bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lycium barbarum polysaccharide increases thermogenesis and energy metabolism through modulation of the gut microbiota to confer resistance to cold temperatures
Authors: Sun Chuanxin , Su Juan , Wang Jiarui , Ding Kan , Chen Chang 
Published: September 2024

AbstractTraditional Chinese medical literature contains numerous records of many traditional Chinese herbal medicines that exhibit efficacy in enhancing resistance to cold, yet there is a lack of scientific explanation. Lycium barbarum is among the herbal medicines that are explicitly documented to enhance resistance to cold in the “Ben Cao Gang Mu (Compendium of Materia Medica)”. Herein, we investigated L. barbarum polysaccharide (LBP)‐induced browning of inguinal white adipose tissue (iWAT), energy expenditure and thermogenic function in a long‐term (4 months) treatment mouse model. LBP supplementation resulted in a significant reduction in weight and adipocyte size in iWAT, along with increased gut microbiota diversity. Specifically, the levels of Lachnospiraceae, Ruminococcaceae and Bacteroidaceae (short‐chain fatty acid‐producing bacteria) were elevated, leading to a higher level of short‐chain fatty acids (SCFAs) in the caecal content. These effects subsequently triggered the release of glucagon‐like peptide‐1 (GLP‐1) and activated the CREB/PGC1α signaling pathway in iWAT, thereby increasing energy expenditure and enhancing thermogenic function. The antibiotic treatment experiments confirmed that the LBP‐mediated gut microbiota participated in the process of iWAT browning. In summary, our findings provide the first scientific explanation and mechanistic insights into the cold resistance of L. barbarum and identify potentially safe natural product supplements for individuals in alpine areas.
Naloxone Stigma Among People Who Use Drugs: Characteristics and Associations With Stigma Toward Medication for Opioid Use Disorder
Authors: Banks Devin E. , Li Xiao , Park Brandon , Winograd Rachel P. , Cavazos-Rehg Patricia 
Published: September 2024

Objectives
Widespread naloxone distribution is key to mitigating opioid-related morbidity, but stigma remains a barrier. Naloxone stigma among providers, emergency responders, and the public is well-documented and associated with treatment and policy preferences, but little is known about naloxone stigma among people who use drugs (PWUD), who may be overdose first responders. This study examines naloxone stigma, its correlates, and its association with stigma toward medication for opioid use disorder (MOUD) among PWUD.

Methods
We recruited 293 individuals with a history of substance misuse from facilities that provide substance use and/or health care services (retained n = 195, 54% women, 75% White). Participants completed self-report measures, including the 5-item Naloxone-Related Risk Compensation Beliefs scale.

Results
One in 5 respondents agreed with beliefs that access to naloxone leads to more opioid use and less treatment seeking and is “enabling.” Those with nonopioid drug misuse, without prior overdose, and with fewer recovery attempts endorsed more naloxone stigma. Opioid misuse, prior overdose, and MOUD utilization were also inversely associated with MOUD stigma. There were no demographic differences in either stigma type. Naloxone stigma was positively associated with MOUD stigma in adjusted models.

Conclusions
This is the first study to quantitatively examine naloxone stigma among PWUD. Findings emphasize the potential role of overdose education and naloxone distribution among those earlier in the substance use disorder course and who use nonopioid drugs. They support integrating MOUD stigma interventions into current overdose education and naloxone distribution targeted at PWUD to increase the acceptance and uptake of both medications.
Surgical Outcomes Following Neoadjuvant Treatment for Locally Advanced and Borderline Resectable Pancreatic Ductal Adenocarcinoma
Authors: Yeung Kai Tai Derek , Kumar Sacheen , Cunningham David , Jiao Long R. , Bhogal Ricky Harminder 
Published: September 2024

Objective:
To assess overall survival (OS), compare the effects of neoadjuvant treatment, and describe surgical outcomes for patients undergoing pancreatic resection following chemotherapy and/or chemoradiotherapy (CRT) for borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).

Background:
We approach BR/LA PDAC using chemotherapy followed by selective CRT to the primary site of disease where either the surgical margin remains radiologically threatened following chemotherapy or as a further downstaging treatment.

Methods:
Retrospective study of patients between December 2005 and June 2023 at the Royal Marsden Hospital, London, United Kingdom.

Results:
A total of 54 patients were included. The OS between R1 and R0 patients was significantly different: 7.5 versus 23 versus 42 versus 51 months for R1 chemo, R1 chemo and CRT, R0 chemo and R0 chemo, and CRT groups, respectively, P < 0.001. Similarly, 9 versus 18 versus 42 versus 41 months for N1 chemo, N1 chemo and CRT, N0 chemo and N0 chemo, and CRT groups, respectively, P = 0.0026. Multivariable Cox regression model demonstrated that perineural invasion (hazard ratio: 2.88, 95% confidence interval: 1.06–7.81; P = 0.038) and perivascular invasion (PVI) (HR: 2.76, 95% CI: 1.24–6.13; P = 0.013) were associated with significantly worse OS. Chemo and CRT conferred OS benefit compared to chemo only (7 vs 23 months, P = 0.004) in PVI-positive patients.

Conclusions:
Neoadjuvant chemotherapy followed by CRT compared to chemotherapy alone for resected BD and LA PDAC was demonstrated to significantly improve median OS, in particular, in patients with R1 resection margins, ypN1 nodal status, and perivascular invasion.
History of infertility and anti-Müllerian hormone levels among participants in the Nurses' Health Study II
Authors: Farland Leslie V. , Degnan William J. , Bertone-Johnson Elizabeth R. , Eliassen A. Heather , Wang Siwen , Gaskins Audrey J. , Chavarro Jorge E. , Rich-Edwards Janet W. , Missmer Stacey A. 
Published: September 2024

Abstract

Objectives
To better understand whether history of infertility is associated with anti-Müllerian hormone (AMH) levels later in life, outside of reproduction.

Methods
Among 1,758 premenopausal women in the Nurses' Health Study II with measured AMH, we used multivariable generalized linear models to compare log-transformed plasma AMH for women with a history of infertility compared with fertile women. We investigated AMH levels by cause of infertility and effect modification by menstrual cycle regularity. Lastly, we investigated AMH levels by history of primary and secondary infertility and age at reported infertility.

Results
Mean age at blood collection was 40 years. We observed no association between overall history of infertility and AMH levels (% difference AMH: −8.1% [CI, −19.4 to 4.8]). The association between overall infertility and AMH was strongest among women who first reported infertility at >30 years (−17.7% [CI, −32.1 to −0.3]).

Conclusions
Overall, we observed no association between the history of infertility and AMH levels later in life. However, specific subgroups of women with a history of infertility may have lower AMH levels throughout life compared with fertile women. This association was observed among subgroups, such as those who first experienced infertility at >30 years. These findings have implications for mechanisms through which infertility may be associated with premature menopause and chronic disease risk.
Vaginal microbiota, menopause, and the use of menopausal hormone therapy: a cross-sectional, pilot study in Chinese women
Authors: Lan Yibing , Jin Bihui , Zhang Yue , Huang Yizhou , Luo Zhou , Su Chang , Li Jingjing , Ma Linjuan , Zhou Jianhong 
Published: September 2024

Abstract

Objective
To compare the vaginal microbiota of premenopausal and postmenopausal women and postmenopausal women undergoing menopausal hormone therapy (MHT) and examine the association between vaginal microbiota and genitourinary syndrome of menopause (GSM).

Methods
This cross-sectional study classified 94 women aged 40 to 60 years into three groups: premenopausal (Pre, n = 32), postmenopausal (Post, n = 30), and postmenopausal women who received MHT orally (Post + MHT, n = 32). Neither the Pre nor the Post group received hormone therapy within the past 6 months. Postmenopausal women who received vaginal MHT were not included. Vaginal swabs were obtained, and microbial composition was characterized by 16S rRNA gene sequencing targeting the V3 to V4 region. Clinical data were collected and serum sex hormones were measured. The most bothersome symptom approach and vaginal health index were used to evaluate GSM. Mann-Whitney U or Kruskal-Wallis ANOVA followed by multiple comparison tests were performed for comparison between or across groups. The correlations between GSM symptom scores and vaginal microbiota were determined using Spearman's correlation analysis.

Results
The vaginal community of postmenopausal women was characterized by a decreased abundance of Lactobacillus (Post 18% vs Pre 69%); an increased abundance of several anaerobic bacteria, including Prevotella, Escherichia-Shigella, and Bifidobacterium; and a higher microbial diversity (P < 0.001 for Shannon and Simpson indexes) than those of premenopausal women. The vaginal community of postmenopausal women who received MHT had an increased abundance of Lactobacillus (54%) and lower microbial diversity (P < 0.001 for Shannon and Simpson indexes) than the postmenopausal women. The vaginal microbial community composition of the Pre group shared more similarity with that of the Post + MHT group (Adonis P = 0.051) than with that of the Post group (Adonis P < 0.001). A decreased abundance of Lactobacillus and high diversity in the vaginal community were found in women with moderate to severe GSM symptoms.

Conclusions
Among Chinese postmenopausal women, those receiving MHT had higher Lactobacillus abundance but lower abundance of diverse anaerobes and diversity of the vaginal microbial community compared to non-MHT women. MHT in postmenopausal women may potentially contribute to reestablishing vaginal microbiota homeostasis. Findings in this pilot study, however, need to be examined in larger, prospective studies.
Effect of Cardiac Rehabilitation on Cardiorespiratory Fitness in Patients With Acute Myocardial Infarction
Authors: Yu Hui-Kung , Chen Chun-Yen , Chen Yu-Chi , Cheng Chu-Han , Chen Chi-Yen , Hu Gwo-Chi 
Published: September 2024

Purpose:
Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels.

Methods:
Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period.

Results:
In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9 ± 1.5 vs. 3.7 ± 3.2 mL/kg/min, P < .001). Among patients with DM, those with HbA1c levels < 7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c ≥ 7% (2.7 ± 1.5 vs. 1.1 ± 1.8 mL/kg/min, P < .001) during the follow-up period.

Conclusions:
Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.
Cat Scratch Disease in Pediatrics: Who Has Systemic Involvement?
Authors: Martínez Lindado Mayra Alejandra , Praino María Laura , Caratozzolo Ana , Toledano Analía , Zambrano Cindy Toala , Tineo María Soledad , Cazes Claudia Inés , Contrini María Marta , López Eduardo Luis 
Published: September 2024

Background:

Bartonella henselae is the agent responsible for cat scratch disease (CSD). Although lymphadenopathy is typically the defining symptom, some patients develop potentially severe systemic compromise. It is unknown why some patients progress to systemic disease. The objective of this study was to describe the clinical, epidemiologic and laboratory characteristics of children with CSD and to analyze the differences between systemic versus localized infections.

Methods:
Patients were identified by a retrospective review of medical records at a tertiary pediatric care hospital in Buenos Aires, Argentina, from January 2012 to July 2021. A CSD case was defined as any patient who presented compatible clinical findings with a positive serologic test (IgG >1/64 or IgM immunofluorescence) for B. henselae.

Results:
A total of 197 patients were identified, with a median age of 8 years (range: 1–17.4 years). The most frequent clinical symptoms were fever and lymphadenopathy. Systemic involvement was present in 34.5% (n = 68) of patients and the most common presentation was splenic abscess (n = 51), followed by liver abscess (n = 23), chorioretinitis (n = 9), osteomyelitis (n = 5) and pneumonitis (n = 3). Patients with invasive disease more frequently presented with fever (79.4% vs. 50.3%) (P<0.001) and had higher C-reactive protein levels (24.9 vs. 6.7 mg/L) (P<0.001). Antibiotic therapy was administered to 95.9% (n = 187) of patients and most with systemic disease (77%) used combination treatment. Most patients recovered fully, and there were no reported deaths.

Conclusions:
CSD must be considered a potential cause of lymphadenopathy. Patients with fever and elevated C-reactive protein should be evaluated to rule out systemic compromise.
Clinical Presentations of Parvovirus B19: A Case Series
Authors: Tricella Chiara , Pagliani Costanza , Quatrale Antonia , Poretti Giulia , Caiazzo Roberta , Coppola Crescenzo , Garcia Lorenzo Marc , Valentino Maria Sole , Giacomet Vania 
Published: September 2024

Background:
Parvovirus B19 (PVB19) is a small, nonenveloped, single-stranded DNA virus commonly causing asymptomatic infections or mild, flu-like symptoms. In children, PVB19 can lead to various clinical conditions, including erythema infectiosum, arthropathy, transient aplastic crisis and papular-purpuric eruptions, among others.

Methods:
We present 3 pediatric cases treated at Luigi Sacco University Hospital in Milan, Italy, in March 2024, each demonstrating distinct manifestations of PVB19 infection. Case 1 involved a 7-year-old girl with a maculopapular rash and panniculitis-like symptoms. Case 2 described an 8-year-old boy with a maculopapular rash, vasculitis component and mild thrombocytopenia. Case 3 focused on a 7-year-old girl with petechial and purpuric eruptions and a mild decrease in platelets. Serological tests confirmed PVB19 infection in all cases.

Results:
The discussed cases highlight the heterogeneous clinical spectrum of PVB19 infection and emphasize its potential to cause thrombocytopenia even in healthy children. The recent surge in PVB19 cases in Europe, aligned with known epidemiological cycles, underscores the importance of vigilance in diagnosis, particularly during peak seasons. Additionally, concerning the role of serological testing in the diagnostic process, the potential for cross-reactivity among viral antigens is pointed out.

Conclusion:
PVB19 is a common infection with a broad range of clinical presentations. Awareness of its potential complications, including thrombocytopenia, even in nonimmunocompromised children, is crucial. Moreover, understanding the epidemiological patterns of PVB19 can aid in anticipating and managing outbreaks, thus minimizing its impact on pediatric health.
Concussion Incidence, Mechanism, and Perspectives Among Australian Elite Surfers: Implications for Medical Support and Safety Protocols
Authors: Ward John , Haakonssen Eric , Parsonage Joanna 
Published: September 2024

Objective:
The primary objective was to investigate the incidence of concussion and the associated mechanisms of injury in elite Australian surfers. The secondary objective was to investigate the current perspectives and behaviors related to experiencing concussion in surfing.

Design:
A cross-sectional, retrospective, descriptive survey.

Setting:
Surfing Australia high-performance program.

Participants:
Forty nationally identified elite Australian surfing athletes.

Intervention:
A retrospective survey collected information pertaining to participant demographics, concussion history, potential concussive symptoms, such as headache, neck pain, dizziness, or unusual fatigue, following a wipeout, and participants' perspectives on concussion.

Main Outcome Measures:
Investigating concussion incidence among elite Australian surfers compared with potential undiagnosed concussive episodes.

Results:
Surfers with a history of diagnosed surfing-related concussion (DC) were compared with those with no history of a diagnosed surfing-related concussion (NDC). A total of 13 of 40 surfers had a DC, with “contact versus the water surface” identified as the primary mechanism. Both DC and NDC groups had a high frequency of concussive symptoms after a surfing wipeout with a total of 447 and 573 concussive symptom occurrences reported in the DC and NDC groups, respectively. Concern regarding the long-term impacts of concussion were reported in 25 of 40 surfers.

Conclusions:
The number of concussive symptoms reported by surfers who had not previously been diagnosed with concussion suggests that concussion may be underreported and underdiagnosed in elite surfing. This underscores the need for increased medical support, education, and improved safety protocols.
Justifying access to kidney care in low resource and humanitarian settings
Authors: Sawhney Simon , Luyckx Valerie A. 
Published: September 2024

Purpose of review
Access to and quality of kidney care is not equitable between or within countries. A natural question is whether global kidney care inequities are always unjustifiable and unfair, or are sometimes due to unavoidable competing or conflicting ethical duties or responsibilities.

Recent findings
Health is a fundamental right for all people. People with kidney conditions should have the same claim on this human right as others. Countries have an obligation to progressively fulfil this right and a duty to do so equitably, but global progress has been slow. Countries with limited resources or faced with humanitarian emergencies must set priorities to allocate resources fairly. This process involves trade-offs and often people requiring kidney replacement therapy are left out because of costs, logistics and lack of data. Major burdens are placed on clinicians who grapple between their duty to their patient and professional codes and their responsibility to a ‘greater good’. These dilemmas apply also to industry, governments and the international community who must recognize their share in these duties.

Summary
Inequities in kidney health and care must be acknowledged and sustainable and collaborative solutions urgently found such that right to kidney care is progressively upheld for everyone everywhere.
Three-dimensional evaluation of a giant torus in the maxilla and mandible that affected pronunciation: a case report
Authors: Sasaki Jun , Suzuki Kenta , Kashihara Sho , Saito Terumi 
Published: September 2024

Introduction and importance:
Tori in the maxilla and mandible are often clinically asymptomatic, but can often lead to issues such as obstruction of denture attachment and dysarthria. The authors describe a case involving a substantial torus in the maxilla and mandible that significantly affected speech articulation.

Case presentation:
A 72-year-old woman presented with a pronounced torus in the maxilla and mandible. Surgical resection of the lesion resulted in improved tongue movement. Through both pre and postoperative assessments, the authors evaluated pronunciation, generated a three-dimensional (3D) computed tomography (CT)–based image, and quantified the extent of bone removal. A 6-month follow-up demonstrated no recurrence of the condition.

Clinical discussion:
Surgical intervention leads to improvements in soft palate sounds. The surgical intervention proved effective in ameliorating speech articulation difficulties, and the application of 3D-CT image construction was valuable.

Conclusion:
To summarize, the authors successfully managed and treated a giant torus in the maxilla and mandible, a condition scarcely been reported in the literature. This report is the first to detail the application of 3D analysis for the evaluation a torus.
Overuse of tetanus toxoid vaccine: a common but under-addressed issue in Nepal
Authors: Shrestha Suraj , Aryal Roshan , Yadav Randhir S. , Baidya Sujita , Acharya Suman , Bhandari Sanjeeb S. 
Published: September 2024

Introduction and importance:
Tetanus, though potentially fatal, is preventable with proper vaccination, but high tetanus titers from frequent or higher doses can lead to increased adverse events. In countries like Nepal, where tetanus vaccines are readily available over the counter, irrational and frequent dosing, especially in certain occupational groups, is a noted issue.

Case presentation:
A 28-year-old metal worker presented with a superficial cut on his forearm, managed with standard wound care, and reported a history of frequent tetanus vaccinations. Given his extensive vaccination history, a tetanus toxoid injection was deemed unnecessary, and he was educated on proper vaccination schedules and advised to seek medical attention for future injuries.

Clinical discussion:
Timely administration of vaccines for pre-exposure and postexposure prophylaxis is crucial for combating tetanus, with booster doses recommended every 10 years or as needed for wound management. High antibody titers from frequent tetanus vaccinations can increase the risk of adverse events, prompting guidelines to avoid administering Td more frequently than every 10 years unless necessary. Local reactions, like pain and swelling at the injection site, are common, while systemic reactions can include fever and peripheral neuropathy. Over-immunization is a concern in some regions, with frequent unnecessary booster doses potentially causing harm and highlighting the need for adherence to vaccination guidelines.

Conclusion:
Modifying and monitoring adult Td booster vaccination can lead to significant cost savings and fewer adverse events, requiring proper vaccination record-keeping, accurate assessment, and adherence to guidelines by healthcare workers.