bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated red blood cell count levels are associated with increased vascular calcification in hemodialysis patients
Authors: Zhang Fan , Li Guoli , Yu Jie , Fu Shuangshuang , Yang Yiya , Liang Yumei , Chen Yinyin , Luo Xun
Published: August 2024

Introduction: Coronary artery calcification (CAC) is a predictor of poor survival and cardiovascular outcome in end-stage renal disease patients.We conducted this study to assess the risk factors for vascular calcification in maintenance hemodialysis patients. Methods: A total of 71 cases of HD patients who underwent hemodialysis in Hunan Provincial People's hospital from January 2022 to September 2022 were enrolled. The general clinical data and Laboratory results of the patients were collected.Chest CT examination was performed,and the CAC score was calculated. Results: CAC occurred in 41 ( 57.75%) of the 71 HD patients in the study.In the logistic regression analysis, CAC in these patients was significantly predicted by an diabetes (OR [95% CI]: 6.20 [1.37–28.11], P = 0.02) and red blood cell count (OR [95% CI]: 2.29 [1.05–5.02], P = 0.04).The ROC curve was applied to analyzing the red blood cell count; the area under the curve (AUC) was 0.66 (P = 0.02) and clinical diagnostic cutoff value = 2.99 (sensitivity = 75.6% and specificity = 56.7%) . Conclusion: The incidence rate of CAC in HD patients was high.Diabetes and red blood cell count were independent risk factors for CAC in HD patients.
Clinicoradiological findings associated with prognostic indicators of sarcomatoid-NSCLC: A multicenter analysis of 135 patients
Authors: Tang Wenjian , Yin Yujin , Wen Chunju , Huang Jinsheng , Lan Bo , Kang Yuan , Zhang Zhiqiang , Liao zhongjian , Wu Zhen , Chen Qing , Wei Jiawang , Qiu Jing , Qiu Xingting , Chen Hua , Luo Shuhua , Peng Jidong , Zhong Junyuan , Jia Ming , Zhong Jianping
Published: August 2024

Purpose: To assess clinical data and preoperative CT findings associated with prognosis in sarcomatoid-NSCLC (s-NSCLC) patients.
Material and Methods: In this retrospective study, s-NSCLC patients who underwent contrast enhanced thoracic CT or PET/CT from January 2013 to June 2023 at three centers were enrolled. Clinicoradiological data, including sex, age, smoking history, TNM classification, tumor size, tumor location, calcification, vacuole/cavity, pleural invasion, low-attenuation area (LAA) ratio, hydrothorax, peritumoral ground-glass opacity (GGO), nodule or atelectasis and SUVmax were calculated. Clinicoradiological findings associated with overall survival were evaluated by a multivariate Cox regression model.
Results: A total of 135 with s-NSCLC were included. The s-NSCLC patients were more likely to be elderly male smokers. The mean age and tumor size at diagnosis was 62 years and 5.8 cm. The median survival time of patients with s-NSCLC was 9 (95% CI: 7, 11) months. The 1-, 3- and 5-year overall survival (OS) rates of the s-NSCLC patients were 28.9%, 11.9% and 5.9%, respectively. s-NSCLC is often peripherally locate (98/135, 70.4%). Calcification (19/135, 14.1%) and Vacuole/cavity (22/135, 16.2%) were rare in s-NSCLC lesions. Pleural invasion and hydrothorax was present in 75/135 (55.6%) and 36/135 (26.7%) of s-NSCLC patients. The s-NSCLC lesions usually present with LAA (87/135, 80.6%), the median LAA ratio was 30.8% (IQR: 10.6%, 50.7%). The SUVmax of s-NSCLC lesions were 20.2 (IQR: 14.0, 23.9). Surgical treatment [hazard ratio (HR) = 0.518] was associated with decreased mortality, while peritumoral GGO, nodule or atelectasis (HR = 1.995) were associated with increased mortality.
Conclusions: Peritumoral GGO, nodule or atelectasis is an independent risk indicator associated with poor prognosis, while complete surgical resection is essential for improving the prognosis in s-NSCLC patients.
Prevalence, pattern and associated risk factors of Dry eye disease: Results of a prospective patient database from a tertiary eye care centre in Central India
Authors: Sabarwal Sunita , . Priyanka , Moharana Bruttendu , Gupta Rituka , Sharma Bhavana
Published: August 2024

Purpose:
To assess the prevalence, pattern, and associated risk factors of dry eye disease at the tertiary eye care centre in Central India.
Methods:
This prospective cross-sectional study, over 24 months, enrolled patients with systematic random sampling. Evaluation of dry eye disease (DED) was done with subjective and objective methods comprising of Ocular Surface Disease Index (OSDI) questionnaire, slit lamp examination, Schirmer’s and FTBUT test. Patients were categorised into levels 1–4 DED. Association with various etiological factors like age, sex, occupation, diabetes mellitus, autoimmune disorders, and other systemic illnesses was assessed. The chi-square test/Fischer exact test was used to analyse categorical data. Bivariate logistic regression analysis was used to calculate the odds ratio (OR). Multivariate analysis was performed to identify independent risk factors.
Results:
A total of 2560 patients were evaluated, of which 640 patients (25%) had DED. Prevalence was higher in patients aged > 50 years, household workers, students, government employees and farmers. Uncorrected refractive status, cigarette smoking, ocular allergy and contact lens usage were associated with increasing odds of developing DED.
Conclusion:
The prevalence of DED was estimated to be 25%. Certain occupations like household workers, students, government employees, farmers, uncorrected refractive errors, cigarette smoking, ocular allergy and contact lens users were significant risk factors for dry eyes.
The efficacy and safety of nab-paclitaxel plus anlotinib in small-cell Lung Cancer for third- line therapy
Authors: Tian Li-Jun , Zhou Fei-Fei , Dai Min , Liu Jun-Li , Meng Fan-Chan , Xu Wen-Chao , Guo Qi-Sen
Published: August 2024

Background: Small-cell lung cancer (SCLC) has a poor prognosis after failure of second-line therapy. This study investigated the efficacy and safety of nab-paclitaxel plus anlotinib as a third-line treatment for recurrent SCLC.
Methods: In this retrospective study, patients with recurrent SCLC with disease progression after two chemotherapeutic regimens were enrolled. Patients were randomized to one of two groups. One group (ANLIB) received 12 mg of anlotinib daily for 14 days until disease progression or unacceptable toxicity. The other group (ANNAB) received 260mg/m2 of nab-paclitaxel on day 1 in combination with 12mg/d of anlotinib for 14 days. The ANNAB regimen was repeated every three weeks for up to 6 cycles, followed by maintenance with anlotinib until disease progression or unacceptable toxicity. The primary endpoints were progression-free survival (PFS) and overall survival (OS).
Results: Between January 1, 2021 and July 31, 2022, 48 patients were enrolled in this study and were randomly assigned to either the ANNAB or ANLIB group. The overall response rate (ORR) was significantly higher in the ANNAB group compared to the ANLIB group (37.5% vs. 8.3%, Fisher's exact test p = 0.0363). The median PFS was 6.0 months in the ANNAB group and 4.7 months in the ANLIB group (p = 0.0004). The median OS was 10.0 months in the ANNAB group compared with 7.3 months in the ANLIB group (p < 0.0001).
Conclusions: The combined-modality therapy of nab-paclitaxel and anlotinib as a third-line treatment for recurrent SCLC represents a promising therapeutic strategy with an acceptable toxicity profile.
Cross-cultural Adaptation and Validation to Brazilian Portuguese of the ‘knowledge of Gestational Diabetes (Gdm)’ Questionnaire for Women With Gdm
Authors: Pereira Laura Betat , Schroeder Helena Trevisan , Santos Juciela Keller dos , Capelari Paulo César Brizolla , Schaan Beatriz D. , Bock Patrícia Martins
Published: August 2024

Background
Gestational diabetes mellitus (GDM) is characterized by hyperglycemia during pregnancy. There are many diabetes-specific tools for collecting information validated in Brazilian Portuguese. However, there are no specific instruments to evaluate knowledge about GDM. The aim of this study was to cross-culturally adapt and validate the Brazilian Portuguese version of the Knowledge of Gestational Diabetes Mellitus questionnaire.
Methods
This study was conducted in southern Brazil from January to December 2023. Women with GDM or diabetes identified during pregnancy were considered eligible based on specific criteria. Clinical and demographic data were obtained by a medical records search. The Knowledge of Gestational Diabetes Mellitus questionnaire underwent a multistep adaptation process, including translation, back-translation, content validity assessment, and cognitive interviews. After administration to participants, internal consistency, item-total correlation, and intraclass correlation were evaluated. Confirmatory factor analysis was also conducted to ensure validity.
Results
In total, 155 pregnant women were recruited for the study. Most participants were aged 18–30 years, and hypertension was the main comorbidity (25,2%). Regarding schooling, most participants (58.7%) attended high school. The Brazilian Portuguese version of the Knowledge of Gestational Diabetes Mellitus instrument comprised 32 items. Intraclass correlation was established by two independent interviews with 57 participants, yielding a correlation coefficient of 0.79 (p < 0.01). The internal consistency (Cronbach’s α) was 0.81 overall but was less than 0.7 for the individual domains. Item-total correlations were computed, and confirmatory factor analysis indicated a good model fit. The final Brazilian Portuguese version of the questionnaire consisted of 32 items.
Conclusions
The Brazilian Portuguese version of the Knowledge of Gestational Diabetes Mellitus Questionnaire yielded a reliable and valid tool for evaluating diabetes knowledge in pregnant women.
Lung Autotransplantation Combined with Postoperative Chemotherapy and Immunotherapy: A Three-Year Follow-Up Case Report
Authors: Wang Jiang , Li Tong , Lu Hengxiao , Zhao Qiang
Published: August 2024

Background
Lung cancer remains a leading cause of cancer-related mortality worldwide. Autotransplantation has emerged as a potential surgical intervention in select cases, with the aim of achieving curative outcomes. This case report describes a novel approach combining lung autotransplantation with postoperative chemotherapy and immunotherapy, delineating the patient's journey over a period of three years.
Case Presentation:
We report on a 37-year-old patient with stage IIIA non-small cell lung cancer (NSCLC) who underwent lung autotransplantation. Despite the complexity of the procedure, the patient had a favorable postoperative course. Adjuvant therapy included a PD-1 inhibitor and a standard chemotherapy regimen. The patient’s follow-up involved regular clinical assessment, imaging, and functional status evaluation, demonstrating a remarkable disease-free survival at the three-year mark postoperatively.
Conclusion
This case highlights the potential for lung autotransplantation coupled with immunotherapy and chemotherapy to yield significant long-term survival benefits in patients with NSCLC. The favorable outcome suggests that this integrative treatment strategy warrants further investigation and may offer hope to patients with similarly advanced lung cancer.
Validation for revision of the stage IIIA(T1N2) in the forthcoming ninth edition of the TNM classification for lung cancer
Authors: Wu Tong , Cai Jingsheng , Li Yun , Chen Kezhong
Published: August 2024

Objectives
The 9th edition of the lung cancer tumor-node-metastasis (TNM) staging system downgrades certain non-small cell lung cancer (NSCLC) patients from stage IIIA (T1N2) to IIB. This study aimed to externally validate this stage adjustment.
Methods
Consecutive resected stage IIB and IIIA NSCLC patients were included. Subgrouping was done based on lymph node involvements: IIB N2a1 (single-station N2 without N1 involvement), IIB N2a2 (single-station N2 with N1 involvements) and IIB N0-1. Overall survival (OS) and disease-free survival (DFS) were compared using the Kaplan-Meier method, with propensity score matching (PSM) employed to mitigate potential biases. COX regression models were utilized to assess prognostic differences.
Results
224 stage IIB and 227 stage IIIA cases was included. There were 38, 66 and 120 patients in the IIB N2a1, IIB N2a2 and IIB N0-1 subgroups, respectively. Univariate COX analysis indicated comparable prognoses between the stage IIB N0-1 and IIB N2a1 patients, whereas stage IIB N2a2 patients exhibited poorer outcomes. Upon combining the stage IIB N2a1 and IIB N0-1 subgroups, multivariate COX analysis demonstrated a significantly worse prognosis for stage IIB N2a2 patients compared to those with stage IIB N2a1/0–1 tumors (OS, P = 0.035; DFS, P = 0.021). Further comparisons between stage IIB N2a2 and IIIA patients, following PSM analysis, indicated similar survivals (OS: P = 0.390; DFS: P = 0.210).
Conclusion
The prognosis of stage IIB N2a2 patients was worse than that of remaining stage IIB patients but comparable to that of stage IIIA patients. We proposed that stage IIB N2a2 patients should be maintained as stage IIIA.
Exploring the potential connection between myocardial cells and peripheral blood in patients with sepsis via bioinformatics method
Authors: Dong Qiufen , Li Gang , Liu Yang , Li Dan , Zhang Leilei , Long Qi
Published: August 2024

Background Mitochondrial dysfunction has been proven to be a characteristic change in the myocardium of patients with sepsis. In our previous research, we revealed that some mitochondrial dysfunctions occur synchronously in the peripheral blood of sepsis patients and affect mortality with inflammatory and other related genes. However, these mitochondrial dysfunctions are not described in detail. Whether mitochondrial dysfunction affects the mortality of sepsis patients as an independent risk factor still needs to be further validated.
Objects and methods In our study, we aimed to present the co-varied genes and pathways related to mitochondrial and aerobic respiratory function in myocardium and peripheral blood of sepsis patients, and to verify their effects regarding the mortality of sepsis. We applied weighted gene co-expression network analysis(WGCNA)to generate different modules from myocardium and blood datasets, and subsequent enrichment analysis was used to identify the mitochondrial-and aerobic respiratory-related modules. We obtained the co-varied differential expressed genes(DEGs)from the modules to separate sepsis patients into different subgroups and compare the survival rate between them. Machine learning algorithms were applied for mortality predictive model construction and validation.
Results Blue and magenta modules in blood and blue modules in the myocardium were identified as being related to mitochondrial and aerobic respiratory function. There was a strong overlap in gene expression and pathways between these modules, and DEGs from them separated sepsis patients into two groups, but there was no statistical difference in mortality between the different groups(p-value=0.078). However, models generated from these DEGs performed well in mortality prediction.
Conclusion Our research has found that some genes and pathways associated with mitochondrial aerobic respiratory dysfunction are generally altered in myocardium and peripheral blood, and the changes of these related genes can reflect the severity and mortality of sepsis. Therefore, we can expect the application prospect of these mitochondria-related genes as biomarkers of infectious cardiomyopathy.
Combination of the right hepatic vein occlusion and pringle maneuver in laparoscopic right posterior sectionectomy: protocol for a prospective non-randomized controlled study using propensity score-matched analysis
Authors: Yang Wugui , Peng Yufu , Yang Yubo , Liang Bin , Li Bo , Wei Yonggang , Liu Fei
Published: August 2024

Introduction:
Laparoscopic right posterior hepatectomy, particularly for standard anatomical resection, presents significant technical challenges. Achieving complete exposure of right hepatic vein (RHV) is the critical step in this procedure. To date, there is currently no universally accepted technique to ensure the safe exposure of RHV. To address this gap, this study designs a novel technique involving RHV occlusion and Pringle maneuver for enhancing the safety of RHV exposure in laparoscopic anatomical right posterior hepatectomy (LARPH). A comparative analysis between this innovative approach and traditional technique is performing to investigate the safety and efficacy of this innovative approach.
Methods and analysis:
This prospective non-randomized controlled trial is being conducted at West China Hospital and Sanya People’s Hospital. Patients undergoing LARPH using the novel technique (double occlusion) will be assigned to the experimental group, while those using the traditional technique (Pringle maneuver only) will be assigned to the control group. Perioperative outcomes and follow-up data will be collected and analyzed. PSM analysis with 1:1 ratio matching will be used to mitigate the potential selection deviation. The primary outcome is intraoperative blood loss. Secondary outcomes include the rate of successful RHV exposure, the incidence of CO2 embolism, postoperative complications, as well as morbidity and mortality at 30 days and 90 days.
Discussion
In this study, the outflow occlusion of the target area is innovative adopted: the RHV is selectively occluded in LARPH to control the outflow of S67. Combined with the pringle maneuver, our technique potential has the benefits of reduced the risk of hemorrhage and CO2 gas embolism. By developing and disseminating standardized protocols based on best practices and evidence from successful cases, this study aims to establish a safe, efficacy, and easily disseminated novel surgical technique.
Trial registration:
This study has been prospectively registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/index.html) on May 26, 2023. The identifier is ChiCTR2300071832 and the registry name is “Caudodorsal approach combined with the occlusion of the right hepatic vein and Pringle maneuver in laparoscopic right posterior sectionectomy”.
Margin Matters: Analyzing the Impact of Circumferential Margin Involvement on Survival and Recurrence After Incomplete Total Mesorectal Excision for Rectal Cancer
Authors: Alipouriani Ali , Almadi Faris , Rosen David R. , Liska David , Kanters Arielle E. , Ban Kristen , Gorgun Emre , Steele Scott R.
Published: August 2024

Backgorund:
Incomplete mesorectal excision during rectal cancer surgery often leads to positive circumferential margins, with uncertain prognostic impacts. This study examines whether negative margins can mitigate the poorer prognosis typically associated with incomplete TME in rectal cancer surgery, thus potentially challenging the prevailing emphasis on complete mesorectal excision.
Methods
A retrospective analysis was conducted on patients who underwent proctectomy for rectal adenocarcinoma with incomplete TME at a single center from 2010–2022.Patients were stratified by margin status as determined by pathologic analysis into three groups: involved,not involved with closest margin distance ≤ 2mm,and not involved with closest margin distance > 2mm. Outcomes included recurrence and survival. Effects of neoadjuvant therapy protocols on margin status was also assessed.
Results
From 2010 to 2022, 7,941 patients underwent proctectomy for rectal cancer, with 236 (3%) having incomplete TME. The median age of these patients was 64 years,and 63% were male.Overall, margin involvement was observed in 54 (23%) patients. The median tumor size was 3.05 (IQR: 2–6) cm for the whole group. Involved margins (23.2%) had reduced overall survival (60.5 vs 87.3 months, p < 0.001), increased local recurrence (20.4% vs 9.4%, p = 0.024),and lower disease-free survival (45.2 vs 58.9 months, p = 0.006) versus uninvolved margins. Margin involvement was prognostic for decreased survival even after adjusting for confounders (p < 0.05). Among uninvolved margins,distance (> 2mm vs ≤ 2mm) did not affect outcomes. Total neoadjuvant therapy (vs standard chemoradiation)was associated with lower involved margins (p = 0.007).
Conclusions
Positive margins retain negative prognostic impact with incomplete TME. Optimization of surgical resection remains vital. Total neoadjuvant therapy may decrease risk of incomplete TME.
Leveraging Explainable AI and Large-Scale Datasets for Comprehensive Classification of Renal Histologic Types
Authors: Moon Seung Wan , Kim Jisup , Kim Young Jae , Kim Sung Hyun , An Chi Sung , Kim Kwang Gi , Jung Chan Kwon
Published: August 2024

Recently, as the number of cancer patients has increased, much research is being conducted for efficient treatment, including the use of artificial intelligence in renal pathology. Recent research has focused largely on the classification of renal cell carcinoma subtypes. Nonetheless, the broader categorization of renal tissue into non-neoplastic normal tissue, benign tumor and malignant tumor remains understudied. This gap in research can primarily be attributed to the limited availability of extensive datasets including benign tumor and normal tissue in addition to specific type of renal cell carcinoma, which hampers the ability to conduct comprehensive studies in these broader categories. This research introduces a model aimed at classifying renal tissue into three primary categories: normal (non-neoplastic), benign tumor, and malignant tumor. Utilizing digital pathology while slide images (WSIs) from nephrectomy specimens of 2,535 patients from multiple institutions, the model provides a foundational approach for distinguishing these key tissue types. The study utilized a dataset of 12,223 WSIs comprising 1,300 WSIs of normal tissue, 700 WSIs of benign tumors, and 10,223 WSIs of malignant tumors. Employing the ResNet-18 architecture and a Multiple Instance Learning approach, the model demonstrated high accuracy, with F1-scores of 0.934 (CI: 0.933–0.934) for normal tissue, 0.684 (CI: 0.682–0.687) for benign tumors, and 0.878 (CI: 0.877–0.879) for malignant tumors. The overall performance was also notable, achieving a weighted average F1-score of 0.879 (CI: 0.879–0.880) and a weighted average area under the receiver operating characteristic curve of 0.969 (CI: 0.969–0.969). This model significantly aids in the swift and accurate diagnosis of renal tissue, encompassing non-neoplastic normal tissue, benign tumor, and malignant tumor.
Association of oxidative balance scores with all-cause and cardiovascular mortality in individuals with prediabetes and the mediating role of oxidative stress and systemic inflammation: Evidence from NHANES 1999-2018
Authors: Guo Hong-peng , Liu Jia-song , Liu Man , Li You , Sun Cheng-lin , Guo Shi , Bai Hai-tao , Pan Xing-he
Published: August 2024

Background
Oxidative stress may be relevant in the progression and cardiovascular complications of prediabetes. The oxidative balance score (OBS) is an emerging metric for assessing dietary and lifestyle oxidative stress exposure. The objective of this prospective cohort study from NHANES 1999–2018 was to explore the association of OBS with all-cause and cardiovascular disease (CVD) mortality in people with prediabetes.
Methods
OBS was composed of 16 dietary components and 4 lifestyle components based on previous research. Prediabetes was diagnosed based on self-reported history or laboratory criteria. Multivariate Cox proportional hazards regression analyses were used to explore these associations and calculate hazard ratios [HR] and 95% confidence intervals [CI].
Results
A total of 8256 adult participants with prediabetes were included. Kaplan-Meier survival analysis showed significantly higher all-cause and CVD-related survival in people with prediabetes at higher OBS. After adjusting for all confounders, OBS, dietary OBS, and lifestyle OBS were all inversely associated with all-cause mortality in people with prediabetes (HR and 95% CI 0.959 (0.946,0.973), 0.965 (0.950,0.980), and 0.847 (0.798,0.899), respectively; all p < 0.0001). Higher OBS was associated with significantly lower all-cause mortality (p for trend all < 0.0001). Similar results were observed for CVD mortality. Most associations were linear, whereas the associations of OBS and dietary OBS with CVD mortality were nonlinear. Mediation analyses suggested that several oxidative stress and systemic inflammatory markers mediated these associations. Stratified and sensitivity analyses demonstrated the stability of the findings.
Conclusions
Adherence to antioxidant dietary and lifestyle patterns assessed by OBS may help prevent excess mortality in population with prediabetes. These effects may be achieved indirectly by influencing oxidative stress and systemic inflammatory markers.
Age Influence on the Prognosis and Management of Non-Functional Pancreatic Neuroendocrine Tumors in the Elderly
Authors: Wang Zhengqiang , Huang Chaoqun
Published: August 2024

Introduction
Pancreatic neuroendocrine tumors (PanNETs) account for about 7% of pancreatic tumors and are increasing in incidence. Non-functional PanNETs in the elderly often present asymptomatically, leading to more conservative treatment due to age bias. The impact of age on prognosis and management needs further clarification.
Methods
Clinical data for patients over 65 with non-functional PanNETs were collected from the SEER database. Kaplan-Meier curves analyzed overall survival between younger elderly (age 65–75 years) and older elderly (age ≥ 75 years) groups. Competing risk models assessed cancer-specific mortality, and Cox regression models identified independent survival risk factors. A prognostic model was constructed and evaluated for performance.
Results
Among 2,157 patients, older elderly patients (n = 695) had larger tumors, poorer differentiation, worse M stage, and lower surgery rates compared to younger elderly patients (n = 1,462). Younger elderly had better overall survival (p < 0.0001) and lower cancer-specific mortality. Surgery improved survival in younger elderly (p < 0.0001), with no age group survival difference in non-surgical patients. Cox regression identified age > 75, male, higher grades, advanced TNM stage, N1 stage, and lack of surgery as significant risk factors. A predictive model with a C-index of 0.77 was developed.
Conclusion
Age is an independent prognostic factor for elderly patients with non-functional PanNETs. Younger elderly patients benefit more from surgical treatment.
Biomechanical Analysis of Customized 3D-Printed Microporous Titanium Prostheses for Large Segmental Bone Defects in the Distal Femur
Authors: Zhang Xiaoyan , Xu Yongqing , Wang Yi , Huang Yuanning
Published: August 2024

Background
Large segmental bone defects in the distal femur, caused by high-energy trauma, tumor resection, and debridement of osteomyelitis, pose significant clinical challenges. The advent of 3D-printed microporous titanium prostheses offers new solutions for these complex reconstructions.
Objective
To investigate the biomechanical distribution and stability of three different 3D-printed microporous titanium prosthesis designs and fixation methods for reconstructing large segmental bone defects in the distal femur.
Methods
Three prosthesis models were developed: single-steel plate, double-steel plate, and intramedullary nail groups. Finite element analysis (FEA) was performed to simulate stress distribution and displacement understanding (0°), semi-squatting (90°), and squatting (150°) postures. The biomechanical properties, including maximum stress and displacement, were analyzed to evaluate the stability and safety of each prosthesis design.
Results
The single-steel-plate group showed higher maximum stress and displacement, particularly under semi-squatting and squatting postures, indicating potential instability. The double-steel-plate group exhibited lower stress and displacement, providing better stability than the single-steel-plate group. The intramedullary nail group demonstrated the most favorable biomechanical performance, with the lowest maximum stress and even stress distribution, enhancing mechanical stability and reducing stress shielding.
Conclusion
For large segmental defects in the distal femur, intramedullary nail fixation is recommended for superior stability and biomechanical performance. Single—or double-steel-plate prostheses are suggested for patients with severe osteoporosis or narrow medullary cavities. These findings provide valuable insights into selecting appropriate fixation methods based on individual patient conditions to achieve optimal biomechanical outcomes.
Classic Divided Sigmoidostomy Vs Loop Sigmoidostomy in Anorectal Malformations: Time for Change?
Authors: Ramirez-Amoros Carla , Carvalho Catarina , Basilio María San , Martinez Leopoldo , Encinas Jose Luis , Vilanova-Sanchez Alejandra
Published: August 2024

Purpose
Divided sigmoidostomy (DS) is the classic stoma for patients with anorectal malformations (ARM). Loop sigmoidostomies (LS) in ARM are associated with higher risk of stoma prolapse and urinary tract infections (UTI). This is not clearly supported by literature. We compared our experience with both techniques.
Methods
Retrospective study of ARM patients who underwent DS or LS between 2013–2023. We analysed demographics, associated malformations, intraoperative variables, oral intake and stoma functioning times, hospital stay, complications, prolapses, and UTI.
Results
Of 40 patients, 29 underwent open DS and 11 laparoscopic LS. Demographics, malformation type, associated anomalies, surgical time, intraoperative and anaesthetic complications were comparable. Postoperative complications were higher in DS than LS [14(48.3%) vs 1(9.1%), (p = 0.02)], mostly due to wound complications [12(41.3%) vs 0(0%), (p = 0.01)]; with 3 dehiscenses and 3 strictures reintervened. The hours to oral intake and stoma functioning were higher for DS [48(39–90) and 48(24–48) vs 24(24–48) and 24(24–24), (p < 0.05)], with more days of hospital stay [36(19–60) vs 8(5–10), (p = 0.001)]. Prolapses [1(3.4%) vs 1(9.1%)] and UTIs [3(10.3%) vs 1(9.1%) (p > 0.05)] were comparable.
Conclusion
LS in ARM patients have no higher risk of prolapse or UTI than DS. DS had more complications, mostly wound infections, strictures and dehiscenses.
Acute skin temperature responses to the 30-15 intermittent fitness test in professional male soccer players
Authors: Alvurdu Sümer , Arslan Yasin , Keskin Kadir , Oliveira Rafael , Nobari Hadi
Published: August 2024

Background
Infrared thermography has emerged as a powerful non-invasive tool with significant applications in the realm of sports science and medicine. This thermal imaging technology provides detailed insights into the skin temperature patterns and asymmetries of athletes, offering valuable data to enhance performance, assess the effectiveness of rehabilitation, monitor fatigue, and prevent injuries.
Methods
The aim of this study was to assess acute skin temperature (Tsk) responses before and after the 30 − 15 Intermittent Fitness Test (IFT) in professional male soccer players. Twenty-one professional soccer players performed a 30 − 15 IFT, and the running time, peak velocity, and true velocity (VIFT) were calculated. Thermal images of the players were acquired using an infrared thermal camera before and immediately after the 30 − 15 IFT, and Tsk measurements were analyzed from the anterior thigh, anterior leg, posterior thigh, and posterior leg.
Results
The Tsk asymmetries differed significantly between all regions of interest, with the greatest difference in the anterior and posterior thighs. Pearson correlation analysis revealed that the 30 − 15 IFT parameters were not correlated with the posttest Tsk asymmetry for any of the ROIs. However, there were significant negative correlations between pretest Tsk asymmetry in the posterior leg region and all 30 − 15 IFT parameters for running time (r = 0.30; p < .05), peak velocity (r = 0.3; p < .05), and VIFT (r = 0.25; p < .05). Finally, athletes with lower baseline Tsk asymmetries in the posterior leg region have better 30 − 15 IFT performance.
Conclusion
Thermal imaging can be used to assess muscular asymmetries following specific endurance tests or conditioning training, and this information can provide valuable information for optimizing performance and injury prevention.
The association between mitral regurgitation and long-term outcomes in acute myocardial infarction undergoing percutaneous coronary intervention: A retrospective large sample cohort study
Authors: Ning Yan , Wu Peng , Wang Fang , Wang Mohan , Ma Juan , Zhu Baozhen , Ma Xueping
Published: August 2024

Background
The relationship between mitral regurgitation (MR) and long-term outcomes in Chinese patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) remains scarce. This study aims to elucidate the connection between MR and long-term clinical outcomes following AMI treated with PCI.
Design and methods:
In this retrospective study 6940 patients who were diagnosed with AMI were consecutively enrolled from General Hospital of Ningxia Medical University(2014–2019). The included AMI patients were divided into no MR, mild MR and moderate/serve MR according to whether MR occurred. All patients were clinically followed for 3-years to collect major adverse cardiac and cerebrovascular events (MACCEs), which included all-cause death, nonfatal myocardial infarction (MI), rehospitalization for angina, rehospitalization for heart failure (RHF) and stroke. After controlling for different confounding factors, Cox regression models were used to investigate the relationship between MR and 3-years clinical outcomes.
Results
In 6940 analyzed patients, mild MR was identified in 3681 patients (53.04%), and moderate/severe MR in 388 patients (5.59%), whereas 2871 patients (41.35%) did not have MR. The cumulative 3 -year incidence of MACCEs was 19.21% in overall patients,15.26% in none MR,20.37% in mild MR, and 37.37% in moderate/severe MR (log-rank p < 0.001). Kaplan–Meier survival curves of MR with all-cause death and RHF were also plotted (log-rank p < 0.001). After controlling confounding variables completely, we found that moderate/severe MR compare to none MR was found to be significantly associated with 3-year MACCEs [hazard ratio (HR) = 1.34; 95% confidence interval (CI) = 1.07–1.69; p=0.0122] ,all-cause mortality (HR = 1.80; 95% CI = 1.33–2.44; P༝0.001) and RHF ( HR = 1.70; 95% CI = 1.33–2.17; P < 0.0001) through Cox proportional hazards regression models.
Conclusion
MR was significantly and positively associated with 3-years clinical outcomes in patients with AMI undergoing PCI. In the clinical practice, physicians should pay more attention to the MR in patients with AMI.
Differential Expression and Prognostic Significance of CDK1 and CDK6 in Breast Cancer: A Multi-Omics Approach
Authors: Islam Md. Wahidul , Fariha Fatema Tuj Johora , Ahmed Md. Zabir , Ferdous Jannatul , Lota Hafeza Bhuiyan , Hossain Md. Jubayer , Kundu Pritom , Shahjahan Muhibullah , Hossain Md. Shohel
Published: August 2024

Breast cancer, a heterogeneous disease with diverse molecular subtypes, poses significant challenges for diagnosis and treatment. Cyclin-dependent kinases (CDKs) play pivotal roles in the regulation of cell cycle progression and have emerged as potential therapeutic targets. However, studies on CDK1 and CDK6 are limited. This study comprehensively investigated the gene expression, genetic alterations, DNA methylation, and prognostic significance of CDK1 and CDK6 using the TIMER 2.0, UALCAN, HPA, cBioPortal, Enrichr, and Kaplan-Meier Plotter databases. The results indicated CDK1 upregulation and CDK6 downregulation compared to normal tissues. Elevated CDK1 levels are correlated with a higher survival rate, whereas increased CDK6 levels are associated with adverse outcomes. The analysis revealed diverse alterations, emphasizing their oncogenic potential. CDK6 methylation varies with the disease stage and ethnicity, suggesting a regulatory role. Immune cell infiltration correlates with CDK expression, indicating its impact on disease progression. Co-expression analysis identifies related genes, elucidating molecular interactions. Functional analysis revealed the pathways involving CDK1 and CDK6 as potential therapeutic targets. In consolidation, the clinical relevance of CDK1 and CDK6 as prognostic determinants and therapeutic targets in breast cancer management is discussed. This multi-omics approach provides a comprehensive framework for understanding breast cancer pathogenesis and advancing precision medical strategies to improve patient outcomes.
Impact of Insulin-like Growth Factor System on the Progression and Survival of Gastric Adenocarcinoma
Authors: Tsai Kun-Feng , Shun Chia-Tung , Fang Yu-Jen , Hong Tzu-Chan , Chen Chieh-Chang , Chen Chih-Cheng , Wu Yi-Ling , Lin Jaw-Town , Lai I-Rue , Wu Ming-Shiang , Liou JyhMing
Published: August 2024

Background
A comprehensive study on the impact of the insulin-like growth (IGF) signaling system in the progression of gastric cancer is lacking. Therefore, we conducted a hospital-based cohort study to comprehensively assess the influence of the IGF family, including IGF1, IGF2, and IGF binding proteins 1, 2, and 3, on gastric cancer (GC).
Method
Expression levels of IGF1, IGF2, IGF IR, IIR, and IGFBP1-3 in GC were determined by immunohistochemistry staining in 28 patients. Plasma levels of IGF1, IGF2, and IGFBP1-3 were measured using immunoradiometric assay or ELISA in the training cohort. Plasma IGFBP2 levels were determined in the validation cohort, consisting of 255 GC patients. Expression of IGFBP2 in gastric cancer tissues was assessed in 484 GC patients. Overall survival (OS) and relapse-free survival (RFS) based on plasma levels of IGF proteins and expression of IGFBP2 in GC tissues were analyzed.
Result
IGFBP2 was expressed in tumors (92.8%, 26/28) and non-tumor tissues (85.7%, 24/28) of GC patients, with low expression rates for other biomarkers. Higher plasma IGFBP2 levels in the training cohort (N = 142) were associated with worse OS (p = 0.0009) and RFS (p = 0.0001). Cox regression analysis confirmed that higher plasma IGFBP2 levels predicted a worse prognosis (HR: 1.51; 95% CI: 1.19–1.92; p = 0.001), whereas IGF1, IGF2, IGFBP1, and IGFBP3 did not. In the validation cohort (N = 255), higher plasma IGFBP2 levels again correlated with worse OS (p = 0.00001) and RFS (p = 0.0001).
Conclusion
IGFBP2, but not other members of the IGF system, correlated with the disease progression and survival of gastric cancer.
Investigation of the relationship between nasal cavity variations and pathological conditions of maxillary sinuses in Cone Beam Computed Tomography
Authors: Alizadeh Fatemeh , Jamalpour Mohammadreza , Shokri Abbas , Ebrahimi Asal , Irani Amin Dousti
Published: August 2024

Objective: Anatomical changes of the nasal cavities play an important role in ostiomeatal complex obstruction and can increase the risk of sinus diseases. It is important to know the prevalence of these anatomical changes and their effect on the occurrence of pathological conditions of the sinuses. The aim of this study was to determine the relationship between anatomical variations of the nasal cavity and pathological conditions of the maxillary sinus.
Methods: This descriptive-analytical study was performed on Cone Beam Computed Tomography (CBCT) scans of the nasal cavity and maxillary sinuses taken from the archives of the Department of Radiology of Hamadan Dental School between 2015 and 2021. Frequency of pathological conditions of the maxillary sinus as well as anatomical variations of nasal cavity such as septal deviation, agger nasi cells, concha bullosa, paradoxical middle concha, Haller cells,enlargement of uncinate process, supraorbital ethmoidal cell, diameter of maxillary ostium and height of infundibulum were evaluated. Finally, the data were analyzed by Stata 14.2 software at a significance level of 0.05.
Results: In this study, 280 CBCT images were collected and examined. Patients with maxillary sinus thickening have the highest frequency (42.86%) of pathological conditions. Also, among the anatomical variations, the size of unciate process on the right (80.36%) and left (86.43%) had the highest frequency. In addition, a significant correlation was observed between maxillary sinus mucosal thickening and paradoxical concha (P˂0.05). However, no association was found between nasal septal deviation, concha bullosa, unciate process size, diameter of maxillary sinus ostium and infundibulum height with maxillary sinus pathological conditions (P˃0.05).
Conclusion: The CBCT imaging is a reliable method in evaluation of anatomical variations and pathological conditions of the paranasal sinus. According to this study, paradoxical concha is associated with mucosal thickening of the maxillary sinus., Basic knowledge of anatomical variations and their relationship to the maxillary mucosa is essential for sinus surgery as well as dental implants.
The relationship between the trajectory of body mass index changes over a long lifecycle and the risk of all-cause mortality in patients with cardiovascular disease: the NHANES longitudinal cohort study
Authors: Hou Xin-Zheng , Wu Qian , Lv Qian-Yu , Yang Ying-Tian , Ye Xue-Jiao , Yang Chen-Yan , Lv Yan-Fei , Wang Shi-Han
Published: August 2024

Background
The relationship between body mass index (BMI) changes over a long lifecycle and the risk of all-cause mortality among patients with cardiovascular disease (CVD) remains understudied. This study aims to investigate the association between BMI changes (from age 25 to after 50) and the risk of all-cause mortality in CVD patients.
Methods
This study leveraged data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018 and the National Death Index (NDI) to construct a longitudinal cohort. Employing weighted multivariable Cox regression and Restricted Cubic Spline (RCS) analyses, we evaluated both the linear and nonlinear associations between BMI (at age 25 and after 50), its changes, and the risk of all-cause mortality among patients with CVD. Furthermore, we stratified the participants based on their BMI categories at these two time points to determine the relationship between different BMI trajectory patterns and all-cause mortality risk.
Results
A total of 2304 CVD patients were included in this study. During a median follow-up of 68 months, 774 participants died. The lowest risk of mortality was observed when BMI was 19.61 at age 25 and 26.55 after the age of 50. The impact of BMI change between these two time points on all-cause mortality risk exhibited a segmented effect with a threshold of 8.27. Specifically, when the change in BMI exceeded 8.27, it was positively associated with all-cause mortality risk [HR = 1.16, 95%CI=(1.00, 1.33)]. This relationship was most pronounced among CVD patients who were overweight at both ages 25 and after 50.
Conclusion
Among CVD patients, a U-shaped relationship is observed between BMI changes over a long lifecycle and the risk of all-cause mortality, where both excessive increases and decreases in BMI contribute to an elevated risk. BMI management strategies should be tailored to individual BMI trajectories, rather than solely focusing on weight loss.
Association of body roundness index with diabetes and prediabetes in US Adults from NHANES 2007-2018: A Cross-sectional Study
Authors: Qiu Liting , Xiao Zixuan , Fan Boyan , Li Ling , Sun Guixiang
Published: August 2024

Objective
The objective in this research is to explore the potential correlation among body roundness index (BRI) as well as incidence of diabetes and prediabetes among adults in USA.
Method
A cross-sectional study was carried out between 2007 and 2018 on 11,980 adults aged ≥ 20 years by National Health and Nutrition Survey (NHANES). Analyzing related correlation among BRI as well as incidence of diabetes and prediabetes was primarily conducted by a logistic regression, including univariate analysis, multivariate regression analysis, smooth curve fitting analysis, and subgroup analysis. What’s more, we applied receiver operating characteristic (ROC) analysis to analyze and further contrast the three predictive values for diabetes and prediabetes, including BRI, body mass index (BMI), and waist circumference (WC).
Results
Following covariate adjustments, each unit increase in BRI was related to a 17% higher risk in diabetes and prediabetes (OR: 1.17, 95% CI: 1.07–1.27). Those with BRI in the high scores (Q4) possessed increased likelihood in having diabetes and prediabetes than individuals in bottom quartile (OR: 1.83, 95% CI: 1.29–2.58). A nonlinear relationship between BRI and diabetes and prediabetes was uncovered through a smooth curve fitting analysis. The results across all population subgroups were uniform to those of the total population. Significantly, BRI demonstrated the highest AUC in predicting diabetes and prediabetes compared to both BMI and WC.
Conclusions
In this study, we revealed there was a positively and non-linearly relationship between BRI with the incident rates about diabetes and prediabetes in adult Americans. The BRI indices could function as predictive markers for diabetes and prediabetes.
Comparison of grip strength measurements for predicting all-cause mortality among adult aged 20+ years: NHANES 2011-2014
Authors: Chai Lirong , Zhang Dongfeng , Fan Junning
Published: August 2024

Background
Little is known about the optimal measure of handgrip strength for predicting all-cause mortality and whether this association is modified by age or sex.
Methods
We used data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES), 9,583 adults aged ≥ 20 years were included. Equal-length grip strength was measured using a digital handheld Takei dynamometer. We defined four measurements of grip strength, i.e., the average of the maximum of both hands (HGS), the maximum of dominant hand (MGS), HGS/BMI, and MGS/weight, and three indicators of low grip strength, namely, low reference grip strength, lowest 20% grip strength, and low grip strength in sarcopenia. Information on deaths were obtained through linkage to National Death Index (NDI). Cox regression was used to assess the association of grip strength with mortality risk.
Results
HGS, MGS, HGS/BMI, and MGS/weight were all inversely associated with all-cause mortality, with HGS (AUC = 0.714) being the optimal predictor of mortality, followed by MGS (AUC = 0.712). Participants with low grip strength showed increased risk of mortality regardless of which indicator was used, and the highest effect size was seen for lowest 20% grip strength group (HR = 2.20 for men, 2.52 for women). The above-mentioned correlations were consistently found in people of different age and sex.
Conclusion
This study suggests the simplest measure of absolute grip strength (HGS, MGS) was the optimal index for predicting all-cause mortality. Keep an adequate level of handgrip strength may be beneficial to reduce the risk of mortality.