bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive fusariosis in patients with leukaemia in the era of mould-active azoles: increasing incidence, frequent breakthrough infections and lack of improved outcomes
Authors: Matsuo Takahiro , Wurster Sebastian , Jiang Ying , Sasaki Koji , Tarrand Jeffrey , Lewis Russell E , Kontoyiannis Dimitrios P 
Published: December 2023

Abstract

Objectives
Historically, patients with leukaemia and invasive fusariosis (IF) have experienced poor outcomes in the setting of persistent immunosuppression. Herein, we retrospectively reviewed the incidence, presentation and outcomes of IF that are scarcely studied in contemporary cohorts of leukaemia patients.

Methods
We identified adult leukaemia patients with proven or probable IF at MD Anderson Cancer Center during 2009–21. Independent risk factors for 42 day mortality after IF diagnosis were determined using a multivariable logistic regression model. Combined with historical data, the annual IF incidence density over the past 23 years was estimated using Poisson regression analysis.

Results
Among 140 leukaemia patients with IF (114 proven), 118 patients (84%) had relapsed/refractory leukaemia and 124 (89%) had neutropenia at IF diagnosis. One hundred patients (71%) had pulmonary IF, 88 (63%) had disseminated IF and 48 (34%) had fungaemia. Coinfections were common (55%). Eighty-nine patients (64%) had breakthrough IF to mould-active triazoles. Most patients (84%) received combination antifungal therapy. Neutrophil recovery [adjusted OR (aOR), 0.04; 95% CI, 0.01–0.14; P &lt; 0.0001], pulmonary IF (aOR, 3.28; 95% CI, 1.11–9.70; P = 0.032) and high SOFA score (aOR, 1.91 per 1-point increase; 95% CI, 1.47–2.50; P &lt; 0.0001) were independent predictors of 42 day mortality outcomes. From 1998 to 2021, IF incidence density increased significantly at an annual ratio of 1.03 (95% CI, 1.01–1.06; P = 0.04).

Conclusions
IF is predominantly seen in patients with relapsed/refractory leukaemia and increasingly seen as a breakthrough infection to mould-active triazoles. Despite frequent combination antifungal therapy, high mortality rates have persisted in patients with lasting neutropenia.
Disease- and stage-specific alterations of the oral and fecal microbiota in Alzheimer's disease
Authors: Troci Alba , Philippen Sarah , Rausch Philipp , Rave Julius , Weyland Gina , Niemann Katharina , Jessen Katharina , Schmill Lars-Patrick , Aludin Schekeb , Franke Andre , Berg Daniela , Bang Corinna , Bartsch Thorsten 
Published: December 2023

Abstract
Microbial communities in the intestinal tract are suggested to impact the ethiopathogenesis of Alzheimer's disease (AD). The human microbiome might modulate neuroinflammatory processes and contribute to neurodegeneration in AD. However, the microbial compositions in patients with AD at different stages of the disease are still not fully characterized. We used 16S rRNA analyses to investigate the oral and fecal microbiota in patients with AD and mild cognitive impairment (MCI; n = 84), at-risk individuals (APOE4 carriers; n = 17), and healthy controls (n = 50) and investigated the relationship of microbial communities and disease-specific markers via multivariate- and network-based approaches. We found a slightly decreased diversity in the fecal microbiota of patients with AD (average Chao1 diversity for AD = 212 [SD = 66]; for controls = 215 [SD = 55]) and identified differences in bacterial abundances including Bacteroidetes, Ruminococcus, Sutterella, and Porphyromonadaceae. The diversity in the oral microbiota was increased in patients with AD and at-risk individuals (average Chao1 diversity for AD = 174 [SD = 60], for at-risk group = 195 [SD = 49]). Gram-negative proinflammatory bacteria including Haemophilus, Neisseria, Actinobacillus, and Porphyromonas were dominant oral bacteria in patients with AD and MCI and the abundance correlated with the cerebrospinal fluid biomarker. Taken together, we observed a strong shift in the fecal and the oral communities of patients with AD already prominent in prodromal and, in case of the oral microbiota, in at-risk stages. This indicates stage-dependent alterations in oral and fecal microbiota in AD which may contribute to the pathogenesis via a facilitated intestinal and systemic inflammation leading to neuroinflammation and neurodegeneration.
‘Insight’ in medical training: what, why, and how?
Authors: Ng Isaac K S , Lin Norman H Y , Goh Wilson G W , Teo Desmond B , Tan Li Feng , Ban Kenneth H K 
Published: December 2023

AbstractThe term ‘insight’ is generically defined in English language as the ability to perceive deeper truths about people and situations. In clinical practice, patient insight is known to have important implications in treatment compliance and clinical outcomes, and can be assessed clinically by looking for the presence of illness awareness, correct attribution of symptoms to underlying condition, and acceptance of treatment. In this article, we suggest that cultivating insight is actually a highly important, yet often overlooked, component of medical training, which may explain why some consistently learn well, communicate effectively, and quickly attain clinical competency, while others struggle throughout their clinical training and may even be difficult to remediate. We herein define ‘insight’ in the context of medical training as having an astute perception of personal cognitive processes, motivations, emotions, and ability (strengths, weaknesses, and limitations) that should drive self-improvement and effective behavioural regulation. We then describe the utility of cultivating ‘insight’ in medical training through three lenses of (i) promoting self-regulated, lifelong clinical learning, (ii) improving clinical competencies and person-centred care, and (iii) enhancing physician mental health and well-being. In addition, we review educational pedagogies that are helpful to create a medical eco-system that promotes the cultivation of insight among its trainees and practitioners. Finally, we highlight several tell-tale signs of poor insight and discuss psychological and non-psychological interventions that may help those severely lacking in insight to become more amenable to change and remediation.
Phenotypic Fungicide Resistance and Cross-Resistance Among Nothopassalora personata Populations
Authors: Renfroe-Becton Hope , Croft Jonathan , Davis Charles , Varn Joe , Culbreath Albert K. , Langston David B. , Anco Daniel J. 
Published: December 2023

Late leaf spot, caused by Nothopassalora personata, is an economically important disease of peanut that routinely requires several applications of preventative fungicides. The objectives of this study were to quantify the risk of phenotypic fungicide resistance and potential cross-resistance among N. personata populations. A total of 59 samples of N. personata isolates were collected from 28 grower or research fields in South Carolina, Georgia, and Virginia. Phenotypic resistance of isolates was evaluated against 14 fungicides and a nontreated control, with active ingredients from the quinone outside inhibitor, demethylation inhibitor, and succinate-dehydrogenase inhibitor (SDHI) classes. Overall, visual incidence of lesion development 15% or greater was observed with nearly all isolates for at least one of the active ingredients tested. Correlations between active ingredients penthiopyrad and pydiflumetofen, as well as bixafen plus flutriafol and pydiflumetofen, and their lesion development risk indicate potential N. personata populations with SDHI cross-resistance. Although these data do not confirm the presence of genetic resistance markers, results paired with observed reduced efficacy in the field reinforce the strong need for an integrated approach in managing late leaf spot. In areas with high probabilities for resistance to several modes of action, longer rotations out of peanut, varieties with greater levels of resistance, earlier planting, and continued incorporation of active ingredients with a multi-site mode of action in fungicide programs are advised for preserving fungicide efficacy or reducing selection pressure. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
A Pilot Study of a Finger Kinematic Parameter-Based Tool for Evaluating Degenerative Cervical Myelopathy
Authors: Li Xingyu , Wang Hui , Xu Zeng , Lu Zhengzhong , Zhang Wenyu , Wang Yunhao , Wang Jianxi , Zang Fazhi , Yuan Wen , Chen Huajiang , Wu Xiaodong 
Published: December 2023

Study Design.This is a cross-sectional study.Objective.To evaluate the effectiveness of a novel finger Kinematic Parameter-Based Tool in grip-and-release (G&R) test for assessing degenerative cervical myelopathy (DCM).Summary of Background Data.The development and progression of DCM symptoms are gradual and obscure. Although previous studies have objectively evaluated hand movements specific to myelopathy using the G&R test, virtual reality, or wearable sensors, these methods have limitations, such as limited discrimination or inconvenience for simple screening. Consequently, there is a need to develop effective screening methods.Methods.297 asymptomatic volunteers and 258 DCM patients were enrolled. This system comprises a wearable acceleration/gyro (A/G) sensor. The A/G sensor was placed on the little finger of the participants to perform 40 cycles of full-range G&R as quickly as possible. The collected data were then transformed into kinematic parameters using sensor-based software and R studio. Gender, age, and BMI subgroups (classified as BMI<18.5—below normal weight; 18.5≤BMI<25—normal weight group; BMI≥25—overweight group) were matched as predictor variables, and 201 pairs were matched. Non-parametric analysis using the Mann-Whitney U test was used for diagnosing the differences between the two groups, and the Kruskal-Wallis’s test followed by the Mann-Whitney U test was used for analyzing the differences among three different age groups (<40 yrs., 41-60 yrs. and >60 yrs. group). The cut-off value of 10s G&R cycles and a combined parameter were determined using receiver operating characteristics (ROC) curve analysis, area under the curve (AUC) and Youden index.Results.We found that little finger kinematic parameters were significantly lower in DCM patients than in asymptomatic participants. The optimal diagnostic indicator appeared to be the average top 10 linear accelerations with an AUC of 0.923.Conclusion.The Finger Kinematic Test System is an objective, practical and quantitative utility that appears to have the capacity to diagnose and evaluate the severity of DCM.Level of Evidence.3
Application of Global Leadership Initiative on Malnutrition criteria in patients with liver cirrhosis
Authors: Jiang Minjie , Chen Juan , Wu Muchen , Wu Jing , Xu Xiaotong , Li Juan , Liu Can , Zhao Yaping , Hua Xin , Meng Qinghua 
Published: December 2023

AbstractBackground:The Global Leadership Initiative on Malnutrition (GLIM) criteria were published to build a global consensus on nutritional diagnosis. Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria. However, there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings. This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition, as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.Methods:This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1, 2018, and February 28, 2022, at Beijing You-An Hospital, Capital Medical University. Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography (CT) examination during hospitalization were included in the study. These patients were randomly divided into a modeling group (cohort 1, 667 patients) and a validation group (cohort 2, 335 patients). In cohort 1, optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index (L3-SMI) were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups. Next, patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. Additionally, the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1. Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.Results:The optimal cut-off values of L3-SMI were 39.50 cm2/m2for male patients and 33.06 cm2/m2for female patients. Based on the cut-off values, 31.63% (68/215) of the male patients and 23.3% (28/120) of the female patients had CT-determined sarcopenia in cohort 2. The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3% (115/335) and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis (Wald= 6.347,P = 0.012).Conclusions:This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis. These reference values will contribute to applying the GLIM criteria in cirrhotic patients.
Comparing the impact of three-dimensional digital visualization technology versus traditional microscopy on microsurgeons in microsurgery: a prospective self-controlled study
Authors: Xu Andi , Yao Ying , Chen Wenben , Lin Yuanfan , Li Ruiyang , Wang Ruixin , Pan Liuqing , Ye Qingqing , Pang Yangfei , Wu Xiaohang , Lin Duoru , Zhao Lanqin , Jin Ling , Shao Hang , Liu Wei , Gao Kun , Zhang Xin , Yan Pisong , Deng Xinpei , Wang Dongni , Huang Weiming , Zhang Xulin , Dongye Meimei , Li Jinrong , Lin Haotian 
Published: December 2023

Background:
Emerging three-dimensional digital visualization technology (DVT) provides more advantages than traditional microscopy in microsurgery; however, its impact on microsurgeons’ visual and nervous systems and delicate microsurgery is still unclear, which hinders the wider implementation of DVT in digital visualization for microsurgery.

Methods and material:
Forty-two microsurgeons from the Zhongshan Ophthalmic Center were enrolled in this prospective self-controlled study. Each microsurgeon consecutively performed 30 min conjunctival sutures using a three-dimensional digital display and a microscope, respectively. Visual function, autonomic nerve activity, and subjective symptoms were evaluated before and immediately after the operation. Visual functions, including accommodative lag, accommodative amplitude, near point of convergence and contrast sensitivity function (CSF), were measured by an expert optometrist. Heart rate variability was recorded by a wearable device for monitoring autonomic nervous activity. Subjective symptoms were evaluated by questionnaires. Microsurgical performance was assessed by the video-based Objective Structured Assessment of Technical Skill (OSATS) tool.

Results:
Accommodative lag decreased from 0.63 (0.18) diopters (D) to 0.55 (0.16) D (P=0.014), area under the log contrast sensitivity function increased from 1.49 (0.15) to 1.52 (0.14) (P=0.037), and heart rate variability decreased from 36.00 (13.54) milliseconds (ms) to 32.26 (12.35) ms (P=0.004) after using the DVT, but the changes showed no differences compared to traditional microscopy (P>0.05). No statistical significance was observed for global OSATS scores between the two rounds of operations [mean difference, 0.05 (95% CI: −1.17 to 1.08) points; P=0.95]. Subjective symptoms were quite mild after using both techniques.

Conclusions:
The impact of DVT-based procedures on microsurgeons includes enhanced accommodation and sympathetic activity, but the changes and surgical performance are not significantly different from those of microscopy-based microsurgery. Our findings indicate that short-term use of DVT is reliable for microsurgery and the long-term effect of using DVT deserve more consideration.
Postoperative results, learning curve, and outcomes of pancreatectomy with arterial resection: a single-center retrospective cohort study on 236 procedures
Authors: Napoli Niccolò , Kauffmann Emanuele F. , Lombardo Carlo , Ginesini Michael , Di Dato Armando , Lami Lucrezia , Annunziata Elena , Vistoli Fabio , Campani Daniela , Cappelli Carla , Amorese Gabriella , Boggi Ugo 
Published: December 2023

Background:
Newer chemotherapy regimens are reviving the role of pancreatectomy with arterial resection (PAR) in locally advanced pancreatic cancer. However, concerns about the early outcomes and learning curve of PAR remain. This study aimed to define the postoperative results and learning curve of PAR and provide preliminary data on oncologic outcomes.

Materials and methods:
A single center’s experiences (1993–2023) were retrospectively analyzed to define the postoperative outcomes and learning curve of PAR. Oncologic results were also reported.

Results:
During the study period 236 patients underwent PAR. Eighty PAR (33.9%) were performed until 2012, and 156 were performed thereafter (66.1%). Pancreatic cancer was diagnosed histologically in 183 patients (77.5%). Induction therapy was delivered to 18 of these patients (31.0%) in the early experience and to 101 patients (80.8%) in the last decade (P<0.0001). The superior mesenteric artery (PAR-SMA), celiac trunk/hepatic artery (PAR-CT/HA), superior mesenteric/portal vein, and inferior vena cava were resected in 95 (40.7%), 138 (59.2%), 189 (80.1%), and 9 (3.8%) patients, respectively. Total gastrectomy was performed in 35 (18.5%) patients. The 30-day mortality rate was 7.2% and 90-day mortality rate was 9.7%. The learning curve for mortality was 106 PAR [16.0 vs. 4.6%; odds ratio, OR=0.25 (0.10–0.67), P=0.0055]. Comparison between the PAR-SMA and PAR-CT/HA groups showed no differences in severe postoperative complications (25.3 vs. 20.6%), 90-day mortality (12.6 vs. 7.8%), and median overall survival. Vascular invasion was confirmed in 123 patients (67.2%). The median number (interquartile range) of examined lymph nodes was 60.5 (41.3–83) and rate of R0 resection was 66.1% (121/183). Median overall survival for PAR was 20.9 (12.5–42.8) months, for PAR-SMA was 20.2 (14.4–44) months, and for PAR-CT/HA was 20.2 (11.4–42.7). Long-term prognosis improved by study decade [1993–2002: 12.0 (5.4–25.9) months, 2003–2012: 15.1 (9.8–23.4) months, and 2013–present: 26.2 (14.3–51.5) months; P<0.0001].

Conclusions:
In recent times, PAR is associated with improved outcomes despite a steep learning curve. Pancreatic surgeons should be prepared to face the technical challenge posed by PAR.
From early risk to 1-year mortality: a comprehensive assessment of postoperative venous thromboembolism in upper gastrointestinal cancer patients – a nationwide cohort study
Authors: Thereaux Jérémie , Badic Bogdan , Fuchs Basile , Leven Cyril , Caillard Anais , Lacut Karin , Metges Jean-Philippe , Couturaud Francis 
Published: December 2023

Background:
Venous thromboembolism (VTE) is a well-recognized complication following gastrointestinal cancer surgery, particularly early postoperatively. The incidence and risk factors of VTE within 1-year after esophageal (including esophago-gastric junction) (ECS) and gastric (GCS) cancer surgeries, and especially its impact on 1-year global mortality, are yet under-explored.

Methods:
This nationwide observational population-based cohort study used data extracted from all patients undergoing ECS and GCS in France between 1 January 2015 and 31 December 2017. Multivariate logistic regression was used to identify risk factors for 90 postoperative days (POD) VTE (OR 95% CI). Cox proportional hazards models investigated the impact of 1-year postoperative VTE on 1-year global mortality [HR (95% CI)].

Results:
During the study period, 8005 patients underwent ECS (N=3429) or GCS (N=4576) (31.8% female; 66.7±12.1 years old). Majority (N=4951) of patients had preoperative treatment (chemotherapy or radiochemotherapy). Ninety POD incidence of VTE were 4.7% (ECS=6.2%) (GCS=3.6%) (44.7% during first hospitalization, 19.0% needing readmission, and 36.3% ambulatory management). Main risk factors were three and two field esophagectomy [3.6 (2.20–5.83) and 2.2 (1.68–3.0)], obesity [1.9 (1.40–2.58)] and history of VTE [5.1 (2.72–9.45)]. Late-onset VTE rates (occurring between the 6th and 12th month) represented 1.80 and 1.46% of the overall ECS and GCS groups. Patients with VTE within 1-year had higher risks of 1-year global mortality: (2.04 1.52; 2.73) and 2.71 (2.09; 3.51), respectively.

Conclusion:
Our extensive analysis of a nationwide database highlights the significant risk of postoperative VTE after ECS and GCS, persisting within 90 POD and up to 1-year. Crucially, a higher risk of global mortality within 1-year for patients experiencing early or late VTE was found. These findings could advocate for further research into extended prophylactic regimens, particularly for those most at risk.
Artificial intelligence-based diagnosis of standard endoscopic ultrasonography scanning sites in the biliopancreatic system: a multicenter retrospective study
Authors: Tian Shuxin , Shi Huiying , Chen Weigang , Li Shijie , Han Chaoqun , Du Fan , Wang Weijun , Wen Hongxu , Lei Yali , Deng Liang , Tang Jing , Zhang Jinjie , Lin Jianjiao , Shi Lei , Ning Bo , Zhao Kui , Miao Jiarong , Wang Guobao , Hou Hui , Huang Xiaoxi , Kong Wenjie , Jin Xiaojuan , Ding Zhen , Lin Rong 
Published: December 2023

Background:
There are challenges for beginners to identify standard biliopancreatic system anatomical sites on endoscopic ultrasonography (EUS) images. Therefore, the authors aimed to develop a convolutional neural network (CNN)-based model to identify standard biliopancreatic system anatomical sites on EUS images.

Methods:
The standard anatomical structures of the gastric and duodenal regions observed by EUS was divided into 14 sites. The authors used 6230 EUS images with standard anatomical sites selected from 1812 patients to train the CNN model, and then tested its diagnostic performance both in internal and external validations. Internal validation set tests were performed on 1569 EUS images of 47 patients from two centers. Externally validated datasets were retrospectively collected from 16 centers, and finally 131 patients with 85 322 EUS images were included. In the external validation, all EUS images were read by CNN model, beginners, and experts, respectively. The final decision made by the experts was considered as the gold standard, and the diagnostic performance between CNN model and beginners were compared.

Results:
In the internal test cohort, the accuracy of CNN model was 92.1–100.0% for 14 standard anatomical sites. In the external test cohort, the sensitivity and specificity of CNN model were 89.45–99.92% and 93.35–99.79%, respectively. Compared with beginners, CNN model had higher sensitivity and specificity for 11 sites, and was in good agreement with the experts (Kappa values 0.84–0.98).

Conclusions:
The authors developed a CNN-based model to automatically identify standard anatomical sites on EUS images with excellent diagnostic performance, which may serve as a potentially powerful auxiliary tool in future clinical practice.