bluuebunny/crossref_metadata_2025_split huggingface dataset:
Movement disorders: a brief practical approach to diagnosis and management
Authors: Burn DJ 
Published: January 2025

The characteristic feature of all movement disorders is an abnormality of the form and velocity of movements of the body. The term ‘movement disorder’ has become synonymous with basal ganglia disease and extrapyramidal features. Although many movement disorders do arise from pathology within the basal ganglia, disorders such as myoclonus may also arise from other structures. Abnormality of movement may be the only manifestation of a disease process, or may be part of a more widespread neurological disorder. It is important not to divorce the disorder of movement from general medical problems, since these may be directly or indirectly related (for example, chorea in systemic lupus erythematosus; DIP caused by amiodarone). Basal ganglia disease is commonly associated with neuropsychiatric symptoms and these may have a greater impact upon the patient and their family than the movement disorder itself. An essential first step in the approach to the patient with a movement disorder is to correctly determine the phenomenology of the problem (for example, is the dominant problem chorea or dystonia?). Once this first step has been made, appropriately targeted investigations may then be required to determine the diagnosis. Thereafter, consideration is given to treatment, based upon clinical and social factors, as well as patient preference. This overview will describe a practical approach to the patient with a movement disorder. It will also briefly consider some broad principles in the investigation and management of such cases.
The opercular syndrome, or, the Foix-Chavany-Marie syndrome
Authors: Gordon N 
Published: January 2025

The opercular syndrome is due to bilateral, and sometimes unilateral, lesions of this area of the cerebral cortex, or its connections with the brain stem. The symptoms and signs of the syndrome are described, especially the type of facial palsy. They differ slightly in childhood, and may be accompanied by developmental delay. They can be reversible when linked to epileptic activity in the opercular areas. The symptoms can be suggestive of two well-established syndromes in childhood. Firstly, the Landau–Kleffner syndrome (and there may well be shared pathophysiological mechanisms) and secondly, those first described by Worster–Drought. The investigations needed to establish the location and the possible causes of the opercular syndrome are discussed. The most common causes are vascular lesions, but other possibilities such as infections and trauma have to be considered. Also malformations of prenatal origin can result in the suprabulbar palsy so typical of the syndrome. If the cause can be established there is always the possibility of treatment.
Non solum… sed etiam: added cardiac benefits of TNFa blockade in rheumatoid arthritis
Authors: GM Raftery  , DJ Armstrong  
Published: January 2025

Tumour necrosis factor alpha (TNFa) has emerged as one of the key cytokines in the fields of infection and inflammation, and has been linked with disease activity and joint damage in rheumatoid arthritis. Acute myocardial infarction remains the leading cause of death in rheumatoid arthritis, and there is now a large body of evidence placing TNFa and other inflammatory cytokines at the centre of the development of atherosclerotic plaques and their subsequent rupture, which is in keeping with the observation of accelerated atherosclerosis in rheumatoid arthritis patients. TNFa might also have a role to play in the increased incidence of congestive cardiac failure seen in rheumatoid arthritis. Although anti-TNFa therapies were originally developed with a view to controlling joint disease in rheumatoid arthritis, evidence is emerging of a positive benefit in reducing heart disease as well. A range of mechanisms has been suggested by which anti-TNFa treatment might achieve a reduction in incidence of myocardial infarction and cardiac failure, some of which will have implications for the treatment of cardiovascular disease in general.
A prospective survey of acute hospital admissions with atrial fibrillation in Karachi, Pakistan
Authors: Haq U , Lip GYH 
Published: January 2025

Background: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation (AF) in non-white populations is scarce. Objectives: To document the clinical epidemiology of AF among hospital admissions to two teaching hospitals in Karachi, Pakistan, over a two-month period and to describe the clinical features and management of these patients. Subjects: 3,766 acute medical admissions, of whom 245 (6.5%) had AF. Results: Of 245 patients with AF, clinical notes of 24 were lost in the system. Of the remaining 221 patients with AF (107 males; mean age 66 years), 22% were Afghani Muslims, 3% Indians, 1% white and the rest were Pakistani with unknown country of origin. The most common associated medical conditions were hypertension (54%), valvular heart disease (54%) and ischaemic heart disease (IHD, 47%). The most common presenting complaints in female patients were palpitations (51%) and anxiety (35%). In males, the most common symptoms were palpitations (46%), chest pain (35%) and anxiety (27%). Among male patients, 100% had an electrocardiogram (ECG), 93% an X-ray, 89% echocardiography and 49% thyroid function testing. Direct current (DC) cardioversion was attempted in 8%. Of the male admissions with AF, 64% were taking aspirin, while 75% were anticoagulated in hospital and 40% of patients were discharged on anticoagulants with cessation documented in 14%. Beta blockers and amiodarone were prescribed in 74% and 19% of male cases respectively. In females, 100% had an ECG, 76% chest X-rays and 81% had echocardiography proposed. Thyroid function tests were done in 46% of cases, and DC cardioversion was attempted in 11%. Of the female AF patients, 70% were anticoagulated in hospital and 48% went home on anticoagulants. Cessation of warfarin was documented in 27% of female patients, and beta blockers and amiodarone were prescribed in 80% and 26% respectively. Conclusion: Among acute medical admissions to hospital in Pakistan the prevalence of AF was 6.5%. Consistent with previous similar surveys in mainly Western (Caucasian) populations, standard investigations in this cohort were inadequate and there was underuse of anticoagulation (with a high cessation rate).
HEPARIN-INDUCED THROMBOCYTOPENIA AND THROMBOSIS
Authors: Oo Thein H 
Published: January 2025

I read with interest the article ‘The diagnosis and treatment of acute pulmonary thromboembolism’ (TN Martin, AJB Brady. J R Coll Physicians Edinb 2009; 39: 107–12) and would like to give some comments. Firstly, the authors did not mention important hereditary and acquired thrombophilic conditions such as antiphospholipid antibody syndrome, factor V Leiden and prothrombin gene mutations, protein C, protein S, antithrombin III deficiencies as risk factors for venous thromboembolism. In my opinion, they are worth mentioning. Secondly, with increasing prophylactic and therapeutic use of heparin, I would like to point out that development of heparin-induced thrombocytopenia (HIT) and thrombosis (HITT) is not rare. The incidence for HIT ranges from 0.1% to 5% depending on the type of heparin used and the risk group of patients. Approximately 40% of patients with HIT subsequently develop thrombosis. Of note, 26% of patients are noted to have concurrent thrombocytopenia and thrombosis.1 The condition is usually typical in that thrombocytopenia (either below 150,000/mm3 or 50% decline in baseline platelet count) develops within 5–10 days of heparin use in patients who have had no heparin exposure or who have had remote history of exposure (more than 100 days). Rarely, precipitous fall in platelet count can occur within hours if there is recent exposure to heparin.1 The management of acute pulmonary embolism due to HITT is entirely different. In those patients, heparin must be avoided. Anticoagulation is commenced with direct thrombin inhibitors such as lepirudin or argatroban. Warfarin therapy should be postponed until there has been substantial resolution of thrombocytopenia as warfarin therapy is associated with a severe reduction in the natural anticoagulant protein C, making the hypercoaguable state worse during the acute phase of HITT.2
THE ROLE OF VENOMETERS IN THE DIAGNOSIS OF DEEP VEIN THROMBOSIS
Authors: Dwarakanath Akshay 
Published: January 2025

I read with interest the recent paper entitled Venous thromboembolism: the role of the clinician (N Curry, D Keeling. J R Coll Physicians Edinb 2009; 39:243-6). It does not highlight the role of the venometer in the diagnosis of venous thromboembolism. Clinical diagnosis for deep vein thrombosis (DVT) is notoriously unreliable because the external symptoms of a DVT are so equivocal. The venometer is a simple bedside non-invasive test that uses automated strain-gauge plethysmography to detect DVT1,2. Although there have been no randomised controlled trials to support the role of venometers, they play a major role in the safe screening of patients and are used successfully in the DVT protocols of many UK hospitals, providing an efficient and a cost-effective way to manage DVT. The definitive characteristic of a DVT is that it blocks normal blood flow. This feature is exploited by the venometer. It determines the likelihood of a thrombosis by objectively measuring the rate at which blood drains under gravity from the patient’s calf. The venometer automatically calculates the likelihood of a DVT based on the measurement taken by the sensor on the calf, while a blood pressure cuff is inflated on the thigh during this brief test. The results, either positive or negative, can help in the diagnosis of venous thromboembolism. A portable device operated by a trained nurse or technician, the venometer is suitable for use in medical admissions units, community health centres or patients’ homes. The test is quick and simple, taking up to l5 minutes for the complete interpretation. The venometer software is extremely user-friendly and guides the operator precisely through every step in the test sequence. Venometers decrease the risk and cost of unnecessary anticoagulation and reduce waiting times and the number of ultrasound tests, thus providing 24-hour DVT care in the NHS.
Acute and Longitudinal Effects of Concussion on Reactive Balance in Collegiate Athletes
Authors: Monoli Cecilia , Morris Amanda J. , Crofts Regan , Fino Nora F. , Petersell Tessa L. , Jameson Trevor , Dibble Leland E. , Fino Peter C. 
Published: January 2025

Background Postural instability is a common observation after concussions, with balance assessments playing a crucial role in clinical evaluations. Widely used post-concussion balance tests focus primarily on static and dynamic balance, excluding the critical aspect of reactive balance. Objectives This study investigated the acute and longitudinal effects of concussion on reactive balance in collegiate athletes. Methods Concussed and healthy matched controls NCAA division I athletes were assessed at pre-season baseline and 4 post-concussion timepoints: acute, pre-return-to-play (RTP), post-RTP, and 6 months post-concussion. The instrumented-modified Push and Release test measured reactive balance during single- and dual-task conditions. Longitudinal effects of concussions on time to stability and step latency metrics were investigated applying Generalized Estimating Equations. Results Acutely after concussion, athletes demonstrated impaired reactive balance, indicated by longer times to stability, in dual-task conditions ( P = .004). These acute impairments were transient and recovered over time. Exploratory analyses revealed that athletes who sustained their first lifetime concussion exhibited both acute ( P = .037) and longitudinal ( P = .004 at post-RTP) impairments in single- and dual-task compared to controls with no lifetime concussion. Conclusions This comprehensive evaluation provides insights into the multifaceted nature of post-concussion impairments and emphasizes the importance of considering cognitive demand and history of concussions in assessing athletes’ balance.
Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access)
Authors: Nasreldein Ahmed , Asyraf Wan , Nguyen Thanh N , Martins Sheila , Lioutas Vasileios-Arsenios , Elbassiouny Ahmed , Ton Mai Duy , Sacco Simona , Micdhadhu Mohamed A , Chen Yimin , Akinyemi Rufus , Kristoffersen Espen Saxhaug , Huo Xiaochuan , Miao Zhongrong , Abdalkader Mohamad , Nagel Simon , Puetz Volker , Thomalla Gotz , Yamagami Hiroshi , Qiu Zhongming , Demeestere Jelle , Qureshi Adnan I , Michel Patrik , Strbian Daniel , Campbell Bruce CV , Yan Bernard , Olorukooba Abdulhakeem , Masoud Hesham E , Haussen Diogo C , Frankel Michael , Mohammaden Mahmoud H 
Published: January 2025

Background: Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015. Aim: Our aim was to determine the key challenges for MT implementation and access worldwide. Methods: We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country. Results: We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43 (8.2%) had available MT only during working hours, 362 (68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used non-contrast computed tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography/CT perfusion), 0.4% used magnetic resonance imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neurointerventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities, and lack of collaboration between departments were the most common obstacles against developing a training program. Conclusion: Our study highlights significant variations in MT availability, accessibility, patient selection criteria, and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.
Open Ecosystem Through Secure Plug and Play Interoperability: An Overview
Authors: Fischer Christoph 
Published: January 2025

Background: Interoperability is a critical enabler for integrated Personalized Diabetes Management (iPDM), automated insulin delivery (AID), and the digital transformation of healthcare in general. However, manufacturers still create closed ecosystems (ie, solutions designed to work end-to-end minimizing collaboration with other organizations) with proprietary interfaces because of various interoperability challenges. Therefore, the aim of this article is to provide an overview of how to achieve organizational interoperability in an open ecosystem (ie, solutions designed to integrate different organizations via interoperability standards) for diabetes management. Methods: The proposed interoperability design approach called Secure Plug and Play Interoperability (SPPI) supports building and using interoperable system elements in an open ecosystem. Secure Plug and Play Interoperability enables interoperability over the entire system life cycle with its reference architecture, secure interoperability standards, and organizational capabilities. These standards were developed with participation from healthcare providers, regulatory authorities, payers, academia, and manufacturers. Publicly available information provides examples of implementation support and practical usage. Results: Organizational interoperability in an open ecosystem can be achieved through organizational capabilities and a selection of secure interoperability standards. ISO/IEEE 11073, Bluetooth profiles, and HL7 FHIR with test specifications, test tools, software development kits, and quality assurance programs represent a coordinated selection suitable for building an open ecosystem. Practical usage is demonstrated with real-world solutions that build on these standards. Conclusions: Secure Plug and Play Interoperability facilitates the end-to-end integration of devices, digital products, and services from partners in an open ecosystem. Moreover, even a single manufacturer, who provides all system elements of a solution, can use and benefit from SPPI.
Primary ovarian peripheral primitive neuroectodermal tumor presented with breast metastasis; Case report
Authors: Rabi Razan , Hamed Allah Majd , Dawabsheh Yusuf 
Published: January 2025

Ewing sarcoma family tumors (ESFT) pose diagnostic challenges, which largely depend on the primary site of involvement and tumor stage. Despite advancements in treatment, metastatic ESFTs remain associated with poor outcomes. This case describes a 21-year-old woman who, in July 2022, presented with a left breast mass identified through ultrasound and CT scan, along with abdominal distention. A biopsy of the breast mass confirmed metastatic extraskeletal Ewing sarcoma. Further imaging revealed an ovarian mass, with subsequent biopsy confirming ovarian origin as extraskeletal Ewing sarcoma. The breast mass was identified as metastatic based on imaging features, including irregular margins and CT scan confirmation of widespread metastasis. Histopathology and immunohistochemistry confirmed Ewing sarcoma, consistent with the ovarian mass pathology that was the primary site. She underwent 15 cycles of VDC/IE chemotherapy ((vincristine, doxorubicin, and cyclophosphamide) for 2 days and 5 days IE (ifosfamide etoposide)), resulting in tumor cytoreduction. However, in less than 2 years, she developed metastases to the dura, spine, and bone, with optic nerve involvement. Despite treatment with radiotherapy and two cycles of high-dose Ifosfamide chemotherapy, her condition deteriorated, and she passed away in April 2024. This case underscores the complexity of managing metastatic ESFTs. Further research is needed to improve outcomes and establish treatment protocols for this malignancy.
Integrating Ambulatory Care Pharmacists Into Value-Based Primary Care: A Scalable Solution to Chronic Disease
Authors: Blood Alexander J. , Saag Harry , Chesler Adam , Ameripour Dalia , Gutierrez Max , Nguyen Van , Richardson Cassandra , Fields Clive , Clair Jen , Yao Aaron , Moodley Sashi 
Published: January 2025

Introduction/Objectives: Patients living with chronic diseases require more medical attention, including more visits to primary care. However, primary care providers are overburdened, and this specialty is attracting fewer new providers than before. Clinical pharmacists can augment these efforts by improving disease state control. In this cohort study, we aimed to demonstrate a retail pharmacy hired and trained clinical pharmacist within a value-based primary care clinic network can improve hypertension (HTN) and type 2 diabetes mellitus (T2DM) control. Methods: In this cohort study, a pharmacist, enabled by a collaborative drug therapy management agreement, prescribed and titrated therapies for HTN and T2DM. Primary outcomes were pre- to post-index changes in hemoglobinA1c, systolic, and diastolic blood pressure (BP) measures. Results: The HTN cohort consisted of 43 patients and the T2DM cohort consisted of 125 patients. The difference-in-differences (β) in the HTN group was −10.2 mmHg ( P < .01) for systolic BP and −2.0 mmHg ( P = .42) for diastolic BP. The β in the T2DM group was −1.16% ( P < .001). Conclusions: Statistically significant reductions in systolic BP and hemoglobinA1c were observed in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into a value based primary care clinic may improve measures of chronic disease associated with morbidity and mortality.
Multi‑omics identification of a novel signature for serous ovarian carcinoma in the context of 3P medicine and based on twelve programmed cell death patterns: a multi-cohort machine learning study
Authors: Ye Lele , Long Chunhao , Xu Binbing , Yao Xuyang , Yu Jiaye , Luo Yunhui , Xu Yuan , Jiang Zhuofeng , Nian Zekai , Zheng Yawen , Cai Yaoyao , Xue Xiangyang , Guo Gangqiang 
Published: January 2025

Abstract
Background
Predictive, preventive, and personalized medicine (PPPM/3PM) is a strategy aimed at improving the prognosis of cancer, and programmed cell death (PCD) is increasingly recognized as a potential target in cancer therapy and prognosis. However, a PCD-based predictive model for serous ovarian carcinoma (SOC) is lacking. In the present study, we aimed to establish a cell death index (CDI)–based model using PCD-related genes.

Methods
We included 1254 genes from 12 PCD patterns in our analysis. Differentially expressed genes (DEGs) from the Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) were screened. Subsequently, 14 PCD-related genes were included in the PCD-gene-based CDI model. Genomics, single-cell transcriptomes, bulk transcriptomes, spatial transcriptomes, and clinical information from TCGA-OV, GSE26193, GSE63885, and GSE140082 were collected and analyzed to verify the prediction model.

Results
The CDI was recognized as an independent prognostic risk factor for patients with SOC. Patients with SOC and a high CDI had lower survival rates and poorer prognoses than those with a low CDI. Specific clinical parameters and the CDI were combined to establish a nomogram that accurately assessed patient survival. We used the PCD-genes model to observe differences between high and low CDI groups. The results showed that patients with SOC and a high CDI showed immunosuppression and hardly benefited from immunotherapy; therefore, trametinib_1372 and BMS-754807 may be potential therapeutic agents for these patients.

Conclusions
The CDI-based model, which was established using 14 PCD-related genes, accurately predicted the tumor microenvironment, immunotherapy response, and drug sensitivity of patients with SOC. Thus this model may help improve the diagnostic and therapeutic efficacy of PPPM.