bluuebunny/crossref_metadata_2025_split huggingface dataset:
091  CIDP mimic in a patient with HIV; An unusual presentation of POEMS syndrome
Authors: Carroll Liam , Osman Chinar , Katifi Haider 
Published: May 2022

A 37-year old woman with HIV on antiretrovirals (undetectable viral load; CD4 count 520) presented with a painful length dependant sensorimotor polyneuropathy. Investigations showed mild neutropenia, IgA 5.2g/L without paraprotein. Nerve conduction studies indicated a demyelinating polyneuropathy. CSF was acellular with protein 1193mg/L. Despite multiple courses of IVIg and subsequently pulsed IV and oral steroids, her power deteriorated considerably. A nerve biopsy showed loss of myelinated fibres with inflammation. On reinvestigation an IgA lambda paraprotein (5.2g/L) with raised VEGF (1190ng/L) was identified. Bone marrow demonstrated 8% plasma cells; a CT-PET was normal. A diagnosis of POEMS syndrome was made and chemotherapy commenced. A full VEGF response and resolution of neuropathic pain was seen 6-months post treatment initiation; however, treatment was complicated by venous sinus thrombosis and hypocortisolaemia.POEMS syndrome is a rare plasma cell dyscrasia with protean clinical manifestations, though all develop a progressive peripheral neuropathy. There is no reported association with HIV and POEMS, though HIV in association with CIDP has been reported and is usually responsive to treatment. It is important to challenge a CIDP diagnosis when refractory to treatment with atypical features, particularly severe neuropathic pain, and to repeat investigations if clinical suspicion is high.liamcarroll@nhs.net
Unhealthy traits and risk of Parkinson’s disease: a mendelian randomisation study
Authors: Jensen Melanie , Heilbron Karl , Bandres-Ciga Sara , Fontanillas Pierre , Blauwendraat Cornelis , Nalls Mike , Singleton Andrew , Smith George Davey , Cannon Paul , Noyce Alastair 
Published: May 2022

IntroductionObservational studies have flagged smoking, alcohol and high body mass index (BMI) as potential protective factors against Parkinson’s disease (PD), however it is unclear whether such asso- ciations are causal. Mendelian randomisation (MR) uses gene variants to explore causal trait-outcome effects, minimising bias from observational studies. Using MR, we sought to determine the causal relation- ship between unhealthy traits (tobacco smoking, alcohol intake, and high BMI) and PD risk.MethodsWe used genome-wide association studies to find single nucleotide polymorphisms associated with each trait. Using split-sample MR, we used inverse weighted (IVW) methods to determine the effect of traits on PD. We used MR-Egger and weighted mean methods to check for bias in IVW analyses.ResultsEver-smoking and high BMI causally reduced PD risk (OR 0.96 95%CI 0.92–0.99 p=0.01; OR 0.99 95%CI 0.98–1.00 per 1 kg/m2 p=0.01, respectively). Alcohol causally increased PD risk (OR 1.13 95%CI 1.03–1.24 p=0.01). Sensitivity analyses did not reveal bias from pleiotropy or invalid instruments.ConclusionsMR analysis in over 2.4 million participants showed a protective effect of smoking on PD; war- ranting prioritisation of related therapeutic targets in clinical trials. Conversely, alcohol causally increased PD risk. Higher BMI protected against PD, but the effect was marginal.m.jensen@cantab.net
226  Reduced synaptic density in progressive supranuclear palsy and corticobasal syndrome, revealed by [11C]UCB-J PET
Authors: Holland Negin , Simon Jones P , Savulich George , Hong Young T , Fryer Tim , Manavaki Roido , Milicevic-Sephton Selena , Aigbirhio Franklin I , O’Brien John , Rowe James B 
Published: May 2022

Synaptic loss is prominent in several human neurodegenerative diseases. We tested the hypothesis that synaptic density is reduced by the primary tauopathies of progressive supranuclear palsy (PSP) and cor- ticobasal syndrome (CBS). Thirty-three participants (10 CBS, 10 PSP, and thirteen age-/sex-/education- matched controls) underwent clinical and neuropsychological assessment, 3T-magnetic resonance imaging, and positron emission tomography with the radioligand [11C]UCB-J which targets the Synaptic Vesicle Glycoprotein 2A (SV2A). Eight CBS patients had negative β-amyloid biomarker. As expected, PSP and CBS groups were impaired in executive, memory and visuospatial tasks. [11C]UCB-J binding was reduced across frontal, temporal, parietal, and occipital lobes, cingulate, hippocampus, insula, amygdala and subcortical structures in both PSP and CBS patients compared to controls (p<0.001), with reductions up to 50%, consistent with post mortem data. The revised Addenbrooke’s Cognitive Examination score correlated positively with cortical [11C]UCB-J binding (frontal, temporal, parietal, and occipital lobes, hippocampus, insula and amygdala, all p<0.05); putamen and precentral [11C]UCB-J binding correlated inversely with the PSP rating scale (both p<0.05). In conclusion, we confirm severe synaptic loss in PSP and CBS, which correlates with disease severity, providing critical insights into the underlying pathophysiology of primary degenerative tauopathies and supporting potential treatment strategies based on synaptic maintenance or restoration.nda26@cam.ac.uk
067  Negative impact of COVID-19 lockdown on papilloedema and idiopathic intracranial hypertension
Authors: Thaller Mark , Tsermoulas George , Sun Rosa , Mollan Susan , Sinclair Alexandra 
Published: May 2022

BackgroundEnforced national lockdown due to COVID-19 limited access to medical services. We evaluated the impact on those presenting with papilloedema, and those with a pre-existing diagnosis of idiopathic intracranial hypertension.DesignA single United Kingdom centre prospective cohort study between May 15, 2020 (start of emergency clinics after first 8 week national lockdown) and July 31, 2020. Demographics, diagnosis and outcomes were documented.ResultsThe study recorded 130 individual patients, 123 with a diagnosis of idiopathic intracranial hyper- tension. 92% were female and mean age was 32.5 years. Emergency cerebrospinal fluid diversion surgery was required in 13% (17/130), a 4.7-fold (367%) increase compared to the same period in 2019. Weight increased in 58% (mean 6.2kg SD 4.6) and corresponded to a significant increase in papilloedema (Optical Coherence Tomography retinal nerve fibre layer 15µm SD 57.3, p=0.014). Elevated anxiety levels (hospital anxiety and depression scale >7) occurred in 64%.ConclusionsThere was a 367% increase in emergency shunting to save vision in idiopathic intracranial hypertension following national lockdown. Worsening of papilloedema, weight gain, and detrimental effects on mental health were recorded. Countermeasures should be implemented to minimise harm in this rare disease during future service restrictions and lockdowns.mark.thaller@nhs.net|ABN Bursary
081  Comparison of 100 remotely assessed neurology outpatients during the COVID-19 pandemic with a 2019 cohort
Authors: Pigott James , McCammon Jacob , Nitkunan Arani 
Published: May 2022

COVID-19 forced a swift change to remote neurology outpatient appointments in order to reduce hospital footfall. The impact of this change on diagnosis, investigations requested, and follow up was unknown.This retrospective study compared 100 general neurology outpatients assessed remotely by a single clinician in 2020, to 100 patients assessed face to face during a similar time frame in 2019. The aim of the study was to identify if remote consultations are a feasible alternative, and if their use resulted in increased numbers of investigations or repeat consultations.There were similar numbers of urgent investigations ordered in 2019 and 2020 (9% and 7% respectively); however, fewer routine investigations were requested (7% compared with 38%). Of 58 new outpatients in 2020, 12% required video assessment, and 1 required a physical review. An additional 10% consultations were needed in 2020. The discharge rate was similar in both cohorts (41% and 44%). Follow up plans were similar between the 2 cohorts, despite an increase in 2020 of 6 month follow up appointments.This study demonstrates remote neurology outpatient consultations are feasible outside the pandemic. We propose follow up appointments could be done remotely as a default and potentially for some selected new patients.james.pigott@nhs.net
The Pathogenesis and Influencing Factors of Adult Hypertension Based on Structural Equation Scanning
Authors: Wu Yaqiong , Ma Guangyu , Feng Nana , Zhang Zhiqiang , Zhang Sijie , Li Xingtao 
Published: May 2022

Explore the pathogenesis and influencing factors of adult hypertension based on structural equation scanning. Using a multistage random sampling method, randomly select 2 community health service centers in each administrative area of a certain city and conduct a sample survey of residents in the community. According to the predetermined sample size

n

, multiply by 1.3 (

1.3
n

) to draw a sample. Community doctors and medical students who have been uniformly trained form an investigation team draw up a questionnaire by consulting the literature, seek expert opinions, and then make changes based on the questions in the preinvestigation. Experiment result shows that the average systolic blood pressure of the experimental subjects was

126.13
+
15.36

mmHg

and the average diastolic blood pressure was

79.52
+
8.81

mmHg

; males are higher than females and increase with age. The prevalence rate of hyperemia is 26.3%, and the prevalence rate of prehypertension among the survey subjects is 55.4%; that of males (62.6%) is higher than that of females (49.2%). The prevalence of isolated systolic hypertension was 7.5%, and that of men (6.9%) was lower than that of women (7.9%). The awareness rate of hypertension was 66.5%, and the treatment rate of hypertension was 62.7%; the control rate of hypertension was 13.2%, and the control rate of hypertension treatment was 25.7%; all the abovementioned rates are higher for women than for men, and they all tend to increase with age which proved that being overweight is a risk factor for hypertension, dyslipidemia, and hypertension. Hypertension, dyslipidemia, and family history of hypertension are risk factors for hypertension. There is a positive correlation between hypertension and dyslipidemia.
Evaluation of Weighted Nuclear Norm Minimization Algorithm for Ultrasound Image Denoising
Authors: Mahaboob Basha Shaik , Neto Aloísio Vieira Lira , Menezes José Wally M. , Chelloug Samia Allaoua , Abd Elaziz Mohamed , de Albuquerque Victor Hugo C. 
Published: May 2022

Anatomical structures manifested in ultrasound (US) images are crucial in efficient disease diagnosis. This modality has been used to analyze different tissue properties, such as blood flow, in-depth tissue motion, and elasticity. Analysis of these US images is posing a critical challenge, as these images are corrupted with noise primarily induced during acquisition. The biological structures intended to be investigated need to be detected, enhanced, and preserved during image processing-based diagnosis. US-based common carotid artery (CCA) images were considered in this study, and five denoising techniques were explored for noise removal after converting the images to grayscale to identify efficient preprocessing for effective diagnosis. Furthermore, filtered images were subjected to different entropy-inspired segmentation for qualitative validation and to segment the CCA. The objective of this paper is a deliberate attempt to investigate the possible use of edge- and structure-preserving filtering techniques to segment tissues of interest. The weighted nuclear norm minimization (WNNM) approach appears to be effective in removing noise and simultaneously preserving the sensitive structures. Quantitative validation with peak signal to noise ratio (PSNR), structural symmetry index measure (SSIM), and feature similarity index measure (FSIM) found to be

27.84
±
1.04

dB;

0.76
±
0.01

and

0.87
±
0.01

were observed to be superiorly high with WNNM filtering. The input image and the filtered image histograms are also compared for qualitative validation. The key finding in this study can be attributed to the ability to remove noise from US images corrupted with noise while preserving the anatomical details. Furthermore, it can be hypothesized that the anatomical structures under the influence of noise can be efficiently preprocessed and can be fed as a viable image towards segmentation followed by recognition and morphological inference.
A novel hybrid jellyfish algorithm for minimizing fuel consumption capacitated vehicle routing problem
Authors: Utama Dana Marsetiya , Widjonarko Bahru , Widodo Dian Setiya 
Published: May 2022

Distribution is a critical activity that must be carefully planned in order to minimize the company's fuel costs. The hybrid jellyfish (HJF) algorithm is proposed in this study to solve the fuel consumption capacity vehicle routing problem (FCCVRP). This problem's objective function is to minimize fuel consumption costs. The proposed HJF algorithm is used in this study to generate optimal fuel consumption through a population and iteration parameter experiment. The experiment results indicate that the HJF increasing parameter has an effect on reducing the total cost of fuel. Additionally, this study presents an algorithm comparison that demonstrates how effectively the proposed HJF algorithm solves FCCVRP.
Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single‐Center Experience
Authors: Burzotta Francesco , Graziani Francesca , Trani Carlo , Aurigemma Cristina , Bruno Piergiorgio , Lombardo Antonella , Liuzzo Giovanna , Nesta Marialisa , Lanza Gaetano Antonio , Romagnoli Enrico , Locorotondo Gabriella , Leone Antonio Maria , Pavone Natalia , Spalletta Claudio , Pelargonio Gemma , Sanna Tommaso , Aspromonte Nadia , Cavaliere Franco , Crea Filippo , Massetti Massimo 
Published: May 2022

Background
A multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking.

Methods and Results

At our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (
P
<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%).

Conclusions
Within the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.
Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease
Authors: Szarek Michael , Hess Connie , Patel Manesh R. , Jones W. Schuyler , Berger Jeffrey S. , Baumgartner Iris , Katona Brian , Mahaffey Kenneth W. , Norgren Lars , Blomster Juuso , Rockhold Frank W. , Hsia Judith , Fowkes F. Gerry R. , Bonaca Marc P. 
Published: May 2022

Background
Peripheral artery disease (PAD) is associated with heightened risk for major adverse cardiovascular and limb events, but data on the burden of risk for total (first and potentially subsequent) events, and the association with polyvascular disease, are limited. This post hoc analysis of the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial evaluated total cardiovascular and limb events among patients with symptomatic PAD, overall and by number of symptomatic vascular territories.

Methods and Results

In the EUCLID trial, patients with symptomatic PAD (lower extremity revascularization >30 days before randomization or ankle‐brachial index ≤0.80) were randomized to treatment with ticagrelor or clopidogrel. Relative effects on total events (cardiovascular death; nonfatal myocardial infarction and ischemic stroke; acute limb ischemia, unstable angina, and transient ischemic attack requiring hospitalization; coronary, carotid, and peripheral revascularization procedures; and amputation for symptomatic PAD) were summarized by hazard ratios (HRs), whereas absolute risks were estimated by incidence rates and mean cumulative functions. Among 13 885 randomized patients, 7600 total cardiovascular and limb events occurred during a median 2.7 years of follow‐up, translating to 60.0 and 62.5 events per 100 patients through 3 years for the ticagrelor and clopidogrel groups, respectively (HR, 0.96; 95% CI, 0.89–1.03;
P
=0.27). Among 1393 patients with disease in 3 vascular territories, event accrual rates through 3 years for the ticagrelor and clopidogrel groups were 87.3 and 97.7 events per 100 patients, respectively. Absolute risk reductions for ticagrelor relative to clopidogrel at 3 years were −0.2, 6.7, and 10.3 events per 100 patients for 1, 2, and 3 affected vascular territories, respectively (
P
interaction
=0.09).

Conclusions
Patients with symptomatic PAD have nearly double the number of total events than first events, with rates reflecting the number of affected vascular territories. These findings highlight the clinical relevance of quantifying disease burden in terms of total events and the need for long‐term preventive treatments in high‐risk patient populations.

Registration

URL:
https://clinicaltrials.gov/
; Unique identifier: NCT01732822.
Understanding Changes in the Tropical Circulation under Global Warming Using a Cloud-Resolving Model and a Conceptual Model
Authors: Neogi Sramana , Singh Martin S. 
Published: May 2022

Abstract
A cloud-resolving model (CRM) is used to investigate how a prototype tropical circulation driven by a sea surface temperature (SST) contrast changes in a warmer climate. The CRM is used to simulate a region of the atmosphere with a positive SST anomaly, and the large-scale circulation in this region is represented using the weak temperature gradient (WTG) and damped gravity wave (DGW) parameterizations, where the large-scale vertical velocity within the domain is related to the deviation of the simulated density profile from a reference profile representative of the tropical mean state. The behavior of the circulation in response to an increase in SST of both the domain and reference state (i.e., uniform warming) is examined. While the vertical velocity shows an increase in its maximum strength with warming, its value in the lower to midtroposphere decreases. Since the water vapor concentration is largest in the lower troposphere, this leads to a dynamic weakening of precipitation under warming. To understand these results, a simple model for the thermodynamic structure of a convecting atmosphere based on a bulk entraining plume is employed. The model uses a fixed entrainment rate and the relative humidity profiles from the CRM to predict the temperature profiles of the domain and reference state. The vertical velocity profiles calculated from these predicted temperature profiles reproduce important aspects of those simulated with the CRM. This simple modeling framework reveals that the effect of entrainment is crucial to understanding the dynamic response of precipitation to warming, providing a stepping stone to understanding the factors driving changes to the tropical precipitation distribution in a future warmer climate.
Colonic Trichobezoar Causing Acute Large Bowel Obstruction
Authors: McCullers Michelle R. , Coutsoumpos Alexandros , Chiu Jeffrey C. , Profeta Bernadette C. 
Published: May 2022

A trichobezoar is a solid mass of undigested hair that accumulates in the gastrointestinal tract that is typically associated with trichotillomania and trichophagia. Most documented cases are reported to be found in the stomach and small intestine. We report a case of a complete large bowel and small bowel obstruction secondary to a trichobezoar in an 81-year-old male with abdominal pain for one month. He presented to the emergency department with sudden onset nausea, vomiting, constipation, and severe abdominal pain, prompting him to come to the emergency department. CT demonstrated a mechanical obstruction with a transition point at the splenic flexure with pneumatosis. He was taken for urgent exploratory laparotomy, where a colotomy was made and the obstructive intraluminal mass in the transverse colon was identified and removed, and a transverse colostomy was matured. Subsequent pathology revealed the mass as hair and fecal material, confirming a diagnosis of colonic obstruction due to trichobezoar.
Anorectal Malignancies Presenting as a Perianal Abscess or Fistula
Authors: Boaz Elad , Freund Michael R. , Harbi Asaf , Dagan Amir , Gilshtein Hayim , Reissman Petachia , Yellinek Shlomo 
Published: May 2022

Background Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. The purpose of this study was to describe patients presenting with acute perianal abscess or fistula who were subsequently diagnosed with anorectal cancer. Methods We performed a retrospective, review of all cases presenting with acute perianal abscess or fistula who were subsequently found to have anorectal carcinoma on biopsy in two tertiary centers. We analyzed the data focusing on the clinical features, laboratory values, clinical staging of the tumors, the subsequent management, the pathological staging, and the outcome of each patient. Results Overall, 3219 patients presenting with anorectal abscess or fistula were reviewed. Cancer was diagnosed in 16 (.5%) patients, 12 with adenocarcinoma of the rectum and 4 with squamous cell carcinoma of the anus. In 5 patients (31.2%), cancer was diagnosed in the setting of chronic perianal fistula, 4 of them had Crohn’s disease. In 10 patients (62.5%), cancer was not diagnosed during the initial evaluation of the acute symptoms. Conclusions A high index of suspicion is required to make the diagnosis of perianal tumors when assessing patients presenting with perianal sepsis, particularly those with Crohn’s disease, a long history of persistent perianal disease, and an advanced age. In most cases, proper drainage followed by proximal diversion are the surgical treatment of choice in the acute setting.