bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Insulin Resistance using the Glucose Tolerance Insulin Response (GTIR) Test and Homeostasis Model Assessment-Estimated Insulin Resistance (HOMA-IR) Test
Authors: Kardus Mona F. , Hallak Rana A. , Alakedi Ahmed , Abdulkarim Alaa S , Alsheddi Shaykhah , Farhan Fouzah S. , Alyousef Othman Y. , Alturki Ruwayda A. , Kurdi Youssef , Mewally Salma A. 
Published: December 2024

Abstract

Background:
The rising global number of Diabetes mellitus (DM) cases indicated the significance of early detection of insulin resistance trying to decrease the economic and healthcare burden caused by DM.

Objectives:
This study aimed to evaluate the efficacy of using Homeostasis Model Assessment-Estimated Insulin Resistance (HOMA-IR) and to define a suitable HOMA-IR cut-off value. The difficulty of performing a euglycaemic-hyperinsulinaemic clamp in extensive studies has stimulated the importance of using and developing surrogate insulin sensitivity indices.

Design:
Retrospective cohort study.

Setting:
Involved 397 participants referred from outpatient clinics at Dr. Sulaiman Alhabib Hospital between January 2011 and December 2021 for a Glucose Tolerance/Insulin Response test.

Methods:
Data was obtained from the electronic medical system in Dr. Sulaiman Alhabib hospital. Insulin response interpretation was based on the Kraft pattern, classifying insulin patterns into five types. HOMA-IR was calculated using the formula HOMA-IR = (FPI*FPG)/22.5. Statistical analyses were performed using MedCalc Statistical Software version 20. Receiver Operating Characteristic curves were plotted to assess the diagnostic performance of HOMA-IR in distinguishing between cases and non-cases of insulin resistance. The area under the curve and 95% confidence intervals were calculated. The Youden index was used to select the optimum cut-off points.

Results:
Youden index was used for selecting the optimum cut off points. For the combined dataset, a cut-off value of >1.93 showed a sensitivity of 66.91% and specificity of 71.31%. The logistic regression was used to assess various predictors of the development of diabetes mellitus. impaired glucose tolerance, impaired fasting glucose, or gestational diabetes. Insulin resistance based on HOMA-IR was a significant predictor.

Conclusion:
Insulin resistance is a hallmark of type 2 diabetes. Establishing and using a sensitive and specific population-based cut-off for HOMAIR is highly recommended for early detection of insulin resistance. The study faced some challenges such as limited participants and incomplete follow-up.
A Comparison of Effective doses for the 16, 64, and 128-slice Computed Tomography Scanners: A First Health Cluster Study in Riyadh
Authors: Al Moudi Mansour , Al Dosari Sultan , Al Hussain Abdullah Ibrahim , Abounassif Mazen 
Published: December 2024

Abstract

Objective:
This study aimed to compare the effective doses among 16, 64, and 128-slice computed tomography (CT) scanners. Several strategies have been implemented to reduce the radiation dose from CT, including a low tube voltage, a high pitch protocol, automatic tube current modulation, and iterative reconstruction algorithms. These strategies have reduced the radiation dose from the previously reported >20 mSv to <3–5 mSv or even <1 mSv. This study compared the radiation doses associated with routine CT scans performed using various multi-slice CT scanners.

Materials and Methods:
A total of 330 patients who underwent CT scans as part of their routine clinical diagnoses from December 4, 2018, to March 26, 2019, were screened cross-sectionally. CT scans were performed using 16-slice GE HealthCare BrightSpeed, 64-slice GE HealthCare Discovery CT750 HD, and 128-slice Siemens Healthineers SOMATOM Definition Flash CT scanner systems. The parameters considered in the analysis were age, sex, body region, scanner type (16, 64, and 128 slices), dose length product, and the estimated mean ED. The effective radiation dose was calculated using the dose length product and compared among the scanner types.

Results:
We evaluated the CT scans of 166 men (50.3%) and 164 women (49.7%) patients. Among the three types of CT scanners used, the 16-slice CT scanner had the highest effective radiation dose for brain (P = 0.024), paranasal sinus (P = 0.027), cervical spine (P = 0.04), chest (P < 0.001) and pelvis (P = 0.014).

Conclusion:
The 16-slice CT scanner has the highest effective radiation dose compared to the 64 and 128-slice scanners. When performing routine CT scans with low-end CT scanner systems, dose-reduction strategies should be considered.
Understanding the Multifaceted Factors Contributing to Autism Spectrum Disorder: A Comprehensive Evidence-Based Narrative Review
Authors: Alsawadi Razan Adib , Jihwaprani Muhammad Candragupta , Sula Idris , Hafez Bushra , Alkhatib Muhannad Mamoun , Qadri Mohammed Arshad 
Published: December 2024

Abstract
Autism spectrum disorders (ASD) are among the most prevalent chronic neurodevelopmental conditions, typically manifesting early in life. They are characterized by challenges in communication and social interaction, as well as repetitive and restrictive behaviors. One of the key features of ASD is its heterogeneity, which indicates a broad spectrum of presentations and predisposing factors. Despite the numerous associated factors that have been studied and proposed to influence the etiology of ASD, the exact cause has not yet been determined. In this work, we undertake a thorough evidence-based study of the risk factors based on systematic reviews and meta-analysis from current literature. We examine the complexity and diversity of genetic risk factors associated with ASD to highlight the wide range of genetic variations and alterations implicated in the development of the condition. Furthermore, we consider familial risk factors and environmental influences, including pre-conception and prenatal factors, obstetrics-related conditions, and early childhood environmental risks. Identifying the at-risk population provides valuable insights for improving understanding, raising awareness, and supporting primary prevention efforts.
Clinical Utility of Systemic Inflammation Markers in Identifying Endometrial Hyperplasia and Adenocarcinoma
Authors: Bıldacı Tevfik B. , Ata Can , Avsar Huseyin A. , Atlıhan Ufuk , Erkılınc Selcuk 
Published: December 2024

Abstract

Introduction:
Inflammation and its associated factors play a pivotal role in the development and progression of cancer. Inflammation markers, such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and the systemic immune-inflammation index can be readily calculated to gauge the level of inflammation. This study aimed to investigate the correlation between these inflammation markers and their role in the progression stages of endometrial cancer.

Methods:
A retrospective analysis was conducted on data collected from 154 patients. The patients were categorized into three groups: normal endometrium, hyperplasia with atypia, and endometrioid-type endometrial cancer. The differences in inflammation marker values among these groups were examined and identified.

Results:
The systemic immune-inflammation index (SII) findings revealed a nonsignificant trend in differentiation between the study groups; however, a significant inverse relationship was observed in the lymphocyte-to-monocyte ratio (LMR) values across the groups (P = 0.037). Post hoc analysis further demonstrated a significant difference in SII values between the group with normal endometrium and group with endometrial cancer (P = 0.042).

Conclusion:
These findings suggest that the SII and LMR show potential as biomarkers for distinguishing between endometrial pathologies in age-controlled patient cohorts.
Isolation, Culture, and Characterization of Primary Kidney Fibroblasts from Human Patients with Chronic Antibody-mediated Kidney Transplant Rejection
Authors: Singh Mantabya Kumar , Rai Mohit Kumar , Agarwal Vikas , Prasad Narayan 
Published: December 2024

Background:
Inflammation and fibrosis are the primary occurrences of chronic antibody-mediated rejection (CABMR) in kidney transplant patients. Fibroblasts are the primary cell type involved in allograft rejection and play a crucial role in the pathogenesis and progression of chronic antibody-mediated rejection (CABMR). The in vitro study of the fibroblast is essential for comprehending biological processes and molecular reasons for CABMR and creating innovative treatment methods. However, establishing primary cultures from the kidney tissue is challenging.

Aim and Objective:
This protocol describes a simple and reproducible method for selective propagation and culture of primary human kidney fibroblasts from kidney cortex tissue. Techniques for their isolation and characterization are described in detail.

Material and Methods:
Primary kidney fibroblast cell culture was performed with a single core of fresh allograft biopsy tissue collected from the patients with CABMR. The biopsy tissue was collected in normal saline or phosphate buffer saline (PBS) and transported immediately on ice to the cell culture laboratory of the department.

Results:
An inverted microscope imaging shows the fibroblast cells during the first passage at 14th day, the cells were characterized by fingerprint monolayers when they were more than 80 % confluent. During the fourth passage at day 90, these cells took on the appearance of a long, elongated, spindle shaped. The immunofluorescence (IF) staining, shows the primary kidney fibroblast cells at the fourth passage were strongly positive for the fibroblast marker, Collagen I (fibrogenic cells), α-SMA (Resident fibroblast to active myofibroblasts conversion), and Vimentin (mesenchymal cells). On the other hand, the epithelial marker, cytokeratin-8, and E-cadherin were found to be very weak positive.

Conclusion:
This study provides an optimized, simple, and cost-effective method for primary fibroblast cultures from kidney tissue that may be reproducible easily at various laboratories and will provide a rich resource for future studies and research.
To Determine Factors Causing Difficulty in Laparoscopic Donor Nephrectomy – Prospective Analytic Study
Authors: Dokania Manoj Kumar , Anshu  , Kumar Peeyush , Ranjan Gyan , Agarwal Nitin , Goel Hemant Kumar , Jain Atul 
Published: December 2024

Background:
Concerns about laparoscopic donor nephrectomies exist. First and foremost, donor safety is a top priority. Second, the kidneys obtained through laparoscopic donor nephrectomy should provide recipients of kidney transplants with excellent short- and long-term renal function. This study aimed to determine the preoperative and intraoperative factors that affect the variation in the laparoscopic donor nephrectomy operative time, as well as the factors that contribute to the difficulty of the procedure.

Materials and Methods:
This prospective analytical study was carried out in the transplant unit over a 2-year period. The study involved all healthy adult donors scheduled for a left-sided laparoscopic nephrectomy. Another parameter used to evaluate the procedure’s results was a difficulty index.

Results:
A total of 33 transplant donors in all who met the requirements for inclusion were included. A laparoscopic left-sided donor nephrectomy was performed on 31 donors, while two donors underwent an open donor nephrectomy conversion. The average age of donors is 43.4 ± 5.65 years, with females outnumbering males. Males had a mean surgery duration of 163.8 min, while females had a mean of 148.4 min. The maximum patient’s body mass index ranges from 24 to 27.9 kg/m2, and the mean operating time is between 158.5 and 149.7 min. The likelihood of conversion and complications rises with the difficulty index, resulting in longer hospital stays.

Conclusion:
The difficulty of a laparoscopic live donor nephrectomy can be predicted by a number of factors, including sex, anatomical variance of multiple vessels, and pyelonephric adhesions, which continue to be important parameters.
Anti T-lymphocyte Globulin (Grafalon®) Use during Rabbit Anti-thymocyte Globulin (Thymoglobulin®) Shortage – A Single-center Experience
Authors: Tiwari Shailendra , Rao Namrata S , Chandra Abhilash , Ansari Majibullah , Singh Sanjeet Kumar 
Published: December 2024

Introduction:
During a period of local nonavailability of rabbit anti-thymocyte globulin (rATG) in India, anti-T-lymphocyte globulin (ATLG) was utilized in high-risk renal transplantation. The study aimed to compare renal transplant recipients (RTRs) in two study periods with rATG and ATLG induction use, in terms of biopsy-proven acute rejection (BPAR) rates, patient and graft survival and infectious complications in the 1st year and beyond.

Methods:
This retrospective, single-center study compared two time periods: June 2019–June 2021 (Period I – rATG induction) and July 2021–October 2022 (Period II – ATLG induction). Only immunologically high-risk, ABO-compatible living donor RTRs were included. Clinical data were sourced from hospital information system, and only infections requiring hospital admissions were collected. Missing information was collected telephonically.

Results:
A total of 78 RTRs were included in the analysis, of whom 28 received rATG at a dose of 3 mg/kg (Period I) and 50 received ATLG at a dose of 5–6 mg/kg (Period II). Delayed and slow graft function (SGF) were significantly increased in Period II (12%, 12% vs. 10.7%, 7.1%, respectively, P < 0.001), trend toward increased BPAR episodes in Period II (12% vs. 10.7%, P = 0.155) and similar death-censored graft survival [60.6 months in Period I vs 73.4 months in Period II (P=0.66)]. Infection-related admissions were significantly lower in Period II. First year rejection-free and infection-free survival plots were similar in the two periods (log-rank test P > 0.05).

Conclusion:
The use of 5–6 mg/kg dose of ATLG (a relatively low dose) during rATG nonavailability, was associated with higher delayed and SGF, similar BPAR, graft and patient survival rates, and lower risk of infectious complications in immunologically high-risk patients.
Auto-delineation of the hippocampus using Mask R-CNN for radiation oncology: A cross-sectional observational study
Authors: Laud Adwait , Talapatra Kaustav , Sankhe Manoj , Gupte Ajinkya , Shetty Ashish , Bardeskar Nikhil , Kanikar Prashasti , Rout Abhishek , Barsing Shubhangi , Tiwari Pranjal , Shah Arya , Patkar Deepak 
Published: December 2024

ABSTRACT

Objective:
Radiotherapy is an effective treatment for brain tumors, but it can lead to adverse side effects, particularly neurocognitive dysfunction. The hippocampus, a crucial structure for memory formation, is vulnerable to radiation-induced damage. To reduce the risk of adverse effects, the precise delineation of the hippocampus is necessary for radiation therapy planning. Automated hippocampal delineation using deep learning and mask regions with convolution neural networks (R-CNN) algorithm reduces the manual delineation time, ensures accuracy, and supports its implementation in radiation therapy. This study aimed to develop an automated method for hippocampal delineation and assess its feasibility for brain radiation treatment using deep learning and Mask R-CNN algorithm.

Materials and Methods:
The study applied several pre-processing techniques, including thresholding, Canny edge detection, and keypoint detection, to enhance the input images of patient hippocampal scans. The processed images were then analyzed using the Mask R-CNN algorithm for automated hippocampal delineation. The Mask R-CNN algorithm was assessed using the following metrics: accuracy, recall, intersection over union (IoU), and mean average precision (mAP).

Results:
The proposed network achieved a mAP of 96.2% and average sensitivity of 0.93, indicating high segmentation accuracy. Moreover, the recall was 0.87 and specificity was 0.96, indicating the high specificity of the method to segment the hippocampus.

Conclusions:
The results of this study suggest that the developed automated method is highly sensitive and specific for delineating the hippocampus. This automated segmentation method may be used to complement the manual review of hippocampal scans during radiotherapy planning for brain tumors.
Definitive radiotherapy with nodal boost for radiologically positive nodes in carcinoma cervix – A retrospective cohort study
Authors: Alexander F Hadrian Noel , Udayashankara Avinash H. , Nirmala S , Sebastian M G John , Muzumder Sandeep , Raju Jayalekshmi , Tripathy Arkaja , Ghosh Santu 
Published: December 2024

ABSTRACT

Background and Purpose:
Definitive radiotherapy (RT) with concurrent cisplatin-based chemotherapy (CT) is the standard of care for the treatment of locally advanced carcinoma uterine cervix. Lymph node (LN) metastasis is one of the major prognostic factors. We plan to analyze the node-positive carcinoma cervix (NPCC) patients treated at our institution.

Materials and Methods:
All NPCC treated with Definitive RT with or without concurrent CT from January 2013 to December 2021 were included in the analysis. Patients were treated to a dose of 4500 cGy, and the gross LNs were boosted to a dose of 6000 cGy in conventional fractionation (180-200 cGy) using three-dimensional conformal radiotherapy or intensity modulated-image guided radiotherapy (3DCRT/IM-IGRT) along with high dose rate (HDR) brachytherapy. We plan to analyze overall survival (OS), disease-free survival (DFS), toxicities, and various factors that might impact the outcome of treatment.

Results:
92 patients were eligible for analyses. With a median follow-up of 36 months, two patients lost to follow-up. The 3-year and 5-year OS was 86% and 77%, respectively. On log-rank analysis, the number of LNs boosted significantly impacted the OS but not with any other factors. The 3-year and 5-year DFS was 81% and 77%, respectively. There were 16 (17.2%) Grade 3 acute toxicities in 15 patients. The most common acute toxicity was gastrointestinal (6.45%). Four patients (4.3%) had developed Grade 3-4 late toxicity.

Conclusions:
Definitive radiotherapy with concurrent chemotherapy for NPCC with boost to the enlarged LNs results in good survival outcomes with acceptable toxicities.
Assessment of pulmonary function tests in carcinoma esophagus patients treated with three-dimensional conformal radiation therapy versus intensity-modulated radiation therapy
Authors: Goyal Navik , Garg Pardeep , Kaur Kiranjit , Kang Manraj , Grover Romi , Singh Simrandeep , Kaur Gurpreet , Gaur Garima 
Published: December 2024

ABSTRACT

Background:
Three-dimensional conformal radiation therapy (3DCRT) provided enhancement in target delineation for the avoidance of normal structures, but considerable doses are still received by normal tissues. Intensity-modulated radiation therapy (IMRT) manipulates the photon beams of radiation to conform to the shape of a tumor and deliver precise radiation doses to the tumor, while sparing normal tissues. The distinct dosimetric advantages of IMRT have been proven by various studies.

Materials and Methods:
Forty histologically proven esophageal carcinoma patients were treated in ARM A (3DCRT) and ARM B (IMRT) and were evaluated for clinical lung toxicity in each arm. Pulmonary function tests and chest radiographs were done preradiotherapy, 6 weeks of radiotherapy, and 6 months of radiotherapy for evaluation and thereafter compared for lung toxicity between both arms. RTOG lung toxicity grading was used to assess clinical lung toxicity.

Results:
We observed in the present study that lung toxicity was seen in patients of esophageal cancer postradiotherapy in both modalities. It was less in IMRT than 3DCRT but not of significant difference. Various levels of restriction were seen in pulmonary function test or spirometry that is mild, moderate, or severe. At 6 weeks of radiotherapy, in ARM A, five patients (25%) and in ARM B, and four patients (20%) had moderate restriction (P value = 0.295). At 6 months of radiotherapy, in ARM A, seven patients (35%) and, in ARM B, five patients (25%) had severe restriction (P value = 0.681).

Conclusion:
We observed that 3DCRT is comparable to IMRT in terms of lung toxicity in esophageal cancer patients as proven from clinical toxicity data. More follow-up is required to see the chronic changes and overall survival.
Incidental finding of diffuse Tc-99m methylene diphosphonate uptake in lungs in a patient with renal insufficiency and lymphoma
Authors: Koç Zehra P. , Özcan Pınar P. , Balcı Yüksel , Sayar Hamide , Turgutalp Kenan 
Published: December 2024

ABSTRACT
Metastatic calcification of the lungs is presented with increased Tc-99m methylene diphosphonate (MDP) accumulation which was reported previously in usually benign causes including pneumonia and renal insufficiency. F-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the gold standard imaging modality in staging of the lymphoma and an accurate modality in showing dissemination of the disease. This case report presents a patient with primary unknown tumor presented by lythic bone metastasis in F-18 FDG PET/CT and increased Tc-99m MDP accumulation in both lungs due to the renal insufficiency in bone scintigraphy who was diagnosed as lymphoma by lymph node biopsy results.
Impact of immobilization devices on the inter-fractional setup error and planning target volume for pelvic radiation therapy
Authors: Agarwal Priyanka , Upadhyay Neeraj , Agarwal Jaiprakash , Nanda Sambit S. , Ajay GV , Mukherjee Ashutosh , Pradhan Satyajit 
Published: December 2024

ABSTRACT

Objectives:
To assess inter-fractional setup errors for patients undergoing pelvic radiation therapy and to determine the optimal immobilization devices, we compared the margins between the clinical target volume and planning target volume while using full immobilization devices, partial immobilization devices, and no immobilization devices in terms of systematic and random errors.

Materials and Methods:
The study was retrospectively conducted at a tertiary care facility and involved three groups of patients. Group A did not use immobilization devices but instead used a knee rest and a U-shaped pillow for patient comfort during the simulation. Group B used a partial-immobilization configuration with an all-in-board (AIO) base plate, a neutral neck rest (NNR), and a knee rest during the simulation. The final group, Group C, used immobilization devices including an AIO baseplate and Vac-lok with NNR during the simulation. All three groups of patients were positioned in a head-first supine position with arms up. The departmental IGRT protocol was followed, with kV CBCT acquired for the first three consecutive days and twice-weekly kV-CBCT imaging for the remaining fractions. Translational displacements, systematic errors, and random errors were calculated for all patients. The CTV to PTV margins were then calculated using the well-known margin recipe Van-Herk formula.

Results:
The study included 125 patients receiving pelvic radiation therapy, and 1297 kV-CBCT images were analyzed. The estimated CTV to PTV margin was lower in Group C patients for all three directions, AP, ML, and CC. However, Group B setup errors were observed slightly more in all three directions than in Group C patients. The largest CTV to PTV margin was found to be 7.1 mm in the ML direction for Group A patients.

Conclusion:
To improve setup reproducibility and patient comfort while minimizing errors in all three directions, we recommend using a partial immobilization setup for patients receiving pelvic radiation therapy.