bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel echocardiographic markers for left ventricular filling pressure prediction in heart failure with preserved ejection fraction (ECHO-PREDICT): a prospective cross-sectional study
Authors: Suleman Muhammad , Saqib Muhammad , Mumtaz Hassan , Iftikhar Muhammad , Raza Ali , Rauf Butt Samia , Talha Kenza Manahal 
Published: September 2023

Heart failure with preserved ejection fraction is a complex clinical syndrome associated with a high level of morbidity and mortality, constituting 56% of heart failure cases and showing an increasing prevalence. The E/Ea ratio, used for echocardiographic assessment of left ventricular (LV) filling pressure, has been commonly recommended as a noninvasive measure. However, its validity lacks robust prospective validation in patients with preserved LV ejection fraction, and its accuracy has been questioned in comparison to patients with reduced LV ejection fraction. The objective of this study was to evaluate the accuracy of novel echocardiographic markers incorporating peak E velocity, left atrial volume index (LAVi), and pulmonary artery systolic pressure (PAP) for noninvasive estimation of LV end-diastolic pressure (LVEDP) against invasive measurement. In this cross-sectional study conducted at a tertiary care hospital, a sample size of 122 participants was utilized. Statistical analyses including independent samples t-test, χ2 test, and linear regression analysis were employed to explore correlations and predict outcomes. The results indicated that Group 1 (LVEDP <20 mmHg) had a mean age of 59.25 years, while Group 2 (LVEDP >20 mmHg) had a mean age of 56.93 years. Mitral E velocity positively predicted LVEDP, while Mitral E/A ratio showed a negative association. Notably, (E+PAP)/2, (E+LAVi)/2, and Mitral E exhibited good discriminative ability, with respective area under the curve values of 0.840, 0.900, and 0.854. (E+LAVi)/2 demonstrated the highest discriminatory power, with a threshold of 40.100, yielding high sensitivity (0.971) but relatively low specificity (0.302) in predicting LVEDP greater than 20. These findings emphasize the accuracy and utility of combining diastolic variables and peak E velocity as markers for left ventricular filling pressure in patients with a high burden of cardiac disease. Additionally, the study highlights the importance of these parameters in assessing cardiac abnormalities and supports the potential of novel echocardiographic parameters, particularly (E+LAVi)/2, in predicting LVEDP greater than 20. Further research is warranted to validate and explore the prognostic implications of these parameters in larger patient populations, ultimately improving the diagnosis and management of cardiac disease and enhancing clinical outcomes.
Propensity score-matched comparison of safety outcomes between high-risk and low-risk patients towards early hospital discharge after laparoscopic cholecystectomy
Authors: Cheewatanakornkul Siripong , Yolsuriyanwong Kamthorn , Wangkulangkul Piyanun , Bualoy Praisuda , Sakolprakaikit Kanittha 
Published: September 2023

Background:
Laparoscopic cholecystectomy (LC), a common treatment for symptomatic gallstones, has demonstrated safety in low-risk patients. However, existing data are scarce regarding the safety of LC in high-risk patients and the feasibility of early hospital discharge.

Materials and methods:
This retrospective study included 2296 patients diagnosed with symptomatic gallstones who underwent LC at a tertiary care centre from January 2009 through December 2019. The authors employed propensity score matching to mitigate bias between groups. Statistical significance was set at P less than 0.05.

Results:
The median age of the patients was 56 years (range 46–67), with a mean BMI of 25.2±4.3 kg/m2. Patients were classified as: American Society of Anesthesiologists (ASA) I (19.7%), II (68.3%), III (12.0%), and IV (0%). ASA I–II included low surgical risk patients (88%) and ASA III–IV comprised high-risk patients (12%). The LC-related 30-day reoperative rate was 0.2% and the readmission rate was 0.87%. Nine patients (0.4%) sustained major bile duct injuries, resulting in a conversion rate of 2.4%. The postoperative mortality rate was 0.04%, and the mean hospitalization time was 3.5 days. Patients in the high-risk group with a history of acute cholecystitis exhibited greater estimated blood loss, longer operative times, and were significantly more likely to be in the longer-stay group.

Conclusion:
These findings suggest that LC can be conducted safely on high-risk patients, and early hospital discharge is achievable. However, specific factors, such as a history of acute cholecystitis, may result in prolonged hospitalization owing to increased blood loss and longer operative times.
Coexistence of choroidal melanoma and rhegmatogenous retinal detachment: a case report and literature review
Authors: Pokawattana Nattapol , Prasert Wiwat , Silpa-archa Sukhum 
Published: September 2023

Introduction and importance:
The simultaneous occurrence of rhegmatogenous retinal detachment (RRD) and choroidal melanoma is extremely rare, and diagnosis of choroidal melanoma in RRD patients is challenging. As a result, choroidal masses in RRD patients tend to be overlooked, resulting in delayed treatment. The authors report a rare case presenting with simultaneous choroidal melanoma and RRD, and the authors review the related literature.

Case presentation:
A 45-year-old Thai man who presented with inferior RRD and choroidal elevation in the left eye was examined using fundoscopy and ultrasonography. The presumptive diagnosis was simultaneous RRD and haemorrhagic choroidal detachment (CD). Vitrectomy and external drainage were attempted but were unsuccessful in draining fluid from the presumed haemorrhagic CD. Although the retina was reattached, the choroidal elevation remained unchanged. After being lost to follow-up, the patient returned later with severe proptosis in the left eye. MRI findings suggested a presumptive diagnosis including choroidal melanoma and choroidal metastasis, which choroidal melanoma was later confirmed through histopathological examination after exenteration.

Clinical discussion:
Important clinical clues were provided for distinguishing between choroidal melanoma and haemorrhagic CD in cases of coexisting RRD.

Conclusions:
In the differential diagnosis of RRD with suspicious choroidal elevation, the possibility of the presence of choroidal melanoma should be considered. In particular, in cases where haemorrhagic CD fails to drain during surgery, the possibility of underlying choroidal melanoma should be investigated.
Jejunal duplication cyst in a female neonate: a case report
Authors: Sah Rajesh Prasad , Bhusal Amrit , Pokhrel Sagar , Yogi Tek Nath , Labh Sujal , Acharya Kshitiz , Pokharel Sushan , Bhattarai Madhur 
Published: September 2023

Introduction and importance:
Duplications are the abnormal portion of the intestine, either externally attached to the intestine or intrinsically placed within the bowel lumen. Their prevalence is noted to be around one in 25 000 deliveries. The rare gastrointestinal tract duplication may be located in any part of the gastrointestinal system from the oral cavity to the anus. The most common site of enteric duplication cyst (DC) is the terminal part of the ileum. Hence, duplications in jejunum are rare.

Case presentation:
Hereby, the authors report a case of jejunal DC in a female neonate which was managed successfully via surgery and adequate post-operative care without any complications.

Clinical discussion:
Duplications are more frequently single. They are usually located in the mesenteric border of the associated native bowel and may vary in shape and size. Most of them are cystic, followed by tubular and mixed type, with or without other congenital anomalies. More than 80% of the cases present before the age of 2 years as an acute abdomen or bowel obstruction, but many duplications remain silent unless complications occur, and therefore may not be diagnosed until adulthood. Complications of enteric DC include volvulus, bleeding, and, rarely, malignant degeneration.

Conclusion:
It is important for paediatric surgeons to include DC in the differential diagnosis if a neonate presents with features of intestinal obstruction.
Rare giant renal artery aneurysm in neurofibromatosis type 1 patient: a case report
Authors: Jawad Ali , Hannouneh Zein Alabdin , Soqia Jameel , Al Nahhas Zaher , Ahmed Adnan , Nahas Mohamad Ali 
Published: September 2023

Introduction and importance:
Neurofibromatosis type 1 (NF1) is a genetic disorder characterised by multiple neurofibromas, café-au-lait spots, and iris hamartomas. The variety of vasculopathies that can occur in NF1 make it difficult for clinicians to accurately follow-up patients. Most cases of vasculopathies are stenotic, and, in few cases, aneurysms may form.

Case presentation:
A 35-year-old male presented with extreme left flank pain for the past 2 days. His physical examination revealed whole-body several café-au-lait skin macules, a subcutaneous lesion, and a palpable abdominal mass in the left flank. His laboratory workup was within normal ranges. A multi-slice computed tomography and computed tomography angiogram with contrast outlined a giant left renal artery aneurysm (RAA). A kidney salvage surgery was planned. However, due to ectatic dilatation and large extension of the aneurysm, the affected renal artery branches and renal vein were found unfit for auto-transplantation during the surgical procedure and a total nephrectomy was necessary. Symptoms improved significantly postoperatively and no complications developed.

Clinical discussion:
RAA is an uncommon finding in NF1 patients. Diagnosis is often dependent on computed tomography angiogram. Management techniques are conservative, endovascular, or surgical. In few surgical cases, a total nephrectomy may be necessary if auto-transplantation is not feasible.

Conclusion:
Despite its rarity, the diagnosis of RAA should be considered in patients with NF1 presenting with flank pain. Moreover, early screening for renal vasculopathies can evade critical surgical outcomes including a total nephrectomy. Hence, the authors recommend a total vascular workup for these patients, consisting of doppler ultrasound and, if necessary, a multi-slice computed tomography with contrast.
Socio-economic and Demographic Factors Influencing Interpersonal Communication Between Patients and Family Physicians: A Protocol for a Systematic Review
Authors: Svyntozelska Olha , Espinoza Suarez Nataly R. , Demers Juliette , Dugas Michèle , LeBlanc Annie 
Published: September 2023

ABSTRACTBackgroundInterpersonal communication is an essential aspect of patients’ relationships with their family physicians. It impacts patients’ experiences and the quality of care. Nevertheless, interpersonal communication can be affected by conscious and unconscious biases based on patients’ socio-economic and demographic characteristics. Evidence synthesis of this aspect of interpersonal communication in primary health care is limited. This systematic review will assess socio-economic and demographic factors influencing interpersonal communication between family physicians and patients living with one or more chronic conditions during clinical encounters.MethodsWe will perform a systematic review following the Joanna Briggs Institute Manual for Evidence Synthesis. The population of interest is adults living with at least one chronic condition. We will collect socioeconomic and demographic factors such as gender, sex, race or ethnicity, levels of literacy and/or health knowledge, level of education, and poverty or socioeconomic status, including employment or income level. Any published empirical study reporting aspects of interpersonal communication between patients and their family physicians will be considered. Three databases (Embase, MEDLINE, and Cochrane) will be assessed for eligible studies. Pairs of independent reviewers will select studies, extract data, and conduct bias assessment using MMAT-2018. We anticipate conducting descriptive and content analyses with narrative synthesis.DiscussionFindings from this review may guide better communication between primary care physicians and their patients and increase awareness of potential health inequalities pathways in clinical practice.Registration numberCRD42023411895 (PROSPERO platform).
Structural network topology correlates with cognitive impairment in Parkinson’s disease
Authors: Chen Zhichun , Li Guanglu , Zhou Liche , Zhang Lina , Yang Li , Liu Jun 
Published: September 2023

ABSTRACTIn patients with Parkinson’s disease (PD), cognitive impairment is common and substantially exacerbates disease severity. The objective of this study is to investigate whether cognitive decline affects disease severity and whether structural network disruption contributes to cognitive impairment in PD patients. PD patients (n = 146) receiving structural and functional magnetic resonance imaging from Parkinson’s Progression Markers Initiative (PPMI) database were included. Based on the scores of Symbol Digit Modalities Test (SDMT), patients were classified into lower quartile group (SDMT score rank: 0%∼25%), interquartile group (SDMT score rank: 26%∼75%), and upper quartile group (SDMT score rank: 76%∼100%) according to their SDMT score quartiles to assess how cognitive function shapes disease manifestations and brain network topology. Patients in the lower quartile group exhibited more severe motor symptoms, non-motor symptoms, and striatal dopamine depletion compared to interquartile group and upper quartile group. In addition, they also showed impaired structural network topology both at global and local levels compared to interquartile group and upper quartile group. Furthermore, different nodal network metrics in structural network contributed to cognitive and motor impairment of PD patients. Taken together, PD patients with worse cognitive function exhibited more severe motor and non-motor symptoms and aberrant structural network metrics were associated with both cognitive and motor decline of PD patients.
Polygenic Risk of Epilepsy and Post-Stroke Epilepsy
Authors: Rivier Cyprien A. , Clocchiatti-Tuozzo Santiago , Misra Shubham , Zelano Johan , Mazumder Rajarshi , Sansing Lauren H , de Havenon Adam , Hirsch Lawrence J. , Liebeskind David S. , Gilmore Emily J. , Sheth Kevin N. , Kim Jennifer A. , Worrall Bradford B. , Falcone Guido , Mishra Nishant K. 
Published: September 2023

ABSTRACTBackground and AimsEpilepsy is highly heritable, with numerous known genetic risk loci. However, the genetic predisposition’s role in post-acute brain injury epilepsy remains understudied. This study assesses whether a higher genetic predisposition to epilepsy raises post-stroke or Transient Ischemic Attack (TIA) survivor’s risk of Post-Stroke Epilepsy (PSE).MethodsWe conducted a three-stage genetic analysis. First, we identified independent epilepsy-associated (p<5x10−8) genetic variants from public data. Second, we estimated PSE-specific variant weights in stroke/TIA survivors from the UK Biobank. Third, we tested for an association between a polygenic risk score (PRS) and PSE risk in stroke/TIA survivors from the All of Us Research Program. Primary analysis included all ancestries, while a secondary analysis was restricted to European ancestry only. A sensitivity analysis excluded TIA survivors. Association testing was conducted via multivariable logistic regression, adjusting for age, sex, and genetic ancestry.ResultsAmong 19,708 UK Biobank participants with stroke/TIA, 805 (4.1%) developed PSE. Likewise, among 12,251 All of Us participants with stroke/TIA, 394 (3.2%) developed PSE. After establishing PSE-specific weights for 39 epilepsy-linked genetic variants in the UK Biobank, the resultant PRS was associated with elevated odds of PSE development in All of Us (OR:1.16[1.02-1.32]). A similar result was obtained when restricting to participants of European ancestry (OR:1.23[1.02-1.49]) and when excluding participants with a TIA history (OR:1.18[1.02-1.38]).ConclusionsOur findings suggest that akin to other forms of epilepsy, genetic predisposition plays an essential role in PSE. Because the PSE data were sparse, our results should be interpreted cautiously.
Developmental progression of the nasopharyngeal microbiome during childhood and association with the lower airway microbiome
Authors: Hernandez-Leyva Ariel J. , Rosen Anne L. , Tomera Christopher P. , Lin Elaina E. , Akaho Elikplim H. , Blatz Allison M. , Otto William R. , Logan Joey , Young Lisa R. , Harris Rebecca M. , Kau Andrew L. , Odom John Audrey R. 
Published: September 2023

ABSTRACTBackgroundThe upper (URT) and lower (LRT) respiratory tract feature distinct environments and responses affecting microbial colonization but investigating the relationship between them is technically challenging. We aimed to identify relationships between taxa colonizing the URT and LRT and explore their relationship with development during childhood.MethodsWe employed V4 16S rDNA sequencing to profile nasopharyngeal swabs and tracheal aspirates collected from 183 subjects between 20 weeks and 18 years of age. These samples were collected prior to elective procedures at the Children’s Hospital of Philadelphia over the course of 20 weeks in 2020, from otherwise healthy subjects enrolled in a study investigating potential reservoirs of SARS-CoV-2.FindingsAfter extraction, sequencing, and quality control, we studied the remaining 124 nasopharyngeal swabs and 98 tracheal aspirates, including 85 subject-matched pairs of samples. V4 16S rDNA sequencing revealed that the nasopharynx is colonized by few, highly-abundant taxa, while the tracheal aspirates feature a diverse assembly of microbes. While no taxa co-occur in the URT and LRT of the same subject, clusters of microbiomes in the URT correlate with clusters of microbiomes in the LRT. The clusters identified in the URT correlate with subject age across childhood development.InterpretationsThe correlation between clusters of taxa across sites may suggest a mutual influence from either a third site, such as the oropharynx, or host-extrinsic, environmental features. The identification of a pattern of upper respiratory microbiota development across the first 18 years of life suggests that the patterns observed in early childhood may extend beyond the early life window.FundingResearch reported in this publication was supported by NIH T32 GM007200 (AJH), F30 DK127584 (AJH), NIH/NIAID R21AI154370 (AOJ, ALK), NIH/NICHD R01HD109963 (AOJ, ALK), and NIH/NICHD R33HD105594 (AOJ). Dr. John is an Investigator in the Pathogenesis of Infectious Diseases of the Burroughs Welcome Fund.
Knowledge, attitudes and usage of electronic medical records system at Ocean Road Cancer Institute in Tanzania; An example of EMR user satisfaction in sub-Saharan Africa
Authors: Msami Khadija , Okoroafor Ugochukwu , Mbwana Mohammed , Ngowi John , Lwanga Charles , Luziga Habibu 
Published: September 2023

ABSTRACTBackgroundElectronic medical records (EMR) is a useful tool to facilitate workflow and improve the quality of patient care and patient safety. Ocean Road Cancer Institute (ORCI) started the computerization of patients’ records and running of administrative tasks via a customized system.Broad objectiveThis study was designed to assess the extent of utilization, staff knowledge, and attitudes towards the EMR system at ORCI. A quantitative data collection tool was adopted and distributed.MethodologyThe study was conducted at Ocean Road Cancer Institute (ORCI), a national tertiary centre located in Dar es Salaam, Tanzania. Of the 259 employees, a standard structured tool for data collection was applied to the 154 staff calculated sample size.ResultsAll the respondents (52) had a working experience of more than three months and had access to the EMR with 49 (94.2%) involved in direct patient care. 25(48.1%) were male and 27(51.9%) were female with a computer literacy rate of 92.3% (48). Only 2(3.8%) of the respondents held postgraduate degrees, and 25 (48.1%) each had diploma (college) and degree (university) level of education. 26(50%) felt the EMR was efficient and met user demands, 19(36.5%) felt it efficient but needing additional modification and only 4 (7.7%) felt it a wastage of time. Attitudes for the usage were fairly distributed with most claiming either slight increase (21, 40.4%) or increase (19,36.5%) quality of work but only 51.9% (27) felt the tasks became easier. 33(63.5%) of the respondents always use paper-based records together with EMR. Whereas 25(48.1%) felt the system provided precise information and 37(71.2%) agreed that the contents provided in the system met their needs, 15(28.8%) felt that the contents never met their needs and 27(51.9%) of the respondents felt that it is not precise. While majority (85%) overall were satisfied with the system and 31(59.6%) rating it as good. 5(9.6%) rated poor satisfaction and there was an even divide on finding the system complicated.ConclusionsOverall, hospital staff know the potential benefits of proper implementation and use of an EMR in capturing clinical care. However, without proper and continuous ICT support, the EMR will continue to struggle with its adaptability and user satisfaction.
Host-encoded CTCF regulates human cytomegalovirus latency via chromatin looping
Authors: Groves Ian J. , O’Connor Christine M. 
Published: September 2023

AbstractHuman cytomegalovirus (HCMV) is a prevalent pathogen that establishes life-long latent infection in hematopoietic cells. While this infection is usually asymptomatic, immune dysregulation leads to viral reactivation, which can cause significant morbidity and mortality. However, the mechanisms underpinning reactivation remain incompletely understood. The HCMV major immediate early promoter (MIEP)/enhancer is a key factor in this process, as its transactivation from a repressed to active state helps drive viral gene transcription necessary for reactivation from latency. Numerous host transcription factors bind the MIE locus and recruit repressive chromatin modifiers, thus impeding virus reactivation. One such factor is CCCTC-binding protein (CTCF), a highly conserved host zinc finger protein that mediates chromatin conformation and nuclear architecture. However, the mechanisms by which CTCF contributes to HCMV latency were previously unexplored. Here, we confirm CTCF binds two convergent sites within the MIE locus during latency in primary CD14+monocytes, and following cellular differentiation, CTCF association is lost as the virus reactivates. While mutation of the MIE enhancer CTCF binding site does not impact viral lytic growth in fibroblasts, this mutant virus fails to maintain latency in myeloid cells. Furthermore, we show the two convergent CTCF binding sites allow looping to occur across the MIEP, supporting transcriptional repression during latency. Indeed, looping between the two sites diminishes during virus reactivation, concurrent with activation of MIE transcription. Taken together, our data reveal that three-dimensional chromatin looping aids in the regulation of HCMV latency, and provides insight into promoter/enhancer regulation that may prove broadly applicable across biological systems.Significance StatementHuman cytomegalovirus (HCMV) remains an important healthcare consideration driven by disease in at-risk populations associated with reactivation of this virus from latent infection. We show here the establishment of latency is aided by a host nuclear architectural protein, CTCF. By binding two convergent sites on the virus major immediate early promoter/enhancer region, which largely acts as a switch from latency to reactivation, CTCF anchors a chromatin loop such that the virus promoter is maintained in a transcriptionally repressed state. Upon differentiation of cells, CTCF protein levels decrease, and this loop is alleviated as the virus reactivates. Our findings reveal further insight into the regulation of HCMV latency and promoter/enhancer elements, which is broadly applicable across biological systems.