bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of hypertonic saline with or without hyaluronic acid among patients with cystic fibrosis: a systematic review and meta-analysis
Authors: Khan Zarghuna , Naeem Muhammad O. , Amin Dr. Anam , Amin Laraib , Shah Abdullah , Khaliq Saad Ul. , Azhar Aima , Naz Sana , Shujauddin Syed M. , Arshad Muhammad A. , Ali Sarosh J. , Sajid Emad U. , Jawad Sayed 
Published: October 2024

Background:
The clinical effectiveness of hypertonic saline (HS) in individuals with cystic fibrosis (CF) can be compromised by adverse effects. The objective of this study was to examine the efficacy of hyaluronic acid (HA) in mitigating these negative occurrences.

Methods:
A comprehensive review of the literature was carried out using three electronic databases: Medline, Cochrane Central, and Embase. This systematic review and meta-analysis investigate the efficacy of hypertonic saline (HS) with and without hyaluronic acid (HA) in treating cystic fibrosis. Primary outcomes include the incidence of cough, throat irritation, unpleasant taste, and changes in FEV1. Our findings suggest that adding HA to HS significantly reduces adverse effects and enhances patient tolerability, marking a potential improvement in cystic fibrosis therapy. Risk ratios (RRs) and mean differences (MDs) with 95% CI were used to present evaluations. The quality of RCTs was evaluated using the Cochrane Risk of Bias Tool (CRBT). The quality of the observational study was evaluated using the Newcastle–Ottawa Scale.

Results:
From the 1960 articles retrieved from the initial search, five relevant studies (n=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28–0.72, P=0.001), throat irritation (RR: 0.43; 95% CI, 0.22–0.81, P=0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23–0.80, P=0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: −2.97; 95% CI, −3.79–−2.15, P=0.52), compared to patients only on HS. Patients on HA + HS had significantly lower rates of cough (RR: 0.45; 95% CI, 0.28–0.72, P=0.001), throat irritation (RR: 0.43; 95% CI, 0.22–0.81, P=0.009), and bad smell (RR: 0.43; 95% CI, 0.23–0.80, P=0.09) when compared to patients on HS alone. Furthermore, compared to patients solely on HS, patients with HS plus HA exhibited a substantially lower forced expiratory volume (FEV1) (MD: −2.97; 95% CI, −3.79 to −2.15, P=0.52) as well.

Conclusion:
For CF patients who need ongoing HS therapy and have a history of poor therapy tolerance, adding HA is beneficial.
Incidental detection of three testes while evaluating an empty left scrotal sac: a case report
Authors: William Munna , Bhusal Amrit , Ahmad Waqar , Anjum Abdul Sattar , Qadeer Usman 
Published: October 2024

Introduction and importance:
Poly-orchidism is a rare congenital anomaly of the genitourinary system, which is characterized by the presence of more than two testicles, also being termed as “supernumerary testis”. Tri-orchidism is the most frequently encountered form of poly-orchidism, which is defined as the presence of more than two intra- or extra-scrotal testicles.

Case presentation:
The authors present a case of a 16-year-old male who presented with a complaint of an empty left scrotal sac, and was later diagnosed as a case of tri-orchidism with each testis in bilateral hemipelvis confirmed by ultrasound with Doppler and MRI. The patient was kept in regular follow-up for 6 months with radiological assessment, which showed no changes in radiological findings as before.

Clinical discussion:
The majority of patients are asymptomatic or present with a painless inguinal or scrotal mass, undescended testis, and rarely torsion of the supernumerary testis. Imaging modalities like US, Doppler study, and MRI are required for the diagnosis. Non-scrotal location of poly-orchidism is considered as the most important risk factor for malignancy. The surgical approach is required for any malignant changes in biopsy, US showing features of malignancy, absent spermatogenesis or in cases where regular follow-up is not possible. Otherwise, a conservative approach with regular follow-up is enough if above indications are absent.

Conclusion:
The complications of poly-orchidism like undescended testes, inguinal hernia, infertility, and possibly malignancy must be borne in mind while diagnosing poly-orchidism. The above-mentioned aspects must also be considered while choosing surgical intervention versus a conservative approach with follow-up, depending upon the position of the supernumerary testicle being scrotal or ectopic.
Epicardial fat and liver stiffness by acoustic radiation force impulse elastography in people with HIV-1 infection without liver disease
Authors: Pastori Daniele , Del Sole Francesco , Brogi Tommaso , del Ben Maria , Fimiani Caterina , Mastroianni Claudio Maria , Mezzaroma Ivano 
Published: October 2024

Objective:
To evaluate the association between increased epicardial fat thickness (EFT) and liver stiffness measurement (LSM), as assessed by elastography in people with human immunodeficiency virus type 1 (HIV-1) infection (PWH)

Methods:
Ninety-one PWH on effective antiretroviral treatment (ART) were enrolled. EFT was measured by transthoracic echocardiography. Liver steatosis was evaluated by ultrasound Hamaguchi criteria and LSM by elastography with acoustic radiation force impulse (ARFI) technique. LSM ≥8 kPa was suggestive of clinically relevant fibrosis.

Results:
Mean age was 54.3 years and 27.5% were women. EFT correlated with HIV-1 infection duration (rS 0.252, P = 0.016), age at study entry (rS 0.527, P < 0.001), BMI (rS 0.363, P < 0.001), waist circumference (rS 0.549, P < 0.001), HDL (rS −0.391, P < 0.001), triglycerides (rS 0.375, P < 0.001), Hamaguchi score (rS 0.279, P = 0.007), right lobe of the liver (rS 0.259, P = 0.014), left ventricular mass/body surface area (rS 0.220, P = 0.036).
A LSM ≥8 kPa was found in 20.9% of PWH, more commonly in those with EFT above the median >5.6 mm (30.4% vs. 11.1%, P = 0.038). LSM significantly correlated with EFT (rS 0.274, P = 0.009), CD4+ cells (rS −0.320, P = 0.003) and nadir of CD4+ cells (rS −0.292, P = 0.007).
In a subgroup (n = 53), a homeostasis model assessment of insulin resistance (HOMA-IR) index >2.33 identified increased EFT, [area under the curve (AUC) 0.73, 95% confidence interval (CI) 0.59–0.84, P = 0.001) while an HOMA-IR >3.27 predicted increased LSM (AUC 0.76, 95% CI 0.62–0.87, P = 0.005).

Conclusions:
PWH with increased EFT have worse metabolic profile and a high proportion of clinically relevant fibrosis at ARFI elastography, despite normal liver function tests. The HOMA-IR index might be used to identify PWH with increased EFT and liver fibrosis.
Trends in the Uptake of Index Testing Among Adolescents in USAID-Supported President's Emergency Plan for AIDS Relief Programs, October 2017–September 2022
Authors: Okegbe Tishina , Bishop Kristina Monroe , Rose Jessica , Srivastava Meena , Baptiste Anne Jean 
Published: October 2024

Introduction:
Adolescents aged 10–19 years account for a growing proportion of people living with HIV (PLHIV). In 2023, 140,000 adolescents were diagnosed with HIV, yet knowledge of HIV status and uptake of testing services remain critically low. Index testing—offering testing to contacts of PLHIV—is an important case-finding strategy. In 2021, President's Emergency Plan for AIDS Relief expanded guidance to explicitly include older adolescents aged 15–19 years. We reviewed index testing data to assess uptake and case-finding trends among biological adolescent-aged children and siblings of PLHIV aged 10–19 years.

Methods:
Routinely collected programmatic data from 27 U.S. Agency for International Development-supported President's Emergency Plan for AIDS Relief country and regional programs were analyzed for fiscal years (FY) 2017 through FY2022 (October 2016–September 2022). We compared the volume of index testing and subsequent new diagnoses across FYs and countries among biological adolescent-aged children and siblings of PLHIV and disaggregated by age, 10–14 and 15–19 years, and sex.

Results:
Index testing among adolescents aged 10–19 years increased from FY17 to FY22, nearly doubling from 147,088 to 291,534. Similarly, new diagnoses among adolescents increased between FY17 and FY22 (3721 vs 10,730). Overall, across FYs, index testing uptake and case-finding were higher among females than males, and the gap in testing uptake between sexes was larger for older than younger adolescents.

Conclusions:
Index testing uptake has increased substantially among adolescents over time, with rebounded gains for adolescents aged 15–19 years noted beginning in FY21. However, uptake across age and sex remained uneven, highlighting an opportunity to ensure that targeted testing strategies are used to reach adolescents aged 15–19 years and males.
Automated Preoperative Planning Algorithm for Mandibular Angle Osteotomy Based on Anatomical Landmarks Detection: A Retrospective Study
Authors: Zhang Yichi , Cao Zhenggang , Xie Le , Lin Li , Chai Gang 
Published: October 2024

Objective:
The aim of the study was to develop and evaluate an automated preoperative planning algorithm based on anatomical landmark point recognition for enhancing the efficiency and intelligence of preoperative planning for mandibular angle osteotomy.

Methods:
A retrospective cohort of 34 patients underwent preoperative planning with this algorithm. The present algorithm was developed using a method based on anatomical marker point recognition. The efficiency, symmetry, and safety of the automated preoperative planning and esthetics were statistically analyzed by paired t test and χ2 test.

Results:
The results showed that the automated planning algorithm was able to achieve a great improvement in preoperative planning efficiency as well as safety and symmetry. A prospective case report of 2 patients is then reported, illustrating the safety and esthetics of the algorithm with 1-year postoperative follow-up and postoperative esthetic scores.

Conclusion:
This algorithm can help to improve the efficiency of preoperative planning for surgeons while ensuring safety and esthetics and can be further applied to other craniomaxillofacial personalized design surgeries in the preoperative design in the future.
Determining Chin Dimensions for Feminizing Genioplasty: An Anatomic Study
Authors: Fodor R’ay , Kalandar Abir , Rampazzo Antonio , Isakov Raymond , Ferrando Cecile , Papay Francis , Bassiri Gharb Bahar 
Published: October 2024

Background:
Feminizing genioplasty warrants chin modification to achieve feminine characteristics. This study compared female and male facial skeletal dimensions and shape to guide feminizing genioplasty.

Methods:
Skulls stored at the Cleveland Museum of Natural History were analyzed. Sex, age, and race were documented. Heights and widths of the face and chin were measured, normalized, and compared.

Results:
Forty-three male (43.58±12.52-y-old) and 43 female (40.48±12.04-y-old) skulls were included. Within each group, 25 skulls were of African American (AA) origin and 18 were of Caucasian (C) origin. Absolute chin heights were larger in AA and C males compared with females (P<0.05). After normalization to lower facial height, there was a trend toward greater chin height in AA males compared with females (P=0.07). Parasagittal chin width in AA males was significantly larger than AA females (P=0.0006). Interforaminal chin width in C males trended toward being significantly larger than females (P=0.08). Following normalization of chin widths, no significant sex-based differences were noted for AA skulls except for the interforaminal/intergonial ratio, which was smaller in AA males (P=0.04). For C skulls, most normalized ratios were significantly smaller in males (P<0.05). C females had wider angles at the point of maximum chin projection (P=0.007) and wider symphyseal inclinations (P<0.0001). These differences were not present in AA skulls (P>0.05). Regardless of race, male chins appeared square, whereas female chins were round.

Conclusions:
While chin width reduction is not needed for most patients, height reduction could be considered. Chin contouring is the most central component of feminizing genioplasty.
The Upper Extremity Lymphatic System Is Not Symmetrical in Individuals
Authors: Fanning James E. , Friedman Rosie , Chen Angela , Bustos Valeria , Aly Mohamed Ismail , Fleishman Aaron , Hong Young Kwon , Tsai Leo , Parker John A. , Donohoe Kevin , Singhal Dhruv 
Published: October 2024

Objective:
We evaluated whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers, and if handedness is associated with symmetry of superficial lymphatic anatomy.

Background:
Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation.

Methods:
36 normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. 13 lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer.

Results:
Among the 36 participants, 10 (28%) showed symmetry of all eight upper extremity lymphatic pathways with ICG. However, only 1 (3%) participant demonstrated complete symmetry amongst the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in seven (39%) participants with hand dominance and three (17%) participants without hand dominance (X2 = 2.215, P = 0.137).

Conclusion:
Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.
Early palliative care and its impact on end of life care
Authors: Monnery Dan , Droney Joanne 
Published: October 2024

Purpose of review
The impacts of early palliative care for patients with advanced cancer are well described. This has led to endorsement of early palliative care, alongside cancer treatment, by leading cancer organisations. The aim of this review is to consider how best to adopt and integrate the learning from studies of early palliative care into an effective, sustainable service that is offered as part of routine cancer care.

Recent findings
‘Timely’, ‘targeted’ and ‘precision’ approaches have been proposed to ensure that limited palliative care resources are available to those who are most likely to benefit. Triage and referral based on individual patients’ needs has been shown to be both efficient and effective. Standardised referral criteria and the use of tools to assess complexity may support equitable service development. A specialist multidisciplinary approach is a common factor underpinning successful integration between palliative care and oncology but does not negate the importance patient-centred considerations such as advance care planning, which can be facilitated by non-specialist teams.

Summary
The challenge is no longer whether early palliative care should be provided, but how. Evidence-based strategies about how best to implement early palliative care are needed to inform appropriate resourcing, funding, and delivery.
On Long-Term Species Coexistence in Five-Species Evolutionary Spatial Cyclic Games with Ablated and Non-Ablated Dominance Networks
Authors: Cliff Dave 
Published: October 2024

AbstractI present a replication and, to some extent, a refutation of key results published by Zhong, Zhang, Li, Dai, & Yang in their 2022 paper “Species coexistence in spatial cyclic game of five species” (Chaos, Solitons and Fractals, 156: 111806), where ecosystem species coexistence was explored via simulation studies of the evolutionary spatial cyclic game (Escg) Rock-Paper-Scissors-Lizard-Spock (Rpsls) with certain predator-prey relationships removed from the game’s “interaction structure”, i.e. with specific arcs ab-lated in the Escg’s dominance network, and with the Escgrun for 105Monte Carlo Steps (mcs) to identify its asymptotic behaviors. I replicate the results presented by Zhong et al. for interaction structures with one, two, three, and four arcs ablated from the dominance network. I then empiri-cally demonstrate that the dynamics of the RpslsEscghave sufficiently long time constants that the true asymptotic outcomes can often only be identified after running the ablated Escgfor 107mcsor longer, and that the true long-term outcomes can be markedly less diverse than those reported by Zhong et al. as asymptotic. Finally I demonstrate that, when run for sufficiently manymcs, the original unablated Rpslssystem exhibits essentially the same asymptotic outcomes as the ablated Rpslssystems, and in this sense the only causal effect of the ablations is to alter the time required for the system to converge to the long-term asymptotic states that the unablated system eventually settles to anyhow.Graphical AbstractHighlightsI replicate key results from Zhong et al. (2022) where biodiversity was explored via the game Rock-Paper-Scissors-Lizard-Spock (Rpsls).Zhong et al. reported results from Rpslsgames where specific predatorprey interactions were ablated from the game’s dominance network.My replication reveals problems in Zhong et al.’s design of experiments.Zhong et al. did not run their simulations for sufficiently long to reveal the true asymptotic behavior of the ablated Rpslssystems.Zhong et al. did not present control outcomes from the unablated Rp-slssystem, so there is no baseline data for comparison to the treatment outcomes.I present results from simulations that are run for 100 to 1000 times longer than the experiments reported by Zhong et al., thereby revealing the true asymptotic behaviors of the system.The asymptotic outcomes are remarkably uniform – practically indistinguishable – in the cases where one, two, or three arcs are ablated from the Rpslsdominance network.My asymptotic results for the baseline original unablated system are also very similar to those for the one-two- and three-ablation systems.My results question whether the ablations have any effect other than speeding the system’s convergence to its eventual asymptotic state.Results from Zhong et al.’s four-ablation system do not fit so well with the lower-ablation-count systems: potential reasons for this, and avenues for further research on it, are discussed.
Lack of circadian entrainment and limited nocturnal plasticity in response to a cyclic aversive stimulus in a diurnal rodent, the antelope ground squirrel (Ammospermophilus leucurus)
Authors: Zhang Victor Y. , Kenagy G.J. , de la Iglesia Horacio O. 
Published: October 2024

AbstractRecent studies have shown that cyclic aversive stimuli, such as random footshocks, act as a nonphotic zeitgeber to entrain circadian behaviors in nocturnal rodents, a pattern termed “fear entrainment”. However, it remains unknown whether diurnal species exhibit similar plasticity in behavioral timing. This study aimed to determine if antelope ground squirrels (Ammospermophilus leucurus;AGS), a naturally diurnal rodent, can also shift their activity patterns to cyclic aversive stimuli. We conducted two experiments with 20 AGS housed in custom cages featuring a safe nesting area and a separate foraging area (for feeding and drinking), rendered aversive by presentation of unsignaled, time-specific footshocks. In the first experiment, animals were subjected to a 12:12 light-dark (LD) cycle. One group experienced aversion during the light phase, while the control group received the same treatment during the dark phase. In the second experiment, a 16:8 LD cycle was used, and animals were divided into three groups with the foraging area rendered aversive either during the first or second half of the light phase or during the dark phase. Following each of these treatments, animals were released into constant darkness (DD) to assess the phase and period of free-running rhythms. Contrary to previous findings in nocturnal rodents, AGS did not exhibit consistent shifts in activity to avoid footshocks. Most animals maintained their normal diurnal activity, with only minor and inconsistent phase shifts. In experiment two, animals exposed to footshocks during half of the light phase also failed to reliably shift activity to the opposite “safe” portion of the light phase. Together, these findings show AGS lack the ability to entrain to cyclic aversive stimuli or become nocturnal; this result suggests a lack of substantial plasticity in activity timing. These results highlight the importance of considering species-specific differences in nonphotic circadian entrainment and temporal niche plasticity.
Competitive Adsorption of a Monoclonal Antibody and Amphiphilic Polymers to the Air-Water Interface
Authors: Hingst Elise J. , Blech Michaela , Hinderberger Dariush , Garidel Patrick , Schwieger Christian 
Published: October 2024

ABSTRACTUnderstanding structure and self-organization of monoclonal antibodies (mAbs) at the air-water interface is important for the stability and effectiveness of protein drug formulations used in pharmaceutical industry. This paper investigates the competitive adsorption of a mAb and the amphiphilic surfactants poloxamer 188 (P188) and polysorbate 20 (PS20), both of which are commonly used to prevent mAb surface adsorption. Firstly, it is studied whether these surfactants prevent mAb adsorption, and secondly, whether it is possible to desorb mAb molecules from the air-water interface by surfactant addition. For surface pressure and surface tension data, Langmuir film balance measurements and drop shape tensiometry were used. Infrared Reflection-Absorption Spectroscopy (IRRAS) provided information on the surface composition, including the amount of adsorbed molecules. P188 exists in different self-assembled phases depending on its surface concentration. Our experiments show that the phase state of P188 has a significant impact on mAb adsorption. The presence of P188 in the brush phase (≥ 0.3 mg/L) consistently inhibits mAb adsorption. On the contrary, addition of P188 after mAb film formation could not cause desorption of mAb. However, addition of PS20 leads to desorption of freshly formed interfacial mAb layers of up to two hours age. Interestingly, an aged mAb layer of 17 hours could not be desorbed by PS20. This suggests a time dependent reorganization of mAb at the air-water interface, which increases its resistance to desorption. These findings are discussed with respect to possible inter-molecular interactions within the interfacial film.