bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does expert opinion match the definition of lupus low disease activity state? Prospective analysis of 500 patients from a Spanish multicentre cohort
Authors: Altabás-González Irene , Rúa-Figueroa Iñigo , Rubiño Francisco , Mouriño Rodríguez Coral , Hernández-Rodríguez Iñigo , Menor Almagro Raul , Uriarte Isacelaya Esther , Tomero Muriel Eva , Salman-Monte Tarek C , Carrión-Barberà Irene , Galindo Maria , Rodríguez Almaraz Esther M , Jiménez Norman , Inês Luis , Pego-Reigosa José Maria 
Published: August 2022

AbstractObjectivesTo apply the lupus low disease activity state (LLDAS) definition within a large cohort of patients and to assess the agreement between the LLDAS and the physician’s subjective evaluation of lupus activity.MethodsWe conducted a cross-sectional analysis of a prospective multicentre study of SLE patients. We applied the LLDAS and assessed whether there was agreement with the clinical status according to the physician’s opinion.ResultsA total of 508 patients [92% women; mean age 50.4 years (s.d. 3.7)] were recruited and 304 (62.7%) patients were in the LLDAS. According to physician assessment, 430 (86.1%) patients were classified as remission or low activity. Overall agreement between both evaluations was 71.4% (95% CI: 70.1, 70.5) with a Cohen’s κ of 0.3 [interquartile range (IQR) 0.22–0.37]. Most cases (96.1%) in the LLDAS were classified as remission or low activity by the expert. Of the patients who did not fulfil the LLDAS, 126 (70.4%) were classified as having remission/low disease activity. The main reasons for these discrepancies were the presence of new manifestations compared with the previous visit and a SLEDAI 2K score &gt;4, mainly based on serological activity.ConclusionsAlmost two-thirds of SLE patients were in the LLDAS. There was a fair correlation between the LLDAS and the physician’s evaluation. This agreement improves for patients fulfilling the LLDAS criteria. The discordance between both at defining lupus low activity, the demonstrated association of the LLDAS with better outcomes and the fact that the LLDAS is more stringent than the physician’s opinion imply that we should use the LLDAS as a treat-to-target goal.
The “Guardian of the Treaties” is No More? The European Commission and the 2021 Humanitarian Crisis on Poland–Belarus Border
Authors: Grześkowiak Maciej 
Published: August 2022

Abstract
In 2021, a humanitarian crisis developed at the Poland–Belarus border due to the considerable influx of migrants from Belarus. Polish authorities responded with a systematic practice of pushbacks, sanctioned prima facie by legislative action, that are incompatible with Poland’s obligations under international and EU legal systems. This policy led to the suffering of migrants stranded between borders and more than a dozen confirmed deaths. Despite credible reports of abuses by Polish authorities, the European Commission largely acquiesced to this practice. The article employs both dogmatic and empirical methods to explore the rationale behind such an approach. It is demonstrated that the Commission’s conduct illustrates a pattern evident in the years following the 2015 migration crisis in Europe. Moreover, the analysis suggests that the 2021 crisis had unique characteristics that further incentivized passivity by the Commission.
Functional Trade-Offs Asymmetrically Promote Phenotypic Evolution
Authors: Burress Edward D , Muñoz Martha M 
Published: August 2022

Abstract
Trade-offs are thought to bias evolution and are core features of many anatomical systems. Therefore, trade-offs may have far-reaching macroevolutionary consequences, including patterns of morphological, functional, and ecological diversity. Jaws, like many complex anatomical systems, are comprised of elements involved in biomechanical trade-offs. We test the impact of a core mechanical trade-off, the transmission of velocity versus force (i.e., mechanical advantage), on rates of jaw evolution in Neotropical cichlids. Across 130 species representing a wide array of feeding ecologies, we find that the velocity–force trade-off impacts the evolution of the surrounding jaw system. Specifically, rates of jaw evolution are faster at functional extremes than in more functionally intermediate or unspecialized jaws. Yet, surprisingly, the effect on jaw evolution is uneven across the extremes of the velocity–force continuum. Rates of jaw evolution are 4- to 10-fold faster in velocity-modified jaws, whereas force-modified jaws are 7- to 18-fold faster, compared to unspecialized jaws, depending on the extent of specialization. Further, we find that a more extreme mechanical trade-off resulted in faster rates of jaw evolution. The velocity–force trade-off reflects a gradient from specialization on capture-intensive (e.g., evasive or buried) to processing-intensive prey (e.g., attached or shelled), respectively. The velocity extreme of the trade-off is characterized by large magnitudes of trait change leading to functionally divergent specialists and ecological stasis. By contrast, the force extreme of the trade-off is characterized by enhanced ecological lability made possible by phenotypes more readily co-opted for different feeding ecologies. This asymmetry of macroevolutionary outcomes along each extreme is likely the result of an enhanced utility of the pharyngeal jaw system as force-modified oral jaws are adapted for prey that requires intensive processing (e.g., algae, detritus, and mollusks). The velocity–force trade-off, a fundamental feature of many anatomical systems, promotes rapid phenotypic evolution of the surrounding jaw system in a canonical continental adaptive radiation. Considering that the velocity–force trade-off is an inherent feature of all jaw systems that involve a lower element that rotates at a joint, spanning the vast majority of vertebrates, our results may be widely applicable across the tree of life. [Adaptive radiation; constraint; decoupling; jaws; macroevolution; specialization.]
Patients from Socioeconomically Distressed Communities Experience Similar Clinical Improvements Following Anterior Cervical Discectomy and Fusion
Authors: Lambrechts Mark J. , Toci Gregory R. , Issa Tariq Z. , Siegel Nicholas S. , O’Connor Patrick , Siniakowicz Claudia , Syal Amit , Weber Jackson , Lawall Charles , Brush Parker , Canseco Jose A. , Kaye Ian David , Woods Barrett I. , Schroeder Gregory D. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. 
Published: August 2022

Study Design.
Retrospective cohort.

Objectives.
To compare patient reported outcome measures (PROMs) following anterior cervical discectomy and fusion (ACDF) when categorizing patients based on socioeconomic status (SES). Secondarily, we sought to compare PROMs based on race.

Summary of Background Data.
Social determinants of health are believed to affect outcomes following spine surgery, but there is limited literature on how combined SES metrics affect PROMs following ACDF.

Methods.
We identified patients who underwent primary elective one- to four-level ACDF from 2014 to 2020. Patients were grouped based on their distressed community index (DCI) quintile (Distressed, At-Risk, Mid-tier, Comfortable, and Prosperous) and then race (White or Black). Multivariate regression for ∆PROMs was performed based on DCI group and race while controlling for baseline demographics and surgical characteristics.

Results.
Of 1,204 patients included in the study, all DCI groups improved across all PROMs, except mental health component score (MCS-12) for the Mid-tier group (P=0.091). Patients in the Distressed/At-Risk group had worse baseline MCS-12, visual analog scale (VAS) Neck, and neck disability index (NDI). There were no differences in magnitude of improvement between DCI groups. Black patients had significantly worse baseline VAS Neck (P=0.002) and Arm (P=0.012) as well as worse postoperative MCS-12 (P=0.016), PCS-12 (P=0.03), VAS Neck (P<0.001), VAS Arm (P=0.004), and NDI (P<0.001). Multivariable regression analysis did not identify any of the DCI groupings to be significant independent predictors of ∆PROMs, but being White was an independent predictor of greater improvement in ∆PCS-12 (β=3.09, P=0.036) and ∆NDI (β=−7.32, P=0.003).

Conclusions.
All patients experienced clinical improvements regardless of DCI or race despite patients in Distressed communities and Black patients having worse preoperative PROMs. Being from a distressed community was not an independent predictor of worse improvement in any PROMs, but Black patients had worse improvement in NDI compared to White patients.

Level of Evidence.
3
Case Report
Authors: Sims Gail L. 
Published: August 2022

Abstract
Falls from wheelchairs are common, particularly in persons with a spinal cord injury. Patients who experience falls frequently incur physical and psychological damages. The underlying causes of falls vary, although one of the most important themes is associated with poor balance. Factors that contribute to ineffective balance include poor trunk and abdominal muscle strength, inability to maintain static or dynamic trunk control, diminished sensation, improper equipment usage, muscle spasms, unsafe speed of mobilization, and lack of protective straps. The literature regarding fall prevention of pediatric patients with a spinal cord injury is very limited. Guidance is needed for this vulnerable population to prevent falls from wheelchairs. Instructions for wheelchair safety must be incorporated into patient and family caregiver education. Behavioral change theory provides a framework for this work. This article is intended to close the gap by discussing the incidence of falls, suggesting the provision of teaching self-management, and introducing suggestions for developing an interdisciplinary fall prevention program.
Arthroscopy-assisted bone grafting for the treatment of SNAC stage I without radial styloidectomy
Authors: Lee Young-Keun , Jung Young-Ran 
Published: August 2022

To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC).
We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up.
All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 − 10) preoperatively to 1.3 ± 1.3 (range, 0 − 3) at the last follow-up (P < .05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P < .05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P < .05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01).
Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.
Validation of the neutrophil-to-lymphocyte ratio as a new simple biomarker of adult onset Still’s disease: A STROBE-Compliant prospective observational study
Authors: Daghor Abbaci Karima , Ait Hamadouche Nadia , Otmani Fifi , Dahou Makhloufi Chafia , Mechid Farida , Makrelouf Mohamed , Otmane Amel , Smail Nourredine , Boucelma Malika , Aissat Fatma Zohra , Lefkir-Teffiani Salima , Bengana Bilel , Boukheris Nadia , Tebaibia Amar , Taharbouchet Baya , Ayoub Soraya , Benziane Brahim , Oumnia Nadia , Haouichet Chafika , Hanni Fella , Laraba Nazim , Hakem Djennete , Benfenatki Nacera , Berrah Abdelkrim 
Published: August 2022

This study was performed to investigate the role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of adult onset Still disease (AOSD) and its performance to improve the sensitivity of the classifications criteria (Yamaguchi and Fautrel Classifications).
We conducted a multicenter prospective nationwide case-control study in Internal medicine, Rheumatology and Infectious disease departments, to include successively patients with suspected AOSD (2 or more major criteria of Yamaguchi or Fautrel classifications). All clinical and biological features were collected in a consensual and standardized clinical assessment at baseline and during follow-up. A receiving operating characteristic (ROC) curve was used to reassess the cutoff value of NLR. After determination of the cutoff value for NLR by ROC curve, 2 composite sets (Yamaguchi classification + NLR as a major criterion and Fautrel classification + NLR as a major criterion) were performed and evaluated.
One hundred sixty patients were included, 80 patients with AOSD and 60 controls with different diagnoses. Twenty patients with incomplete data were excluded. The cutoff value for NLR equals 4 (area under the curve, AUC: 0.82). The NLR was ≥ 4 in 93.7% (75/80) of AOSD patients with a sensitivity of 93.8% and specificity of 61.7%. The association of NLR as a major criterion with the classification of Yamaguchi or Fautrel improved their sensitivity, respectively for Fautrel (76.3% to 92.5%, P = .004) and Yamaguchi (78.8% to 90%, P = .05).
This study validates the NLR as a good simple biomarker of AOSD with a cutoff value of 4 and high sensitivity (93.8%). The addition of NLR (NLR ≥ 4) as a major criterion to the classifications (Yamaguchi and Fautrel) improved significantly their sensitivity and accuracy.
Pulmonary cryptococcosis after recovery from COVID-19 in an immunocompetent patient: A rare case report
Authors: Choi Hye Sook 
Published: August 2022

Rationale:

Cryptococcus neoformans (C neoformans) infection typically occurs in immunocompromised patients infected with human immunodeficiency virus (HIV), or those taking immunosuppressive drugs, corticosteroids, or chemotherapy. Recently, there have been an increasing number of reports of cryptococcosis as opportunistic infections in COVID-19 patients, all of which have been related to immunocompromising conditions, underlying medical diseases, immune suppression drugs, or corticosteroids. Here, we report the first case of pulmonary cryptococcosis in an immunocompetent patient with a history of COVID-19 who had no history of underlying diseases or immune modulation drugs.

Patient concerns:
A previously healthy 46-year-old man presented with tiny lung nodules. He had quit smoking 6 years prior. He had no significant medical history except for COVID-19 3 months prior, and had not received corticosteroids or cytokine blockers when he had COVID-19. He had been coughing since he recovered from COVID-19.

Diagnosis:
Bronchoalveolar lavage cultures showed the growth of C neoformans. A CT-guided percutaneous needle biopsy of the lung lesion was performed. Histopathology of the biopsy specimen showed granulomas with encapsulated yeast. There was no growth of C neoformans in the CSF or blood. He was diagnosed with pulmonary cryptococcosis.

Intervention:
Antifungal drug (fluconazole) was administered for 6 months in the outside clinic.

Outcomes:
The lung lesions disappeared after 6 months medication.

Lessons:
This case may illustrate the risk of pulmonary cryptococcosis after SARS-CoV-2 infection in an immunocompetent patient. Opportunistic infections can occur even after recovery from COVID-19 for several reasons. First, SARS-CoV-2 infection causes immune dysregulation including lymphocytopenia. Second, T lymphocytes play a principal role against Cryptococcus. Third, these changes in the immune system due to COVID-19 may last for several weeks. Thus, we suggest careful consideration of lung lesions in patients with a history of COVID-19.
Role of T follicular helper and T follicular regulatory cells in antibody-mediated rejection: new therapeutic targets?
Authors: Zhang Hengcheng , Sage Peter T. 
Published: August 2022

Purpose of review
Antibody-mediated rejection (AbMR) after solid organ transplantation is tightly controlled by multiple cells of the immune system. Tfh and Tfr cells are essential controllers of antibody responses making them putative targets for therapeutics. However, the mechanisms of how Tfh and Tfr cells regulate B cell and antibody responses are not completely understood. Here, we summarize recent studies elucidating the functions of T follicular helper (Tfh) and T follicular regulatory (Tfr) cells as well as their possible roles in regulating AbMR in solid organ transplantation.

Recent findings
New tools have been developed to study the roles of Tfh and Tfr cells in specific disease states, including AbMR after solid organ transplantation. These tools suggest complex roles for Tfh and Tfr cells in controlling antibody responses. Nevertheless, studies in solid organ transplant rejection suggest that Tfh and Tfr cells may be high value targets for therapeutics. However, specific strategies to target these cells are still being investigated.

Summary
AbMR is still a substantial clinical problem that restricts long-term survival after solid organ transplantation. Growing evidence has demonstrated a pivotal role for Tfh and Tfr cells in controlling AbMR. In addition to providing an early indication of rejection as a biomarker, targeting Tfh and Tfr cells as a therapeutic strategy offers new hope for alleviating AbMR.
Stratification of responses to tDCS intervention in a healthy paediatric population based on resting-state EEG profiles
Authors: Dagnino Paulina Clara , Braboszcz Claire , Kroupi Eleni , Splittgerber Maike , Brauer Hannah , Dempfle Astrid , Breitling-Ziegler Carolin , Prehn-Kristensen Alexander , Krauel Kerstin , Siniatchkin Michael , Moliadze Vera , Soria-Frisch Aureli 
Published: August 2022

ABSTRACTTranscranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique with a wide variety of applications in both the clinical and cognitive psychology domains. As increasingly acknowledged, its effectiveness is subject dependent, which may lead to timely and costly treatments with ineffective results if this variability is not taken into account. We propose the usage of electroencephalography (EEG) for the analysis and prediction of individual responses to tDCS. In this context the application of machine learning can be of enormous help.We analysed resting-state EEG activity to identify subgroups of participants with an homogeneous electrophysiological profile and their response to different tDCS interventions. The study described herein, which focuses on healthy controls, was conducted within a clinical trial for the development of treatments based on tDCS for age-matched children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).We have studied a randomized, double-blind, sham-controlled tDCS intervention in 56 healthy children and adolescents aged 10-17, applied in 2 parallel groups over 2 target regions, namely left Dorsolateral Prefrontal Cortex (lDLPFC) and right Inferior Frontal Gyrus (rIFG). Cognitive behavioural tasks were used to both activate particular brain areas during the stimulation and to assess the impact of the intervention afterwards. We have implemented an unsupervised learning approach to stratify participants based on their resting-state EEG spectral features before the tDCS application. We have then applied a correlational analysis to identify EEG profiles associated with tDCS subject response to the specific stimulation sites and the presence or not of concurrent tasks during the intervention.In the results we found specific digital electrophysiological profiles that can be associated to a positive response, whereas subjects with other profiles respond negatively or do not respond to the intervention. Findings suggest that unsupervised machine learning procedures, when associated with proper visualization features, can be successfully used to interpret and eventually to predict responses of individuals to tDCS treatment.
Beneficial Effects of Bempedoic Acid Treatment in Polycystic Kidney Disease Cells and Mice
Authors: Hallows Kenneth R. , Li Hui , Saitta Biagio , Sepehr Saman , Huang Polly , Pham Jessica , Wang Jonathan , Mancino Valeria , Chung Eun Ji , Pinkosky Stephen L. , Pastor-Soler Núria M. 
Published: August 2022

ABSTRACTADPKD has few therapeutic options. Tolvaptan slows disease but has side effects limiting its tolerability. Bempedoic acid (BA), an ATP citrate-lyase (ACLY) inhibitor FDA-approved for hypercholesterolemia, catalyzes a key step in fatty acid/sterol synthesis important for cell proliferation. BA is activated by very long-chain acyl-CoA synthetase (FATP2) expressed primarily in kidney and liver. BA also activates AMPK. We hypothesized that BA could be a novel ADPKD therapy by inhibiting cyst growth, proliferation, injury, and metabolic dysregulation via ACLY inhibition and AMPK activation.Pkd1-null kidney cell lines derived from mouse proximal tubule (PT) and collecting duct (IMCD) were grown in 2D or 3D Matrigel cultures and treated ± BA, ± SB-204990 (another ACLY inhibitor) or withAclyshRNA before cyst analysis, immunoblotting or mitochondrial assays using MitoSox and MitoTracker staining.Pkd1fl/fl;Pax8-rtTA;Tet-O-CreC57BL/6J mice were induced with doxycycline injection on postnatal days 10 and 11 (P10-P11) and then treated ± BA (30 mg/kg/d) ± tolvaptan (30-100 mg/kg/d) by gavage from P12-21. Disease severity was determined by % total-kidney-weight-to-bodyweight (%TKW/BW) and BUN levels at euthanasia (P22). Kidney and liver homogenates were immunoblotted for expression of key biomarkers. ACLY expression and activity were upregulated inPkd1-null PT and IMCD-derived cells vs. controls. Relative to controls, both BA and SB-204990 inhibited cystic growth inPkd1-null kidney cells, as didAclyknockdown. BA inhibited mitochondrial superoxide production and promoted mitochondrial elongation, suggesting improved mitochondrial function. In ADPKD mice, BA reduced %TKW/BW and BUN to a similar extent as tolvaptan vs. untreated controls. Addition of BA to tolvaptan caused a further reduction in %TKW/BW and BUN vs. tolvaptan alone. BA generally reduced ACLY and stimulated AMPK activity in kidneys and livers vs. controls. BA also inhibited mTOR and ERK signaling and reduced kidney injury markers. In liver, BA treatment, both alone and together with tolvaptan, increased mitochondrial biogenesis while inhibiting apoptosis. We conclude that BA and ACLY inhibition inhibited cyst growth in vitro, and BA decreased ADPKD severity in vivo. Combining BA with tolvaptan further improved various ADPKD disease parameters. Repurposing BA may be a promising new ADPKD therapy, having beneficial effects alone and along with tolvaptan.