bluuebunny/crossref_metadata_2025_split huggingface dataset:
Syndromic Atlanto-axial Instability
Authors: Oertel Joachim , Uriza Gustavo , Radtke Karen , Lee June Ho , Costa Francesco , Dantas Fernando , Sharif Salman , Parthiban Jutty , Visocchi Massimiliano , Klekamp Jörg , Zileli Mehmet , Botelho Ricardo , Alves Óscar L. 
Published: February 2025

Study Design.
Systematic review plus expert opinion framed on Delphi Method.

Objective.
Define criteria to on (i) how to screen for instability of cranio-vertebral CVJ in a high-risk population, especially in Down or Morquio syndrome, (ii) if or when which surgical procedure is indicated and (iii) whether syndromic patients can safely participate in sports activities.

Summary Background Data.
Syndromic abnormalities of CVJ may lead to potentially devastating neurological deficits. As of now, there is no international consensus on how to handle syndromic patients with atlanto-axial instability.

Methods.
International spine specialists of the WFNS spine committee reviewed statements from articles published between 2012 and 2022 to reach an expert agreement. Each statement was voted for on a Likert scale. The Delphi method was used to achieve a high level of validity.

Results.
Due to the high incidence of craniovertebral instability in Down’s patients, close neurological and radiological screening is advocated. In Morquio’s patients older than 5 years, it is recommended to perform an annual neurological examination and imaging studies to detect cervical stenosis or instability. For atlanto-axial instability (AAI), the recommended screening should include cervical spine lateral radiograph in controlled flexion/extension projections. In asymptomatic Down’s and Morquio syndrome patients with proven AAI, preventive stabilization might be considered. Neurological symptoms deriving from AAI are an indication for stabilization through Goel-Harms C1-C2 technique.
Patients without AAI and intact neurological status are cleared to unrestricted sports. Down syndrome patients with symptoms but without AAI or spinal cord compression can participate in most Special Olympics sports competition activities

Conclusions.
Consent was achieved on treatment recommendations for patients with syndromic disorders of the CVJ, with special focus laid on participation in physical activity and sports competitions. This should help spine surgeons and sports medicine doctors decide on a management path for each individual patient.
Breast Cancer Occurrence After Risk-reducing Mastectomies in 274 Cases: A Single Center With More Than 42 Years of Experience
Authors: Patzelt Matej , Livancova Tereza , Le Thanh Xuan , Rosetzka Kristyna , Drozd Jan , Sukop Andrej 
Published: February 2025

Introduction:
Carriers of genetic mutations with a high risk of developing breast cancer have a lifetime risk of this cancer of up to 70%. To reduce the risk, patients have the option of a risk-reducing mastectomy. There is limited data with only short follow-ups on its safety. The aim of the study was to determine the long-term incidence of breast cancer in healthy patients with no previous surgery, who underwent bilateral risk-reducing mastectomies (BRRMs).

Methods:
We retrospectively reviewed 274 patients from our facility with no previous breast surgery, who underwent BRRM from 1981 to 2022, due to genetic mutations, a strong family history, or having very dense mammary glands. We approached these patients during their checkups, by phone call or email, and we asked them if they had developed breast cancer after their procedures. We recorded the patients’ demographic factors, their genetic mutation types, and the mastectomy methods carried out.

Results:
A total of 274 patients had BRRMs with a mean follow-up after 76 months; 208 patients had undergone nipple-sparing mastectomies, 39 patients had undergone skin-sparing mastectomies, and 27 patients had skin-reducing mastectomies. One BRCA1+ patient developed breast cancer 21 months after undergoing the risk-reducing skin-sparing mastectomy procedure. None of the patients died of breast cancer.

Conclusions:
The incidence of breast cancer in the monitored patients is comparable to the results of the other related studies. The study result confirms that risk-reducing mastectomies reduce the risk of breast cancer in high-risk populations, regardless of the type of mastectomy performed.
Aptamer-directed, nanovesicle-mediated targeting of undruggable molecules in preclinical cholangiocarcinoma models
Authors: Yu Mincheng , Sample Jack W. , Yan Irene K. , Takaichi Shohei , Tomlinson Jennifer L. , Loeuillard Emilien J. , Watkins Ryan D. , Werneburg Nathan W. , Abdelrahman Amro M. , Carlson Danielle , Kuipers Hendrien , Cai Meina , Ozmert Enis H. , Kimball Brooke , Yang Jinchun , Ilyas Sumera I. , Gores Gregory J. , Patel Tushar , Smoot Rory L. 
Published: February 2025

Background and Aims:
Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium with limited therapeutic options and poor long-term survival rates. To address the limitations in CCA treatment, we investigated cell-targeted nanovesicles as a delivery platform for transcriptome-targeting therapeutics.

Approach & Results:
Milk-derived nanovesicles (MNVs) were loaded with short interfering RNAs targeting YAP, the downstream effector of the Hippo pathway; LCK, an upstream regulator of YAP; and tafazzin, a protein critical for the integrity of the inner mitochondrial membrane. These transcriptome-targeting nanovesicles (tMNVs) were decorated with a lipid-coupled RNA aptamer to epithelial cell adhesion molecule (EpCAM), including a tracking fluorophore. In vitro studies were conducted using multiple CCA cell lines. In vivo studies were performed using C57BL/6 and NOD/SCID mice to evaluate delivery and efficacy in both an immunocompetent syngeneic murine and a patient-derived xenograft (PDX) model. We demonstrated that tMNVs were selectively taken up by liver tumor cells, which was augmented by the incorporation of a targeting aptamer, and that MNVs loaded with siRNA effectively downregulated target gene expression, both in vitro and in vivo. Downstream effects of target gene inhibition were observed, including downregulation of YAP-TEAD target genes and an increase in reactive oxygen species production at the mitochondrial level. Administration of tMNVs targeting YAP, LCK, and tafazzin inhibited CCA growth and further synergized with chemotherapy in two preclinical CCA models.

Conclusions:
Herein, we show that aptamer-directed, nanovesicle-mediated targeting of YAP, LCK, and tafazzin potentiates chemosensitivity in two CCA models when delivered using aptamer-guided milk-derived nanovesicles.
Tissue engineering of the vitreous body: recent progress and future trends
Authors: Schulz André , Boneva Stefaniya K. , Lange Clemens , Sebag J. 
Published: February 2025

Purpose of review
In contrast to current clinically used tamponades including oils and gases, hydrogels offer a vitreous replacement that has the potential to present a niche for vitreous cells and elevate vitreous substitutes to the level of tissue engineering. This article, therefore, highlights and discusses recent hydrogel-based vitreous replacement strategies as well as the latest progress on vitreous cells, towards the development of a cellularized vitreous substitute.

Recent findings
A variety of different crosslinked hydrogel systems have been recently investigated as preformed and in situ forming vitreous substitutes, based on biopolymers and/or synthetic polymers. In addition, a comprehensive understanding of the precise function and immunological significance of hyalocytes as vitreous macrophages has recently emerged using advanced imaging techniques and high-throughput transcriptional and protein analyses.

Summary
Tissue engineering offers transformative potential for vitreous replacement by combining advanced hydrogel systems with hyalocytes as vitreous cells to further replicate the versatile characteristics and functions of the native vitreous.
Salivary duct carcinoma presenting with unilateral multiple cranial nerve lesions and concurrent intracranial metastasis: A case report
Authors: Zhu Bo , Zhang Qing-Zi , Guo Kun , Gu Nai-Bing , Di Zheng-Li , Liu Zhi-Qin , Yang Xiang-Chun , Chai Li-Li , Yang Yan-Ping , Jia Xiao-Tao 
Published: February 2025

Rationale:
Salivary gland ductal carcinoma (SDC) is a rare malignant tumor of the head and neck, accounting for 1% to 3% of salivary gland malignancy. SDC usually occurs in parotid gland, has a high malignancy degree, poor prognosis, and is prone to distant metastasis. In particular, intracranial metastasis accompanied by multiple cranial nerve lesions is very rare, and early diagnosis is difficult, which easily leads to missed diagnosis and misdiagnosis. Therefore, the diagnosis and treatment of SDC face major challenges. We report a unique case of SDC, which initially presented with progressive facial paralysis followed by progressive intracranial metastases and multiple cranial nerve lesions. After surgery and pathological examination, SDC was finally diagnosed.

Patient concerns:
A previously healthy 53-year-old male with persistent facial paralysis gradually developed symptoms of ipsilateral multiple cranial nerve lesions, and was hospitalized 8 months after onset.

Diagnoses:
Brain magnetic resonance imaging enhancement showed multiple irregular intracranial T1 and T2 with uneven signal intensity. Brain computed tomography showed intracranial space-occupying lesions, the largest of which was about 55 × 42 × 38 mm, with extensive bone destruction. Pathological findings showed malignant cell mass in the left temporal lobe tumor. Immunohistochemical: (++), CK7(+++), AR(++), Brg-1(+), Her-2(2+), Ki67(+, approximately 80%), consistent with high-grade ductal carcinoma, considering salivary gland origin. The final diagnosis was SDC.

Interventions:
The space-occupying lesions in the left cavernous sinus region and temporal lobe were partially resected. Local radiotherapy was recommended, but the patient refused.

Outcomes:
Postoperative symptoms did not improve significantly. Follow-up after 4 months showed no improvement in the extensive cranial nerve lesions on the left side.

Lessons:
In clinical practice, in the face of persistent facial palsy symptoms that gradually spread to other cranial nerves, the possibility of secondary facial nerve injury and malignant salivary gland tumors, especially SDC, cannot be easily ruled out even if imaging studies do not reveal any space-occupying intracranial lesions. Through the comprehensive use of imaging, pathology and immunohistochemistry and other diagnostic methods, the early detection and accurate diagnosis of SDC can be achieved, so as to provide the best treatment strategy for patients and improve the prognosis.
A real-world study to observe the efficacy and safety of Lutai Danshen Baishao Granules for improving melasma
Authors: Lv Mei-Yu , Yang Yi , Fei Wen-Ting , Liu Jin-Lian , Zhang Rui , Zhou Lan-Hua , Zhang Feng-Hong , Wang Chun , Wang Lin-Yuan , Zhang Jian-Jun 
Published: February 2025

Background:
Traditional Chinese Medicine categorizes melasma into various syndromes, one of which is the kidney-deficiency and blood-stasis syndrome. Different Chinese medicines are used for each syndrome to achieve a personalized treatment approach, resulting in a more effective outcome. The study aimed to investigate the efficacy and safety of Lutai Danshen Baishao Granules (LDBG) in alleviating melasma and to compare the effects of LDBG in patients with and without kidney-deficiency and blood-stasis syndrome through a real-world, large-sample investigation.

Methods:
A multicenter, prospective, nonrandomized, observational trial was conducted from December 2021 to May 2023, recruiting 1000 female participants with melasma. After enrollment, participants were divided into Group A (kidney-deficiency and blood-stasis syndrome) and group B (non-kidney-deficiency and blood-stasis syndrome) based on the traditional Chinese medicine (TCM) syndrome scale. General physical signs, melasma indicators, Dermatology Life Quality Index, and TCM syndrome scores were recorded before and after the intervention. The long-term effectiveness was assessed 2 months after the intervention ended.

Results:
Following the intervention, melasma-related indicators and TCM syndrome scores were significantly lower than those before the intervention (P < .001). Compared to Group B, Group A showed a more significant reduction in the total area of melasma and the Melasma Area and Severity Index score (P < .05). The reduction in melasma area was also more pronounced in Group A (group A: 425.00 vs group B: 312.50, P < .001). Two months after the intervention, intergroup and intragroup comparisons revealed that LDBG had a long-term effect with a lower tendency for recurrence, and the long-term effect in Group A was better than in group B (P < .05). The overall incidence of adverse events during the trial was 1.2%.

Conclusion:
LDBG can reduce facial melasma and improve TCM syndromes, particularly in cases of melasma associated with kidney-deficiency and blood-stasis syndrome, with high safety and low risk of relapse.
Efficacy comparison of two doses of dezocine on preventing sufentanil-induced cough in patients undergoing coronary artery bypass grafting surgery: A prospective, randomized controlled trial
Authors: Xie Chun-mei , He Li-xian , Shen Meng-qi , Yao Yun-tai ,   The Evidence in Cardiovascular Anesthesia (EICA) Group
Published: February 2025

Background:
Sufentanil-induced cough (SIC) is a common but irritating phenomenon during general anesthesia (GA) induction; studies have reported that high doses of dezocine can effectively prevent it. The aim is to explore the efficacy and safety of low-dose dezocine in preventing SIC during GA induction in coronary artery bypass grafting (CABG) surgery.

Methods:
81 elective CABG surgery patients were randomly and equally divided into 2 dezocine groups of different doses and 1 control group. Before GA induction, the patients received “pre-injection” solution: 0.1 mg/kg dezocine in the high-dose (HD) group, 0.05 mg/kg dezocine in the low-dose (LD) group or an equal volume of saline in the control (C) group. The primary outcome was the incidence of SIC within 1 minute after sufentanil administration. The secondary outcomes included the severity of SIC, the adverse reactions within 1 minute after injection of the “pre-injection” solution, and the vital signs at various time points.

Results:
One patient had moderate SIC in the HD group (3.7%), 3 patients (11.1%) had SIC (1 mild and 2 severe) in the LD group, and 8 patients (29.6%) had SIC (3 mild, 1 moderate, and 4 severe) in the C group. The difference between the HD and the C groups was statistically significant (P = .01). In contrast, in comparing the LD and the C groups, the LD and the HD groups had no statistically significant difference (P > .017).

Conclusion:
The current study suggested that pretreatment of 0.05 mg/kg dezocine neither prevented SIC occurrence nor attenuated SIC severity during GA induction in CABG surgery, but 0.1 mg/kg dezocine did.
The efficacy of Sijunzi on immune function in patients with gastrointestinal cancers after surgery: Integrating systematic review and network pharmacology
Authors: Wu Zhulin , Zhang Weiqing , Miao Wangdong , Li Siyi , Xie Jing , Lu Wensong , Yan Yuting , Peng Lisheng , Luo Weijun 
Published: February 2025

Background:
Patients with gastrointestinal cancer often have impaired immune function after surgery. This study aimed to assess the efficacy of Sijunzi decoction (SJZD) on immune function in patients with gastrointestinal cancers after surgery.

Methods:
The electronic databases, including CNKI, Wanfang, SinoMed, Weipu, PubMed, Web of Science, EMBASE, and Cochrane databases were retrieved (March 1, 2024), and the randomized controlled trials (RCTs) that met the criteria were included. Methodologic quality assessment of RCTs was performed using the Cochrane risk of bias tool. The data of RCTs were acquired and analyzed by meta-analysis by Review Manager 5.3, and the quality of the evidence followed the Grading of Recommendations, Assessment, Development and Evaluations approach. This research was registered in the International Platform of Registered Systematic Review and Meta-analysis, 202440001. Based on the network pharmacology, relationships between key genes of SJZD and tumor-infiltrating immune cells in gastrointestinal cancers were explored.

Results:
Thirteen articles (RCTs) were included, containing 1010 patients with gastrointestinal cancers after surgery. The results of meta-analysis revealed that SJZD with conventional therapies could improve CD3+ T lymphocyte (mean difference [MD] = 5.73, 95% confidence interval [CI]: 2.07–9.39, P = .002), CD4+ T lymphocyte (MD = 5.86, 95% CI: 3.90–7.82, P < .00001), CD4+/CD8+ (MD = 0.29, 95% CI: 0.15–0.43, P < .0001), and reduce CD8+ T lymphocyte (MD = −2.44, 95% CI: −4.03 to −0.85, P = .003) compared with conventional therapies alone. In addition, the funnel plot showed the included RCTs might have publication bias. The Grading of Recommendations, Assessment, Development and Evaluations classification showed low-quality evidence for CD4+, CD8+, and CD4+/CD8+, and very low-quality evidence for other indicators. The network pharmacology results suggested that SJZD may exert effects by regulating the immune cells in the microenvironment of gastrointestinal cancers.

Conclusion:
SJZD could enhance the immune function of patients with gastrointestinal cancers after surgery. Due to the low quality of articles, more high-quality RCTs are needed to improve the level of evidence.
The impact, prevalence, and association of different forms of hair loss among individuals with anxiety disorder: Systematic review and meta-analysis
Authors: Almudimeegh Almuntsrbellah , Alajlan Ahmed Hamad , Alrasheed Abdulelah Ibrahim , Alrasheed Mansour Ibrahim , Alqahtani Abdullah Khalid , Idris Reem Bin , Alomar Muhannad Abdullah , Alobaid Shaden Ahmad , Alotaibi Nouf Ali 
Published: February 2025

Background:
Hair loss is a serious health concern, with individuals having to bear the associated psychological impact of the condition. Alopecia has been linked to emotional and psychological anguish in relationships, career, and personal life.

Objective:
This study aimed to elucidate the intricate association, prevalence, and impact of hair loss with anxiety disorders, distinguished from other psychological impacts of alopecia.

Methods:
The current review and meta-analysis were performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework. A comprehensive search was performed using the Cochrane, PubMed, and Google Scholar electronic databases studies published in English and conducted between January 2014 and September 2024. Statistical analysis was performed using STATA version 16.0 (StataCorp LLC), and the Newcastle-Ottawa Scale and RoB 2 tools were used for critical quality appraisal.

Results:
A total of 24 eligible articles were included in the current study, with a cumulative of 5553 patients presenting with 1 or more forms of hair loss. Anxiety disorder was significantly prevalent among patients with alopecia event rate (ER) 0.47 (95% CI: 0.39–0.54). Anxiety severity analysis also showed a significant relationship between anxiety and hair loss, with ERs of 0.35 (95% CI: 0.10–0.60), 0.15 (95% CI: 0.01–0.29), and 0.05 (95% CI: 0.03–0.29), respectively. Statistical significance was also demonstrated by a mean HADS-A score of 7.87 (95% CI: 6.85–8.88). However, considerable heterogeneity was observed in various statistical analyses.

Conclusion:
In summary, our study showed that among people with hair loss-related diseases, alopecia was substantially linked to anxiety disorders, with the frequency of anxiety among those affected being noticeably higher.
Suction pressure levels during bronchial obstruction are related to bronchoalveolar lavage recovery failure: A clinical trial
Authors: Shimoda Masafumi , Kodama Tatsuya , Ito Masashi , Morimoto Kozo , Yoshimori Kozo , Ohta Ken , Tanaka Yoshiaki 
Published: February 2025

Background:
Bronchoalveolar lavage (BAL) is a valuable diagnostic tool, with an optimal recovery rate of ≥ 30% for effective diagnosis. The primary cause of BAL recovery failure is bronchial collapse due to negative pressure, which is potentially influenced by bronchial wall weakness. This study aimed to measure suction pressure levels during bronchial collapse to explore their relationship with BAL recovery rates.

Methods:
We included 103 patients who underwent BAL procedures at Fukujuji Hospital from May 2024 to July 2025. Suction pressure levels during bronchial obstruction were evaluated and compared between patients with a BAL recovery rate < 30% (the failure group) and those with a BAL recovery rate ≥ 30% (the success group).

Results:
Of the 103 patients, 13 were categorized into the failure group, and 90 into the success group. The median age of patients in the failure group was 74 years (range 47–86), with 7 males (53.8%), which was not significantly different from that of patients in the success group (median age 72 years [range 18–90], P = .290; male n = 56 [62.2%], P = .560). Patients in the failure group had significantly lower suction pressure levels during bronchial obstruction than those in the success group did (median 8 hPa [95% confidence interval: 3–13] vs 10 hPa [4–22], P < .001). The area under the receiver operating characteristic curve for suction pressure levels during bronchial obstruction for predicting BAL recovery failure was 0.807 (95% confidence interval: 0.687–0.927). A cutoff value of <9.5 hPa was identified as a predictable suction pressure level causing bronchial obstruction, with a sensitivity of 67.8% and a specificity of 92.3%.

Conclusion:
Suction pressure levels during bronchial obstruction were predictive of BAL recovery rate failure, suggesting that a weak bronchial wall may be more prone to collapse under suction pressure.
Value of Prenatal 3D HD-Live Flow in the Evaluation of True and False Knots of the Umbilical Cord
Authors: Zheng Lipeng , Liu Ying , Gong Lili , Wang Yingluan , Chang Hongbo 
Published: February 2025

Abstract
In this study, 3D HD-live Flow was used to differentiate true and false knots. The study involved 9161 fetuses who underwent ultrasound during the 13th to 40th week of pregnancy. Among them, 38 cases of true knots of umbilical cord were found, with 24 cases correctly identified by 3D HD-live Flow, representing a detection rate of 63.2%. There were 19 cases of false knots of umbilical cord, with 13 cases correctly identified by 3D HD-live Flow, representing a detection rate of 68.4%.
The detection rates of true knots of umbilical cord by 2D ultrasound and color Doppler ultrasound were significantly lower than that of 3D HD-live Flow (P < 0.05). However, there was no significant difference in detection rate between color Doppler ultrasound and 2D ultrasound (P > 0.05).
This study demonstrates that 3D HD-live Flow is an effective imaging technique for distinguishing true and false knots of the umbilical cord in the prenatal period. It has the potential to improve the accuracy of diagnosis and provide valuable information for clinical management.