bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unveiling neural activity changes in mild cognitive impairment using microstate analysis and machine learning
Authors: Wu Xiaotian , Liu Yanli , Che Jiajun , Cheng Nan , Wen Dong , Liu Haining , Dong Xianling 
Published: January 2025

Background Mild cognitive impairment (MCI) is recognized as a condition that may increase the risk of developing Alzheimer's disease (AD). Understanding the neural correlates of MCI is crucial for elucidating its pathophysiology and developing effective interventions. Electroencephalogram (EEG) microstates, reflecting brain activity changes, have shown promise in MCI research. However, current approaches often lack comprehensive characterization of the complex neural dynamics associated with MCI. Objective This study aims to investigate neurophysiological changes associated with MCI using a comprehensive set of microstate features, including traditional temporal features and entropy measures. Methods Resting-state EEG data were collected from 69 MCI patients and healthy controls (HC). Microstate analysis was performed to extract conventional features (duration, coverage) and entropy measures. Statistical analysis, principal component analysis (PCA), and machine learning (ML) techniques were employed to evaluate neurophysiological patterns associated with MCI. Results MCI displayed altered microstate dynamics, with significantly longer coverage and duration in Microstate C but shorter in Microstates A, B, and D compared to HCs. PCA revealed two principal components, primarily composed of microstate dynamics and entropy measures, explaining over 75% of the variance. ML models achieved high accuracy in distinguishing MCI patterns. Conclusions Our comprehensive analysis of EEG microstate features provides new insights into neurophysiological changes associated with MCI, highlighting the potential of EEG microstates for investigating complex neural changes in cognitive decline.
Medications and cognitive decline in Alzheimer's disease: Cohort cluster analysis of 15,428 patients
Authors: Grau-Jurado Pol , Mostafaei Shayan , Xu Hong , Mo Minjia , Petek Bojana , Kalar Irena , Naia Luana , Kele Julianna , Maioli Silvia , Pereira Joana B , Eriksdotter Maria , Chatterjee Saikat , Garcia-Ptacek Sara 
Published: January 2025

Background Medications for comorbid conditions may affect cognition in Alzheimer's disease (AD). Objective To explore the association between common medications and cognition, measured with the Mini-Mental State Examination. Methods Cohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters. Results 15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15–1.83] at first follow-up, simvastatin (1.41 [1.11–1.78] at second follow-up), warfarin (1.56 [1.22–2.01] first follow-up), zopiclone (1.35 [1.15–1.58], and metformin (2.08 [1.35–3.33] second follow-up. Oxazepam (0.60 [0.50–0.73] first follow-up), paracetamol (0.83 [0.73–0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia. Conclusions We performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.
Update on musculoskeletal ultrasonography
Authors: Keen HI , Brown AK , Wakefield RJ , Conaghan PG 
Published: January 2025

Rheumatologists are increasingly utilising MUS in both the research setting and in clinical practice. Factors such as improvements in image quality and decreasing cost of machines have made MUS more accessible in the routine clinical care setting. Musculoskeletal ultrasonography is an attractive tool, as it is portable and can be used in the outpatient clinic, allowing multiple joints to be imaged in a single visit. In contrast to conventional radiography, it allows multiplanar imaging of soft tissue structures, such as tendons and synovium, as well as providing information about articular integrity. As MUS does not require ionising radiation or contrast agents, it can be used repeatedly to monitor temporal changes. However, as with all imaging techniques, there are technical limitations which, to some extent,may vary between machines; access to some joints may be limited, and the quality of image obtained may depend on the size of joint and the frequency of the MUS transducer employed. Whilst MUS shows much promise in aiding and optimising the practice of rheumatology, there is still a relative paucity of evidence to fully demonstrate the utility of MUS. In addition, a number of practical issues need addressing. These include educational aspects relating to the competence of physicians performing MUS, confirming MUS definitions of pathology, establishing validity and reliability, and further understanding the utility of this modality in managing rheumatological diseases. Work is underway to address many of these issues.
Acute renal failure in severe falciparum malaria patients in an intensive care unit in Malaysia
Authors: Koh KH , Tan Cl , Chew PH 
Published: January 2025

Objectives: Identify the risk factors and the clinical impact of ARF in patients with severe falciparum malaria. Method: Intensive care unit cases of severe falciparum malaria of Sarawak General Hospital were analysed. Results: Out of 40 cases of severe falciparum malaria, 19 developed ARF. Patients with ARF were older (p=0·030), had higher AST (p=0·014), higher unconjugated bilirubin (p=0·041), and lower globulin (p=0·015). Aspartate transaminase level positively correlated with creatinine and urea level (log AST and urea: r=0·464, p=0·004; log AST and log creatinine: r=0·430, p=0·008); while unconjugated bilirubin level positively correlated with creatinine level with geometric transformation (r=0·402, p=0·020). Patients with ARF have higher mortality (p=0·004),and more failing organs (p = 0·0003). Patients with ARF that died had a higher number of organs failing compared with those that survived (p=0·043). Among patients with total parasite count of >300,000/µL, those patients treated with dialysis, haemofiltration or exchange transfusion developed less organ failure (p=0·050). Logistic regression with adjustment for age and malarial complications identified ARF to be the major predictor of mortality. Conclusions: 1) Patients with severe falciparum malaria who developed ARF have higher rate of haemolysis, more organs failing and higher mortality rate. 2) Dialysis, haemofiltration or exchange transfusion may reduced the rate of organ failure among patients with parasite count >300000/µL.
Polycythaemia: diagnosis and management
Authors: Kumar R , Prem S 
Published: January 2025

Patients with raised haemoglobin or haematocrit need evaluation for the presence of polycythaemia. The term erythrocytosis should be used when only the red cells are affected, while polycythaemia is preferred for the clonal disorder involving all three haematopoietic cell lines, namely PV. Secondary erythrocytosis is far more common and is usually consequent to increased erythropoietin production. It is important to diagnose PV, as it has a high morbidity and mortality. The diagnostic criteria for PV are complex. Recently, an activating point mutation in the JAK2 gene (JAK2-V617F) has been detected in a majority of PV patients, but is not specific, and needs more evaluation. Patients may present with plethora, thrombosis in arterial or venous circulations, erythromelalgia, pruritus, haemorrhage, splenomegaly, gout, leucocytosis, or thrombocytosis. Management consists of reducing haematocrit to below 0·45, primarily by venesection. Low-dose aspirin should be administered to all patients unless contraindicated. Cyto-reductive therapy is indicated only if venesection is not tolerated, for high-risk illness, extreme thrombocytosis, and progressive disease. Hydroxycarbamide (previously known as hydroxyurea) is the simplest and most effective medication, being preferred in all except young patients. Interferon is also effective, but is more toxic and inconvenient to use. Anagrelide may be used to control platelet counts, but hydroxycarbamide appears superior. In the very elderly, 32P or low-dose busulfan has a role because of the convenience, despite a greater risk of leukaemic transformation. With appropriate therapy, survival has improved from an average of two years to more than ten years. Special care is needed during pregnancy, prior to general surgery, and in the management of haemorrhage, pruritis, and splenomegaly.
ANCA-associated systemic vasculitis (AASV)
Authors: Kluth DC , Hughes J 
Published: January 2025

Anti-neutrophil cytoplasmic antibody-associated systemic vasculitis is a multi-system disease that can present to a number of medical specialties, and where early identification and treatment improves outcome. The vasculitides are commonly divided into WG, MPA, and CSS. This review will revise the common clinical presentations of these diseases and initial investigations. Anti-neutrophil cytoplasmic antibodies have provided a valuable test to aid in diagnosis and there is increasing clinical and experimental evidence that suggests they have an important role in the pathogenesis of disease. Anti-neutrophil cytoplasmic antibodies are directed at either MPO or PR3 which are present in the granules and on the cell surface of neutrophils. They can be detected by indirect immunofluoresence and ELISA-based assay, and both are essential when vasculitis is suspected. The antibodies are able to activate neutrophils and promote injury, and recent data have shown they can directly cause glomerulonephritis and systemic vasculitis in animal models. Diagnosis of AASV is made using clinical features, ANCA test, and relevant tissue biopsy. Treatment with cytotoxics has transformed the prognosis but until recently there has been limited trial evidence to determine which regime is best. This article will review a range of studies published over the last five years and preliminary evidence from ongoing studies to give an outline of current practice for immunosuppression and monitoring of disease. There is also now a range of biological therapies available including anti-TNF and anti-B-cell antibodies, which may have an increasing role as either adjunctive therapy or new regimes to induce remission.
What ACE inhibitor-induced changes in serum creatinine tell us about a possible diagnosis of renal artery stenosis
Authors: Main J 
Published: January 2025

In renal artery stenosis, GFR becomes angiotensin II-dependent and therefore sensitive to ACE inhibitor. However, the effect of ACE inhibitor on SCr in the presence of RAS is complicated by several factors: serum creatinine is a poor indicator of GFR, RAS can affect one or both kidneys, GFR depends on systemic blood pressure and ACE inhibitor dose, and other conditions can render GFR ACE inhibitor-sensitive. A basic understanding of the mechanism of glomerular filtration allows us to interpret ACE inhibitor-induced changes in SCr, and to decide whether they warrant further investigation of the renal arteries or exclude the possibility of RAS.
Diarrhoeal-associated haemolytic uraemic syndrome
Authors: Maxwell H 
Published: January 2025

Diarrhoeal-associated HUS is a common cause of acute renal failure, particularly in young children. The diagnosis is made by the presence of the following triad of findings: haemolytic anaemia (<10 g/dl), thrombocytopenia (<150x109/l) and a creatinine value that is above the upper limit of normal for age. Ninety per cent of cases follow a diarrhoeal prodrome, and of these the majority are due to enterohaemorrhagic E. coli or VTEC. Sporadic and epidemic cases occur and sources of infection include undercooked meat, contact with farm animals and their faeces, and contaminated water, fruit, or vegetables. Typically, children under three years of age are affected and present with abdominal pain and diarrhoea. The diarrhoea is often watery and soon becomes bloody. There may also be vomiting. The diarrhoea lasts on average for eight days, and the colitis can be so severe that children may present with an acute abdomen. Perforation, bowel infarction, and intussusception are rare complications. Rectal prolapse is a more common complication. Diagnosis of VTEC infection is by stool culture and serology. Ten per cent of patients with VTEC infection go on to develop HUS. Of these, 50–60% will develop acute renal failure requiring dialysis. Extrarenal manifestations include seizures and somnolence, with cerebral infarcts and oedema being less common complications. Pancreatitis and altered glucose tolerance can occur and cardiac ischaemia has been reported. On average, dialysis is required for 8–10 days; those requiring dialysis for longer than four weeks are unlikely to make a full renal recovery. Acute mortality is 5–10%, being more common in patients with neurological involvement. End-stage renal failure develops in 3–5%, and up to 25% may be left with renal impairment. At one year after the illness, a normal GFR, normal BP, and absence of proteinuria are predictive of a complete recovery.
The modern management of asthma
Authors: Douglas JG 
Published: January 2025

Asthma is among the most common of all chronic disorders at all ages. Despite increased understanding of cell biology and access to numerous drugs and inhaler, asthma is not under control. One in six people requiring emergency treatment for asthma will require emergency treatment again within two weeks and, sadly, in the UK one person dies of asthma every seven hours. Modern management of asthma is supported by the rigorously evidence-based BTS/SIGN guidelines which are now are updated annually. There is increasing emphasis on starting inhaled steroid for milder cases and using lower doses, the usual starting adult dose is now 400 ug BDP or equivalent. Education using a written personalised Asthma Action Plan is central to good management and should be reinforced at every opportunity. For adults and older children with more troublesome symptoms a LABA is the most effective add-on therapy. Those not controlled at Step 3 should be considered for referral to a specialist hospital clinic.
Physician-assisted suicide in Oregon: a personal view
Authors: Jeffrey D 
Published: January 2025

Proponents for the legalisation of PAS in the UK claim that it works well in Oregon in the US. About 30 patients have used PAS each year since it was legalised in Oregon in 1997. This paper reports the result of a visit to Portland in Oregon to listen to the views of healthcare professionals, hospice association leaders and proponents of PAS. ‘Palliative care’ and ‘hospice’ mean different things in the US and the UK. ‘Hospice’ in the US means end-of-life care at home, and many of those ‘eligible’ patients receive this only for the last two or three weeks of life. ‘Palliative care’ tends to be delivered by hospital support teams and is largely concerned with the last days of life in the acute hospital setting. There are no specialist palliative care inpatient units in Oregon. It is commonly assumed that those patients who carry out PAS must be suffering terrible pain or are depressed. However, the experience in Oregon suggests that the small number of patients who carry out PAS are not depressed, nor are they in pain. They all share an overpowering need for control and they simply want to be able to choose when they should die. Although PAS is legal in Oregon, only a small number of doctors take part in the process. No hospitals permit PAS to be carried out on their premises. Hospice home care programs adopt an ambivalent moral stance, distancing themselves from the act of PAS whilst continuing to support the patient and their family. The implications of these findings for notions of autonomy and moral agency are discussed here.
Primary spontaneous pneumothorax: why all
Authors: Mackenzie SJ , Gray A 
Published: January 2025

The management of PSP continues to be a source of debate. There are few randomised control trials comparing treatment options, and current guidelines based on specialist opinion vary in their recommendations. Initial management options include observation, aspiration, intercostal drainage with and without pleurodesis, and video-assisted thoracoscopic surgery. Primary spontaneous pneumothoraces arise in patients without clinically apparent lung disease, and no obvious precipitating factor. It is a relatively common presentation with a reported incidence of 18 to 28 per 100,000 men per year and 1·2 to 6 per 100,000 women per year. Primary spontaneous pneumothorax usually occurs in young, tall males between the ages of 15 and 34. The BTS and ACCP have both published guidelines on the treatment of PSP. While they agree on the management of small asymptomatic PSP (observation and outpatient review) and clinically unstable PSP (intercostal drain insertion and admission), they differ on the management of symptomatic small PSP and clinically stable large PSP. The ACCP advise that simple aspiration is rarely appropriate in the treatment of PSP, while the BTS recommend simple aspiration as a first-line treatment. A 2007 Cochrane report, which systematically reviewed all published randomised control trials comparing aspiration to intercostal drain insertion, concluded that there was no difference in the immediate success rate, early failure rate, or one-year success rate between the two interventions. However, aspiration resulted in a lower number of patients requiring admission, and decreased the duration of hospital stay. Current evidence supports the 2003 BTS guidelines, and simple aspiration as first-line treatment in clinically stable pneumothoraces. Until a large randomised control trial is performed, and provides a conclusive evidence base for the most appropriate management of spontaneous pneumothorax, confusion will remain over first-line treatment.
Exercise for obesity – how much is enough?
Authors: Haboubi N , Axe K 
Published: January 2025

Exercise is an important part of weight management, particularly in the long term. However, there is conflicting evidence about how much exercise obese subjects need to perform. Diet, genetic or other factors may contribute to the difference in weight between normal and obese subjects if physical activities are equal between groups. Obese subjects may therefore need to be more active and perform more exercise than their normal weight counterparts in order to lower or maintain their weight. Regarding the amount of exercise, duration has a greater effect on weight loss than intensity. Moderate-intensity exercise is as beneficial as high-intensity exercise for weight loss and, as it appears to be more attractive to obese subjects, leads to a greater adherence to exercise programmes. Preservation of lean body mass is greater when exercise is performed as part of a weight management programme. If diet only is used for weight loss, lean tissue is lost. Combining aerobic and resistance exercise appears to preserve lean tissue, so both types of exercise should be encouraged. Aerobic exercise has a greater effect on weight loss, but resistance exercise could potentially increase lean tissue. High-intensity exercise may spare more lean tissue than moderate exercise, but the benefits of greater adherence of subjects to moderate exercise outweigh those of high-intensity exercise. When barriers to exercise exist, lifestyle changes combined with diet should be advised. In general, obese subjects should be encouraged to start off with lowintensity exercise and gradually progress to a higher level.
OTHER CORRELATES OF THE DECLINE IN AUTOPSY RATE
Authors: Jolobe OMP 
Published: January 2025

The decline in the autopsy rate (Horowitz RE. Autopsies: an exercise in futility? J R Coll Physicians Edinb 2009; 39:l94-5) might well be a manifestation of the increasing reliance on technological advances in imaging so as to arrive at a diagnosis. Although imaging techniques have led to huge improvements in the quality of healthcare, the paradox is that there has not been a corresponding improvement in the quality of the content of the undergraduate medical curriculum because the decline in autopsy rate has resulted in an atrophy of the skills of clinico-pathological correlation, the latter skills being ones traditionally taught in tandem with skills in eliciting physical signs. Even bedside teaching of clinical skills is ‘unfortunately in steady decline’,1 and it has now also become a ‘badge of honour’ to arrive at a diagnosis without the benefit of performing a clinical examination.2 The latter development is a fortunate one for the National Health Service because in the new era of nurse-led consultations (a third of consultations in general practice in England in 2008 were with nurses3) it is much less labour-intensive to bypass the clinical examination altogether when teaching diagnostic skills to prospective nurse practitioners. Only in non-Western rural societies such as that in the Eastern Cape province in South Africa, where I practised medicine for seven years, was there an expectation among members of the public that the ingredients of the ‘complete package’ of a medical consultation should comprise, in this order, history taking, clinical examination, diagnosis (articulated in terms which the patient could understand) and treatment. Fortunately, highly sophisticated patients in the West have no such expectations when they attend clinics in primary as well as in secondary and tertiary care, where stripping down to the waist to have a full clinical examination has become increasingly anachronistic, thanks to the advent of high-tech imaging. The ‘downside’ is the inappropriate use of laboratory tests and imaging, as shown in a study where ‘selecting tests based on history and [clinical] examination and prioritising less expensive and higher yield tests’ would have been more cost-effective.4 In that study postural blood pressure recording, performed in only 38% of episodes, had a higher yield with respect to affecting diagnosis and management and determining aetiology of the syncopal episode than head computed tomography scans, which were performed in as many as 63% of instances.4 The wastefulness (in this era of economic stringency) of bypassing the clinical examination is compounded by the scant respect with which the results of high-tech tests are themselves treated, exemplified by the traditional disorder prevailing in the health record, where ‘anything’ is filed ‘anywhere’ and ‘anyhow’,5 and no audit is made either of the quality and content record-keeping or of the quality and content of discharge summaries and clinic letters.