bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study
Authors: Paudel Sharma , Regmi Pradeep R. , Kayastha Prakash , Katuwal Shailendra , Ghimire Prasoon , Shrestha Suraj , Gurung Urmila 
Published: August 2023

Background:
Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease.

Materials and methods:
This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel’s cave, and the brain parenchyma.

Results:
The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients.

Conclusion:
The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.
Portal vein thrombosis in a 10-month-old infant as a complication of neonatal umbilical catheterization: a case report
Authors: Haddad Sultaneh , Haddad Salim , Swaid Komait , Martini Nafiza , Mansour Marah , Alkouri Lina 
Published: August 2023

Introduction:
Esophageal varices bleeding after portal hypertension is a rare condition in children but is associated with significant morbidity and mortality. Neonatal umbilical catheterization is one of the risk factors for the development of portal vein thrombosis (PVT) and portal hypertension.

Case presentation:
Neonatal umbilical catheterization was used here to provide appropriate treatment for postpartum sepsis. Color Doppler revealed an approximate total obstruction of the portal vein, and endoscopy showed esophageal varices. The patient was sequentially managed with endoscopic sclerotherapy.

Discussion:
The manifestations associated with PVT (like splenomegaly and bleeding esophageal varices) have been detected in a 10-month-old, which is considered a relatively young age according to the medical literature review.

Conclusion:
Using umbilical vein catheterization in neonates may be associated with several complications, including PVT. This case report describes a rare instance of portal hypertension complicated by bleeding esophageal varices in a 10-month-old infant who had undergone newborn umbilical catheterization.
What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments
Authors: Yeager Valerie A. , Burns Ashlyn B. , Lang Britt , Kronstadt Jessica , Hughes Monica J. , Gutta Jyotsna , Kirkland Chelsey , Orr Jason , Leider Jonathon P. 
Published: August 2023

Objective:
Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans).

Design:
This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021.

Main Outcome Measures:
Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme.

Results:
The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18).

Conclusion:
While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.
A Clinical-Community Partnership to Address Food Insecurity and Reduce Emergency Department Utilization Among Medicaid-Insured Patients in North Carolina
Authors: Mayfield Carlene A. , Robinson-Taylor Tanya , Rifkin Danielle , Harris Mamie-Eleanor 
Published: August 2023

Context:
Socioeconomic risk factors have the greatest impact on overall health trajectory. Patients with Medicaid insurance are more likely to experience food insecurity, in addition to poor health and increased health care utilization. Targeted food and produce prescription programs can reduce food insecurity, but sustainable implementation is challenging and evidence demonstrating the impact on clinical utilization outcomes is lacking.

Program:
In 2021, a cross-sector collaboration between Mecklenburg County Public Health, Reinvestment Partners, and Atrium Health initiated a food prescription program in urban North Carolina. A low-cost mass text message campaign was used to identify and enroll Medicaid-insured patients with a history of emergency department (ED) utilization.

Methods:
A nonrandomized before/after evaluation design was used with a 12-month data collection window (6 months before/after program enrollment) for 711 patients enrolled between June 2021 and 2022. Changes in the odds of nonadmission ED utilization were modeled using logistic regression, adjusting for race/ethnicity, gender, age, comorbidity, and dose, along with interaction by comorbidity.

Results:
A majority of the sample was non-Hispanic Black (61%; n = 436), female (90%; n = 643), with “none to mild” chronic disease comorbidity (81%; n = 573). The unadjusted and adjusted odds of nonadmission ED utilization significantly reduced between time periods, along with significant interaction by comorbidity. Among the subsamples, patients with “none to mild” comorbidity showed 34% reduction in odds of nonadmission ED utilization (OR = 0.64; 95% CI, 0.47-0.86).

Discussion:
Food prescription programming targeting Medicaid-insured patients may reduce ED utilization, particularly among those without severe comorbidity. Retrospective data collection and sample homogeneity reduced the quality of evidence, but results offer a pragmatic example that can be replicated for further study. Additional research is needed to strengthen the body of evidence and support cross-sector investment in food and produce prescription programming.
Decompression of Axillary Vein: An Essential Adjunct for Advanced Lymphedema
Authors: Jeong Hyung Hwa , Yoon In Ah , Al-Shomer Feras M. , Suh HyunSuk Peter , Pak ChangSik John , Neligan Peter , Hong Joon Pio 
Published: August 2023

Background:
In advanced lymphedema, lymphovenous anastomosis (LVA) can be a solution based on using the pressure gradient between the high-pressure lymphatics and the low-pressure veins. If the vein pressure is high, the effect of surgery will be less optimal. This study evaluated the effect of axillary vein perivascular scar release on LVA.

Methods:
This is a retrospective study of 40 upper limb stage 2 and 3 lymphedema patients divided into 2 groups with an average follow-up of 33 months (minimum of at least 12 months): the scar release group (n = 25) and the control group (n = 15). All patients underwent LVA with or without lymph node transfer. Demographic data, outcome (volumetric change and bioimpedence analysis [BIA]), and major vein (axillary, basilic, and cephalic) diameter changes were evaluated.

Results:
Both groups showed significant reduction in volume and BIA parameters after LVA. The scar release group (24 of 25 with lymph node transfer and 1 without) showed statistically higher reduction of BIA analysis compared with the control group at 1, 6, and 12 months after LVA. The changes in the major veins after axilla scar release showed significant changes in all 3 veins. There was a significant correlation between cephalic vein diameter reduction and BIA measurement.

Conclusions:
The release of perivascular scar in the axillary vein may result in better outcome after LVA. This is based on the finding that scar release shows correlation between cephalic vein diameter reduction and BIA measurement suggesting reduction of venous pressure in the peripheral vein increasing the pressure gradient between the lymphatic and venous system allowing better outflow after LVA.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Barriers and Solutions for Pediatric Rheumatology Referrals in a Rural Area
Authors: Campbell Julie A. , Wilson Lauren , Shenoi Susan 
Published: August 2023

Background
Currently, there are 9 states across the United States that do not have a pediatric rheumatologist, including the state of Montana. Patients in these states are often cared for by outreach clinics staffed by pediatric rheumatology (PR) providers from other states or looked after by in-state adult rheumatologists or in-state primary care providers.

Methods
Using a web-based survey, we determined barriers and potential solutions to PR referrals from referring providers (including primary care providers and subspecialists) in Montana state.

Results
Eighty-five Montana referring providers responded, with 44% being pediatric physicians and 33% being family medicine physicians. Other respondents were adult rheumatologists, pediatric and family medicine advanced practice providers, orthopedic surgeons, and pediatric subspecialists. Eighty-five percent of providers had previously referred a patient to PR. Referring providers rated difficulty referring MT patients to PR as 27 (on a linear numeric scale of 0–100, with 0 being very difficult) and noted lack of access to local pediatric rheumatologist as the most significant barrier to referral. The top patient barrier as perceived by 95% of providers was travel time. Potential solutions to improve care included presence of local pediatric rheumatologist with 50 miles, development of algorithms for common PR complaints, and outreach clinics.

Conclusion
Referring providers in Montana report difficulty in referring to PR, with lack of access and travel time being key barriers. Improving access through expanding local PR workforce and increasing access through outreach clinics may help reduce these barriers.
Severity of Mandibular Dysmorphology in Treacher Collins Syndrome for Stratification of Perioperative Airway Risk
Authors: Barrero Carlos E. , Wietlisbach Larissa E. , Pontell Matthew E. , Salinero Lauren K. , Wagner Connor S. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A. 
Published: August 2023

Background:
Patients with Treacher Collins syndrome (TCS) and attendant airway dysmorphology may be predisposed to airway complications in the perioperative period. However, limited data correlates severity of mandibular hypoplasia and airway status. This study aims to improve risk stratification for perioperative airway insufficiency in TCS by using a previously proposed mandibular severity index.

Methods:
Patient demographics, perioperative airway status, difficulty of intubation, and Cormack Lehane grade were collected and compared using a TCS mandibular hypoplasia severity grading scale in patients with TCS treated between 2000 and 2022.

Results:
Twenty-six patients underwent 222 procedures with institutional mandibular severity gradings as follows: 23% Grade I, 31% Grade II, 39% Grade III, 8% Grade IV. Our severity index was associated with intubation difficulty (P<0.001) and difficult airway status (P<0.001), with 72% of difficult airways found in grade III and grade IV patients. Mandibular retrusion and ramal hypoplasia subscores were positively correlated with measures of airway severity (P<0.001), whereas the gonial angle was negatively correlated (P<0.001). Age was negatively correlated with difficult visualization for endotracheal intubation (P=0.02) but had no association with difficult airway status (P=0.2).

Conclusions:
This study found a positive correlation between severity of maxillomandibular dysmorphology and perioperative airway difficulty in TCS patients. Our findings suggest that severely affected patients require heightened vigilance throughout life, as difficult airways may not completely resolve with aging. Given the risk of morbidity and mortality associated with airway complications, proper identification and preparation for challenging airways is critical for TCS patients.
The multipolar elastic fields of ellipsoidal and polytopal plastic inclusions
Authors: Gurrutxaga-Lerma B. 
Published: August 2023

The article offers a general formulation for the multipolar field expansion of an inclusion. The multipolar moments of arbitrary order for the ellipsoidal inclusion are derived, showing known features of their elastic fields in both the far and near field. Using integer point enumeration theory, the same formulation is extended to all polytopal inclusions, which serve to model faceted inclusions found in, e.g. igneous and metamorphic rocks, particle reinforced composite materials, or as intermetallic precipitates in alloys. A general algorithm for the calculation of the multipolar moments of polytopes of any number of vertices is derived. A number of examples for tetrahedral, cuboidal and dodecahedral inclusions are given. It is shown that the parity of the axial moment function of a polytopal inclusion mirrors the symmetry of the inclusion. This represents the main properties of their elastic fields, including the long- and near-field decay. If the inclusion is symmetric with respect to a given axes, the fields will decay with

1

/

r
2

in the far field and

1

/

r
4

in the near field. If symmetry along that direction is lost, as is expected in most real inclusions, the decay rate progresses with

1

/

r
2

but the near field with

1

/

r
3

.
A low molecular weight dextran sulphate, ILB®, for the treatment of amyotrophic lateral sclerosis (ALS): an open-label, single-arm, single-centre, phase II trial
Authors: Srinivasan Venkataramanan , Homer Victoria , Barton Darren , Clutterbuck-James Abigail , Jenkins Siân , Potter Claire , Brock Kristian , Logan Ann , Smith Donna , Bruce Lars , Nagy Zsuzsanna , Bach Simon P 
Published: August 2023

AbstractBackgroundAmyotrophic lateral sclerosis (ALS), also known as Lou Gehriǵs disease, is a rare neurological disease and is the most common motor neurone disease. It is a fatal disease with specific loss of motor neurons in the spinal cord, brain stem, and motor cortex leading to progressive paralysis and usually death within five years of diagnosis. There remains no cure for ALS, and management is focused on a combination of neuroprotective medication, respiratory support, and management by multidisciplinary clinics.Patients and MethodsThis prospective, single-arm, open-label phase II clinical trial of sustained weekly administration of 2 mg/kg ILB® (a low-molecular weight dextran sulphate) was conducted in a single UK hospital. Eligible patients were at least 18 years and had a definite diagnosis of ALS according to El Escorial Criteria. The co-primary outcomes were safety, tolerability, and quantity of ILB® administered. All evaluable patients were analysed in a modified intention-to-treat analysis.EudraCT number. 2018-000668-28FindingsBetween 18-Apr-2019 and 27-Mar-2020, 11 patients were recruited and treated for up to 38 weeks. There were no treatment terminations or withdrawals. One serious adverse event was reported, which was not related to ILB® and resolved without sequalae. 270 mild/moderate adverse events were reported with no intolerable events occurring during the trial. The total number of ILB® treatments administered per patient ranged from 4 to 38, with a cumulative dose ranging from 745 to 6668 mg. As a result of the COVID-19 pandemic and the high-risk status of study participants, recruitment and treatment was suspended early in Mar-2020. At the long-term follow-up, three patients had died after the trial was halted, between 53 and 62 weeks after their final ILB® injection.InterpretationLong-term weekly ILB® injections of 2 mg/kg was well tolerated and had an acceptable safety profile in patients with ALS.
Comparison of the Diagnostic Performance from Patient’s Medical History and Imaging Findings between GPT-4 based ChatGPT and Radiologists in Challenging Neuroradiology Cases
Authors: Horiuchi Daisuke , Tatekawa Hiroyuki , Oura Tatsushi , Oue Satoshi , Walston Shannon L , Takita Hirotaka , Matsushita Shu , Mitsuyama Yasuhito , Shimono Taro , Miki Yukio , Ueda Daiju 
Published: August 2023

AbstractPurposeTo compare the diagnostic performance between Chat Generative Pre-trained Transformer (ChatGPT), based on the GPT-4 architecture, and radiologists from patient’s medical history and imaging findings in challenging neuroradiology cases.MethodsWe collected 30 consecutive “Freiburg Neuropathology Case Conference” cases from the journal Clinical Neuroradiology between March 2016 and June 2023. GPT-4 based ChatGPT generated diagnoses from the patient’s provided medical history and imaging findings for each case, and the diagnostic accuracy rate was determined based on the published ground truth. Three radiologists with different levels of experience (2, 4, and 7 years of experience, respectively) independently reviewed all the cases based on the patient’s provided medical history and imaging findings, and the diagnostic accuracy rates were evaluated. The Chi-square tests were performed to compare the diagnostic accuracy rates between ChatGPT and each radiologist.ResultsChatGPT achieved an accuracy rate of 23% (7/30 cases). Radiologists achieved the following accuracy rates: a junior radiology resident had 27% (8/30) accuracy, a senior radiology resident had 30% (9/30) accuracy, and a board-certified radiologist had 47% (14/30) accuracy. ChatGPT’s diagnostic accuracy rate was lower than that of each radiologist, although the difference was not significant (p= 0.99, 0.77, and 0.10, respectively).ConclusionThe diagnostic performance of GPT-4 based ChatGPT did not reach the performance level of either junior/senior radiology residents or board-certified radiologists in challenging neuroradiology cases. While ChatGPT holds great promise in the field of neuroradiology, radiologists should be aware of its current performance and limitations for optimal utilization.
Pharmacokinetics-based identification of antiviral compounds ofRheum palmatumrhizomes and roots (Dahuang)
Authors: Tian Nan-Nan , Ren Ling-Ling , Zhu Ya-Xuan , Sun Jing-Ya , Lu Jun-Lan , Zeng Jia-Kai , Wang Feng-Qing , Du Fei-Fei , Yang Xi-He , Ge Shu-Ning , Huang Rui-Min , Jia Wei-Wei , Li Chuan 
Published: August 2023

AbstractThe potential of Dahuang to eliminate lung pathogens was often highlighted inWenyi Lun. This investigation aimed to identify potential antiviral compounds of herbal component Dahuang (Rheum palmatumrhizomes and roots) of LianhuaQingwen capsule, with respect to their systemic exposure and lung reachability. Circulating Dahuang compounds were identified in human volunteers receiving LianhuaQingwen. The reachability of these compounds to SARS-CoV-2 3CLprowas assessed byin vitrotransport, metabolism, immunohistochemistry, and 3CLpro-biochemical studies. LianhuaQingwen contained 55 Dahuang constituents (0.01–2.08 μmol/day), categorized into eight classes. Only three compounds rhein (3), methylisorhein (10; a new Dahuang anthraquinone), and 4-O-methylgallic acid (M42M2) exhibited significant systemic exposure in humans. Two intestinal absorption mechanisms for3and10were proposed: active intestinal uptake of3/10by human TAUT/ASBT and human MRP1/3/4, and intestinal lacate-phlorizin hrdrolyase-mediated hydrolysis of rhein-8-O-β-D-glucoside (9), followed by the transporter-mediated absorption of released3. Targeted reachability of circulating3/10could be achieved as rat orthologues of human ASBT/TAUT was observed in alveolar and bronchial epithelia. These compounds exhibited potential ability to inhibit the 3CLproenzyme responsible for coronaviral replication. Notably, Dahuang anthraquinones and tannins varied greatly in pharmacokinetics between humans and rats after dosing LianhuaQingwen. This investigation, along with such investigations of other components, has implications for precisely defining the therapeutic benefits of Dahuang-containing medicines.
A neuronal circuit driven by GLP-1 in the olfactory bulb regulates insulin secretion
Authors: Montaner Mireia , Denom Jessica , Simon Vincent , Jiang Wanqing , Holt Marie K , Brierley Dan , Rouch Claude , Foppen Ewout , Kassis Nadim , Jarriault David , Khan Dawood , Eygret Louise , Mifsud Francois , Hodson David J , Broichhagen Johannes , Van Oudenhove Lukas , Fioramonti Xavier , Gault Victor , Cota Daniela , Reimann Frank , Gribble Fiona M , Migrenne-Li Stephanie , Trapp Stefan , Gurden Hirac , Magnan Christophe 
Published: August 2023

SummaryGlucagon-like peptide 1 (GLP-1) stimulates insulin secretion and holds significant pharmacological potential. Nevertheless, the regulation of energy homeostasis by centrally-produced GLP-1 remains partially understood. Preproglucagon cells, known to release GLP-1, are found in the olfactory bulb (OB). We demonstrate that activating GLP-1 receptors (GLP-1R) in the OB stimulates insulin secretion in response to oral glucose in lean and diet-induced obese mice. This is associated with reduced noradrenaline content in the pancreas and blocked by an α2-adrenergic receptor agonist, highlighting the functional implication of the sympathetic nervous system (SNS). Inhibiting GABAA receptors in the paraventricular nucleus of the hypothalamus (PVN), the control centre of the SNS, abolishes the enhancing effect on insulin secretion induced by OB GLP-1R. Therefore, OB GLP-1-dependent regulation of insulin secretion relies on a relay within the PVN. These findings identify a novel top-down neural mechanism engaged by OB GLP-1 signaling to control insulin secretion via the SNS.