bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of renal biomarkers with fast progressor phenotype and related outcomes in anterior circulation large vessel occlusion stroke
Authors: Rios Rocha Lucas , Kayyali Mohammad N. , Mahat Bishow C. , Al-Qudah Abdullah , Doheim Mohamed F. , Al-Bayati Alhamza R. , Bhatt Nirav R. , Starr Matthew T. , Song Shlee S. , Nogueira Raul G. , Rocha Marcelo 
Published: October 2024

BackgroundRenal dysfunction is a known predictor of long-term functional dependency after anterior circulation large vessel occlusion (ACLVO) stroke. However, the impact of renal dysfunction on early infarct growth rate (IGR) has not been previously demonstrated. The objective of this study was to define the association of creatinine-based renal biomarkers with fast or slow progressor phenotypes and related clinical outcomes in ACLVO stroke.MethodsThis retrospective study examined patients with acute intracranial internal carotid artery or middle cerebral artery-M1 occlusions admitted between 2014 and 2019. Patients were included if they received baseline CT perfusion (CTP) or MRI on presentation within 24 h of estimated stroke onset. Infarct growth rate (IGR) was determined by ischemic core volume on CTP or MRI divided by time from stroke onset to imaging. IGR was used to stratify fast progressor (IGR ≥10 mL/h) and slow progressor (IGR &lt; 10 mL/h) status. Renal dysfunction was assessed based on serum creatinine and estimated glomerular filtration rate (eGFR) on presenting laboratories. Logistic regression models, adjusted for significant covariates, identified independent associations between renal dysfunction biomarkers, progressor status, and clinical outcomes based on modified Rankin Scale (mRS) at 90 days.ResultsAmong 230 patients with ACLVO, 29% were fast progressors, with median serum creatinine levels higher than slow progressors (1.1 vs. 0.9 mg/dL, p &lt; 0.05) and lower median eGFR (66.2 vs. 69.0 mL/min/1.73m2, p &lt; 0.05). Elevated creatinine (≥1.2 mg/dL) was independently associated with fast progressor status (adjusted OR 2.37, 95% CI 1.18–4.77), worse 90-day mRS (adjusted OR 1.88, 95% CI 1.01–3.51) and mortality (adjusted OR 2.57, 95% CI 1.14–5.79). Reduced eGFR (&lt;60 mL/min/1.73m2) was independently associated with fast progressor status (adjusted OR 2.38, 95% CI 1.14–4.94), but not with 90-day mRS or mortality.ConclusionSerum creatinine-based biomarkers of renal dysfunction were associated with fast progressor phenotype of ACLVO stroke, and worse clinical outcomes, which may help identify such patients earlier during emergency evaluation for expedited access to EVT. Future prospective studies are warranted to confirm and test implementation of these findings.
Are tinnitus burden and tinnitus exacerbation after cochlear implantation influenced by insertion technique, array dislocation, and intracochlear trauma?
Authors: Everad F. , Beck R. L. , Aschendorff A. , Rauch A. K. , Fries Leonie , Arndt S. , Ketterer M. C. 
Published: October 2024

IntroductionAlthough numerous studies suggest that cochlear implantation (CI) generally alleviates the overall burden of tinnitus, certain patients experience tinnitus exacerbation following CI. The exact cause of this exacerbation is still uncertain. This prospective study aimed to investigate whether cochlear trauma, resulting from scalar dislocation of the electrode array, affected postoperative tinnitus intensity, tinnitus burden, and speech perception. Additionally, the influence of CI insertion technique, insertion depth, insertion angle, and cochlear morphology on postoperative tinnitus was assessed.MethodsWe evaluated 66 CI recipients preoperatively at 2 days, 4 weeks, and 12- and 24-months following surgery. Digital volume tomography was employed to document scalar position, insertion depth, and cochlear morphology postoperatively. Speech perception was analyzed using Freiburg monosyllables. The tinnitus burden was evaluated using the tinnitus questionnaire, while the tinnitus intensity was quantified using a visual analog scale.ResultsStudy results pertaining to tinnitus intensity and burden did not reveal a significant difference in elevation regarding scalar position and dislocation after CI surgery compared to preoperative tinnitus levels. However, dislocation was only identified in four patients, and scala vestibuli insertions were observed in two patients. Comparing preoperative and 1-year postoperative outcomes, CI was noted to substantially reduce the tinnitus burden. When the speech processor was worn, the tinnitus intensity was significantly diminished. In comparison to round window (RW) insertion, the insertion technique cochleostomy (CS) did not exhibit a significant difference or a trend toward increased tinnitus intensity.ConclusionThis study demonstrates that CI significantly decreases the tinnitus burden. The observation implies that the electrical stimulation of the auditory pathway, facilitated by wearing the speech processor, significantly reduced the tinnitus intensity. The incidence of dislocations and scala vestibuli insertions has declined to the extent that it is no longer feasible to formulate statistically significant conclusions.
Clinical trajectories of patients with multiple sclerosis from onset and their relationship with serum neurofilament light chain levels
Authors: Quintanilla-Bordás Carlos , Cubas-Núñez Laura , Castillo-Villalba Jéssica , Carratalá-Boscá Sara , Gasque-Rubio Raquel , Tortosa-Carreres Jordi , Alcalá Carmen , Forés-Toribio Lorena , Lucas Celia , Gorriz David , Pérez-Miralles Francisco , Casanova Bonaventura 
Published: October 2024

BackgroundSerum neurofilament light chain (sNfL) is a biomarker of neuroaxonal destruction that correlates with acute inflammation (AI) in multiple sclerosis (MS). However, in the treatment era, progression without AI is the main driver of long-term disability. sNfL may provide added value in detecting ongoing axonal damage and neurological worsening in patients without AI. We conducted a prospective three-year study on patients with a first MS relapse to evaluate the basal cut-off value predicting early increased disability unrelated to relapses.MethodssNfL levels and AI presence were measured every 6 months during the first year and the Expanded Disability Status Scale (EDSS) was monitored until the third year. Baseline cohorts were stratified by sNfL levels, using a cut-off derived from patients without AI (absence of clinical relapses, new/enlarging T2 lesions, or gadolinium enhancement in magnetic resonance imaging) at year one.ResultsFifty-one patients were included. A sNfL cut-off of 11 pg/mL predicted sustained neurological worsening independent of AI. Patients exceeding this threshold exhibited features of highly active MS (higher proportion of AI, oligoclonal M bands and higher EDSS). Despite AI ablation, sNfL levels persisted elevated and were significantly associated with increased EDSS at baseline and year 3. Patients with low sNfL and concurrent AI (n = 8) experienced relapses in the optic nerve, brainstem, and spinal cord topographies.ConclusionsNfL elevation may detect patients with increased disability even when AI is controlled. This may reveal mechanisms associated with early axonal degeneration and help identify patients at higher risk of progression.
Mortality and its predictors among patients with Guillain–Barré syndrome in the intensive care unit of a low-income country, Ethiopia: a multicenter retrospective cohort study
Authors: Bayu Habtu Tsehayu , Demilie Atalay Eshetie , Molla Misganew Terefe , Kumie Fantahun Tarekegn , Endeshaw Amanuel Sisay 
Published: October 2024

BackgroundGuillain–Barré syndrome (GBS) is a rare autoimmune disease that affects the peripheral nervous system. It is characterized by the destruction of nerves involved in movement. This condition can lead to transient pain, changes in temperature and touch sensations, muscle weakness, loss of sensation in the legs and/or arms, and difficulty swallowing or breathing. Published data on the outcomes of critical care for patients with GBS are extremely scarce in Africa, particularly Ethiopia. Therefore, this study aimed to assess mortality and its predictors among patients with GBS in the intensive care unit (ICU) of specialized hospitals in Ethiopia, a low-income country.Materials and methodsThis retrospective cohort study was conducted at the Tibebe Ghion Specialized Hospital and the Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar, Ethiopia, from 1 January 2019 to 30 December 2023. Data were collected in the medical record rooms. Cox regression analysis was performed to identify the predictors of mortality among GBS patients in the ICU. The crude and adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs) were calculated using bivariable and multivariable Cox regression models. A p-value of &lt;0.05 was considered statistically significant.ResultsOf 124 GBS patients admitted to the ICU, 120 were included in the final analysis. During the follow-up, there were 23 (19.17%) deaths. The overall incidence rate of death was 1.96 (95% CI: 1.30, 2.95) per 100 person-days of observation. Traditional medicine (AHR = 3.11, 95%: 1.12, 16.70), COVID-19 infection (AHR = 5.44, 95% CI: 1.45, 73.33), pre-ICU cardiac arrest (AHR = 6.44, 95% CI: 2.04, 84.50), and ICU readmission (AHR = 4.24, 95% CI: 1.03, 69.84) were identified as the independent predictors of mortality.ConclusionThe mortality rate among GBS patients admitted to the ICU was high. Traditional medicine, COVID-19 infection, pre-ICU cardiac arrest, and readmission to the ICU were the significant predictors of mortality. Conducting large-scale studies with a prospective design in the future would yield more robust evidence.
Efficacy comparison of five antidepressants in treating anxiety and depression in cancer and non-cancer patients
Authors: Zhao Kuan , Wang Youyang , Liu Qun , Yu Ze , Feng Wei 
Published: October 2024

IntroductionCancer patients have a heightened susceptibility to anxiety and depressive disorders, which significantly impact the effectiveness of cancer treatments and long-term quality of life. This study aimed to compare the efficacy of different antidepressants in cancer and non-cancer patients.MethodsA total of 610 patients diagnosed with depressive episodes and/or anxiety disorders were retrospectively included and divided into a cancer group and a non-cancer control group. Antidepressants used included escitalopram, duloxetine, sertraline, venlafaxine, and vortioxetine, combined with trazodone or not. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire-7 (GAD-7) scores were used to evaluate the efficacy after 4 weeks and 8 weeks of systematic antidepressants treatment.ResultsCompared to the non-cancer group, the cancer group had higher proportions of females, older individuals, and patients with poor sleep quality, while reporting fewer somatic symptoms at baseline (all p &lt; 0.05). PHQ-9 and GAD-7 scores in cancer patients treated with antidepressants were significantly lower than baseline at week 4 and week 8 (all p &lt; 0.05). The sertraline group demonstrated significantly less improvement in GAD-7 scores at week 4 and in both GAD-7 and PHQ-9 scores at week 8 compared to the escitalopram group, while duloxetine, venlafaxine, and vortioxetine showed comparable efficacy to escitalopram. Antidepressants combined with trazodone showed significant improvement in PHQ-9 scores at week 4 compared to those without trazodone. The gynecological cancer group showed significantly more improvement in GAD-7 and PHQ-9 scores at week 4 and 8 compared to breast cancer patients.ConclusionAntidepressant treatment in cancer patients with anxiety and depression is as effective as in non-cancer patients. The efficacy of escitalopram is comparable to duloxetine, venlafaxine, and vortioxetine, all of which outperformed sertraline in cancer patients.
Mediterranean diet and atrial fibrillation: a case-control study from China
Authors: Zhang Qian , Wu Su-Ping , Liu Xu , Wang Yun-Long 
Published: October 2024

ObjectiveThe aim of this study was to assess the association between adherence to Mediterranean diet and the presence of atrial fibrillation (AF) in a Northern Chinese population.MethodsThis study was a single center, case–control study. A total of 952 low risk participants in Beijing Anzhen Hospital from 2016 to 2021 were collected, including 476 patients with first diagnosed of atrial fibrillation and 476 age and sex matched controls. According to the food frequency questionnaire (FFQ), the alternate Mediterranean diet score (AMED) was calculated, which was 0–9 points, indicating the adherence to the Mediterranean diet from low to high.ResultsThe average age of the participants was 57.6 ± 9.1 years old, and 70.2% were men. After analyzing every component of AMED, vegetable consumption shows a negative correlation with the risk of AF, whereas alcohol consumption demonstrates a positive correlation with it (OR = 0.61, 95% CI 0.44–0.80, p &lt; 0.001; OR = 1.99, 95% CI 1.48–2.58, p &lt; 0.001). All patients were grouped according to AMED score. A significant inverse association between AMED and the risk of AF was observed. Compared with participants with AMED&lt;4, the multivariable-adjusted ORs of AF were 0.75 (95% CI 0.55–1.06) for AMED 4–5 and 0.61 (95% CI 0.43–0.89) for AMED ≥6, with a trend in risk (p = 0.008). Results were consistent in stratified analyses of gender, age, BMI and smoking.ConclusionThe Mediterranean diet was inversely associated with the risk of AF in this Northern Chinese population.
Associations of dietary sources of antioxidant intake and NAFLD: NHANES 2017–2020 and Mendelian randomization
Authors: Yue Zilong , Jiang Ziming , Qian Long , Li Lele , Qi Xianliang , Hu Kaifeng 
Published: October 2024

PurposeTo determine the association between dietary antioxidant sources and non-alcoholic fatty liver disease (NAFLD).MethodsIn this observational study, we utilized NHANES 2017–2020 data to identify the factors associated with NAFLD in dietary antioxidant sources via weighted multivariate logistic regression models. Then, Mendelian randomization (MR) was applied to investigate the effect of dietary antioxidant sources on NAFLD at the genetic level.ResultsOf the six dietary sources of antioxidants, only vitamin E (Vit E) was significantly associated with NAFLD (OR = 0.98; 95% CI: 0.97–0.99; p = 0.001). Upon adjusting for all covariates, it was determined that the highest quartile of dietary Vit E intake was associated with a decreased NAFLD occurrence compared with the lowest quartile of dietary Vit E intake (p &lt; 0.001). The results of IVW-MR analysis revealed an association between Vit E and NAFLD (OR = 0.028; p = 0.039).ConclusionOur research indicates a negative and linear relationship between daily vitamin E intake and NAFLD.
The association of vitamin D insufficiency with the prevalence of obesity in children: implications for serum calcium levels, alkaline phosphatase activity, and bone maturation
Authors: Xu Yue , Song Lingyun , Zhou Li 
Published: October 2024

BackgroundVitamin D deficiency has been identified as a potential risk factor for various adverse health outcomes. However, its specific role in metabolic regulation and skeletal development in school-aged children is not fully understood. This study aimed to explore the correlation between vitamin D deficiency and childhood obesity rates, and its impact on serum calcium, alkaline phosphatase, and bone age in children.MethodsThe study analyzed clinical data from 159 school-aged children who underwent medical examinations. Participants were divided into the 25-hydroxyvitamin D3 (25(OH)D3) deficiency group and the 25(OH)D3 normal group based on their serum levels. We compared body mass index (BMI), total cholesterol (TC), triglycerides (TG), Ca, ALP, bone age, fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) between the two groups. Logistic regression and Spearman correlation analyses were performed to further investigate relationships between 25(OH)D3 levels and metabolic and bone-related markers.ResultsThis study showed that the 25(OH)D3 deficiency cohort exhibited significantly higher BMI, TC, TG, and ALP levels, with lower Ca levels and delayed bone age compared to the normal group. Logistic regression analysis identified Ca, ALP, and bone age as significant predictors of 25(OH)D3 deficiency. Subgroup analysis showed that in the 25(OH)D3 deficient group, children with higher BMI had elevated TC, ALP levels, and delayed bone age, while Ca levels were lower. Correlation analysis confirmed the predictive value of these markers for 25(OH)D3 deficiency.ConclusionOur findings demonstrate that 25(OH)D3 deficiency is strongly associated with obesity in school-aged children and may negatively affect normal skeletal development. Regular monitoring of 25(OH)D3 levels in school-aged children is essential for ensuring proper growth and development, especially in those at risk for obesity.
The value of multiple diffusion metrics based on whole-lesion histogram analysis in evaluating the subtypes and proliferation status of non-small cell lung cancer
Authors: Chen Yao , Yang Hong , Qin Yuan , Guan Chuanjiang , Zeng Wenbing , Luo Yong 
Published: October 2024

ObjectiveLimited studies have explored the utility of whole-lesion histogram analysis in discerning the subtypes and proliferation status of non-small cell lung cancer (NSCLC), despite its potential to provide comprehensive tissue assessment through the computation of additional quantitative metrics. This study sought to assess the significance of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) histogram parameters in discriminating between squamous cell carcinoma (SCC) and adenocarcinoma (AC), and to examine the correlation of each parameter with the proliferative marker Ki-67.Materials and methodsPatients with space-occupying lesions detected by chest CT examination and with further routine MRI, DKI and IVIM functional sequence scans were enrolled. Based on the pathological results, seventy patients with NSCLC were selected and divided into AC and SCC groups. Histogram parameters of IVIM (D, D*, f) and DKI (Dapp, Kapp) were calculated, and the Mann–Whitney U test or independent samples t test was used to analyze the differences in each histogram parameter of the SCC and AC groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the histogram parameters. The correlation coefficient between histogram parameters and Ki-67 was calculated using Spearman’s or Pearson’s methods.ResultsThe D 10th percentile, D 90th percentile, D mean, D median, Dapp10th percentile, Dapp90th percentile, Dappmean, Dappmedian, Dappskewness, DappSD of the AC groups were significantly higher than those of the SCC groups, while the Kappentropy and KappSD of the SCC groups were significantly higher than those of the AC groups. All the above differences were statistically significant (all P &lt; 0.05). ROC curve analysis revealed that Dappmean showed the best performance for differentiating AC from SCC lesions, with an area under the ROC curve of 0.832 (95% confidence interval [CI]: 0.707-0.919). But there was no statistically significant difference in diagnostic efficacy compared to other histogram parameters (all P&gt;0.05). Dapp90thpercentile, Dappmean, Kappskewnes showed a slight negative correlation with Ki-67 expression (r value -0.340, -0.287, -0.344, respectively; P&lt; 0.05), while the other histogram parameters showed no significant correlation with Ki-67 (all P &gt; 0.05).ConclusionsOur study demonstrates the utility of IVIM and DKI histogram analyses in differentiating NSCLC subtypes, particularly AC and SCC. Correlations with the Ki-67 index suggest that Dappmean, Dapp90th percentile, and Kappskewness may serve as markers of tumor aggressiveness, supporting their use in NSCLC diagnosis and treatment planning.
Analysis of the therapeutic effect and influencing factors on unresectable gastric cancer treated with conversion therapy
Authors: Han Saiyi , Han Shaoliang , Qian Jun , Guo Mengfu , Fan Jianping 
Published: October 2024

BackgroundGastric cancer (GC) is one of the leading causes of cancer-related death in China, and with the extensive development of conversion therapy, the treatment of advanced unresectable gastric cancer (AUGC) patients has ushered in a new dawn. This study aimed to analyze the efficacy of conversion therapy in AUGC patients and explored the relevant factors affecting the efficacy.MethodWe collected information from GC patients who received conversion therapy from this center and designed a retrospective study.ResultsWe collected relevant clinical data from 160 patients with AUGC. A total of 120 patients who underwent routine R0 resection were identified as conversion cases. A total of 25 patients (15.6%) achieved pCR, 92 patients (57.5%) achieved objective response rate (ORR), 140 patients (87.5%) achieved disease control rate (DCR), and 20 cases (12.5%) observed tumor progression. There were 86 patients who achieved pathological downgrading, with a total downgrading rate of 53.8%. Among the 160 patients, 37 patients (23.1%) had postoperative complications of varying degrees. A total of 72 patients (45.0%) had tumor recurrence/progression at the end of follow-up. The last chemotherapy and surgery (CST) (OR = 1.046, 95% CI 1.013–1.081, p = 0.006), tumor invasion (OR = 32.096, 95% CI 5.091–202.349, p &lt; 0.001), and distant metastasis (OR = 7.050, 95% CI 1.888–26.323, p = 0.004) were independent factors influencing the efficacy of conversion therapy.ConclusionConversion therapy may have a good therapeutic efficacy for AUGC, and some clinical factors affect the efficacy response.
Endoscopic and clinicopathological features of early gastric papillary adenocarcinoma
Authors: Zuo Zhenxiang , Qi Xing , Cui Xiujie , Yu Bin , Zhang Huimin , Wu Honglei 
Published: October 2024

ObjectivesGastric papillary adenocarcinoma (GPA), a well-differentiated gastric adenocarcinoma, is associated with a worse prognosis compared to other differentiated gastric adenocarcinomas. Therefore, there is an urgent need to characterize its endoscopic manifestations for guiding biopsy site selection and achieving accurate diagnosis.MethodsFrom January 1, 2016, to December 31, 2022, the data of 46 cases of early gastric papillary adenocarcinoma (EGPA) and 183 cases of early gastric differentiated tubular adenocarcinoma (EGDTA) diagnosed via pathological examination following endoscopic submucosal dissection (ESD) at the Second Hospital of Shandong University were collected. Propensity score matching (PSM) was employed to match 92 EGDTA patients at a ratio of 1:2, serving as the control group. Differences between the two groups were analyzed using multivariable logistic regression. Lastly, the relationship between vessels within epithelial circle (VEC) structures in EGPA and the degree of malignancy was assessed.ResultsCompared with EGDTA, EGPA was more likely to infiltrate the submucosa, more frequently associated with poorly differentiated cancer components, and more prone to invading lymphatic and blood vessels. EGPA was primarily located in the lower stomach and manifested as a uniformly elevated pattern under endoscopy, while VEC structural positivity could be visualized under ME-NBI. Moreover, EGPA lesions had larger diameters and were characterized by high expression of gastric mucins, namely MUC5AC and MUC6. When EGPA infiltrated the submucosa or contained poorly differentiated cancer components, the VEC structures were smaller.ConclusionsThe present study demonstrated that EGPA exhibits a higher degree of malignancy. Endoscopic findings of a raised lesion with a uniform color under endoscopy and the presence of VEC structures under ME-NBI suggest a high possibility of EGPA. Moreover, smaller VEC structures were associated with a higher degree of malignancy, which may assist in guiding the selection of biopsy sites under endoscopy.