bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicopathological manifestations of biopsy-proven renal sarcoidosis: A retrospective cohort study
Authors: Liu Aichun , Wang Yina , Yan Yu , Dong Bao , Cai Meishun , Zuo Li
Published: October 2024

Background
While many studies have reported renal involvement in sarcoidosis, there is limited description of the pathological manifestations of renal sarcoidosis. The relationship between clinical presentation, renal pathology, and prognosis remains unclear. The aim of this study is to examine the clinical, laboratory, and histological characteristics, as well as the prognosis of patients with renal sarcoidosis (RS).
Methods
We conducted a retrospective, single-center study of RS in renal biopsy cases treated in our department between January 2019 and December 2023.
Results
We identified 5 patients (4 men, 1 woman; median age 52 years, IQR 36–61 years). All patients had renal insufficiency with a median creatine level of 456 µmol/L (IQR 430.5-942.5µmol/L) and a median proteinuria of 0.5 g/24 h (IQR 0.2–0.73 g/24 h). Three (60%) of the five patients presented with both hypercalcemia and hypercalciuria. Histologically, two of the three patients who with hypercalcemia presented with renal calcinosis and tubulointerstitial nephritis (TIN) without granuloma. The other patient with hypercalcemia presented with renal calcinosis and acute tubular necrosis (ATN). The other two (40%) patients who with normal serum calcium presented with noncaseating granulomas interstitial nephritis (GTIN). For light microscopy, the interstitial inflammatory infiltrate also contains lymphocytes, monocytes cells, and sometimes eosinophils. By immunohistochemical stain, the infiltrating lymphocytes were CD4 + T cells that formed nodular granulomas, surrounded by CD8 + T cells. Chronic lesions such as interstitial fibrosis was mild in all five patients. A favorable response to steroid therapy was noted in all cases, and only one (case 4) had biopsy-proven recurrence of sarcoidosis granulomatous interstitial nephritis.
Conclusions
RS is extremely rare among kidney biopsy cases. Early and accurately diagnosis depends on renal pathology. The hallmark histological manifestation of RS is noncaseating GTIN, with CD4 + T cells primarily located in the center and CD8 + T cells primarily located in the periphery. Early diagnosis and prompt treatment with corticosteroids can improve the prognosis.
Human epididymis protein 4: a novel predictor of acute non-ST segment myocardial infarction
Authors: Tang Yi , Liu Zhibin , Hu ZhengQi , Liu Tiancheng , Peng Jianqiang , Pan Hongwei , He Jin
Published: October 2024

The prognostic value of human epididymis protein 4 (HE4) in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear. From August 2021 to October 2023, patients diagnosed with NSTEMI at Hunan Provincial People's Hospital were prospectively enrolled. The HE4 levels of enrolled patients were measured using the chemiluminescent microparticle immunoassay.The endpoint events of the study included hospitalization for unstable angina, readmission for heart failure, nonfatal myocardial infarction, and cardiovascular death.A total of 240 NSTEMI patients were finally included, among whom 53 experienced endpoint events. The serum HE4 levels in patients who experienced events were significantly higher than those in patients without events [154.50 (96.25-324.45) pmol/L vs. 72.5 (50.60,125.65) pmol/L, P < 0.001]. Multivariate Cox regression analysis shows that HE4 [HR = 1.001 (1.000-1.002), P < 0.004] and The Global Registry of Acute Coronary Events (GRACE) risk score [HR = 1.017 (1.003–1.030), P < 0.014] are independent predictors of endpoint events. The receiver operating characteristic (ROC) curve analysis show that the area under the curve (AUC) of HE4 is the largest, with an AUC value of 0.712. In the Kaplan-Meier curve, the survival rate of patients with HE4 > 100.25 pmol/L is lower than that of patients with HE4 ≤ 100.25 pmol/L (P < 0.001).These findings show that HE4 can independently predict the occurrence of endpoint events in patients with NSTEMI.
Ecological Dynamics and Human Impact Assessment of a Small Mangrove Forest in the Northern Persian Gulf: A Multidimensional Approach Using Satellite-derived, Drone- based, and Field-measured Data
Authors: Kabiri Keivan , Abedi Ehsan
Published: October 2024

The ecological dynamics of Mangroves of Dayyer City (MDC) in the northern Persian Gulf were assessed. This study employs satellite-based data, drone-based photography, and field measurements/observations to assess changes in mangrove areas, investigate human-made structures affecting the MDC. Satellite imagery from Google Earth, spanning from 2011 to 2022, reveals fluctuations in the MDC area, with notable afforestation efforts until 2018, followed by rapid degradation. The mangrove forest, initially covering ~ 2.2 ha in 2011, expanded to 3.2 ha by 2015 due to mangrove planting efforts. However, subsequent years witnessed a decline, with the area diminishing to 1.7 ha by June 2022. Human-made structures, specifically a nonstandard road and its relevant bridge construction in 2018, are identified as the main potential cause of mangrove degradation by obstructing freshwater flow from upper areas. Drone-based observations conducted on March 2023, provided a detailed map revealing that ~ 44% of healthy mangroves are damaged. However, field measurements performed on November 2023, revealed higher salinity levels at MDC stations than at other adjacent mangrove areas (Nayband and Melgonzeh). The principal component analysis (PCA) showed that the first two principal components explained a significant portion (99.7%) of the variability in the environmental data. Specifically, the first principal component represented variations in water temperature, accounting for 93.2% of the observed environmental variability. On the other hand, the second principal component was associated with salinity and dissolved oxygen concentrations, explaining 6.5% of the observed variability. This multidimensional approach enhances our understanding of the complex interactions influencing mangrove ecosystems.
A network-based systems genetics framework identifies pathobiology and drug repurposing in Parkinson’s disease
Authors: Cheng Feixiong , Dou Lijun , Xu Zhenxin , Xu Jielin , Su Chang , Pieper Andrew , Zhu Xiongwei , Leverenz James , Wang Fei , Cummings Jeffrey
Published: October 2024

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disorder. However, current treatments are directed at symptoms and lack ability to slow or prevent disease progression. Large-scale genome-wide association studies (GWAS) have identified numerous genomic loci associated with PD, which may guide the development of disease-modifying treatments. We presented a systems genetics approach to identify potential risk genes and repurposable drugs for PD. First, we leveraged non-coding GWAS loci effects on multiple human brain-specific quantitative trait loci (xQTLs) under the protein-protein interactome (PPI) network. We then prioritized a set of PD likely risk genes (pdRGs) by integrating five types of molecular xQTLs: expression (eQTLs), protein (pQTLs), splicing (sQTLs), methylation (meQTLs), and histone acetylation (haQTLs). We also integrated network proximity-based drug repurposing and patient electronic health record (EHR) data observations to propose potential drug candidates for PD treatments. We identified 175 pdRGs from QTL-regulated GWAS findings, such as SNCA, CTSB, LRRK2, DGKQ, CD38 and CD44. Multi-omics data validation revealed that the identified pdRGs are likely to be druggable targets, differentially expressed in multiple cell types and impact both the parkin ubiquitin-proteasome and alpha-synuclein (a-syn) pathways. Based on the network proximity-based drug repurposing followed by EHR data validation, we identified usage of simvastatin as being significantly associated with reduced incidence of PD (fall outcome: hazard ratio (HR) = 0.91, 95% confidence interval (CI): 0.87–0.94; for dementia outcome: HR = 0.88, 95% CI: 0.86-0.89), after adjusting for 267 covariates. Our network-based systems genetics framework identifies potential risk genes and repurposable drugs for PD and other neurodegenerative diseases if broadly applied.
Comparative evaluation of large-language models and purpose-built software for medical record de-identification
Authors: Kuo Rachel , Soltan Andrew , O’Hanlon Ciaran , Hasanic Alan , Clifton David , Collins Gary , Furniss Dominic , Eyre David
Published: October 2024

Background:

Robust de-identification is necessary to preserve patient confidentiality and maintain public acceptability for electronic health record (EHR) research. Manual redaction of personally identifiable information (PII) is time-consuming and expensive, limiting the scale of data-sharing. Automated de-identification could alleviate this burden, but the best strategy is not clear. Advances in natural language processing (NLP) and the emergence of foundational large language models (LLMs) show promise in performing clinical NLP tasks with no, or limited training.

Methods:

We evaluated two task-specific (Microsoft Azure de-identification service, AnonCAT) and five general LLMs (Gemma-7b-IT, Llama-3-8B-Instruct, Phi-3-mini-128k-instruct, GPT3.5-turbo-base, GPT-4-0125) in de-identifying 3650 medical records from a UK hospital group, split into general and specialised datasets. Records were dual-annotated by clinicians for PII. Inter-annotator reliability was used to benchmark performance. The primary outcome was F1, precision (positive predictive value) and recall (sensitivity) for each comparator in classifying words as PII vs. non-PII. The secondary outcomes were performance per-PII-subtype, per-dataset, and the presence of LLM hallucinations. We report outcomes at zero- and few-shot learning for LLMs, and with/without fine-tuning for AnonCAT.

Results:

17496/479760 (3.65%) words were PII. Inter-annotator F1 for word-level PII/non-PII was 0.977 (95%CI 0.957-0.991), precision 0.967 (0.923-0.993), and recall 0.986 (0.971-0.997). The best performing redaction tool was the Microsoft Azure de-identification service: F1 0.933 (0.928-0.938), precision 0.916 (0.930-0.922), recall 0.950 (0.942-0.957). The next-best were fine-tuned-AnonCAT: F1 0.873 (0.864-0.882), precision 0.981 (0.977-0.985), recall 0.787 (0.773-0.800), and GPT-4-0125 (ten-shots): F1 0.898 (0.876-0.915), precision 0.924 (0.914-0.933), recall 0.874 (0.834-0.905). There was hallucinatory output in Phi-3-mini-128k-instruct and Llama-3-8B-Instruct at zero-, one-, and five-shots, and universally for Gemma-7b-IT. Names/dates were consistently redacted by all comparators; there was variable performance for other categories. Fine-tuned-AnonCAT demonstrated the least performance shift across datasets.

Conclusion:

Automated EHR de-identification could facilitate large-scale, domain-agnostic record sharing for medical research, alongside other safeguards to prevent patient reidentification.
Boundary Between FDA Approved and Non-Approved Anticancer Drugs in Survival Benefit: A Meta-analysis
Authors: Ishizuka Koji , Ono Shunsuke
Published: October 2024

Survival benefit is a fundamental property of anticancer drugs for cancer patients. However, the survival benefits observed in registrational trials broadly ranged from significant to marginal, even for US Food and Drug Administration (FDA)-approved drugs. This study explores the boundary of survival benefits between FDA-approved and non-approved drugs. We screened 3,463 phase 3 investigational studies initiated from January 1990 to January 2021 with survival measurement on ClinicalTrial.gov and identified 208 randomized controlled registrational trials for anticancer drugs with overall survival (OS) measurement. Among 208 studies, 79 (38%) were conducted for FDA-approved, and 129 (62%) were for FDA-non-approved drugs. The pooled mean risk reduction of death across FDA-approved drugs was 29% (Hazard ratio (HR) 0.71), whereas FDA-non-approved drugs exhibited only a 6% risk reduction in OS (HR 0.94). The probability of FDA approval showed a sharp sensitivity to the HR for OS in the logistic regression model. A boundary was observed ranging from 0.74 to 0.86 in the HR for OS, with a 50% probability of FDA approval at HR 0.80. Our findings delineate the required survival benefits for new anticancer drugs based on the clinical and regulatory outcomes over 20 years.
Quantitative Physiologic MRI Combined with Feature Engineering for Developing Machine Learning Based Prediction Models in Distinguishing Glioblastomas from Single Brain Metastases
Authors: Hosseini Seyyed Ali , Servaes Stijn , Hall Brandon , Bhaduri Sourav , Rajan Archith , Rosa-Neto Pedro , Brem Steven , Mohan Suyash , Chawla Sanjeev
Published: October 2024

Background
Accurate and early distinction of glioblastomas (GBMs) from single brain metastases (BMs) provide a window of opportunity for reframing treatment strategies enabling optimal and timely therapeutic interventions. We sought to leverage physiologically sensitive parameters derived from diffusion tensor imaging (DTI), and dynamic susceptibility contrast (DSC)-perfusion weighted imaging (PWI) along with machine-learning based methods to distinguish GBMs from single BMs.
Methods
Patients with histopathology confirmed GBMs (n = 62) and BMs (n = 26) and exhibiting contrast enhancing regions (CERs) underwent 3T anatomical imaging, DTI and DSC-PWI. Median values of mean diffusivity (MD), fractional anisotropy, linear, planar and spheric anisotropic coefficients, minimum MD, and maximum relative cerebral blood volume values were measured from CERs. Data normalization and scaling were performed. In the next step, most relevant features were extracted (non-interacted features), which were subsequently used to generate a set of new, innovative, high-order features (interacted features) using a feature engineering method. Finally, 10 machine-learning classifiers were employed in distinguishing GBMs and BMs. Cross-validation and receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic performance.
Results
Random forest classifier with ANOVA F-value feature selection algorithm using both interacted and non-interacted features provided the best diagnostic performance in distinguishing GBMs from BMs with a classification accuracy of 87.8%, area under the ROC curve of 92.67%, a sensitivity of 73.64%, and a specificity of 97.5%.
Conclusion
Machine learning based approach involving combined use of interacted and non-interacted physiologic MRI parameters shows promise to differentiate between glioblastoma and brain metastasis with high accuracy.
Impact of Telemedicine through Social Media: A Study of Topics in User Comments on Twitter
Authors: Martín Mario Sierra , Chen Fang-Wei , Urbistondo Pilar Alarcón
Published: October 2024

Background The use of new technologies has transformed society, affecting communication, information seeking and ways of working. Telemedicine, as a remote health practice through ICTs, has grown exponentially, especially after the pandemic.
Objective This qualitative study aims to explore users' perceptions and concerns about telemedicine through comments posted on Twitter by users, identifying primary, secondary and residual themes.
Methods Natural Language Processing (NLP) and Machine Learning techniques, specifically the Latent Dirichlet Allocation (LDA) model, were used to analyse 156,633 comments extracted from Twitter related to telemedicine topics.
Results The study revealed several issues to be addressed. Data was collected using keywords such as "teleconsultation" and "telemedicine". We can see that the most frequent words in the comments include words such as "health", "service", "doctor" and "patient". The themes identified were grouped into four dimensions: general information, benefits sought, specific information and professional issues. The results showed that 60.1% of the comments focused on generic telemedicine topics, ease of use and service information. Twitter queries were observed to be public and general in nature, focusing on benefits and accessibility, while disease or treatment specific topics were less frequent.
Conclusions The results provide information for the proper development and study of telemedicine through social networks. Twitter is a platform mainly used for general telemedicine queries, with convenience and accessibility as the main benefits mentioned. The results suggest that online telemedicine interactions are complex and offer valuable insights for improving telemedicine communication strategies. Future research could explore the use of hashtags and analyse differences in interaction patterns according to user profile, providing a deeper understanding of audiences' behaviour on social networks. These findings underline the importance of considering audience preferences to improve the effectiveness of telemedicine communications.
Effect of etomidate combined with propofol on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients: a clinical, randomized, controlled study
Authors: Wang Xing , Ju Xia , Duan Jinjuan , Shu Teng , Xu Siqi , Wang Shengbin
Published: October 2024

Purpose
To observe the effect of etomidate combined with propofol on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients.
Methods
Ninety patients undergoing elective laparoscopic abdominal surgery, aged 65 ~ 87 years, American society of anesthesiologists (ASA) physical status II or III, were randomly allocated into three groups: propofol group (group P), etomidate group (group E) and etomidate combined with propofol group (group EP), 30 patients in each group. Group P received 2.5 mg/kg propofol for anesthesia induction, followed by 6 ~ 8 mg·kg− 1·h− 1 propofol to maintain anesthesia. Group E received 0.3 mg/kg etomidate for anesthesia induction, followed by 0.4 ~ 0.7 mg·kg− 1·h− 1 etomidate to maintain anesthesia. Group EP received 0.2 mg/kg etomidate combined with 1 mg/kg propofol for anesthesia induction, followed by 0.2 ~ 0.4 mg·kg− 1·h− 1 etomidate combined with 4 ~ 6 mg·kg− 1·h− 1 propofol to maintain anesthesia. The incidence of postoperative pulmonary complications (PPCs) was recorded as the primary indicator. Secondary indicators included mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction (T0), after tracheal intubation (T1), 30min after anesthesia induction (T2), and at the end of surgery (T3), the levels of IL-6 and TNF-α before anesthesia induction (T0), at the end of surgery (T3), and 24 hours after surgery (T4), awakening time, time to tracheal extubation, postoperative nausea and vomiting (PONV) and quality of recovery-15 (QoR-15) scale scores 1 day before and after surgery.
Results
The incidence of PPCs in group EP and group E was significantly lower than that in group P (P < 0.05). Compare with T0, the MAP and HR at T2 and T3 were more stable in group EP (P < 0.05). The levels of IL-6 and TNF-α in groups EP and E were lower than those in group P at T3 and T4 (P < 0.05). Compared with group E, the incidence of PONV was significantly lower in group EP and group P (P < 0.05). The QoR-15 scale scores in group EP were higher than that in group P and group E (P < 0.05).
Conclusion
Combination of etomidate and propofol for anesthesia can reduce the incidence of PPCs, alleviate inflammatory response, achieved better hemodynamic stability, reduce the incidence of PONV and improve the postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery.
Trial registration
ChiCTR2200065117.
Cost-Effectiveness Analysis of Second Intravenous Immunoglobulin Infusion versus Infliximab for Treating IVIG-resistant Kawasaki Disease Patients
Authors: Johnson Jada M. , Simpson Kit N. , Simpson Annie N. , Tremoulet Adriana H. , Burns Jane C.
Published: October 2024

Objective
Intravenous immunoglobulin (IVIG) is a known effective treatment to reduce the incidence of coronary artery aneurysms in Kawasaki disease (KD) patients. However, there has been an increase in IVIG-resistant patients and a lack of clinical trial data to determine the best second treatment. The Kawasaki Disease Comparative Effectiveness (KIDCARE) trial was a randomized trial comparing infliximab to a second IVIG infusion. Data from the trial were used for a cost-effectiveness analysis.
Methods
We developed a decision tree to estimate total costs and outcomes and calculated cost-effectiveness ratios for both treatment pathways. Cost and resource use was estimated from IBM MarketScan Commercial Database, US Bureau Labor of Statistics, IBM Micromedex Redbook and relevant peer-reviewed sources. Outcomes were measured using fever free days based on the KIDCARE study results. We addressed uncertainty using a one-way sensitivity analysis.
Results
Infliximab was the less costly treatment pathway in children with IVIG-resistant KD compared to a second dose of IVIG. The second IVIG treatment pathway cost $1,809 per additional fever free day while the infliximab treatment pathway cost $1,289 per additional fever free day. The incremental cost-effective ratio (ICER) was -$11,812 and was most sensitive to patient weight due to weight-based dosing but infliximab remained cost-effective.
Conclusions
Infliximab was the dominant economic treatment choice compared to a second dose of IVIG under a range of assumptions for both treatment patterns. This study suggests that clinicians could consider this when choosing treatment for IVIG-resistant KD patients.
Recurrence patterns in patients with low-grade intermediate-risk non-muscle invasive bladder cancer eligible for active surveillance
Authors: Zaurito Paolo , Scilipoti Pietro , Longoni Mattia , de Angelis Mario , Re Chiara , Quarta Leonardo , Tremolada Giovanni , Burgio Giusy , Pellegrino Francesco , Rosiello Giuseppe , Necchi Andrea , Colombo Renzo , Gandaglia Giorgio , Salonia Andrea , Montorsi Francesco , Briganti Alberto , Moschini Marco
Published: October 2024

Objective
The intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) prognostic group is heterogeneous. Growing evidence supports the role of active surveillance (AS) for patients with low-risk NMIBC, however, no clear data exists considering IR-NMIBC.
Methods
We retrospectively evaluated 174 LG IR-NMIBC patients who underwent transurethral resection of bladder tumor (TURBT) from 2012 to 2023 at a tertiary referral center and fulfilled the inclusion criteria for enrollment in AS protocols at the index TURBT (≤ 5 suspicious lesions, no macrohematuria, negative urine cytology, lesions ≤ 1cm). Patients were then stratified according to the International Bladder Cancer Group (IBCG) risk factors: frequent recurrence, early recurrence, previous instillation, and multifocality. Kaplan Meier plots and multivariable Cox regression analysis (MVA) were used to assess the risk of any and high-grade (HG) recurrence according to the number of risk factors.
Results
Overall, 168 (97%) patients had a TaLG disease. After a median follow-up of 36 months (IQR 20–54), 75 (43%) and 32 (18%) patients experienced any- and HG recurrence, respectively. The 3-year RFS was 86% [95% Confidence Interval (CI), 76–98%] for patients with 0, 76% (95% CI, 68–84%) for those with 1–2, and 54% (95% CI, 34–84%) for those with ≥ 3 risk factors. The 3-year HG-RFS was > 90% for patients with 0 and 1–2 risk factors, compared to 76% (95% CI, 58–99%) of those with ≥ 3 risk factors. At MVA, the presence of ≥ 3 risk factors was associated with a higher risk of recurrence [hazard ratio: 4.74, 95% CI: 1.75–12.8, p = 0.002].
Conclusion
Among patients with LG IR-NMIBC eligible for AS, those with more than 2 IBCG risk factors may not be suitable candidates due to a higher risk of HG recurrence. Randomized controlled trials with standardized AS protocols are necessary to validate these findings and optimize patient selection for AS in LG IR-NMIBC.
The Hidden Cost of Illness: Exploring the Relationship Between Seasonal Respiratory Illness, Self-Efficacy, and Academic Achievement of Undergraduate Science Students
Authors: White Jenna , Todd Amy M.
Published: October 2024

Background
Seasonal respiratory illnesses (SRIs), including COVID-19, have significantly disrupted university students' academic experiences. This study examines the impact of SRIs on key academic factors such as attendance, self-efficacy, and academic performance, alongside the effectiveness of preventative behaviours like handwashing and mask-wearing.
Methods
Undergraduate students were surveyed during the Winter 2023 Semester. The survey collected data on SRIs, self-efficacy (using the General Academic Self-Efficacy scale), perceived attendance, and academic performance. SRI scores were derived from illness frequency, duration, and severity. Analyses included descriptive statistics, correlation, and multiple linear regression.
Results
Among participants, 84.5% reported experiencing SRIs, with an average of 3.8 occurrences lasting a total of 22 days. Regular handwashing correlated with lower SRI scores (β = -1.87, p = 0.05), while mask-wearing unexpectedly correlated with higher SRI scores (β = +1.79, p = 0.02). Higher SRI scores were significantly linked to lower self-efficacy (p = 0.0011) and academic performance (p < 0.0001).
Conclusions
SRIs notably affect students' academic outcomes, likely through their impact on self-efficacy, while a diminished role for attendance on academic achievement may reflect the post-pandemic shift in instructional strategies towards online access. The unexpected link between mask-wearing and higher SRI scores suggests a need for further research on specific factors relating to the efficacy of masks in university environments. Overall findings suggest that supporting students' psychological resilience and promoting regular handwashing are critical for reducing SRIs' significant impact on academic success.
How to evaluate Ultra-processed Food Intake in pediatrics? UPF Score: an easy alternative
Authors: Rosales-Arreola Laura Fernanda , Ayala-Galván Citlali , Villa-Aguilar Estefany , Villegas-González Analí , Soriano-Rosales Rosa E , Pérez-Guillé Beatriz , González-Zamora José Francisco , González-Ortiz Ailema
Published: October 2024

Background
The rising intake of ultra-processed foods (UPFs) among children and adolescents poses challenges due to the lack of precise and accessible tools to quantify such intake. This complicates understanding its effects on dietary quality and hampers the design of effective preventive interventions across diverse socioeconomic and geographic contexts. Objective: This paper aims to determine the relationship between the UPF score and dietary characteristics.
Methods
This cross-sectional study involved 353 participants aged 3 to 17. The methods included (1) a three-day food intake record; (2) an evaluation of intake across five food groups; (3) categorization of intake frequency (0, 1, 2, or up to 3 times weekly); and (4) scoring by cumulative intake. Principal component analysis and regression models were utilized to assess diet associations with UPF score.
Results
Higher UPF score groups showed increased intake of energy, fats, and sodium (p < 0.01); decreased fiber intake (p = 0.03), vegetables, fruits, and cereals (p < 0.05); higher sugar intake (p < 0.01); and reduced intake of vitamins A and C (p < 0.05). Four principal components, representing over 65% of sample variability, identified two healthy and two less healthy dietary patterns. Linear regression indicated higher fiber intake at lower UPF scores, declining with higher UPF scores.
Conclusions
The UPF score represents a useful tool for efficiently and swiftly assessing UPF intake and dietary characteristics in pediatric population.
The Economic Impact of the Multifaceted Stroke 1-2-0 Educational Campaign in China
Authors: Yuan Jing , Wang Yong , Lu Kevin Z. , Liu Yang , Liu Renyu , Zhao Jing
Published: October 2024

Background
Stroke prehospital time is exceptionally long in China. The multifaceted Stroke 1-2-0 Amplifying Version Engagement (SAVE) intervention has substantially reduced onset-to-door time for patients with acute stroke in Shanghai, China. This study aimed to assess the implementation and downstream healthcare costs associated with the educational program.
Methods
Data were extracted anonymously from the hospital information systems for all ischemic stroke patients admitted to the hospital from 2016 to 2019. Cost data from different years were converted into 2019 Chinese Yuan (CNY) using a 5% discount rate. We used a multivariate generalized linear model (GLM) with log-link to examine the campaign's impact on LOS and costs.
Results
The SAVE intervention was estimated to cost CNY 1,768,067 for Xinzhuang County from October 2016 to December 2019. Most costs (59.64%) were for the mass media broadcast. 2830 stroke patients met the inclusion criteria, including 490 in the pre-campaign and 2,340 in the post-campaign period. Following the multifaceted SAVE intervention, the mean (SD) LOS decreased from 9.48 (3.80) days to 8.80 (3.55) days. The mean (SD) hospitalization costs per patient dropped from ¥21950.72 (10410.74) to ¥19262.50 (12772.81) CNY (P < .01). In the GLM model, the campaign was associated with reduced LOS (Table; β coefficient [95% CI]: -0.070 [-0.11 to -0.030]; P < 0.01) and hospitalization costs (β coefficient [95% CI]: -0.11 [-0.17 to -0.053]; P < 0.01).
Conclusions
Our findings suggest that the SAVE intervention generated economic savings through its effect on reducing LOS, which could be explained by improved intravenous thrombolytic therapy. Innovative ways of delivering educational materials, e.g., via digital health, will need to be explored by lowering costs for personnel and mass media.
Predictability of Adult Patient Medical Emergency Condition from Triage Vital Signs and Comorbidities: A Single-Center, Observational Study
Authors: YAZICI Maral , YETER Ahmet Sefa , GENÇ Sinan , KOCA Ayça , OĞUZ Ahmet Burak , ENEYLİ Müge GÜNALP , POLAT Onur
Published: October 2024

Background
Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.
Methods
This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 hours, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 hours, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.
Results
A total of 10022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. The median age of patients was 46 (min-max: 18–104). Six hundred four patients presented with a MEC. 3480 (34.7%) patients had at least one comorbidity, while 5031 (50.2%) patients had at least one abnormal vital sign. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, a MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.
Conclusion
Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of a MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.
Among renal cell carcinoma subtypes, only papillary renal cell carcinoma demonstrated relevant TROP-2 positivity as a rationale for antibody-drug conjugates targeting TROP-2
Authors: Kessler Carolina , von Brandenstein Melanie , Klümper Niklas , Krausewitz Philipp , Storz Enno , Rieger Constantin , Sperber Laurenz , Paffenholz Pia , Tolkach Yuri , Nestler Tim , Wirtz Ralph , Eckstein Markus , Heidenreich Axel , Weiten Richard
Published: October 2024

Objective
To evaluate the expression of trophoblast cell surface antigen-2 (TROP-2), a broadly expressed antibody-drug conjugate (ADC) target, in non-clear cell renal cell carcinoma (non-ccRCC) and to conduct a proof-of-concept analysis assessing the effect of TROP-2-directed ADC Sacituzumab govitecan (SG) in RCC cell lines.
Methods
A cohort comprising a ccRCC (n=44), pRCC (n=22), chRCC (n=22), and benign tumors subcohort (n=8) including oncocytoma and angiomyolipoma, was analysed using quantitative real-time PCR, ELISA and immunohistochemical staining with evaluation of H-score. The cytotoxic efficacy of the TROP-2-targeted ADC Sacituzumab govitecan (SG) in vitro was analysed using Western Blot, FACS, and MTT assay.
Results
We observed increased TROP-2 mRNA expression levels in pRCC compared to ccRCC, chRCC and benign tumors (p<0.001). Immunohistochemical analysis revealed moderate to strong membranous TROP-2 expression in most of pRCC patients [n=20/22 with H-score ≥ 100, median H-score 265 (IQR 202.5-290)], while TROP-2 was absent or weak in patients with ccRCC and chRCC (p<0.0001). Additionally, we detected soluble TROP-2 in the serum of RCC patients, establishing a strong positive correlation with membranous TROP-2 expression (ρ=0.78, p=0.0001, R2=0.52), indicating its potential as a non-invasive biomarker for RCC. In vitro findings indicated that the efficacy of SG depended on the extent of TROP-2 expression. Notably, SG inhibited the growth of TROP-2 expressing Caki-1 cells, whereas TROP-2 negative 769-P cells were resistant to SG (p<0.01).
Conclusion
In conclusion, the substantial expression of TROP-2 in pRCC, combined with our preclinical in vitro results, provides preclinical evidence supporting the potential effectiveness of TROP-2-directed ADCs such as SG in patients with TROP-2 positive metastatic pRCC.
The Effect of One-Week Spinach and NBS Superfood Supplementation on Interleukin-6, Superoxide Dismutase, and Malondialdehyde Levels after Repeated Bouts of Wingate Test in Trained Men
Authors: shirinbayan mohammadmehdi , Azizi Mohammad , Amiri Ehsan
Published: October 2024

Background: Consuming nutritional supplements for improving athletic performance has always been considered an ergogenic aid. However, there is limited information on the efficacy of this strategy for enhancing antioxidant capacity in response to strenuous exercise with repeated nature. Therefore, this study investigated the effect of one week of spinach and NBS superfood supplementation on superoxide dismutase, malondialdehyde, and interleukin-6 in response to repeated bouts of Wingate test.
Methods: Fifteen trained men voluntarily participated in this within-subject and counter-balanced study. Participants were exposed to three different conditions including 1) seven days of raw spinach supplementation (daily dose of 70 g); 2) seven days of NBS superfood supplementation (daily dose of 10 g); and 3) the control condition. One day after the supplementation period, participants came to the lab and performed 3 bouts of 30-second Wingate test with 4-minute rest intervals. Before the supplementation and 24 hours after performing the Wingate, test blood samples were taken in each condition to measure serum levels of superoxide dismutase, malondialdehyde, and interleukin-6. One week of wash-out was applied between the conditions. Two-way repeated measures ANOVA were used for statistical analysis.
Results: The results showed that at post-test measurement the serum level of interleukin-6 was significantly lower under the spinach and superfood conditions (p=0.001, p=0.003, respectively) compared to the control. The serum level of superoxide dismutase under the spinach (p=0.035)and superfood (p=0.01) conditions was significantly higher compared to the control at post-test measurement. Also, at post-test measurement, the serum level of malondialdehyde was significantly lower under the spinach (p=0.001)and superfood (p=0.017) conditions compared to the control.
Conclusion:According to the results of the present study, it seems that seven days’ supplementation of either raw spinach or NBS superfood could positively affect the inflammatory responses to repeated anaerobic all-out activities. Therefore, these supplementation strategies might be considered ergogenic aids and used by athletes before participating in repeated strenuous activities.
Coping after breast cancer (CABC-trial): Testing two digital stress-management interventions in a randomized controlled trial at 6 months
Authors: Svendsen Karianne , Nes Lise Solberg , Leithe Sigrid , Meland Anders , Gjelsvik Ylva M. , Børøsund Elin , Larsson Ine M. , Myklebust Tor Åge , Balto Aina , Rygg Christine M. , Kiserud Cecilie E. , Antoni Michael H. , Chalder Trudie , Mjaaland Ingvil , Carlson Linda E. , Eriksen Hege R. , Ursin Giske
Published: October 2024

Purpose
The digital stress-management intervention StressProffen has been shown to be associated with improved well-being and quality of life for cancer survivors. In the Coping After Breast Cancer (CABC) trial, effects of 6 months access to modified versions of StressProffen, delivered through a digital download-only model, were examined.
Methods
Women with breast cancer were invited to participate in the trial 6–9 months following diagnosis. Eligible participants were randomized to either: 1) digital cognitive behavioral therapy stress-management intervention (CBI), n = 140, 2) digital mindfulness-based stress-management intervention (MBI), n = 143, or 3) usual-care (control group), n = 147. Primary outcome was change in perceived stress level (PSS-10), while secondary outcomes included changes in health-related quality of life (HRQoL), anxiety and depression, fatigue, mindfulness, sleep and coping.
Results
Perceived stress level at baseline was low for all groups. No statistically significant mean differences (MD) were detected between either of the intervention groups and the control group from baseline to 6-month follow-up for perceived stress level (MBI: MD -0.28 [95%CI: -1.75, 1.19], CBI: MD -0.42 [95%CI: -1.89, 1.06]), nor for the majority of the secondary outcomes.
Conclusion
After 6 months of access, the CBI and MBI stress-management interventions did not yield significantly improved outcomes for women with breast cancer compared with usual-care controls. Further explorations of which delivery models may optimize use and effect, best timing for delivery, and individual preferences, are needed.
ClinicalTrials.gov identifier NCT04480203.
Cardiac damage in a dog with natural acute infection by Trypanosoma cruzi III in an endemic area in the state of Rio Grande do Norte, Brazil
Authors: Araújo-Neto Vicente Toscano , Barbosa-Silva Andressa Noronha , Batista Lucas Abrantes , Mendes Rodrigo Souza , Negreiros Christiane Carlos Araújo , Fidellis Barbara Araújo , Sampaio George Harisson Felinto , Brito Carlos Ramon Nascimento , Guedes Paulo Marcos Matta , Galvão Lúcia Maria Cunha , Câmara Antonia Claudia Jácome
Published: October 2024

Background
Dogs are the main domestic reservoir of Trypanosoma cruzi and they are considered sentinels for new infection cases in humans. These animals are well-established infection models, but little is known about the natural development of the disease, especially in the acute phase. Dogs and triatomines are infected in the same environment with wide distribution of discrete typing units (DTUs) I, II e III in triatomines in several municipalities in the state of Rio Grande do Norte. This study describes clinical, hematological, biochemical, cardiological and parasitological aspects of a dog in the acute phase of T. cruzi infection and characterizes the isolate obtained by biological, molecular and phylogenetic methods.
Results
An apparently asymptomatic young animal showed a prolonged period of patent parasitemia, normocytic and hypochromic anemia. In addition, cardiac damage in this animal was observed by high concentration of biomarkers such as troponin I, NT-ProBN and doppler echocardiography examination with qualitative segmental hypokinesia. The isolated parasite was genotyped as TcIII using three molecular markers and phylogenetic analysis, initially described in a wild environment, this DTU is now present in the peridomicile.
Conclusions
The cardiac alterations detected in Canis familiaris with natural infection by T. cruzi contribute to expanding knowledge of the disease in these animals and the epidemiological scenario in an area where Triatoma brasiliensis is the main vector.
Association of Serum Chloride Levels with all-cause mortality among Patients in Surgical Intensive Care Unit: A Retrospective Analysis of the MIMIC-IV Database
Authors: Ma Quan , Tian Wei , Wang Kaifeng , Xu Bin , Lou Tianyu
Published: October 2024

This study aims to explore the correlation between serum chloride levels and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU).A retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, focusing on patients admitted to surgical/trauma ICUs. Data included demographic information, laboratory results, medical history, vital signs, and prognosis-related variables. Patients were categorized into four groups based on serum chloride levels. Outcome measures included 30-day, 90-day, and 180-day mortality rates post-ICU admission. Kaplan–Meier survival analysis curves, Cox proportional hazards regression analysis, and Restricted Cubic Spline (RCS) models were used to analyze the relationship between serum chloride levels and clinical outcomes.A total of 10,996 patients were included in the study. The 30-day mortality rate was 12.78%, the 90-day mortality rate was 17.14%, and the 180-day mortality rate was 20.32%. Kaplan-Meier survival analysis demonstrated significant differences in survival rates among different serum chloride level groups during the 30-day, 90-day, and 180-day follow-up periods (p < 0.001). Multivariate Cox regression analysis results indicated that elevated serum chloride levels were significantly associated with decreased all-cause mortality rates at 30-days (adjusted hazard ratio [aHR]: 0.96; 95% confidence interval [CI]: 0.94–0.98; P < 0.001), 90-days (aHR: 0.97; 95% CI: 0.96–0.98; P < 0.001), and 180-days (aHR: 0.97; 95% CI: 0.96–0.98; P < 0.001). Moreover, compared with the first quartile of serum chloride levels, the risk of death was significantly lower in the fourth quartile (30-days aHR = 0.65, 90-days aHR = 0.71, 180-days aHR = 0.69, P < 0.001).RCS curves showed an L-shaped relationship between serum chloride levels and all-cause mortality risk for SICU patients at 30-days, 90-days, and 180-days. Although the magnitude of reduction diminished when levels reached 104 mmol/L, an increase in serum chloride levels was associated with a decreased risk of mortality.This study demonstrates a significant nonlinear relationship between serum chloride levels and all-cause mortality rates among SICU patients. This finding contributes to a more precise monitoring of chloride levels in SICU patients.
Urinary phytoestrogens were associated with reduced sensitivity to thyroid hormone in NHANES 2007-1010: A large cross-sectional study
Authors: Li Zongbao , Hu Fan , Yu Han , Yao Yao , Lu Yanhui
Published: October 2024

Background
Estrogen and thyroid hormone interact extensively in vivo, but the relationship between phytoestrogens and thyroid function and thyroid hormone sensitivity remains unclear.
Methods
Using 2007–2010 NHANES data of United States, we analysed the association of 6 types of urinary phytoestrogens with thyroid function and thyroid hormone sensitivity using a multivariate linear regression model.
Results
A total of 2,521 participants were included in the final analysis. After adjustment for multiple factors, we found that urinary phytoestrogens were associated with thyroid function and thyroid hormone sensitivity, and the associations were sex and type specific. For thyroid function: Phytoestrogens were negatively associated with FT4 and TT4 in overall analysis. After sex stratification, Equol, Enterodiol and TT4 were negatively associated in men. In women, Daidzein, O-Desmethylangolensin (O-DMA) and Genistein were positively associated with FT4, while Enterodiol was negatively associated with FT4. In addition, Enterolactone was negatively associated with TT4. For thyroid hormone sensitivity: Phytoestrogens were associated with Thyroid feedback quantile-based index (TFQI) in overall analysis. After sex stratification, Genistein was positively associated with FT3/FT4 ratio and Enterolactone was positively associated with TFQI in men. In women, Daidzein and O-DMA were negatively associated with FT3/FT4 ratio and positively associated with TFQI.
Conclusion
Urinary phytoestrogens were associated with FT4 and TT4 levels and may adversely affect the central thyroid hormone sensitivity. Given the risk of hypothyroidism and SCH associated with reduced thyroid hormone sensitivity, more health monitoring of people with high phytoestrogens intake is warranted.
Understanding the Role of Social Support in the Adherence to Hypertension Treatment in Cambodia
Authors: Chham Savina , Buffel Veerle , Ir Por , Ku Grace Marie , Chhim Srean , Damme Wim Van , Olmen Josefien Van , Wouters Edwin
Published: October 2024

Background
The prevalence of hypertension (HTN) in Cambodia was high (35.2%) in 2020 and only one-third achieved well-control. Effective HTN management strategies are needed but with focus on some key potential factors related to the poor adherence to treatment. Social support, especially from family members, is considered as a potential factor determining treatment adherence; however, evidence remains inconsistent with limited research conducted in Asia. Therefore, we assessed the role of social support on HTN treatment adherence in Cambodia to get a better understanding of the role of social support from family members in HTN management.
Methods
We performed a population-based survey among individuals aged ≥ 40 years and included 948 patients who were in-treatment in this study. Further key information was collected on adherence using the Medication Adherence Self-Report Scale (MARS-5) and family social support with eight-item modified Medical Outcomes Study Social Support (mMOS-SS) scale. Descriptive statistics were used to present the basic characteristics of the respondents. Chi-square test was used for the bivariate analysis of factors for treatment adherence. Multiple logistic regression was used to assess the association between family social support and HTN treatment adherence while controlling for some potential covariates.
Results
Among the 948 study participants, 43.5% reported non-adherence and 56.5% reported adherence to HTN treatment. For family social support, 19.7% reported poor level, 31.3% reported fair level, and 49.9% reported good level of support. Of those with adherence to HTN treatment, 29.2% had fair level of family social support, and 54.1% had good level of family social support. Unadjusted odd ratios (OR) from the univariate analysis showed a significant association between HTN treatment adherence and level of social support (P = 0.001). After controlling for covariates, having a good level of family social support increased the rate of adherence to HTN treatment by two-fold (AOR = 2.16, 95%CI = 1.49–3.14) compared to poor level.
Conclusions
The role of social support from family members was very positive in enhancing treatment adherence among patients with HTN in Cambodia. Potential strategic interventions should include focus on establishing an intervention involving family members to provide support for HTN treatment.