bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of hepatic steatosis on liver stiffness measurement by vibration-controlled transient elastography and its diagnostic performance for identifying liver fibrosis in patients with chronic hepatitis B
Authors: Chen Zhiyuan , Huang Ye , Zhang Yan , Zhou Dongjing , Yang Yu , Zhang Shuping , Xiao Huanming , Li HaiXia , Liu Yupin 
Published: November 2024

Abstract
Objectives
To explore the impact of hepatic steatosis measured by MRI-proton density fat fraction (MRI-PDFF) on liver stiffness measurement (LSM) value and its diagnostic performance for staging liver fibrosis in patients with chronic hepatitis B (CHB).

Methods
A total of 914 patients with CHB who underwent liver biopsy and MRI-PDFF were retrospectively reviewed. The influence of MRI-PDFF on LSM value was assessed using univariate and multivariate linear analyses. To assess the influence of liver steatosis on the diagnostic performance of LSM, a series of ROC analyses were performed and compared by stratifying patients into non-steatosis (PDFF < 5%) and steatosis (PDFF ≥ 5%) groups according to MRI-PDFF values. The effects of different LSM cut-off values on the false-positive rate in the steatosis cohort were compared using McNemar’s test.

Results
LSM values were significantly affected by MRI-PDFF in the entire cohort (B-coefficient: 0.003, p < 0.001), F1 cohort (B-coefficient: 0.005, p < 0.001), and F2 cohort (B-coefficient: 0.003, p = 0.002). Hepatic steatosis was not observed to have a significant influence on the ROC curve of LSM for staging liver fibrosis. Compared with using the cut-off values for the CHB cohort, using relatively higher cut-off values for hepatic steatosis significantly improved the false-positive rate of LSM in the steatosis cohort.

Conclusion
Steatosis significantly influenced LSM, with a higher value in the early stage of liver fibrosis but did not affect the diagnostic efficiency of LSM for staging liver fibrosis. Moreover, using relatively high cut-off values significantly improved the false-positive rate of LSM in CHB patients with steatosis.

Clinical relevance statement
The identified correlation between MRI-PDFF and VCTE-measured LSM is not clinically relevant since the diagnostic performance of LSM in staging liver fibrosis is not affected by steatosis. A higher cut-off should be applied in CHB patients with steatosis to improve the false-positive rate.

Key Points

Steatosis can affect liver stiff measurement (LSM) values in the early stage of liver fibrosis.

The diagnostic performance of LSM in staging liver fibrosis is not affected by steatosis.

LSM’s cutoffs should be increased in patients with steatosis to improve the false-positive rate.

Graphical Abstract
Patient-related prognostic factors for function and pain after shoulder arthroplasty: a systematic review
Authors: Hesseling Brechtje , Prinsze Nisa , Jamaludin Faridi , Perry Sander I. B. , Eygendaal Denise , Mathijssen Nina M. C. , Snoeker Barbara A. M. 
Published: November 2024

Abstract
Background
While shared decision making is a cornerstone of orthopedic care, orthopedic surgeons face challenges in tailoring their advice and expectation management to individual shoulder arthroplasty patients due to the lack of systematically summarized evidence-based knowledge. This systematic review aims to provide an overview of current knowledge on independent predictive effects of patient-related factors on functional and pain-related outcomes after shoulder arthroplasty.

Methods
We included longitudinal cohort studies including patients receiving total or reverse shoulder arthroplasty or hemiarthroplasty for primary osteoarthritis or cuff tear arthropathy. Studies with only univariable analyses were excluded. MEDLINE, Embase, and CINAHL databases were last searched on June 27, 2023. Risk of bias was evaluated using the QUIPS tool. For the analyses, we divided outcomes into three domains (Functional Recovery, Pain, and Functional Recovery & Pain) and four time points (short term, medium-short term, medium-long term and long term). When appropriate, meta-analyses were conducted to pool regression coefficients or odds ratios. Otherwise, results were summarized in a qualitative analysis. We used the GRADE approach to rate the certainty of the evidence.

Results
Thirty-three studies analyzing over 6900 patients were included; these studied 16 PROMs and 52 prognostic factors. We could perform meta-analyses for six combinations of prognostic factor, domain, and time point. Only the meta-analysis for medium-long term poor ASES scores indicated worse outcomes for previous shoulder surgery (OR (95%CI) of 2.10 (1.33–3.33)). The majority of reported factors showed unclear or neutral independent effects on functional outcomes.

Conclusions
Methodological heterogeneity and selective/incomplete reporting prevented us from pooling most results, culminating in a largely qualitative analysis. Depression, preoperative opioid use, preoperative ASES and SST scores, surgery on the dominant side, previous surgery, male gender, no. of patient-reported allergies, back pain, living alone, CTA vs OA, diabetes, and greater preoperative external ROM predicted neutral to worse or worse outcomes. In contrast, higher electrical pain threshold on the operative side, OA/RCA vs other diagnosis, and private insurance vs Medicaid/Medicare predicted neutral to better or better outcomes.
These results can help orthopedic surgeons tailor their advice and better manage expectations.

Systematic review registration
PROSPERO CRD42021284822.
CUL4A-DDB1-circRFWD2 E3 ligase complex mediates the ubiquitination of p27 to promote multiple myeloma proliferation
Authors: Min Jie , Mao Jialei , Shi Hui , Peng Yumeng , Xu Xiaoning , Guo Mengjie , Tang Xiaozhu , Yang Ye , Gu Chunyan 
Published: November 2024

AbstractMultiple myeloma (MM) is an incurable disease characterized by the abnormal expansion of plasma cells in the bone marrow (BM). Numerous studies have shown that BM tumor cells can influence the tumor microenvironment (TME) through communication with extracellular vesicle circular RNAs (circRNAs), a type of noncoding RNA. Our study revealed that a circular RNA, circRFWD2 (hsa_circ_0015361), is expressed by MM cells and translated into a new protein, circRFWD2_369aa. We found that elevated levels of circRFWD2_369aa in MM peripheral blood samples were closely associated with poor outcomes in MM patients. Further investigation revealed that circRFWD2 promoted the degradation of p27 through the ubiquitination pathway, leading to increased proliferation of MM cells. We also confirmed the interaction between circRFWD2 and its downstream genes DDB1 and CUL4A, indicating that circRFWD2 could form an E3 ligase complex with other genes to mediate the ubiquitination of p27. Notably, the protein translated by a circular RNA of RFWD2 can also function as an E3 ligase. Our study highlights the potential of circRFWD2 as a biomarker for MM, which may improve the sensitivity and specificity of diagnosis and efficacy analyses.
An integrated multistage ensemble machine learning model for fraudulent transaction detection
Authors: Talukder Md. Alamin , Khalid Majdi , Uddin Md Ashraf 
Published: November 2024

AbstractFraudulent transactions continue to pose a concern for financial institutions and organizations, necessitating the development of effective detection tools. Identification and prevention of fraudulent transactions depend heavily on the detection of credit card fraud. Even though instances of credit card fraud are uncommon, they can nonetheless cause significant financial losses because of the high cost of fraudulent transactions. When fraud is discovered early on, investigators can act quickly to stop additional losses. But because the investigation process takes a while, there are only so many warnings that can be looked through in detail in a given day. Thus, a fraud detection model’s main goal is to minimize false alarms and missed fraud situations while producing accurate alerts. To improve fraud identification, we provide in this study an integrated multistage ensemble Machine Learning (IMEML) model that incorporates various multistage ensemble models intelligently, such as Ensemble Independent Classifier (EIC), Ensemble Bagging Classifier (EBC), and Ensemble ML Classifier (EMC). In order to overcome the problem of data imbalance, we use a number of methods-including Instant Hardness Threshold with EMC (IHT+EMC), Cluster Centroids (CC), and Randon Under Sampler (RUS)-that go beyond traditional methods. We run our studies on a 284,807-transaction credit card dataset that is made available to the public. The accuracy rates of 99.94%, 99.91%, 99.14%, 99.52%, and perfect 100% for accuracy, precision, recall, f1-score, and AUC score, respectively, are achieved by the suggested model, demonstrating remarkable performance scores. For real-world fraud detection applications, the EIBMC model sets a new benchmark for identifying fraudulent transactions in high-frequency scenarios by outperforming cutting-edge techniques.
Impact of neighborhood-level COVID-19 mortality on the increase in drug overdose mortality in New York City during the COVID-19 pandemic
Authors: Olawole Wuraola , Li Guohua , Zhou Ziqi , Wu Zhixing , Chen Qixuan 
Published: November 2024

Abstract
Background
Overdose mortality increased substantially during the COVID-19 pandemic, but it is unclear to what extent the COVID-19 mortality had contributed to this increase at the neighborhood level.

Methods
This was an ecological study based on New York City United Hospital Fund (NYC UHF) neighborhood-level data from 2019 to 2021, split into two time-windows: pre-COVID (2019) and during-COVID (2020 and 2021). Linear regression models were used to estimate the effect of cumulative COVID-19 mortality on the increase in drug overdose mortality from the pre-COVD to during-COVID periods at the neighborhood level, with and without adjusting for neighborhood characteristics.

Results
Drug overdose mortality rate increased from 21.3 to 33.4 deaths per 100,000 person-years across NYC UHF neighborhoods from pre-COVID to during-COVID. For each additional COVID-19 death per 1,000 person-years at the neighborhood level, the increase in drug overdose mortality rose 2.4 (95% CI: 1.7, 3.3) times. Furthermore, neighborhoods with a higher percentage of Hispanic residents, a higher percentage of single-person households, and a higher percentage of residents with health insurance experienced significantly larger increases in drug overdose mortality. In contrast, neighborhoods with a higher percentage of residents aged 75 and older had a smaller increase in drug overdose mortality.

Conclusions
NYC neighborhoods with higher cumulative COVID-19 mortality experienced a greater increase in drug overdose mortality during the first two years of the COVID-19 pandemic.
Sudden-onset gastrointestinal bleeding in a young adult: diagnostic and therapeutic challenges of a Dieulafoy’s lesion in the jejunum
Authors: Tripathi Shikhar , Narayanagowda Rakesh , Das Sri Aurobindo Prasad , Jain Sunila , Nundy Samiran 
Published: November 2024

Abstract
Background
A Dieulafoy’s lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation.

Case
A 30-year-old male presented with sudden onset syncope and the passage of 200–300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy’s lesion.

Conclusions
Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient’s postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes.
The impact of insulin resistance and glycaemic control on insulin-like growth factor-1 in patients with type 2 diabetes: a cross-sectional study
Authors: AbdlWhab Hasanain MohammedHuthaifa , Al-Saffar Araz , Mahdi Osama Abbas , Alameri Rafid Badri 
Published: November 2024

Abstract
Background
Type 2 diabetes mellitus (T2DM) is a multifaceted metabolic disorder. Over the past decade, the potential role of Growth Hormone (GH) and Insulin-like Growth Factor-1 (IGF-1) in the pathogenesis and progression of T2DM has garnered scientific interest. These hormones, while interrelated, exert differential effects on glucose homeostasis; GH elevates blood glucose levels, whereas IGF-1 sustains insulin secretion and augments insulin sensitivity.

Objective
The study aimed to investigate the impact of insulin resistance and glycaemic control on IGF-1 levels and to assess other risk factors influencing IGF-1 in T2DM.

Methods
A cross-sectional study was conducted at the National Diabetes Centre, Baghdad, Iraq, from May 2020 to May 2021. Sixty patients with T2DM were evaluated for fasting plasma glucose (FPG), GH, IGF-1, HbA1c, HOMA-IR, HOMA-B, and anthropometric measures following a comprehensive history and physical examination, focusing on any variables that could influence their metabolic profile. Patients with Type 1 diabetes mellitus, thyroid disease, pituitary disease, chronic kidney disease, hepatic disease, and pregnancy were excluded from the study.

Results
Patients with poorly controlled diabetes (HbA1c > 8) exhibited significantly elevated IGF-1 levels compared to those with HbA1c < 8 (166 vs. 134, P = 0.016). The mean IGF-1 was significantly lower in patients with insulin resistance (IR) compared to those without IR (143 vs. 192, P = 0.001), with a significant negative correlation with Body Mass Index (BMI) and a significant positive correlation with HbA1c and Quantitative Insulin Sensitivity Index (QUICKI). Elevated IGF-1 levels were observed with increasing age, duration of T2DM, higher HbA1c, higher QUICKI, and lower BMI. No significant difference was found in IGF-1 values with regards to HOMA-B, fasting insulin, and waist-hip ratio.

Conclusion
Patients with poorly controlled T2DM exhibit higher IGF-1 levels, while those with obesity and high insulin resistance demonstrate lower IGF-1 levels. Further prospective studies are warranted to evaluate the potential of using IGF-1 to reduce insulin resistance and improve metabolic and glycaemic measures in individuals with T2DM and obesity or insulin resistance.
Molecular diagnosis of mtDNA syndromes in Egyptian pediatric patients: a hospital-based study
Authors: Mehaney Dina , Abaas Donia , Sayed Wajeet , Sharawy Mai , Selim Laila 
Published: November 2024

Abstract
Background
MCDs, or mitochondrial disorders, are a major contributor to morbidity and mortality. There are few studies on the prevalence of gene mutations in pediatric MCD patients in Egypt. The objective of the current study was to determine the frequencies of the most prevalent mtDNA mutations in a group of Egyptian children with classical mitochondrial disorders.

Methods
Over two years, 140 pediatric patients clinically suspected of having classical mitochondrial disorders and 50 controls were examined for the most prevalent mtDNA mutations at Cairo University Children’s Hospital. Polymerase Chain Reaction/Restriction Fragment Length Polymorphism analyses were used to screen for the 17 most common mtDNA mutations (G3460A, G11778A, T14484C, T3271C, G13513A, A3243G, A8344G, G8363A, T9176C, T8993C/G, A8344G, T8356C, G8363A, C3303T, A3260G, A4300G, and C9997T) based on the suspected syndrome. To validate the abnormal patterns, direct sequencing was carried out.

Results
Of the 114 children evaluated, 54 were female and 60 were male, with a median age (range) of 3.5 years (7 months–16 years). 77 out of 114 (67.5%) patients were born into consanguineous marriages. Merely 1.8% of mtDNA point mutations were detected; of those with Leber’s hereditary optic neuropathy, only two had the homoplasmic pathogenic variant T14484C of MTND6 verified.

Conclusions
Screening for the most prevalent mtDNA mutations could be used as preliminary noninvasive testing for such syndromes. The low positive incidence raises the possibility that these mtDNA point mutations are not unique to pediatric patients in Egypt. Given Egypt’s high percentage of consanguineous marriage, the molecular pathogenesis of such disorders is suspected to be of nuclear genetic origin.
Lower respiratory tract bacterial colonization among newly diagnosed lung cancer patients
Authors: Madkour Ashraf Mokhtar , Elkady Mona Ahmed Elhady , Melegy Amira Sabry Saad , Ibraheem Yasmeen Mohammad Mahmood Ali 
Published: November 2024

Abstract
Background
Recent studies suggest a mutual relationship between lung cancer and microbial colonization of the bronchial airways. However, data on this subject is scarce, especially among Egyptian studies. This study aimed to evaluate the rate and type of bronchial colonization in patients with proven lung cancer at the time of diagnosis by bronchoscopy. Fifty patients who fulfilled the study inclusion criteria underwent bronchial wash or bronchoalveolar lavage samples and were subjected to bacteriological culture and susceptibility.

Results
Bacterial colonization was recorded in 40% of the studied patients, all of which were potentially pathogenic microorganisms (PPMs). All 23 isolated organisms were Gram-negative bacteria of which 39% were multidrug-resistant (MDR). The most common were Pseudomonas aeruginosa 73.9% and Klebsiella spp. 17.4%. Double growth was detected in 15% of cases. Bronchial colonization in lung cancer had a statistically significant relationship with male gender (p = 0.032), old age (p = 0.037), and chronic obstructive pulmonary disease (p = 0.001). The highest antibiotic sensitivity was observed with Imipenem (69.2%), while the highest antibiotic resistance rates were observed with Ampicillin/Sulbactam and Ceftriaxone (100%).

Conclusion
Gram-negative PPMs were isolated in 40% of lung cancer cases at the time of diagnosis by bronchoscopy with higher frequency among males, old age, and patients with associated COPD. Among isolated organisms, 39% were MDR pathogens.
Rescripting contested monuments amid shifting regionings of concern: the case of the President M.T. Steyn statue
Authors: Auret Hendrik , du Preez JL 
Published: November 2024

AbstractThe way monuments hold sway seem stable and predictable, yet their ‘meanings’ migrate and their traditionally accepted roles shift. In South Africa there are monuments that commemorate achievements once considered laudable, that have become symbols of oppressive systems. The challenge facing the current generation is to make sense of these monuments in a way that will dignify the lived situation of all stakeholders. One such contested monument is the statue of President M.T. Steyn that used to stand in front of the Main Building of the University of the Free State. The statue divided the campus community. It provoked some students to violent unrest, while others saw it as an important heritage marker. How could the seemingly irreconcilable conflict between these stakeholders be resolved while adhering to heritage laws and without alienating a significant portion of the student body? The complex process that followed relied on creative leaps to provoke public participation and stimulate new forms of appreciation amid shifting regions of concern. One important facet of this process was the construction of a reflective triangular prism installation which provoked new visual, experiential and spatial relationships with the monument, including the visual removal of the statue from the ‘axis of power’, the celebration of oblique views, and opportunities to face the statue in a distorted mirror. This article will critically reflect on the poetic process of strange-making that was followed in the relocation of the President M.T. Steyn statue in order to illustrate how traditional conflict resolution strategies can be reinterpreted in terms of German philosopher, Martin Heidegger’s notion of inceptual thinking. The resulting approach opens new possibilities for creatively rescripting contested monuments; a way of thinking which engages the inceptual regionings impacting the way people live as beings of emplaced care.
A case of right middle lobectomy for primary lung cancer in a patient with heterotaxy syndrome
Authors: Demura Ryo , Imai Kazuhiro , Takashima Shinogu , Kurihara Nobuyasu , Kuriyama Shoji , Suzuki Haruka , Harata Yuzu , Minamiya Yoshihiro 
Published: November 2024

Abstract
Background
Anatomical abnormalities in the pulmonary vessels have long aroused great interest among thoracic surgeons, and numerous variations of pulmonary vessels have been reported. Heterotaxy syndrome is an anatomical abnormality in which typically asymmetrical organs, including the lungs, develop symmetrically. We report the case of a 71-year-old man with heterotaxy syndrome undergoing radical lobectomy in the treatment of non-small cell lung cancer.

Case presentation
Computed tomography (CT) revealed an irregular nodule 25 mm in diameter in the right middle lobe. Two months later, at his first visit to our University Hospital, CT revealed a rapidly growing tumor 60 mm in diameter. In addition, three-dimensional (3D) CT revealed the upper and middle lobar bronchi forming a common trunk with the mediastinal type of the right pulmonary artery (PA). The patient underwent video-assisted right middle lobectomy + systematic complete hilar and mediastinal lymph node dissection. The interlobar fissure between the right upper and middle lobes was incomplete, and the common trunk formed by the upper-middle bronchus emerged from an area between the right PA (A1+3) and the right superior pulmonary vein.

Conclusion
The finding of A4+5 branching from the right main PA and descending posterior to the right upper-middle bronchus, which formed a common trunk, resembled a mirror image of the normal left lung. To our knowledge, a common trunk with the mediastinal type of the right PA has never been reported during video-assisted right middle lobectomy. In patients with heterotaxy syndrome, 3D-CT to preoperatively understand their anatomy is essential.