bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between comprehensive dietary antioxidant index and erectile dysfunction in adult men: a cross-sectional study from the 2001-2004 U.S. National Health and Nutrition Examination Survey
Authors: Liu Meijun , Zhang Peihai 
Published: December 2024

Abstract

Background
Increasing evidence suggests that a diet rich in antioxidants may prevent erectile dysfunction (ED), but the impact of comprehensive dietary antioxidants on ED has been little studied.

Aim
To investigate the association between the composite dietary antioxidant index (CDAI) and ED risk in adult men.

Methods
The study performed a cross-sectional analysis using data from the 2001-2004 National Health and Nutrition Examination Survey to investigate the association between the composite dietary antioxidant index (CDAI) and ED. The connection between the CDAI and ED was assessed using univariate and multivariate weighted logistic regression models, as well as the restricted cubic spline.

Outcomes
Association between the CDAI and the prevalence of ED.

Results
The study included a total of 3699 participants, among whom 1042 were diagnosed with ED, resulting in a prevalence of 28.17%. Multivariate weighted logistic regression consistently showed a negative association between the CDAI and ED (OR = 0.95, 95% CI: 0.92-0.98, P = .005). The group with the highest CDAI (Q4) had a 33% reduced risk of ED than the group with the lowest CDAI (Q1) when the CDAI was regarded as a categorical variable (OR = 0.67, 95% CI: 0.49-0.91, P = .014). Restricted cubic spline analysis showed that the CDAI was linearly related to the risk of ED (non-linearity P = .652). Furthermore, subgroup analysis indicated that the inverse relationship between CDAI and ED was more pronounced in individuals under 60 years of age, those with diabetes, and those without hypertension.

Clinical Implications
Dietary strategies to increase antioxidant intake might offer a potential approach to reducing ED risk and supporting men’s sexual health.

Strengths and Limitations
This is a large-scale study investigating the association between the CDAI and ED. However, as a cross-sectional study, the timeliness of the dataset and the recall bias inherent in dietary data somewhat limit the reliability of the results.

Conclusion
This study identified a significant inverse association between the CDAI and ED risk among adult men in the United States; however, as a cross-sectional study, this research cannot establish causation, and further longitudinal studies are needed to validate these findings and provide more definitive evidence.
Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway
Authors: Ahmed Zahra , Zargaran Alexander , Zargaran David , Sousi Sara , Hakimnia Keiron , Panagiota Glynou Sevasti , Davies Julie , Hamilton Stephen , Mosahebi Afshin 
Published: December 2024

Background:
The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated.

Methods:
A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A bottom-up approach was adopted to calculate carbon dioxide equivalent estimates for the initial consultation, preoperative, intraoperative, and immediate postoperative periods.

Results:
This study estimated the carbon footprint of a patient undergoing DIEP flap surgery to be approximately 233.96 kg CO2eq. Induction, maintenance, and running of anesthesia had the highest overall contribution to the carbon footprint (158.17 kg CO2eq, 67.60% overall). Patient and staff travel contributed more than 15% overall carbon emissions in this study. The impact of sterilization was less than half of that from waste management (0.81 versus 1.81 kg CO2eq, respectively). Waste management alone contributed 4.21 kg CO2eq of the overall carbon emissions, the majority of which was accountable to the incineration of 14.75 kg of noninfectious offensive waste.

Conclusions:
This study estimates the carbon footprint of the DIEP pathway. Strategies to mitigate the impact of carbon emissions including usage of reusable vs single-use equipment, virtual consultations, standardization of equipment packs, and optimizing waste disposal were suggested areas for improvement. Data from manufacturers on life-cycle assessments were limited, and further work is needed to fully understand and optimize the impact of DIEP surgery on the environment.
LRP4 mutations promote tumor progression and resistance to anti-PD-1 therapy in recurrent hepatocellular carcinoma
Authors: Sun Rongqi , Liu Kaixuan , Pan Siyuan , Ye Yuhang , Li Ning , Chen Shuangyi , Cui Xinyi , Zhang Yuxi , Chen Long , Pan Jingyue , Hu Zhiqiang , Luo Chubin , Fan Jia , Zhou Zhengjun , Zhou Shaolai , Zhou Jian 
Published: December 2024

Background and Aims:
HCC recurrence is a major factor limiting long-term survival and the cause of most deaths in patients with HCC. However, molecular characterization and potential therapeutic targets of recurrent HCC remain mostly unknown.

Approach and Results:
We performed whole-exome sequencing in 63 matched primary and recurrent HCC tumors and combined the data with whole-genome sequencing results in 43 paired samples from our previous study. Sanger sequencing was used to identify all low-density lipoprotein receptor-related protein 4 (LRP4) coding exons in 203 additional patients with recurrent HCC. We identified LRP4 somatic mutations in 7.8% (24/309) of recurrent tumors and only 0.97% (3/309) of primary tumors (p<0.001). Prognosis after the second liver resection was poorer in patients with an LRP4 mutation. Biofunctional investigations demonstrated that inactivating LRP4 mutations promoted tumor progression and immunosuppression. Mechanistically, mutated LRP4 reduced intratumoral conventional type 1 dendritic cell and CD8+ T cell infiltration by repressing C-C motif chemokine ligand 4 expression and secretion through activation of β-catenin signaling, resulting in resistance to anti-programmed cell death protein-1 therapy. Patients with recurrent HCC carrying an LRP4 mutation did not benefit from anti-programmed cell death protein-1 treatment after their second resection surgery. A β-catenin inhibitor–reversed LRP4-induced resistance to anti-programmed cell death protein-1 therapy in humanized tumor-bearing mice.

Conclusions:
Our results identified novel LRP4 mutations important in recurrent HCC. Inactivating LRP4 mutations were associated with resistance to anti-programmed cell death protein-1 therapy and could be useful biomarkers for precision therapy in patients with recurrent HCC.
Transforming the logistics of liver transplantation with normothermic machine perfusion: Clinical impact versus cost
Authors: Gao Qimeng , Alderete Isaac S. , Aykun Nihal , Samy Kannan P. , Nauser Christopher L. , Raigani Siavash , DeLaura Isabel F. , Kahan Riley , Anwar Imran J. , Abraham Nader , Dunkman W. Jonathan , Miller Timothy E. , King Lindsay Y. , Berg Carl L. , Vikraman Deepak S. , Ravindra Kadiyala , Rege Aparna S. , Collins Bradley H. , McElroy Lisa M. , Jamieson Ian , Knechtle Stuart J. , Sudan Debra L. , Barbas Andrew S. 
Published: December 2024

Normothermic machine perfusion (NMP) facilitates the utilization of marginal liver allografts. It remains unknown whether clinical benefits offset additional costs in the real-world setting. We performed a comparison of outcomes and hospitalization costs for donor livers preserved by NMP versus static cold storage at a high-volume center. Adult patients receiving deceased donor liver transplants preserved by either NMP (TransMedics Organ Care System) or static cold storage between January 1, 2021, and December 31, 2023, were included. Donor and recipient characteristics, operative parameters, post-transplant outcomes, and hospitalization costs were compared. A total of 144 NMP and 149 static cold storage cases were included. A higher proportion of NMP cases were donation after circulatory death (38.2% vs. 4.7%, p<0.001). Despite a significantly higher Liver Donor Risk Index (2.1 vs. 1.7, p<0.001) and longer preservation time (877 vs. 355 min, p<0.001), recipients of NMP experienced lower rates of reperfusion syndrome (4.3% vs. 32.9%, p<0.001), less blood loss (1.5 vs. 3.0 L, p<0.001), and required less blood product transfusion. This resulted in shorter operative time for NMP cases (357 vs. 438 min, p<0.001) and significant reductions in both intensive care unit (3 vs. 5 d, p=0.005) and hospital length of stay (11 vs. 13 d, p=0.03). NMP facilitated the transition of cases to daytime hours (88.9% vs. 46.3%, p<0.001). Despite the clinical and logistical benefits observed, index hospitalization costs were significantly higher in the NMP cohort ($256,810 vs. $209,144, p<0.001), driven largely by higher organ acquisition costs ($135,930 vs. $50,940, p<0.001). In conclusion, utilization of NMP comes with an attendant increase in cost but provides substantial clinical benefit. Transplant programs must weigh these considerations in their practice environments before initiating an NMP program.
A retrospective cohort studying about time to recovery and its predictors among children aged 6–59 months admitted with severe acute malnutrition to inpatient therapeutic feeding centers at public hospitals in west Shoa Zone, Western Ethiopia.2022 G.C.
Authors: Mekonnen Chala , Abebe Mitsiwat , Mosisa Wagari 
Published: December 2024

Background:
World Health Organization recommends in patient therapeutic feeding program as a standard treatment protocol for the management of complicated severe acute malnutrition. This program has been decentralized to public hospitals in Ethiopia. Early recovery is a performance indicator for severe acute malnourished children for the therapeutic feeding.

Objective:
The aim of the study was to assess time to recovery and its predictors among children aged 6-59 months admitted with severe acute malnutrition to inpatient therapeutic feeding centers at hospitals in west Shoa zone, Ethiopia.

Methods:
Institution based retrospective cohort study was conducted on 428 children aged 6 to 59 months admitted with Severe Acute malnutrition cases at selected hospitals in West Shewa zone from January 1, 2017 to December 30, 2021. A total of 428 charts were selected using a systematic random sampling method and 395 of them were used for the final analysis. Kaplan–Meier estimates and survival curve were used to estimate the survival time, log-rank test was used compare survival time between groups of categorical variables, and Cox-proportional hazard model was used to identify significant predictor of the time to recovery. P value <0.05 was considered statistically significant.

Results:
The nutritional of recovery rate was 81.27% (95% CI; 77.09-84.83) with a median nutritional recovery time of 15 days (IQR; 10). The predictors of time to recovery were having HIV (AHR = 0.31, 95% CI, 0.14-0.66), Tuberculosis (AHR = 0.25, 95% CI, 0.16-0.38), not breast feeding until 24 months (AHR = 0.29, 95% CI, 0.22-0.41), partially vaccinated for age (AHR = 0.43, 95% CI, 0.31-0.61), Admitted during production season (AHR = 0.49, 95% CI, 0.37-0.67) and not took deworming (AHR = 0.60, 95% CI, 0.48-0.75) were associated with longer periods of nutritional recovery time.

Conclusion and recommendations:
Both percentage of recovery and the recovery time were within the acceptable minimum standards. But special attention has to be given to children who having HIV, Tuberculosis, breast feeding less than 24 months, partially vaccinated for their age, children admitted during production season and not supplementing with deworming during inpatient management. The health workers with different stages of health administer must increase the awareness of breastfeeding, fully vaccination and ways of preventing communicable disease.
Genetic evidence of circulating metabolites linking to gastric cancers: a two-sample Mendelian randomization study
Authors: Haiwen Yu , Yongjian Liu , Penglong Xie , Wanting Feng , Dongchu Xu 
Published: December 2024

Observational studies have implicated that blood metabolites were correlated with gastric cancer. This study was designed to reveal the potential causal link between gastric cancer and the levels of circulating metabolites. Single-nucleotide polymorphisms associated with lipid traits in univariate analysis were obtained from the Genome Wide Association Study (GWAS) repositories, involving 8299 European individuals, respectively. Blood metabolites in multivariate analysis were obtained from the latest GWAS Catalog, covering 850 known and 241 unknown metabolites, plus 309 metabolite ratios. Data on gastric cancer were obtained from the FinnGen Consortium, including 279 444 individuals of European descent, 1037 cases of which were gastric cancer. Subsequently, MR analysis was performed using conventional methods, including inverse variance-weighted, weighted median, weighted-mode, simple-mode and MREgger regression to demonstrate the causal relationship between circulating metabolites and gastric cancer. Two-sample Mendelian randomization method showed that seven circulating metabolites (X-24588, SAH to ribothymidine ratio, histidine to asparagine ratio, 1-dihomo-linolenylglycerol, ribothymidine, 2-linoleoylglycerol levels, and 2ʹ-o-methyluridine) were causally associated with the risk of gastric cancer. After verification of MR results and meta-analysis, levels of histidine to asparagine ratio, SAH to ribothymidine ratio, and 2ʹ-o-methyluridine consistently achieved statistical significance. Furthermore, histidine metabolism was identified as the most significant metabolic pathway. It is indicated that three circulating metabolites (histidine to asparagine ratio, SAH to ribothymidine ratio, and 2ʹ-o-methyluridine) achieved statistical significance in the casual relationship with the occurrence of gastric cancer, indicating that histidine metabolism may serve as the crucial metabolic pathway and therapeutic targets for gastric cancer.
The diagnostic dilemma of adult-onset Still’s disease: a case report
Authors: Yadav Manoj Kumar , Rauniyar Aarati , Magar Lalkiran Gharti , Rouniyar Sangam , Adhikari Bigyan , Sah Sandip Kumar 
Published: December 2024

Introduction and importance:
Adult-onset Still’s disease (AOSD) is a rare auto-inflammatory disorder, characterized by high-grade fever, arthritis, and a variety of systemic signs/symptoms. AOSD is very often misdiagnosed because of the overlapping clinical features, necessitating a thorough differential diagnosis, especially in cases of fever of unknown origin (FUO).

Case presentation:
A 55-year-old male with high-grade fever, myalgia, and arthralgia for the past 4 weeks. Yamaguchi criteria for AOSD met following an extensive evaluation. Laboratory findings showed leukocytosis with neutrophilic predominance, elevated ferritin levels, and mild abnormalities in liver function tests. The patient was started on intravenous corticosteroids, followed by oral corticosteroids in tapering dose of the drug and the introduction of methotrexate as a steroid-sparing agent (DMARDs).

Clinical discussion:
The case illustrates the diagnostic challenges associated with AOSD in older persons and the importance to consider this condition in the context of a FUO. The diagnosis of AOSD remains exclusive, yet effective management typically involves corticosteroids and DMARDs.

Conclusion:
AOSD, though rare, can occur uncommonly in older populations. This case highlights the need for awareness among clinicians to ensure early diagnosis and appropriate management, ultimately aiding in better outcomes of patient.
Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings
Authors: Rahnemayan Sama , Ala Alireza , Taghizadeh Nasrin , Sadeghi-Hokmabadi Elyar , Entezari Ipak , Shamsvahdati Samad 
Published: December 2024

Objectives:
The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened version, for its efficacy compared with NIHSS-11 in an emergency department setting.

Methods:
A cohort study was conducted from May 2018 to May 2019 at Imam Reza Hospital, Tabriz, Iran. Patients with suspected acute stroke were assessed using both NIHSS-11 and NIHSS-8. The modified Rankin Scale (mRS) was used to evaluate patient outcomes at discharge. Correlations between NIHSS-8, NIHSS-11, and mRS were analyzed, and diagnostic performance metrics were calculated.

Results:
The study included 292 patients with a mean age of 70.40 years. Approximately 68.5% of patients were categorized as having moderate stroke severity using NIHSS-11, with a similar 67.1% using NIHSS-8. The correlation between NIHSS-11 and NIHSS-8 scores was high (intraclass correlation coefficient of 0.970). Both scales showed strong relationships with mRS at discharge but were not significantly correlated with long-term outcomes. NIHSS-8 demonstrated a sensitivity of 97.5% and specificity of 96.9%, while NIHSS-11 showed 100% sensitivity and 96.9% specificity.

Conclusions:
NIHSS-8 is a reliable and efficient alternative to NIHSS-11 for assessing stroke severity in emergency departments. It provides high sensitivity and specificity while being less time-consuming, making it suitable for rapid stroke assessment and triage.
Peatland restoration can provide climate change mitigation over all time-scales: A UK case-study
Authors: Zhang Xiao , Ots Minna , Johnston Eleanor , Brown Kathryn , Doar Nigel , Lynch John 
Published: December 2024

AbstractPeatlands provide one of the largest terrestrial carbon stocks in the UK. However, a large proportion of peatlands are drained for peat extraction, agriculture and other uses, turning them into a major source of the UK’s land use greenhouse gas (GHG) emissions. Successful restoration can ultimately return peatlands into carbon sinks. However, rewetting - the primary step in peatland restoration - can reduce CO2emissions while increasing CH4emissions. This may result in little overall climate benefit, or even increased warming for several years post peatland restoration, as CH4is a short-lived but strong GHG, and may overpower the reduction in CO2. Such consequences are rarely explored in detail, since most studies are based on comparing total CO2-equivalent emissions pre- and post-restoration using the 100-year Global Warming Potential (GWP100), which can fail to reveal the full dynamics. We evaluated the emissions and resultant climate impacts from peatland restoration using data from The Wildlife Trusts, a federation of UK-based conservation charities, as a case-study. The total emissions of each restoration stage were estimated by multiplying peatland areas under restoration with up-to-date UK emission factors (EF), then compared under multiple pulse emission metrics (GWP100, GWP20, GTP100) to indicate the impacts over a range of time-horizons, and GWP* to reveal the varying warming impacts over time. We also used Monte-Carlo Simulation to investigate the uncertainties in total emissions drawing from EF ranges. We found that the restoration so far has provided large emission reductions under all metrics, even considering the uncertainties. Increased CH4is unlikely to cause extra warming in the extremely near-term (<20 years), and if the peatlands are maintained in their rewetted states, they can contribute to net-cooling in the long term. There is less certainty over the climate benefits of further restoration, from rewetted to “near-natural” states, especially in the shorter term, but we argue that any risks are low, while this continued restoration will provide further ecological benefits and support biodiversity. Our study lends further support for peatland restoration in the UK and other regions with similar habitats, and provides insight into the climate roles of peatlands more broadly.
Simulating Alpha Particle Doses at the Micron Scale from Prostate Cancer Patient Derived Bone Metastatic Biopsies Using GATE
Authors: Said Abdulaziz , Hamdi Mahdjoub , Salerno Isabella , Benabdallah Nadia , Turtle Norman F. , Abou Diane , Allan Thomas M. , Mikell Justin , Thorek Daniel 
Published: December 2024

AbstractRadiopharmaceutical therapies are poised to enhance patient care for several currently untreatable metastatic cancers. Radium-223 dichloride citrate is indicated for treatment of bone metastatic castrate resistant prostate cancer, serving as the primary use of alpha particle emitting radium to irradiate bone lesions. Improvements and refinement of such therapies relies on patient centric and micro scale quantification to assess and compare efficacy. Computational modeling and Monte Carlo simulations provide a valuable tool for understanding micro scale phenomena of radiopharmaceutical therapies. Via simulation, we undertake and illuminate dose profiles of radium-223 dichloride treatment, evaluating energy and dose distributions based on primary, patient-derived specimens. A set of four activity distributions were simulated on three patient bone lesion biopsy samples. These simulations validate the novel tool for micron-scale modeling with patient-derived specimens. Ablative dose profiles are shown to be driven by uptake distributions as well as the target tissues’ microstructure.
Low and facultative mycorrhization of ferns in a low-montane tropical rainforest in Ecuador
Authors: Michel Jennifer , Lehnert Marcus , Nebel Martin , Quandt Dietmar 
Published: December 2024

AbstractArbuscular mycorrhizal fungi (AMF) are amongst the most studied plant symbionts and regularly found in terrestrial plants. However, global estimates of AMF abundance amongst all land plants are difficult because i) the mycorrhizal status of many non-commercial, wild plant species is still unknown ii) numerous plant species engage in facultative symbiosis, meaning that they can, but do not always do, associate with mycorrhiza and iii) mycorrhizal status can vary amongst individuals of one same plant species at one location, as well as for different plant species within a given genus or family.To gain new insights to the pristine distribution of the plant-AMF symbiosis, we investigated the mycorrhizal status of one of the oldest lineages of extant vascular plants, Polypodiophyta (aka ferns), in one of the hotspots of natural plant diversification, the tropical rainforest. Providing a new data set of AMF abundance for 79 fern species, we hypothesized that (1) AMF would be found in 60-80% of the studied plants and (2) plant species with AMF symbionts would be more abundant than non-mycorrhizal species.Both hypotheses were rejected while unexpected observations were made: (1) AMF occurred in 33% of studied species, representing 56% of the studied fern families, (2) AMF colonisation was not correlated with species abundance, (3) a small but significant proportion of AMF-positive ferns was epiphytic (7%) and (4) as expected, mycorrhization was inconsistent among different populations of the same species.Together this empirical data supports recent reservations regarding global abundance of AMF, and further demonstrates that mycorrhization is not a taxonomic trait. In addition, the occurrence of AMF in epiphytic plants and no net benefits of AMF for plant abundance indicate that the mycorrhization observed here is on the commensalism, possibly parasitism, side of the symbiosis spectrum.HighlightsSmall fraction of fern species mycorrhized (33% species level, 56% of families)Mycorrhization of species can vary with location (facultative symbiosis)AMF colonisation does not increase plant species abundanceAMF presence in epiphytic ferns suggests commensalism / parasitism