochemical tumor cells were positive for chromogranin A, CD56, focally for thyroglobulin and CK 19, and negative for S-100 and NSE. RET gene mutation analysis was performed and it was negative. Additional diagnostic tests were performed for MEN2A and MEN 2B and they were excluded. Postoperative levels of calcitonin and CEA were in normal range.

Conclusion
Normal calcitonin levels do not exclude medullar carcinoma. Follow-up and monitoring of the patients with thyroid nodules is very important for timely diagnososis and treatment of medullar carcinoma.