bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Case 13—An unusual culprit: challenging diagnosis, easy solution
Authors: Ribeiro Mané Fernando Guilherme , Flores Rui , Conde Inês , Silva Rodrigo , Pires Carla Marques , Medeiros Paulo , Oliveira Cátia , Costa João , Marques Jorge 
Published: October 2022

Abstract

Presentation
A 59-year-old woman, with multiple cardiovascular risk factors, a history of CABG (left internal mammary artery—obtuse marginal artery; right internal mammary artery—left anterior descending artery) and PAD; presented to the emergency department with prolonged thoracic pain (3 hours) associated with dyspnea. She was hypertense at admission, but the remaining physical exam was unremarkable. Initial electrocardiogram showed descendent segment ST depression in the lateral leads (DI, aVL and V4-V6). Blood test showed a rise in troponin I 0.6 → 8.3 ng/mL). Cardiac catheterization demonstrated patency of both bypasses. However, a calcified stenosis (70–80%) of the left subclavian artery proximal to the emergence of the left internal mammary artery was observed.

Diagnosis
The findings suggested a possible coronary subclavian steal syndrome (CSSS).

Management
The patient was reevaluated and was found to have a systolic blood pressure differential of 18mmHg between the two arms. Despite anti-anginal therapeutic optimization, episodes of angina upon minimal exertion continued. Consequently, she was submitted to percutaneous subclavian artery angioplasty with symptom resolution and was discharged under dual antiplatelet therapy and high-intensity statin.

Learning points
CSSS complicates 0.2–6.8% of the patients who have undergone CABG with a left internal mammary graft. Peripheral artery disease is its strongest predictor and atherosclerosis is the main pathogenic mechanism. In patients with suspected CSSS, physical examination is paramount, often showing a systolic blood pressure differential. Subclavian artery angiography should be performed, whenever it is relevant, during the coronary angiography. First-line therapy includes percutaneous angioplasty and optimal medical therapy.
Clinical Case 15—Warburg effect and pulmonary embolism: a confounding clinical case
Authors: Ferreira Gonçalo Rafael Marques , Correia Joana , Fiuza João , Santos João Miguel , Neto Vanda , Cunha Joana , Fernandes Filipe , Pires Inês , Marmelo Bruno , Cabral Costa 
Published: October 2022

Abstract

Presentation
A 61 year old man with a history of multiple lymph node metastasis of unknown primary cancer was admitted in the Emergency Room with sudden dyspnea preceded by left leg swelling. Physical examination revealed a blood pressure of 91/70mmHg, tachycardia, tachypnea and signs of deep vein thrombosis (DVT).

Diagnosis and management
Blood analysis showed increased serum lactate (SL) (5,5 mmol/L), a slight increase of cardiac enzymes and hypoglycemia, and imagiologic tests showed signs of bilateral pulmonary embolism (PE) and an increase of the right cardiac chambers. The patient was hospitalized with the diagnosis of intermediate-high risk PE. Because the patient presented persistent elevated SL and borderline hypotension, fibrinolysis was performed. However, the patient maintained high SL levels and hypotensive profile. After receiving the lymph node's biopsy result, which pointed towards a follicular lymphoma, the persistent hyperlactatemia, together with the hypoglycemic profile, was interpreted as a consequence of the Warburg Effect. Luckily, the patient didn't had any side effects of the fibrinolytic treatment.

Learning points
Acute high risk PE is marked by the presence of haemodynamic instability at presentation, and the finding of increased SL suggests peripheral hypoperfusion. Systemic thrombolytic therapy is indicated in most of patients with high risk PE. However, there are other causes of hyperlactatemia which the physician must be aware, as it can act as a confounder of PE risk assessment. The Warburg Effect may cause elevated SL in patients with cancer, which in turn are at risk of developing PE.
Clinical Case 18—Management of patient with cancer and confirmed systemic thrombosis and rectal bleeding
Authors: Kateryna Moskalenko , Evgeny Levenko , Zoreslava Lysak , Myroslava Doronina , Oleh Yukish 
Published: October 2022

Abstract
A 55-year-old patient has been suffering from prostate cancer since February 2020. He received radiotherapy and developed disease progression in June 2021. Pt was started on chemotherapy with positive dynamic per CT scan. There was a worsening of anemia, and erythropoietin was prescribed, with not significant improvement.
During planned CT scan monitoring, pulmonary embolism of medial and distal segments of the left and distal parts of the right pulmonary artery was revealed. Pt had dyspnea on mild exertion, tachycardia at rest and left leg edema (which was present earlier and considered as lymphedema that time). Thrombosis of the left popliteal vein was confirmed. Pt was started on rivaroxaban 15 mg BID. In 5 days, he reported rectal bleeding. Hb was 71 g/l. Rivaroxaban was stopped. Proctological examination was not informative, due to bleeding. Tranexamic acid and IV iron were started. The attempt to add prophylaxis dose of enoxaparin increased bleeding and was stopped immediately. In 5 days, he underwent colonoscopy. Disease progression, severe hemorrhoids were excluded. Findings were considered as radiation proctitis. Sulfasalazine was added. In 2 weeks Hb = 91 g/l, however, patient has episodes of the rectal bleeding 1–2 times per week. He doesn’t receive recurrent PE prevention with no worsening of clinical picture. Our strategy is to reassess bleeding risk after 1 month of treatment with sulfasalazine and to start prevention doses of DOACs.
Conclusion: In complex clinical situations prevention of thrombosis should be based on patient-related risk factors, must be flexible and reviewed more often and thoroughly.
Clinical Case 22—When the unusual appears
Authors: Temtem Ana Margarida de Abreu , Sá Débora , Santos Marina , Leça Sofia , Rodrigues Ricardo , Serrão Gomes , Silva Bruno , Caires Graça , Brazão António , Rodrigues João Manuel , Freitas Drumond 
Published: October 2022

Abstract

Clinical case
A 57 years old female, smoker, presented to emergency department with a constrictive chest and epigastric pain lasting for 30 minutes. Admission electrocardiogram showed a sinus bradycardia and ST elevation in the inferior leads. Inferior STEMI was assumed and was referred for primary coronary intervention. Coronary angiography revealed a right coronary artery (RCA) occluded at ostial level and primary angioplasty was performed with drug eluting stent implantation. After angioplasty, the chest pain didn´t relief, although the procedure had no complications. Transthoracic echocardiogram revealed a ‘flap’ on the ascending aorta (AAo), suggesting dissection of the AAo; left ventricular systolic function preserved, with hypokinesia of the inferior wall; right ventricular dysfunction; aortic regurgitation and no pericardial effusion. Emerging angio CT confirmed type A aortic dissection extending to abdominal aorta. The patient was then admitted to the operating room and a supracoronary conduit (hemiarch) and a bypass (saphenous vein/RCA) procedure was done. She had progressive clinical improvement and was discharged on the 17th day.

Learning points
Acute aortic dissection is the most common acute aortic syndrome (AAoS), being more prevalent in males and in the elderly, presenting high mortality rate. Acute type A aortic dissection can be difficult to diagnose and can mimic STEMI. RCA is more often involved when myocardial infarction is present. What appeared to be a linear STEMI turned out to be an AAoS that could have a catastrophic outcome. This was a successful case of this unusual diagnosis that surprised the entire team.
Clinical validation of a 13-lead electrocardiogram derived from a self-applicable 3-lead recording for diagnosis of myocardial supply ischaemia and common non-ischaemic electrocardiogram abnormalities at rest
Authors: Van Heuverswyn Frederic , De Schepper Céline , De Buyzere Marc , Coeman Mathieu , De Pooter Jan , Drieghe Benny , Kayaert Peter , Timmers Liesbeth , Gevaert Sofie , Calle Simon , Kamoen Victor , Demolder Anthony , El Haddad Milad , Gheeraert Peter 
Published: October 2022

AbstractAimsIn this study, we compare the diagnostic accuracy of a standard 12-lead electrocardiogram (ECG) with a novel 13-lead ECG derived from a self-applicable 3-lead ECG recorded with the right exploratory left foot (RELF) device. The 13th lead is a novel age and sex orthonormalized computed ST (ASO-ST) lead to increase the sensitivity for detecting ischaemia during acute coronary artery occlusion.Methods and resultsA database of simultaneously recorded 12-lead ECGs and RELF recordings from 110 patients undergoing coronary angioplasty and 30 healthy subjects was used. Five cardiologists scored the learning data set and five other cardiologists scored the validation data set. In addition, the presence of non-ischaemic ECG abnormalities was compared. The accuracy for detection of myocardial supply ischaemia with the derived 12 leads was comparable with that of the standard 12-lead ECG (P = 0.126). By adding the ASO-ST lead, the accuracy increased to 77.4% [95% confidence interval (CI): 72.4–82.3; P &lt; 0.001], which was attributed to a higher sensitivity of 81.9% (95% CI: 74.8–89.1) for the RELF 13-lead ECG compared with a sensitivity of 76.8% (95% CI: 71.9–81.7; P &lt; 0.001) for the 12-lead ECG. There was no significant difference in the diagnosis of non-ischaemic ECG abnormalities, except for Q-waves that were more frequently detected on the standard ECG compared with the derived ECG (25.9 vs. 13.8%; P &lt; 0.001).ConclusionA self-applicable and easy-to-use 3-lead RELF device can compute a 12-lead ECG plus an ischaemia-specific 13th lead that is, compared with the standard 12-lead ECG, more accurate for the visual diagnosis of myocardial supply ischaemia by cardiologists.
Classifying End-of-Life Patterns: Evidence From the National Health and Aging Trends Study
Authors: Bhagianadh Divya , Arora Kanika 
Published: October 2022

Abstract

Background and Objectives
End-of-life (EOL) care quality encompasses multiple domains, which are typically studied in silos. This paper explores interrelationships across domains and how they simultaneously shape patterns of EOL care quality.

Research Design and Methods
Secondary analysis using National Health and Aging Trends Study. Latent class analysis was used to identify subgroups of decedents according to quality of symptoms and needs management, care experience, care processes, and site of death. Multinomial logistic regression was employed to investigate the association between decedent characteristics and class membership.

Results
Five groups of decedents were identified. Multiple sites of death with high care coordination (Class 4: 35%) comprised decedents with least concerns regarding symptom management and care experience. Decedents in Predominantly home deaths with no hospice use (Class 1: 26%), predominantly hospital deaths with low hospice use (Class 2: 18%), and multiple sites of death with hospice use (Class 3: 7%) presented similar symptom management and care experience patterns. Multiple sites of death with low care coordination (Class 5: 14%) comprised decedents experiencing poor quality EOL care across multiple domains. Non-Hispanic Black and Hispanic decedents were more likely to be in Class 2 and decedents with dementia diagnosis in Class 4.

Discussion and Implications
There is considerable heterogeneity in EOL care patterns. Assessing quality based on discrete metrics in silos may lead to unintended consequences like stinting of necessary care or increased caregiving burden on families. There is a need for greater focus on patient-centeredness and how care processes and structures interact in the context of shifting care patterns, care preferences, and payment reforms.
Safety Surveillance of Varicella Vaccines in the Vaccine Adverse Event Reporting System, United States, 2006–2020
Authors: Moro Pedro L , Leung Jessica , Marquez Paige , Kim Yeowon , Wei Shaokui , Su John R , Marin Mona 
Published: October 2022

AbstractBackground. The Vaccine Adverse Event Reporting System (VAERS) is the United States national passive vaccine safety surveillance system. We updated the data on the safety of single-antigen varicella vaccine (VAR) and assessed the safety of combination measles, mumps, rubella, and varicella vaccine (MMRV) licensed in the United States using VAERS data.MethodsUS VAERS reports received after administration of VAR and MMRV during 2006–2020 were identified. Reports were analyzed by vaccine type, age, seriousness, most common adverse events (AEs), and concomitant vaccines. We reviewed medical records of selected reports of AEs of special interest and conducted empirical Bayesian data mining to identify disproportionally reported AEs.ResultsDuring 2006–2020, approximately 132.8 million VAR doses were distributed; 40 684 reports were received in VAERS (30.6/100 000 doses distributed), with 4.1% classified as serious (1.3/100 000 doses distributed). Approximately 35.5 million MMRV doses were distributed; 13 325 reports were received (37.6/100 000 doses distributed) with 3.3% classified as serious (1.3/100 000 doses distributed). The most common adverse health events after both VAR and MMRV were injection site reactions (31% and 27%), rash (28% and 20%), and fever (12% and 14%), respectively. Vaccination errors accounted for 23% of reports after VAR administration and 41% after MMRV administration, but ≥95% of them did not describe an adverse health event. AEs associated with evidence of vaccine strain varicella-zoster virus (vVZV) infection included meningitis, encephalitis, herpes zoster, and 6 deaths (all in immunocompromised persons with contraindications for vaccination). No new or unexpected AE was disproportionally reported.ConclusionsNo new or unexpected safety findings were detected for VAR and MMRV given as recommended, reinforcing the favorable safety profiles of these vaccines. Providers should obtain specimens for viral testing and strain-typing for serious AEs if they consider vVZV as the possible causative agent.
Carbon storage in plants: a buffer for temporal light and temperature fluctuations
Authors: Zepeda Ana Cristina , Heuvelink Ep , Marcelis Leo F M 
Published: October 2022

Abstract
Carbon (C) storage allows a plant to support growth whenever there is a temporal asynchrony between supply (source strength) and demand of carbon (sink strength). This asynchrony is strongly influenced by changes in light and temperature. In most crop models, C storage is included as a passive process that occurs whenever there is an excess of C from photosynthesis compared with the demand of C for metabolism. However, there are numerous studies that challenged this concept, and provided experimental evidence that C storage is an active process that allows buffering of environmental fluctuations and supports long-term plant growth. We propose that an active C pool needs to be included in simulation models for a better understanding of plant growth patterns under fluctuating environment. Specifically, we propose that the two main mechanisms actively regulating C storage in plants are the partitioning of assimilates between soluble sugars and starch and the degradation and remobilization of storage compounds. The insights gained here are important to optimize crop performance under fluctuating conditions and thus for developing more resource-efficient crop production systems.
Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain
Authors: Hill David M , Ly Austin , Desai Jay P , Atmeh Kais R , Velamuri Sai R , Jones Jerry 
Published: October 2022

Abstract
Patients with severe burn injuries often require split-thickness skin grafting to expedite wound healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Peripheral nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. The purpose of this case series is to assess the safety, feasibility, and clinical efficacy of a recently demonstrated novel continuous LAM (lateral, anterior, medial) femoral cutaneous block technique in a larger cohort. The study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 and May 2021 who had the continuous LAM block performed for donor site pain by the acute pain service team. Demographics were reported with descriptive statistics and morphine milligram equivalents (MME) were analyzed via Friedman analysis of variance. Forty-seven patients had a total of 53 blocks placed, where 2 patients received the LAM block on two separate occasions and 4 patients had bilateral LAM blocks placed. Most were African–American males, but mechanism of injury varied. Over half had a neurologic (17%) or psychiatric history (34%) outside of substance use. Almost three-quarters had a history of substance use with 17% being opioids, and a quarter had a history of polysubstance use. Median day from admission to LAM was 7 (2.5, 11.5) with a median duration of 4 (3, 5) days. Temperature and pressure sensation were reduced at the donor site. Quadricep strength remained intact, and median day until first ambulation after LAM placement was 2 (1, 3) days. Pain was adequately controlled, and there were no significant adverse events associated with the block. There was a significant reduction in MME after block placement (p &lt; .001). Continuous peripheral nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids or multimodal regimens. The novel LAM technique reduced sensation and pain without inhibiting early ambulation, and patients were able to fully participate in their rehabilitation.
Distance and Alternative Signals of Status: A Unifying Framework
Authors: Bellezza Silvia 
Published: October 2022

Abstract
In the past decades, as traditional luxury goods and conspicuous consumption have become more mainstream and lost some of their signaling value, new alternative signals of status (e.g., vintage, inconspicuous consumption, sustainable luxury) have progressively emerged. This research applies the grounded theory method to establish a novel framework that systematically unifies existing conceptualizations, findings, and observations on alternative signals of status. The proposed framework organizes alternative signals in terms of their distance from traditional status symbols and categorizes them along six focal dimensions: time (new/old), quantity (many possessions/few possessions), conspicuousness (conspicuous/inconspicuous), aesthetics (beautiful/ugly), culture (highbrow/lowbrow), and pace of life (slow/fast). This parsimonious framework captures various consumption phenomena related to status signaling, unifies existing theories, and generates a fruitful agenda for future research.
A Molecular Diagnostic Assay for the Discrimination of Aphid Species (Hemiptera: Aphididae) Infesting Citrus
Authors: Kapantaidaki Despoina Ev , Krokida Afroditi , Evangelou Vasiliki , Milonas Panagiotis , Papachristos Dimitrios P 
Published: October 2022

Abstract
Aphid species (Hemiptera: Aphididae) are among the most serious pests for citrus cultivation throughout the world causing substantial crop damages. Accurate identification of aphids to the species level can be difficult, though being crucial for their effective management. In this study, a molecular diagnostic assay for distinguishing eleven aphid species was developed. A fragment of the mitochondrial Cytochrome Oxidase I (mtCOI) gene was used and a Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR–FLP) analysis with five restriction enzymes, based on DNA sequence polymorphisms, was applied to differentiate the eleven aphid species. This molecular technique allows aphid species at any life stage to be discriminated accurately and simply and can be a useful tool for monitoring the populations of economically important aphid species.
Executive Control of Agency Adjudication: Capacity, Selection, and Precedential Rulemaking
Authors: Hausman David K , Ho Daniel E , Krass Mark S , McDonough Anne 
Published: October 2022

AbstractWhile the volume of adjudication by federal agencies far outstrips the volume of cases decided by the federal judiciary, researchers have devoted relatively little attention to agency adjudication and political control thereof. We study three mechanisms of presidential control of immigration adjudication: capacity-building, selection, and precedential rulemaking. First, consistent with work on bureaucratic capacity, the Trump administration achieved its goal of increasing removals of noncitizens through an unprecedented increase in total hiring of immigration judges (IJs). Second, contrary to expectations from the literatures on judicial behavior and bureaucratic politics, we find little evidence of partisan effects in IJ selection. Third, we demonstrate the substantial power of what we call “precedential rulemaking”—the power by the Attorney General to select cases in which to issue binding precedent. These results illustrate the importance of incorporating mechanisms of supervisory and legal control into the study of administrative courts.
Identification of Forensically Important Carrion Beetles (Coleoptera: Staphilinidae) in China Based on COI and COII
Authors: Luo Yifei , Meng Fanming 
Published: October 2022

Abstract
Unambiguous and speedy necrophagous insect species identification is common task in forensic entomological study. Carrion beetles (Staphilinidae: Silphinae) belong to a small group of Coleoptera with less than 200 species worldwide. Some species are commonly found on dead body during forensic entomological investigation. Despite some species are hard to be categorized morphologically, present DNA-based technologies offer a potential identification strategy. Here, 37 carrion beetle specimens were collected from 15 locations throughout Chinese mainland. The cytochrome oxidase subunit I (COI) and II (COII) genes among all specimens were successfully sequenced, which provided reliable markers for precise identification. Mostly, the interspecific distance could clarify the capability of these genes for identifying included carrion beetle species. Exceptions existed between close species in Nicrophorus genus (Fabricius 1775). The sequenced gene’s phylogenetic analysis revealed that all carrion beetle specimens were correctly classified into eight genera, and most have relatively high supporting values (&gt;90%). Our data gives genetic diversity and a reference for global forensically important carrion beetle species identification, as well as a conductive significance for future application of Chinese carrion beetles in forensic entomology.