bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lactic Dehydrogenase to Albumin Ratio Is Associated With the Risk of Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke
Authors: Yan Dan , Huang Qiqi , Dai Caijun , Ren Wenwei , Chen Siyan 
Published: September 2021

Background:Stroke-associated pneumonia (SAP) is one of the common complications of stroke patients. Higher lactic dehydrogenase (LDH) and lower albumin levels were associated with SAP, but the contribution of the LDH to albumin ratio (LAR) to the risk of SAP in acute ischemic stroke (AIS) patients remained unclear.Methods:A total of 3173 AIS patients were included in this study, divided into SAP (n= 417) and non-SAP groups (n= 2756). Characteristics were compared between these two groups. The receiver operating characteristic curves (ROC) were used to evaluate the discrimination ability of the LAR, LDH, and albumin levels in predicting SAP. Logistic regression analysis was furtherly adopted to estimate the association between LAR and SAP. We also used the restricted cubic spline (RCS) to clarify the relationship between LAR and the risk of SAP.Results:LAR in the SAP group was significantly higher than that of the non-SAP group (8.75 ± 4.58 vs. 6.10 ± 2.55,P&lt; 0.001). According to the results of ROC, LAR had the highest prognostic accuracy compared to LDH and albumin (P&lt; 0.05). Besides, the logistic regression model showed that higher LAR (LAR &gt; 6.75) were more vulnerable to SAP (OR, 2.80; 95% CI, 2.18–3.59,P&lt; 0.001), controlling the confounders. The RCS model showed that there was a non-linear relationship between LAR and the risk of SAP.Conclusion:High LAR was associated with an increased risk of SAP in patients with AIS. LAR may be a potential predictor for the incidence of SAP. Appropriate prevention measures were needed in patients with high LAR (LAR &gt; 6.75).
Accurately Locating Metastatic Foci in Lymph Nodes With Lugol’s Iodine-Enhanced Micro-CT Imaging
Authors: Xia Cheng-Wan , Hu Shi-Qi , Zhou Qun-Zhi , Gan Rong-Lin , Pan Jiong-Ru , Zhang Qian , Pu Yu-Mei , Chen Shen , Hu Qin-Gang , Wang Yu-Xin 
Published: September 2021

BackgroundAccurate evaluation of lymph node (LN) status is the key factor to determine the treatment and evaluate prognosis for patients with cancer. However, traditional pathological examination resulted in a 30% false-negative rate of detection of metastases in LNs. This study aimed to utilize Lugol’s iodine (I2-IK)-enhanced micro-CT imaging to reveal the 3-dimensional structure of regional LNs and decrease the false-negative rate in pathological examination.MethodsTo explore the feasibility of I2-IK-enhanced micro-CT imaging in locating metastatic lesion in LNs, nonmetastatic and metastatic LNs from mice were used to mimic the imaging process. Then, the LNs from oral squamous cell carcinoma (OSCC) patients were applied to verify the value of I2-IK-enhanced micro-CT imaging in revealing LN structure and locating metastatic lesions in LNs. The glycogen content in nonmetastatic and metastatic LNs was further detected by the use of a glycogen assay kit and periodic acid–Schiff (PAS) staining to explain the imaging differences between them.ResultsIn nude mice, 0.5% I2-IK staining for 4 h was the best parameter for normal LN. The metastatic foci in metastatic LNs were also clearly outlined in this condition. For nonmetastatic LNs from patients with OSCC, 1% I2-IK staining for 12 h was the best parameter. However, due to the increased volume of metastatic LNs, the image effect of 3% I2-IK staining for 12 h was superior to 1% I2-IK staining [tumor background ratio (TBR), 3% vs. 1%, 1.89 ± 0.10 vs. 1.27 ± 0.07, p &lt; 0.001]. Compared with subsequent pathological sections, we found the CT intensity of metastatic foci in LNs and muscle tissues was significantly higher than in nonmetastatic regions. Meanwhile, the glycogen content of metastatic foci in LNs detected was also significantly higher than in nonmetastatic region.ConclusionsI2-IK-enhanced micro-CT imaging could identify the spatial location of metastatic foci in LNs. This will be an effective method to assist in decreasing the LN false-negative rate for cancer pathology.
Individualized Prediction of Survival Benefits of Pancreatectomy Plus Chemotherapy in Patients With Simultaneous Metastatic Pancreatic Cancer
Authors: Nie Duorui , Lai Guihua , An Guilin , Wu Zhuojun , Lei Shujun , Li Jing , Cao Jianxiong 
Published: September 2021

BackgroundMetastatic pancreatic cancer (mPC) is a highly lethal malignancy with poorer survival. However, chemotherapy alone was unable to maintain long‐term survival. This study aimed to evaluate the individualized survival benefits of pancreatectomy plus chemotherapy (PCT) for mPC.MethodsA total of 4546 patients with mPC from 2004 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. The survival curve was calculated using the Kaplan-Meier method and differences in survival curves were tested using log-rank tests. Cox proportional hazards regression analyses were performed to evaluate the prognostic value of involved variables. A new nomogram was constructed to predict overall survival based on independent prognosis factors. The performance of the nomogram was measured by concordance index, calibration plot, and area under the receiver operating characteristic curve.ResultsCompared to pancreatectomy or chemotherapy alone, PCT can significantly improve the prognosis of patients with mPC. In addition, patients with well/moderately differentiated tumors, age ≤66 years, tumor size ≤42 mm, or female patients were more likely to benefit from PCT. Multivariate analysis showed that age at diagnosis, sex, marital status, grade, tumor size, and treatment were independent prognostic factors. The established nomogram has a good ability to distinguish and calibrating.ConclusionPCT can prolong survival in some patients with mPC. Our nomogram can individualize predict OS of pancreatectomy combined with chemotherapy in patients with concurrent mPC.
Birt-Hogg-Dubé Syndrome and Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome: An Effective Multidisciplinary Approach to Hereditary Renal Cancer Predisposing Syndromes
Authors: Al-Shinnag Mohammad , Marfan Helen , Susman Rachel , Wakeling Jan , Gustafson Sonja , Wood Simon , Mallett Andrew John 
Published: September 2021

AimWe aimed to describe and analyse clinical features, characteristics, and adherence to surveillance guidelines in an Australian Birt-Hogg-Dubé syndrome (BHD) and hereditary leiomyomatosis and renal cell cancer (HLRCC) cohort.MethodsAll identified patients with a diagnosis of BHD or HLRCC at RBWH 01/01/2014-01/09/2019 were included (HREC/17/QRBW/276). All patients were initially assessed and counselled by a clinical geneticist and then referred to an adult nephrologist. Baseline and incidental clinical variables were extracted and analysed.ResultsFifty-seven patients were identified (28 BHD, 29 HLRCC) with a median age of 47 years. The median and cumulative follow-up were 1 and 99 years, respectively. Baseline renal MRI occurred in 40/57 patients, and 33/57 had regular MRI as per the national guidelines (eviQ). Of 18/57 without baseline imaging, nine were yet to have imaging, seven were lost follow-up, and two patients had logistic difficulties. RCC was diagnosed in 11/57 patients: two of 28 with BHD were diagnosed with RCC aged 73 and 77, both prior to commencement of surveillance. Nine of 29 patients with HLRCC were diagnosed with RCC (one of 29 during surveillance at 47 years of age) and eight of 29 prior to commencement of surveillance (11–55 years). Amongst BHD patients, cutaneous fibrofolliculomas were noted in 15 patients, lung cysts were detected in seven patients, spontaneous pneumothoraces in five patients, and parotid oncocytoma in two of 28. Amongst those with HLRCC, cutaneous leiomyomas were noted in 19/29, cutaneous leiomyosarcoma diagnosed in one of 29, and uterine fibroids in 13 female patients.ConclusionEvidence-based RCC screening in BHD and HLRCC cohort is feasible and able to identify incidental renal lesions. Multidisciplinary patient management enables expedited genetic counselling, diagnosis, longitudinal screening, and RCC management. The success of this clinical model warrants consideration of undertaking longitudinal screening of BHD and HLRCC patients by nephrologists.
The Efficacy and Safety of Infliximab in Refractory Noninfectious Uveitis: A Meta-Analysis of Observational Studies
Authors: Xiong Anji , Liu Deng , Chen Huini , Yang Guancui , Xiong Chen , Shuai Yu , He Linqian , Guo Zepeng , Zhang Liangwen , Yang Yuan , Cui Beibei , Shuai Shiquan 
Published: September 2021

Background: Although infliximab has been recommended for the second-line treatment of seronegative spondyloarthropathy- or juvenile idiopathic arthritis-related uveitis, the issue of its systemic efficacy and safety in a broader diversity of refractory noninfectious uveitis is debatable. To assess the short-term and relatively long-term efficacy of infliximab in refractory noninfectious uveitis, we performed a systematic review and meta-analysis of observational studies.Methods: PubMed, Cochrane Library, EMBASE, and Wanfang Med Online were systematically searched from January 2005 to March 2020. Two investigators independently assessed eligibility. Data were independently collected by two investigators. The pooled proportions were estimated with patients for intraocular inflammation control and improvement of visual acuity. Pooled proportions with 95% credible intervals were computed. Study homogeneity was investigated using I2 statistics to quantify the percentage of variation across studies. To pool the results, the Mantel–Haenszel fixed-effects or random-effects models were used.Results: Of 2316 studies identified, 16 unique studies with 509 unique participants were included in the meta-analysis. The pooled proportions of intraocular inflammation control reached 92% (95% CI: 87%–98%; I2: 1%; p=0.42) and 95% (95% CI: 93%–97%; I2: 0%; p=0.91) in groups of ≤6- and ≥12-month follow-up durations. During the relatively long follow-up period, the pooled proportions of maintaining visual acuity stable or increasing at least one line reached 99% (95% CI: 96%–100%; I2: 0%; p=0.54) in the involved eyes. The corticosteroid-sparing effect of infliximab was also well demonstrated, with the proportion of corticosteroid-sparing success reaching 85.5% (112/131). Besides, about serious adverse events, 2.6% (13/500) of patients experienced hypersensitivity reactions, 2.4% (12/500) of patients experienced serious infections, 1.8% (9/500) of patients experienced autoimmune diseases, and 0.6% (3/500) of patients experienced neoplasia.Conclusions: This meta-analysis provided evidence that infliximab might be a promising choice in controlling inflammatory activity, gaining visual acuity, and sparing corticosteroid use with relatively few side effects when applied in treating refractory noninfectious uveitis.Systematic Review Registration: [website], identifier [registration number]
Alcohol Abstinence Rescues Hepatic Steatosis and Liver Injury via Improving Metabolic Reprogramming in Chronic Alcohol-Fed Mice
Authors: Pi Aiwen , Jiang Kai , Ding Qinchao , Lai Shanglei , Yang Wenwen , Zhu Jinyan , Guo Rui , Fan Yibin , Chi Linfeng , Li Songtao 
Published: September 2021

Background: Alcoholic liver disease (ALD) caused by chronic ethanol overconsumption is a common type of liver disease with a severe mortality burden throughout the world. The pathogenesis of ALD is complex, and no effective clinical treatment for the disease has advanced so far. Prolonged alcohol abstinence is the most effective therapy to attenuate the clinical course of ALD and even reverse liver damage. However, the molecular mechanisms involved in alcohol abstinence-improved recovery from alcoholic fatty liver remain unclear. This study aims to systematically evaluate the beneficial effect of alcohol abstinence on pathological changes in ALD.Methods: Using the Lieber-DeCarli mouse model of ALD, we analysed whether 1-week alcohol withdrawal reversed alcohol-induced detrimental alterations, including oxidative stress, liver injury, lipids metabolism, and hepatic inflammation, by detecting biomarkers and potential targets.Results: Alcohol withdrawal ameliorated alcohol-induced hepatic steatosis by improving liver lipid metabolism reprogramming via upregulating phosphorylated 5′-AMP -activated protein kinase (p-AMPK), peroxisome proliferator-activated receptor-α (PPAR-α), and carnitine palmitoyltransferase-1 (CPT-1), and downregulating fatty acid synthase (FAS) and diacylglycerol acyltransferase-2 (DGAT-2). The activities of antioxidant enzymes, including superoxide dismutase (SOD) and glutathione peroxidase (GSH-px), were significantly enhanced by alcohol withdrawal. Importantly, the abstinence recovered alcohol-fed induced liver injury, as evidenced by the improvements in haematoxylin and eosin (H&amp;E) staining, plasma alanine aminotransferase (ALT) levels, and liver weight/body weight ratio. Alcohol-stimulated toll-like receptor 4/mitogen-activated protein kinases (TLR4/MAPKs) were significantly reversed by alcohol withdrawal, which might mechanistically contribute to the amelioration of liver injury. Accordingly, the hepatic inflammatory factor represented by tumour necrosis factor-alpha (TNF-α) was improved by alcohol abstinence.Conclusion: In summary, we reported that alcohol withdrawal effectively restored hepatic lipid metabolism and reversed liver injury and inflammation by improving metabolism reprogramming. These findings enhanced our understanding of the biological mechanisms involved in the beneficial role of alcohol abstinence as an effective treatment for ALD.
Shared Decision Making With Young People at Ultra High Risk of Psychotic Disorder
Authors: Simmons Magenta Bender , Brushe Mary , Elmes Aurora , Polari Andrea , Nelson Barnaby , Montague Alice 
Published: September 2021

Introduction: While the majority of young people who meet the criteria for being considered at increased risk of psychosis do not go on to develop a psychotic disorder, young people are currently being identified and treated in early intervention services. Ethical concerns have been raised concerning the decision about whether or not to provide treatment, and if so, what type of treatment. This study sought to support young people themselves to make these decisions with support from their clinician through a shared decision-making approach, facilitated by an online decision aid.Methods: This project used the International Patient Decision Aid Standards (IPDAS) to guide the development and piloting of an online decision aid across two phases: (1) qualitative, semi-structured focus groups with young people who were past clients and clinicians from an early psychosis service; and (2) pilot testing of the decision aid with clinicians and young people who were current clients to finalize the development.Results: Issues discussed by clinicians in the focus group were grouped into three main areas: (1) engagement phase; (2) assessment and priorities for treatment; and (3) initial and ongoing decision making. Clients focused on the context in which the decisions were made, including as they experienced initial feelings of resistance, and then acceptance of efforts made to describe and treat their mental health challenges. Clients highlighted the need for collaboration between themselves and their clinician, and the need to be equipped with the knowledge and tools to take care of themselves. These focus group data were used to refine the online decision aid. Pilot testing revealed that while it was overall useful and relevant, important limitations were noted by both clients and clinicians.Discussion: The use of a decision aid to facilitate shared decision making (SDM) in this area is feasible and has utility for both clients and clinicians. Use of such a tool can help to address the need to uphold the rights of young people as decision makers about their own care. Future efforts should embed decision aids within complex SDM interventions, and research to understand issues relating to implementation of these interventions.
Prevalence and Risk Factors of Hernia in Patients With Rectus Abdominis Diastasis: A 10-Year Multicenter Retrospective Study
Authors: Yuan Sue , Wang Honghong , Zhou Jie 
Published: September 2021

Objectives: Hernias are very common in patients with rectus abdominis diastasis (RAD). This study aimed to identify and compare the risk factors and patterns of hernia between men and women with RAD.Method: We included patients with RAD from six hospitals within the Partners Healthcare System in Massachusetts, USA between 2009 and 2018. Univariate and multivariable binary logistic regression analyses were used to identify risk factors associated with hernia.Results: Of the 1,294 RAD cases, 866 (67%) were women. The risk of RAD in women was 1.9 times greater than that of men. There were 240 men (56.1%) and 310 women (35.8%) having one or more hernia (P &lt; 0.001). Of the 550 hernia cases, 278 men and 175 women had umbilical hernia (28.1 vs. 38.3%, P = 0.085). The distribution of hernia type differed between the two groups (P &lt; 0.0001). Multivariate analysis identified that alcohol use [odd ratio (OR) 1.74 (1.17–2.59); P = 0.006] and depressive disorder [OR 1.90 (1.209–2.998); P = 0.005] were risk factors of coexisting hernia for men with RAD; age [OR 1.51 (1.33–1.72); P = 0.000] and smoking/tobacco use [OR 1.66 (1.13–2.44); P = 0.010] were risk factors of hernia for women.Conclusion: The prevalence and risk factors of hernia in women with RAD significantly differed from that in men with RAD. Umbilical hernia is an important type of hernia. Alcohol use and depressive disorder in men, and age and smoking in women were risk factors of hernias in patients with RAD.
Stroke in Hemodialysis Patients Randomized to Different Intravenous Iron Strategies: A Prespecified Analysis from the PIVOTAL Trial
Authors: Mark Patrick B. , Jhund Pardeep S. , Walters Matthew R. , Petrie Mark C. , Power Albert , White Claire , Robertson Michele , Connolly Eugene , Anker Stefan D. , Bhandari Sunil , Farrington Kenneth , Kalra Philip A. , Tomson Charles R.V. , Wheeler David C. , Winearls Christopher G. , McMurray John J.V. , Macdougall Iain C. , Ford Ian 
Published: September 2021

Key Points

In analysis of the PIVOTAL trial, proactive intravenous iron dosing was not associated with increased stroke risk in patients on hemodialysis.Risk factors for stroke included diabetes, prior stroke, higher BP, lower serum albumin, inflammation, and women.Mortality of stroke was high; 58% of patients with a stroke event died during follow-up compared with 23% without a stroke.

Background
People with kidney failure treated with hemodialysis (HD) are at increased risk of stroke compared with similarly aged people with normal kidney function. One concern is that treatment of renal anemia might increase stroke risk. We studied risk factors for stroke in a prespecified secondary analysis of a randomized, controlled trial of intravenous iron treatment strategies in HD.

Methods
We analyzed data from the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial, focusing on variables associated with risk of stroke. The trial randomized 2141 adults who had started HD <12 months earlier and who were receiving an erythropoiesis-stimulating agent (ESA) to high-dose IV iron administered proactively or low-dose IV iron administered reactively in a 1:1 ratio. Possible stroke events were independently adjudicated. We performed analyses to identify variables associated with stroke during follow-up and assessed survival following stroke.

Results
During a median 2.1 years of follow-up, 69 (3.2%) patients experienced a first postrandomization stroke. Fifty-seven (82.6%) were ischemic strokes, and 12 (17.4%) were hemorrhagic strokes. There were 34 postrandomization strokes in the proactive arm and 35 postrandomization strokes in the reactive arm (hazard ratio, 0.90; 95% confidence interval, 0.56 to 1.44; P=0.66). In multivariable models, women, diabetes, history of prior stroke at baseline, higher baseline systolic BP, lower serum albumin, and higher C-reactive protein were independently associated with stroke events during follow-up. Hemoglobin, total iron, and ESA dose were not associated with risk of stroke. Fifty-eight percent of patients with a stroke event died during follow-up compared with 23% without a stroke.

Conclusions
In patients on HD, stroke risk is broadly associated with risk factors previously described to increase cardiovascular risk in this population. Proactive intravenous iron does not increase stroke risk.

Clinical Trial registry name and registration number: Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL), 2013-002267-25
Comparison of the Sustainability of the Vegetable, Wet-White and Chromium Tanning Processes through the Life Cycle Analysis
Authors: Bacardit Anna , Combalia Felip , Font Joaquim , Baquero Grau 
Published: September 2021

Public concerns about the quality of life of human beings as well as the quality of natural environments and ecosystems have led to the increasing importance of sustainability for governments and for all industries, including the leather industry. In this context, more "ecological" leather goods are being demanded. It should be noted that this concept is often used without a scientific study to support it.
This concept of sustainable or ecological product in the field of leather goods, are mainly associated with chrome-free tanneries (that is vegetable and wet-white), but this association should be backed up or dismissed by scientific evidence. A complete scientific study is required, which takes into account the different stages of leather production, including also the treatment of water and by-products, analyzing in a scientific and systematic way the environmental impact of each of these tanning processes.
This study focuses on the life cycle analysis of the three basic tanning processes: chrome, vegetable and wet-white leather production. It will focus on European manufacturing to have reliable data and reduce uncertainty.
In the tanning stage, the process with the greatest impact is the vegetable one, to highlight its high impact on global warming at 100 years (GWP100). This result is due to the energy necessary for the production of mimosa and quebracho in addition to the energy for the processing of the leather in the drums.
Wet white tanning with glutaraldehyde has lowest environmental results than vegetable tanning.
The chrome tanning process (wet blue) also stands out for its reduced environmental impact.
Subsequently, to have a global view of the entire production, the LCA of the post-tanning stages must be performed to evaluate the impact of each of the systems studied.