bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of on-scene Glasgow Coma Scale with GCS-motor for prediction of 30-day mortality and functional outcomes of patients with trauma in Asia
Authors: Chien Yu-Chun , Chiang Wen-Chu , Chen Chi-Hsin , Sun Jen-Tang , Jamaluddin Sabariah Faizah , Tanaka Hideharu , Ma Matthew Huei-Ming , Huang Edward Pei-Chuan , Lin Mau-Roung ,   The PATOS Clinical Research Network
Published: December 2023

Background and importance
This study compared the on-scene Glasgow Coma Scale (GCS) and the GCS-motor (GCS-M) for predictive accuracy of mortality and severe disability using a large, multicenter population of trauma patients in Asian countries.

Objective
To compare the ability of the prehospital GCS and GCS-M to predict 30-day mortality and severe disability in trauma patients.

Design
We used the Pan-Asia Trauma Outcomes Study registry to enroll all trauma patients >18 years of age who presented to hospitals via emergency medical services from 1 January 2016 to November 30, 2018.

Settings and participants
A total of 16,218 patients were included in the analysis of 30-day mortality and 11 653 patients in the analysis of functional outcomes.

Outcome measures and analysis
The primary outcome was 30-day mortality after injury, and the secondary outcome was severe disability at discharge defined as a Modified Rankin Scale (MRS) score ≥4. Areas under the receiver operating characteristic curve (AUROCs) were compared between GCS and GCS-M for these outcomes. Patients with and without traumatic brain injury (TBI) were analyzed separately. The predictive discrimination ability of logistic regression models for outcomes (30-day mortality and MRS) between GCS and GCS-M is illustrated using AUROCs.

Main results
The primary outcome for 30-day mortality was 1.04% and the AUROCs and 95% confidence intervals for prediction were GCS: 0.917 (0.887–0.946) vs. GCS-M:0.907 (0.875–0.938), P = 0.155. The secondary outcome for poor functional outcome (MRS ≥ 4) was 12.4% and the AUROCs and 95% confidence intervals for prediction were GCS: 0.617 (0.597–0.637) vs. GCS-M: 0.613 (0.593–0.633), P = 0.616. The subgroup analyses of patients with and without TBI demonstrated consistent discrimination ability between the GCS and GCS-M. The AUROC values of the GCS vs. GCS-M models for 30-day mortality and poor functional outcome were 0.92 (0.821–1.0) vs. 0.92 (0.824–1.0) (P = 0.64) and 0.75 (0.72–0.78) vs. 0.74 (0.717–0.758) (P = 0.21), respectively.

Conclusion
In the prehospital setting, on-scene GCS-M was comparable to GCS in predicting 30-day mortality and poor functional outcomes among patients with trauma, whether or not there was a TBI.
Rare case in Somalia: Fahr’s syndrome
Authors: Adam Aisha M. , Sheikh Omar A. , Roble Miski A. , Yaşar Mehmet Z. , Mohamed Shukri S. , Kassim Mohamed M. 
Published: December 2023

Introduction and importance:
Fahr’s syndrome is primarily familial, autosomal dominant, and genetically diverse. Basal ganglia calcification that is bilaterally symmetrical is a hallmark of this illness. Although the specific origins of this illness are unknown, it may be brought on by problems with calcium metabolism, infections, toxins, hereditary factors, hypoparathyroidism, and pseudohypoparathyroidism. The prevalence of this syndrome is less than 0.5%.

Case presentation:
An 11-year-old female comes to the Emergency Department with her parents complaining of high-grade fever and convulsions for 1 week. Convulsion, which is a generalized tonic–clonic seizure, duration was ~5 min and associated with urinary incontinence and biting tongue. On examination, the patient was confused and irritable. Vital signs were normal; there is weakness in the right arm and right leg, associated with irregular movement. There was alternation in her level of consciousness, slurring of speech, and psychiatric symptoms. Another aspect of the neurological examination and systems was normal, and there was no meningeal irritation.

Clinical discussion:
The pathogenesis of Fahr’s syndrome is not completely known. The calcification is caused by flaws in the transport of radioactive particles and tissue damage caused by free radicals. Bilateral calcification found on a computed tomography (CT) scan of the brain, autosomal dominant inheritance, the absence of any infection, drugs, or toxins, the absence of mitochondrial dysfunction, and the presence of progressive neurological dysfunction is the clinical criteria for diagnosing Fahr’s syndrome.

Conclusion:
Basal ganglia calcification that is bilaterally symmetrical is a hallmark of Fahr’s syndrome. CT scans are the gold standard for conclusively diagnosing Fahr’s syndrome.
Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions
Authors: Fisher Steve R. , Halder Gabriela E. , Lee Mi Jung , Allen Lindsay , Kilic Gokhan S. 
Published: December 2023

(Abstracted from Urogynecology 2023;29:763–769)
Beyond impaired quality of life, the effects of urinary incontinence (UI) and overactive bladder (OAB) put older adults with this condition as at risk of social isolation, institutionalization, loss of independence, and injurious falls. Although the prevalence of older women with these conditions is reported as more than 30%, it is also believed that fewer than half of affected persons report bladder control problems to their health care providers.
Atypical Postmortem “Incaprettamento” After an Honor Homicide
Authors: Porzio Antonietta , Feola Alessandro , La Sala Francesco , Pietra Bruno Della , Campobasso Carlo Pietro 
Published: December 2023

Abstract
Honor killing is a murder carried out to protect the family's reputation by actions that are perceived as shameful. Usually, honor killing occurs to preserve family's honor, which has been violated by adulteries, premarital pregnancies, or inappropriate relationships. In Southern Italy, the culture of honor is quite strong especially among the local criminal organizations. Honor crimes by Italian Mafia are intended to have an admonitory significance, and they can be carried out following a macabre ritual of “incaprettamento.” The aim is to humiliate the victim treating him like an animal, a bonded young goat where the victim is secured by a rope passing behind the back from the upper to lower extremities. In this case study, the honor homicide was perpetrated against the lover of a butcher's wife by sharp weapon, followed by a postmortem atypical incaprettamento of the corpse. The wrists and ankles were tied together by ropes, and the extremities were fixed to the abdomen with a string. The body was also wrapped in a plastic tape after penile amputation. According to killer's confession, the mutilation and the incaprettamento were expressions of revenge and contempt for the victim to restore the honor lost.
A distinctive evolution of alveolar T cell responses is associated with clinical outcomes in unvaccinated patients with SARS-CoV-2 pneumonia
Authors: Markov Nikolay S. , Ren Ziyou , Senkow Karolina J. , Grant Rogan A. , Gao Catherine A. , Malsin Elizabeth S. , Sichizya Lango , Kihshen Hermon , Helmin Kathryn A. , Jovisic Milica , Arnold Jason M. , Pérez-Leonor Xóchitl G. , Abdala-Valencia Hiam , Swaminathan Suchitra , Nwaezeapu Julu , Kang Mengjia , Rasmussen Luke , Ozer Egon A. , Lorenzo-Redondo Ramon , Hultquist Judd F. , Simons Lacy M. , Rios-Guzman Estefany , Misharin Alexander V. , Wunderink Richard G. , Budinger G.R. Scott , Singer Benjamin D. , Morales-Nebreda Luisa ,   The NU SCRIPT Study Investigators
Published: December 2023

AbstractPathogen clearance and resolution of inflammation in patients with pneumonia require an effective local T cell response. Nevertheless, local T cell activation may drive lung injury, particularly during prolonged episodes of respiratory failure characteristic of severe SARS-CoV-2 pneumonia. While T cell responses in the peripheral blood are well described, the evolution of T cell phenotypes and molecular signatures in the distal lung of patients with severe pneumonia caused by SARS-CoV-2 or other pathogens is understudied. Accordingly, we serially obtained 432 bronchoalveolar lavage fluid samples from 273 patients with severe pneumonia and respiratory failure, including 74 unvaccinated patients with COVID-19, and performed flow cytometry, transcriptional, and T cell receptor profiling on sorted CD8+and CD4+T cell subsets. In patients with COVID-19 but not pneumonia secondary to other pathogens, we found that early and persistent enrichment in CD8+and CD4+T cell subsets correlated with survival to hospital discharge. Activation of interferon signaling pathways early after intubation for COVID-19 was associated with favorable outcomes, while activation of NF-κB-driven programs late in disease was associated with poor outcomes. Patients with SARS-CoV-2 pneumonia whose alveolar T cells preferentially targeted the Spike and Nucleocapsid proteins tended to experience more favorable outcomes than patients whose T cells predominantly targeted the ORF1ab polyprotein complex. These results suggest that in patients with severe SARS-CoV-2 pneumonia, alveolar T cell interferon responses targeting structural SARS-CoV-2 proteins characterize patients who recover, yet these responses progress to NF-κB activation against non-structural proteins in patients who go on to experience poor clinical outcomes.
Longitudinal associations between weight indices, cognition, and mental health from childhood to early adolescence
Authors: Li Zhaolong Adrian , Ray Mary Katherine , Gu Yueping , Barch Deanna M. , Hershey Tamara 
Published: December 2023

AbstractChildhood obesity has been associated with lower cognitive performance and worse mental health in cross-sectional studies. However, it is unclear whether these findings extend longitudinally and in what causal direction. Using data from the Adolescent Brain Cognitive Development (ABCD) Study (maximum analytical n = 6671, 48.3% girls, 42.8% non-White), we examined how body mass index (BMI) at baseline (ages 9-11) relate prospectively to changes in cognition or psychopathology across the 2 years thereafter, and vice versa. Cognitive tests included the National Institutes of Health Toolbox Cognition Battery, Little Man Task of mental rotation, and Rey Auditory Verbal Learning Test. Psychopathology was assessed using caregiver-reported Child Behavior Checklist. Linear mixed models adjusted for sociodemographic and developmental covariates indicated that lower baseline performance on most cognitive tests was associated with greater longitudinal BMI gain (eg, 1 point lower than median on Picture Vocabulary corresponded to 0.012 kg/m2[1.6%; 95% CI, 0.008 to 0.016 kg/m2] more annual BMI gain,PFDR< .001), whereas baseline BMI was unrelated to longitudinal changes in cognition (PFDR≥ .12; including after considering practice effects). Greater broad-spectrum psychopathology at baseline was associated with increased BMI gain (eg, each endorsement of externalizing problems than none corresponded to 0.015 kg/m2[2.2%; 95% CI, 0.009 to 0.021 kg/m2] more annual BMI gain,PFDR< .001) and, reciprocally, greater baseline BMI was linked specifically to more longitudinal withdrawn/depressed and depression problems (0.010 [22%; 95% CI, 0.004 to 0.016] and 0.011 [15%; 95% CI, 0.004 to 0.017] more problems annually per 1 kg/m2above median BMI,PFDR= .003 and .008). The associations did not differ in boys vs. girls (PFDR≥ .40), and remained stable with waist circumference as the weight index and in subgroups of participants without weight-altering medications or common baseline psychiatric diagnoses. Our longitudinal findings expand previous cross-sectional works and highlight the importance of cognitive and mental health to children’s weight development and links between weight and depression.
Major depression is not an inflammatory disorder: depletion of the compensatory immunoregulatory system is a hallmark of a mild depression phenotype
Authors: Maes Michael , Vasupanrajit Asara , Jirakran Ketsupar , Zhou Bo , Tunvirachaisakul Chavit , Almulla Abbas F. 
Published: December 2023

AbstractBackgroundMajor depression comprises two discrete subtypes, major (MDMD) and simple (SDMD) dysmood disorder. MDMD, but not SDMD, patients were identified to have highly sensitized cytokine/growth factor networks using stimulated whole blood cultures. However, no information regarding serum cytokines/chemokines/growth factors in SDMD is available.ObjectivesThis case-control study compares 48 serum cytokines/chemokines/growth factors in academic students with SDMD (n=64) and first episode (FE)-SDMD (n=47) to those of control students (n=44) using a multiplex assay.FindingsBoth FE-SDMD and SDMD exhibit a notable inhibition of immune profiles, such as the compensatory immunoregulatory response system (CIRS) and alternative M2 macrophage and T helper-2 (Th-2) profiles. We observed a substantial reduction in the serum concentrations of five proteins: interleukin (IL)-4, IL-10, soluble IL-2 receptor (sIL-2R), IL-12p40, and macrophage colony-stimulating factor. A significant proportion of the variability observed in suicidal behaviors (26.7%) can be accounted for by serum IL-4, IL-10, and sIL-2R (all decreased), and CCL11 (eotaxin) and granulocyte CSF (both increased). The same biomarkers (except for IL-10), accounted for 25.5% of the variance in SDMS severity. A significant correlation exists between decreased levels of IL-4 and elevated ratings of the brooding type of rumination.ConclusionsThe immune profile of SDMD and FE-SDMD exhibits a significant deviation from that observed in MDMD, providing additional evidence that SDMD and MDMD represent distinct phenotypes. SDMD is characterized by the suppression of the CIRS profile, which signifies a disruption of immune homeostasis and tolerance, rather than the presence of an inflammatory response.
Asymptomatic SARS-CoV-2 infections tend to occur less frequently in developed nations
Authors: Chowdhury Shreya , Tiwari Akshay , James Ananthu , Chatterjee Budhaditya , Dixit Narendra M. 
Published: December 2023

ABSTRACTUnlike severe infections, asymptomatic infections occur independently of healthcare access and reflect the natural immunity to SARS-CoV-2. What determines their prevalence,ψ, and its variation across nations is unknown. We conducted a systematic review of serosurveys performed on samples representative of national populations before vaccination and the emergence of variants. The studies that met our selection criteria together sampled 4,58,489 individuals and yielded estimates ofψin 33 nations. Using random-effects modeling, we found the pooled globalψto be 45.3% (95% CI: 33.6%-57.5%).ψvaried widely across nations (range: 6%-96%;I2=99.7%), highlighting the enormous underlying variation in the natural immunity to SARS-CoV-2. Performing meta-regression with national-level metrics, we found that the human development index (HDI) was negatively correlated withψ(p=10−13;R2=65.5%). More developed nations thus experienced less frequent asymptomatic infections on average. These findings have implications for unraveling the origins of asymptomatic infections and for future pandemic preparedness.
What influences ambulance clinician decisions to pre-alert Emergency Departments: a qualitative exploration of decision-making in three UK Ambulance Services
Authors: O’Hara Rachel , Sampson Fiona , Long Jaqui , Coster Joanne , Pilbery Richard 
Published: December 2023

ABSTRACTBackgroundAmbulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving Emergency Department or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ amongst ED staff. This research aims to provide a better understanding of pre-alert decision-making practice.MethodsSemi-structured interviews were conducted with 34 ambulance clinicians from three ambulance services and 40 ED staff from six receiving EDs. Observation (162 hours) of responses to pre-alerts (n=143, call-to-handover) was also conducted in the six EDs. Interview transcripts and observation notes were imported into NVIVO and analysed using thematic analysis.FindingsPre-alert decisions involve rapid assessment of clinical risk based on physiological observations, clinical judgement, and perceived risk of deterioration, with reference to pre-alert guidance. Clinical experience (pattern recognition and intuition) and confidence helped ambulance clinicians to understand which patients required immediate ED care upon arrival or were at highest risk of deterioration. Ambulance clinicians primarily learned to pre-alert ‘on the job’ and via informal feedback mechanisms, including the ED response to previous pre-alerts. Availability and access to clinical decision support was variable, and clinicians balanced the use of guidance and protocols with concerns about retention of clinical judgement and autonomy. Differences in pre-alert criteria between ambulance services and EDs created difficulties in deciding whether to pre-alert and was particularly challenging for less experienced clinicians.ConclusionWe identified potentially avoidable variation in decision-making, which has implications for patient care and emergency care resources, and can create tension between the services. Consistency in practice may be improved by greater standardisation of guidance and protocols, training and access to performance feedback, and cross-service collaboration to minimise potential sources of tension.
Explainable machine learning-based prediction of depression severity in medical students
Authors: Liu Dianhao , Chen Zequn , Marrero Wesley J. , Jacobson Nicholas C. , Thesen Thomas 
Published: December 2023

AbstractImportanceMedical students exhibit depression or depressive symptoms at a higher rate than the general population, with a potential for reduced academic performance and increased risk of suicide and physical health problems. Understanding the factors contributing to depression severity is critical for early detection and creating support systems personalized to the mental health challenges of medical students.ObjectiveTo predict and identify the key biopsychosocial factors influencing the severity of depression in medical students across the United States using explainable machine learning algorithms.DesignThis prognostic study is built upon survey data from the Healthy Minds Study student survey spanning the academic years of 2009 to 2021 across the US. Students’ depression severity is measured using the Patient Health Questionnaire-9 (PHQ-9).SettingAll undergraduate and graduate students from the American universities participating in the Healthy Minds Study are included in our study. While our target cohort is composed of medical students only, we include undergraduate and graduate students in our population to increase the size of our data during the machine learning training process.ParticipantsA total of 167,999 students completed the PHQ-9 inventory, including 2,174 medical students.Main Outcome and MeasurePrediction accuracy is measured by the mean absolute error across a previously unseen cohort of medical students. This metric estimates the average absolute difference between the predicted and actual responses of the general medical student population.ResultsBy testing several predictive machine learning algorithms, we found that a sequence of binary XGBoost models achieved the lowest mean absolute error amongst all interpretable algorithms. Depression severity was best predicted by factors in the following order of importance: 1. history of depressive diagnosis, 2. disordered eating behaviors, 3. current financial stress, and 4. younger age.Conclusions and RelevanceBy identifying predictors of student risk for developing depressive symptoms, our findings can help facilitate early identification of medical students at risk for developing depressive symptoms and providing them with early support and proactive strategies to prevent future depressive episodes.
cCMP and cUMP stimulate the acid phosphatase activity of AphA inHaemophilus influenzae
Authors: Kronborg Kristina , Zhang Yong Everett 
Published: December 2023

AbstractWe recently detailed the competitive inhibition of cyclic AMP (cAMP) on three periplasmic enzymes, AphA, NadN, and Hel, inHaemophilus influenzaeRd KW20. This inhibitory effect is vital for orchestrating the nutritional growth and competence development in KW20. Here, we extended the study to the three other second messengers, i.e., cyclic GMP, cyclic UMP, and cyclic CMP, each sharing structural similarities with cAMP. Notably, cGMP competitively inhibits AphA’s acid phosphatase activity akin to cAMP. In contrast, both cUMP and cCMP stimulate AphA’s phosphatase activity in a dose-dependent manner. This novel finding underscores the intriguing opposing effects of cyclic purine and pyrimidine nucleotides on AphA, suggesting potential intricate biological crosstalk among these second messengers.
DNA binding and bridging by human CtIP in the healthy and diseased states
Authors: Balaji Shreya Lokanathan , De Bragança Sara , Balaguer-Pérez Francisco , Northall Sarah , Wilkinson Oliver , Aicart-Ramos Clara , Seetaloo Neeleema , Sobott Frank , Moreno-Herrero Fernando , Dillingham Mark Simon 
Published: December 2023

AbstractThe human DNA repair factor CtIP helps to initiate the resection of double-stranded DNA breaks for repair by homologous recombination, in part through its ability to bind and bridge DNA molecules. However, CtIP is a natively disordered protein that bears no apparent similarity to other DNA-binding proteins and so the structural basis for these activities remains unclear. In this work, we have used bulk DNA binding, single molecule tracking, and DNA bridging assays to study wild-type and variant CtIP proteins to better define the DNA binding domains and the effects of mutations associated with inherited human disease. Our work identifies a monomeric DNA-binding domain in the C-terminal region of CtIP. CtIP binds non-specifically to DNA and can diffuse over thousands of nucleotides. CtIP-mediated bridging of distant DNA segments is observed in single-molecule magnetic tweezers experiments. However, we show that binding alone is insufficient for DNA bridging, which also requires tetramerization via the N-terminal domain. Variant CtIP proteins associated with Seckel and Jawad syndromes display impaired DNA binding and bridging activities. The significance of these findings in the context of facilitating DNA break repair is discussed.Significance StatementCtIP helps to repair broken chromosomes through its ability to bind and bridge DNA molecules. We studied the structural and biochemical basis for these activities and how they are affected by hereditary CtIP mutations associated with developmental disorders. We discovered a minimal domain in the C-terminal region of CtIP which supports DNA binding as a monomer. DNA binding is non-specific and facilitates 1D diffusion, but binding alone is insufficient for intermolecular tethering of DNA molecules which requires tetramerization of CtIP via N-terminal coiled-coil domains. All disease variants tested displayed impaired DNA bridging activity. These results have important implications for understanding the role of CtIP as a hub protein for DNA break repair and its dysfunction in human disease.