bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting In-hospital of Death of Patients with Acute Stroke in the ICU Using Stacking Model
Authors: Wang Kai , Liu JianMo , Li Fang , Lei KeQi , Guo TingHao , Cheng ZhiJuan , Tu Jianglong
Published: October 2024

Objective: To establish the in-hospital death prediction model of acute stroke patients in ICU based on 8 kinds of machine learning algorithms (SVC, Logistics, RandomForest, XGboost, GBDT, LightGBM, Catboost, MLP).
Methods: The data of 1882 acute stroke patients in ICU of the Second Affiliated Hospital of Nanchang University from November 2006 to October 2022 were collected, Lasso regression was used to screen the features, multifactorial Logistics regression algorithm was utilized to mine the risk factors of acute stroke death in ICU, and eight machine learning algorithms were utilized to build ICU patient death prediction models, and selecting the four optimal algorithms as the Stacking model base learner, as well as selecting the optimal algorithms as the Stacking model meta-learners to construct ICU stroke death prediction models. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC) of the subjects, accuracy, sensitivity, and specificity, and the gain value of the model was evaluated using the decision curve.
Result: The multi-factorial logistics regression analysis showed that atrial fibrillation, pulmonary infection, coma, high creatinine, international normalized ratio(INR) of prothrombin time, serum sodium, neutrophil count and low platelet count were independent risk factors for in-hospital death in stroke patients (P<0.05). In the training set, validation set, and external validation set, the AUC values of the Stacking prediction model were 0.878, 0.871, and 0.809, respectively. The sensitivity values were 0.82, 0.85, and 0.87, respectively. The specificity values were 0.87, 0.84, and 0.68, respectively. The top four AUC values in the eight algorithms were MLP, XGBoost, GBDT, and CatBoost with correspondingly test set AUC values of 0.829, 0.786, 0.78, and 0.777. The decision curve showed that when the probability threshold predicted by the Stacking prediction model was greater than 0.1, the model had a positive net benefit.
Conclusion: The Stacking model has a better prediction effect on ICU in-hospital death in stroke patients and can be applied to early prediction of death in ICU stroke patients, providing a basis for early clinical intervention.
Integrated Bioinformatical Analysis for Identification the invasion-related Genes in ovarian cancer
Authors: Guo Xiaoxia , Wu Xiaojing , Yu Ping , Xie Yao , Mei Jie , Yu Shiqing , Kong Lijuan , Liu Congrui , Feng Xinru , Su Dan
Published: October 2024

Ovarian cancer (OC) is the most prevalent cancer among females and its prognosis is closely related to the tumor microenvironment and the progression of the disease. This study aimed to explore the relationship between invasion-related genes (IRGs) and the prognosis of OC. Using the Cancer Genome Atlas (TCGA) database, 65 IRGs were identified and a risk model was constructed based on 4 of these IRGs. This model was able to differentiate OC patients into two risk groups with significant differences in prognosis, immune cell infiltration, and phenotypes. The model was validated using multiple methods and datasets, and the expressions of the four hub genes were confirmed using qPCR and immunohistochemistry staining assays. The results of this study suggest that the risk model could play a significant role in predicting the prognosis of OC. The findings also contribute to a better understanding of OC invasion and could assist in the development of more personalized and precise therapeutic strategies.
Prevalence of Toxoplasmosis among the Human Population in Indonesia: A Systematic Review and Meta-Analysis
Authors: Perdana Taufik Mulya , Dwiputro Alfin Harjuno , Kusuma Stefanie
Published: October 2024

Background
Toxoplasma gondii is a ubiquitous parasite that can cause significant complications when it infects pregnant women and immunocompromised patients. These complications include miscarriage, fetal abnormalities, and fatal cerebral toxoplasmosis. Despite its significance, the true burden of toxoplasmosis in Indonesia remains underexplored. Therefore, we aim to assess the prevalence of toxoplasmosis among the human population in Indonesia using serological, molecular, and histopathological examinations. In addition, we assessed whether the prevalence differed across geographical regions, populations, or population risk levels.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review and meta-analysis of data retrieved from PubMed, Google Scholar, and Portal Garuda. We pooled prevalence data using the inverse-variance method and a random effects model. Heterogeneity was assessed using I2 statistics and Cochran’s Q test. Study quality was evaluated using a checklist for prevalence studies developed by the Joanna Briggs Institute. Publication bias was assessed using Doi plots and Luis Furuya-Kanamori (LFK) index. We performed subgroup analysis, meta-regression, and sensitivity analysis to explore sources heterogeneity and the robustness of the pooled estimates.
Result
In total, 52 studies were included in this study. The adjusted pooled seroprevalence was 58.13% (95% CI: 49.56–66.24%). We observed no subgroup differences based on study location, study population, population risk level, sample size, detection method, or study quality. The range of toxoplasmosis prevalence as measured via polymerase chain reaction and histopathological examination was 0–32.81% and 0%, respectively. Meta-analysis was not performed for molecular or histopathological data.
Conclusion
Toxoplasmosis is highly prevalent among the human population in Indonesia; however, our study mainly relied on studies with small-sample sizes. Furthermore, most of the studies were performed in Java; therefore, some high-quality population-based studies must be conducted in other regions of Indonesia to better estimate the prevalence of toxoplasmosis across the country.
Comparison of treatment outcomes of single-session and 2-stage gamma knife surgery for large brain metastases from lung adenocarcinoma
Authors: Wang Xiaoyi , Weng Yuxiang , Huang Kaiyuan , Xu Qingsheng , Ye Ke , Wu Fan , Zhu Yu , Zhang Luyuan , Tong Ying , Zhan Renya , Zhou Hengjun
Published: October 2024

PURPOSE
To compare the therapeutic outcomes of single-session gamma knife surgery (GKS) and 2-stage GKS for large (diameter ≥ 2 cm) brain metastases from lung cancer.
METHODS
For the first time, patients with brain metastases from a single primary tumor were selected, and the treatment data of patients with large lung brain metastases from lung adenocarcinoma treated with single-session or 2-stage GKS between January 2019 and June 2022 at our hospital were retrospectively analyzed. Seventy-seven patients (85 lesions) were in the single-session GKS group, while 62 patients (72 lesions) were in the 2-stage GKS group. Propensity score matching of cases was performed because of differences in the number of patients and clinical factors prior to GKS between the two groups. Finally, 90 patients (45 in each group) were included in the matched case-control study. Therapeutic outcomes were measured based on the Karnofsky performance status score, local tumor control, cumulative incidence of radiation necrosis, and overall survival of each patient.
RESULTS
In the overall patient cohort, the cumulative incidence of radiation necrosis was significantly lower in the staged GKS group than in the single-session GKS group (5.0% vs. 18.4% at 1 year, p = 0.028). In the case-matched cohort, the cumulative incidence of neurological death was significantly lower in the staged GKS group than in the single-session GKS group (2.4% vs. 4.9% at 1 year, p = 0.045). In both the overall and case-matched cohorts, the rate of tumor volume change after GKS was significantly higher in the staged GKS group (67.5%, 67.5%) than in the single-session GKS group (53.0, 51.1%) (p < 0.05). The local tumor control and rate of tumor volume change were also significantly better in the staged GKS group than in the single-session GKS group. No significant difference in overall survival was observed between the two groups. Besides, the rate of tumor volume change is a significant factor that influences the long-term efficacy of local tumor control. Additionally, the control of the primary tumor is an independent influencing factor for the overall survival of patients.
CONCLUSION
Our findings suggest that staged GKS is safer and more efficacious than single-session GKS for large brain metastases (≥ 2 cm in diameter) from lung adenocarcinoma, and that the rate of tumor volume change after treatment influences local tumor progression.
Prediction of Ki‑67 expression in gastrointestinal stromal tumors by measuring body composition using CT plain scan images
Authors: Chen Wei , Duan Long-Yu , Peng Xiao-Juan , Kuang Lian-Qin , Yi Kun-Ming
Published: October 2024

Background and Aim
: Using plain CT images to measure the body composition of patients with gastrointestinal stromal tumors to preoperatively predict Ki-67 expression in gastrointestinal stromal tumors (GISTs).
Method
A total of 233 patients with pathologically confirmed gastrointestinal stromal tumors were included in this study. The pre-treatment complete abdominal CT images of the patients included in the study were processed and analyzed using the Siemens Syngo imaging system.SPSS26.0 statistical software was used to organize and analyze the data.
Results
The GIST cases included 1 case in the esophagus, 69 cases in the small intestine (with 10 cases in the duodenum), 129 cases in the stomach, 1 case in the colon, 5 cases in the rectum, and 28 cases in the abdominopelvic mesentery. The results showed that the lower VFI value and larger tumor volume were independent risk factors for poor prognosis of GIST patients, VFI in the high KI-67 PI group was lower than that in the low KI-67 PI group (P < 0.05),the tumor volume was larger in the high KI-67 PI group than in the low KI-67 PI group (P < 0.05), and "VFI + tumor volume" can effectively predict Ki-67 expression level in stromal tumors。Hosmer-Lemeshow test revealed showed that the prediction model exhibited high consistency with the actual clinical observations.
Conclusions
Visceral fat and tumor volume in GIST patients can be accurately assess using plain CT scan images. These findings a basis for adoption of effective treatment strategies, enhancing patient prognosis.
Exploring necroptosis-associated genes: implications for immune responses and therapeutic strategies in diabetic foot ulcers
Authors: Yuan Meijie , Sun Jian , Zhao Zhuo , Hu Xiaoming , Fan Weijing , Shi Hongshuo , Liu Guobin
Published: October 2024

Diabetic foot ulcers (DFUs) are among the most severe and debilitating diabetic complications, often leading to extremely high morbidity and mortality. Recently, increasing evidence has highlighted the role of necroptosis, a distinct type of programmed cell death distinct from apoptosis, in the progression and severity of DFUs. Understanding necroptosis-associated genes in DFUs could open new therapeutic avenues aimed at modulating this form of cell death, potentially improving outcomes for patients suffering from this serious diabetic complication. This study focuses on discovering and confirming potential necroptosis biomarkers linked to DFU through the application of machine learning and bioinformatics approaches. We obtained three microarray datasets associated with DFU individuals from the Gene Expression Omnibus (GEO) database: GSE68183, GSE134431, and GSE80178. In GSE134431, we identified necroptosis-associated genes (NRGs) with differential expression between DFU patients and healthy controls, totaling 37 NRGs. Additionally, we observed an activated immune response in both groups. Moreover, clustering analysis revealed two distinct clusters within the DFU samples, showcasing immune heterogeneity. Subsequently, we constructed a Random Forest (RF) model utilizing 5 genes (CENPB, TRIM56, ZNF768, PLIN4, and ATP1A1). Notably, this model demonstrated outstanding performance on the external validation datasets GSE134431, GSE68183 (AUC = 1.000). The study has pinpointed five genes linked to necroptosis in the context of DFU, unveiling new potential biomarkers and targets for DFU therapy. Bioinformatics analysis elucidated that CENPB, TRIM56, ZNF768, PLIN4, and ATP1A1 could serve as potential biomarkers for future DFU research.
Investigating the contextual drivers and factors impacting child growth failure in Mining Communities; A Structural Equation Modeling approach.
Authors: Nyirenda HERBERT TATO , Mulenga David , Nyambe-Silavwe Hildah
Published: October 2024

Objective: Child growth and nutritional development are significantly impacted by various factors. This paper investigated the contextual drivers influencing child growth failure in local communities dominated by mining activities.
Methods: The study employed a cross-sectional study design and comprised a random sample of 781 under-five children and their caregivers. Structured interviews were conducted with caregivers, and anthropometric measurements were taken from the children. Bivariate chi-square, Structural Equation Modeling and multivariate logistic regression analysis were performed.
Results: Over half (51%) of the children were female. On average, households consisted of 6.1±2.7 SD persons. Primary caregivers had an average age of 24.2±9.4 while the children's average age was 21.3±15.7 SD months. The average height of children was 80.4±13.7 SD with a height-for-age Z-Score of 0.2±4.9 SD. Further, 35% of children experience child growth failure. Drivers include; age-caregiver [AOR = 1.04, 95% CI = 1.028- 1.056], high-school education [AOR = 0.24, 95% CI = 0.089 - 0.677], unemployment-housewife [AOR = 0.45, 95% CI = 0.226 - 0.901], feeding-strategies [AOR = 0.39, 95% CI = 0.226 - 0.663] and cooking-duration [AOR = 2.16, 95% CI = 1.131 - 4.129].
Conclusion: Child growth failure remains a concern, with individual and contextual-level factors identified as significant contributors and thus crucial to take them into account when designing nutrition interventions in vulnerable communities. Therefore, as mining cooperation’s undertake corporate social investment initiatives, it's crucial to consider contextual factors in the design of community interventions.
Association between resolved hepatitis B virus infection and diabetes in adult Americans: National Health and Nutrition Examination Survey 2007-2018
Authors: Qin Zihan , Xin Xiaojing , Zhang Zijia , Zhang Lingye , Zhang Shutian
Published: October 2024

Background and aims: Currently, hepatitis B virus (HBV) infection and diabetes are both prominent global health challenges. Resolved HBV infection, often perceived as a milder form of HBV infection, are often overlooked. This study aims to explore the potential link between resolved HBV infection and diabetes among adult Americans.
Methods: The cross-sectional study involved adults aged 20-80 years participants from the 2007-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Adjusted odds ratios were calculated using multivariate logistic regression and subgroup analyses were performed to validate the findings.
Results: Final analysis included 17,524 participants from NHANES cycles, 1,405 recovered from HBV infection (12.1%) among these participants. Resolved HBV infection was significantly correlated with an elevated diabetes risk, even after adjusting fully (OR: 1.19, 95% CI: 1.02-1.39, P=0.024), especially those with normal or low BMI and no hypertension.
Conclusion: Our research reveals that in the adult American, resolved HBV infection is positively associated with diabetes, highlighting the complex interaction between chronic HBV infection and physical health. Therefore, it is crucial to emphasize routine diabetes assessments for individuals with resolved HBV infection.
Cloning and expression studies of osmotin like protein gene from Solanum nigrum in Escherichia coli
Authors: Saleem Muhammad Zafar , Arshad Fatima , Ahmad Nauman , Saleem Ammara , Jahangir Ghulam Zahra , Zulfiqar Asma , Arshed Muhammad Zeeshan , Shah Anis Ali , Iftikhar Muhammad , Shaffique Shifa , Gatasheh Mansour K.
Published: October 2024

Plants usually face different types of stresses both biotic and abiotic. To combat against these stresses, they have defensive proteins. That only induce when there is a need of them. Plant pathogenesis related proteins (PR) is a group of proteins that help plants to fight against the stresses. Osmotin like protein is one of them and belongs to superfamily PR 5. In this study, OLP gene was isolated from the DNA of a medicinal plant Solanum nigrum. The plant was cultured in tissue culture laboratory under specific conditions. Plant genomic DNA was isolated by following a modified protocol. To isolate the gene, primers set was designed by Primer3 software with retrieved gene sequence from NCBI data base. The OLP gene was amplified by gradient PCR at specific set conditions. The annealing temperature range was set at 50°C-60°C. The primers to be optimized showed the optimum annealing temperature at 58.3°C to 60°C. The gel eluted amplified PCR product was cloned in cloning vector pTZ57R/T by using a cloning kit. The transformed plasmid DNA was sequenced to confirm the insertion of gene. The homology of sequenced gene was 98% with the reported sequences. To study the expression of the gene, the OLP gene was cloned in an expression vector pET15b. The construct was transformed into BL21 DE3 (E. coli strain). The expression of protein was analyzed through12% SDS- PAGE after inducing the cells for 3 h at 37°C with 1mM final concentration of IPTG as inducer. The clear difference was observed between induced and un-induced cells through protein profile. The induced OLP was at the right size of 26 kDa. Protein inclusions were made and protein blotting was done by Protein Dot Blot method. By using anti histidine antibodies and color reaction, the clear result of induced osmotin like protein was observed.
Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial
Authors: Abou Jamila , Elders Petra J.M. , Huijts Danielle , Marum Rob van , Hugtenburg Jacqueline
Published: October 2024

Background Deprescribing of inappropriate cardiovascular and diabetes medication has shown to be adequate, feasible and safe. Healthcare providers often experience the deprescribing of cardiovascular and diabetes medication as a challenge and therefore it is still not widely implemented in daily practice.Aim The aim was to assess whether a training on the performance of a more deprescribing-focused clinical medication review results in a greater reduction of inappropriate use of cardiovascular and diabetes medication.Method A cluster randomized controlled trial involving 20 community pharmacists, who conducted a clinical medication review in 10 patients. The intervention group received a training on deprescribing. Patients 70 years or older; polypharmacy and use of antihypertensive medication and having a systolic blood pressure below 140 mmHg, and/or use of diabetes medication and HbA1c level below 54 mmol/mol were included. Follow-up took place within four weeks (T1) and after three months (T2).Results 71 and 69 patients were included in the intervention and control group, respectively. At T2 32% and 26% of the patients in the intervention and control group had the use of one or more cardiovascular or diabetes medication discontinued. With regard to any medication these percentages were 51% and 36%, respectively.Conclusion Increased awareness and ability of community pharmacists to deprescribe medication and use of general practitioners data, led community pharmacists and general practitioners to successfully conduct a more deprescribing-focused clinical medication review in daily practice. Further research on the need for additional training to optimize deprescribing cardiovascular and diabetes medication is required.
Urinary KIM-1 and CA 19-9: Biomarkers for Guiding Treatment Decisions after Pyeloplasty
Authors: GAUR SUNIL KS , SHARMA KANIKA , CHOWDHARY SARITA , SHARMA SHIV PRASAD , PANIGRAHI PRANAY
Published: October 2024

Background- Urinary biomarkers KIM−1 and CA 19−9 are explored as diagnostic tools for congenital obstructive hydronephrosis in children. This study investigates their pre- to post-operative quantification, correlating with sonography and histopathology to enhance diagnosis and treatment. Biomarker analysis can identify patients requiring surgery and resolve the dilemma of persistent obstruction after pyeloplasty, enabling timely and targeted interventions to preserve kidney function. Methods-This two-year prospective study analyzed urinary KIM−1 and CA 19−9 levels in 40 patients with UPJO before and after surgery. Patients under 16 with consent for follow-up were included. Three patients were excluded due to loss to follow-up or repeat surgery. Urine samples were collected pre-operatively and at 1, 3, and 6 months post-operatively, and analyzed using ELISA kits. Ultrasonography and nuclear scans were also performed. Statistical significance was set at p < 0.05. Results-This study analyzed 37 cases of UPJO requiring pyeloplasty and healthy controls. The majority of cases (51.3%) were children between 1–5 years old, with a male predilection (81.08%). The mean serum urea and creatinine values were 22.9 ± 6.1 mg/dl and 0.48 ± 0.1 mg/dl, respectively. The antero-posterior diameter (APD) decreased significantly post-operatively. Urinary biomarkers KIM−1 and CA 19−9 showed a significant reduction post-operatively, with KIM−1 showing a more pronounced decrease. The sensitivity and specificity of CA 19−9 were slightly higher than those of KIM−1. Biomarker analysis can identify patients requiring surgery and resolve the dilemma of persistent obstruction after pyeloplasty, enabling timely and targeted interventions to preserve kidney function. This study validates using biomarkers as an objective monitoring parameter, allowing healthcare providers to offer reassurance to patients and their families while avoiding unwarranted and costly renal scans. Conclusions-Urinary biomarkers KIM−1 and CA 19−9 effectively monitor pyeloplasty outcomes in children with congenital obstructive hydronephrosis, offering a child-friendly and cost-effective alternative to renal scans.
The microRNAs inhibiting atheroprotective pathways in correlation with atherosclerosis severity in chronic coronary syndrome patients – case control study and network analysis
Authors: Michał Kowara , Michał Kopka , Karolina Kopka , Renata Główczyńska , Sławomir Kujawski , Piotr Baruś , Agnieszka Cudnoch-Jędrzejewska
Published: October 2024

Atherosclerotic plaque progression is regulated by microRNAs. In addition to atherogenic pathways, there are also factors that inhibit the plaque development at crucial stages - KLF2, KLF4, Mert-K, IL-10 and TGF-β. These factors are downregulated by the following microRNAs – miR-92a downregulates KLF-2, miR-10b – KLF4, miR-126 – Mert-K, miR-98 – IL10 and miR-29b – TGFβ1 and TGFβ3. A total of 44 patients with chronic coronary syndrome and atherosclerotic lesions confirmed by coronary angiography and 10 healthy volunteers were enrolled in the study. Patients were classified according to atherosclerotic burden (assessed by the Gensini Score) and the presence of advanced atherosclerotic lesion in a coronary branch (i.e. significant stenosis or chronic occlusion). The relative expression levels in plasma of miR-92a, miR-10b, miR-126, miR-98 and miR-29b in plasma were measured by quantitative RT-PCR and relations between these particles were also assessed by network analysis. The study showed that patients with the lowest burden of atherosclerosis had significantly increased levels of miR-126 (57.93 ± 6.87 for Gensini tertile 1 vs. 41.60 ± 4.52 for Gensini tertiles 2 and 3 considered as one group, p = 0.0472), whereas patients with advanced atherosclerosis had significantly increased levels of miR-92a − 51.02 [20.56–72.68] vs 94.93 [67.04-133.78], p = 0.0074). Moreover, the network analysis revealed strong positive correlation between miR-92a and miR-98, miR-10b and miR-126 as well as miR-10b and miR-29 in chronic coronary syndrome patients. The results demonstrated that microRNAs downregulating atheroprotective pathways may differ according to atherosclerotic plaque burden and progression. This finding may suggest a potential role for this miRNA (especially miR-92a) as a diagnostic marker reflecting advanced atherosclerosis with significant lesions, or even as a possible therapeutic target.
DNA profiles obtained from molars with carious lesions
Authors: Huerta Luis Mario , López-Armenta Mauro , Avilés-Villada David , Jiménez-Baltazar Carlos , Hernández-Romano Pablo , López-Balderas Nayali
Published: October 2024

Background: Teeth can be used to obtain a DNA profile, such as for identifying human remains. The recommendation is to use teeth without carious lesions or other changes; however, this complicates tooth-based DNA profiling and related human identification in countries such as Mexico, where 93.3% of the adult population has caries. Objective: To analyze whether the degree of caries correlates with the amount of DNA extracted from a tooth and/or the ability to obtain a complete DNA profile. Method: Thirty-five molar teeth with dental caries were collected from private clinics located in the center of the state of Veracruz, Mexico. DNA was extracted and autosomal STRs were amplified using an Investigator 24plex GO! kit.
Results: The mean DNA concentration was 6.08 ng/μL. There was no significant difference in DNA concentration with respect to tooth type (p = 0.113), caries size (p = 0.104), or location (p = 0.718). Twenty-one complete DNA profiles were obtained (60.0%), one partial profile was obtained (2.9%), and 13 cases failed to amplify (37.1%). The obtained DNA concentration showed a significant difference (p =0.023) between teeth that yielded a complete profile (9.503 ng/μL) and those that failed to amplify (1.009 ng/μL) but did not differ with respect to caries size (p = 0.816).
Conclusions: The damage caused by the carious lesion does not affect the amount of DNA obtained, and therefore does not affect the likelihood of obtaining of a complete DNA profile. The use of caries-bearing teeth for the identification of human remains should be investigated.
Survival Analysis of TACE Monotherapy vs. Combination Therapy in BCLC B and C Stage Hepatocellular Carcinoma: A Retrospective Cohort Study
Authors: Guo Chengxiang , Du Weiran , Chen Yiwen , Xiao Wenbo , Sun Ke , Shen Yan , Zhang Min , Wu Jian , Gao Shunliang , Yu Jun , Que Risheng , Xue Xing , Bai Xueli , Liang Tingbo
Published: October 2024

Introduction
Standard treatments provide limited benefits for patients with intermediate or advanced hepatocellular carcinoma (HCC). This retrospective observational study aimed to assess potential improvements associated with systemic therapies in patients receiving transarterial chemoembolization (TACE) for initially unresectable HCC.
Methods
Between February 2019 to March 2023, we reviewed patients diagnosed with intermediate- to-advanced HCC, treated with either TACE or TACE combined with antiangiogenic and immunotherapy (combination group) as their initial treatment. To balance the impact of confounding biases, we further divided the entire study population into surgical and non-surgical cohorts and conducted separate assessments. The analysis focused on comparing the progression-free survival (PFS), overall survival (OS) and safety profile of the combination group with those of TACE monotherapy.
Results
Out of 279 patients with initially unresectable intermediate or advanced HCC, 156 successfully underwent subsequent curative intent liver resection after preoperative treatments (TACE group, n = 69, combination group, n = 87), while 123 patients continued non-surgical treatments (TACE group, n = 31, combination group, n = 92). After PSM, 26 matched patient pairs were generated in non-surgical cohort. The combination group exhibited a significantly extended PFS for non-surgical patients (9.4 vs. 7.2 months, p = 0.043). Cox analysis also suggested that this combination therapy regimen was associated with improved PFS in non-surgical cohort (HR = 0.476, 95% CI: 0.257–0.883, p = 0.019). In surgical patients exceeding up-to-seven criteria, the combination group demonstrated superior median PFS (18.0 vs. 14.6 months, p = 0.03) and OS (Not reached vs. 50.1 months, p = 0.049) compared to the TACE group. Adverse events were manageable and did not result in any treatment-related fatalities.
Conclusion
TACE in combination with systemic antitumor therapy demonstrated improved survival benefits in patients with intermediate to advanced HCC, particularly among surgical patients with higher tumor burden.
Machine learning-based prediction of 5-year weight trajectories after bariatric surgery in adolescents: a retrospective cohort study from France and Sweden
Authors: Gueorguieva Iva , Lespagnol Celine , Saux Patrick , Jarvholm Kajsa , Stenberg Erik , Amsellem-Jager Jessica , Coutant Regis , Dabbas Myriam , Khen-Dunlop Naziha , De Filippo Gianpaolo , Dagher Ibrahim , Dubern Beatrice , Terraz Catherine , Olbers Torsten , Pattou François , Verkindt Helene , Oukhouya Naima , Aubry Estelle , Caiazzo Robert , Preux Philippe
Published: October 2024

Background
Metabolic-bariatric surgery is an efficient therapy in selected adolescents with severe obesity. However, predicting the postoperative weight loss is challenging. A machine learning calculator predicting 5-year weight loss trajectory has been developed in adults, based on seven simple preoperative features. The aim of the present study was to adapt and test this model in adolescents.
Methods
Retrospective cohort study in patients aged 12 to 20 years undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric band (AGB) in France and Sweden between 2001 and 2022. Primary outcome was the accuracy of 5-year BMI prediction, expressed as the median absolute deviation (MAD) between predicted and observed BMI. The model, initially developed in adults, was trained in a subset of adolescents consisting of 80 % of randomly selected participants, and secondly tested in the remaining 20%.
Results
We enrolled 2255 patients (1705 female [75.6%], 12 to 20 years [median 19]). The median (IQR) 5-year total weight loss was 30.2% (23.9–38.6) for RYGB, 23.4% (13.7–32.8) for SG, and 13.4% (0.0–30.1) for AGB. The adapted model predicted the observed 5-year BMI with a MAD of 3.7 kg/m² (95% CI [3.3–3.9]). The accuracy of the model was maximal for bypass (3.2 kg/m² [3.0–3.7]), good for SG (3.9 kg/m² [3.1–5.0]), and lower for AGB (7.3 kg/m² [5.5–8.4]), and accuracy decreased with time and in adolescents under 19 years. Age, height, weight, and type of intervention influenced 5-year weight loss. Coexisting type 2 diabetes influenced weight loss until 2 years after surgery but not after 5 years.
Conclusion
The model had an acceptable accuracy to predict 5-year postoperative weight loss trajectory when adapted in adolescents. Accuracy decreased over time of follow up and was influenced by type of intervention and age.
Ultrasound assessment of pediatric bone age based on wrist and knee joint ossification ratios: An observational cohort study.
Authors: Chen Shujun , Liu Junjie , Xiong Yijun , Li Wei , Tang Siqi , Zhang Haixia , Zhang Yingping , Luo Yong , Li Pan
Published: October 2024

Objectives This study aims to develop an accurate and straightforward bone age (BA) assessment model using high-frequency ultrasound. It evaluates the ossification rates of five target bones at the wrist and knee joints, reallocating weighting values to enhance assessment precision.
Methods This observational study (July 2023–March 2024) involved children aged 0–19 years, who were divided into pilot, modelling, and validation groups. High-frequency ultrasound assessed ossification rates at the wrist and knee joints, with radiographic BAs determined via the TW3-C-RUS method. Statistical analyses evaluated the correlation and accuracy between ultrasound-based and radiographic BAs.
Results The study included 2,049 children (median age 9 years) divided into pilot, modelling, and validation groups. The ossification rates of the five target sites were strongly positively correlated with the BA. Using ridge regression, a robust ultrasound-based BA model was established, which demonstrated high accuracy with an intraclass correlation coefficients of 0.99, compared with radiographic BA. In the validation group, ultrasound showed high sensitivity and specificity for diagnosing abnormal BAs, with strong inter- and intra-rater reliability.
Conclusion This study successfully generated an accurate ultrasound-based BA model that demonstrates high sensitivity and specificity, showing strong consistency with radiographic bone age assessments.
Trial registration NO. ChiCTR2400080249 (retrospectively registered).
The Association of Vitamin D Insufficiency with the Prevalence of Obesity in Children: Implications for Serum Calcium Levels, Alkaline Phosphatase Activity, and Bone Maturation
Authors: Xu Yue , Song Lingyun , Zhou Li
Published: October 2024

Background: Vitamin D deficiency emerges as a potential risk factor implicated in a spectrum of detrimental health outcomes. However, its role in school-aged children’s metabolic regulation remains to be fully elucidated. This study aimed to explore the correlation between vitamin D deficiency and childhood obesity rates, and its impact on serum calcium, alkaline phosphatase, and bone age in children.
Methods: The study analyzed clinical data from 159 school-aged children who underwent medical examinations. The children were divided into the 25-hydroxyvitamin D3 (25(OH)D3) deficiency group and the 25(OH)D3 normalgroup based on their serum levels. The two groups were compared in terms of body mass index (BMI), total cholesterol (TC), triglycerides (TG), fasting blood G=glucose (FBG), hemoglobin A1c (HbA1c), calcium (Ca), alkaline phosphatase (ALP), and bone age differences.
Results: This study showed that the 25(OH)D3 deficiency cohort exhibited notably higher BMI, TC, TG, and ALP levels compared to the 25(OH)D3 normal cohort, whereas Ca and bone age were vigorously lowered in the 25(OH)D3 deficiency group. Moreover, BMI, TC, TG, Ca, ALP, and bone age have a significant diagnostic value in forecasting 25(OH)D3 deficiency in school-aged children. Correlation analysis revealed an inverse relationship between 25(OH)D3 levels and BMI, TC, TG, and ALP, as well as a positive association with serum Ca levels and bone age.
Conclusion: Our findings demonstrated that the deficiency of 25(OH)D3 is positively correlated with the incidence of obesity among school-aged children, which may adversely affect normal skeletal development. Therefore, regularly monitoring the levels of 25(OH)D3 is crucial for clinicians and healthcare providers in accurately assessing and ensuring the proper growth and development of school-aged children.
Efficacy and safety of trastuzumab deruxtecan in HER2-positive breast cancer patients with brain metastases after failure of pyrotinib-based therapy
Authors: Zhou Jinmei , Xiao Jinyi , Wu Xuexue , Wang Xiaobo , Bian Li , Zhang Shaohua , Jiang Zefei , Wang Tao
Published: October 2024

Purpose: Tyrosine kinase inhibitors (TKIs) and trastuzumab deruxtecan (T-DXd) have shown efficacy in HER2-positive patients with brain metastasis (BMs). This paper analyzed the efficacy and safety of T-DXd in HER2-positive breast cancer patients with BMs who progressed after pyrotinib treatment.Methods: We conducted a single-center, retrospective cohort study. HER2-positive patients with BMs received T-DXd treatment that previously received pyrotinib therapy and progressed were identified from electronic medical records. The primary endpoint of this study was central nervous system progression-free survival (CNS-PFS).Results: From April 2021 to July 2023, 15 patients were included in the study. The median CNS-PFS was 7.4 months [95% confidence interval (CI), 6.1–8.8 months], the median PFS for patients with extracranial/total lesions was 6.4 months (95% CI, 4.4–8.3 months), and the median OS was 9.8 months (95% CI, 5.9–13.8 months). The ORR rates for intracranial, extracranial, and overall lesions were 33.3%, 71.4%, and 73.3%, respectively. Adverse events of grade 3 or higher with an incidence rate ≥ 5% included leukopenia (20.0%), neutropenia (13.3%), thrombocytopenia (6.7%), and nausea (6.7%). Adverse events of specific interest, interstitial lung disease or pneumonitis, occurred in 2 patents (13.3%), and both were grade 1.Conclusions: The preliminary data in this study suggest that in clinical practice in China, T-DXd is an optional treatment for patients with active/stable BMs who have progressed on pyrotinib. However, further studies are needed to determine its efficacy and the best treatment sequence for these patients.
The Use of Tourniquet in Total Knee Arthroplasty Does Not Impact the Functional Outcome: A Randomised Controlled Study
Authors: Johnsen Magnus , Havik Steinar , Husby Vigdis Schnell , Winther Siri Bjørgen , Foss Olav A. , Husby Otto Schnell , Lian Øystein Bjerkestrand
Published: October 2024

Background
This study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use.
Questions/purposes
The aims were to determine if the tourniquet has an impact on (1) Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; (2) postoperative strength and function; (3) postoperative pain and opioid analgesic use; and (4) operative time, bleeding, and length of stay (LOS).
Methods
Eighty-one patients were randomised to TKA with or without a tourniquet. The outcome measures, FJS-12, muscle strength, functional test, pain, estimated blood loss, haemoglobin (Hb) loss, knee circumference, opioid consumption, and LOS were assessed preoperatively and at 1 day, 8 weeks, and 1 year after surgery.
Results
No significant difference in FJS-12 scores was found between the two groups at postoperative 8 weeks. However, the tourniquet group showed statistically significant better knee extension strength at 8 weeks (p = 0.045). There were no differences in other outcomes, except for a greater decrease in haemoglobin levels (p = 0.02) and higher estimated perioperative blood loss (p < 0.001) in the no tourniquet group than the torniquet group.
Conclusions
Our study indicates that tourniquet use during TKA causes no significant differences in FJS-12 at 8 weeks, significantly reduces bleeding and postoperative Hb loss, and improves quadriceps strength at 8 weeks.
Trial registration
Clinicaltrails.gov. Registry Number: NCT03666598. Registered 30 August 2018.
The Multiple Mediating Effects of Internalized Weight Stigma, Breastfeeding Difficulties, and Breastfeeding Self-Efficacy on the Association Between Pre-pregnancy Overweight/Obesity and Exclusive Breastfeeding at 6 Months Postpartum: A Prospective Cohort Study
Authors: Ren Ziqi , Tang Huiting , Fan Xuemei , Feng Jingyi , Zhang Aixia
Published: October 2024

Background
Despite the World Health Organization's (WHO) emphasis on the essential role of exclusive breastfeeding for both maternal and infant health, exclusive breastfeeding rates among women with pre-pregnancy overweight/obesity remain suboptimal. The underlying mechanisms driving this negative association are not well-understood. This study aimed to explore these mechanisms by examining the independent and sequential mediation effects of internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy on the relationship between pre-pregnancy overweight/obesity and exclusive breastfeeding at six months postpartum.
Methods
In this prospective cohort study, 296 primiparous women were stratified by pre-pregnancy body mass index (BMI) into two groups: pre-pregnancy overweight/obese (n = 146) and normal BMI (n = 150). Data were collected via questionnaires during the antenatal period and at 6 months postpartum. After adjusting for covariates, structural equation modeling with maximum likelihood estimation was utilized, along with bias-corrected bootstrap testing, to estimate and assess the mediation effects in the negative association between maternal pre-pregnancy overweight/obesity and exclusive breastfeeding at 6 months postpartum.
Results
The study confirmed a negative correlation between pre-pregnancy overweight/obesity and exclusive breastfeeding at 6 months postpartum. Significant indirect paths were identified from pre-pregnancy overweight/obesity to exclusive breastfeeding at 6 months postpartum through internalized weight stigma (β = −0.217, p = 0.001), breastfeeding difficulties (β = −0.078, p = 0.018), and breastfeeding self-efficacy (β = −0.052, p = 0.025), each contributing separately. Additionally, a significant indirect path was found through the serial mediation of breastfeeding difficulties and breastfeeding self-efficacy (β = −0.053, p = 0.001).
Conclusions
This study elucidated the complex relationship between pre-pregnancy overweight/obesity and reduced exclusive breastfeeding rates at 6 months postpartum, identifying internalized weight stigma, breastfeeding difficulties, and decreased breastfeeding self-efficacy as significant mediating factors. Future research should concentrate on developing targeted interventions to overcome these obstacles, potentially including psychological therapies, hands-on breastfeeding support, and self-efficacy enhancement.
Trial registration
This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/, registry number: ChiCTR2200057038). The trial registration date was (26/02/2022).
Moderate-vigorous multimodal circuit training to boost steps and reduce seated time in post- stroke survivors: Protocol for a randomized clinical trial
Authors: Silveira Ana Flavia , Uliam Nicoly Ribeiro , Feltrin Marluci Castagna , Araujo Paloma Nepomuceno , Roscani Meliza Goi , Takahashi Anielle Christine M. , Faria Christina Danielli Coelho Morais , Santos Rafaelle Silva , Libardi Milena Carvalho , Russo Thiago Luiz
Published: October 2024

Background: Post-stroke survivors commonly display troubling levels of physical inactivity, resulting in diminished daily step counts. Guidelines advocate for multimodal circuit training (GTCir) with intensity set on moderate-vigorous intensity to bolster their mobility. Nevertheless, the efficacy of GTCir, particularly when executed at moderate-vigorous heart rate intensities, in augmenting real-world walking capacity post-stroke remains uncertain. Objective: To assess the effectiveness of a moderate-vigorous intensity GTCir protocol in increasing the number of steps and reducing seated time in post-stroke survivors.
Methodology: It is a randomized clinical trial protocol involving 78 individuals capable of independent walking at least six months post-stroke. Participants will be randomly assigned to either a GTCir group with moderate-vigorous intensity (heart ratetarget 70-84% of heart ratemaximum), or a control group undergoing light-intensity balance training (heart ratetarget <64% heart ratemaximum). Both groups will engage in supervised sessions three times weekly over 12 weeks, with assessments conducted pre- and post-intervention, along with a follow-up at 6 weeks. The primary outcome will be the number of steps/day and sedentary behavior, with secondary outcomes including mobility, balance, lower limbs and global strengths, self-reported use of the paretic lower extremity, gait speed and endurance, functional and physical activity level, sensorimotor impairment, and quality of life. Statistical analysis will be performed using RStudio software. Generalized Least Squares models, will be utilized to estimate the effect of GTCir on various clinical outcomes, with a significance level set at 5%.
Discussion: Moderate-vigorous GTCir holds promise as a rehabilitation strategy for post-stroke survivors.
Clinical trial registration: https://ensaiosclinicos.gov.br/rg/RBR-2gf7h77
CDCA8 promotes the proliferation and migration of cervical cancer through regulating CDK1
Authors: Chen Caizhi , Li Xinrong , Tan Jiajia , Zou Wen
Published: October 2024

Cervical cancer (CC) is the 4th most common female cancer globally. Although its overall incidence rate has been declining for decades, the occurrence of advanced diseases and cervical adenocarcinoma (usually undetectable by cytology) are increasing. Therefore, predictors and therapeutic targets for CC are urgently required. Cell division cycle-associated 8 (CDCA8) has been observed to participate in mitotic regulation as a component of the chromosomal passenger complex. Furthermore, the activity of cancer-related CDCA8 hyperactivation has been comprehensively studied; however, its association and underlying molecular mechanism in CC remain elusive. Therefore, this study investigated the association of CDCA8 with CC and revealed that CDCA8 is significantly overexpressed in CC patients and related to poor clinical prognosis. Moreover, CDCA8 knockdown using small hairpin RNA (shRNA) inhibited the CC cell line’s proliferation and migration, as well as enhanced apoptosis. In addition, CDCA8 knockdown was also related to reduced tumor growth in the mouse CC model. RNA sequencing and co-immunoprecipitation assay revealed that CDCA8 interacted with cyclin-dependent kinase 1 (CDK1). The study also observed that CDK1 overexpression inhibited the suppressive effect of CDCA8 knockdown on CC cell growth and migration. In summary, this study indicated that the CDCA8/CDK1 axis plays an essential carcinogenic role in CC, thereby providing a potential novel target for CC diagnosis and treatment.
Disulfidptosis and pentose phosphate pathway-associated prognosis signature guides immunotherapy for lung adenocarcinoma patients
Authors: Zhou hanyu , yun xiao , wu jun , Wang xinzhu
Published: October 2024

Background
Disulfidptosis is a form of cell death, where generation of nicotinamide adenine dinucleotide phosphate (NADPH) through the pentose phosphate pathway (PPP) play an important role. The discovery of disulfidptosis provides new in-sights into lung adenocarcinoma (LUAD) therapeutics.
Research Design and Methods:
Disulfidptosis regulators (DSRs) was used to identify subgroups. Meanwhile, WGCNA and single-cell analysis were performed to identify genes related to disulfidptosis and PPP (DPRGs). To determine the risk signature, clinical features were analyzed, as well as prognostic pre-dictive ability, tumor immune microenvironment (TIME), immunotherapeutic response and drug sensitivity. Finally, the results were experimentally verified in vitro and vivo.
Results
We identified two DSR and DPRG clusters associated with distinct immune profiles involved in regulating different biological processes. The risk signature was effective in assessing LUAD prognosis in patients. It showed a strong correlation with TIME and could predict the immunotherapy response. After LRRC61 knockdown, the proliferation, migration and anti-apoptotic ability of LUAD cells were significantly reduced. Moreover, the xenograft tumors showed tumour growth was promoted when overexpressing LRRC61.
Conclusion
We analyzed DSRs and DPRGs in LUAD and developed an evaluation system that assesses the risk and guides the clinical application of drugs, including chemotherapeutic and immunotherapeutic agents.