bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Yield of Urine Xpert MTB/RIF Ultra in Adults With Suspected Extrapulmonary Tuberculosis
Authors: Ndege Robert , Rohacek Martin , Bani Farida , Ngome Omary , Okuma James , Sasamalo Mohamed , Mnzava Dorcas , Reither Klaus , Vanobberghen Fiona , Hella Jerry , Paris Daniel H , Weisser Maja 
Published: June 2024

Abstract
We assessed the diagnostic yield of urine GeneXpert MTB/RIF Ultra and factors associated with a positive test among adult patients suspected to have extrapulmonary tuberculosis. Urine Ultra was positive in 14% of participants with definite or probable tuberculosis. Hospitalization, disseminated tuberculosis, and human immunodeficiency virus infection were associated with a positive result.
Association of sarcopenia with severe chemotherapy toxicities and survival in patients with advanced gastric cancer
Authors: Chan Wing-Lok , Yun Ho-Kwan Bryan , Cheung Emina Edith , Liu Michelle , Hou Li-Yu , Lam Ka-On , Wong Ian Yu-Hong , Chiu Wan-Hang Keith , Law Simon , Kwong Dora 
Published: June 2024

Abstract

Background
Sarcopenia or skeletal muscle depletion is a poor prognostic factor for gastric cancer (GC). However, existing cutoff values of skeletal muscle index (SMI) for defining sarcopenia have been found to have limitations when clinically applied. This study aimed to determine the optimal cutoff for SMI to predict severe toxicities of chemotherapy and overall survival (OS) in patients with advanced GC.

Methods
Patients with metastatic gastric adenocarcinoma who received first-line palliative chemotherapy between January 2014 and December 2021 at Queen Mary Hospital, Hong Kong, were included in this study. The SMI was determined via a pre-chemotherapy computed tomography scan. Optimal cutoff points of SMI were identified by recursive partitioning analysis. Univariate and multivariate analyses evaluating risk factors of severe chemotherapy toxicities and OS were also performed.

Results
A total of 158 patients (male: 108 (68.4%), median age: 65.3) were included. The SMI cutoff to define low SMI was ≤33 cm2/m2 for males and ≤28 cm2/m2 for females; 30 patients (19.0%) had low SMI. Patients with low SMI had a higher incidence of hematological toxicities (63.3% vs 32.0%, P = .001) and non-hematological toxicities (66.7% vs 36.7%, P = .003). Multivariable analysis indicated that low SMI and low serum albumin (≤28 g/L) were independent predictive factors of hematological toxicity, while low SMI and neutrophil-lymphocyte ratio ≥5 were predictive factors of non-hematological toxicity. Moreover, patients with low SMI had a significantly shorter OS (P = .011), lower response rate to chemotherapy (P = .045), and lower utilization of subsequent lines of treatment (P &lt; .001).

Conclusions
Using pre-chemotherapy SMI cutoff (≤33 cm2/m2 for males and 28 cm2/m2 for females) one can identify individuals with a higher risk of severe chemotherapy toxicities and worse prognosis.
Multifunctional surface of the nano-morphic PEEK implant with enhanced angiogenic, osteogenic and antibacterial properties
Authors: Zhang Jiajia , Ma Tongtong , Liu Xueye , Zhang Xiaoran , Meng Wenqing , Wu Junling 
Published: June 2024

Abstract
Polyetheretherketone (PEEK) is a high-performance polymer suitable for use in biomedical coatings. The implants based on PEEK have been extensively studied in dental and orthopedic fields. However, their inherent inert surfaces and poor osteogenic properties limit their broader clinical applications. Thus, there is a pressing need to produce a multifunctional PEEK implant to address this issue. In response, we developed sulfonated PEEK (sPEEK)-Cobalt-parathyroid hormone (PTH) materials featuring multifunctional nanostructures. This involved loading cobalt (Co) ions and PTH (1-34) protein onto the PEEK implant to tackle this challenge. The findings revealed that the controlled release of Co2+ notably enhanced the vascular formation and the expression of angiogenic-related genes, and offered antimicrobial capabilities for sPEEK-Co-PTH materials. Additionally, the sPEEK-Co-PTH group exhibited improved cell compatibility and bone regeneration capacity in terms of cell activity, alkaline phosphatase (ALP) staining, matrix mineralization and osteogenic gene expression. It surpassed solely sulfonated and other functionalized sPEEK groups, demonstrating comparable efficacy even when compared to the titanium (Ti) group. Crucially, animal experiments also corroborated the significant enhancement of osteogenesis due to the dual loading of cobalt ions and PTH (1-34). This study demonstrated the potential of bioactive Co2+ and PTH (1-34) for bone replacement, optimizing the bone integration of PEEK implants in clinical applications.
Ecological momentary assessment of sleep, pain, and opioid use among adolescents following surgery
Authors: Rogers Andrew H , Rabbitts Jennifer A , Saper Michael G , Schmale Gregory A , Palermo Tonya M , Groenewald Cornelius B 
Published: June 2024

Abstract

Background
Opioids are effective for acute pain management following surgery among adolescents, yet are associated with significant negative consequences, including respiratory depression and opioid misuse. Sleep deficiency is common following surgery and extant research indicates strong cross-sectional associations between sleep deficiency and increased problematic opioid use.

Objective
This study examined longitudinal associations between postsurgical sleep deficiency and opioid use among adolescents undergoing outpatient surgery. We also examined daily pain and mood as mechanisms linking previous night’s sleep deficiency and next day prescription opioid use.

Methods
This prospective, observational study enrolled 106 adolescents (11–19 years) who underwent orthopedic outpatient surgery and collected pre-surgery and longitudinal measurements. Participants were 52% female, African-American (7%), American Indian/Alaska Native (7%), Hispanic (9%), Native Hawaiian or Other Pacific Islander (4%), or white, non-Hispanic (66%). Using ecological momentary assessment methods, participants reported sleep, pain, and mood in real time over the first 14 days following surgery. Postsurgical opioid use was measured using an electronic medication cap monitoring device, eCAPTM. Associations between variables were measured using multilevel structural equation modeling.

Results
Using multi-level mediation models, pain, but not mood-mediated associations between postsurgical sleep deficiency (sleep quality, total sleep time, sleep onset latency, and wake after sleep onset) and opioid use, at both the within-person and between-person levels. Results highlight that greater previous night’s sleep deficiency (both generally and greater than a person’s mean level) was associated with higher next day pain (both generally and greater than a person’s mean level), which, in turn, was associated with higher opioid use. Furthermore, between-person total effect models provide support for sleep deficiency predicting higher opioid use.

Conclusions
Our findings should be considered preliminary yet underscore the need for a comprehensive and personalized approach to postsurgical pain management and opioid use, potentially implementing interventions targeting sleep quality and quantity to reduce pain and opioid use.
Arf6 GTPase deficiency leads to porcine oocyte quality decline during aging
Authors: Zhang Kun‐Huan , Jiao Le , Wang Yue , Sun Shao‐Chen 
Published: June 2024

AbstractArf6 is a member of ADP‐ribosylation factor (Arf) family, which is widely implicated in the regulation of multiple physiological processes including endocytic recycling, cytoskeletal organization, and membrane trafficking during mitosis. In this study, we investigated the potential relationship between Arf6 and aging‐related oocyte quality, and its roles on organelle rearrangement and cytoskeleton dynamics in porcine oocytes. Arf6 expressed in porcine oocytes throughout meiotic maturation, and it decreased in aged oocytes. Disruption of Arf6 led to the failure of cumulus expansion and polar body extrusion. Further analysis indicated that Arf6 modulated ac‐tubulin for meiotic spindle organization and microtubule stability. Besides, Arf6 regulated cofilin phosphorylation and fascin for actin assembly, which further affected spindle migration, indicating the roles of Arf6 on cytoskeleton dynamics. Moreover, the lack of Arf6 activity caused the dysfunction of Golgi and ER for protein synthesis and signal transduction. Mitochondrial dysfunction was also observed in Arf6‐deficient porcine oocytes, which was supported by the increased ROS level and abnormal membrane potential. In conclusion, our results reported that insufficient Arf6 was related to aging‐induced oocyte quality decline through spindle organization, actin assembly, and organelle rearrangement in porcine oocytes.
Acute Effects of Breaking up Sitting Time With Isometric Wall Squat Exercise on Vascular Function and Blood Pressure in Sedentary Adults
Authors: Silva Jéssika K.T.N.F. , Menêses Annelise L. , Silva Gustavo O. , O’Driscoll Jamie M. , Ritti-Dias Raphael M. , Correia Marilia A. , Farah Breno Q. 
Published: June 2024

Purpose:
The World Health Organization has recommended breaking up sitting time to improve cardiovascular health. However, whether isometric exercise can be effectively used as a strategy to break up sitting time remains unclear. Thus, the aim of this study was to analyze the acute effects of breaking up prolonged sitting with isometric wall squat exercise (IWSE) on vascular function and blood pressure (BP) in sedentary adults.

Methods:
This randomized crossover trial included 17 adults (53% male, 26 ± 6 yr, 22.4 ± 3.6 kg/m2) with high sedentary behavior (≥ 6 hr/d). The participants completed 2 experimental sessions in a randomized order, both sharing a common sitting period of 180 min: Breaks (2-min breaks were incorporated into the IWSE, with participants maintaining their knees at the angle determined by the incremental test, which occurred every 30 min) and Control (sitting for 180 min continuously). Popliteal artery flow-mediated dilation (FMD) and brachial BP were measured before and at 10 and 30 min after the experimental sessions.

Results:
The results did not indicate significant session vs time interaction effects on popliteal FMD and brachial BP (P > .05). A subanalysis including only participants with popliteal FMD reduction after the Control session (n = 11) revealed that Breaks enhanced popliteal FMD after 10 min (1.38 ± 6.45% vs −4.87 ± 2.95%, P = .002) and 30 min (−0.43 ± 2.48% vs −2.11 ± 5.22%, P = .047).

Conclusion:
Breaking up prolonged sitting with IWSE mitigates impaired vascular function resulting from prolonged sitting but has no effect on BP in sedentary adults.
Optimum tacrolimus trough levels for enhanced graft survival and safety in kidney transplantation: a retrospective multicenter real-world evidence study
Authors: Han Ahram , Jo Ae Jeong , Kwon Hyunwook , Kim Young Hoon , Lee Juhan , Huh Kyu Ha , Lee Kyo Won , Park Jae Berm , Jang Eunju , Park Sun Cheol , Lee Joongyub , Lee Jeongyun , Kim Younghye , Soliman Mohamed , Min Sangil 
Published: June 2024

Background:
The current study aimed to determine the optimal tacrolimus trough levels for balancing graft survival and patient safety following kidney transplantation.

Materials and methods:
We conducted a retrospective cohort study involving 11 868 kidney transplant recipients from five medical centers. The association between tacrolimus exposures (periodic mean trough level, coefficient of variability, time in therapeutic range) and composite allograft outcome (de novo donor-specific antibody, biopsy-proven rejection, kidney dysfunction, and graft failure), as well as safety outcomes (severe infection, cardiovascular events, malignancy, and mortality) were assessed. Data were sourced from Clinical Data Warehouses and analyzed using advanced statistical methods, including Cox marginal structural models with inverse probability treatment weighting.

Results:
Tacrolimus levels of 5.0–7.9 ng/ml and 5.0–6.9 ng/ml during the 2–12 month and 12–72 month post-transplantation periods, respectively, were associated with reduced risks of composite allograft outcomes. During the first post-transplant year, the adjusted hazard ratios (aHR) for composite allograft outcomes were 0.69 (95% CI 0.55–0.85, P<0.001) for 5.0–5.9 ng/ml; 0.81 (95% CI 0.67–0.98, P=0.033) for 6.0–6.9 ng/ml; and 0.73 (95% CI 0.60–0.89, P=0.002) for 7.0–7.9 ng/ml (compared to levels ≥8.0 ng/ml). For the 6-year composite outcomes, aHRs were 0.68 (95% CI 0.53–0.87, P=0.002) for 5.0–5.9 ng/ml and 0.65 (95% CI 0.50–0.85, P=0.001) for 6.0–6.9 ng/ml. These optimal ranges showed reduced rates of severe infection (6 years), malignancy (6 years), and mortality (1 year).

Conclusion:
This multicenter study provides robust evidence for optimal tacrolimus trough levels during the periods 2–12 and 12–72 months following kidney transplantation.
Application of indocyanine green fluorescence imaging in hepatobiliary surgery
Authors: Zhou Jia , Tan Zhiguo , Sun Bo , Leng Yufang , Liu Sulai 
Published: June 2024

Indocyanine green (ICG) is a fluorescent dye with an emission wavelength of about 840 nm, which is selectively absorbed by the liver after intravenous or bile duct injection, and then it is excreted into the intestines through the biliary system. With the rapid development of fluorescence laparoscopy, ICG fluorescence imaging is safe, feasible, and widely used in hepatobiliary surgery. ICG fluorescence imaging is of great significance in precise preoperative and intraoperative localization of liver lesions, real-time visualization of hepatic segmental anatomy, intrahepatic and extrahepatic biliary tract visualization, and liver transplantation. ICG fluorescence imaging facilitates efficient intraoperative hepatobiliary decision-making and improves the safety of minimally invasive hepatobiliary surgery. Advances in imaging systems will increase the use of fluorescence imaging as an intraoperative navigation tool, improving the safety and accuracy of open and laparoscopic/robotic hepatobiliary surgery. Herin, we have reviewed the status of ICG applications in hepatobiliary surgery, aiming to provide new insights for the development of hepatobiliary surgery.
The role of immune cell signatures in the pathogenesis of ovarian-related diseases: a causal inference based on Mendelian randomization
Authors: Lu Yangguang , Yao Yingyu , Zhai Sijia , Ni Feitian , Wang Jingyi , Chen Feng , Zhang Yige , Li Haoyang , Hu Hantao , Zhang Hongzhi , Yu Bohuai , Chen Hongbo , Huang Xianfeng , Ding Weiguo , Lu Di 
Published: June 2024

Background:
Immune cells play a pivotal role in maintaining ovarian function. However, the specific contributions of different immune cell phenotypes to the pathogenesis of specific ovarian-related diseases remain poorly understood. The authors aim to investigate the correlation between 731 immunophenotypes and ovarian-related diseases.

Materials and methods:
Utilizing publicly available genetic data, the authors undertook a series of quality control measures to identify instrumental variables associated with exposure. Subsequently, we conducted two-sample Mendelian randomization (MR) using inverse variance weighting to explore the causal relationships between 731 immune cell features and six ovarian-related diseases: ovarian cysts, ovarian dysfunction, premature ovarian failure (POF), polycystic ovary syndrome (PCOS), benign neoplasm of ovary, and malignant neoplasm of ovary at the genetic level. Sensitivity analyses, including leave-one-out and other MR analysis models, were performed. Finally, Bayesian colocalization (COLOC) analysis was employed to identify specific co-localized genes, thereby validating the MR results.

Results:
At the significance level corrected by Bonferroni, four immune phenotypes, including CD25 on IgD- CD38- B cells, were associated with ovarian cysts; four immune phenotypes, including CD39+ CD4+ T cell Absolute Count, were associated with ovarian dysfunction; eight immune phenotypes, including SSC-A on HLA DR+ CD8+ T cells, were associated with POF; five immune phenotypes, including CD20- CD38- B cell Absolute Count, were associated with PCOS; five immune phenotypes, including CD4+ CD8dim T cell Absolute Count, were associated with benign ovarian tumors; and three immune phenotypes, including BAFF-R on IgD- CD38+ B cells, were associated with malignant ovarian tumors. Sensitivity analysis indicated robust results. COLOC analysis identified four immune cell co-localized variants (rs150386792, rs117936291, rs75926368, and rs575687159) with ovarian diseases.

Conclusion:
Our study elucidates the close genetic associations between immune cells and six ovarian-related diseases, thereby providing valuable insights for future research endeavors and clinical applications.
Digital assessment of tertiary lymphoid structures and therapeutic responses in gastric cancer: a multicentric retrospective study
Authors: Chen Yan , Sun Zepang , Yin Junmei , Ahmad M. Usman , Zhou Zixia , Feng Wanying , Yang Fan , Zhou Kangneng , Xie Jingjing , Bie Caiqun , Chen Hongzhuan , Jiang Yuming 
Published: June 2024

Background:
Tertiary lymphoid structures (TLSs) are associated with favorable prognosis and enhanced response to anticancer therapy. A digital assessment of TLSs could provide an objective alternative that mitigates variability inherent in manual evaluation. This study aimed to develop and validate a digital gene panel based on biological prior knowledge for assessment of TLSs, and further investigate its associations with survival and multiple anticancer therapies.

Materials and methods:
The present study involved 1704 patients with gastric cancer from seven cancer centers. TLSs were identified morphologically through hematoxylin-and-eosin staining. The authors further developed a digital score based on targeted gene expression profiling to assess TLSs status, recorded as gene signature of tertiary lymphoid structures (gsTLS). For enhanced interpretability, we employed the SHapley Additive exPlanation (SHAP) analysis to elucidate its contribution to the prediction. The authors next evaluated the signature’s associations with prognosis, and investigated its predictive accuracy for multiple anticancer therapies, including adjuvant chemotherapy and immunotherapy.

Results:
The gsTLS panel with nine gene features achieved high accuracies in predicting TLSs status in the training, internal, and external validation cohorts (area under the curve, range: 0.729–0.791). In multivariable analysis, gsTLS remained an independent predictor of disease-free and overall survival (hazard ratio, range: 0.346–0.743, all P<0.05) after adjusting for other clinicopathological variables. SHAP analysis highlighted gsTLS as the strongest predictor of TLSs status compared with clinical features. Importantly, patients with high gsTLS (but not those with low gsTLS) exhibited substantial benefits from adjuvant chemotherapy (P<0.05). Furthermore, the authors found that the objective response rate to antiprogrammed cell death protein 1 (anti-PD-1) immunotherapy was significantly higher in the high-gsTLS group (40.7%) versus the low-gsTLS group (5.6%, P=0.036), and the diagnosis was independent from Epstein–Barr virus, tumor mutation burden, and programmed cell death-ligand 1 (PD-L1) expression.

Conclusion:
The gsTLS digital panel enables accurate assessment of TLSs status, and provides information regarding prognosis and responses to multiple therapies for gastric cancer.
Early admission is better–the time to admission (TTA) is associated with one-year mortality in hip fracture
Authors: Zhang Bin-Fei , Xu Shuai-Liang , Yang Zhi , Xu Peng 
Published: June 2024

Objective:
This study evaluated the probable association between time to admission (TTA) and 1-year mortality in geriatric hip fractures.

Methods:
Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of the patients were collected at the largest trauma center in Northwest China. TTA can be obtained from the medical record system and converted into a categorical variable. Multivariate binary logistic regression and generalized additive model were used to identify the linear and nonlinear association between TTA and 1-year mortality. Analyses were performed using EmpowerStats and the R software.

Results:
Two thousand three hundred and sixty-one patients who met the criteria were finally included. There were 1618 (68.53%) female and 743 (31.47%) male patients. All patients were divided into three groups according to their TTA. The proportions of patients with low (≤6 h), middle (>6, ≤24 h), and high (>24 h) waiting times were 995, 654, and 712, respectively, and the corresponding 1-year mortality rates were 62 (6.23%), 72 (11.01%), and 82 (11.52%). We found a curve relationship between TTA and 1-year mortality by two-piecewise linear regression, and 9 h was an inflection point. When TTA was less than 9 h, the 1-year mortality of patients increased by 9% for every 1 h increase in TTA (OR=1.09, 95% CI: 1.03–1.16; P<0.01). When TTA was greater than 9 h, the mortality of patients no longer increased with the rise of TTA (OR=1.00, 95% CI: 1.00–1.00; P=0.26).

Conclusion:
TTA is a probable predictor of 1-year mortality. The authors found that 9 h was an inflection point. If TTA is less than 9 h, the mortality rate of patients will be lower. If it takes more than 9 h, the mortality will be higher. Therefore, the elderly who are found to have possible hip fractures should be admitted to the hospital as soon as possible.
Factor XIII deficiency leading to a life-threatening intracranial hemorrhage in a young female: a case report
Authors: Poombal FNU , Fayyaz Hafiz Noor Ullah , Saeed Hira , Adhikari Sugat 
Published: June 2024

Introduction and importance:
Factor XIII (FXIII) deficiency, a rare coagulation disorder resulting from F13A1 gene mutations, can lead to severe bleeding episodes, especially in infants. The authors’ case study featuring a 16-year-old female with a history of this deficiency revealed intracranial hemorrhage necessitating immediate medical intervention. The text emphasizes the importance of understanding the epidemiology and genetics of FXIII deficiency, as well as the challenges in diagnosis and management.

Case presentation:
A 16-year-old female with FXIII deficiency presented to the Emergency Department (ER) after a fall, experiencing weakness on her right side, headache, seizures, and altered consciousness. Neurological examination showed weakness and increased tone on the right side of the body. Computed tomography (CT) scan revealed an intracranial subdural hemorrhage overlying the superior parietal lobe. Treatment included IV fluids, sodium valproate, antibiotics, fresh frozen plasma, and mannitol. Serial neurological assessments were normal, and the patient remained stable. MRI later confirmed hemorrhage. Upon discharge, she was prescribed medication and physiotherapy, leading to significant improvement at the 6-month follow-up.

Clinical discussion:
The prevalence of FXIII deficiency, a rare disorder, is higher in populations with consanguineous marriages, particularly in regions like Pakistan, India, Tunisia, Finland, and Iran due to specific genetic mutations. Diagnosis involves thorough evaluation and specific lab tests, with varied clinical symptoms including prolonged bleeding, especially in newborns. FXIII deficiency can also develop in association with conditions like hepatic failure and leukemia, complicating diagnosis. Treatment options include blood products and recombinant FXIII, with management of intracranial bleeding requiring a multidisciplinary approach.

Conclusion:
The case underscores the critical need for early identification and specialized care for individuals with FXIII deficiency to mitigate life-threatening complications like intracranial hemorrhage, promoting tailored treatment approaches and improved patient outcomes.