bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of urinary albumin excretion with all-cause and cardiovascular mortality among patients with rheumatoid arthritis: a national prospective study
Authors: Bin Zexuan , Shen Ruihua , Wu Ruihe , Fan Yuxin , Zhang Xin , Gao Chong , Li Xiaofeng , Wang Caihong 
Published: September 2024

BackgroundRheumatoid arthritis (RA) patients suffering from chronic renal insufficiency tend to exhibit subtle manifestations at the beginning. Urine albumin to creatinine ratio (ACR) is a sensitive indicator for early assessment of renal function. However, it is unclear whether it serves as an independent risk factor influencing the prognosis of RA patients.MethodsNational Health and Nutrition Examination Survey (NHANES) data from 2009-2018 were included. Kaplan-Meier (K-M) curves were plotted to compare the cumulative survival probability of RA patients with different urinary albumin excretion. The association of ACR with mortality among RA patients was investigated with Cox regression model, restricted cubic spline (RCS) and stratified analyses. The prognostic efficacy of ACR and estimated glomerular filtration rate (eGFR) was evaluated by receiver operating characteristic (ROC) curves.ResultsThe Cox regression model adjusted with covariates showed a 53% (HR 1.53, 95% CI 1.06-2.21) increase in all-cause mortality and a statistically non-significant increase in cardiovascular disease (CVD) mortality in RA patients with microalbuminuria (30mg/g ≤ACR&lt;300mg/g). ACR≥300mg/g was associated with an increase in all-cause mortality (HR 2.62, 95% CI 1.55-4.45) and CVD mortality (HR 5.67, 95% CI 1.96-16.39). RCS demonstrated a nonlinear correlation between ACR and all-cause mortality in RA patients with microalbuminuria. Subgroup analysis showed that CVD mortality was higher in RA patients with microalbuminuria characterized by the following features: female, other ethnicity, eGFR≥60 ml/min/1.73 m2, hypertension or hyperlipidemia. Compared with eGFR, ACR provided better prognostic efficacy than eGFR with higher values of the area under the curve (AUC) for all-cause mortality (AUC=0.683, 95% CI 0.613-0.754) and CVD mortality (AUC=0.681, 95% CI 0.541-0.820).ConclusionACR is an independent risk factor affecting the prognosis of RA patients. The all-cause mortality was increased in RA patients with albuminuria. There was an upward trend in the CVD mortality of those with macroalbuminuria when ACR increased.
Comparing the effectiveness and safety of videolaryngoscopy and direct laryngoscopy for endotracheal intubation in the paediatric emergency department: a systematic review and meta-analysis
Authors: Warinton Emma , Ahmed Zubair 
Published: September 2024

IntroductionEndotracheal intubation is an uncommon procedure for children in the emergency department but can be technically difficult and cause significant adverse effects. Videolaryngoscopy (VL) offers improved first-pass success rates over direct laryngoscopy (DL) for both adults and children undergoing elective surgery. This systematic review was designed to evaluate current evidence regarding how the effectiveness and safety of VL compares to DL for intubation of children in emergency departments.MethodsFour databases (MEDLINE, Embase, CENTRAL and Web of Science) were searched on 11th May 2023 for studies comparing first-pass success of VL and DL for children undergoing intubation in the emergency department. Studies including adult patients or where intubation occurred outside of the emergency department were excluded. Quality assessment of included studies was carried out using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken for first-pass success and adverse event rate.ResultsTen studies met the inclusion criteria representing 5,586 intubations. All included studies were observational. Significantly greater first-pass success rate was demonstrated with VL compared to DL (OR 1.64, 95% CI [1.21–2.21], p = 0.001). There was no significant difference in risk of adverse events between VL and DL (OR 0.79, 95% CI [0.52–1.20], p = 0.27). The overall risk of bias was moderate to serious for all included studies.ConclusionVL can offer improved first-pass success rates over DL for children intubated in the emergency department. However, the quality of current evidence is low and further randomised studies are required to clarify which patient groups may benefit most from use of VL.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=415039, Identifier CRD42023415039.
Deep learning-based multimodal image analysis predicts bone cement leakage during percutaneous kyphoplasty: protocol for model development, and validation by prospective and external datasets
Authors: Xi Yu , Chen Ruiyuan , Wang Tianyi , Zang Lei , Jiao Shuncheng , Xie Tianlang , Wu Qichao , Wang Aobo , Fan Ning , Yuan Shuo , Du Peng 
Published: September 2024

BackgroundBone cement leakage (BCL) is one of the most prevalent complications of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF), which may result in severe secondary complications and poor outcomes. Previous studies employed several traditional machine learning (ML) models to predict BCL preoperatively, but effective and intelligent methods to bridge the distance between current models and real-life clinical applications remain lacking.MethodsWe will develop a deep learning (DL)-based prediction model that directly analyzes preoperative computed tomography (CT) and magnetic resonance imaging (MRI) of patients with OVCF to accurately predict BCL occurrence and classification during PKP. This retrospective study includes a retrospective internal dataset for DL model training and validation, a prospective internal dataset, and a cross-center external dataset for model testing. We will evaluate not only model’s predictive performance, but also its reliability by calculating its consistency with reference standards and comparing it with that of clinician prediction.DiscussionThe model holds an imperative clinical significance. Clinicians can formulate more targeted treatment strategies to minimize the incidence of BCL, thereby improving clinical outcomes by preoperatively identifying patients at high risk for each BCL subtype. In particular, the model holds great potential to be extended and applied in remote areas where medical resources are relatively scarce so that more patients can benefit from quality perioperative evaluation and management strategies. Moreover, the model will efficiently promote information sharing and decision-making between clinicians and patients, thereby increasing the overall quality of healthcare services.
Acceleration of brain aging after small-volume infarcts
Authors: Peng Ying-Ju , Kuo Chen-Yuan , Chang Sheng-Wei , Lin Ching-Po , Tsai Yuan-Hsiung 
Published: September 2024

IntroductionPrevious studies have shown that stroke patients exhibit greater neuroimaging-derived biological “brain age” than control subjects. This difference, known as the brain age gap (BAG), is calculated by comparing the chronological age with predicted brain age and is used as an indicator of brain health and aging. However, whether stroke accelerates the process of brain aging in patients with small-volume infarcts has not been established. By utilizing longitudinal data, we aimed to investigate whether small-volume infarctions can significantly increase the BAG, indicating accelerated brain aging.MethodsA total of 123 stroke patients presenting with small-volume infarcts were included in this retrospective study. The brain age model was trained via established protocols within the field of machine learning and the structural features of the brain from our previous study. We used t-tests and regression analyses to assess longitudinal brain age changes after stroke and the associations between brain age, acute stroke severity, and poststroke outcome factors.ResultsSignificant brain aging occurred between the initial and 6-month follow-ups, with a mean increase in brain age of 1.04 years (t = 3.066, p &lt; 0.05). Patients under 50 years of age experienced less aging after stroke than those over 50 years of age (p = 0.245). Additionally, patients with a National Institute of Health Stroke Scale score &gt;3 at admission presented more pronounced adverse effects on brain aging, even after adjusting for confounders such as chronological age, sex, and total intracranial volume (F1,117 = 7.339, p = 0.008, η2 = 0.059). There were significant differences in the proportional brain age difference at 6 months among the different functional outcome groups defined by the Barthel Index (F2,118 = 4.637, p = 0.012, η2 = 0.073).ConclusionStroke accelerates the brain aging process, even in patients with relatively small-volume infarcts. This phenomenon is particularly accentuated in elderly patients, and both stroke severity and poststroke functional outcomes are closely associated with accelerated brain aging. Further studies are needed to explore the mechanisms underlying the accelerated brain aging observed in stroke patients, with a particular focus on the structural alterations and plasticity of the brain following minor strokes.
QSM-detected iron accumulation in the cerebellar gray matter is selectively associated with executive dysfunction in non-demented ALS patients
Authors: Aiello Edoardo Nicolò , Contarino Valeria Elisa , Conte Giorgio , Solca Federica , Curti Beatrice , Maranzano Alessio , Torre Silvia , Casale Silvia , Doretti Alberto , Colombo Eleonora , Verde Federico , Silani Vincenzo , Liu Chunlei , Cinnante Claudia , Triulzi Fabio Maria , Morelli Claudia , Poletti Barbara , Ticozzi Nicola 
Published: September 2024

BackgroundThis study aimed to assess whether quantitative susceptibility imaging (QSM)-based measures of iron accumulation in the cerebellum predict cognitive and behavioral features in non-demented amyotrophic lateral sclerosis (ALS) patients.MethodsA total of ALS patients underwent 3-T MRI and a clinical assessment using the ALS Functional Rating Scale-Revised (ALSFRS-R) and the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Regression models were applied to each subscale of the cognitive section of the ECAS and the ECAS-Carer Interview to examine the effect of QSM-based measures in white and gray matter (WM; GM) of the cerebellum, separately for right, left, and bilateral cerebellar regions of interest (ROIs). These effects were compared to those of cerebellar volumetrics in WM/GM, right and left hemispheres while controlling for demographics, disease status, and total intracranial volume.ResultsHigher QSM measures of the cerebellar GM on the left, right, and bilateral sides significantly predicted (ps ≤ 0.003) a greater number of errors on the executive functioning (EF) subscale of the ECAS (ECAS-EF). Moreover, higher GM-related, QSM measures of the cerebellum were associated with an increased probability of a below-cut-off performance on the ECAS-EF (ps ≤ 0.024). No significant effects were observed for QSM measures of the cerebellar WM or for volumetric measures on the ECAS-EF. Other ECAS measures showed no significant effects. Bilateral QSM measures of the cerebellar GM also selectively predicted performance on backward digit span and social cognition tasks.DiscussionIron accumulation within the cerebellar GM, particularly in the cerebellar cortices, may be associated with executive functioning deficits in non-demented ALS patients. Therefore, QSM-based measures could be useful for identifying the neural correlates of extra-motor cognitive deficits in ALS patients.
Dietary total antioxidant capacity and risk of stroke: a systematic review and dose–response meta-analysis of observational studies
Authors: Huang Yiqian , Ni Yajun , Yu Lin , Shu Long , Zhu Qin , He Xingzhen 
Published: September 2024

BackgroundPrevious studies have reported the association between dietary total antioxidant capacity (TAC) and risk of stroke, but these findings have been inconsistent. We therefore performed this systematic review and dose–response meta-analysis of observational studies to evaluate the association between dietary TAC and risk of stroke.MethodsA systematic literature search was carried out through PubMed, ISI Web of Science, EBSCO, Scopus and China National Knowledge Infrastructure (CNKI) databases, to find the relevant articles published up to 31 May, 2024. Random-effects or fixed-effects models were used to pool the relative risks (RRs) and their 95% confidence intervals (CIs) where appropriate. Heterogeneity across studies were determined using the Cochran’s Q test and I-square (I2) statistics.ResultsEight observational studies (six cohort and two case–control studies) were included in the final analysis. The pooled results showed that higher intake of dietary TAC was associated with a lower risk of stroke (RR = 0.88; 95%CI: 0.81–0.95, p = 0.002). Additionally, dose–response analysis of cohort studies demonstrated a linear association between dietary TAC intake and risk of stroke (RR = 0.994; 95%CI: 0.990–0.999, Pnon-linearity = 0.329, Pdose–response = 0.014). Subgroup analyses showed the inverse association between dietary TAC intake and risk of stroke in the studies with mean age &lt; 50 (RR = 0.82, 95%CI: 0.67–0.99, p = 0.044), and there was no evidence of heterogeneity (p = 0.360; I2 = 0.0%).ConclusionOur findings indicated that higher intake of dietary TAC was inversely associated with the risk of stroke. Future studies in particular of longitudinal design are needed to confirm this inverse relationship.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024547706.
Various steaming durations alter digestion, absorption, and fermentation by human gut microbiota outcomes of Polygonatum cyrtonema Hua polysaccharides
Authors: Wu Weijing , Wang Yanling , Yi Ping , Su Xufeng , Mi Yan , Wu Lanlan , Tan Qianglai 
Published: September 2024

IntroductionDifferent steaming durations dramatically alter the structure of Polygonatum cyrtonema polysaccharides (PCPs). This study aimed to compare characteristics of digestion, absorption, and fermentation by gut microbiota across four representative PCPs from different steaming durations (0, 4, 8, and 12 h), each with unique molecular weights and monosaccharide profiles.MethodsChemical composition of the four PCPs was analyzed. Digestibility was evaluated using an in vitro saliva-gastrointestinal digestion model. Absorption characteristics were assessed with a Caco-2 monolayer model, and impacts on gut microbiota composition and short chain fatty acid (SCFA) levels were analyzed using in vitro fermentation with human gut microbiota.ResultsLonger steaming durations altered the chemical profiles of PCPs, reducing carbohydrate content (84.87–49.58%) and increasing levels of uronic acid (13.99–19.61%), protein (1.07–5.43%), and polyphenols (0.05–2.75%). Four PCPs were unaffected by saliva digestion but showed enhanced gastrointestinal digestibility, with reducing sugar content rising from 4.06% (P0) to 38.5% (P12). The four PCPs showed varying absorption characteristics, with P0 having the highest permeability coefficient value of 9.59 × 10−8 cm/s. However, all PCPs exhibited poor permeability, favoring gut microbiota fermentation. The four PCPs altered gut microbiota composition and elevated SCFA production, but levels declined progressively with longer steaming durations. All PCPs significantly increased the abundance of Bacteroidota, Firmicutes, and Actinobacteriota, making them the dominant bacterial phyla. Additionally, all PCPs significantly increased the abundance of Bifidobacterium, Prevotella, and Faecalibacterium compared to the control group, which, along with Bacteroides, became the dominant microbiota. Increasing the steaming duration led to a reduction in Prevotella levels, with PCPs from raw rhizomes showing the highest relative abundance at 24.90%. PCPs from moderately steamed rhizomes (4 h) led to a significant rise in Faecalibacterium (7.73%) among four PCPs. P8 and P12, derived from extensively steamed rhizomes (≥8 h), exhibited similar gut microbiota compositions, with significantly higher relative abundances of Bacteroides (20.23–20.30%) and Bifidobacterium (21.05–21.51%) compared to P0 and P4.DiscussionThis research highlights the importance of adjusting steaming durations to maximize the probiotic potential of P. cyrtonema polysaccharides, enhancing their effectiveness in modulating gut microbiota and SCFA levels.
The estimation of pubertal growth spurt parameters using the superimposition by translation and rotation model in Korean children and adolescents: a longitudinal cohort study
Authors: Chun Dohyun , Kim Seo Jung , Kim Yong Hyuk , Suh Junghwan , Kim Jihun 
Published: September 2024

ObjectivesUnderstanding the characteristics of the pubertal growth spurt in Korean children and adolescents can serve as crucial foundational data for researching puberty and growth-related disorders. This study aims to estimate the key parameters of pubertal growth, specifically the age and magnitude of the pubertal growth spurt, utilizing longitudinal data from a cohort of Korean children and adolescents.MethodsThis study used mixed longitudinal height data from a cohort of Korean elementary, middle, and high school students aged 7–18 years. The Superimposition by Translation and Rotation (SITAR) model, a shape-invariant growth curve model, was utilized to estimate a reference height velocity curve for the entire dataset and individual curves via random effects to evaluate pubertal growth parameters. Altogether, 3,339 height measurements (1,519 for boys and 1,820 for girls) from 270 individuals (123 boys and 147 girls) were analyzed.ResultsThe average age of growth spurt onset in Korean boys was 10.17 ± 0.61 years (mean ± SE), with peak height velocity occurring at 12.46 ± 0.69 years of age (9.61 ± 1.26 cm/year). Korean girls, contrarily, experience their growth spurt at an earlier age (8.57 ± 0.68 years), with peak height velocity occurring at 10.99 ± 0.74 years of age (8.32 ± 1.09 cm/year). An earlier onset of puberty in both sexes is associated with a shorter growth spurt duration (0.63 years for boys and 0.58 years for girls) and a higher peak height velocity (1.82 cm/year for boys and 1.39 cm/year for girls). These associations were statistically significant for both sexes (all p &lt; 0.0001).ConclusionThis study is the first to use the height velocity curve from the SITAR model to examine the pubertal growth spurt of Korean children and adolescents. The estimated timing and magnitude of the pubertal growth spurt, and their relationships can be useful data for clinicians and researchers.
Comparative study of robotic-assisted single-incision-plus-one port and single-incision laparoscopic choledochal cyst excision
Authors: Zhang Ling , Chen Shan , Lin Yang , Wang Jianbin , Qiu Xinyi , Li Lizhi 
Published: September 2024

ObjectiveTo compare the efficacy of robotic-assisted single-incision-plus-one-port laparoscopic choledochal cyst excision (R-SILC + 1) and single-incision laparoscopic choledochal cyst (SILC) in treating pediatric choledochal cyst (CDC).MethodsWe retrospectively analyzed the clinical data of patients diagnosed with CDC in our hospital from June 2021 to October 2023. Among them, patients underwent either R-SILC + 1 or SILC procedures. Demographic parameters, operative details, and postoperative outcomes were studied.ResultsA total of forty-nine patients were included, with 23 children undergoing R-SILC + 1 and 26 children undergoing SILC. There were no statistically significant differences in demographic data, postoperative pain scores, and postoperative complication rates between the two groups (all p &gt; 0.05). Compared with the SILC group, the R-SILC + 1 group demonstrated less intraoperative bleeding volume (10.4 ± 3.6 vs. 15.0 ± 3.6 ml, p &lt; 0.05), a shorter indwelling time of the abdominal drainage tube [5(5,6) vs. 7(5.8,8.3) d, p &lt; 0.05], a shorter postoperative fasting time [4(3,4) vs. 6(5,7) d, p &lt; 0.05], and a shorter postoperative discharge time [6(6,7) vs. 8(6,11) d, p &lt; 0.05]. However, the R-SILC + 1 group had a longer operation time [388(295,415) vs. 341(255.8,375.2) min, p &lt; 0.05] and higher hospitalization cost (7.9 ± 0.4 vs. 3.2 ± 0.3 ten thousand, p &lt; 0.05).ConclusionCompared with the SILC group, the R-SILC + 1 group demonstrated clear advantages in treating pediatric CDC, but it is associated with a prolonged learning curve and operation time, and high costs. With improvements in physician experience and technological advancements, its potential will be further unleashed.
Senolytic effect of triterpenoid complex from Ganoderma lucidum on adriamycin-induced senescent human hepatocellular carcinoma cells model in vitro and in vivo
Authors: Abdelmoaty Ahmed Attia Ahmed , Chen Jing , Zhang Kun , Wu Changhui , Li Ye , Li Peng , Xu Jianhua 
Published: September 2024

BackgroundGanoderma lucidum (G. lucidum) is a famous medicinal mushroom that has been reported to prevent and treat a variety of diseases. Different extractions from G. lucidum have been used to manage age-related diseases, including cancer. Nevertheless, the senolytic activity of G. lucidum against senescent cancer cells has not been investigated. Although cellular senescence causes tumor growth inhibition, senescent cells promote the growth of the neighboring tumor cells through paracrine effects. Therefore, the elimination of senescent cells is a new strategy for cancer treatment.MethodsIn this study, senescence was triggered in HCC cells by the chemotherapeutic agent Adriamycin (ADR), and subsequently, cells were treated with TC to assess its senolytic activity.ResultsWe found for the first time that the triterpenoid complex (TC) from G. lucidum had senolytic effect, which could selectively eliminate adriamycin (ADR)-induced senescent cells (SCs) of hepatocellular carcinoma (HCC) cells via caspase-dependent and mitochondrial pathways-mediated apoptosis and reduce the levels of senescence markers, thereby inhibiting the progression of cancers caused by SCs. TC could block autophagy at the late stage in SCs, resulting in a significant activation of TC-induced apoptosis. Furthermore, TC inhibited the senescence-associated secretory phenotype (SASP) in SCs through the inhibition of NF-κB, TFEB, P38, ERK, and mTOR signaling pathways and reducing the number of SCs. Sequential administration of ADR and TC in vivo significantly reduced tumor growth and reversed the toxicity of ADR.ConclusionA triterpenoid complex isolated from G. lucidum may serve as a novel senolytic agent against SCs, and its combination with chemotherapeutic agents may enhance their antitumor efficacy.
The impact of EU public procurement regulations on tenders in Spain: a study with adalimumab
Authors: Esplugues F. J. , Andújar I. , Esplugues J. V. 
Published: September 2024

IntroductionPharmaceutical spending accounts for a significant portion of public healthcare budgets. To manage these costs, EU countries implement various cost-containment policies, including competitive tendering for pharmaceuticals. This study examines the impact of EU public procurement regulations on medication procurement practices.MethodsA search for all published tenders of adalimumab in Spain from 2018 to 2024 in the Spanish Public Sector Procurement Database, a period that coincides with the implementation of European legislation and the emergence of adalimumab biosimilars. All available documentation for each tender was reviewed, including the tender offer, technical specifications, specific administrative clauses, appointments of evaluation commissions, supporting memorandum, and evaluation reports.Results and DiscussionOur findings reveal substantial price reductions following the introduction of adalimumab biosimilars, yet highlight significant variability in tender criteria and practices across different regions. Despite adherence to EU directives, the inconsistent application of economic and non-economic factors and an erratic criteria concerning price undermine the intended balance of quality and cost, complicating procurement processes and potentially affecting the availability of a given treatment for patients.