bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of atrial fibrillation detection in embolic stroke of undetermined source patients with implantable loop recorder
Authors: D’Anna Lucio , La Cava Roberta , Khetarpal Ashni , Karjikar Abeer , Almohtadi Ahmad , Romoli Michele , Foschi Matteo , Ornello Raffaele , De Santis Federico , Sacco Simona , Abu-Rumeileh Samir , Lorenzut Simone , Pavoni Daisy , Valente Mariarosaria , Merlino Giovanni , Almeida Soraia , Barnard Asha , Guan Jianqun , Banerjee Soma , Lim Phang Boon
Published: March 2024

Background

Covert atrial fibrillation (AF) is a predominant aetiology of embolic stroke of undetermined source (ESUS). Evidence suggested that AF is more frequently detected by implantable loop recorder (ILR) than by conventional monitoring. However, the predictive factors associated with occult AF detected using ILRs are not well established yet. In this study we aim to investigate the predictors of AF detection in patients with ESUS undergoing an ILR.

Methods

This observational multi-centre study included consecutive ESUS patients who underwent ILR implantation. The infarcts were divided in deep, cortical infarcts or both. The infarction sites were categorized as anterior and middle cerebral artery, posterior cerebral artery with and without brainstem/cerebellum involvement. Multivariable logistic regression analysis was performed to investigate variables associated with AF detection.

Results

Overall, 3,000 patients were initially identified. However, in total, 127 patients who consecutively underwent ILR implantation were included in our analysis. AF was detected in 33 (26%) out of 127 patients. The median follow-up was 411 days. There were no significant differences in clinical characteristics and comorbidities between patients with and without AF detected. AF was detected more often after posterior cerebral artery infarct with brainstem/cerebellum involvement (p < 0.001) whereas less often after infarction in the anterior and middle cerebral artery (p = 0.021). Multivariable regression analysis demonstrated that posterior cerebral artery infarct with brainstem/cerebellum involvement was an independent predictor of AF detection.

Conclusion

Our study showed that posterior circulation infarcts with brainstem/cerebellum involvement are associated with AF detection in ESUS patients undergoing ILR. Larger prospective studies are needed to validate our findings.
Influence mechanism of the diameter of the energy accumulation hole on the bi-directional cumulative tension blasting
Authors: Zhang Xiaohu , Jiang Yijun , Zhao Peng , Zhao Zhifeng , Hao Xiaobo
Published: March 2024

This study focuses on evaluating the influence of the energy accumulation hole diameter on bi-directional cumulative tension blasting. Firstly, the penetration depth of bi-directional cumulative tension blasting is determined, followed by an analysis of the corresponding fracture mechanics behavior. Secondly, the Smooth Particle Hydrodynamics (SPH) method is used for numerical analysis of the bi-directional cumulative tension blasting process, and the Johnson-Holmquist constitutive model is then employed to examine the dynamic process during tensile blasting-induced cracking. This analysis provides insights into damage development, particle distribution, stress distribution, and crack propagation in the rock at different opening diameters. The findings reveal that, except for the 2 mm case, bi-directional cumulative tension blasting effectively produces directional cracks aligned with the energy accumulation direction. For hole diameters between 4–8 mm, linear through cracks form in the energy accumulation direction. However, a 2 mm diameter opening only generates short shear cracks around the blast hole. With energy accumulation hole diameters ranging from 10–14 mm, the crack propagation depth is insufficient for complete penetration, despite the presence of linear cracks in the energy accumulation direction. When diameter exceeds 14 mm, symmetrical airfoil cracks appear in non-concentrated energy directions, with larger diameters resulting in shorter crack propagation lengths. During the directional cracking process for hole diameters of 4–8 mm, explosive particles facilitate crack expansion in width and length through the action of a “gas wedge.” On-site blasting tests confirm the excellent directional pre-splitting effect of bi-directional cumulative tension blasting.
Stability analysis of slopes with cracks using the finite element limit analysis method
Authors: Hu Chao , Zeng Yong-hong , Yao Hao-yu
Published: March 2024

There are numerous slope projects involved in railway and highway constructions, and ensuring the stability of slopes, especially those with cracks, is very important. Compared with the limit equilibrium method, the limit analysis method takes into account the soil’s stress-strain behavior and boundary conditions, thereby yielding more rigorous and accurate results. The stability of slopes with cracks was examined using the finite element limit analysis method in this study. Results indicate that the stability of the slope decreases with the crack length, especially for slope with small slope ratio (i.e., α ≤ 1:1.5) and when lc/H exceeds 25%. The influence of crack inclination angle on slope stability increases with crack length, and the safety factor is larger in cases of negative inclination value cases as compared to those in positive inclination value cases when lc/H ≥ 0.33. Values of safety factor are larger in cases of slope with reinforcement as compared to those without reinforcement, and the values of F increase by about 20%. Additionally, the slip planes for slopes with reinforcement are located 10% further away from the slope surface compared to those without reinforcement, and reinforcements enhance the slope integrity.
Beyond play: a comparative study of multi-sensory and traditional toys in child education
Authors: Fan Yijun , Chong Daphne Khee , Li Yuanzhe
Published: March 2024

As educational paradigms evolve, the integration of multi-sensory theory into the design of children’s educational toys presents a promising avenue for enhancing learning experiences. This paper explores the efficacy of multi-sensory toys in improving children’s attraction, interest, and learning efficiency through a systematic review and a pilot empirical study. The study specifically assesses the hypothesis that multi-sensory educational toys significantly increase children’s engagement and learning outcomes compared to traditional toys. Conducted with a diverse group of children aged 3–6 in Guangzhou and Shenzhen, China, the research employs both quantitative and qualitative methodologies, including engagement metrics and observational studies. The findings suggest that multi-sensory toys not only hold the potential to augment learning experiences but also require careful consideration of individual learning styles and preferences. The paper concludes with a discussion on the implications for future research and toy design, emphasizing the need for continued innovation and personalization in the development of educational toys to cater to the multifaceted needs of young learners.
Secretory leukocyte protease inhibitor as a novel predictive biomarker in patients with diabetic kidney disease
Authors: Sun Weiwei , Yang Hanwen , Zhang Jiale , Wei Shuwu , Wu Qiaoru , Yang Jie , Cao Can , Cui Zhaoli , Zheng Huijuan , Wang Yaoxian
Published: March 2024

Background

Secretory leukocyte protease inhibitor (SLPI) is a multifunctional protein involved in the chronic inflammatory process, implicated in the pathogenesis of diabetic kidney disease (DKD). However, its potential as a diagnostic and prognostic biomarker of DKD has yet to be evaluated. This study explored the clinical utility of SLPI in the diagnosis and prognosis of renal endpoint events in patients with DKD.

Methods

A multi-center cross-sectional study comprised of 266 patients with DKD and a predictive cohort study comprised of 120 patients with stage IV DKD conducted between December 2016 and January 2022. The clinical parameters were collected for statistical analysis, a multivariate Cox proportional hazards model was used to evaluate the independent risk factors for renal endpoints.

Results

Serum SLPI levels gradually increased with DKD progression (p<0.01). A significant correlation was observed between serum SLPI levels and renal function in patients with DKD. The mean follow-up duration in this cohort study was 2.32 ± 1.30 years. Multivariate Cox regression analysis showed SLPI levels≥51.61ng/mL (HR=2.95, 95% CI[1.55, 5.60], p<0.01), 24h urinary protein levels≥3500 mg/24h (HR=3.02, 95% CI[1.66, 5.52], p<0.01), Alb levels<30g/l (HR=2.19, 95% CI[1.12, 4.28], p<0.05), HGB levels<13g/dl (HR=3.18, 95% CI[1.49, 6.80], p<0.01), and urea levels≥7.1 mmol/L (HR=8.27, 95% CI[1.96, 34.93], p<0.01) were the independent risk factors for renal endpoint events in DKD patients.

Conclusions

Serum SLPI levels increased with DKD progression and were associated with clinical parameters of DKD. Moreover, elevated SLPI levels showed potential prognostic value for renal endpoint events in individuals with DKD. These findings validate the results of previous studies on SLPI in patients with DKD and provide new insights into the role of SLPI as a biomarker for the diagnosis and prognosis of DKD that require validation.
Development and validation of a prediction model for unexpected poor ovarian response during IVF/ICSI
Authors: Xu Xiaohang , Wang Xue , Jiang Yilin , Sun Haoyue , Chen Yuanhui , Zhang Cuilian
Published: March 2024

Background

Identifying poor ovarian response (POR) among patients with good ovarian reserve poses a significant challenge within reproductive medicine. Currently, there is a lack of published data on the potential risk factors that could predict the occurrence of unexpected POR. The objective of this study was to develop a predictive model to assess the individual probability of unexpected POR during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments.

Methods

The development of the nomogram involved a cohort of 10,404 patients with normal ovarian reserve [age, ≤40 years; antral follicle count (AFC), ≥5; and anti-Müllerian hormone (AMH), ≥1.2 ng/ml] from January 2019 to December 2022. Univariate regression analyses and least absolute shrinkage and selection operator regression analysis were employed to ascertain the characteristics associated with POR. Subsequently, the selected variables were utilized to construct the nomogram.

Results

The predictors included in our model were body mass index, basal follicle-stimulating hormone, AMH, AFC, homeostasis model assessment of insulin resistance (HOMA-IR), protocol, and initial dose of gonadotropin. The area under the receiver operating characteristic curve (AUC) was 0.753 [95% confidence interval (CI) = 0.7257–0.7735]. The AUC, along with the Hosmer–Lemeshow test (p = 0.167), demonstrated a satisfactory level of congruence and discrimination ability of the developed model.

Conclusion

The nomogram can anticipate the probability of unexpected POR in IVF/ICSI treatment, thereby assisting professionals in making appropriate clinical judgments and in helping patients to effectively manage expectations.
Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study
Authors: Hu Minxiong , Wu Yangbiao , Xu Xiao , Cai Wenchao , Lin Jiangui , Cai Wanghai , Pan Honghong , Yang Zesong , Ye Liefu , Wu Jinfeng
Published: March 2024

Objectives

The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m2. This paper aims to summarize our institution’s seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm.

Patients and methods

Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang’s technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05.

Results

In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05).

Conclusion

MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases.

Patient summary

We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.
PANoptosis-related genes function as efficient prognostic biomarkers in colon adenocarcinoma
Authors: Liu Yang , Wang Yizhao , Feng Huijin , Ma Lianjun , Liu Yanqing
Published: March 2024

Background

PANoptosis is a newly discovered cell death type, and tightly associated with immune system activities. To date, the mechanism, regulation and application of PANoptosis in tumor is largely unknown. Our aim is to explore the prognostic value of PANoptosis-related genes in colon adenocarcinoma (COAD).

Methods

Analyzing data from The Cancer Genome Atlas-COAD (TCGA-COAD) involving 458 COAD cases, we concentrated on five PANoptosis pathways from the Molecular Signatures Database (MSigDB) and a comprehensive set of immune-related genes. Our approach involved identifying distinct genetic COAD subtype clusters and developing a prognostic model based on these parameters.

Results

The research successfully identified two genetic subtype clusters in COAD, marked by distinct profiles in PANoptosis pathways and immune-related gene expression. A prognostic model, incorporating these findings, demonstrated significant predictive power for survival outcomes, underscoring the interplay between PANoptosis and immune responses in COAD.

Conclusion

This study enhances our understanding of COAD’s genetic framework, emphasizing the synergy between cell death pathways and the immune system. The development of a prognostic model based on these insights offers a promising tool for personalized treatment strategies. Future research should focus on validating and refining this model in clinical settings to optimize therapeutic interventions in COAD.
A study on the application of discrete curvature feature extraction and optimization algorithms to battery health estimation
Authors: Goh Hui Hwang , An Zhen , Zhang Dongdong , Dai Wei , Kurniawan Tonni Agustiono , Goh Kai Chen
Published: March 2024

Lithium-ion batteries are extensively utilised in various industries and everyday life. Typically, these batteries are considered retired when their state of health (SOH) drops below 80%. These retired batteries, known as secondary batteries, can be repurposed for applications that demand lower battery performance. Precise forecasting of the lifespan of secondary batteries is crucial for determining suitable operational management approaches. Initially, we use the CACLE dataset for thorough investigation. Therefore, to account for the unpredictable and random character of the application circumstances, we employ the U-chord long curvature feature extraction approach to minimise errors resulting from rotation and noise. Additionally, we utilise the discharged power as a feature. This study employs two optimization algorithms, namely, particle swarm optimization (PSO) and sparrow optimization algorithm (SSA), in conjunction with least squares support vector machine (LSSVM) to compare the model against three conventional models, namely, Gaussian process regression (GPR), convolutional neural networks (CNN), and long short-term memory (LSTM). This work comprises two experiments: Experiment 1 utilises the battery’s charging and discharging history data to train the model for estimating the SOH of the remaining cycles of the same battery. Experiment 2, on the other hand, employs the complete discharging data of the battery to train the model for predicting the SOH of the remaining cycles of other batteries. The error evaluation metrics used are mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE). The results indicate that the average MAE for SSA-LSSVM, LSTM, CNN, PSO-LSSVM, and GPR in Experiment 1 and Experiment 2 are 1.11%, 1.82%, 2.02%, 2.04%, and 12.18% respectively. The best prediction results are obtained by SSA-LSSVM.
Elevation gradients alter vegetation attributes in mountain ecosystems of eastern Himalaya, India
Authors: Negi Vikram S. , Pandey Aseesh , Singh Ajay , Bahukhandi Amit , Pharswan Dalbeer S. , Gaira K. S. , Wani Zishan Ahmad , Bhat Jahangeer A. , Siddiqui Sazada , Yassin Habab M.
Published: March 2024

The present study describes how vegetation (the tree layer) is shaped along the elevation gradients in the eastern part of the Indian Himalayan Region. Various vegetation attributes, distribution, population structure, and regeneration patterns of 75 tree species belonging to 31 families were studied. Tree species richness shows a low plateau (peaked between 1,300–1,500 m) with a linearly decreasing pattern above 1,500 m asl. Ericaceae was found as the dominant family, followed by Lauraceae and Rosaceae. The distributional pattern of species-to-genera ratio (S/G) did not follow any particular trends, while β-diversity increased along the elevation gradient. The Margalef index of species richness, the Menheink index of species richness, and the Fisher alpha were found to be highest at lower altitudes (1,000–1,500 m), while the Simpson index was highest at middle altitudes (2,600–3,000 m). Random distribution was shown by maximum tree species (47.3%), followed by a contagious distribution (42.9%), and regular distribution (10.8%). The regeneration of tree species was found to be good with a healthier number of seedlings (10.2%), fair (43.5%), poor (30.3%), while 16% were observed not regenerating. Acer laevigatum (1,500 m), Prunus nepalensis (3,300 m), Viburnum sympodiale (3,400 m) were among the new regenerating species at the respective altitudes. The population structure of tree species in terms of proportion of individuals in seedlings, saplings, and the adult class varied in all the elevation transects. Species with better regeneration on upper distribution limits have been recognized as probable for upward movement.
Genetic interrogation for sequence and copy number variants in systemic lupus erythematosus
Authors: Yeo Nicholas Kim-Wah , Lim Che Kang , Yaung Katherine Nay , Khoo Nicholas Kim Huat , Arkachaisri Thaschawee , Albani Salvatore , Yeo Joo Guan
Published: March 2024

Early-onset systemic lupus erythematosus presents with a more severe disease and is associated with a greater genetic burden, especially in patients from Black, Asian or Hispanic ancestries. Next-generation sequencing techniques, notably whole exome sequencing, have been extensively used in genomic interrogation studies to identify causal disease variants that are increasingly implicated in the development of autoimmunity. This Review discusses the known casual variants of polygenic and monogenic systemic lupus erythematosus and its implications under certain genetic disparities while suggesting an age-based sequencing strategy to aid in clinical diagnostics and patient management for improved patient care.
Impact of Helicobacter pylori and metabolic syndrome-related mast cell activation on cardiovascular diseases
Authors: Doulberis Michael , Papaefthymiou Apostolis , Polyzos Stergios A. , Boziki Marina , Kazakos Evangelos , Tzitiridou-Chatzopoulou Maria , Vardaka Elisabeth , Hammrich Carola , Kulaksiz Hasan , Riva Daniele , Kiosses Christos , Linas Ioannis , Touloumtzi Maria , Stogianni Aggeliki , Kountouras Jannis
Published: March 2024

Helicobacter pylori, a widely renowned bacterium, has recently gained attention owing to its potential impact on extragastric health. The emergence of research linking H. pylori infection with metabolic syndrome (MetS)-related cardiovascular diseases (CVDs) has raised intriguing questions about the pathogenic linkage and its translational implications for clinicians. MetS encompasses a collection of metabolic abnormalities that considerably elevate the risk of CVDs and cerebrovascular diseases. Emerging evidence supports a potential pathogenetic role of H. pylori for MetS-related disorders through mechanisms implicating chronic smoldering inflammation, insulin resistance (IR), and modulation of immune responses. One intriguing aspect of this possible connection is the role of mast cells (MCs), a subset of immune cells representing innate immune system effector cells. They play a fundamental role in innate immune responses and the modulation of adaptive immunity. Activated MCs are commonly found in patients with MetS-related CVD. Recent studies have also suggested that H. pylori infection may activate MCs, triggering the release of pro-inflammatory mediators that contribute to IR and atherosclerosis. Understanding these intricate interactions at the cellular level provides new insights into the development of therapeutic strategies targeting both H. pylori infection and MetS-related MCs activation. This review investigates the current state of research regarding the potential impact of H. pylori infection and MetS-related MCs activation on the pathophysiology of CVD, thereby opening up new avenues for related research and paving the way for innovative approaches to prevention and treatment in clinical practice
Anti-synthetase syndrome is associated with a higher risk of hospitalization among patients with idiopathic inflammatory myopathy and COVID-19
Authors: Wu Wanlong , Wang Runci , Xie Cuiying , Chen Yi , Teng Xiangyu , Sun Shuhui , Xu Wenwen , Fu Yakai , Ma Yiyangzi , Xu Antao , Lyu Xia , Ye Yan , Li Jia , Zhang Chunyan , Shen Nan , Wang Xiaodong , Ye Shuang , Fu Qiong
Published: March 2024

Background

Data with fine granularity about COVID-19-related outcomes and risk factors were still limited in the idiopathic inflammatory myopathies (IIMs) population. This study aimed to investigate clinical factors associated with hospitalized and severe COVID-19 in patients with IIMs, particularly those gauged by myositis-specific antibodies.

Methods

This retrospective cohort study was conducted in the Renji IIM cohort in Shanghai, China, under an upsurge of SARS-CoV-2 omicron variant infections from December 2022 to January 2023. Clinical data were collected and analyzed by multivariable logistic regression to determine risk factors. High-dimensional flow cytometry analysis was performed to outline the immunological features.

Results

Among 463 infected patients in the eligible cohort (n=613), 65 (14.0%) were hospitalized, 19 (4.1%) suffered severe COVID-19, and 10 (2.2%) died. Older age (OR=1.59/decade, 95% CI 1.18 to 2.16, p=0.003), requiring family oxygen supplement (2.62, 1.11 to 6.19, 0.028), patients with anti-synthetase syndrome (ASyS) (2.88, 1.12 to 7.34, 0.027, vs. other dermatomyositis), higher IIM disease activity, and prednisone intake >10mg/day (5.59, 2.70 to 11.57, <0.001) were associated with a higher risk of hospitalization. Conversely, 3-dose inactivated vaccination reduced the risk of hospitalization (0.10, 0.02 to 0.40, 0.001, vs. incomplete vaccination). Janus kinase inhibitor (JAKi) pre-exposure significantly reduced the risk of severe COVID-19 in hospitalized patients (0.16, 0.04 to 0.74, 0.019, vs. csDMARDs). ASyS patients with severe COVID-19 had significantly reduced peripheral CD4+ T cells, lower CD4/CD8 ratio, and fewer naive B cells but more class-switched memory B cells compared with controls.

Conclusion

ASyS and family oxygen supplement were first identified as risk factors for COVID-19-related hospitalization in patients with IIMs. JAKi pre-exposure might protect IIM patients against severe COVID-19 complications.
Respiratory function after 30+ years following sulfur mustard exposure in survivors in Sweden
Authors: Moradi Faraidoun , Kjellberg Sanna , Li Ying , Daka Bledar , Olin Anna-Carin
Published: March 2024

Background

Sulfur mustard (SM) exposure causes acute and chronic respiratory diseases. The extent of small airway dysfunction (SAD) in individuals exposed to SM is unclear. This study evaluated and compared SAD in SM-exposed and SM-unexposed participants using noninvasive lung function tests assessing small airway function.

Methods

This retrospective cohort study involved SM-exposed (n = 15, mean age: 53 ± 8 years) and SM-unexposed (n = 15, mean age: 53 ± 7 years) Kurdish-Swedish individuals in Sweden. Small airway resistance and reactance were assessed using impulse oscillometry (IOS). Nitrogen (N2) multiple breath washout (MBW) was employed to assess lung ventilation heterogeneity. The gas-exchanging capacity of the lungs was assessed using the diffusing capacity of the lungs for the carbon monoxide (DLCO) test. Lung function outcomes were reported as absolute values and z-scores. Group comparisons were performed using the Mann–Whitney U test.

Results

No statistically significant differences in age, height, or body mass index were observed between the two groups. IOS showed significantly increased small airway resistance, while N2MBW exhibited significantly increased global and acinar ventilation heterogeneity in SM-exposed individuals compared to that in unexposed individuals. SAD was identified in 14 of 15 SM-exposed individuals, defined as at least one abnormal IOS difference between resistance at 5 and 20 Hz (R5-R20) and/or area of reactance (AX) or N2MBW lung’s acinar zone (Sacin), and DLCO adjusted to the alveolar volume (DLCO/VA) outcome. Of these 14 individuals, only 5 demonstrated concordant findings across the IOS and N2MBW tests.

Conclusion

Exposure to SM was positively associated with long-term impairment of respiratory tract function in the small airways in the majority of the previously SM-exposed individuals in the present study. Furthermore, both IOS and N2MBW should be employed to detect SAD in SM-exposed survivors as they provide complementary information. Identifying and characterizing the remaining pathology of the small airways in survivors of SM exposure is a first step toward improved treatment and follow-up.
False positive elevation in serum creatinine: a case report
Authors: Oliveras Laia , Coloma Ana , Escartín Teresa , Castro Maria José , Vicente Natalia , Gomà Montse , Cruzado Josep Maria
Published: March 2024

Background

Paraproteins can interfere with several substances, producing erroneous laboratory measurements. The diagnosis of kidney disease in patients with hematological disorders has important prognosis implications. An elevated creatinine with no other signs of kidney disease should prompt the idea of a spurious creatinine. Communication between the clinical team and the laboratory is key.

Case presentation

In this case, we present a 68-year-old woman with an elevated creatinine and an IgM lambda paraprotein. Interestingly, there were no other signs of chronic kidney disease besides the creatinine value, with no albuminuria or microhematuria. A kidney biopsy showed normal parenchyma and ruled out the possibility of paraprotein-related damage. The monoclonal component and creatinine levels raised parallelly during follow-up while maintaining normal urea levels. This prompted the hypothesis of a falsely elevated creatinine. It was confirmed with a normal glomerular filtration rate determined by a radioisotope, a cystatin C measurement and a reduction in creatinine when diluting the sample.

Conclusion

It is important to consider the possibility of a falsely elevated creatinine in patients with paraproteinemia and no other signs of kidney disease to avoid unnecessary diagnostic tests and for the prognostic implications.
Increased functional connectivity between default mode network and visual network potentially correlates with duration of residual dizziness in patients with benign paroxysmal positional vertigo
Authors: Chen Zhengwei , Cai Yaxian , Xiao Lijie , Wei Xiu-E , Liu Yueji , Lin Cunxin , Liu Dan , Liu Haiyan , Rong Liangqun
Published: March 2024

Objective

To assess changes in static and dynamic functional network connectivity (sFNC and dFNC) and explore their correlations with clinical features in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning maneuvers (CRM) using resting-state fMRI.

Methods

We studied resting-state fMRI data from 39 BPPV patients with RD compared to 38 BPPV patients without RD after successful CRM. Independent component analysis and methods of sliding window and k-means clustering were adopted to investigate the changes in dFNC and sFNC between the two groups. Additionally, temporal features and meta-states were compared between the two groups. Furthermore, the associations between fMRI results and clinical characteristics were analyzed using Pearson’s partial correlation analysis.

Results

Compared with BPPV patients without RD, patients with RD had longer duration of BPPV and higher scores of dizziness handicap inventory (DHI) before successful CRM. BPPV patients with RD displayed no obvious abnormal sFNC compared to patients without RD. In the dFNC analysis, patients with RD showed increased FNC between default mode network (DMN) and visual network (VN) in state 4, the FNC between DMN and VN was positively correlated with the duration of RD. Furthermore, we found increased mean dwell time (MDT) and fractional windows (FW) in state 1 but decreased MDT and FW in state 3 in BPPV patients with RD. The FW of state 1 was positively correlated with DHI score before CRM, the MDT and FW of state 3 were negatively correlated with the duration of BPPV before CRM in patients with RD. Additionally, compared with patients without RD, patients with RD showed decreased number of states and state span.

Conclusion

The occurrence of RD might be associated with increased FNC between DMN and VN, and the increased FNC between DMN and VN might potentially correlate with the duration of RD symptoms. In addition, we found BPPV patients with RD showed altered global meta-states and temporal features. These findings are helpful for us to better understand the underlying neural mechanisms of RD and potentially contribute to intervention development for BPPV patients with RD.
A toolbox for decoding BCI commands based on event-related potentials
Authors: Reichert Christoph , Sweeney-Reed Catherine M. , Hinrichs Hermann , Dürschmid Stefan
Published: March 2024

Commands in brain-computer interface (BCI) applications often rely on the decoding of event-related potentials (ERP). For instance, the P300 potential is frequently used as a marker of attention to an oddball event. Error-related potentials and the N2pc signal are further examples of ERPs used for BCI control. One challenge in decoding brain activity from the electroencephalogram (EEG) is the selection of the most suitable channels and appropriate features for a particular classification approach. Here we introduce a toolbox that enables ERP-based decoding using the full set of channels, while automatically extracting informative components from relevant channels. The strength of our approach is that it handles sequences of stimuli that encode multiple items using binary classification, such as target vs. nontarget events typically used in ERP-based spellers. We demonstrate examples of application scenarios and evaluate the performance of four openly available datasets: a P300-based matrix speller, a P300-based rapid serial visual presentation (RSVP) speller, a binary BCI based on the N2pc, and a dataset capturing error potentials. We show that our approach achieves performances comparable to those in the original papers, with the advantage that only conventional preprocessing is required by the user, while channel weighting and decoding algorithms are internally performed. Thus, we provide a tool to reliably decode ERPs for BCI use with minimal programming requirements.
Responsiveness to exoskeleton loading during bimanual reaching is associated with corticospinal tract integrity in stroke
Authors: Brunfeldt Alexander T. , Bregman Barbara S. , Lum Peter S.
Published: March 2024

Background

Device-based rehabilitation of upper extremity impairment following stroke often employs one-sized-fits-all approaches that do not account for individual differences in patient characteristics.

Objective

Determine if corticospinal tract lesion load could explain individual differences in the responsiveness to exoskeleton loading of the arms in chronic stroke participants.

Methods

Fourteen stroke participants performed a bimanual shared cursor reaching task in virtual reality while exoskeletons decreased the effective weight of the more-impaired arm and increased the effective weight of the less-impaired arm. We calculated the change in relative displacement between the arms (RC) and the change in relative muscle activity (MC) between the arms from the biceps and deltoids. We calculated corticospinal tract lesion load (wCSTLL) in a subset of 10 participants.

Results

Exoskeleton loading did not change RC (p = 0.07) or MC (p = 0.47) at the group level, but significant individual differences emerged. Participants with little overlap between the lesion and corticospinal tract responded to loading by decreasing muscle activity in the more-impaired arm relative to the less-impaired arm. The change in deltoid MC was associated with smaller wCSTLL (R2 = 0.43, p = 0.039); there was no such relationship for biceps MC (R2 < 0.001, p = 0.98).

Conclusion

Here we provide evidence that corticospinal tract integrity is a critical feature that determines one’s ability to respond to upper extremity exoskeleton loading. Our work contributes to the development of personalized device-based interventions that would allow clinicians and researchers to titrate constraint levels during bimanual activities.
A potential brain functional biomarker distinguishing patients with Crohn’s disease with different disease stages: a resting-state fMRI study
Authors: Huang Mengting , Ma Guina , Zou Yan , Ma Hui , Fan Wenliang , Li Xin , Zhu Liangru , Han Ping , Wang Huan , Shi Heshui
Published: March 2024

Background

The previous studies have demonstrated that patients with Crohn’s disease in remission (CD-R) have abnormal alterations in brain function. However, whether brain function changes in patients with Crohn’s disease in activity (CD-A) and the relationship with CD-R are still unclear. In this study, we aimed to investigate whether the different levels of disease activity may differentially affect the brain function and to find the brain functional biomarker distinguishing patients with different disease stages by measuring the amplitude of low frequency fluctuations (ALFF).

Methods

121 patients with CD and 91 healthy controls (HCs) were recruited. The clinical and psychological assessment of participants were collected. The criteria for the disease activity were the Crohn’s disease activity index (CDAI) scores. CD-R refers to CD patients in remission which the CDAI score is less than 150. Conversely, CD-A refers to CD patients in activity which the CDAI score is ≥150. The ALFF was compared among three groups by performing one-way analysis of variance, followed by a post hoc two-sample t-test. Differences among the groups were selected as seeds for functional connectivity analyses. We also investigated the correlation among clinical, psychological scores and ALFF. Binary logistic regression analysis was used to examine the unique contribution of the ALFF characteristics of the disease stages.

Results

There were widespread differences of ALFF values among the 3 groups, which included left frontal pole (FP_L), right supramarginal gyrus (SG_R), left angular gyrus (AG_L), right cingulate gyrus (CG_R), right intracalcarine cortex (IC_R), right parahippocampal gyrus (PG_R), right lingual gyrus (LG_R), right precuneous cortex (PC_R), left occipital fusiform gyrus (OFG_L). Significant brain regions showing the functional connections (FC) increased in FP_L, SG_R, PC_R and OFG_L between CD-A and HCs. The erythrocyte sedimentation rate had a negative correlation with the ALFF values in PC_R in the patients with CD. The phobic anxiety values had a negative correlation with the ALFF values in OFG_L. The psychoticism values had a negative correlation with ALFF values in the IC_R. And the hostility values had a positive correlation with the ALFF values in CG_R. Significant brain regions showing the FC increased in FP_L, SG_R, CG_R, PG_R, LG_R and OFG_L between CD-R and HCs. In binary logistic regression models, the LG_R (beta = 5.138, p = 0.031), PC_R (beta = 1.876, p = 0.002) and OFG_L (beta = 3.937, p = 0.044) was disease stages predictors.

Conclusion

The results indicated the significance of the altered brain activity in the different disease stages of CD. Therefore, these findings present a potential identify neuroimaging-based brain functional biomarker in CD. Additionally, the study provides a better understanding of the pathophysiology of CD.
Diagnostic and prognostic potential of exosome non-coding RNAs in bladder cancer: a systematic review and meta-analysis
Authors: Chen Yani , Shi Kesong , Fu Xinyao , Guo Hua , Gao Tian , Yu Haiquan
Published: March 2024

Background

Bladder cancer stands as the predominant malignant tumor in the urological system, presenting a significant challenge to public health and garnering extensive attention. Recently, with the deepening research into tumor molecular mechanisms, non-coding RNAs (ncRNAs) have emerged as potential biomarkers offering guidance for the diagnosis and prognosis of bladder cancer. However, the definitive role of ncRNAs in bladder cancer remains unclear. Hence, this study aims to elucidate the relevance and significance of ncRNAs through a Meta-analysis.

Methods

A systematic meta-analysis was executed, including studies evaluating the diagnostic performance of ncRNAs and their associations with overall survival (OS) and disease-free survival (DFS). Key metrics such as hazard ratios, sensitivity, specificity, and diagnostic odds ratios were extracted and pooled from these studies. Potential publication bias was assessed using Deeks’ funnel plot, and the robustness of the results was ascertained through a sensitivity analysis.

Results

Elevated ncRNA expression showed a positive correlation with improved OS, evidenced by a hazard ratio (HR) of 0.82 (95% CI: 0.66-0.96, P<0.001). Similarly, a significant association was observed between heightened ncRNA expression and DFS, with an HR of 0.86 (95% CI: 0.73-0.99, P<0.001). Diagnostic performance analysis across 17 articles yielded a pooled sensitivity of 0.76 and a specificity of 0.83. The diagnostic odds ratio was recorded at 2.71, with the area under the ROC curve (AUC) standing at 0.85.

Conclusion

Exosome ncRNAs appear to possess potential significance in the diagnostic and prognostic discussions of bladder cancer. Their relationship with survival outcomes and diagnostic measures suggests a possible clinical utility. Comprehensive investigations are needed to fully determine their role in the ever-evolving landscape of bladder cancer management, especially within the framework of personalized medicine.
The TGF-β superfamily as potential therapeutic targets in pancreatic cancer
Authors: Tindall Rachel R. , Bailey-Lundberg Jennifer M. , Cao Yanna , Ko Tien C.
Published: March 2024

The transforming growth factor (TGF)-β superfamily has important physiologic roles and is dysregulated in many pathologic processes, including pancreatic cancer. Pancreatic cancer is one of the most lethal cancer diagnoses, and current therapies are largely ineffective due to tumor resistance and late-stage diagnosis with poor prognosis. Recent efforts are focused on the potential of immunotherapies in improving therapeutic results for patients with pancreatic cancer, among which TGF-β has been identified as a promising target. This review focuses on the role of TGF-β in the diseased pancreas and pancreatic cancer. It also aims to summarize the current status of therapies targeting the TGF-β superfamily and postulate potential future directions in targeting the TGF-β signaling pathways.
East Asian American cultural essentialism
Authors: Chiou Andy Y. , Feng Jing Betty
Published: March 2024

Introduction

Past research on the “bamboo ceiling” tend to focus on the barriers it presents, with few studies examining individuals who break through the bamboo ceiling. The purpose of this study is to explain the psychological factors driving the individual differences between East Asian Americans who break through the bamboo ceiling and those who do not.

Methodology

This two-study sequential mixed-methods exploratory research study included 19 one-on-one semi-structured interviews and 338 survey respondents by East Asian Americans.

Results

In Study 1, based on 19 one-on-one semi cultural essentialism and bicultural identity integration emerged from the interview data as contributing factors. Interviewees who exhibited essentialist or social constructionist beliefs showed different behavioral and career patterns. This mediating relationship was supported in Study 2. Taken together, it was found that East Asian Americans who had less essentialist views of culture were more likely to have a fluid and integrated bicultural identity and more likely to break the bamboo ceiling in their careers.

Discussion

The findings from both qualitative and quantitative data suggest that having more fluid concepts of culture, associating with more integrated bicultural identities, may improve career prospects in a multicultural work environment. This article offers practical implications for Asian Americans who desire to achieve their career goals to be authentic self while remaining adaptable and developing a mindset of “flexibility.”
Morquio B disease: a case report
Authors: Gholamian Tara , Chhina Harpreet , Stockler Sylvia , Cooper Anthony
Published: March 2024

Mucopolysaccharidosis IV type B, or Morquio B disease (MBD), is an autosomal recessive disorder caused by a genetic mutation in GLB1 gene encoding for β-galactosidase on chromosome 3p22.33. β-galactosidase deficiency can result in two different conditions, GM1 gangliosidosis and MBD, of which MBD has a milder phenotype and presents later in life with keratan sulfate accumulation in the retina and cartilage. In this case report, we present a patient diagnosed with MBD at the age of 5 after initially presenting with Morquio dysostosis multiplex and characteristic radiographic findings. Genetic testing confirmed that the patient has β-galactosidase deficiency due to mutation W273l/N484K on GLB1 gene. The patient exhibited elevated mucopolysaccharide levels in urine at 18 mg/mmol and demonstrated an abnormal band pattern of urine oligosaccharides on electrophoresis. The activity of β-galactosidase in his white blood cells was reduced to 12.3 nmol/h/mg protein. At the time of diagnosis, the patient did not present with gait and ambulation issues, but his ability to walk progressively deteriorated in his adolescence as a result of instability and pain in the ankle, knee, and hip joints, accompanied by a global decrease in muscle strength. This case report is the first in the literature to provide an in-depth exploration of the orthopedic treatment and follow-up received by a young adolescent with MBD to provide symptom relief and improve walking ability.
Case Report: ECMO-assisted tracheal reconstruction in a 30-week-gestation preterm infant with tracheal stenosis
Authors: Li Zi-Hao , Li Shi-Hao , Geng Zhen-Yang , Wu Bin , Sheng Yin-Liang , Yuan Ping , Li Feng , Qi Yu
Published: March 2024

Tracheal stenosis is a rare but life-threatening disease in preterm infants. Misdiagnosis as congenital tracheal stenosis is common, making surgical management challenging. This report presents a case of a preterm infant with tracheal stenosis and congenital heart malformation treated with ECMO-assisted tracheal resection and end-to-end anastomosis. A male infant was born at 30 weeks of gestation with severe asphyxia, cardiac insufficiency, and pneumonia. Following failed medical treatment, fiberoptic bronchoscopy confirmed mid-tracheal to carinal stenosis. After a 2-week treatment course, ECMO-assisted tracheal resection and end-to-end anastomosis were performed successfully. This case confirms the feasibility of tracheal resection and end-to-end anastomosis in low-weight, preterm infants with tracheal stenosis born at 30 weeks gestation. The utilization of ECMO for oxygenation during surgery provides a clear surgical field and shorter operating time. Surgical intervention may be necessary for neonatal tracheal stenosis depending on the clinical presentation.
The therapeutic potential of natural metabolites in targeting endocrine-independent HER-2-negative breast cancer
Authors: Püsküllüoğlu Mirosława , Michalak Izabela
Published: March 2024

Breast cancer (BC) is a heterogenous disease, with prognosis and treatment options depending on Estrogen, Progesterone receptor, and Human Epidermal Growth Factor Receptor-2 (HER-2) status. HER-2 negative, endocrine-independent BC presents a significant clinical challenge with limited treatment options. To date, promising strategies like immune checkpoint inhibitors have not yielded breakthroughs in patient prognosis. Despite being considered archaic, agents derived from natural sources, mainly plants, remain backbone of current treatment. In this context, we critically analyze novel naturally-derived drug candidates, elucidate their intricate mechanisms of action, and evaluate their pre-clinical in vitro and in vivo activity in endocrine-independent HER-2 negative BC. Since pre-clinical research success often does not directly correlate with drug approval, we focus on ongoing clinical trials to uncover current trends. Finally, we demonstrate the potential of combining cutting-edge technologies, such as antibody-drug conjugates or nanomedicine, with naturally-derived agents, offering new opportunities that utilize both traditional cytotoxic agents and new metabolites.