bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remission versus low disease activity as treatment targets in rheumatoid arthritis: how to strike the right balance between too strict and too lenient targets? A meta-epidemiological study of individual patient data
Authors: Duarte Catia , Jacobs Johannes W G , Ferreira Ricardo J O , Welsing Paco M J , Gossec Laure , Machado Pedro M , van der Heijde Désirée , da Silva Jose Antonio Pereira 
Published: November 2024

ObjectivesTo evaluate the impact of using Simplified Disease Activity Index (SDAI)-LDA (low disease activity) versus different definitions of remission as a treatment target in established rheumatoid arthritis.MethodsA meta-epidemiological study of individual patient data from eight randomised controlled trials was performed. Four definitions of the target were considered at 6 months: (1) SDAI-LDA: SDAI≤11; (2) SDAI-Remission: SDAI≤3.3; (3) 4V-Remission: Tender and swollen 28-joint counts and C reactive protein (mg/dL) all ≤1 and patient global assessment (PGA)≤2 and (4) 3-variable (3V)-Remission: as 4V, excluding PGA. The mean radiographic change in the modified total Sharp-van der Heijde score (mTSS) and the Good Radiographic Outcome rates (defined as a change of ≤0.5 units mTSS) over 2 years were compared among target definitions. Radiographic progression and the distribution of the individual criteria of the Boolean definition in the only LDA subgroup (3.3<SDAI≤11) were analysed.ResultsIn total, 4374 patients (mean disease duration of 5.9 years (95% CI 4.6; 7.1)) were included. The pooled rate of SDAI-LDA at 6 months was 49%, with 13% in SDAI-remission. The 4V-Remission and 3V-Remission were achieved by 16% and 23%, respectively. Mean radiographic progression was 0.55 (0.14; 0.96) units for SDAI-LDA and 0.22 (−0.09; 0.54), 0.28 (−0.07; 0.62), 0.28 (−0.10; 0.65) for SDAI-Remission, 4V-Remission and 3V-Remission states, respectively. Patients with SDAI Pure-LDA presented significantly more radiographic progression than patients in SDAI-Remission (mean 0.72 vs 0.22 units, p<0.05). Over 53% of all patients achieving SDAI-LDA were not in 3V-Remission and had more mean radiographic progression over 2 years than those who met both targets (0.70 vs 0.25 units, p=0.014). Among patients with SDAI-LDA but not in SDAI-Remission, 40% scored PGA>2, reflecting relevant disease impact.ConclusionSDAI-LDA is associated with more structural damage over 2 years than any of the definitions of remission. It also allows substantial disease impact to go unchecked and uncontrolled. Physicians should strive for remission whenever possible and safe while also taking into account the different individual disease activity parameters included in the adopted definition.
Enhanced Fuzzy Score-Based Decision Support System for Early Stroke Prediction
Authors: Ben Kahla Mayssa , Kanzari Dalel , Ben Amor Sana , Ayachi Ghannouchi Sonia , Martinho Ricardo 
Published: November 2024

According to the Global Health Observatory, stroke ranks second worldwide in causing dementia, right after Alzheimer’s disease. The mortality rate linked to dementia resulting from stroke is high because symptoms are often recognized late, and stroke can be misinterpreted as other brain disorders. Early detection and diagnosis of stroke is crucial. Therefore, increasing awareness of stroke symptoms and implementing preventive measures becomes imperative. Prompt intervention by healthcare professionals can improve outcomes and reduce long-term complications of stroke.
The research introduces an innovative approach for early stroke prediction using a fuzzy scoring-based Decision Support System. This approach encompasses three main modules: Mind map-based Data Modeling, Fuzzy scoring computing, and Machine Learning (ML)-Based Decision System. By incorporating fuzzy logic, the approach extracts valuable knowledge from imprecise and uncertain data. Combining the fuzzy stroke risk model with a ML-based decision support system aims to enhance stroke prediction accuracy and improve preventive measures and patient outcomes. The approach’s effectiveness was validated using real clinical data and tested with various ML classifiers, including K-Nearest Neighbor (KNN), Logistic Regression (LR), Decision Tree (DT), Artificial Neural Network (ANN), and Support Vector Machine (SVM). The results showed a strong correlation between stroke cases and computed risk-scoring values.
In comparison to predictions without fuzzy scoring and other related works, the stroke risk prediction using the proposed approach demonstrated higher accuracy, making it a promising method for early stroke detection and prevention.
Renal Effects of Combination Phosphodiesterase V Inhibition and Low-Dose B-Type Natriuretic Peptide in Acute Heart Failure: A Randomized Clinical Trial
Authors: Hubers Scott A. , Benike Sherry L. , Johnson Bradley K. , McKie Paul M. , Scott Christopher , Chen Horng H. 
Published: November 2024

BACKGROUND:
Cardiorenal dysfunction with impaired cyclic GMP (cGMP) response is common in patients presenting with acute heart failure (HF). Type V phosphodiesterase (PDEV) is known to be upregulated in HF and may explain the dysfunction of renal response. The aim of this study was to determine whether B-type natriuretic peptide (BNP) alone or in combination with PDEV inhibition improves renal function and increases urinary sodium and cGMP excretion in acute HF.

METHODS:
This open-label study included 67 patients hospitalized with acute HF and renal dysfunction. Patients were randomized to standard care, low-dose intravenous BNP (0.005 µg/kg per minute), or combination BNP/PDEV inhibition with sildenafil (25 mg q12 hours) for 48 hours. The coprimary end points were the percent change in estimated glomerular filtration rate and blood urea nitrogen from baseline to 48 hours.

RESULTS:

Treatment with BNP and BNP/PDEV inhibitor significantly increased plasma cGMP at 24 hours (+25.6% [+9.8%, +84.7%] and +60.8% [+32.3%, +103.8%] for BNP and BNP/PDEV versus −13.5% [−29.1%, +14.2%] with standard care;
P
=0.001). However, there was no significant change in estimated glomerular filtration rate 0 (−10.8%, +12.7%) for standard care versus 0 (−15.3%, +11.8%) for the BNP group versus –8.8% (−14.3%, +8.3%) for the BNP/PDEV group (
P
=0.60) or blood urea nitrogen −1.4% (−10.7%, +12.0%) for standard care versus –5.9% (−14.6%, +9.4%) for the BNP group versus +6.9% (−5.3%, +18.8%) for the BNP/PDEV group (
P
=0.38) between groups. Hypotension was more common in the BNP/PDEV inhibitor group.

CONCLUSIONS:
BNP and combination BNP/PDEV inhibition increased plasma cGMP in patients with acute HF but did not improve renal function or urinary sodium/cGMP excretion. Our study does not support the use of intravenous low-dose BNP with or without PDEV inhibition to enhance renal function in patients admitted with acute HF.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00972569.
Discrepancy in the Diagnosis of Heart Failure With Preserved Ejection Fraction Between Supine Versus Upright Exercise Hemodynamic Testing
Authors: Fudim Marat , Kittipibul Veraprapas , Swavely Ashley , Gray Anna , Mikitka Jeffrey , Young Erin , Dobbin Olivia , Radzom Matthew , Fee Jacqueline , Molinger Jeroen , Patterson Brandy , Battista Perego Giovanni , Badano Luigi P. , Parati Gianfranco , Vachiéry Jean-Luc , Senni Michele , Lanzarone Ettore , Previdi Fabio , Paleari Stefano , Baratto Claudia , Caravita Sergio 
Published: November 2024

BACKGROUND:
Invasive exercise right heart catheterization is a gold standard in diagnosing heart failure with preserved ejection fraction (HFpEF). Body positions during the test influence hemodynamics. However, the discrepancy in HFpEF diagnosis between exercise testing in supine versus upright position is unknown.

METHODS:
We conducted a 2-center prospective study enrolling patients referred for exercise right heart catheterization for HFpEF. We performed a Supright protocol integrating submaximal supine bicycle ergometry (20 W) followed by maximal upright bicycle ergometry with a breath-by-breath oxygen analyzer. HFpEF hemodynamic criteria specific to testing positions were applied. Patients were considered to have concordant HFpEF if they met criteria in both positions or discordant HFpEF if they met criteria only in the supine position.

RESULTS:

Of 36 patients who met HFpEF criteria in supine position, 18 (50%) did not meet criteria in upright position (discordant HFpEF). Discordant HFpEF had less atrial fibrillation (0% versus 55%;
P
<0.001), lower left atrial volume (60±14 versus 77±21 mL;
P
=0.010), and lower H
2
FPEF score (2.1±1.3 versus 5.1±2.3;
P
<0.001). In supine position, pulmonary arterial wedge pressure was lower in discordant HFpEF at rest (15±4 versus 19±7 mm Hg;
P
=0.040). In upright position, pulmonary arterial wedge pressure was lower in discordant HFpEF both at rest (8±4 versus 14±6 mm Hg;
P
=0.002) and at peak exercise (14±4 versus 27±7 mm Hg;
P
<0.001). Pulmonary arterial wedge pressure/cardiac output slope was lower in discordant HFpEF (1.6±1.7 versus 3.6±2.9;
P
<0.001). Maximal workload (46±18 versus 49±24 W;
P
=0.59) or peak oxygen consumption (11.4±2.8 versus 12.9±3.4 mL/[kg·min];
P
=0.15) was similar between groups.

CONCLUSIONS:
Half of patients who met HFpEF criteria in the supine position did not meet the criteria in the upright position. Patients with a discordant HFpEF phenotype had less structural and hemodynamic abnormalities compared with those with concordant HFpEF. A Supright exercise right heart catheterization approach is feasible and merits further investigation to determine the clinical implications of discordant exercise hemodynamic findings in supine and upright positions.
ANK Deficiency-Mediated Cytosolic Citrate Accumulation Promotes Aortic Aneurysm
Authors: Wu Hao , Li Zhiqing , Yang Liu , He Lin , Liu Hao , Yang Shiyu , Xu Qinfeng , Li Yanjie , Li Wenqiang , Li Yiran , Gong Ze , Shen Yicong , Yang Xueyuan , Huang Jiaqi , Yu Fang , Li Li , Zhu Junming , Sun Luyang , Fu Yi , Kong Wei 
Published: November 2024

BACKGROUND:
Disturbed metabolism and transport of citrate play significant roles in various pathologies. However, vascular citrate regulation and its potential role in aortic aneurysm (AA) development remain poorly understood.

METHODS:

Untargeted metabolomics by mass spectrometry was applied to identify upregulated metabolites of the tricarboxylic acid cycle in AA tissues of mice. To investigate the role of citrate and its transporter ANK (progressive ankylosis protein) in AA development, vascular smooth muscle cell (VSMC)-specific
Ank
-knockout mice were used in both Ang II (angiotensin II)- and CaPO
4
-induced AA models.

RESULTS:

Citrate was abnormally increased in both human and murine aneurysmal tissues, which was associated with downregulation of ANK, a citrate membrane transporter, in VSMCs. The knockout of
Ank
in VSMCs promoted AA formation in both Ang II- and CaPO
4
-induced AA models, while its overexpression inhibited the development of aneurysms. Mechanistically, ANK deficiency in VSMCs caused abnormal cytosolic accumulation of citrate, which was cleaved into acetyl coenzyme A and thus intensified histone acetylation at H3K23, H3K27, and H4K5. Cleavage under target and tagmentation analysis further identified that ANK deficiency-induced histone acetylation activated the transcription of inflammatory genes in VSMCs and thus promoted a citrate-related proinflammatory VSMC phenotype during aneurysm diseases. Accordingly, suppressing citrate cleavage to acetyl coenzyme A downregulated inflammatory gene expression in VSMCs and restricted ANK deficiency-aggravated AA formation.

CONCLUSIONS:
Our studies define the pathogenic role of ANK deficiency-induced cytosolic citrate accumulation in AA pathogenesis and an undescribed citrate-related proinflammatory VSMC phenotype. Targeting ANK-mediated citrate transport may emerge as a novel diagnostic and therapeutic strategy in AA.
Molecular and morphological characterisation of Ditylenchoides anyae sp. n. (Nematoda: Anguinoidea) from Iran
Authors: Esmaeili Mehrab , Ye Weimin , Subbotin Sergei A. 
Published: November 2024

Summary
A new species, Ditylenchoides anyae sp. n., recovered from soil in the headland areas of non-cultivated fields in Alborz Province, Iran, is described and illustrated based on its morphological, morphometric, and molecular characters. The new species was characterised by a slender body and length of 784 (663-925) μm (females) and 667-712 μm (males), lip region continuous, stylet length 6.4 (6.0-7.0) μm, lateral fields with four incisures, and excretory pore situated 110 (82-137) μm from the anterior end, median bulb of pharynx fusiform, non-muscular, and non-valvate, isthmus elongate, slender ending at a pyriform basal pharyngeal bulb not overlapping intestine, vulva with distinct and relatively large lateral flaps, a well-developed post-vulval uterine sac, 31.3 (27-35) μm long, a female tail elongate-conoid with pointed terminus; and male with adanal bursa and spicules 21-22 μm long. The new species was characterised using the D2-D3 expansion segments of 28S rRNA, ITS rRNA, and partial 18S rRNA gene sequences. Phylogenetic analyses of the genus Ditylenchoides are given based on the analysis of these genes.
Back to the Future: Möhämmäd Zahir Bigiev and His Journey to Bukhara in the Age of Steam and Print
Authors: Naganawa Norihiro 
Published: November 2024

Abstract
Following Nile Green’s analysis of Muslim travelers heading west, this article probes the nature of the Muslim subjectivities expressed by a Tatar who traveled eastwards to Russia’s new periphery. First, I explore the place of Zahir Bigiev’s A Journey to Mawara’annahr within the growing number of Tatar accounts of westward travels including the hajj at the turn of the century. Second, I compare Bigiev’s travelogue with Esper Ukhtomskii’s From the Kalmyk Steppe to Bukhara to reveal the different imaginary pasts each author experienced in their almost identical itinerary. Third, I examine how these two authors’ imaginary travels “back to the future” functioned to assess Turkestan’s colonial present.
From Regional Islamic Reform to Global Anti-colonialism? Jamaladdin al-Afghani and Russia’s Muslims
Authors: Kemper Michael 
Published: November 2024

Abstract
In Russia’s revolutionary year of 1917, the Muslim journalist and educator Rida’addin b. Fakhraddin (1858–1936) published a biography of Jamaladdin al-Afghani (d. 1897), a person famous for his Pan-Islamic political agitation in many countries of the Middle East and beyond. Fakhraddin’s Tatar-language biography is the central source for studying Afghani’s reception among Russia’s Muslims. I argue that Fakhraddin constructed a sanitized image of Afghani that emphasized the latter’s compatibility with the homegrown movement of Islamic reform (islah) that Fakhraddin himself stood for, and which was shaped by the Kazan theologian Shihabaddin al-Marjani (d. 1889). The article analyzes the transnational links that Fakhraddin established, concluding that Fakhraddin depicted himself as Afghani’s foremost disciple in Russia, in competition with others, and independent of Afghani’s most famous disciple, Muhammad ʿAbduh. At the center of Fakhraddin’s account are his own memories of a meeting he had with Afghani in St. Petersburg in 1888.
Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease
Authors: Shin Sun-Hwa , Won Mi Hwa 
Published: November 2024

Background: Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited. Objectives: This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD. Methods: This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records. Results: The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = −0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables. Conclusions: Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.
The Oswestry Disability Index is not a good measure for low back pain in adolescents: A Rasch analysis of data from 200 people
Authors: Selhorst Mitchell , Degenhart Todd , Jackowski Michael , Meyer Samuel , Rospert Alexander 
Published: November 2024

Objective To evaluate the psychometric properties of the modified Oswestry Disability Index in adolescents with low back pain through Rasch analysis. Design This is a psychometric study. Setting Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States). Subjects Two hundred adolescent patients with low back pain (112 female, 15.4 ± 1.9 years old). Main measure The modified Oswestry Disability Index. Results The mean modified Oswestry Disability Index score was 17.1 ± 12.1, with scores ranging from 0 to 56 on the 100-point scale. The Rasch person reliability for the Oswestry Disability Index was 0.70, representing minimal acceptable person reliability. The Oswestry Disability Index demonstrated poor item spacing, hierarchy, and targeting of the adolescents’ disability level (>1 logit between person mean and item mean). A significant misfit was observed in three of 10 items. There were significant issues with the functioning of responses on all items of the Oswestry Disability Index. Principal component analysis of residuals revealed a ratio of 5.3:1, demonstrating acceptable unidimensionality. Conclusion Due to multiple psychometric issues, the Oswestry Disability should not be used to assess disability in adolescents with low back pain. The Oswestry Disability Index significantly mistargets adolescent ability and only provides an acceptable assessment of the most disabled adolescents.
Effects of immersive virtual reality stimulation and/or multicomponent physical exercise on cognitive and functional performance in hospitalized older patients with severe functional dependency: study protocol for a randomized clinical trial
Authors: de la Casa-Marín Antón , Zambom-Ferraresi Fabiola , Ferrara Maria Cristina , Ollo-Martínez Iranzu , Galbete Arkaitz , González-Glaría Belén , Moral-Cuesta Débora , Marín-Epelde Itxaso , Chenhuichen Chenhui , Lorente-Escudero Marta , Molero-de-Ávila Rodrigo , Baztán Agurne García , Zambom-Ferraresi Fabricio , Martínez-Velilla Nicolás 
Published: November 2024

Abstract
Background
Hospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index < 60 points).

Methods
This clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥ 75, Barthel Index < 60, able to collaborate, expected length of stay ≥ 5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days. The ME group will undergo aerobic and strength exercise for progressive training of the upper and lower limbs. The IVR + ME group will do both cognitive and physical intervention. The primary outcomes will be cognitive and physical measures at discharge. Mood, quality of life, isometric strength, and acceptance of IVR will be also assessed.

Discussion
This project has the potential to enhance physical and psychological well-being of patients with severe functional dependency hospitalized for acute conditions, using technology. Virtual reality is expected to be favourably perceived by hospitalized older adults. This intervention represents a novelty in the geriatric patients’ care, comprising IVR and/or ME dispensed within the patient’s room, and including patients who are commonly excluded from research clinical trials.

Trial registration
This study was approved by the Navarra Clinical Research Ethics Committee on May 17th, 2023 (PI_2023/60). The trial is registered at ClinicalTrials.gov, registration number NCT06340282, 24th May 2024.