bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of exosomes in the pathogenesis and management of diabetic kidney disease: a systematic review and meta-analysis
Authors: Zheng Yan , Xu Chu , Jin Yan 
Published: December 2024

ObjectiveThis systematic review and meta-analysis aimed to synthesize the role of exosomes in the pathogenesis and management of diabetic kidney disease.MethodsPubMed, Embase, Cochrane Library, and Web of Science were searched for studies that compared the levels of exosomes between patients with diabetic kidney disease and controls published up to 27 November 2023. Methodological quality was assessed using the JBI Appraisal Checklist for Case–Control Studies. The methodology of the samples and the main results were summarized. A meta-analysis of the diagnostic performance of exosomes was performed using estimates of test sensitivity and specificity, and these values were summarized using summary receiver-operating characteristic curves. The results were reported following the PRISMA 2020 checklist.ResultsA total of 32 studies, including 1,119 patients with diabetic kidney disease and 1,328 controls, met the inclusion criteria. A total of 78 upregulated and 22 downregulated microRNAs, 2 upregulated and 4 downregulated mRNAs, 6 upregulated and 1 downregulated proteins, and 4 upregulated lipids were identified. The miR-126, miR-145, miR-150, miR-21, and WT1 mRNA dysregulation were consistently reported in at least two studies. The overall sensitivity and specificity of the exosomes in diabetic kidney disease diagnosis were 0.70 (95% CI: 0.59–0.80) and 0.79 (95% CI: 0.70–0.85), respectively. The summary receiver operating characteristic curve was plotted to assess diagnostic accuracy with the area under the curve (AUC) of 0.82 (95% CI: 0.78–0.85).ConclusionExosomes have great potential to become effective diagnostic biomarkers for diabetic kidney disease. Panels of exosomes or the combination of exosomes with other clinical indicators seemed more accurate than single exosomes.
Exposure to air pollution and the risk of type II diabetes mellitus: a time-series study
Authors: Hou Zhuomin , Wang Yongbin , Chen Zhigang , Sun Siyu , Xie Na , Chen Yingen , Wang Lujie , Lin Fei , Zhao Guoan 
Published: December 2024

BackgroundEnvironmental factors have been identified as primary risk factors for type 2 diabetes mellitus (T2DM). However, studies on the association between environmental factors and T2DM have mainly focused on morbidity and mortality, which do not fully reflect the disease burden stemming from air pollution. Therefore, we aimed to evaluate the correlation between air pollution and T2DM, including hospital length of stay (LOS) and costs.MethodsWe collected data on patients with T2DM from three healthcare institutions in Xinxiang from 2016–2021. Data on particulate and gaseous pollutants in Xinxiang and daily meteorological data were collected from national databases. The distribution lag nonlinear model was used to evaluate the correlation between air pollution and the number of inpatients with T2DM, LOS, and hospital costs. Subgroup analyses were conducted to identify potential modifying factors.ResultsOverall, 13,797 patients with T2DM were included in our analysis. Within the cumulative lag of 7 days, with every increase of 1 mg/m3 of carbon monoxide (CO) and 10 μg/m3 of 2.5 microns particulate matter, nitrogen dioxide and ozone exhibited significant associations with an increase in diabetes hospitalization risk. CO exhibited adverse effects on LOS on most lag days. Moreover, hospital costs were significantly associated with the attributable fraction of LOS and hospital costs attributed to diabetes.ConclusionsExposure to air pollutants increased T2DM risk, imposing significant economic and social burdens in Xinxiang, China. Implementing policies to reduce air pollutant exposure may decrease T2DM admissions, costs, and LOS.
Exploring lymphocyte subsets in COVID-19 patients: insights from a tertiary academic medical center with a high proportion of patients on immunosuppression
Authors: Daenen Katrijn , van Hooijdonk Samantha , Tong-Minh Kirby , Dik Willem A. , van Hagen Petrus M. , Huijben Jilske A. , Gommers Diederik , van Gorp Eric C. M. , Endeman Henrik , Dalm Virgil A. S. H. 
Published: December 2024

IntroductionSevere COVID-19 is associated with reduced absolute lymphocyte counts, suggesting that lymphocyte subsets may serve as predictors of clinical outcomes in affected patients. Early identification of patients at risk for severe disease is crucial for optimizing care, accurately informing patients and their families, guiding therapeutic interventions, and improving patient flow in the ED. Given that immunosuppressive drugs significantly impact lymphocyte profiles, we aimed to determine the association between prior use of immunosuppressive drugs, lymphocyte subsets, and COVID-19 severity in our population with a high prevalence of immunosuppression.MethodsIn 2021, suspected COVID-19 patients were included in the ED. Lymphocyte subsets were determined in peripheral blood within 24 hours after presentation and comparative analyses was performed between SARS-CoV-2 negative and positive patients, mild versus severe disease and patients with and without prior immunosuppressive drug use. Mild cases were patients discharged home or admitted to a general ward, severe cases were patients with COVID-19-related mortality or necessitating ICU admission. Logistic regression analysis was performed to assess the association between lymphocyte subsets and COVID-19 severity, and between prior immunosuppressive drug use and COVID-19 severity.ResultsTwenty-five SARS-CoV-2 negative and 77 SARS-CoV-2 positive patients were included, whereof 57 (74%) had mild and 20 (26%) severe COVID-19. No significant differences were observed in the absolute counts of CD3+, CD4+, and CD8+ T-lymphocytes, B-lymphocytes, and NK-cells between SARS-CoV-2 negative and positive patients or between mild and severe cases. The 36 patients with prior use of immunosuppressive drugs had significantly lower CD4+ T-lymphocytes (p&lt;0.01). Prior use of immunosuppressive drugs was not associated with COVID-19 severity (adjusted OR 1.074, 0.355-3.194).ConclusionLymphocyte subsets were not significantly different between SARS-CoV-2 negative and positive patients and between mild versus severe cases. Neither lymphocyte subsets nor prior immunosuppressive drug use were associated with COVID-19 severity.
Genetically predicted serum metabolites mediate the association between inflammatory proteins and polycystic ovary syndrome: a Mendelian randomization study
Authors: Jia Ming-Jie , Zhou Li , Liu Xing-Ning , Li Hui-Lin 
Published: December 2024

ObjectiveTo investigate the association between polycystic ovary syndrome (PCOS) and inflammatory proteins, and to identify and quantify the role of serum metabolites as potential mediators.MethodsUtilizing summary-level data from a genome-wide association study (GWAS), we conducted a two-sample Mendelian Randomization (MR) analysis, a genetic approach that uses genetic variants as instrumental variables to assess the causal relationships between risk factors and outcomes. This analysis involved genetically predicted PCOS (1,639 cases and 218,970 controls) and inflammatory proteins (14,824 participants of primarily European descent). Additionally, a two-step MR analysis was performed to quantify the proportion of the effect of serum metabolites-mediated inflammatory proteins on PCOS. The Inverse Variance Weighted (IVW) method, a statistical technique used within MR to combine data from multiple genetic variants, was used to estimate the causal effects.ResultsThe IVW method revealed that the inflammatory proteins IFN-γ (p-value = 0.037, OR = 1.396, 95% CI = 1.020–1.910) and CCL7 (p-value = 0.033, OR = 1.294, 95% CI = 1.021–1.641) were associated with an increased risk of PCOS, while IL-6 (p-value = 0.015, OR = 0.678, 95% CI = 0.495–0.929) and MMP-10 (p-value = 0.025, OR = 0.753, 95% CI = 0.587–0.967) were associated with a decreased risk. No significant evidence suggested an effect of genetically predicted PCOS on inflammatory proteins. The serum metabolite X-11444 was found to mediate 5.44% (95% CI: 10.8–0.0383%) of the effect of MMP-10 on PCOS.ConclusionThis study not only introduces novel causal associations between inflammatory proteins and PCOS but also highlights the mediating role of serum metabolites in these associations. By applying MR, we were able to minimize confounding and reverse causality, offering robust insights into the biological mechanisms underlying PCOS. These findings advance the understanding of PCOS pathogenesis, particularly in relation to inflammatory pathways and serum metabolite interactions, and suggest potential therapeutic targets that could inform future clinical interventions aimed at mitigating inflammation-related PCOS risks.
Observation on the therapeutic effect of probiotics on early oral feeding in the treatment of severe acute pancreatitis
Authors: Zhao Yanan , Zhang Rui , Wang Shuling , Yang Chunchun , Wang Yang , Fan Hongyun , Yang Mingyue 
Published: December 2024

ObjectivesTo evaluate the clinical efficacy of probiotics and early oral feeding in patients with severe acute pancreatitis.MethodsA prospective, randomized, controlled trial was conducted involving 66 patients, who were randomly divided into a control group (n = 32) receiving standard enteral nutrition and an observation group (n = 34) receiving additional Bifidobacterium quadruplex live bacterial tablets. Serum inflammatory markers, including white blood cells (WBC), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP), were measured on days 1, 3, and 7 post-admission. Abdominal pain scores, the computed tomography severity index (CTSI), and the Bedside Index for Severity in Acute Pancreatitis (BISAP) scores were also assessed. Additionally, defecation time and the total duration of hospitalization were compared between the two groups.ResultsInflammatory markers declined in all groups by the third day post-admission, with the observation group exhibiting a significantly greater reduction compared to the control group (p &lt; 0.05). Similarly, from the first day to the third day, both groups experienced a decrease in abdominal pain scores, CTSI, and BISAP scores, with the observation group showing a significantly more pronounced decrease in BISAP scores compared to the control group (p &lt; 0.05). By the seventh day of admission, inflammatory markers continued to decline in all groups compared to the third day, except for TNF-α levels, and the observation group demonstrated a significantly greater decrease compared to the control group (p &lt; 0.05). Abdominal pain scores, CTSI, and BISAP scores also decreased further in both groups compared to the third day, with the observation group again showing a significantly greater improvement than the control group (p &lt; 0.05). Additionally, the observation group had a significantly shorter time to bowel movement resumption (38.23 ± 2.31 h vs. 43.43 ± 2.75 h, p = 0.013) and total hospital stay compared to the control group (10.97 ± 0.35 days vs. 13.40 ± 0.50 days, p &lt; 0.001).ConclusionEarly oral ingestion combined with probiotics can reduce the levels of inflammatory factors, improve abdominal pain symptoms, alleviate pancreatic edema and shorten defecation time and hospital stay in patients with severe acute pancreatitis.
Handgrip strength is independently associated with physical quality of life in patients undergoing maintenance hemodialysis: a cross-sectional study
Authors: Li Chunlei , Pan Xiangyou , Xu Shilin , Hu Jianguang , Zhong Xiaoshi , Wen Luona , Qiu Jingxian , Tan Rongshao 
Published: December 2024

ObjectiveWe aimed to identify the association between Health-related quality of life (HRQoL) and muscle strength in patients undergoing maintenance hemodialysis (MHD).MethodsIn this cross-sectional study from March 2021 to December 2021, 110 MHD patients with a mean age of 63.9 ± 13.0 years and a median dialysis vintage of 25.5 (12.0–52.3) months, were enrolled at a hemodialysis center in Guangzhou city, China. HRQoL was assessed using the Short Form 36 Health Survey (SF-36) and converted into the Physical Component Summary (PCS) and the Mental Component Summary (MCS). The groups were assigned according to the mean score of PCS and MCS, and those with higher PCS/MCS scores (high-PCS/MCS) were compared with those with lower PCS/MCS scores (low-PCS/MCS). Independent factors were evaluated using multivariate analysis. Muscle strength was estimated by handgrip strength (HGS).ResultsThe mean HGS was 23.7 ± 9.60 kg in men and 14.3 ± 5.30 kg in women. Compared to the high-PCS group, the low-PCS group had older age, higher levels of creatinine, total cholesterol, high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6), and had lower HGS (all p &lt; 0.05). After adjusting for confounding factors in different models, the five-model multivariate binary logistic regression analyses revealed that HGS was the only independent factor in PCS domain, but not in MCS.ConclusionHGS may be an independent factor of poor HRQoL in MHD patients, particularly in relation to physical health. The management of muscle strength may improve the HRQoL in MHD patients.Clinical trial registrationThe study was registered at https://www.chictr.org.cn/ as ChiCTR2100053790.
Obstacles and sustainability of enhanced recovery after surgery in pediatric laparoscopic pyeloplasty
Authors: Zhu Wenliang , Lai Huajian , He Ziqin , Zhang Yifei , Guo Qiang , Zhong Wenwen , Ye Lei , Qiu Jianguang , Wang Dejuan 
Published: December 2024

ObjectivesPrevious studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked clear control cases and discussed the obstacles in the implementation process. This article details the obstacles and lessons learned during the implementation of ERAS in patients with ureteropelvic junction obstruction (UPJO).MethodsAn ERAS protocol was implemented in the UPJO population undergoing LP, which included preoperative, intraoperative, and postoperative management. The clinical data of ERAS program Before Implementation (BI) and After Implementation (AI) were collected and analyzed retrospectively.ResultsA total of 107 patients (BI 46, AI 61) were enrolled. Compared with the BI group, the AI group had an earlier normal diet (19.83 h vs. 9.53 h, p &lt; 0.001), ambulation (39.10 h vs. 12.70 h, p &lt; 0.001), resumption of defecation (89.88 h vs. 27.90 h, p &lt; 0.001), less need for additional analgesia (19.5% vs. 1.6%, p = 0.002) and shorter postoperative hospital stay (POS) (6.00 d vs. 1.91 d, p &lt; 0.001) without increasing complications and readmission rates. Patients in the AI group had a median protocol score of 17 (IQR 16–18), and the compliance rate of the ERAS protocol was negatively correlated with the length of POS (R2 = 0.69, p &lt; 0.001).ConclusionsThe application of ERAS in pediatric LP is feasible and sustainable, with the potential for even greater impact as compliance improves. Common barriers were uncertain start time of surgery, lack of knowledge of ERAS among pathway participants, and support from anesthesiologists. Pre-determining the start time of surgery, strengthening preoperative education and positive communication among team members can help to promote the full implementation of ERAS program.
Clinical characteristics and predictive indictors of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a retrospective study
Authors: Li Yun , Liu Yunwei , Chen Xinying , Xiao Xiaolan , Chen Yiting , Wang Lianyu , Jiang Wenwen , Yang Jinghua 
Published: December 2024

IntroductionMacrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) cases have been rapidly increasing. The primary reason for this increased incidence is the pathogen's acquisition of resistance through mutations in 23S rRNA genes. Due to the unfeasibility of testing for macrolide susceptibility at the time of admission, this study aimed to assess the clinical features of pediatric MUMPP, using insights from laboratory tests and patterns of chest radiographic resolution.Material and methodsWe conducted a retrospective review of 161 patients with M. pneumoniae pneumonia (MPP) between January 2023 and December 2023. These patients were categorized into two groups based on their responsiveness to macrolides: 72 patients were in the MUMPP group, and 89 patients were in the macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP) group.ResultsMUMPP patients experienced a longer duration of fever and hospital stay. A higher proportion of MUMPP patients had shortness of breath, transcutaneous blood oxygen saturation (SpO2) lower than 94%, bilateral lobar infiltrates, lobar pneumonia and pleural effusion. The serum level of serum ferritin (SF), interleukin-6(IL-6), D-dimer, lactate dehydrogenase to albumin rate (LAR), and neutrophil to lymphocyte rate (NLR) were higher in MUMPP group.ConclusionsOur findings revealed that patients with MUMPP exhibit more severe initial radiographic indicators and clinical course compared to those with MSMP. Therefore, it is crucial to promptly administer alternative therapeutic agents besides macrolides for the management of MUMPP.
Trabecular bone scores in children with osteogenesis imperfecta respond differently to bisphosphonate treatment depending on disease severity
Authors: Futagawa Natsuko , Hasegawa Kosei , Miyahara Hiroyuki , Tanaka Hiroyuki , Tsukahara Hirokazu 
Published: December 2024

IntroductionOsteogenesis imperfecta (OI) is a congenital skeletal disorder characterized by bone fragility. Bisphosphonates (BISs) have become the mainstream treatment in children with OI. However, an optimal treatment protocol has not yet been established, while BIS treatment tends to be administered to normalize bone mineral density (BMD). Bone quality is an important component of bone strength. The trabecular bone score (TBS) is a quantitative measure of the microstructure that affects bone quality. This study investigated the TBS during BIS treatment in children with OI.Materials and methodsTwenty-nine children with OI were enrolled and classified into two groups: mild (type 1) and moderate to severe (types 3 and 4). Dual-energy x-ray absorptiometry images were retrospectively analyzed for TBS calculation. The relationship between the areal BMD (aBMD), its Z-score, height-adjusted BMD (BMDHAZ) Z-score, TBS, and TBS Z-score with the treatment duration was assessed for each group.ResultsIn the mild group, the aBMD, its Z-score, and BMDHAZ Z-score showed a significant positive correlation with treatment duration (r = 0.68, 0.68, 0.72, respectively, p &lt; 0.01). The TBS Z-score tended to increase with treatment duration, albeit without reaching significance. In the moderate to severe group, the TBS Z-score showed a significant positive correlation with treatment duration (r = 0.48, p &lt; 0.01), in contrast to the aBMD Z-score, which did not increase. Finally, the BMDHAZ Z-score only showed a weak positive correlation with treatment duration (r = 0.37, p &lt; 0.01).ConclusionBecause BIS affect the BMD and TBS differently based on the severity of OI, treatment goals may need to be stratified by disease severity.
Clinical predictors of treatment response to gabapentin in women with unexplained chronic pelvic pain
Authors: Coxon Lydia , Amer Maryam , Daniels Jane , Doust Ann M. , Mackenzie Scott C. , Horne Andrew W. , Vincent Katy 
Published: December 2024

IntroductionChronic pelvic pain affects up to 24% of women worldwide and for up to 55% of these there is no associated pathology. Despite this there are no established treatments in this cohort. This is a secondary analysis of a randomised-controlled trial (GaPP2) to explore if there are measures which enable us to predict treatment outcome.MethodsGaPP2 recruited women with chronic pelvic pain and no identified pathology and compared the response to gabapentin and placebo. This analysis used variables collected at baseline including validated questionnaires. Binary logistic regression was used to create models to explore whether baseline variables predicted treatment response. Treatment response was determined using 30% reduction in average pain intensity, 30% reduction in worst pain intensity and the Patient Global Impression of Change (‘marked’ or ‘very marked’ improvement) individually. We also explored whether baseline variables predicted the occurrence of side-effects (dizziness, visual disturbances and drowsiness).ResultsUsing the Patient Global Impression of Change questionnaire, we found a significant binary logistic regression (p = 0.029, explaining 31% of the variance), with those with lower worst pain intensity (odds ratio (OR) of 0.393, 95% CI [0.217, 0.712]), lower bladder symptom score (OR = 0.788, CI [0.628, 0.989]), and higher mental component quality of life score (OR = 0.911, CI [0.840, 0.988]), more likely to have ‘marked’ or ‘very marked’ improvement when treated with gabapentin. We could not identify predictors of experiencing side-effects to gabapentin. However, we did find predictors of these in the placebo group (binary logistic regression (p = 0.009) and explained 33% of the variance). Worse mental health (OR = 1.247, CI [1.019, 1.525]) and lower baseline pain interference (OR = 0.687, CI [0.483, 0.978]) were associated with having side effects, whilst the use of hormones reduced the risk of experiencing side effects (OR = 0.239, CI [0.084, 0.676]).DiscussionResearchers and clinicians are increasingly aware of the importance of personalised medicine and treatment decisions being driven by knowledge of what treatments work for whom. Our data suggests an important role of the Patient Global Impression of Change in clinical trials as it may better reflect balance between symptoms reduction and side-effects and therefore be more useful in clinician-patients joint decision making.