bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parkinson's disease and comorbid myasthenia gravis: a case report and literature review
Authors: Zhang Qihao , Xu Erhe , Li Hai-Feng , Chan Piu , Zhao Zhenzhen , Ma Jinghong 
Published: January 2024

BackgroundParkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. Myasthenia gravis (MG) is a rare autoimmune disease caused by antibodies against the neuromuscular junction. PD and comorbid MG are rarely seen.Case presentationHere we report on a patient who was diagnosed with PD and MG. A 74-year-old man had a 4-year history of bradykinesia and was diagnosed with PD. He subsequently developed incomplete palpebral ptosis, apparent dropped head, and shuffling of gait. The results of neostigmine tests were positive. Repetitive nerve stimulation (RNS) showed significant decremental responses at 3 and 5 Hz in the orbicularis oculi. The patient's anti-acetylcholine receptor (anti-AchR) antibody serum level was also elevated. Meanwhile, 9-[18F]fluoropropyl-(+)-dihydrotetrabenazine positron emission tomography–computed tomography (18F-AV133 PET-CT) scan revealed a significant decrease in uptake in the bilateral putamen. After addition of cholinesterase inhibitors, his symptoms of palpebral ptosis and head drop improved greatly and he showed a good response to levodopa.ConclusionAlthough PD with MG is rare, we still need to notice the possibility that a PD patient may have comorbid MG. The underlying mechanism of PD and comorbid MG remains unknown, but an imbalance between the neurotransmitters dopamine and acetylcholine and the immune system are likely to play significant roles in the pathogenesis. In this article, we present our case and a literature review on the co-occurrence of PD and MG, reviewing their clinical features, and discuss the underlying pathogenic mechanism of this comorbidity.
The association between high jugular bulb and mastoid pneumatization in adults
Authors: Chen Chenyu , Weng Simin , Chen Zhifeng , Chen Yuqing , Yao Guangnan , Huang Xiying , Gu Xi , Lin Chang 
Published: January 2024

PurposeThe purpose of this study was to analyze the relationship between the degree of high jugular bulb (HJB) and mastoid pneumatization using high-resolution computed tomography (HRCT).MethodsBetween April 2019 and June 2022, HRCT of the temporal bone was retrospectively analyzed in 1,025 patients. By excluding the other coexistent pathologies, 113 patients with HJBs were recruited for the study. The degree of the HJBs were defined as follows: Grade I, JB situated between inferior annulus of tympanic membrane and cochlear basal turn (CBT). Grade II, JB situated between CBT and lateral semicircular canal (LSC). Grade III, JB situated above LSC. The volume of mastoid pneumatization was based on HRCT images using a 3D reconstruction.ResultsThere were 32 male and 81 female subjects (mean age, 41.2 ± 14.0 years; age range, 18–80 years). The male group included 16 Grade I, 28 Grade II and 6 Group III HJB subjects. The female group included 38 Grade I, 62 Grade II and 31 Group III HJB cases. In the different groups of HJB, the mastoid cell volume differences were also not statistically significant (p = 0.165). In the classification, Grade II was most common (90/181, 49.7%).ConclusionThis study found no correlation between mastoid air cell volume and HJB, suggesting that HJB may not affect the mastoid air cell development and disease occurrence. These data must be considered exploratory, requiring more extensive cross-sectional studies.
Secondary outcomes of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder
Authors: Wang Bo , Skarphedinsson Gudmundur , Weidle Bernhard , Babiano-Espinosa Lucía , Wolters Lidewij , Arntzen Jostein , Skokauskas Norbert 
Published: January 2024

BackgroundObsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT’s broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD.MethodsThis open trial involved 25 pediatric patients with OCD (7−17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects.ResultsResults indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly post-treatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up.ConclusionA significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to post-treatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions.
Intracranial recordings reveal high-frequency activity in the human temporal-parietal cortex supporting non-literal language processing
Authors: Soni Shweta , Overton Jacqueline , Kam Julia W. Y. , Pexman Penny , Prabhu Akshay , Garza Nicholas , Saez Ignacio , Girgis Fady 
Published: January 2024

ObjectiveNon-literal expressions such as sarcasm, metaphor and simile refer to words and sentences that convey meanings or intentions that are different and more abstract than literal expressions. Neuroimaging studies have shown activations in a variety of frontal, parietal and temporal brain regions implicated in non-literal language processing. However, neurophysiological correlates of these brain areas underlying non-literal processing remain underexplored.MethodsTo address this, we investigated patterns of intracranial EEG activity during non-literal processing by leveraging a unique patient population. Seven neurosurgical patients with invasive electrophysiological monitoring of superficial brain activity were recruited. Intracranial neural responses were recorded over the temporal-parietal junction (TPJ) and its surrounding areas while patients performed a language task. Participants listened to vignettes that ended with non-literal or literal statements and were then asked related questions to which they responded verbally.ResultsWe found differential neurophysiological activity during the processing of non-literal statements as compared to literal statements, especially in low-Gamma (30–70 Hz) and delta (1–4 Hz) bands. In addition, we found that neural responses related to non-literal processing in the high-gamma band (&gt;70 Hz) were significantly more prominent at TPJ electrodes as compared to non-TPJ (i.e., control) electrodes in most subjects. Moreover, in half of patients, high-gamma activity related to non-literal processing was accompanied by delta-band modulation.ConclusionThese results suggest that both low- and high-frequency electrophysiological activities in the temporal-parietal junction play a crucial role during non-literal language processing in the human brain. The current investigation, utilizing better spatial and temporal resolution of human intracranial electrocorticography, provides a unique opportunity to gain insights into the localized brain dynamics of the TPJ during the processing of non-literal language expressions.
An interpretable machine learning model for stroke recurrence in patients with symptomatic intracranial atherosclerotic arterial stenosis
Authors: Gao Yu , Li Zi-ang , Zhai Xiao-yang , Han Lin , Zhang Ping , Cheng Si-jia , Yue Jun-yan , Cui Hong-kai 
Published: January 2024

Background and objectiveSymptomatic intracranial atherosclerotic stenosis (SICAS) is the most common etiology of ischemic stroke and one of the main causes of high stroke recurrence. The recurrence of stroke is closely related to the prognosis of ischemic stroke. This study aims to develop a machine learning model based on high-resolution vessel wall imaging (HR-VWI) to predict the risk of stroke recurrence in SICAS.MethodsThis study retrospectively collected data from 180 SICAS stroke patients treated at the hospital between 2020.01 and 2022.01. Relevant imaging and clinical data were collected, and follow-up was conducted. The dataset was divided into a training set and a validation set in a ratio of 7:3. We employed the least absolute shrinkage and selection operator (LASSO) regression to perform a selection on the baseline data, laboratory tests, and neuroimaging data generated by HR-VWI scans collected from the training set. Finally, five machine learning techniques, including logistic regression model (LR), support vector machine (SVM), Gaussian naive Bayes (GNB), Complement naive Bayes (CNB), and k-nearest neighbors algorithm (kNN), were employed to develop a predictive model for stroke recurrence. Shapley Additive Explanation (SHAP) was used to provide visualization and interpretation for each patient. The model’s effectiveness was evaluated using average accuracy, sensitivity, specificity, precision, f1 score, PR curve, calibration curve, and decision curve analysis.ResultsLASSO analysis revealed that “history of hypertension,” “homocysteine level,” “NWI value,” “stenosis rate,” “intracranial hemorrhage,” “positive remodeling,” and “enhancement grade” were independent risk factors for stroke recurrence in SICAS patients. In 10-fold cross-validation, the area under the curve (AUC) ranged from 0.813 to 0.912 in ROC curve analysis. The area under the precision-recall curve (AUPRC) ranged from 0.655 to 0.833, with the Gaussian Naive Bayes (GNB) model exhibiting the best ability to predict stroke recurrence in SICAS. SHAP analysis provided interpretability for the machine learning model and revealed essential factors related to the risk of stroke recurrence in SICAS.ConclusionA precise machine learning-based prediction model for stroke recurrence in SICAS has been established to assist clinical practitioners in making clinical decisions and implementing personalized treatment measures.
Folic acid supplements and perinatal mortality in China
Authors: Liu Xiaojing , Liu Xiaowen , An Hang , Li Zhiwen , Zhang Le , Zhang Yali , Liu Jianmeng , Ye Rongwei , Li Nan 
Published: January 2024

IntroductionPericonceptional use of multivitamins containing folic acid prevents external major birth defects, especially neural tube defects. We aimed to explore the effects of maternal folic acid supplementation alone on perinatal mortality with or without external major birth defects plus neural tube defects.MethodsFrom the China-US Collaborative Project for Neural Tube Defects Prevention, we identified 222, 303 singleton pregnancies with detailed information on periconceptional folic acid use, defined as folic acid supplementary before the last menstrual date until to the end of the first trimester. Perinatal mortality included stillbirths after 20 weeks’ gestation and early neonatal deaths within 7 days of delivery.ResultsAmong the fetuses or infants of women who did not take folic acid, the rate of perinatal mortality was 2.99% and 1.62% at least 20 weeks’ gestation in the northern and southern regions. Among the fetuses or infants of the women with periconceptional use of folic acid, the rates were 1.85% and 1.39% in the northern and southern region. The estimated relative risk for perinatal mortality [adjusted risk ratio (RR), 0.72; 95% confidence interval (CI), 0.61- 0.85], stillbirth (adjusted RR, 0.78; 95% CI, 0.64-0.96), early neonatal mortality (adjusted RR, 0.61; 95% CI, 0.45-0.82), and neonatal death (adjusted RR, 0.64; 95% CI, 0.49-0.83) in northern China was significantly decreased in association with periconceptional folic acid supplementation. Compared with northern, there was a lesser effect in southern China.ConclusionPericonceptional intake of 400μg folic acid daily reduces the overall risk perinatal mortality, as well as the risk from external major birth defects and neural tube defects, especially in northern China.
Characterizing the secretome of EGFR mutant lung adenocarcinoma
Authors: Luu Jennifer K. , Johnson Fraser D. , Jajarmi Jana , Sihota Tianna , Shi Rocky , Lu Daniel , Farnsworth Dylan , Spencer Sandra E. , Negri Gian Luca , Morin Gregg B. , Lockwood William W. 
Published: January 2024

BackgroundLung cancer is the leading cause of cancer related death worldwide, mainly due to the late stage of disease at the time of diagnosis. Non-invasive biomarkers are needed to supplement existing screening methods to enable earlier detection and increased patient survival. This is critical to EGFR-driven lung adenocarcinoma as it commonly occurs in individuals who have never smoked and do not qualify for current screening protocols.MethodsIn this study, we performed mass spectrometry analysis of the secretome of cultured lung cells representing different stages of mutant EGFR driven transformation, from normal to fully malignant. Identified secreted proteins specific to the malignant state were validated using orthogonal methods and their clinical activity assessed in lung adenocarcinoma patient cohorts.ResultsWe quantified 1020 secreted proteins, which were compared for differential expression between stages of transformation. We validated differentially expressed proteins at the transcriptional level in clinical tumor specimens, association with patient survival, and absolute concentration to yield three biomarker candidates: MDK, GDF15, and SPINT2. These candidates were validated using ELISA and increased levels were associated with poor patient survival specifically in EGFR mutant lung adenocarcinoma patients.ConclusionsOur study provides insight into changes in secreted proteins during EGFR driven lung adenocarcinoma transformation that may play a role in the processes that promote tumor progression. The specific candidates identified can harnessed for biomarker use to identify high risk individuals for early detection screening programs and disease management for this molecular subgroup of lung adenocarcinoma patients.
Quality of life and associated factors among patients with cancer receiving chemotherapy at Dessie Comprehensive Specialized Hospital, North-East Ethiopia: a cross-sectional study
Authors: Bayked Ewunetie Mekashaw , Yimam Mekdes Getachew , Yalew Zemen Mengesha , Toleha Husien Nurahmed , Zewdie Segenet 
Published: January 2024

BackgroundCancer is a major public health problem around the world. Cancer by itself and its treatment modalities affect the quality of life (QoL) of patients with it. However, there were a paucity of studies about the QoL of patients receiving chemotherapeutic treatment in Ethiopia. This study was aimed at addressing such a gap. Accordingly, we investigated QoL and associated factors among cancer patients receiving chemotherapy at Dessie Comprehensive Specialized Hospital (DCSH), North East Ethiopia, in 2023.MethodsWe employed a cross-sectional study from April 1 to May 30, 2023. The data was collected using the European Organization for Research and Treatment of Cancer Core QoL Questionnaire, version 3.0 (EORTC QLQ-C30). The data was entered and cleaned using EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 27 for analysis. The association between the dependent and independent variables was determined using Odds Ratios (ORs) at a p value &lt; 0.05 with a 95% CI.ResultsData was collected from 394 patients. Their mean summary QoL score was 36.3 ± 9.0. About 39.3% demonstrated a good QoL summary score, whereas 60.7% were impacted by symptoms. A good functional QoL score was observed in 42.6% of the participants. About 54.8% and 31.7% reported good overall health status and good overall QoL, respectively. The most impacted functional domain was social functioning, affecting 64.5% of participants. The most common symptom was diarrhea, affecting 65.5% of the participants. Secondary school education level (Adjusted Odds Ratio-AOR = 3.16, 95% CI: 1.14-8.81), diploma and above education level (AOR = 4.90, 95% CI: 1.29-18.62), and urban residency (AOR = 1.74, 95% CI: 1.07-2.82) had a significant positive association with QoL, while being a civil servant (AOR = 0.13, 95% CI: 0.04-0.49), having stage III cancer (AOR = 0.14, 95% CI: 0.05-0.39), and stage IV cancer (AOR = 0.16, 95% 0.06-0.44) had a significant negative association with it.ConclusionThe QoL for cancer patients undergoing chemotherapy was significantly low and associated with their level of education, occupational status, area of residence, and stage of cancer. Incorporating psychosocial support is thus crucial in their treatment plans.
Atypical presentations of UTUC: a case report of three patients
Authors: Guo Linfa , Bai Xiaojie , Tuoheti Kuerban , Wang Xiaolong , Liu Tongzu 
Published: January 2024

BackgroundUpper tract urothelial carcinoma (UTUC) is a rare clinical condition primarily characterized by symptoms such as gross or microscopic hematuria, flank pain, and renal colic. Although computed tomography urography (CTU) is currently the most accurate imaging modality for diagnosis, atypical presentations and physical examination findings can sometimes obscure lesions, posing diagnostic challenges.Case presentationIn this report, three patients exhibited atypical symptoms, sharing a common complaint of flank pain. Notably, the first patient, who had recently undergone laparoscopic right duplex nephrectomy, presented with microscopic hematuria, whereas the other two did not show any gross or microscopic hematuria. Computed tomography urography revealed hydronephrosis and infection without significant renal pelvic space-occupying lesions, with persistently elevated white blood cell (WBC) counts, but no fever. These atypical clinical presentations confounded clinicians, delaying the diagnosis of upper tract urothelial carcinoma until postoperative pathological examination for the first two patients and resulting in advanced-stage diagnosis for the third patient. Postoperative pathology confirmed high-grade invasive upper tract urothelial carcinoma in all three patients.ConclusionUpper tract urothelial carcinoma can manifest atypically without hematuria and may be challenging to visualize on computed tomography urography, potentially leading to misdiagnosis. Therefore, clinicians should maintain a high level of suspicion for malignant tumors when patients exhibit hydronephrosis, infection on imaging, and persistently elevated white blood cell counts without fever, even in the absence of typical signs of upper urothelial carcinoma on computed tomography urography.
“I want to be there. I have to be there.”: Parents’ perceived barriers and facilitators to bedside presence in the pediatric intensive care unit
Authors: Poole Emily I. , Ryan Molly , Walls Martha , Slumkoski Corey , Curran Janet A. , Seabrook Jamie A. , Foster Jennifer R. 
Published: January 2024

IntroductionParental presence at the bedside during a stressful pediatric intensive care unit (PICU) admission may improve child comfort, reduce parental anxiety, and enable family engagement. We performed this study to identify factors that parents perceive impact their capability, opportunity, and motivation to be at the bedside in PICU.MethodsWe conducted a qualitative descriptive study using semi-structured interviews based on the Theoretical Domains Framework (TDF). We included parents of children admitted to the PICU for at least 24 h at IWK Health in Nova Scotia, Canada. Interviews were coded independently by two researchers using a directed content approach based on the TDF. We generated themes and subthemes, with the subthemes identified as factors impacting parental presence, and assigned TDF domains to each of the subthemes.ResultsFourteen primary caregivers (8 mother figures, 6 father figures) participated in 11 interviews. The factors associated with parental presence were captured by 6 themes: Understanding the Medicalized Child; Maintaining the Parent Role; Life Beyond the Hospital; Parental Intrinsic Responses and Coping; Support Structures; and The PICU Environment. Fifty-two barriers and enablers were identified within 13 TDF domains; 10 TDF domains were determined to be relevant to parental presence, which may be used to guide design of future interventions. Participants emphasized the importance of self-care to enable them to remain physically at their child's bedside and to be engaged in their care.ConclusionsParents perceive multiple factors within 6 themes act as barriers or enablers to presence with their critically ill child in the PICU. Guided by relevant TDF domains, interventions may be designed to optimize presence, particularly engaged presence, which may improve health-related outcomes of children and their parents.