bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case report: A case report and literature review on spontaneous bacterial peritonitis induced by intestinal barrier damage in a colorectal cancer patient with malnutrition
Authors: Xu Peng , Shi Sanbao , Yu Zhiyu , Li Da , Zhang Cheng 
Published: February 2025

BackgroundSpontaneous bacterial peritonitis (SBP) is an infectious condition characterizing the presence of bacterial infection in the peritoneal fluid with no apparent source of infection within the abdomen. It is extremely rare for patients with malnutrition after colorectal cancer (CRC) surgery to develop SBP. This is the first ever case reported case of SBP resulting from intestinal barrier compromise in a patient with colorectal cancer with malnutrition.Case summaryA 72-year-old woman with malnutrition was diagnosed with CRC, and following brief nutritional support, she underwent the laparoscopic-assisted radical right hemicolectomy. The patient was then diagnosed with peritonitis after the operation. An emergency laparotomy was performed, and the patient was finally diagnosed with SBP. The patient ultimately recovered following a series of appropriate postoperative supportive treatments.ConclusionThis case highlights the poor outcomes of short preoperative nutritional therapy in CRC patients with malnutrition. Further studies should investigate the role of the intestinal barrier function in the recovery of patients with CRC after surgery.
TriSwinUNETR lobe segmentation model for computing DIR-free CT-ventilation
Authors: Nomura Gabriela Roque Oliveira , Luong Aaron T. , Prakash Ananya , Alemand Annabelle , Bhowmick Tanish , Ali Alisa , Ren Jaimie , Rehani Basil , Nair Girish , Castillo Richard , Vinogradskiy Yevgeniy , Castillo Edward 
Published: February 2025

PurposeFunctional radiotherapy avoids the delivery of high-radiation dosages to high-ventilated lung areas. Methods to determine CT-ventilation imaging (CTVI) typically rely on deformable image registration (DIR) to calculate volume changes within inhale/exhale CT image pairs. Since DIR is a non-trivial task that can bias CTVI, we hypothesize that lung volume changes needed to calculate CTVI can be computed from AI-driven lobe segmentations in inhale/exhale phases, without DIR. We utilize a novel lobe segmentation pipeline (TriSwinUNETR), and the resulting inhale/exhale lobe volumes are used to calculate CTVI.MethodsOur pipeline involves three SwinUNETR networks, each trained on 6,501 CT image pairs from the COPDGene study. An initial network provides right/left lung segmentations used to define bounding boxes for each lung. Bounding boxes are resized to focus on lung volumes and then lobes are segmented with dedicated right and left SwinUNETR networks. Fine-tuning was conducted on CTs from 11 patients treated with radiotherapy for non-small cell lung cancer. Five-fold cross-validation was then performed on 51 LUNA16 cases with manually delineated ground truth. Breathing-induced volume change was calculated for each lobe using AI-defined lobe volumes from inhale/exhale phases, without DIR. Resulting lobar CTVI values were validated with 4DCT and positron emission tomography (PET)-Galligas ventilation imaging for 19 lung cancer patients. Spatial Spearman correlation between TriSwinUNETR lobe ventilation and ground-truth PET-Galligas ventilation was calculated for each patient.ResultsTriSwinUNETR achieved a state-of-the-art mean Dice score of 93.72% (RUL: 93.49%, RML: 85.78%, RLL: 95.65%, LUL: 97.12%, LLL: 96.58%), outperforming best-reported accuracy of 92.81% for the lobe segmentation task. CTVI calculations yielded a median Spearman correlation coefficient of 0.9 across 19 cases, with 13 cases exhibiting correlations of at least 0.5, indicating strong agreement with PET-Galligas ventilation.ConclusionOur TriSwinUNETR pipeline demonstrated superior performance in the lobe segmentation task, while our segmentation-based CTVI exhibited strong agreement with PET-Galligas ventilation. Moreover, as our approach leverages deep-learning for segmentation, it provides interpretable ventilation results and facilitates quality assurance, thereby reducing reliance on DIR.
Risk factors and incidence of unplanned re-operation after transumbilical single-hole laparoscopic appendectomy in children
Authors: Luo Yuanyuan , Zhang Hong , Wu Qiang , Li Qianlong , Ye Zhihua , Zeng Jixiao , Xu Xiaogang 
Published: February 2025

PurposeThis study aims to investigate the factors associated with unplanned re-operations (UR) following transumbilical single-hole laparoscopic appendectomy (TUSILA) in pediatric patients.MethodsWe conducted a retrospective analysis of clinical data from children diagnosed with acute appendicitis (AA) who underwent TUSILA at our center between January 2020 and January 2024. All the operations were performed under single-port laparoscopy, including two methods of appendectomy, intra-TUSILA and extra-TUSILA. Patients were categorized into the UR and control groups to compare baseline characteristics, clinical data, postoperative management, and surgical outcomes.ResultsThe study included 188 patients (110 males and 78 females), with 4 (2.1%) in the UR group. Within the UR group, three cases (75%) necessitated re-operation due to adhesive intestinal obstruction, while one case (25%) was due to an appendiceal remnant fistula. The baseline characteristics, operation duration, intraoperative blood loss, surgeon experience, and postoperative fasting times showed no significant difference between the two groups (all P &gt; 0.05). However, the incidences of procedures beyond standard TUSILA, lateral peritoneum lysis, appendiceal perforation, complicated appendicitis as confirmed by pathology, drainage tube placement, and the length of antibiotic duration were significantly higher in the UR group compared to the control group (all P &lt; 0.05).ConclusionA notable percentage of pediatric patients undergoing TUSILA experience UR, primarily due to adhesive ileus, with a substantial proportion potentially linked to surgical technical errors and postoperative management.
Comparison of the effects of perioperative fentanyl and morphine use on the short-term prognosis of patients with cardiac surgery in the ICU
Authors: Zhong Jingtao , Sui Runqian , Zi Jie , Wang Anbiao 
Published: February 2025

AimThis study aimed to analyze the effects of perioperative morphine and fentanyl use on delirium, length of ICU stay, and in-hospital mortality after cardiac surgery.MethodsThis cohort study retrieved the data of 4,596 patients admitted to ICU after cardiac surgery in MIMIC-IV database from 2008 to 2019. The primary outcome was postoperative delirium. The secondary outcomes were length of ICU stay, and in-hospital mortality. To compare the effects of perioperative fentanyl and morphine use on postoperative delirium, length of ICU stay, and in-hospital mortality, univariate, two-way stepwise, as well as multivariable Logistic regression, linear regression, and Cox proportional hazards models was respectively used. Odd ratio (OR), β coefficient, hazard ratio (HR), and respective confidence interval (CI) were calculated. Subgroup analysis was conducted in terms of age, use of extracorporeal circulation, midazolam, dexmedetomidine or surgery type.ResultsIn total, the data of 4,596 patients were analyzed including 2,589 morphine user and 2007 fentanyl user. We found that the risk of postoperative delirium was reduced in patients with cardiac surgery undergoing perioperative morphine relative to perioperative fentanyl (OR = 0.62, 95%CI: 0.40–0.96). Perioperative morphine use was negatively correlated with the length of ICU stay in patients with cardiac surgery in comparison to patients with perioperative fentanyl use (β = −0.72, 95%CI: −1.06, −0.39). Relative to patients who had perioperative fentanyl, patients who had perioperative morphine were associated with reduced risk of in-hospital mortality in patients with cardiac surgery after adjusting for respective confounding factors (HR = 0.35, 95%CI: 0.13–0.91).ConclusionPerioperative morphine use was related to lower risk of delirium and in-hospital mortality as well as shortened length of ICU stay in these patients. The findings might offer a reference for perioperative anesthesia management in patients receiving cardiac surgery.
A limited sampling strategy for estimating busulfan exposure in pediatric hematopoietic stem cell transplantation
Authors: Jia Chenhong , Qin Yabin , Han Yu , Ding Weijing , Pei Yuntao , Zhao Yile 
Published: February 2025

BackgroundBusulfan (Bu) is the foundation of conditioning regimens for pediatric hematopoietic stem cell transplantation (HSCT). Evidence indicates that the efficacy and side effects of Bu are intimately tied to the area under its concentration-time curve (AUC). Given its cytotoxic nature and a small therapeutic index, coupled with marked inter-individual pharmacokinetic variability, Bu requires therapeutic drug monitoring to facilitate individualized therapy. However, research investigating the relationship between Bu exposure and clinical outcomes among the Chinese population remains scarce. This study aimed to develop a limited sampling strategy (LSS) for estimating Bu exposure in pediatric HSCT recipients using multiple linear regression (MLR) analysis to predict the AUC0-360.MethodsWe enrolled 26 pediatric patients who underwent Bu-based conditioning for HSCT. Blood samples were collected at 11 time points after Bu infusion. Pharmacokinetic parameters were calculated using non-compartmental methods. MLR models were developed using 1–4 sampling points to predict the AUC0-360. Model accuracy was assessed using the Jackknife and Bootstrap methods, with consistency evaluated via intraclass correlation coefficient (ICC) and Bland–Altman (BA) analyses.ResultsThe mean ± standard deviation (SD) for AUC0-t, mean residence time 0-t, clearance, and volume of distribution were 845.54 ± 111.03 μmol min/L, 181.37 ± 10.55 min, 0.23 ± 0.04 L/h/kg, and 0.73 ± 0.15 L/kg, respectively. Models with 2–4 sampling points showed improved prediction accuracy compared to single-point models. The four-point model (60, 135, 240 and 360 min) demonstrated the highest accuracy with an adjusted r2 of 0.965. Internal validation confirmed the models’ stability and accuracy, with the four-point model exhibiting the best performance. External validation using three additional cases supported the predictive accuracy of the model.ConclusionThe LSS model developed in this study accurately predicts the Bu AUC0-360 with 2–4 sampling points, offering a practical and clinically valuable tool for therapeutic drug monitoring in pediatric HSCT recipients. The four-point model was found to be the most accurate and is recommended for clinical applications.
Loss-of-function mitochondrial DNA polymerase gamma variants cause vascular smooth muscle cells to secrete a diffusible mitogenic factor
Authors: Rothwell Samantha , Ng Irvin , Shalchy-Tabrizi Sophia , Kalinowski Pola , Taha Omnia M. , Paris Italia , Baniqued Angelica , Lin Lisa , Mezei Michelle M. , Lehman Anna , Julian Lisa M. , Poburko Damon 
Published: February 2025

IntroductionMitochondrial dysfunction promotes vascular aging and disease through diverse mechanisms beyond metabolic supply, including calcium and radical signaling and inflammation. Mitochondrial DNA (mtDNA) replication by the POLG-encoded mitochondrial DNA polymerase (POLG) is critical for mitochondrial health. Loss-of-function POLG variants are associated with a predisposition to hypertension. We hypothesized that impaired POLG, through reduced mtDNA copy number or other mechanisms, would promote smooth muscle hypertrophy or hyperplasia that drives vascular remodeling associated with hypertension.MethodsWe characterized the effect of over-expressing POLG variants that were previously observed in a cohort of hypertensive patients (p.Tyr955Cys, p.Arg964Cys, p.Asn1098Ile, and p.Arg1138Cys) in A7r5 cells.ResultsAlphaFold modeling of the POLG holoenzyme complexed with DNA predicted changes in the catalytic site in the p.Tyr955Cys and p.Asn1098Ile variants, while p.Arg964Cys and p.Arg1138Cys showed minimal effects. The POLG variants reduced mtDNA copy number, assessed by immunofluorescence and droplet digital PCR, by up to 27% in the order p.Tyr955Cys &gt; p.Arg964Cys &gt; p.Asn1098Ile &gt; p.Arg1138Cys relative to wild-type-transfected cultures. Loss of mtDNA was reduced in cultures grown in low serum and glucose media, but the cell density was increased in the same rank order in both 10% serum and 1% serum. POLG constructs contained a Myc epitope, the counterstaining for which showed that the mtDNA copy number was reduced in both transfected cells and untransfected neighbors. Live-cell imaging of mitochondrial membrane potential with TMRM and radical oxygen species production with MitoSOX showed little effect of the POLG variants. POLG variants had little effect on oxygen consumption, assessed by Seahorse assay. Live-cell imaging growth analyses again showed increased growth in A7r5 cells transfected with p.Tyr955Cys but a decreased growth with p.Arg1138Cys, while p.Tyr955Cys increased growth of HeLa cells. Conditioned media from HeLa cells transfected with POLG variants reduced doubling times in naïve cultures. Pharmacologically, wedelolactone and MitoTEMPOL, but not indomethacin or PD98059, suppressed the mitogenic effects of p.Tyr955Cys and p.Arg964Cys in A7r5 cells.DiscussionWe conclude that POLG dysfunction induces secretion of a mitogenic signal from A7r5 and HeLa cells even when changes in mtDNA copy number are below the limit of detection. Such mitogenic stimulation could stimulate hypertrophic remodeling that could contribute to drug-resistant hypertension in patient populations with loss-of-function POLG variants.
The organelle genomes of the endangered seagrass Zostera caespitosa reveal sequence divergences, massive gene transfer, and uncommon RNA editing types
Authors: Yong Yushun , Wang Yulian , Wang Dawei , Yuan Xingfang , Zhang Quansheng 
Published: February 2025

IntroductionZostera caespitosa, a rare submerged angiosperm, is considered endemic to the northwestern Pacific.MethodsThis study assembled and compared the mitochondrial (mt) and chloroplast (cp) genomes of Z. caespitosa to understand the organelle evolutionary patterns.Results and discussionThe cp genome (143,972 bp) was the second smallest within the seagrasses, whereas the mt genomes (192,246 bp) of Z. caespitosa and other seagrasses were smaller compared to those of other monocotyledons. The protein-coding genes (PCGs) in the organelle genome exhibit a strong A/U bias at codon endings, a selection-driven codon bias. The rates of nonsynonymous (Ka) and synonymous (Ks) substitutions in the mt genes of Zostera were two times higher than those in the cp genes. Additionally, 50 mitochondrial plastid DNA (MTPT) segments, totaling 44,662 bp, were identified, constituting 23.23% of the mt genome, which is significantly higher than those in most land plants. Phylogenetic analysis of 13 seagrass core cp-PCGs supported previous studies showing two genera in family Zosteraceae: Phyllospadix and Zostera, the latter comprising Zostera and Zosterella as subgenera. RNA editing was remarkably abundant in the 167 mt-PCGs and 172 in cp-PCGs, particularly in the cp genome. There are 11 different RNA editing types in the cp and 3 in the mt, most of which are C to U. Unexpectedly rare editing events, such as A to C, A to U, U to A, G to C, and U to G, have also been found in the cp.
Arginine metabolism and neurocognitive impairment in offspring of bipolar parents: a high-risk case-control study
Authors: Arıcı Sağlıyan Gökçeçiçek , Çetin Fatih Hilmi , Akyürek Fikret , Tok Oğuzhan , Çiçek Zekey Özlem , Tezcan Mustafa Esad , Sağlıyan Bilal , Türkoğlu Serhat , Uçar Halit Necmi , Öztürk Bahadır , Altınbaş Kürşat 
Published: February 2025

IntroductionThe aim of this study is to investigate whether arginine and its metabolites can be an endophenotype for bipolar disorder (BD) and to evaluate the role of arginine metabolites and neurocognitive function levels in unaffected healthy children of parents diagnosed with BD in cognitive impairment.MethodsThe study included 37 healthy children of parents diagnosed with BD Type I as the high-risk group and 36 healthy children of parents without any psychiatric disorders as the control group. The arginine, n-monomethyl-l-arginine acetate (L-NMMA), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), citrulline, homoarginine, ornithine serum levels, and nitric oxide synthase (NOS) activity level of both groups were compared.ResultsThe study found that in the high-risk group, ADMA, SDMA, and ornithine levels were significantly higher compared to the controls, while citrulline and NOS activity level were significantly lower in the high-risk group compared to the controls. All neurocognitive performances of the high-risk group were considered statistically significantly worse compared to controls. The impairment in neurocognitive functions in the high-risk group was found to be correlated with ADMA, L-NMMA, citrulline, homoarginine, ornithine levels, and NOS activity level.DiscussionThese findings highlight a potential link between arginine metabolism and executive dysfunction in individuals at high risk for BD. Further longitudinal studies are essential to fully understand the complex interactions between these factors.
Exploring the interconnections of loneliness, anxiety, and depression among nursing students: a network analysis approach
Authors: Mi Yuqing , Ahn Sukhee , Ren Liping 
Published: February 2025

ObjectiveNursing students experience higher rates of anxiety and depression than students in other disciplines due to the demanding academic requirements and clinical training challenges. Loneliness and symptoms of anxiety and depression occur simultaneously; however, the specific interrelationships between these states remain inadequately investigated. This study aimed to utilize network analysis to examine the item-level reciprocal action between loneliness, anxiety, and depression among nursing students.MethodsA total of 888 nursing students were assessed using the short-form UCLA Loneliness Scale (ULS-6), the Generalized Anxiety Disorder 7-item Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) on loneliness, anxiety, and depression, respectively. Descriptive analyses were conducted using SPSS 26.0, whereas other statistical analytical procedures were performed using R software. The Gaussian graphical model was used to estimate network, and the Network Comparison Test was applied to compare differences in networks across gender and grades.ResultsThe results indicated that 58.6% of nursing students exhibited varying degrees of loneliness. Network analysis revealed that loneliness formed a separate cluster with limited connections to anxiety and depression communities. The edges between PHQ3-PHQ4 (insomnia or hypersomnia and fatigue), GAD1-GAD2 (feeling anxious and excessive worrying), ULS1-ULS2 (lonely and no one) showed the strongest positive edges within their communities, respectively. And the strongest inter-community edges were observed between GAD5-PHQ8 (fidgety-retardation), ULS6-PHQ4 (isolation-fatigue), and ULS1-GAD1 (lonely-feeling anxious). The centrality analysis identified GAD2 (excessive worrying), ULS6 (isolation), PHQ4 (fatigue), and PHQ2 (feeling down) as the most central node, indicating their significant influence on the overall network structure. Additionally, PHQ8 (retardation), PHQ2 (feeling down), GAD5 (fidgety), and GAD1(feeling anxious) played a crucial role as bridging symptoms that linked the three communities. In addition, there is no statistically significant difference in the network structure except strength of GAD3 (generalized anxiety) and GAD6 (irritable) between sexes.ConclusionsThis study highlights the high prevalence of loneliness among nursing students and its distinct yet limited connection to anxiety and depression, emphasizing its unique role as a standalone psychological construct. The central symptoms in the network and important bridge symptoms across different psychological communities highlight the complexity of mental health symptom networks. This underscores the importance of targeting central symptoms for domain-specific interventions and addressing bridge symptoms to mitigate comorbidities across psychological conditions among nursing students.
Knowledge, attitude, and practice towards occupational burnout among doctors and nurses in intensive care unit
Authors: Lu Xiahui , Li Dawei , Luo Hu , Wang Lishan , Lou Yan , Yu Yanyan 
Published: February 2025

BackgroundOccupational burnout is prevalent among doctors and nurses. This study aimed to investigate the knowledge, attitude, and practice (KAP) of ICU doctors and nurses regarding occupational burnout.MethodsA cross-sectional study was conducted between December 2023 and June 2024 at the Zhejiang Medical &amp; Health Group Hangzhou Hospital in Zhejiang Province. Demographic information and KAP scores were collected through distributed questionnaires. Occupational burnout was measured by the Maslach Burnout Inventory-General Survey (MBI-GS).ResultsThis study included 105 doctors and 165 nurses, with an average age of 32.23 ± 7.38 years. Among all the participants, 6 (2.22%) reported no occupational burnout, 230 (85.19%) experienced moderate occupational burnout, and 34 (12.59%) reported severe occupational burnout. The mean knowledge, attitude, and practice scores were 9.64 ± 4.21 (possible range: 0–18), 29.01 ± 3.15 (possible range: 7–35), and 16.96 ± 4.29 (possible range: 6–30), respectively. Multivariate logistic regression revealed that a higher knowledge score was independently associated with more proactive practice (OR = 1.33, 95% CI: [1.18, 1.50], p &lt; 0.001). Structural equation modeling showed that knowledge positively influenced both (β = 0.33, p &lt; 0.001) and practice (β = 0.37, p &lt; 0.001), while practice negatively impacted the MBI-GS (β = −0.92, p &lt; 0.001).ConclusionMost ICU doctors and nurses exhibited moderate occupational burnout, with insufficient knowledge, positive attitude, and moderate practice toward occupational burnout. Implementing strategies to increase knowledge and promote active practical engagement is essential to effectively mitigate occupational burnout among ICU staff.