bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischaemic stroke despite antiplatelet therapy: Causes and outcomes
Authors: Silimon Norbert , Drop Boudewijn , Clénin Leander , Nedeltchev Krassen , Kahles Timo , Tarnutzer Alexander A , Katan Mira , Bonati Leo , Salmen Stephan , Albert Sylvan , Salerno Alexander , Carrera Emmanuel , Berger Christian , Peters Nils , Medlin Friedrich , Cereda Carlo , Bolognese Manuel , Kägi Georg , Renaud Susanne , Niederhauser Julien , Bonvin Christophe , Schärer Michael , Mono Marie-Luise , Luft Andreas , Rodic-Tatic Biljana , Fischer Urs , Jung Simon , Arnold Marcel , Meinel Thomas , Seiffge David 
Published: May 2023

Background: Ischaemic stroke may occur despite antiplatelet therapy (APT). We aimed to investigate frequency, potential causes and outcomes in patients with ischaemic stroke despite APT. Methods: In this cohort study, we enrolled patients with imaging-confirmed ischaemic stroke from the Swiss Stroke Registry (01/2014-07/2022). We determined the frequency of prior APT, assessed stroke aetiology (modified TOAST classification) and determined the association of prior APT with unfavourable functional outcome (modified Rankin Scale score 3–6) and recurrent ischaemic stroke at 3 months using regression models. Results: Among 53,352 patients, 27,484 (51.5%) had no prior antithrombotic treatment, 17,760 (33.3%) were on APT, 7039 (13.2%) on anticoagulation and 1069 (2.0%) were on APT + anticoagulation. In patients with a history of ischaemic stroke/TIA ( n = 11,948; 22.4%), 2401 (20.1%) had no prior antithrombotic therapy, 6594 (55.2%) were on APT, 2489 (20.8%) on anticoagulation and 464 (3.9%) on APT + anticoagulation. Amongst patients with ischaemic stroke despite APT, aetiology was large artery atherosclerosis in 19.8% ( n = 3416), cardiac embolism in 23.6% ( n = 4059), small vessel disease in 11.7% ( n = 2011), other causes in 7.4% ( n = 1267), more than one cause in 6.3% ( n = 1078) and unknown cause in 31.3% ( n = 5388). Prior APT was not independently associated with unfavourable outcome (aOR = 1.06; 95% CI: 0.98–1.14; p = 0.135) or death (aOR = 1.10; 95% CI: 0.99–1.21; p = 0.059) at 3-months but with increased odds of recurrent stroke (6.0% vs 4.3%; aOR 1.26; 95% CI: 1.11–1.44; p < 0.001). Conclusions: One-third of ischaemic strokes occurred despite APT and 20% of patients with a history of ischaemic stroke had no antithrombotic therapy when having stroke recurrence. Aetiology of breakthrough strokes despite APT is heterogeneous and these patients are at increased risk of recurrent stroke.
Iron removal from kaolin by oxalic acid using a novel pre-agitating and high-pressure washing technique
Authors: Taheri Bijan 
Published: May 2023

AbstractThis study reports a leaching process along with a novel physical pretreatment technique to remove iron impurities from kaolin using oxalic acid. A detailed examination of the physical properties of the minerals confirmed that almost none of the leaching-resistant iron oxides, specifically hematite, was completely interlocked with the clay minerals. Accordingly, a pre-agitating technique followed by high-pressure washing of the sample on a 600 μm sieve were applied. In this method, by discarding up to 20% of the raw material, >54% of the total iron content of the raw kaolin was removed, and the iron content was reduced from 9.75% in the initial sample to <6.00% in the passing fraction. Application of this pretreatment method rendered the leaching process successful at 97°C using 0.3 M oxalic acid solutions for 1 h under atmospheric pressure. Compared to the leaching of the raw material without pretreatment, which consumed at least 0.5 M oxalic acid over a minimum period of 2 h, the method used was very cost-effective and favourable, reducing the iron content of the product to <1% and producing high-quality kaolin.
Sedimentary architecture of shallow-water fan-delta front in a lacustrine basin: Sangyuan section of Lower Cretaceous Xiguayuan Formation, Luanping Basin, northeast China
Authors: Zhang Ke , Wu Shenghe , Wang Hehua , Mi Zhongrong , Qu Jianhua , Wang Zhikun , Wang Haonan 
Published: May 2023

AbstractThe sedimentary architecture of fan deltas, which commonly constitute reservoirs, is a primary control on distribution and recovery efficiency of oil and gas. Deep-water fan deltas have been extensively discussed in the literature, whereas the sedimentary architecture of shallow-water fan-delta fronts, especially the characterization of mouth bar, quantification of architectural elements, and factors controlling the various architectural elements, remain poorly understood. Here, based on the integration of field survey and unmanned aerial vehicle (UAV) observation, the sedimentary architecture of Sangyuan section of the Lower Cretaceous Xiguayuan Formation in the Luanping Basin to is qualitatively and quantitatively characterized. Furthermore, factors controlling the architecture of the shallow-water fan-delta front are highlighted. Five facies associations, which differ in both lithofacies and dimensions, were interpreted in gravel-sand deposits of Sangyuan section, and indicate variations in flow conditions during deposition. The width/thickness ratio of facies associations generally increases rapidly as the flow energy and flow concentration decreases from debris flow to traction currents during the evolution of shallow-water fan delta. Both distributary channels and mouth bars dominate facies associations in the shallow-water fan-delta front, accounting for 53.42% and 36.88% of gravel-sand deposits respectively in Sangyuan section. Mouth bar consists of gravel accretions and sand accretions. Grain size of sediments influences the relative strength of the inertial force and bed friction, which determine the effluent behavior in a river-mouth system and the vertical grain-size trend of mouth bar accretions. Gravel accretions are characterized by normal grading, and these are interpreted as the products of inertia-dominated effluent. Sand accretions exhibit coarsening-upward trends in the river-mouth systems where friction-dominated outflow occurred. The overall vertical grain-size trend of mouth bar depends on the stacking pattern of accretions rather than the grading of one accretion.
Genesis of host rock in the Tamusu Mudstone pre-selected area in Northwest China for high-level radioactive waste geological disposal purposes
Authors: Xiang Long , Liu Xiaodong , Liu Pinghui , Dai Chaocheng , Jiang Meixia 
Published: May 2023

AbstractMudstone characterized by typical structures and mineral assemblages in the Tamusu Mudstone pre-selected area, in Inner Mongolia, Northwest China, has been selected as a potential host rock for China’s high-level radioactive waste (HLW) repository purpose. Based on indications of petrological and geochemical characteristics, hydrothermal sedimentary geneses of host rock are well discussed from the perspectives of hydrothermal sedimentary structures, sedimentary environments, and the hydrothermal sedimentary model. The results show that host rocks have the characteristics of low-temperature "white smoke" hydrothermal sedimentary rocks. The rocks developed in a dry, anaerobic and reducing saline lake environment with transient oxidation and dry–wet evolution. The 100–120 Ma tectonic activity in the Altun fault may have been the main factor controlling the process of hydrothermal exhalative, which provided the migration pathway for water–rock reactions and contributed to the formation of typical structures and mineral assemblages. The hydrothermal sedimentary rock is a new kind of argillaceous rock that serves as a potential host rock, and will provide new insights into suitability evaluations of mudstone properties to promote the site screening of the Tamusu Mudstone pre-selected area for China’s HLW disposal purpose.
Male obesity is associated with sperm telomere shortening and aberrant mRNA expression of autophagy-related genes
Authors: Raee Pourya , Shams Mofarahe Zahra , Nazarian Hamid , Abdollahifar Mohammad-Amin , Ghaffari Novin Mahsa , Aghamiri Shahin , Ghaffari Novin Marefat 
Published: May 2023

Abstract
Background
Obesity is regarded a global public health crisis. It has been implicated in a variety of health problems, but when it comes to male fertility, how and to what extent obesity affects it are poorly understood.
Accordingly, semen samples from 32 individuals with obesity (body mass index (BMI) ≥ 30 kg/m2) and 32 individuals with normal weight (BMI: 18.5-25 kg/m2) were obtained. Here, for the first time, we examined the association between obesity, relative sperm telomere length (STL) and autophagy-related mRNA levels such as Beclin1, AMPKa1, ULK1, BAX, and BCL2. Each group was also evaluated for conventional semen parameters, sperm apoptotic changes, DNA fragmentation index (DFI), sperm chromatin maturation, and reactive oxygen species (ROS) levels.

Results
Based on our findings, there was a marked reduction in relative STL in individuals with obesity as compared to the normal-weight group. We also found a significant negative correlation between relative STL and age, BMI, DFI, percentage of sperm with immature chromatin, and intracellular ROS levels in patients with obesity. In the normal-weight group, relative STL was only negatively correlated with DFI and intracellular ROS levels. Regarding mRNA expression, there was considerable upregulation of Beclin1, ULK1, and BCL2 in the group with obesity compared to the normal-weight group. Obesity was also found to be associated with a considerable decline in semen volume, total sperm count, progressive motility, and viability in comparison to normal-weight individuals. Furthermore, obesity was associated with considerably higher percentages of DFI, sperm with immature chromatin, late-stage apoptosis, and elevated ROS levels.

Conclusion
According to our findings, obesity is associated with sperm telomere shortening and aberrant autophagy-related mRNA expression. It should be emphasized that telomere shortening in sperm may be an indirect consequence of obesity due to the oxidative stress associated with the condition. Nevertheless, further investigation is required for a more comprehensive understanding.
Employing computational tools to design a multi-epitope vaccine targeting human immunodeficiency virus-1 (HIV-1)
Authors: Sher Hamza , Sharif Hafsa , Zaheer Tahreem , Khan Sarmad Ahmad , Ali Amjad , Javed Hasnain , Javed Aneela 
Published: May 2023

AbstractBackgroundDespite being in the 21stcentury, the world has still not been able to vanquish the global AIDS epidemic, and the only foreseeable solution seems to be a safe and effective vaccine. Unfortunately, vaccine trials so far have returned unfruitful results, possibly due to their inability to induce effective cellular, humoral and innate immune responses. The current study aims to tackle these limitations and propose the desired vaccine utilizing immunoinformatic approaches that have returned promising results in designing vaccines against various rapidly mutating organisms. For this, all polyprotein and protein sequences of HIV-1 were retrieved from the LANL (Los Alamos National Laboratory) database. The consensus sequence was generated after alignment and used to predict epitopes. Conserved, antigenic, non-allergenic, T-cell inducing, B-cell inducing, IFN-ɣ inducing, non-human homologous epitopes were selected and combined to propose two vaccine constructs i.e., HIV-1a (without adjuvant) and HIV-1b (with adjuvant).ResultsHIV-1a and HIV-1b were subjected to antigenicity, allergenicity, structural quality analysis, immune simulations, and MD (molecular dynamics) simulations. Both proposed multi-epitope vaccines were found to be antigenic, non-allergenic, stable, and induce cellular, humoral, and innate immune responses. TLR-3 docking andin-silicocloning of both constructs were also performed.ConclusionOur results indicate HIV-1b to be more promising than HIV-1a; experimental validations can confirm the efficacy and safety of both constructs andin-vivoefficacy in animal models.Graphical Abstract
Association between intraoperative remifentanil use and postoperative hyperalgesia in adolescent idiopathic scoliosis surgery: a retrospective study
Authors: Hasan M. Shahnaz , Abdul Razak Norashekeen , Yip Hing Wa , Lee Zheng-Yii , Chan Chris Yin Wei , Kwan Mun Keong , Chiu Chee Kidd , Yunus Siti Nadzrah , Ng Ching Choe 
Published: May 2023

Abstract
Background
The liberal use of remifentanil in spine surgery has been associated with an increased incidence of postoperative hyperalgesia. Nevertheless, controversies remain as the existing evidence is inconclusive to determine the relationship between remifentanil use and the development of opioid-induced hyperalgesia. We hypothesized that intraoperative infusion of higher dose remifentanil during scoliosis surgery is associated with postoperative hyperalgesia, manifesting clinically as greater postoperative morphine consumption and pain scores.

Methods
Ninety-seven patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion surgery at a single tertiary institution from March 2019 until June 2020 were enrolled in this retrospective study. Anesthesia was maintained using a target-controlled infusion of remifentanil combined with volatile anesthetic desflurane in 92 patients, while five patients received it as part of total intravenous anesthesia. Intravenous ketamine, paracetamol, and fentanyl were administered as multimodal analgesia. All patients received patient-controlled analgesia (PCA) morphine postoperatively. Pain scores at rest and on movement, assessed using the numerical rating scale, and the cumulative PCA morphine consumption were collected at a six-hourly interval for up to 48 h. According to the median intraoperative remifentanil dose usage of 0.215 µg/kg/min, patients were divided into two groups: low dose and high dose group.

Results
There were no significant differences in the pain score and cumulative PCA morphine consumption between the low and high dose remifentanil group. The mean duration of remifentanil infusion was 134.9 ± 22.0 and 123.4 ± 23.7 min, respectively.

Conclusion
Intraoperative use of remifentanil as an adjuvant in AIS patients undergoing posterior spinal fusion surgery was not associated with postoperative hyperalgesia.
Physicians’ experiences and actions in making complex level-of-care decisions during acute situations within older patients’ homes: a critical incident study
Authors: Forsgärde Elin-Sofie , Rööst Mattias , Elmqvist Carina , Fridlund Bengt , Svensson Anders 
Published: May 2023

Abstract
Background
Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians’ decision-making during acute situations in older patients’ homes is limited. Therefore, this study aimed to describe physicians’ experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes.

Methods
Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included.

Results
In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients’ and their significant others’ needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians’ actions involved searching for an understanding of older patients’ and their significant others’ wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved.

Conclusion
Physicians strive to individualize complex level-of-care decisions based on older patients’ and their significant others’ wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 − 7 collaboration between organizations and health care professionals.
Dolutegravir-associated resistance mutations after first-line treatment failure in Brazil
Authors: Diaz Ricardo Sobhie , Hunter James R. , Camargo Michelle , Dias Danilo , Galinskas Juliana , Nassar Isabela , de Lima Isaac Barbosa , Caldeira Debora Bellini , Sucupira Maria Cecilia , Schechter Mauro 
Published: May 2023

Abstract
Background
Since January 2017, the recommended first-line antiretroviral regimen in Brazil is the fixed-dose combination of tenofovir plus lamivudine with dolutegravir (TL + D). According to the literature, integrase resistance-associated mutations (INRAMs) are rarely found upon virologic failure to first-line dolutegravir plus two nucleoside reverse transcriptase inhibitors. We evaluated the HIV antiretroviral genotypic resistance profile of patients referred for genotyping in the public health system who failed first-line TL + D after at least six months of therapy on or before December 31, 2018.

Methods
HIV Sanger sequences of the pol gene were generated from plasma of patients with confirmed virologic failure to first-line TL + D in the Brazilian public health system before December 31, 2018.

Results
One hundred thirteen individuals were included in the analysis. Major INRAMs were detected in seven patients (6.19%), four with R263K, one with G118R, one with E138A, and one with G140R. Four patients with major INRAMs also had the K70E and M184V mutations in the RT gene. Sixteen (14.2%) additional individuals presented minor INRAMs, and five (4,42%) patients had both major and minor INRAMS. Thirteen (11.5%) patients also presented mutations in the RT gene selected by tenofovir and lamivudine, including four with both the K70E and M184V mutations and four with only M184V. The integrase mutations L101I and T124A, which are in the in vitro pathway for integrase inhibitor resistance, were found in 48 and 19 patients, respectively. Mutations not related to TL + D, thus probable transmitted resistance mutations (TDR), were present in 28 patients (24.8%): 25 (22.1%) to nucleoside reverse transcriptase inhibitors, 19 (16.8%) to non-nucleoside reverse transcriptase inhibitors, and 6 (5.31%) to protease inhibitors.

Conclusions
In marked contrast to previous reports, we report a relatively high frequency of INRAMs among selected patients failing first-line TL + D in the public health system in Brazil. Possible reasons for this discrepancy include delays in detecting virologic failure, patients inadvertently on dolutegravir monotherapy, TDR, and/or infecting subtype.
“I take it and give it to my partners who will give it to their partners”: Secondary distribution of HIV self-tests by key populations in Côte d’Ivoire, Mali, and Senegal
Authors: Ky-Zerbo Odette , Desclaux Alice , Boye Sokhna , Maheu-Giroux Mathieu , Rouveau Nicolas , Vautier Anthony , Camara Cheick Sidi , Kouadio Brou Alexis , Sow Souleymane , Doumenc-Aidara Clémence , Gueye Papa Alioune , Geoffroy Olivier , Kamemba Odé Kanku , Ehui Eboi , Ndour Cheick Tidiane , Keita Abdelaye , Larmarange Joseph ,   for the ATLAS team
Published: May 2023

Abstract
Introduction
HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage.
We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d’Ivoire, Mali, and Senegal.

Methods
A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed.

Results
A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners’ reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse.
Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants).

Conclusion
The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps.
Prenatal care and infant outcomes of teenage births: a Project WATCH study
Authors: Gardner Madelin E. , Umer Amna , Rudisill Toni , Hendricks Brian , Lefeber Candice , John Collin , Lilly Christa 
Published: May 2023

Abstract
Introduction
Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations.

Purpose
To determine the association between inadequate PNC (< 10 visits) and poor infant outcomes neonatal intensive care unit (NICU) stay, low APGAR score, small for gestational age (SGA) and length of stay (LOS).

Methods
The study used West Virginia (WV) Project WATCH population level data (May 2018-March 2022). Multiple logistic regressions and survival analysis were performed on infant outcomes; NICU stay, APGAR score, infant size, and infant length of stay (LOS) with PNC categories inadequate (< 10 PNC visits) vs adequate (10 or more) adjusting for covariates including maternal race, insurance status, parity, smoking status, substance use status, and diabetes status.

Results
Of births to teenagers, 14% received inadequate PNC. Teens who received inadequate PNC had increased odds of infant admitted to NICU (aOR: 1.84, CI:(1.41, 2.42), p < 0.0001), low 5- minute APGAR score (aOR: 3.26, CI:(2.03,5.22), p < 0.0001), and increased LOS (Est. = -0.33, HR: 0.72, CI:(0.65,0.81), p < 0.0001).

Conclusions
Results demonstrated that infants of teenagers who received inadequate PNC are at increased risk of requiring a NICU stay, having a low APGAR score and requiring an increased LOS. PNC is particularly important for these groups as they are at increased risk of poor birth outcomes.