bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vibrio gazogenes Inhibits Aflatoxin Production Through Downregulation of Aflatoxin Biosynthetic Genes in Aspergillus flavus
Authors: Kandel Shyam L. , Jesmin Rubaiya , Mack Brian M. , Majumdar Rajtilak , Gilbert Matthew K. , Cary Jeffrey W. , Lebar Matthew D. , Gummadidala Phani M. , Calvo Ana M. , Rajasekaran Kanniah , Chanda Anindya 
Published: January 2022

Aspergillus flavus is an opportunistic pathogen of oilseed crops such as maize, peanut, cottonseed, and tree nuts and produces carcinogenic secondary metabolites known as aflatoxins during seed colonization. Aflatoxin contamination not only reduces the value of the produce but is also a health hazard to humans and animals. Previously, we observed inhibition of A. flavus aflatoxin biosynthesis on exposure to the marine bacterium Vibrio gazogenes ( Vg). In this study, we used RNA sequencing to examine the transcriptional profiles of A. flavus treated with both live and heat-inactivated dead Vg and control samples. Fungal biomass, total accumulated aflatoxins, and expression profiles of genes constituting secondary metabolite biosynthetic gene clusters were determined at 24, 30, and 40 h after treatment. Statistically significant reductions in total aflatoxins were detected in Vg-treated samples as compared with control samples at 40 h. However, no statistical difference in fungal biomass was observed on these treatments. The Vg treatments were most effective on aflatoxin biosynthesis, as was reflected in significant downregulation of most genes in the aflatoxin gene cluster, including the aflatoxin pathway regulator gene, aflR. Along with aflatoxin genes, we also observed significant downregulation in some other secondary metabolite gene clusters, including cyclopiazonic acid and aflavarin, suggesting that the treatment could inhibit other secondary metabolites as well. Finally, a weighted gene correlation network analysis identified an upregulation of 10 genes that were most strongly associated with Vg-dependent aflatoxin inhibition and provide a novel starting point in understanding the mechanisms that result in this phenomenon. [Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2022.
A Pilot Study of the Generalizability of Preclinical Entrustment Assessments in Undergraduate Medical Education
Authors: Meyer Eric G. , Boulet John R. , Monahan Patrick B. , Durning Steven J. , Uijtdehaage Sebastian 
Published: January 2022

Purpose
The reproducibility and consistency of assessments of entrustable professional activities (EPAs) in undergraduate medical education (UME) have been identified as potential areas of concern. EPAs were designed to facilitate workplace-based assessments by faculty with a shared mental model of a task who could observe a trainee complete the task multiple times. In UME, trainees are frequently assessed outside the workplace by faculty who only observe a task once.

Method
In November 2019, the authors conducted a generalizability study (G-study) to examine the impact of student, faculty, case, and faculty familiarity with the student on the reliability of 162 entrustment assessments completed in a preclerkship environment. Three faculty were recruited to evaluate 18 students completing 3 standardized patient (SP) cases. Faculty familiarity with each student was determined. Decision studies were also completed. Secondary analysis of the relationship between student performance and entrustment (scoring inference) compared average SP checklist scores and entrustment scores.

Results
G-study analysis revealed that entrustment assessments struggled to achieve moderate reliability. The student accounted for 30.1% of the variance in entrustment scores with minimal influence from faculty and case, while the relationship between student and faculty accounted for 26.1% of the variance. G-study analysis also revealed a difference in generalizability between assessments by unfamiliar (φ = 0.75) and familiar (φ = 0.27) faculty. Subanalyses showed that entrustment assessments by familiar faculty were moderately correlated to average SP checklist scores (r = 0.44, P < .001), while those by unfamiliar faculty were weakly correlated (r = 0.16, P = .13).

Conclusions
While faculty and case had a limited impact on the generalizability of entrustment assessments made outside the workplace in UME, faculty who were familiar with a student’s ability had a notable impact on generalizability and potentially on the scoring validity of entrustment assessments, which warrants further study.
Association Between Prenatal Cannabis Use and Psychotropic Medication Use in Pregnant Patients With Depression and Anxiety
Authors: Hirschtritt Matthew E. , Avalos Lyndsay A. , Sarovar Varada , Ridout Kathryn K. , Goler Nancy C. , Ansley Deborah R. , Satre Derek D. , Young-Wolff Kelly C. 
Published: January 2022

Objectives
This cross-sectional study examined associations between prenatal cannabis use and prescribed psychotropic medication use among pregnant patients with depression or anxiety in a large, integrated healthcare system.

METHODS
Study patients had a confirmed pregnancy and a depressive or anxiety disorder defined by International Classification of Diseases codes between 2012 and 2018 at Kaiser Permanente Northern California. Patients were screened for prenatal substance use via a self-reported questionnaire and urine toxicology test as part of standard prenatal care. Generalized estimating equation models tested for associations between prenatal cannabis use and any dispensation of antidepressants, benzodiazepines, and hypnotics during gestation. Models were stratified by diagnosis (depression or anxiety) and depression symptom severity.

Results
This study included 35,047 pregnancies (32,278 patients; 17.6% aged <25 years, 48.1% non-Hispanic White). Adjusting for patient age, income, race/ethnicity, and depression symptom severity, the 12.6% of patients who screened positive for prenatal cannabis use demonstrated higher odds of prenatal benzodiazepine (adjusted odds ratios [aOR] = 1.40; 95% confidence interval [CI] = 1.20–1.62) and hypnotic (aOR = 1.28; 95% CI = 1.11–1.48), but not antidepressants (aOR = 1.05, 95% CI = 0.96–1.14) use. This pattern persisted when diagnostic groups were examined separately. The odds of prenatal benzodiazepine and hypnotic use associated with prenatal cannabis use were higher among pregnancies with severe depression symptom severity (31.8% of the sample).

CONCLUSIONS
Among pregnant patients with depression or anxiety, prenatal cannabis use was associated with higher odds of prenatal benzodiazepine and hypnotic use. As patients may be using cannabis to address depression and anxiety, prescribers should remain vigilant for under- or untreated psychiatric symptoms among pregnant patients and provide evidence-based treatments.
Effect of body size and intensive blood pressure management on cardiovascular and serious adverse events
Authors: Pei Junyu , Wang Xiaopu , Zheng Keyang , Su Wen , Hu Xinqun 
Published: January 2022

Background:
Previous studies have shown that obese hypertensive patients have a lower risk of cardiovascular events than normal-weight patients, and that the performed hypertension treatment affects cardiovascular outcomes depending on the patient's body size. This study aimed to investigate the relationship between the BMI and cardiovascular outcomes and safety endpoints in hypertensive patients with intensive or standard blood pressure (BP) management.

Methods:
We used data from the Systolic Blood Pressure Intervention Trial (SPRINT). Cox proportional hazards models were used to analyze the data. The primary endpoint was cardiovascular disease (CVD) death, and the safety endpoint was serious adverse events.

Results:
In total, 9284 patients were included in our analysis. Thirty-seven patients in the intensive arm and 65 patients in the standard arm had CVD death. After multivariable adjustment, the BMI was not associated with the incidence of CVD death in the standard arm [hazard ratio 0.96, 95% confidence interval (CI) 0.91–1.02]. In the intensive arm, the incidence of CVD death decreased (hazard ratio 0.86, 95% CI 0.78–0.96) first and, then, increased (hazard ratio 1.15, 95% CI 1.07–1.25) with an increase in the BMI (inflection point, 32.33 kg/m2).

Conclusion:
Intensive BP management in overweight, class I, and class II obese patients significantly reduced the cardiovascular outcomes without increasing the safety risks. Nevertheless, further clinical evidence is needed to verify the effectiveness of intensive BP management in patients with normal weight and class III obesity.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN PIGMENTED PARAVENOUS CHORIORETINAL ATROPHY
Authors: Battaglia Parodi Maurizio , Arrigo Alessandro , Chowers Itay , Jarc-Vidmar Martina , Shpigel Michal , Bandello Francesco , Michaelidis Michel 
Published: January 2022

Purpose:
To analyze the retino-choroidal vascular characteristics of patients affected by pigmented paravenous chorio-retinal atrophy by means of optical coherence tomography (OCT) angiography.

Methods:
This study was designed as an observational, cross-sectional case series. Multimodal imaging included fundus autofluorescence, structural OCT, and OCT angiography. The quantitative OCT angiography analyses included the calculation of the vessel density and choriocapillaris porosity.

Results:
Overall, 12 patients (24 eyes) affected by pigmented paravenous chorio-retinal atrophy were recruited. Structural OCT of the areas involved by pigmented paravenous chorio-retinal atrophy as visualized on the fundus autofluorescence showed a complete ellipsoid zone and external limiting membrane absence, with thinning of ganglion cell complex, outer nuclear layer, and outer plexiform layer, but associated with the optical partial preservation of the retinal pigment epithelium. Optical coherence tomography angiography quantitative assessment of the retinal regions affected by PPRCA, as visualized by fundus autofluorescence, was characterized by normal vessel density at the level of superficial capillary plexus but significantly altered vessel density of deep capillary plexus and choriocapillaris, with higher choriocapillaris porosity. The presence of macular atrophy was significantly correlated with worse deep capillary plexus and choriocapillaris vessel density values. Furthermore, a statistically significant correlation between the fundus autofluorescence patterns and the retinal vascular status was found.

Conclusion:
Optical coherence tomography angiography quantitative analyses in pigmented paravenous chorio-retinal atrophy demonstrate a specific impairment at the level of the deep capillary plexus, which could in turn bring about a thinning of ganglion cell complex and outer nuclear layer. The alterations at the level of the choriocapillaris and the choroid, in general, could then represent a secondary effect.
UNSUSPECTED CENTRAL VISION DECREASE FROM MACULAR GANGLION CELL LOSS AFTER POSTERIOR SEGMENT SURGERY
Authors: Spaide Richard F. 
Published: January 2022

Purpose:
To describe a novel postsurgical complication of circumscribed macula ganglion cell loss as an apparent cause of unsuspected vision loss following posterior segment surgery.

Methods:
Patients were seen in referral and were evaluated with comprehensive examination to include optical coherence tomography and microperimetry.

Results:
All eight patients had a sudden central vision loss following vitrectomy, and many patients suspected the central loss was present even before the eye patch was removed on the first postoperative day. Of the eight patients, one had a vitrectomy with no membrane peeling, whereas the remaining seven had membrane peeling. The mean postoperative visual acuity was 20/200. The mean ganglion cell layer volume was 0.69 µm3 in the involved eye and 1.035 µm3 in the fellow eye (P < 0.001). The global retinal nerve fiber layer thicknesses in the involved and fellow eyes were 81.3 and 90 µm, respectively (P = 0.08). The outer retinal architecture was unremarkable in the involved eyes and did not appear to explain the poor acuity. The ganglion cell layer volume loss was not necessarily associated with retinal nerve fiber layer thicknesses that were in the abnormal range or in optic nerve pallor. Microperimetry showed severe depression of the threshold sensitivities.

Conclusion:
Severe loss of the macular ganglion cells may occur after vitrectomy and is associated with central vision loss. The diagnosis is made by having a high index of suspicion when examining optical coherence tomography B-scan images and by evaluating ganglion cell layer volumes. The frequency of this occurrence is currently unknown.
SCLERAL EXCAVATION AT OBLIQUE MUSCLE INSERTIONS: IMAGING CHARACTERISTICS AND CORRELATION WITH SCLERAL PLAQUES AND SCLEROCHOROIDAL CALCIFICATION
Authors: Cabral Diogo , Fisher Yale L. , Freund K. Bailey 
Published: January 2022

Purpose:
To compare the imaging features of lesions showing hyporeflective posterior scleral excavation found near the insertions of the oblique extraocular muscles to the features and the natural course of Cogan scleral plaques.

Methods:
Multimodal imaging with color fundus photography, spectral-domain optical coherence tomography (OCT), swept-source optical coherence tomography, and B-scan ultrasonography.

Results:
A 71-year-old man and an 89-year-old man presented with ring-shaped hypopigmented lesions measuring between 200 μm and 300 μm transversally, and located along the superior vascular arcade and temporal to the fovea. All lesions were identified near the insertion of oblique muscles, with one observed in the temporal macula, and two found along the superotemporal arcades. Enhanced depth imaging-optical coherence tomography showed hyporeflective boat-shaped areas of scleral excavation with reduced choroidal thickness along their margins. B-scan ultrasonography showed the lesions to be intensely reflective with varying degrees of posterior shadowing.

Conclusion:
To our knowledge, this is the first report of excavated hyporeflective scleral lesions found near the oblique muscle insertions. Imaging and clinical data support the diagnosis of a posterior form of Cogan scleral plaque and are consistent with the natural course of this entity.
Telemedicine for Preoperative Evaluation of Upper Eyelid Malposition: Reliability of Diagnosis and Surgical Plan
Authors: Wagner Lilly H. , Fairbanks Aaron M. , Hodge David O. , Bradley Elizabeth A. 
Published: January 2022

Purpose:
Outpatient visits and surgeries for nonurgent indications in ophthalmology have intermittently been restricted during the COVID-19 pandemic. Telemedicine services have rapidly gained acceptance during this period, and could improve patient access for routine oculoplastic evaluations in the future. The objective of this study is to investigate interobserver and intraobserver reliability of eyelid and brow position assessment and surgical plan when comparing photography-based and face-to-face evaluation.

Methods:
This was an observational study conducted at a single academic center. Thirty randomly selected patients who had completed an in-office evaluation for chief complaint of “drooping eyelids” between June 2019 and March 2020 were included. Virtual assessment of brow position, dermatochalasis, blepharoptosis, and margin-reflex distance 1 was performed by 2 oculoplastic surgeons based on external photographs, and a surgical plan was formulated. Fraction of agreement and Cohen’s κ were determined to evaluate reliability of the virtual assessment compared to face-to-face examination.

Results:
For 60 eyes from 30 study subjects, diagnostic reliability for observer A was near perfect for brow ptosis, substantial for blepharoptosis and moderate for dermatochalasis (κ = 0.86, 0.67, and 0.57, respectively); for observer B, reliability was moderate for brow and blepharoptosis and substantial for dermatochalasis (0.47, 0.59, and 0.79). Fraction of agreement for blepharoptosis was 94% in eyes where the eyelid margin was visible, and 66% in eyes where the eyelid margin was obscured by overhanging skin. Virtual margin-reflex distance 1 measurements were highly correlated with those obtained face to face (r = 0.77, p < 0.01). Fraction of agreement for surgical plan after virtual examination by observer A/B, respectively, was 100%/94% for brow lift, 90%/87% for blepharoptosis repair and 83%/83% for functional upper blepharoplasty.

Conclusions:
Virtual evaluation of upper eyelid and brow malposition can be performed with acceptable reliability. Co-existing dermatochalasis or brow ptosis may require special photographic technique or video examination to ensure an appropriate diagnosis. A photography-based preliminary surgical plan offers a viable alternative to face-to-face encounters.
Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure
Authors: Ozasa Neiko , Kato Takao , Morimoto Takeshi , Yaku Hidenori , Yamamoto Erika , Inuzuka Yasutaka , Tamaki Yodo , Kitai Takeshi , Washida Koichi , Seko Yuta , Yoshikawa Yusuke , Sato Yukihito , Motoki Hirohiko , Kuwahara Koichiro , Kimura Takeshi 
Published: January 2022

Background
Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities.

Objective
The aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year.

Methods
We evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, ≤ 5; quartile 2, 6–8; quartile 3, 9–11; and quartile 4, ≥ 12).

Results
At hospital discharge, the median number of medications was 8 (interquartile range, 6–11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant (P = .01).

Conclusions
In the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients.
Reliability and Validity of the State-Trait Hopelessness Scale in a Primarily Rural Population of Adults With Ischemic Heart Disease in the US Great Plains
Authors: Dunn Susan L. , Bomgaars Deb , Van De Griend Kristin M. , Jensen Gwenneth A. , White Lynn L. , Goodyke Madison P. , Luong Anna , Gutierrez-Kapheim Melissa , Tintle Nathan L. 
Published: January 2022

Purpose
Hopelessness and rurality are each independently associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining hopelessness in rural patients with IHD. The authors of this study evaluated the reliability and validity of the State-Trait Hopelessness Scale (STHS) in a primarily rural population of adults with IHD living in West North Central United States (US Great Plains).

Methods
Reliability, concurrent validity, and convergent validity were evaluated for 115 adults hospitalized for IHD. Rural-Urban Commuting Area codes were used to stratify participants by rurality level, with 66% categorized as rural. Principal component analysis was used to examine potential factor structure of the STHS.

Findings
Cronbach α for the State and Trait Hopelessness subscales were 0.884 and 0.903, respectively. Concurrent validity was supported for the State and Trait subscales using the Patient Health Questionnaire-8 (State: r = 0.50, P < .001; Trait: r = 0.35, P < .001). Convergent validity was supported for the State subscale using the Duke Activity Status Index (r = −0.23, P = .013). Principal component analysis showed 2 factors (hopelessness present and hopelessness absent) for the State and Trait subscales, accounting for 63% and 58% of variance, respectively.

Conclusions
Findings support the reliability and validity of the STHS for evaluation of hopelessness in rural adults with IHD in clinical and research settings. Results replicated the same factor structure found in testing of the STHS in a primarily urban sample. Because of the prevalence of hopelessness in rural adults with IHD and association with increased mortality, hopelessness should be assessed during hospitalization and in the recovery period.
Gastric and colonic metastasis from NSCLC
Authors: Catalano Martina , Marini Andrea , Ferrari Katia , Voltolini Luca , Cianchi Fabio , Comin Camilla Eva , Castiglione Francesca , Roviello Giandomenico , Mini Enrico 
Published: January 2022

Abstract

Rationale:
Lung cancer is the most common cause of cancer-related deaths worldwide. Approximately 50% of patients is metastatic at diagnosis and the most common metastatic sites are bone, lungs, brain, adrenal glands, liver, and extra thoracic lymph nodes. The occurrence of gastrointestinal metastasis from lung carcinoma is rare and seems more commonly related to small cell lung cancer compared to non-small cell lung cancer (NSCLC).

Patient information and diagnosis:
A 78-year-old man with completely surgically resected NSCLC and no initial evidence of distant metastases developed colon and gastric metastases 7 months after diagnosis, confirmed by serial radiological examinations and endoscopic biopsies.

Interventions:
The patient was subjected to total gastrectomy with D2 lymph node dissection plus partial colectomy for intraoperative detection of a transverse colon neoformation. Subsequent instrumental imaging showed bilateral lung tumor recurrence, treated with gemcitabine monotherapy for 8 months as first line chemotherapy for lung adenocarcinoma.

Results:
The patient presented complete response to therapy and was disease-free for 4 years.

Lessons:
Colonic and gastric metastasis are very infrequent in NSCLC. The resection of gastrointestinal metastasis may provide benefits in terms of both symptom control and survival in patients properly selected.