bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single‐cell RNA‐seq with spatial transcriptomics to create an atlas of human diabetic kidney disease
Authors: Chen Duo , Shao Mingwei , Song Yi , Ren Gaofei , Guo Feng , Fan Xunjie , Wang Yanyan , Zhang Wei , Qin Guijun 
Published: May 2023

AbstractDiabetic kidney disease (DKD) develops in ~40% of patients with diabetes and is the leading cause of chronic kidney disease worldwide. We used single‐cell RNA‐sequencing and spatial transcriptomic analyses of kidney specimens from patients with DKD. Unsupervised clustering revealed distinct cell clusters, including epithelial cells and fibroblasts. We also identified differentially expressed genes (DEGs) and assessed enrichment, and cell–cell interactions. Specific enrichment of DKD was evident in venous endothelial cells (VECs) and fibroblasts with elevated CCL19 expression. The DEGs in most kidney parenchymal cells in DKD were primarily enriched in inflammatory signaling pathways. Intercellular crosstalk revealed that most cell interactions in DKD are associated with chemokines. Spatial transcriptomics revealed that VECs co‐localized with fibroblasts, with most immune cells being enriched in areas of renal fibrosis. These results provided insight into the cell populations, intercellular interactions, and signaling pathways underlying the pathogenesis and potential targets for treating DKD.
Bridge Plate Fixation of Distal Femur Fractures: Defining Deficient Radiographic Callus Formation and Its Associations
Authors: Crutcher William L. , Magnusson Erik A. , Griffith Kyle M. , Alford Cory A. , Nielsen Ena D. , Elkins Jacob M. , Lujan Trevor J. , Kleweno Conor P. , Lack William D. 
Published: May 2023

Objective:
To determine whether deficient early callus formation can be defined objectively based on the association with an eventual nonunion and specific patient, injury, and treatment factors.

Methods:
Final healing outcomes were documented for 160 distal femur fractures treated with locked bridge plate fixation. Radiographic callus was measured on postoperative radiographs until union or nonunion had been declared by the treating surgeon. Deficient callus was defined at 6 and 12 weeks based on associations with eventual nonunion through receiver–operator characteristic analysis. A previously described computational model estimated fracture site motion based on the construct used. Univariable and multivariable analyses then examined the association of patient, injury, and treatment factors with deficient callus formation.

Results:
There were 26 nonunions. The medial callus area at 6 weeks <24.8 mm2 was associated with nonunion (12 of 39, 30.8%) versus (12 of 109, 11.0%), P = 0.010. This association strengthened at 12 weeks with medial callus area <44.2 mm2 more closely associated with nonunion (13 of 28, 46.4%) versus (11 of 120, 9.2%), P <0.001. Multivariable logistic regression analysis found limited initial longitudinal motion (OR 2.713 (1.12–6.60), P = 0.028)) and Charlson Comorbidity Index (1.362 (1.11–1.67), P = 0.003) were independently associated with deficient callus at 12 weeks. Open fracture, mechanism of injury, smoking, diabetes, plate material, bridge span, and shear were not significantly associated with deficient callus.

Conclusion:
Deficient callus at 6 and 12 weeks is associated with eventual nonunion, and such assessments may aid future research into distal femur fracture healing. Deficient callus formation was independently associated with limited initial longitudinal fracture site motion derived through computational modeling of the surgical construct but not more routinely discussed parameters such as plate material and bridge span. Given this, improved methods of in vivo assessment of fracture site motion are necessary to further our ability to optimize the mechanical environment for healing.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
An Asymptomatic Case of Invisible Mycosis Fungoides
Authors: Peters Kristopher , Onajin Oluwakemi , Ruiz de Luzuriaga Arlene , Lullo Jenna , Shea Christopher R. 
Published: May 2023

Abstract:
Mycosis fungoides has previously been reported in ‘invisible’ form, when biopsy of normal-appearing skin in the background of undifferentiated chronic pruritus demonstrated histopathologic findings of the malignancy. Asymptomatic cases have been reported more infrequently on biopsies of individual skin lesions. We present a case of invisible and asymptomatic mycosis fungoides, confirmed with immunohistochemical and T-cell receptor gene rearrangement studies, diagnosed on a re-excision specimen of an atypical melanocytic nevus. The case highlights the importance of alert examination of all tissue specimens for evidence of unrelated pathologic findings.
Comparative Immunohistochemical Analysis of Macrophage Phenotypes in Cutaneous Sarcoid Granuloma, Suture Granuloma, and Lipogranuloma
Authors: Nakamura Toshitsugu , Fujiwara Masayuki 
Published: May 2023

Abstract:
Granulomas are composed of a heterogeneous population of resident and recruited macrophages according to the type of lesion, extent of injury, and local tissue environment (eg, involved site and interaction with infiltrating lymphocytes). Although macrophage phenotypes in various types of granulomas have been previously described, the experimental conditions varied across studies, precluding a comparative and comprehensive understanding of granulomas. This study was conducted to comparatively analyze the expression of markers of the M1 and M2 phenotypes in macrophages that compose various types of granulomas, including epithelioid lesions, under strict conditions. Surgical specimens of cutaneous sarcoidosis (11 lesions), suture granuloma (10 lesions), and subcutaneous lipogranuloma (12 lesions) were immunohistochemically stained for CD11c, CD206, CD163, and CD10. The expression of these markers in macrophages composing each type of granuloma was scored and statistically analyzed. Granuloma macrophages were mostly immunoreactive for CD11c and CD206 in all the examined cases, although many intermingling CD206-negative cells were observed in 5 cases of lipogranuloma. CD163 and CD10 were diffusely expressed in macrophages composing suture granuloma and lipogranuloma, whereas they were not expressed in epithelioid cells in cutaneous sarcoidosis. Meanwhile, “interstitial” macrophages around epithelioid granulomas revealed moderate to marked CD163 expression in 7 lesions of cutaneous sarcoidosis. These results indicate significant differences of expression of CD163 and CD10 between cutaneous sarcoidosis and suture granuloma/lipogranuloma; CD163 and CD10 are downregulated after the epithelioid transformation of macrophages in cutaneous sarcoidosis.
Cutaneous Malignant Melanoma With Rhabdomyosarcomatous Dedifferentiation: an Immunohistological and Molecular Case Study With Literature Review
Authors: O'Neill Paul , Amanuel Benhur , Mesbah Ardakani Nima 
Published: May 2023

Abstract:
Cutaneous malignant melanoma can show a wide range of cytomorphological variability, in particular exhibiting a rhabdoid appearance is not uncommon in melanoma cells; however, the phenomenon of “dedifferentiation” with loss of melanocytic immunohistochemical properties and expression of skeletal muscle immunomarkers is exceedingly rare. Owing to the rarity of such melanomas, their clinicopathological features and molecular profile remain largely unknown. In this report, we describe the clinical, immunomorphological, and molecular features of melanomas with rhabdomyosarcomatous dedifferentiation by presenting a new case and exploring the literature for the previously reported cases.
Effect of Anesthesia Duration on Intravitreal Injection Pain：A Double-blinded Randomized Comparative Study
Authors: Ma Xiubin , Liang Qianqian , Xue Shuyue , Ren Qi , Du Qing , Zhang Zhichun , Li Xinying , Liu Xin , Gao Yan , Li Jun 
Published: May 2023

Abstract

Purpose:
To determine the effect of different durations of topical anesthesia on intravitreal injection (IVI) pain.

Methods:
This was a double-blinded randomized comparative study. Three hundred and twelve sequential eyes undergoing IVI were randomized to one of six groups according to the duration of topical anesthesia (from 1 to 30 minutes, one group for every 5-minute range, Group 1–6). Topical anesthesia before IVI was standardized. Patients graded their pain using the visual analogue scale (VAS) and the Wong-Baker FACES Scale (WBF) at 15 minutes after the procedure.

Results:
The pain scores among the six groups were significantly different for the VAS (P = 0.013) and WBF (P = 0.024). The mean pain scores for Group 4 were 1.97 ± 1.04 (VAS) and 2.02 ± 1.08 (WBF) and were significantly lower than those of Group 1, 2, 5, or 6.

Conclusion:
The duration of topical anesthesia was significantly correlated with IVI pain. Preoperative 0.5% proparacaine hydrochloride drops were most effective in relieving IVI pain 11–20 minutes after topical administration.
Can ChatGPT Accurately Answer a PICOT Question? Assessing AI Response to a Clinical Question
Authors: Branum Candise , Schiavenato Martin 
Published: May 2023

Background:
ChatGPT, an artificial intelligence (AI) text generator trained to predict correct words, can provide answers to questions but has shown mixed results in answering medical questions.

Purpose:
To assess the reliability and accuracy of ChatGPT in providing answers to a complex clinical question.

Methods:
A Population, Intervention, Comparison, Outcome, and Time (PICOT) formatted question was queried, along with a request for references. Full-text articles were reviewed to verify the accuracy of the evidence summary provided by the chatbot.

Results:
ChatGPT was unable to provide a certifiable response to a PICOT question. The references cited as evidence included incorrect journal information, and many study details summarized by ChatGPT proved to be patently false, including providing fabricated data.

Conclusions:
ChatGPT provides answers that appear legitimate but may be factually incorrect. The system is not transparent in how it gathers data to answer questions and sometimes fabricates information that looks plausible, making it an unreliable tool for clinical questions.
Increasing Diversity in the Advanced Practice Nursing Workforce Through Partnerships With Historically Black Colleges
Authors: Johnson Ragan , Lyons-Smith Marquita , Derouin Anne , Carter Brigit , VanRiel Yolanda 
Published: May 2023

Background:
Health inequities have enhanced efforts to diversify the nursing workforce. Despite recruitment strategies, the percentage of Black nurse practitioners (NPs) lags in comparison with the populous.

Problem:
Barriers to improving workforce diversity can be traced to academic nursing’s lack of diversity in faculty, under-resourced education opportunities for students from underrepresented backgrounds, and historical hurdles.

Approach:
One systems-level approach to increasing NP workforce diversity is developing pathway programs aimed at preparing, recruiting, and supporting Black students into advanced practice nursing education. Current undergraduate RN students from 2 historically Black colleges and universities (HBCUs) attended a 1-week summer immersion program at a graduate school of nursing at a predominately White institution.

Conclusion:
Pathway programs for Black undergraduate RN students show promise for increasing awareness of graduate nursing, offering race and ethnicity concordant mentorship, and cultivating deep awareness for health equity.
Spatial clusters and social inequities in Covid-19 vaccine coverage among children in Brazil
Authors: Boing Alexandra Crispim , Boing Antonio Fernando , Borges Marcelo Eduardo , Rodrigues Denis de Oliveira , Barberia Lorena , Subramanian SV 
Published: May 2023

AbstractThis study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran`s I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.
A double-blind trial of decoded neurofeedback intervention for specific phobias
Authors: Cushing Cody A. , Lau Hakwan , Kawato Mitsuo , Craske Michelle G. , Taschereau-Dumouchel Vincent 
Published: May 2023

AbstractAimA new closed-loop fMRI method called multi-voxel neuro-reinforcement has the potential to alleviate the subjective aversiveness of exposure-based interventions by directly inducing phobic representations in the brain, outside of conscious awareness. The current study seeks to test this method as an intervention for specific phobia.MethodsIn a randomized, double-blind, controlled single-university trial, individuals diagnosed with at least two (1 target, 1 control) animal subtype specific phobias were randomly assigned (1:1:1) to receive 1, 3, or 5 sessions of multi-voxel neuro-reinforcement in which they were rewarded for implicit activation of a target animal representation. Amygdala response to phobic stimuli was assessed by study staff blind to target and control animal assignments. Pre-treatment to post-treatment differences were analyzed with a 2-way repeated-measures ANOVA.ResultsA total of 23 participants (69.6% female) were randomized to receive 1 (n=8), 3 (n=7), or 5 (n=7) sessions of multi-voxel neuro-reinforcement. Eighteen (n=6 each group) participants were analyzed for our primary outcome. After neuro-reinforcement, we observed an interaction indicating a significant decrease in amygdala response for the target phobia but not the control phobia. No adverse events or dropouts were reported as a result of the intervention.ConclusionResults suggest multi-voxel neuro-reinforcement can specifically reduce threat signatures in specific phobia. Consequently, this intervention may complement conventional psychotherapy approaches with a non-distressing experience for patients seeking treatment. This trial sets the stage for a larger randomized clinical trial to replicate these results and examine the effects on real-life exposure.Clinical Trial RegistrationThe now-closed trial was prospectively registered atClinicalTrials.govwith IDNCT03655262.
Improving capacity for advanced training in obstetric surgery: Evaluation of a blended learning approach
Authors: Allott Helen , Smith Alan , White Sarah , Nyaoke Irene , Evans Ogoti , Oduor Michael Oriwo , Karangau Steven , Sawe Sheila , Shaaban Nassir , Ephraim Ochola , Ameh Charles Anawo 
Published: May 2023

AbstractIntroductionSignificant differences in outcomes for mothers and babies following obstetric surgical interventions between low- and middle-income countries and high-income settings have demonstrated a need for improvements in quality of care and training of obstetric surgical and anaesthetic providers. To address this a five-day face-to-face training intervention was developed. When the COVID-19 pandemic interrupted its roll-out, the course was redesigned for delivery by blended learning.MethodsThis 3-part blended-learning course (part-1: 15 hours self-directed online learning, part-2: 13 hours facilitated virtual workshops and part-3: 10 hours face-to-face delivery), was conducted in Kenya. We assessed the completion rate of part-1 (21 assignments), participation rate in parts 2 and 3, participant satisfaction, change in knowledge and skills and compared the cost of the blended delivery compared to the 5-day face-to-face delivery, in GB Pounds.Results65 doctors took part in part 1, 53 completing at least 90% of the assignments. 60 doctors participated in part 2, and 53 participated in part 3. Participants completing an evaluation reported (n=53) attending the training was a good use of their time (each of parts-1 and 3: 98%, part-2: 94%) and would recommend this to other colleagues (part-1 and 3: 98%, part-2: 90%). Mean (SD) knowledge score improved from 64% (7%) to 80% (8%) and practical skills from 44% (14%) to 87% (7%). The blended course achieved a cost-saving of £207 per participant compared to the 5-day face-to-face delivery approach.ConclusionWe have demonstrated that a blended learning approach to clinical training in a low resource setting is feasible, acceptable and more cost effective. More studies are required to investigate the effectiveness of this approach on health outcomes.
Validation of a Visual Midline Gauge: A Cross-Sectional Study
Authors: Stalin Amritha , Ding Ran , J. Leat Susan , Binhilabi Ohwod , Labreche Tammy 
Published: May 2023

BackgroundThis study standardized the parameters of a novel visual midline gauge and presents normative data, which can be used by optometrists in the assessment of visual midline.MethodsNinety-three participants from three age groups (18 to 44, 45 to 64, and > 65 years) without history of significant neurological or ocular problems were recruited in Waterloo, Canada and Hong Kong. In experiment 1, the perceived horizontal and vertical visual midline was measured using the gauge for 2 speeds and 2 repositioning methods. In experiment 2, the perceived midline was measured for three different distances (25, 50 and 100 cm) using a target speed and repositioning method chosen from the first experiment results. Since there was no significant difference between the two sites in any of the measures, data were combined for analysis.ResultsFor experiment 1, linear mixed models showed no effect of age, speed or repositioning method and no interaction (p>0.05) for the perceived midline position (p>0.05). In experiment 2, there was no significant effect of age or distance and no interaction effects on the perceived horizontal and vertical visual midline position using the chosen speed and method (2.3 degrees per second, adjustment method). Normative data (mean and 95% ranges of the perceived visual midline for control participants) was tabulated. The measurements were found to be repeatable. A few participants were found to have significant midline shifts.ConclusionThis study shows that the measurement of midline is tolerant of differences of target speed, testing method, test distance, and age group of the participants and that the measurements using the visual midline gauge are repeatable. It is possible for even individuals without a history of neurological or ocular disorders to have significant shifts in their perceived visual midline.
Payments to healthcare organisations reported by the medical device industry in Europe from 2017 to 2019: an observational study
Authors: Larkin James , Mulinari Shai , Ozieranski Piotr , Lynch Kevin , Fahey Tom , Ozaki Akihiko , Moriarty Frank 
Published: May 2023

AbstractBackgroundMedical device industry payments to healthcare organisations (HCOs) can create conflicts of interest which can undermine patient care. One way of addressing this concern is by enhancing transparency of industry financial support to HCOs. MedTech Europe, a medical device trade body, operate a system of disclosure of education payments to European HCOs. This study aimed to characterise payments reported in this database and to evaluate the disclosure system.MethodsAn observational study of education-related payments to HCOs reported by the medical device industry in Europe was conducted. Data was manually extracted from transparentmedtech.eu. The primary outcome variable is the value of the payments, overall, and for each year, payment type, and country. The accessibility, availability and quality of the database was also analysed, using a proforma with 15 measures.FindingsOverall, 116 medical device companies reported education-related payments in 53 countries, valuing over €420 million between 2017-2019, increasing in value between 2017-2019, from €91,289,672 to €175,414,302. Ten countries accounted for 94% of all payments and ten companies accounted for 80% of all payments. The accessibility, availability and quality of the database, rated low for six measures, medium for six measures and high for three measures.InterpretationThere is a large amount of education-related payments from medical device companies to European HCOs, creating substantial potential for conflicts of interest. MedTech Europe’s disclosure system has many shortcomings. A European-wide publicly mandated disclosure system for both the medical device and pharmaceutical industries should be introduced.FundingSwedish Research Council (SM, PO)
Genetic characterization of the ALFA study: Uncovering genetic profiles in the Alzheimer’scontinuum
Authors: Vilor-Tejedor Natalia , Genius Patricia , Rodríguez-Fernández Blanca , Minguillón Carolina , Sadeghi Iman , González-Escalante Armand , Crous-Bou Marta , Suárez-Calvet Marc , Grau-Rivera Oriol , Brugulat-Serrat Anna , Sanchez-Benavides Gonzalo , Esteller Manel , Fauria Karine , Molinuevo José Luis , Navarro Arcadi , Gispert Juan Domingo ,   the Alzheimer’s Disease Neuroimaging Initiative,   the ALFA study
Published: May 2023

AbstractIn 2013, the ALFA (ALzheimer and FAmilies) project was established to investigate pathophysiological changes in preclinical Alzheimer’s disease (AD), and to foster research on early detection and preventive interventions. Since then, it has prospectively followed cognitively unimpaired late/middle-aged participants, most of whom are adult children of AD patients. Risk stratification of cognitively unimpaired individuals, including genetic factors is key for implementing AD prevention strategies. Here, we report the genetic characterization of ALFA participants with respect to neurodegenerative/cerebrovascular diseases, AD biomarkers, brain endophenotypes, risk factors and aging biomarkers, emphasizing amyloid/tau status and gender differences. We additionally compared AD risk in ALFA to that across the full disease spectrum from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Results show that the ALFA project has been successful at establishing a cohort of cognitively unimpaired individuals at high genetic risk of AD. It is, therefore, well-suited to study early pathophysiological changes in the preclinical ADcontinuum.HighlightsPrevalence of ε4 carriers in ALFA is higher than in the general European population.The ALFA study is highly enriched in AD genetic risk factors beyondAPOE.AD genetic profiles in ALFA are similar to clinical groups along thecontinuum.ALFA has succeeded in establishing a cohort of CU individuals at high genetic AD risk.ALFA is well suited to study pathogenic events/early pathophysiological changes in AD.