bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurological history both twinned and queried by generative artificial intelligence
Authors: Lee Jung-Hyun , Choi Eunhee , Angulo Sergio L. , McDougal Robert A. , Lytton William W. 
Published: January 2025

Background and objectivesWe propose the use of GPT-4 to facilitate initial history-taking in neurology and other medical specialties. A large language model (LLM) could be utilized as a digital twin which could enhance queryable electronic medical record (EMR) systems and provide healthcare conversational agents (HCAs) to replace waiting-room questionnaires.MethodsIn this observational pilot study, we presented verbatim history of present illness (HPI) narratives from published case reports of headache, stroke, and neurodegenerative diseases. Three standard GPT-4 models were designated Models P: patient digital twin; N: neurologist to query Model P; and S: supervisor to synthesize the N-P dialogue into a derived HPI and formulate the differential diagnosis. Given the random variability of GPT-4 output, each case was presented five separate times to check consistency and reliability.ResultsThe study achieved an overall HPI content retrieval accuracy of 81%, with accuracies of 84% for headache, 82% for stroke, and 77% for neurodegenerative diseases. Retrieval accuracies for individual HPI components were as follows: 93% for chief complaints, 47% for associated symptoms and review of systems, 76% for relevant symptom details, and 94% for histories of past medical, surgical, allergies, social, and family factors. The ranking of case diagnoses in the differential diagnosis list averaged in the 89th percentile.DiscussionOur tripartite LLM model demonstrated accuracy in extracting essential information from published case reports. Further validation with EMR HPIs, and then with direct patient care will be needed to move toward adaptation of enhanced diagnostic digital twins that incorporate real-time data from health-monitoring devices and self-monitoring assessments.
Impact of liver graft steatosis on long-term post-transplant hepatic steatosis and fibrosis via magnetic resonance quantification
Authors: Mak Lung-Yi , Fung James , Lo Gladys , Lo Christine Shing-Yen , Wu Trevor Kwan-Hung , Chung Matthew Shing-Hin , Wong Tiffany Cho-Lam , Seto Wai-Kay , Chan Albert Chi-Yan , Yuen Man-Fung 
Published: January 2025

BackgroundThe rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has led to an increased occurrence of steatotic liver grafts (SLG) in liver transplantation (LT). However, the implications of SLG on post-transplant de novo hepatic steatosis (PTHS) and advanced fibrosis (≥F3) remain uncertain. This study aimed to characterize PTHS and ≥ F3 using magnetic resonance imaging (MRI) in patients who underwent LT for non-MASLD indications and to examine their relationship with SLG.MethodsPost-LT patients with implant biopsy fat content data were recruited for MRI assessments. MRI-proton density fat fraction (MRI-PDFF) and MR elastography (MRE) were performed using a 1.5 Tesla Optima 450 W MR scanner with a 3D volumetric sequence. PTHS and ≥ F3 were defined as MRI-PDFF ≥5% and MRE ≥3.64 kPa, respectively. SLG was defined as implant biopsy fat content ≥5%.ResultsA total of 292 patients (70.5% men, median age at LT: 51.9 years, 22.6% with SLG) were recruited. The majority (73.6%) were transplanted for hepatitis B virus (HBV)-related complications. MRI performed at a median of 12.2 years post-LT identified PTHS in 27.4 and 10.6% of patients. PTHS was independently associated with SLG (OR 2.067, 95% CI 1.082–3.951), central obesity (OR 3.952, 95% CI 1.768–8.832), and hypertension (OR 2.510, 95% CI 1.268–4.966). In contrast, ≥F3 was associated with sex, change in BMI, and abnormal liver biochemistry but not with PTHS or SLG.ConclusionMRI identified a high prevalence of PTHS, which was associated with SLG and metabolic risk factors among Chinese patients transplanted for non-MASLD indications. Advanced graft fibrosis was not associated with PTHS or SLG.
Factors influencing image quality in Tibetan children by optical coherence tomography
Authors: Yao Yao , Liu Jiawen , Li Lei , Chen Weiwei , Meng Zhaojun , Fu Jing 
Published: January 2025

PurposeThis study aim to investigate the clinical findings of subjects characteristics and image quality related factors in Tibetan children by optical coherence tomography (OCT) in epidemiological cohort study.MethodsParticipants were 1,856 first-grade students (mean age = 6.82 ± 0.46 years) from seven selected elementary schools in Lhasa. Following comprehensive systemic and ophthalmic examinations, OCT scans were assessed by specialists with manual segmentation as needed.ResultsA total of 1,698 students completed the examination protocol in this study (91.5%). After manual screening, 1,447 (78%) and 1,289 (70%) images could be analyzed in the macular and optic disc regions, respectively. Common image flaws were blinking or fixation error (70%+), poor focusing, and positioning errors. Among students who have completed OCT, a higher percentage of boys (X2 = 8.48, P = 0.004) and suburban students (X2 = 34.97, P &lt; 0.001) with younger age (t = -2.20, P = 0.03), worse near vision (t = -3.95, P &lt; 0.001), higher IOP (t = 2.38, P = 0.017) and higher heart rate (t = 3.15, P = 0.002) have unsatisfactory image quality in the macular region, almost same as the optic disc region. Students in suburban schools (OR = 1.74, P &lt; 0.001) with lower near VA (OR = 6.64, P &lt; 0.001) or boys (OR = 0.78, P = 0.03) were more likely to have worse image quality on OCT scans when corrected for ethnicity. Manual segmentation was more prevalent in the optic disc region, resulting in increased retinal thickness across most subregions.ConclusionThis study underscores the imperative for stringent image quality control in pediatric OCT assessments to ensure precise clinical outcomes.
Global trends and emerging insights in BRAF and MEK inhibitor resistance in melanoma: a bibliometric analysis
Authors: Bai Jianhao , Wan Zhongqi , Zhou Wanru , Wang Lijun , Lou Wei , Zhang Yao , Jin Haiying 
Published: January 2025

ObjectiveThis study aims to perform a comprehensive bibliometric analysis of global research on BRAF and MEK inhibitor resistance in melanoma, identifying key research trends, influential contributors, and emerging themes from 2003 to 2024.MethodsA systematic search was conducted in the Web of Science Core Collection (WoSCC) database to retrieve publications related to BRAF and MEK inhibitor resistance from 1 January 2003, to 1 September 2024. Bibliometric analyses, including publication trends, citation networks, and keyword co-occurrence patterns, were performed using VOSviewer and CiteSpace. Collaborative networks, co-cited references, and keyword burst analyses were mapped to uncover shifts in research focus and global cooperation.ResultsA total of 3,503 documents, including 2,781 research articles and 722 review papers, were analyzed, highlighting significant growth in this field. The United States, China, and Italy led in publication volume and citation impact, with Harvard University and the University of California System among the top contributing institutions. Research output showed three phases of growth, peaking in 2020. Keyword and co-citation analyses revealed a transition from early focus on BRAF mutations and MAPK pathway activation to recent emphasis on immunotherapy, combination therapies, and non-apoptotic cell death mechanisms like ferroptosis and pyroptosis. These trends reflect the evolving priorities and innovative approaches shaping the field of resistance to BRAF and MEK inhibitors in melanoma.ConclusionResearch on BRAF and MEK inhibitor resistance has evolved significantly. This analysis provides a strategic framework for future investigations, guiding the development of innovative, multi-modal approaches to improve treatment outcomes for melanoma patients.
Application of the Uniform Data Set version 3 tele-adapted test battery (T-cog) for remote cognitive assessment preoperatively in older adults
Authors: Rockholt Mika M. , Wu Rachel R. , Zhu Elaine , Perez Raven , Martinez Hamleini , Hui Jessica J. , Commeh Ekow B. , Denoon Romario B. , Bruno Gabrielle , Saba Braden V. , Waren Daniel , O'Brien Courtney , Aggarwal Vinay K. , Rozell Joshua C. , Furgiuele David , Macaulay William , Schwarzkopf Ran , Schulze Evan T. , Osorio Ricardo S. , Doan Lisa V. , Wang Jing 
Published: January 2025

IntroductionOlder adults undergoing surgery are at risk of postoperative neurocognitive disorders, prompting the need for preoperative cognitive screening in this population. Traditionally, cognitive screening has been conducted in-person using brief assessment tools such as the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE). More comprehensive test batteries, such as the Uniform Data Set (UDS) Neuropsychological Battery, and its remote testing version, the Uniform Data Set version 3 tele-adapted test battery (UDS v3.0 T-cog), have been developed to assess cognitive decline in normal aging and disease conditions, but have not been applied in the perioperative setting.MethodsWe assessed the feasibility of using this remote UDS v3.0 T-cog battery for preoperative cognitive assessment in 81 older adults 65+ scheduled for lower extremity joint replacement surgery.ResultsOur results indicate that the UDS v3.0 T-cog achieves 99% completion rates and demonstrates high patient satisfaction. Further, we found 28% of subjects were cognitively impaired in this patient cohort.DiscussionThese findings suggest that the UDS v3.0 T-cog is a feasible tool for assessing cognitive function in the older adult perioperative population. To our knowledge, this is the first study to apply this comprehensive remote test battery in the preoperative setting.
Cross-modality fusion with EEG and text for enhanced emotion detection in English writing
Authors: Wang Jing , Zhang Ci 
Published: January 2025

IntroductionEmotion detection in written text is critical for applications in human-computer interaction, affective computing, and personalized content recommendation. Traditional approaches to emotion detection primarily leverage textual features, using natural language processing techniques such as sentiment analysis, which, while effective, may miss subtle nuances of emotions. These methods often fall short in recognizing the complex, multimodal nature of human emotions, as they ignore physiological cues that could provide richer emotional insights.MethodsTo address these limitations, this paper proposes Emotion Fusion-Transformer, a cross-modality fusion model that integrates EEG signals and textual data to enhance emotion detection in English writing. By utilizing the Transformer architecture, our model effectively captures contextual relationships within the text while concurrently processing EEG signals to extract underlying emotional states. Specifically, the Emotion Fusion-Transformer first preprocesses EEG data through signal transformation and filtering, followed by feature extraction that complements the textual embeddings. These modalities are fused within a unified Transformer framework, allowing for a holistic view of both the cognitive and physiological dimensions of emotion.Results and discussionExperimental results demonstrate that the proposed model significantly outperforms text-only and EEG-only approaches, with improvements in both accuracy and F1-score across diverse emotional categories. This model shows promise for enhancing affective computing applications by bridging the gap between physiological and textual emotion detection, enabling more nuanced and accurate emotion analysis in English writing.
Automatic etiological classification of stroke thrombus digital photographs using a deep learning model
Authors: Lucero-Garófano Álvaro , Aliena-Valero Alicia , Vielba-Gómez Isabel , Escudero-Martínez Irene , Morales-Caba Lluís , Aparici-Robles Fernando , Tarruella Hernández Diana L. , Fortea Gerardo , Tembl José I. , Salom Juan B. , Manjón José V. 
Published: January 2025

BackgroundEtiological classification of ischemic stroke is fundamental for secondary prevention, but frequently results in undetermined cause. We aimed to develop a Deep Learning (DL)-based model for automatic etiological classification of ischemic stroke using digital images of thrombi retrieved by mechanical thrombectomy.MethodsPatients with large vessel occlusion stroke subjected to mechanical thrombectomy between April 2016 and January 2023 at La Fe University and Polytechnic Hospital in Valencia were included. Thrombus digital images were obtained and clinical characteristics, including TOAST etiological classification as reference standard, were retrieved. Statistical analysis was performed to compare clinical characteristics between atherothrombotic and cardioembolic strokes. A DL method was designed based on two deep neural networks for: (1) image segmentation and (2) image classification including clinical characteristics. The metrics used were DICE coefficient for the segmentation network, and accuracy, precision, sensitivity, specificity and area under the curve (AUC) for the predictions of the classification network.ResultsA total of 166 patients (mean age 69 [SD, 13], 67 female) were included. TOAST classification was: 31 atherothrombotic, 87 cardioembolic, and 48 cryptogenic. The segmentation network achieved an average DICE coefficient of 0.96 [SD, 0.13]. The optimal fused imaging and clinical classification network had a 0.968 accuracy [95% CI, 0.935–0.994], and AUC of 0.947 [95% CI, 0.870–1]. Cryptogenic thrombi were classified as cardioembolic (96%) or atherothrombotic (4%).ConclusionTwo convolutional neural networks perform the automatic segmentation of thrombus images and, combined with selected clinical characteristics, their accurate and precise classification into atherothrombotic or cardioembolic etiology in patients with acute ischemic stroke.
Maintenance of patient-reported health-related quality of life post neoadjuvant relugolix prior to the initiation of prostate radiation therapy
Authors: Koh Min Jung , Koh Min Ji , Hsueh Jessica Y. , Gallagher Lindsey , Danner Malika , Zwart Alan , Ayoob Marilyn , Kumar Deepak , Carrasquilla Michael , Leger Paul , Dawson Nancy A. , Suy Simeng , Collins Sean P. 
Published: January 2025

IntroductionStudies have demonstrated that injectable GnRH receptor agonists further suppress cancer progression when paired with radiotherapy (RT) in patients with intermediate- to high-risk prostate adenocarcinoma. Relugolix is a newly available oral GnRH receptor antagonist that achieves swift and profound castration (total testosterone &lt;20 ng/dl) at high rates, which may shape patients’ health-related quality of life. The main objective of this prospective study was to explore the effects of neoadjuvant relugolix on health-related quality of life in prostate cancer patients immediately prior to stereotactic body radiation therapy (SBRT).MethodsPatients treated at Georgetown between January 2021 and September 2023 with neoadjuvant relugolix per an institutional protocol were included in the study (IRB 12-1775). The five-item EQ-5D-3L, a well-established tool for quantifying patient-reported health status, was administered to each patient at baseline (prior to relugolix treatment) and again 1 h before the start of SBRT. Higher EQ Visual Analog Scale (VAS) overall scores reflected better quality of life (range 0 to 100). In line with the questionnaire framework, individual elements (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) were rated on a three-point scale from 1 (no problems) to 3 (severe problems). McNemar’s test and paired-sample t-test were performed to analyze changes pre- and post-relugolix treatment. Our investigation determined clinical significance based on minimally important difference (MID) calculated as 0.5 times the baseline standard deviation.ResultsAmong the 87 patients, average age was 71 years, 42% were non-white, and 24% were considered obese (BMI ≥30 kg/m²). Relugolix was initiated a median of 4 months before SBRT initiation (IQR: 3.9–5.4), with 87% of patients reaching profound castration (&lt;20 ng/dl). The VAS overall score was notably higher at baseline (mean ± SD: 82 ± 10) compared to the paired score before RT (79 ± 14, p = 0.02), although this difference was not clinically significant. No statistically or clinically significant changes were observed in any of the five individual items.ConclusionThe use of neoadjuvant relugolix prior to prostate radiation therapy had no clinically significant impact on patient-reported health-related quality of life. Moreover, no statistically significant reductions were observed in any of the five individual health-related quality of life measures. As a key direction for future research, relugolix-associated changes to healthy-related quality of life should be contrasted to those brought about by injectable GnRH agonists.
Retrospective analysis of 1539 nasopharyngeal carcinoma cases: chemotherapy should not be excluded for non-Asian patients with T1-2N1M0 stage
Authors: Li Xin-Yu , Zhong Chang-Ying , Xu Hui-Xian 
Published: January 2025

BackgroundMany results suggested that chemotherapy cannot provide survival benefit for stage II nasopharyngeal carcinoma. It remained unclear whether the efficacy of chemotherapy differed in non-Asian populations.ObjectiveIt was designed to analyze the effect of chemotherapy for Asian and non-Asian patients with stage II nasopharyngeal carcinoma.MethodPatients were collected using the SEER program. The variables included age, sex, race, marital status, survival time, survival status, TNM stage, radiation and chemotherapy. Utilizing the Rstudio (version: 2024.4.1.748) and R (version: 4.4.1), backward elimination method was employed to screen the variables and multivariate Cox regression analyses was conducted on the screened variables. Kaplan-Meier method was utilized to analyze the survival of sub-stages and different races with T1-2N1M0 stage. The log-rank test was used for statistical analysis.Result1539 patients were collected. Chemotherapy was statistically significant, with a hazard ratio (HR) of 0.64, P=0.003 in stage II patients. The HR for radiation was 0.33, P&lt;0.001. Chemotherapy didn’t improve cancer-specific survival for patients with T2N0M0 stage. Asian and non-Asian races showed no difference in cancer-specific survival in T2N0M0 stage with HR of 1.85, P=0.13. For patients with T1-2N1M0 stage, chemotherapy improved cancer-specific survival with a HR of 0.53, P&lt;0.001. No significant difference was in the Kaplan-Meier analysis between the two sub-stages (P=0.065). In T1-2N1M0 stage, multivariate Cox regression analysis for Asian race indicated that chemotherapy didn’t improve cancer-specific survival with a HR of 0.64, P=0.190. For non-Asian race, chemotherapy was found to improve cancer-specific survival, with a HR of 0.51, P&lt;0.001. The Kaplan-Meier analysis of Asian and non-Asian patients with T1-2N1M0 stage exhibited significant differences (P&lt;0.0001).ConclusionChemotherapy is correlated with the cancer-specific survival in non-Asian patients with T1-2N1M0-stage nasopharyngeal carcinoma, but not in Asian patients at the same stage. For patients with the T2N0M0 stage, chemotherapy is not correlated with the cancer-specific survival rate, regardless of ethnicity.
Post-extrasystolic variation of ST segment and T wave as a mortality risk predictor after myocardial infarction
Authors: Dirschinger Ralf J. , Müller Alexander , Barthel Petra , Steger Alexander , Dommasch Michael , Bauer Axel , Laugwitz Karl-Ludwig , Schmidt Georg , Sinnecker Daniel 
Published: January 2025

AimsEfficient use of preventive cardiac therapies is often limited by inefficient risk prediction, calling for new prediction tools. Ventricular premature complexes (VPCs) elicit electrocardiographic changes in the repolarization of the first post-extrasystolic normal beat. The aim of this study was to assess whether this post-extrasystolic ST segment and T wave variation (PEST) conveys prognostic information regarding the mortality risk of cardiac patients.MethodsPEST was calculated from 30-min ECGs obtained from 941 survivors of acute myocardial infarction (AMI) as mean difference between the sum of squared voltages from three orthogonal leads (XYZ) of the first (post-extrasystolic) and second (reference) beat after each VPC, in a time window between the limits ϕ1 and ϕ2. Optimal limits yielding a maximum area under the receiver-operating characteristics (ROC) curve were determined by systematic testing, covering the time window from the J point to the end of the T wave. A strong association was found with ϕ1/ϕ2 encompassing 40–230 ms after the J point, which was used to calculate PEST in the analysis. Kaplan-Meier curves and univariable/multivariable Cox proportional hazards models were used to study mortality prediction by PEST. The findings were validated in an independent cohort of 1.788 general population subjects aged 60 years or older.ResultsThe area under the ROC curve for PEST was 0.72, with an optimum cutoff at ≤ −6.69 mV2. The 88 patients with PEST values below this cutoff had a considerably higher mortality than the remainder of the patients (25% vs. 5.8%, p &lt; 0.0001; univariable hazard ratio 4.7, 95% CI 2.4–12.0, p &lt; 0.001). In a multivariable Cox regression analysis considering left-ventricular ejection fraction, presence of diabetes mellitus, and Global Registry of Acute Coronary Events (GRACE) score, PEST remained significantly associated with mortality (hazard ratio 3.6, 95% CI 1.9–6.9, p &lt; 0.0001). In the validation cohort, abnormal PEST was also associated with significantly increased 4-year mortality (11.9% vs. 4.3%, p = 0.00095).ConclusionPEST is a strong independent predictor of all-cause mortality in AMI survivors and elderly subjects from the general population. While the pathophysiology of this association remains to be investigated, PEST may complement current risk prediction tools in various clinical settings.
The formaldehyde stress on photosynthetic efficiency and oxidative stress response of moss Racomitrium japonicum L.
Authors: Li Wanting , Zhang Jiawen , Ma Siqi , Zhou Min , Li Ruixin , Tang Hao , Qiu Haiyan , Ren Peng , Tang Yunlai , Lu Yunmei , Huang Renhua , Chen Ke 
Published: January 2025

IntroductionFormaldehyde is a common gaseous pollutant emitted by buildings and decorative materials. In recent years, growing concerns have been raised regarding its harmful effects on health in indoor air. Therefore, this study aims to investigate the physiological and photosynthetic response mechanisms of Racomitrium japonicum under formaldehyde stress.MethodsR. japonicum was exposed to dynamic fumigation with formaldehyde for 7 days, with each day comprising an 8-h exposure period within a sealed container. The effects on plant structure, pigment content, photosynthetic efficiency, and reactive oxygen species (ROS) generation were assessed.Results and discussionOur findings revealed that formaldehyde stress caused structural damage, reduced pigment content, decreased photosynthetic efficiency, and increased ROS production in R. japonicum. Significantly, distinct stress-response pathways were observed at different formaldehyde concentrations. In response to low and moderate formaldehyde concentrations, R. japonicum activated its antioxidant enzyme system to mitigate ROS accumulation. In contrast, the high-concentration treatment group demonstrated suppressed antioxidant enzyme activity. In response, R. japonicum used nonphotochemical quenching and activated cyclic electron flow to mitigate severe cellular damage. This study provides an in-depth understanding of the physiological changes in R. japonicum under formaldehyde stress, elucidating its response mechanisms. The findings offer valuable insights for developing effective indoor formaldehyde monitoring and purification methods.