bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insights into the complex relationship between triglyceride glucose-waist height ratio index, mean arterial pressure, and cardiovascular disease: a nationwide prospective cohort study
Authors: Xu Jie , Cai Dihui , Jiao Yuheng , Liao Yingying , Shen Yinyin , Shen Yunli , Han Wei 
Published: February 2025

Abstract

Background
Both the triglyceride glucose-waist height ratio (TyG-WHtR) index and elevated arterial blood pressure are risk factors for cardiovascular disease (CVD). However, it is uncertain whether the TyG-WHtR index can increase the risk of CVD by influencing arterial blood pressure, and the extent to which the TyG-WHtR index may mediate the association between arterial blood pressure and CVD. The purpose of this study is to evaluate complex association of the TyG-WHtR index and mean arterial pressure (MAP) with CVD.

Methods
All data in this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS) free of CVD at baseline. CVD was defined as self-reporting heart disease and stroke. Cox proportional hazards model and restricted cubic spline (RCS) were used to analyze the association of the TyG-WHtR index and MAP with the risk of CVD. Time-dependent receiver operating characteristic (ROC) analysis was used to assess the predictive performance of TyG-WHtR, MAP for CVD. Four-way decomposition method explored the mediating effects of the TyG-WHtR index and MAP in CVD.

Results
A total of 7976 participants were included in this study. The mean age of the participants was 58.68 ± 9.60 years, and 4263 (53.45%) were females. During a maximum follow-up of 7.0 years, 1326 (16.62%) people developed CVD. Both the TyG-WHtR index and MAP were signifcantly associated with CVD. The RCS regression analyses demonstrated a positive linear association of the TyG-WHtR index and MAP with the incidence of CVD. Compared with participants with TyG-WHtR < median and MAP < median, those with TyG-WHtR ≥ median and MAP ≥ median had the highest risk of CVD (HR 1.961; 95%CI 1.660–2.317). The combination of TyG-WHtR and MAP demonstrated incremental predictive utility over either biomarker alone, as evidenced by improvements in integrated discrimination improvement (IDI) and net reclassification improvement (NRI). While absolute predictive performance remained moderate. Increased MAP signifcantly mediated 52.43% of the associations between TyG-WHtR index and CVD, and increased TyG-WHtR index signifcantly mediated 83.40% of the associations between MAP and CVD.

Conclusion
The combination of a higher TyG-WHtR index and a higher MAP was associated with the highest risk of CVD. The combined model of the TyG-WHtR index and MAP showed improved predictive ability, as indicated by IDI and NRI, although its overall predictive performance was still moderate. The MAP could partially mediate the association between TyG-WHtR index and CVD, as well as TyG-WHtR index could also partially mediate the association between MAP and CVD. These findings suggested that the combination of TyG-WHtR index and MAP helps identify populations at early risk of CVD and improve risk stratifcation.

Graphical abstract
Automatic gait EVENT detection in older adults during perturbed walking
Authors: Wang Shuaijie , Omar Kazi Shahrukh , Miranda Fabio , Bhatt Tanvi 
Published: February 2025

Abstract
Accurate detection of gait events in older adults, particularly during perturbed walking, is essential for evaluating balance control and fall risk. Traditional force plate-based methods often face limitations in perturbed walking scenarios due to the difficulty in landing cleanly on the force plates. Subsequently, previous studies have not addressed gait event automatic detection methods for perturbed walking. This study introduces an automated gait event detection method using a bidirectional gated recurrent unit (Bi-GRU) model, leveraging ground reaction force, joint angles, and marker data, for both regular and perturbed walking scenarios from 307 healthy older adults. Our marker-based model achieved over 97% accuracy with a mean error of less than 14 ms in detecting touchdown (TD) and liftoff (LO) events for both walking scenarios. The results highlight the efficacy of kinematic approaches, demonstrating their potential in gait event detection for clinical settings. When integrated with wearable sensors or computer vision techniques, these methods enable real-time, precise monitoring of gait patterns, which is helpful for applying personalized programs for fall prevention. This work takes a significant step forward in automated gait analysis for perturbed walking, offering a reliable method for evaluating gait patterns, balance control, and fall risk in clinical settings.
Effect of bronchofiberscopic lavage with acetylcysteine instillation on refractory mycoplasma pneumoniae pneumonia in children: a retrospective clinical observation
Authors: Li Pei-long , Fu Hong-min , Liu Kai , Li Feng , Yang Jia-wu 
Published: February 2025

Abstract

Background
Bronchofiberscopic lavage is a therapeutic treatment for mycoplasma infection. However, there are limited reports on the use of bronchofiberscopic lavage with acetylcysteine instillation. The aim of our study was to investigate the clinical effect of bronchofiberscopic lavage with acetylcysteine instillation on refractory mycoplasma pneumoniae pneumonia in children.

Methods
This was a retrospective study. Clinical and laboratory data were collected from 280 children hospitalized with MPP in the Department of Pulmonary and Critical Care Medicine at Kunming Children′s Hospital from January 2021 to January 2023, and these were divided into two groups: the study group and the control group. Children in the control group were treated with anti-infective, antitussive, and antipyretic routine symptomatic treatment and nebulization of acetylcysteine suspension, while children in the study group were treated with bronchofiberscopic lavage with acetylcysteine instillation along with standard treatment as in the control group. The clinical characteristics, adverse reactions, pulmonary imaging changes, and laboratory examination indicators were compared between the two groups.

Results
The treatment effective rate and the absorption area of lung lesions in the study group were significantly higher than those in the control group (P < 0.05). Before treatment, there were no statistically significant differences in WBC, IgG, IgE, CRP, and IL-6 levels between the two groups (P > 0.05). After 7 days of treatment, IgG levels in both groups were higher than those before treatment, while WBC, IgE, CRP, and IL-6 levels were lower than those before treatment (P < 0.05).

Conclusions
The bronchofiberscopic lavage with acetylcysteine instillation constitutes a safe and efficacious therapeutic regimen, which might alleviate the clinical symptoms experienced and reduce the levels of inflammatory factors for children with RMPP.
Sublingual sufentanil after orthopaedic and abdominal surgery: long-term outcome and safety
Authors: Borck Michael , Wandrey Jan D. , Spies Claudia , Tafelski Sascha 
Published: February 2025

Abstract

Background
Acute postoperative pain management often requires opioid treatment with patient-controlled analgesia (PCA). Non-invasive PCA with a sublingual sufentanil tablet system (SSTS) may reduce acute pain sufficiently, but opioids are associated with central nerve system side effects and risk of long-term opioid use postoperatively. The objective of this study was to observe the SSTS to assess the incidence of postoperative chronic pain (PCP) and postoperative delirium (POD).

Methods
This was a longitudinal cohort study based at a university hospital between November 2017 and November 2021. Adults undergoing elective orthopaedic knee or abdominal surgery planned for PCA as postoperative pain management were included. They received the SSTS in addition to a standardised pain medication protocol depending on the surgery they underwent. Exclusion criteria were pregnancy, emergency surgery, concurrent participation in another clinical trial and chronic opioid use before surgery. Patients were followed after surgery in hospital and over 3 and 12 months for pain, cognitive function and side effects.

Results
Altogether N = 80 patients were included with SSTS postoperatively. Daily pain experience decreased from pre-operatively 89.2% of patients to 45.7% and 22.5% at 3 and 12 months. None of our patients developed postoperative delirium after surgery. Patients reported high overall satisfaction with SSTS (median 8.0/10 points, IQR 3). However, 51% of patients had difficulties with handling the SSTS and required acute replacement of the authentication tag.

Conclusions
SSTS sufficiently treated acute postoperative pain without incidence of POD and demonstrated good tolerability and overall ease. Postoperative pain improved significantly over time but 22% still reported chronic pain related to surgery. Technical issues with the identification thumb tag limited the feasibility of SSTS.

Trial registration
This prospective longitudinal cohort study was approved by the ethics committee of the Charité Universitätsmedizin Berlin (Ethics committee 2, Campus Charité Virchow Klinikum, EA2/041/17, Prof. Dr. jur. R. Seeland, 21.03.2017) and was registered in the study register (https://clinicaltrials.gov/ct2/show/NCT03133858).
Enterocloster clostridioformis protects against Salmonella pathogenesis and modulates epithelial and mucosal immune function
Authors: Beresford-Jones Benjamin S. , Suyama Satoshi , Clare Simon , Soderholm Amelia , Xia Wangmingyu , Sardar Puspendu , Lee Junhee , Harcourt Katherine , Lawley Trevor D. , Pedicord Virginia A. 
Published: February 2025

Abstract

Background
Promoting resistance to enteric pathogen infection is a core function of the gut microbiota; however, many of the specific host–commensal interactions that mediate this protection remain uncharacterised. To address this knowledge gap, we monocolonised germ-free mice with mouse-derived commensal microbes to screen for microbiota-induced resistance to Salmonella Typhimurium infection.

Results
We identified Enterocloster clostridioformis as a protective species against S. Typhimurium infection. E. clostridioformis selectively upregulates resistin-like molecule β and cell cycle pathway expression at the level of caecal epithelial cells and increases T-regulatory cells in the underlying mucosal immune system, potentially contributing to reduced infection-induced pathology.

Conclusions
We highlight novel mechanisms of host–microbe interactions that can mediate microbiota-induced resistance to acute salmonellosis. In the backdrop of increasing antibiotic resistance, this study identifies novel potential avenues for further research into protective host responses against enteric infections and could lead to new therapeutic approaches.
Prevalence and risk factors of acute respiratory infection and diarrhea among children under 5 years old in low-middle wealth household, Indonesia
Authors: Purnama Tri Bayu , Wagatsuma Keita , Saito Reiko 
Published: February 2025

Abstract

Background
Acute respiratory infection (ARI) and diarrhea remain critical public health concerns. In Indonesia, various interventions have been implemented to reduce the prevalence of ARIs and diarrhea among children in low- and middle-income households. Hence, the absence of detailed data on the prevalence of ARIs and diarrhea among children under five in low- and middle-income households in Indonesia restricts the formulation of targeted health interventions and policies. This study sought to evaluate the prevalence of ARI and diarrhea while examining modifiable risk factors related to malnutrition, sanitation, and social protection characteristics in Indonesia.

Methods
This study utilized a cross-sectional design based on data from the Nutrition Status Survey 2022 covering 514 districts/cities in Indonesia. It analyzed 289,631 children under five years out of 334,848 households with low and middle wealth indices. Multivariable binary logistic regression analysis was employed to calculate the risk associated with cases of ARI and diarrhea.

Results
The prevalence of ARI and diarrhea among low- and middle-wealth households were 5.7% and 6.0%, respectively, with infants under six months being the most vulnerable group to these infections, including malnutrition. The most significant risk factors for ARI and diarrhea are unclean cooking fuel [adjusted odds ratio (aOR) = 1.53, 95% CI 1.47–1.60] and shared toilet facilities (aOR = 1.45, 95% CI 1.38–1.51), with households using shared toilets having 1.45 times higher risk of diarrhea (aOR = 1.45, 95% CI 1.38–1.51) compared to those with private access. Additionally, households lacking social protection support are also at increased risk for these infections and malnutrition issues.

Conclusions
This study revealed a notable prevalence of ARI and diarrhea among low- and middle-wealth households, particularly affecting infants under six months. Vulnerable children, especially those who were stunted or underweight, and households lacking sanitation and social protection faced heightened risks for these health issues.

Graphical Abstract
Associations Between Lactate Thresholds and 2000 m Rowing Ergometer Performance: Implications for Prediction—A Systematic Review
Authors: Kilbey Timothy , Vecchi Eugenio , Salbany Paulo , Handa Ashok , Stride Eleanor , Sheth Mihir 
Published: February 2025

Abstract

Background
Various exercise thresholds have been evaluated to predict athlete performance. However, a systematic review of the literature assessing the association between lactate-based exercise thresholds and 2000 m rowing ergometer performance is still lacking. These may have utility in the prediction of 2000 m rowing ergometer performance due to the close relationship between metabolic parameters and development of endurance capacity. The aim of the present study is to review and assess the extent, quality, and reliability of lactate-based exercise testing and methodologies in their association with 2000 m rowing ergometer performance, and to discuss the potential implications for performance prediction.

Methods
The systematic review was performed following PRISMA 2020 guidelines. The databases searched were EMBASE, MEDLINE and SPORTDiscus. The initial search took place in July 2022, with an update search performed in September 2023, and again in August 2024. Studies which reported a lactate test and its correlation to 2000 m ergometer performance were included. No meta-analysis was performed.

Results
Twenty-four studies comprising 797 athletes (513 male, 257 female, 27 not stated) met the eligibility criteria for inclusion in the review. The most commonly used testing protocol involved the use of incremental step-tests. A range of exercise intensity parameters, lactate-based exercise thresholds and interpretation methodologies were employed. Of these, the power or velocity at a blood lactate concentration of 4 mmol l−1 was the most common test, with correlation coefficients ranging from 0.53 to 0.96 suggesting that 28–92% of the variance in rowing performance can be explained by this metric. Six studies that rated as GOOD on the risk of bias assessment found very strong correlations > 0.85 (p < 0.05).

Conclusions
This systematic review found that there is good evidence that the power generated at a blood lactate concentration of 4 mmol l−1 correlates strongly to 2000 m rowing ergometer performance and may have useful predictive power. However, the review also identified the varying quality of the available literature, with a variety of parameters, exercise protocols, testing methods, and performance metrics being used to report performance making it difficult to compare results between studies. Other tests such as

$$\dot{V}{O}_{2}$$

V
˙

O
2

at a blood lactate concentration of 4 mmol l−1 and power at the initial non-linear inflection blood lactate threshold merit further investigation as the extent and reliability of the available data is currently insufficient to draw firm conclusions.

Protocol registration: The protocol was registered on Open Science Framework on 17/11/2022. https://doi.org/10.17605/OSF.IO/D8YCE
Unexpected negative-pressure pulmonary edema after tracheostomy: two case reports
Authors: Kotani Taichi , Naito Yusuke , Okuda Chie , Sonobe Shota , Egawa Junji , Kawaguchi Masahiko 
Published: February 2025

Abstract

Background
Negative-pressure pulmonary edema (NPPE) often develops with upper airway obstruction, and is uncommon in secured airways, for example, after tracheostomy. Herein, we report two cases of NPPE post-tracheostomy.

Case presentation
Case 1: A 69-year-old man underwent prophylactic tracheotomy for possible airway obstruction secondary to glottic carcinoma. Two hours after awakening from general anesthesia, he had difficulty expectorating and developed NPPE due to airway secretions obstructing the tracheostomy tube.
Case 2: An 11-year-old boy was admitted to the intensive care unit for continuous hemodiafiltration on a ventilator under sedation. On the 76th day, the day after the tracheostomy was performed, the patient developed patient-ventilator asynchrony due to sedative withdrawal syndrome. The postulated primary mechanism was functional airway obstruction due to patient-ventilator asynchrony.

Conclusion
These cases highlight the need to consider NPPE, even in patients with an airway secured with a tracheostomy.
Catheter diameter and infection control are important in neonatal continuous kidney replacement therapy: a single-center retrospective study
Authors: Otsuka Hiroki , Kibe Masaya , Ishihara Chie , Tokuhisa Takuya 
Published: February 2025

Abstract

Background
Neonates have smaller bodies than children; reports on circuit lifetime in neonates remain scarce, even though the mortality rate is high with continuous kidney replacement therapy (CKRT). In this study, we determined the circuit lifetime of CKRT in neonates and examined the associated factors.

Methods
We retrospectively identified patients who were admitted to our neonatal intensive care unit and underwent CKRT from 1 January 2014 to 31 December 2022. A survival analysis of circuit lifetime was performed, and the Cox proportional hazards model was developed to analyze the impact on circuit occlusion.

Results
In total, 88 circuits were assembled, with 69 occluded and 19 detached circuits. The median corrected age at CKRT therapy was 39.6 (interquartile range [IQR] 35.4–42.3) weeks, weight was 2508 (1500–3090) g, catheter diameter was 1.2 (0.8–1.8) mm, and circuit lifetime was 16.0 (7.5–38.1) h. The hazard ratio for circuit lifetime was 1.04 (95% confidence interval [CI] 0.97–1.11), 1.00 (1.00–1.00), 0.62 (0.40–0.96), and 0.41 (0.21–0.80) for corrected age, weight, catheter diameter, and bacteremia, respectively.

Conclusions
Appropriate selection of catheter and infection management are important for safe CKRT.
Barriers and facilitators for treatment-seeking among women with genital fistula: a facility-based qualitative study in Bangladesh
Authors: Kon Kanako , Imoto Atsuko , Rashid Sabina Faiz , Masuda Ken 
Published: February 2025

Abstract

Background
Women living with genital fistula often endure prolonged suffering and face multiple barriers to accessing treatment. Bangladesh’s government has enhanced referral mechanisms, enabling case detection in communities and facilitating surgical interventions at medical college hospitals through nationwide initiatives. However, research on barriers and facilitators for fistula treatment in Bangladesh remains limited. Detailed insights into treatment-seeking paths with time sequences are scarce. This study aimed to explore facilitators and barriers to completing fistula treatment with the description of treatment-seeking paths. This study is important to assist with future policy and program strategies for fistula treatment.

Methods
A facility-based qualitative study was conducted at Dhaka Medical College Hospital, Dhaka, Bangladesh. Data were collected from February to May 2024 through 18 in-depth interviews (IDIs) with in-patients, five IDIs with families, and 11 key informant interviews with health service providers. Participants’ treatment-seeking paths were described chronologically and identified patterns of treatment-seeking paths. Thematic analysis, guided by the Partners for Applied Social Sciences model for health-seeking behavior and access to care, was used to analyze case histories.

Results
The average duration of treatment-seeking by the women was 39 months, with a maximum of 22 years. Women with fistula often sought care at multiple facilities (up to eight), suspended treatment, and encountered systemic obstacles that delayed treatment. Key barriers included scarce information on illness and treatment in the community, less decision-making power, failure of medical communication, and systemic failures in cost, treatment, and referral systems. Facilitators that motivated women to complete treatment included informal peer support through shared treatment experiences and emotional, physical, and financial support.

Conclusions
Analysis of treatment-seeking paths revealed the absence of standardized treatment routes for women with fistula. To ensure effective care, raising societal awareness about fistula, improving treatment and referral systems, enhancing medical communication, and providing peer and emotional support are strongly recommended.
Toxicity assessment of collagen from Decapterus macarellus: a zebrafish model study
Authors: Wimalagunarathna Nipuna Deelaka , Gunathilake Varuni Karunika 
Published: February 2025

Abstract

Background
Collagen, derived from various biological sources, is crucial in supporting a range of physiological processes and developmental pathways. However, concerns have been raised regarding the potential teratogenic effects of collagen. The zebrafish (Danio rerio) model has emerged as a premier vertebrate model for investigating the impact of biomaterials on vertebrate development, both under normal and pathological conditions. The present study sought to assess the acute toxicity, developmental toxicity, cardiotoxicity, and teratogenic toxicity of fish collagen extracted from Decapterus macarellus fish species on various developmental parameters. Acid-solubilized collagen was extracted from D. macarellus, and zebrafish embryos (< 96 h) were subsequently exposed to varying collagen concentrations of 62.5 parts per million (ppm), 125 ppm, 250 ppm, 500 ppm, and 1000 ppm. Key developmental parameters, including survival rate, hatching rate, heart rate, and deviations in four apical points: embryo coagulation, lack of somite formation, non-detachment of the tail, and lack of heartbeat observations were recorded over a period of 0–96 h post-fertilization (hpf). Positive and negative controls were parallelly carried out analysing the results statistically with pairwise Kruskal–Wallis test followed by a Dunn pairwise test.

Results
The results indicated that the survival rate of zebrafish embryos ranged from 96.97 ± 5.25 to 82.28 ± 9.80% at 96 hpf across all tested collagen concentrations. No significant differences were observed (P > 0.05) compared to the negative control group or between the various treated concentrations. The hatching rate at 48 hpf and heart rates at 72 hpf and 96 hpf in the treated groups showed no significant variations compared to the negative control (P > 0.05). Furthermore, no abnormal changes were recorded in the four apical points; embryo coagulation, lack of somite formation, non-detachment of the tail, and lack of heartbeat in embryos, treated with collagen. All the observed results cumulatively indicated the nontoxic effect of collagen from D. macarellus on zebrafish embryo development.

Conclusions
The results confirm the extracted from D. macarellus is nontoxic and causes no teratogenic effects in zebrafish embryo development. It further validates the potential of using collagen as a biocompatible material, where non-toxicity and developmental safety are paramount.