bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proportional Internal Work—a New Parameter of Exercise Testing in Study of Health in Pomerania (SHIP)
Authors: Ittermann Till , Ewert Ralf , Habedank Dirk , Kaczmarek Sabine , Felix Stephan B. , Dörr Marcus , Stubbe Beate , Bahls Martin 
Published: May 2023

Purpose:Cardiopulmonary exercise testing usually requires a maximal exhaustive effort by the patient and is time consuming. The purpose of this study was to assess whether the cost to initiate exercise termed “proportional internal work” (PIW) was related to cardiovascular disease (CVD) risk factors, ventilatory parameters, and mortality.Methods:We used data from population-based Study of Health in Pomerania. A total of 2829 (49.5% female) study participants with a median age of 52 (42-62) yr were included. Standardized questionnaires were used to assess CV risk factors. The cardiopulmonary exercise testing was performed using a modified Jones protocol. Regression models adjusted for sex and age were used to relate PIW with CVD risk factors and ventilatory parameters. The PIW was calculated by the following formula: (Oxygen uptake at rest – Oxygen uptake without load)/V˙o2peak) × 100. Cox regression analysis was used to relate PIW and all-cause mortality.Results:We identified a nonlinear association between PIW and percent predicted V˙o2peak. Women had a 2.96 (95% CI, 2.61-3.32) greater PIW than men. With each year of age and every point in body mass index, the PWI increased by 0.04 (95% CI, 0.03-0.05) and 0.16 (95% CI, 0.12-0.20), respectively. After adjustment for age, sex, smoking, and body mass index, a 1-point greater PIW was associated with a 5% higher risk to die (HR = 1.05; 95% CI, 1.01-1.07).Conclusions:The PIW is a new cardiopulmonary exercise testing parameter related to CVD risk and all-cause mortality. Future studies should assess the prognostic relevance of PIW for CVD prevention.
Work as a Frontline Volunteer During the COVID-19 Outbreak in Hubei, China: A Qualitative Inquiry of Male Nurses
Authors: CHEN Liuliu , CHEN Xiangying , DENG Zhijian , ZHAO Junyan , YANG Liu , ZHANG Jianghui , PENG Jianying , SUN Lili , QIU Yeyin , DENG Renli , ZHANG Hongtao 
Published: May 2023

ABSTRACT

Background
During the coronavirus (COVID-19) outbreak in 2019, an increased large number of male nurses volunteered for frontline assignment. Their excellent performance suggests that male nurses have several advantages over female nurses. However, research into the activities of Chinese male nurses engaged in frontline work during the COVID-19 pandemic remains limited.

Purpose
This study was designed to summarize the reflections of male nurses on their experiences while volunteering for frontline COVID-19 duty in Hubei, China.

Methods
An interpretative qualitative descriptive study was conducted from May to July 2020 on male nurses who had volunteered for frontline COVID-19 duty in Hubei. Twelve male nurses were selected using a purposive sampling method. Data were collected using semistructured interviews, transcribed verbatim, and analyzed using thematic analysis.

Results
Four main themes and 11 subthemes were identified, including (a) changing the way of thinking at work (four subthemes), (b) clarity regarding career development (three subthemes), (c) change in life philosophy (two subthemes), and (d) personal growth (two subthemes).

Conclusions
The experience of volunteering during the COVID-19 public health emergency influenced the male nurses positively in terms of improved organizational, management, and decision-making skills as well as improved performance. The beneficial attributes of male nurses should be taken into consideration when developing management policies related to nursing personnel.
American Medical Society of Sports Medicine Position Statement: Mononucleosis and Athletic Participation
Authors: Putukian Margot , McGrew Christopher A. , Benjamin Holly J. , Hammell Mary Kitazono , Hwang Calvin E. , Ray Jeremiah W. , Statuta Siobhan M. , Sylvester Jillian , Wilson Kristina 
Published: May 2023

Abstract:
Infectious mononucleosis (IM) is a common illness in children and young adults caused primarily by the Epstein–Barr Virus (EBV). Transmission occurs primarily through sharing oral secretions, thus IM is known as the “kissing disease.” Common clinical manifestations include fever, pharyngitis, posterior cervical lymphadenopathy, and splenomegaly. Atypical lymphocytosis and transaminase elevations are common, and the diagnosis of IM is confirmed with laboratory findings of a positive heterophile antibody (“Monospot”), polymerase chain reaction, or antibodies specific to EBV. Individuals with acute IM may be quite symptomatic and not feel well enough to participate in sports. Splenic enlargement is common, with rupture a relatively rare occurrence, typically occurring within a month of symptom onset, but this risk complicates sports participation, and is often the reason for restricting activity. The management of IM is primarily supportive, with no role for antivirals or corticosteroids. The variability of clinical presentation and the risk of splenic rupture in patients with IM present clinicians with challenging return to play/return to sport (RTS) decisions. This position statement updates the Evidence-Based Subject Review on Mononucleosis by the American Medical Society for Sports Medicine published in 2008 and reviews the epidemiology, clinical manifestations, laboratory assessment, and management including RTS for the athlete with IM. This statement also addresses complications, imaging, special considerations, diversity and equity considerations, and areas for future clinical research. Understanding the evidence regarding IM and sport is essential when communicating with athletes and their families and incorporating shared decision-making in the RTS decision.
Secondary renal amyloidosis due to primary Sjogren’s syndrome: a case report
Authors: Mohammed Shorsh A. , Karim Dana O. , Fakhralddin Saman S. , Bapir Rawa , Hadi Tahani Shakr , Hussein Dlsoz M. , Hiwa Dilan S. , Hamasalih Hussein M. , Hasan Sabah J. , Kakamad Fahmi H. 
Published: May 2023

Introduction and importance:
Amyloidosis is a rare disorder characterized by the deposition of abnormal proteins in extracellular tissues, resulting in the dysfunction of vital organs and, eventually, death. The occurrence of amyloidosis due to primary Sjogren’s syndrome (pSS) is a rare finding. This study describes a rare case of pSS complicated by amyloid-associated amyloidosis.

Case presentation:
A 35-year-old male was diagnosed with nephrotic syndrome and secondary amyloidosis caused by pSS. He had microscopic hematuria, a creatinine level of 6.59 mg/dl, and an elevated erythrocyte sedimentation rate of 107 mm/hrs. Furthermore, investigations of antinuclear antibodies, antimitochondrial antibodies, SSA, SSA native, and Ro-52 recombinant as well as rheumatoid factor showed positive results. After establishing the diagnosis of pSS through clinical, physical, and laboratory assessments, a renal biopsy was performed, which revealed the occurrence of secondary amyloidosis.

Clinical discussion:
The risk of developing secondary amyloidosis depends on the extent of elevated serum amyloid levels as well as persistent subclinical inflammation. The definitive diagnosis of amyloidosis requires histological confirmation of amyloid fibril deposition in tissue.

Conclusion:
Secondary renal amyloidosis is an unusual condition in patients with pSS. Still, it should be regarded in the differential diagnosis of patients with proteinuria and/or renal failure, and a renal biopsy should be performed.
Li-Fraumeni syndrome in the setting of re-occurring malignancies after 27 years of remission: a case report
Authors: Mousa Ahmed H. , Ibrahim Abdullatif S. , Alsayed Abdelrahman Waleed , Albukhari Zain Z. , Mogharbel Ajfan , Alshanberi Asim M. , Albar Nezar Y. 
Published: May 2023

Introduction and importance:
Multiple primary tumors are defined as multiple simultaneous (within 6 months) or heterogeneous tumors.

Case presentation:
Here, the authors present the case of a 58-year-old Saudi female patient with Li-Fraumeni syndrome who has multiple primary tumors.

Clinical discussion:
The surgical cytoreduction or ‘debulking’ technique is the main treatment option started in individuals with High Grade Serous Ovarian CanceR. This surgical strategy aims to completely remove all disseminated tumor masses that are present in the patient’s peritoneal cavity on a macroscopic level.

Conclusion:
In conclusion, in our case, she has developed her ovarian cancer 27 years after her breast cancer got treated. This was already stage IIIB to stage IV. If it was not for her incidental discovery of her urinary bladder cancer, which is most likely is a long-term sequel of using cyclophosphamide 27 years ago.
Multiple primary tumors are defined as multiple simultaneous (within 6 months) or heterogeneous tumors. Here, the authors present the case of a 58-year-old Saudi female patient with Li-Fraumeni syndrome who has multiple primary tumors. In conclusion, in our case, she has developed her ovarian cancer 27 years after her breast cancer got treated. This was already stage IIIB to stage IV. If it was not for her incidental discovery of her urinary bladder cancer, which is most likely is a long-term sequel of using cyclophosphamide 27 years ago.
Effectiveness of mixture of aspirin and ethanol regimen in the management of geographic tongue: a prospective study
Authors: Sohal Karpal S. , Owibingire Sira S. , Moshy Jeremiah R. , Odhiambo Walter A. , Lubasha Boniphace 
Published: May 2023

Background:
Geographic tongue is usually an asymptomatic inflammatory disorder of the tongue; however, symptomatic cases do occur and require treatment. Several management strategies have been reported yet they are neither specific nor curative.

Objective:
The objective was to evaluate the effectiveness of an aspirin-ethanol mixture in the management of geographic tongue.

Methods:
In this prospective study, an analysis of medical reports of symptomatic cases of geographic tongue managed using an aspirin-ethanol mixture was done. The treatment regimen involved dissolving 3 mg of aspirin (acetylsalicylic acid) into 1 ml of 70% v/v ethanol. Then a sterile gauze is soaked in the prepared mixture and is topically used to clean the tongue with gentle pressure for 2–3 min.

Results:
The records of 23 patients were analyzed. There were more females (19, 82.6%), and the age range of patients was 15–43 years (mean age of 23.4 years). The symptoms that the patient described included: oral discomfort, burning sensations of the tongue, pain, and loss of taste. Only 21 (91.3%) patients were asymptomatic at 3 months of follow-up.

Conclusions:
Short-term topical application of the aspirin-ethanol mixture was shown to be effective in treating symptomatic geographic tongue.
Delayed diagnosis of duodenal duplication cyst in a child with recurrent pancreatitis operated by Whipple procedure: a case report
Authors: Shubietah Abdalhakim R. M. , Deek Soud M. S. , Zakaria Zaid , Saleh Fares , Abdulkareemsrour Abdulmotti , Naser Mohamad , Dibas Yazan M.S. , Jabri Mohammed S.M. , AbuMohsen Haytham M. A. 
Published: May 2023

Introduction:
Children with acute pancreatitis may experience abdominal pain; the causes of which include anatomical abnormalities and medications. The rare anatomical etiology of duodenal duplication cyst is typically asymptomatic and discovered incidentally. The authors present a unique case of a Whipple-operated duodenal duplication cyst.

Case presentation:
The authors present the case of a 12-year-old Arab male who was admitted to our hospital with worsening, severe epigastric pain, stabbing in nature, and radiating to the back, suggestive of acute pancreatitis. Serum lipase levels were significantly elevated. The patient received appropriate care. His medical history is notable for multiple bouts of pancreatitis in the last 18 months. Previous investigations at other hospitals were mostly unrevealing. A more extensive workup was performed, revealing a duodenal cystic structure. This led to the diagnosis of a duodenal duplication cyst. The Whipple procedure was decided upon due to his recurrent pancreatitis, which caused fibrotic adhesions and anatomic region distortion. The patient underwent surgery and recovered uneventfully.

Discussion:
Acute pancreatitis in children is frequent and can be caused by unrecognized duodenal duplication cysts. When symptomatic, the majority present with vague abdominal pain. Despite using ultrasound as an adjunctive for diagnosis, the cyst might not become apparent until the condition has progressed to an advanced stage. A delayed diagnosis may result in complications necessitating risky surgeries.

Conclusion:
Children with recurrent pancreatitis should be evaluated for a duodenal duplication cyst. Early use of computed tomography scans may be necessary to identify the cause and spare the patient from risky procedures like Whipple surgery.
Cutaneous metastases as a primary manifestation of invasive ductal carcinoma of the breast: a case report
Authors: Kara Tahhan Nour , Abou Azan Anas , Jomaa Al Ali Isam , Abdul Aziz Jeer , Sara Samer 
Published: May 2023

Introduction:
Cutaneous metastases as the first sign of invasive ductal carcinoma are not common. The ambiguous presentation of asymptomatic lesions may result in various diagnoses including dermatologic causes. Early diagnosis is essential in such cases.

Case presentation:
A 43-year-old woman with no risk factors for developing breast cancer at a young age was diagnosed with invasive ductal carcinoma of the left breast after dermatologic complaints of diffuse lesions on the left-back and right subclavian region. The patient remained asymptomatic except for the recent cutaneous presentation, which did not arouse much suspicion.

Conclusion:
Cutaneous metastases of breast cancer remain uncommon, but at the same time represent a poor prognosis for the patient, and when they do occur, treatment options are limited. The delay in taking the proper diagnostic measures in such cases imposes a need to adopt a wider perspective when dealing with the possible occurrence of advanced disease. This also adds up to the importance of breast self-examination by women at a young age and full examination by physicians, especially when they encounter a misguiding presentation.
Feasibility of Bone Mineral Density and Bone Microarchitecture Assessment Using Deep Learning With a Convolutional Neural Network
Authors: Yoshida Kazuki , Tanabe Yuki , Nishiyama Hikaru , Matsuda Takuya , Toritani Hidetaka , Kitamura Takuya , Sakai Shinichiro , Watamori Kunihiko , Takao Masaki , Kimura Eizen , Kido Teruhito 
Published: May 2023

Objectives
We evaluated the feasibility of using deep learning with a convolutional neural network for predicting bone mineral density (BMD) and bone microarchitecture from conventional computed tomography (CT) images acquired by multivendor scanners.

Methods
We enrolled 402 patients who underwent noncontrast CT examinations, including L1–L4 vertebrae, and dual-energy x-ray absorptiometry (DXA) examination. Among these, 280 patients (3360 sagittal vertebral images), 70 patients (280 sagittal vertebral images), and 52 patients (208 sagittal vertebral images) were assigned to the training data set for deep learning model development, the validation, and the test data set, respectively. Bone mineral density and the trabecular bone score (TBS), an index of bone microarchitecture, were assessed by DXA. BMDDL and TBSDL were predicted by deep learning with a convolutional neural network (ResNet50). Pearson correlation tests assessed the correlation between BMDDL and BMD, and TBSDL and TBS. The diagnostic performance of BMDDL for osteopenia/osteoporosis and that of TBSDL for bone microarchitecture impairment were evaluated using receiver operating characteristic curve analysis.

Results
BMDDL and BMD correlated strongly (r = 0.81, P < 0.01), whereas TBSDL and TBS correlated moderately (r = 0.54, P < 0.01). The sensitivity and specificity of BMDDL for identifying osteopenia or osteoporosis were 93% and 90%, and 100% and 94%, respectively. The sensitivity and specificity of TBSDL for identifying patients with bone microarchitecture impairment were 73% for all values.

Conclusions
The BMDDL and TBSDL derived from conventional CT images could identify patients who should undergo DXA, which could be a gatekeeper tool for detecting latent osteoporosis/osteopenia or bone microarchitecture impairment.
The mammalian skull: development, structure and function
Authors: Fostowicz-Frelik Łucja , Tseng Z. Jack 
Published: May 2023

The mammalian skull is an informative and versatile study system critical to research efforts across the broad spectrum of molecular, cellular, organismal and evolutionary sciences. The amount of knowledge concerning mammalian skull continues to grow exponentially, fuelled by the advent of new research methods and new material. Computed microtomography, including X-ray imaging using synchrotron radiation, proved to be an important tool for the descriptive and quantitative analysis of cranial anatomy. A major conceptual change, namely combining genetics and development with evolution into ‘evo-devo’ studies, also contributed to our knowledge of the mammalian skull enormously. These advances, coupled with novel techniques now allow researchers to integrate the process of cranial development with data from the fossil record, which is also augmented by seminal discoveries from Africa, Asia and both Americas. However, for decades, there has been no comprehensive source covering fundamental aspects of this vibrant field of evolutionary biology. To address this gap, we offer in this theme issue a balanced mix of research papers and reviews from leading experts in the field and a younger generation of scientists from five continents.This article is part of the theme issue ‘The mammalian skull: development, structure and function’.
Updated knowledge and a proposed nomenclature for nuclear receptors with two DNA Binding Domains (2DBD-NRs)
Authors: Wu Wenjie , LoVerde Philip T. 
Published: May 2023

ABSTRACTNuclear receptors (NRs) are important transcriptional modulators in metazoans. Typical NRs possess a conserved DNA binding domain (DBD) and a ligand binding domain (LBD). Since we discovered a type of novel NRs each of them has two DBDs and single LBD (2DBD-NRs) more than decade ago, there has been very few studies about 2DBD-NRs. Recently, 2DBD-NRs have been only reported in Platyhelminths and Mollusca and are thought to be specific NRs to lophotrochozoan. In this study, we searched different databases and identified 2DBD-NRs in different animals from both protostomes and deuterostomes. Phylogenetic analysis shows that at least two ancient 2DBD-NR genes were present in the urbilaterian, a common ancestor of protostomes and deuterostomes. 2DBD-NRs underwent gene duplication and loss after the split of different animal phyla, most of them in a certain animal phylum as paralogues, rather than orthologues, of that in another animal phylum. Amino acid sequence analysis shows that the conserved motifs in typical NRs are also present in 2DBD-NRs and they are gene specific. From our phylogenetic analysis of 2DBD-NRs and following the rule of Nomenclature System for the Nuclear Receptors, a nomenclature for 2DBD-NRs is proposed.
Chronic exposure of mice to phthalates enhances TGF beta signaling and promotes uterine fibrosis
Authors: Shukla Ritwik , Mahmuda Arshee , Laws Mary J. , Flaws Jodi A. , Bagchi Milan K. , Wagoner Johnson Amy J. , Bagchi Indrani C. 
Published: May 2023

ABSTRACTPhthalates are synthetic chemicals widely used as plasticizers and stabilizers in various consumer products. Because of the extensive production and use of phthalates, humans are exposed to these chemicals daily. While most studies focus on a single phthalate, humans are exposed to a mixture of phthalates on a regular basis. The impact of continuous exposure to phthalate mixture on uterus is largely unknown. Thus, we conducted studies in which adult female mice were exposed for 6 months to 0.15 ppm and 1.5 ppm of a mixture of phthalates containing di(2-ethylhexyl) phthalate, di-iso-nonyl phthalate, benzyl butyl phthalate, di-n-butyl phthalate, diisobutyl phthalate, and diethyl phthalate via chow ad libitum. Our studies revealed that consumption of phthalate mixture at 0.15 ppm and 1.5 ppm for 6 months led to a significant increase in the thickness of the myometrial layer compared to control. Further investigation employing RNA-sequencing revealed an elevated transforming growth factor beta (TGF-β) signaling in the uteri of mice fed with phthalate mixture. TGF-β signaling is associated with the development of fibrosis, a consequence of excessive accumulation of extracellular matrix components, such as collagen fibers in a tissue. Consistent with this observation, we found a higher incidence of collagen deposition in uteri of mice exposed to phthalate mixture compared to unexposed controls. Second Harmonic Generation imaging showed disorganized collagen fibers and an increase in uterine stiffness upon exposure to phthalate mixture. Collectively, our results demonstrate that chronic exposure to phthalate mixture can have adverse effects on uterine homeostasis.
NAIP—NLRC4 Inflammasome Activation in Tuft Cells Activates a PGD2–ILC3 Signaling Circuit that Protects Against Enteric Infection
Authors: Churchill Madeline J. , Bauer Renate , Honodel Roslyn , Christopher Tighe , Smita Shuchi , Warner Lindsey , Mooney Bridget M. , Wojno Elia D. Tait , Rauch Isabella 
Published: May 2023

AbstractIntestinal epithelial cells (IEC) use innate sensing pathways to distinguish pathogens from commensals. One such pathway, the NAIP—NLRC4 inflammasome, initiates extrusion of infected IEC and mediator release upon cytosolic bacterial sensing. Tuft cells are primarily known for their function in anti-parasite immunity. We previously reported that activation of the inflammasome in tuft cells leads to release of prostaglandin D2 (PGD2). We test the hypothesis that tuft cell specific release of PGD2after inflammasome activation initiates antibacterial responses. NAIP—NLRC4 inflammasome activation in tuft cells leads to a type 3 antimicrobial response with increased IL-22 and antimicrobial protein levels within the small intestine, which is dependent on PGD2signaling. A subset of ILC3 express the PGD2receptor CRTH2 and we show them as the source of the increased IL-22. Inflammasome activation in tuft cells also leads to better control ofSalmonellaTyphimurium. These data support that intestinal tuft cells can also induce antibacterial responses.SummaryPGD2release after NAIP—NLRC4 inflammasome activation in tuft cells signals onto ILC3s and mediates host defense mechanisms againstSalmonellaTyphimurium within the small intestine. Tuft cells therefore not only promote immune reactions against parasites, but also bacteria.