bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term follow-up of antibiotic-loaded calcium sulfate in treating chronic periprosthetic joint infection during two-stage revision
Authors: Sun Xiao , Tan Jun , Zhan Lijuan , Sheng Mingkui , Tang Zhongxin , Wu Lingxiao , Xu Jianzhong , Ma Haijun 
Published: January 2025

BackgroundPeriprosthetic joint infection (PJI) is a significant and challenging complication following total knee arthroplasty (TKA). This study aimed to evaluate the efficacy and safety of treating chronic knee PJI with and without antibiotic-loaded calcium sulfate during two-stage revision surgery.MethodsThis retrospective study analyzed 94 patients with TKA infections who underwent two-stage revision between May 2017 and January 2022 at the First Affiliated Hospital of Zhengzhou University. Key outcomes assessed included infection recurrence rates, postoperative range of motion (ROM), Knee Society Score (KSS), Hospital for Special Surgery (HSS) scores, hematological parameters, and complication rates during the follow-up period.ResultsThe demographic characteristics of the two groups showed no significant differences. The infection control rate was significantly higher in the calcium sulfate group (95.7%) compared to the matched control group (80.9%) (P &lt; 0.05). Both groups demonstrated statistically significant improvements in ROM, HSS, and KSS scores compared to preoperative values (P &lt; 0.05). However, intergroup differences in these outcomes were not statistically significant (P &gt; 0.05). Additionally, there was no significant difference in postoperative complication rates between the two groups.ConclusionThe use of antibiotic-loaded calcium sulfate in two-stage revision surgery for chronic knee PJI ensures sustained local antibiotic release at high concentrations, leading to rapid reduction in inflammatory markers, effective infection control, and a low complication rate. This approach is a safe and effective treatment for chronic knee PJI.
Distribution of sasX, mupA, and qacA/B genes and determination of genetic relatedness of epidemic methicillin-resistant Staphylococcus aureus strains associated with bloodstream infections in southern China
Authors: Zhao Rui , Du Bingyu , Hu Lingling , Li Chenxi , Xue Fen , Wang Xing , Jiang Changhong , Wang Jinghua , Zhao Yanfeng 
Published: January 2025

IntroductionMethicillin-resistant Staphylococcus aureus (MRSA) exhibits diverse genotypes with varying virulence and resistance profiles, particularly in the context of bloodstream infections (BSI). This study investigates the prevalence of the sasX, mupA, and qacA/B genes among MRSA isolates from bloodstream infections in southern China and analyzes their genetic relatedness.MethodsA polymerase chain reaction (PCR) assay was developed to detect the presence of the sasX gene, which is associated with nasal colonization, immune evasion, and virulence, the mupirocin resistance gene mupA, and the chlorhexidine tolerance gene qacA/B in a total of 77 MRSA isolates. Multilocus sequence typing (MLST) was performed to determine the sequence types (STs) and assess the genetic relatedness of the isolates. The resistance of these strains to 16 antibiotics was also analyzed. The distribution of these genes and their association with epidemic STs were analyzed.ResultsA total of 26 STs were identified, with notable prevalence in five epidemic clones: ST59, ST5, and ST764. The prevalence of the sasX, mupA, and qacA/B genes across all isolates was 23.4%, 33.8%, and 79.2%, respectively. Specifically, the frequency of the sasX gene was highest in ST59 (29.4%), ST239 (100%), and ST764 (37.5%); mupA was most prevalent in ST5 (66.7%), ST59 (17.6%), ST764 (37.5%), and ST15 (100%); qacA/B was predominantly found in ST59 (88.2%), ST5 (66.7%), ST398 (85.7%), ST764 (50.0%), and ST239 (100%). The gene distribution patterns revealed that sasX+ qacA/B+ mupA+ strains were closely associated with epidemic clones ST6290 and ST88, whereas sasX+ qacA/B+ mupA- strains were linked to ST59, ST239, and ST764. DiscussionNotably, forty-seven (61%) MRSA BSI strains were multidrug-resistant, with the majority exhibiting resistance to penicillin, erythromycin, and clindamycin. Major MRSA clones in southern China include ST59, ST5, ST764, and ST398. In this study, sasX, mupA and qacA/B genes were present in the MRSA isolates, with the mupA gene being the most prevalent. Variations in the prevalence of virulence and resistance genes among these epidemic strains underscore the need for targeted infection control measures. These findings contribute to a better understanding of the genetic epidemiology of MRSA in the region, facilitating the development of effective prevention and control strategies for BSI.
Endovascular management of a spontaneous aorto-caval fistula resulting from abdominal aortic aneurysm: case report and literature review
Authors: Wu Dongbo , Peng Cheng , Zhou Zhiyong , Chen Jie , He Bin , Ye Zhidong 
Published: January 2025

BackgroundAorto-caval fistula is a rare complication of abdominal aortic aneurysms that can occur spontaneously, iatrogenically, or traumatically, associated with high morbidity and mortality. Endovascular stent graft repair represents a practical approach to managing this fatal condition.Case presentationA 75-year-old male patient was admitted to the nephrology department of our hospital, complaining of acute back pain, hematuria, and repeated vomiting for one week. The laboratory assessments yielded high creatinine levels, indicating an acute renal impairment. Computed tomography angiography revealed an aorto-caval fistula complicating infrarenal abdominal aortic aneurysm. The patient was successfully treated with the endovascular approach by deploying covered stent grafts that completely excluded the fistula.ConclusionUtilizing covered stent grafts for endovascular management of aorto-caval fistula is a good alternative to conventional surgery, especially in elderly high-risk patients.
Radiofrequency ablation vs. cryoablation for pediatric atrioventricular nodal reentrant tachycardia in the era of three-dimensional electroanatomical mapping
Authors: Chan Yao-Wei , Chuang Chieh-Mao , Lee Pi-Chang , Tai I-Hsin , Peng Ying-Hsuan , Fan Wen-Po , Lee Yu-Shin , Lin Ming-Chih , Jan Sheng-Ling , Fu Yun-Ching , Chen Shih-Ann 
Published: January 2025

BackgroundCryoablation for pediatric atrioventricular nodal reentry tachycardia (AVNRT) is favored for reducing conduction system injury compared to radiofrequency (RF) ablation. The safety advantage of cryoablation over RF ablation primarily results from studies conducted without a three-dimensional electroanatomical mapping (3D EAM) system. Currently, 3D EAM systems offer precise and efficient guidance, improving safety and outcomes. This study compares RF ablation and cryoablation using a 3D EAM system for pediatric AVNRT treatment.MethodsA retrospective study enrolled consecutive pediatric patients with AVNRT who underwent RF ablation (RF group) or cryoablation (Cryo group) guided by a 3D EAM system at multiple centers from July 2018 to January 2024.ResultsAmong 95 patients, 69 received RF ablation and 26 received cryoablation. Recurrence rates were 2.9% in the RF group and 0% in the Cryo group (p &gt; 0.99), with no difference in AVNRT-free survival. No major complications, such as permanent atrioventricular (AV) block, were observed. The minor complication rates, including transient AV block, did not differ significantly (14.5% vs. 11.5%, p &gt; 0.99). The RF group had a significantly shorter procedure time (111 vs. 153.5 min, p = 0.005). Ablation outside the low Koch triangle and cryoablation were independently associated with longer procedure times. The procedure time decreased significantly in the recent 50% of RF ablation cases, but not in cryoablation cases.ConclusionWith 3D EAM guidance, both RF ablation and cryoablation are considered safe and effective for pediatric AVNRT. RF ablation is more efficient with a shorter procedure time after increasing experience.
Evaluation of microRNAs as liquid biopsy markers in adrenocortical tumors
Authors: Mytareli Chrysoula , Kalotychou Vassiliki , Lafioniatis Alexandros , Kaltsas Gregory , Zografos George N. , Markou Athina , Papanastasiou Labrini , Fountas Athanasios , Vasilliadi Dimitra Argyro , Kassi Evanthia , Mantzourani Marina , Angelousi Anna 
Published: January 2025

IntroductionAdrenal tumors (ATs) encompass a wide differential diagnosis, necessitating a multi-step process for accurate identification. Liquid biopsy emerges as a promising non-invasive technique for distinguishing between malignant and benign, as well as hyperfunctioning and non-functioning cases. Recent studies have highlighted the potential of microRNAs as circulating biomarkers; however, their clinical utility remains underexplored. This study aims to validate the diagnostic performance of selected circulating microRNAs, (miR-483-5p, miR-210, miR-335 and miR-22-3p), identified through microRNA profiling studies, as markers of malignancy or cortisol hypersecretion in a cohort of patients with ATs.MethodsWe collected serum samples from 75 patients with ATs, including 50 cases of adrenocortical adenomas (ACA) and 25 cases of adrenocortical carcinomas (ACC), along with 15 controls. In the ACC subgroup, 16 samples were obtained preoperatively or upon detection of recurrence (active ACC group), while the remaining from disease-free patients with long-term follow-up. Among the 56 patients with ATs evaluated preoperatively (50 with ACAs and 6 with ACC), 26 had non-functioning tumors, 22 exhibited mild autonomous cortisol secretion, and 8 had Cushing syndrome. Quantitative real-time polymerase chain reaction was employed to analyze microRNA expression.ResultsCirculating levels of miR-483-5p and miR-210 were significantly elevated in patients with active ACC compared to both ACAs (p&lt;0.001 and p=0.004, respectively) and controls (p=0.02 and p = 0.03, respectively). Notably, miR-483-5p serum levels were higher in patients with active ACC compared to disease-free ACC patients (p = 0.01). MiR-483-5p demonstrated the best diagnostic accuracy for distinguishing active ACC cases from ACAs, achieving a sensitivity of 81.3% and a specificity of 88%, and from disease-free ACC patients, reaching sensitivity of 81.3% and specificity of 89%. MiR-22-3p serum levels successfully differentiated patients with Cushing syndrome from those with non-functioning ATs (area under the curve=AUC=0.800, 95% CI: 0.653–0.953, p=0.01) and controls (AUC= 0.800, 95% CI: 0.610–0.990, p=0.02). Additionally, circulating miR-22-3p levels exhibited a significant correlation with traditional diagnostic tests for hypercortisolism.ConclusionThis study supports the potential of a liquid biopsy approach as an innovative method for diagnosing and monitoring patients with ATs, offering a complementary tool to existing diagnostic methods.
Agricultural structure management based on water–energy–food and carbon sink scenarios in typical fuel ethanol raw material planting areas—a case study of the Hulan River Basin, Northeast China
Authors: Cui Guannan , Wang Haitao , Li Xiaofei , Li Wenchao , Li Huijie , Dong Liming 
Published: January 2025

The implementation of Chinese policies promoting fuel ethanol has significantly influenced the land use structure, water resources, and soil environment in ethanol raw material planting areas. This paper focuses on the Hulan River Basin, a benchmark region for maize cultivation, to investigate the specific crop allocation issues in relation to the impact of land use changes on water quality. The study projects an environmentally and economically sustainable structure for the cultivation of fuel ethanol raw materials using the CLUE-S model and multiple linear programming. Additionally, the carbon sequestration potential is assessed under different scenarios. Throughout the study period, the net ecosystem productivity (NEP) in the Hulan River Basin demonstrated variability, evidenced by a decrease of 33.96 gC·m−2·a−1 from 2010 to 2015 and a subsequent augmentation of 55.64 gC·m−2·a−1 from 2015 to 2020. Furthermore, the three scenarios (Grain Crop Priority Policy, Fuel Ethanol Crop Priority Policy, and Carbon Storage Priority Policy) effectively addressed the requirements for land use/cover types and enhanced carbon sequestration within the study area. Consequently, the outcomes provide a conceptual foundation for regional policymakers, providing insights into the refinement of land use within ethanol crop zones and fostering the advancement of the fuel ethanol industry, thus undergirding prospective land use strategies and refinement from the water, energy, food, and carbon perspectives.
Clinical phenotype and genetic analysis of patients with severe oligoasthenospermia carrying heterozygous SOHLH1 c.346-1G>A mutation
Authors: Wen Xiaojun , Li Zhiming , Cheng Lizi , Wei Jianhong , Yu Wenjuan , Lin Xiufeng , Fang Xiaowu 
Published: January 2025

IntroductionSevere oligoasthenospermia (SOA) is a prevalent cause of male infertility. However, the underlying causes of most SOA cases remain unclear due to the complexity of germ cell development and the significant genetic heterogeneity associated with male infertility. Therefore, in this study, we aimed to elucidate the genetic etiology of two cases of male infertility resulting from SOA and clarify the novel clinical phenotype associated with a heterozygous mutation at the c.346-1G&gt;A site of the SOHLH1 gene.Methods and resultsThrough whole-exome sequencing, we found that patients with SOA carried heterozygous mutations at the c.346-1G&gt;A site. This variant is classified as pathogenic based on disease database records and literature reports. Notably, our study demonstrated that patients with heterozygous mutations at the c.346-1G&gt;A site exhibited severely reduced sperm counts, significantly impaired sperm motility, and pronounced morphological deformities. One patient underwent assisted reproductive treatment through an intracytoplasmic sperm injection and achieved a favorable outcome, resulting in a successful pregnancy.DiscussionIn conclusion, our study provides the first evidence that the heterozygous mutation at the c.346-1G&gt;A site of SOHLH1 is associated with SOA, and elucidates the new clinical phenotype associated with this mutation.
Use of artificial intelligence for gestational age estimation: a systematic review and meta-analysis
Authors: Naz Sabahat , Noorani Sahir , Jaffar Zaidi Syed Ali , Rahman Abdu R. , Sattar Saima , Das Jai K. , Hoodbhoy Zahra 
Published: January 2025

IntroductionEstimating a reliable gestational age (GA) is essential in providing appropriate care during pregnancy. With advancements in data science, there are several publications on the use of artificial intelligence (AI) models to estimate GA using ultrasound (US) images. The aim of this meta-analysis is to assess the accuracy of AI models in assessing GA against US as the gold standard.MethodsA literature search was performed in PubMed, CINAHL, Wiley Cochrane Library, Scopus, and Web of Science databases. Studies that reported use of AI models for GA estimation with US as the reference standard were included. Risk of bias assessment was performed using Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Mean error in GA was estimated using STATA version-17 and subgroup analysis on trimester of GA assessment, AI models, study design, and external validation was performed.ResultsOut of the 1,039 studies screened, 17 were included in the review, and of these 10 studies were included in the meta-analysis. Five (29%) studies were from high-income countries (HICs), four (24%) from upper-middle-income countries (UMICs), one (6%) from low-and middle-income countries (LMIC), and the remaining seven studies (41%) used data across different income regions. The pooled mean error in GA estimation based on 2D images (n = 6) and blind sweep videos (n = 4) was 4.32 days (95% CI: 2.82, 5.83; l2: 97.95%) and 2.55 days (95% CI: −0.13, 5.23; l2: 100%), respectively. On subgroup analysis based on 2D images, the mean error in GA estimation in the first trimester was 7.00 days (95% CI: 6.08, 7.92), 2.35 days (95% CI: 1.03, 3.67) in the second, and 4.30 days (95% CI: 4.10, 4.50) in the third trimester. In studies using deep learning for 2D images, those employing CNN reported a mean error of 5.11 days (95% CI: 1.85, 8.37) in gestational age estimation, while one using DNN indicated a mean error of 5.39 days (95% CI: 5.10, 5.68). Most studies exhibited an unclear or low risk of bias in various domains, including patient selection, index test, reference standard, flow and timings and applicability domain.ConclusionPreliminary experience with AI models shows good accuracy in estimating GA. This holds tremendous potential for pregnancy dating, especially in resource-poor settings where trained interpreters may be limited.Systematic Review RegistrationPROSPERO, identifier (CRD42022319966).
Identification and validation of a novel autoantibody biomarker panel for differential diagnosis of pancreatic ductal adenocarcinoma
Authors: Mowoe Metoboroghene O. , Allam Hisham , Nqada Joshua , Bernon Marc , Gandhi Karan , Burmeister Sean , Kotze Urda , Kahn Miriam , Kloppers Christo , Dharshanan Suba , Azween Zafirah , Maimela Pamela , Townsend Paul , Jonas Eduard , Blackburn Jonathan M. 
Published: January 2025

IntroductionNew biomarkers are urgently needed to detect pancreatic ductal adenocarcinoma (PDAC) at an earlier stage for individualized treatment strategies and to improve outcomes. Autoantibodies (AAbs) in principle make attractive biomarkers as they arise early in disease, report on disease-associated perturbations in cellular proteomes, and are static in response to other common stimuli, yet are measurable in the periphery, potentially well in advance of the onset of clinical symptoms.MethodsHere, we used high-throughput, custom cancer antigen microarrays to identify a clinically relevant autoantibody biomarker combination able to differentially detect PDAC. Specifically, we quantified the serological AAb profiles of 94 PDAC, chronic pancreatitis (CP), other pancreatic- (PC) and prostate cancers (PRC), non-ulcer dyspepsia patients (DYS), and healthy controls (HC).ResultsCombinatorial ROC curve analysis on the training cohort data from the cancer antigen microarrays identified the most effective biomarker combination as CEACAM1-DPPA2-DPPA3-MAGEA4-SRC-TPBG-XAGE3 with an AUC = 85·0% (SE = 0·828, SP = 0·684). Additionally, differential expression analysis on the samples run on the iOme™ array identified 4 biomarkers (ALX1-GPA33-LIP1-SUB1) upregulated in PDAC against diseased and healthy controls. Identified AAbs were validated in silico using public immunohistochemistry datasets and experimentally using a custom PDAC protein microarray comprising the 11 optimal AAb biomarker panel. The clinical utility of the biomarker panel was tested in an independent cohort comprising 223 PDAC, PC, PRC, colorectal cancer (CRC), and HC samples. Combinatorial ROC curve analysis on the validation data identified the most effective biomarker combination to be CEACAM1-DPPA2-DPPA3-MAGEA4-SRC-TPBG-XAGE3 with an AUC = 85·0% (SE = 0·828, SP = 0·684). Subsequently, the specificity of the 11-biomarker panel was validated against other cancers (PDAC vs PC: AUC = 70·3%; PDAC vs CRC: AUC = 84·3%; PDAC vs PRC: AUC = 80·2%) and healthy controls (PDAC vs HC: AUC = 80·9%), confirming that this novel AAb biomarker panel is able to selectively detect PDAC amongst other confounding diseases.ConclusionThis AAb panel may therefore have the potential to form the basis of a novel diagnostic test for PDAC.
Altered hemostatic balance in favor of a procoagulant state in pregnant women with systemic lupus erythematosus
Authors: Antovic Aleksandra , Lini Daniele , Soutari Nida , Lalic-Cosic Sanja , Zickert Agneta , Mc Nicholas Andrea , Bremme Katarina , Sennström Maria , Franceschini Franco , Svenungsson Elisabet , Andreoli Laura , Gunnarsson Iva 
Published: January 2025

ObjectivesThis study aimed to investigate hemostatic parameters in pregnant patients with systemic lupus erythematosus (SLE) in relation to the use of antithrombotic prophylaxis, preeclampsia (PE), and antiphospholipid antibody status.Patients and methodsIn total, 34 pregnant patients with SLE and 80 pregnant healthy controls (HC) without PE were included. Patients with SLE were sampled during the first and third trimester of gestation. We analyzed fibrinogen, D-dimer, and global hemostatic parameters including the overall coagulation potential (OCP), overall hemostatic potential (OHP), and the overall fibrinolysis potential (OFP). Fibrin structure was visualized using scanning electron microscopy.ResultsThe median age of the patients with SLE was 33 (range 23–42) years and 31 (26–38) years in the HC. The median disease duration was 10 (range 0–26) years. All but two patients with SLE received prophylaxis with low-dose acetylsalicylic acid (LDASA) and 11 received low-molecular-weight heparin (LMWH). OCP and OHP were significantly increased in the patients with SLE compared to HC (p &lt; 0.01). The levels of fibrinogen and D-dimer increased throughout the pregnancies in the patients with SLE, but no differences were found in the third trimester compared to controls. Among the patients treated with LMWH, OCP, OHP, and OFP were undetectable in two, both of whom were on high prophylactic dosage, and one developed PE. OCP, OHP, and OFP levels were not affected by low prophylactic doses of LMWH. Despite LDASA, preeclampsia occurred in four patients with SLE (12.5%); of whom two received a high prophylactic LMWH dose. Five of 32 (15.6%) patients had major bleeding complications at delivery. There were no thromboembolic complications.ConclusionsIn this pilot study, pregnant patients with SLE developed a hypercoagulable state throughout pregnancy, as demonstrated by the global hemostatic parameters OCP and OHP, except for two patients who were treated with a full dosage of LMWH. The alterations in the coagulation system in SLE pregnancy need to be further studied with the aim of optimizing treatment strategies.
Exploration of policy feedback mechanism for healthcare improvement in China: a grounded theory model
Authors: Zhu Tuo-Dong , Yang Ming-Jin , Wu Hao 
Published: January 2025

BackgroundDespite increasing governments’ endeavors to improve the quality of medical services focused on patient experience, it has been difficult due to a lack of systematic and replicable theories to guide healthcare improvement. This study aimed to construct a theoretical model of a policy feedback mechanism for guiding healthcare improvement based on healthcare improvement in China’s context.MethodsWe constructed a theoretical model of policy feedback mechanism for improving healthcare using a grounded theory approach to collect and analyze textual data on healthcare improvement in China.ResultsIn this study, the theoretical model of policy feedback mechanism for healthcare improvement contained five core modules: multi-level objects, policy context, policy tools driven, policy feedback process, and policy feedback results. At the theoretical level, we innovatively constructed the module of “patient feelings,” including “patient sense of gain,” “patient happiness,” and “patient sense of safety.” Practically, we generated a list of ways through the “medical organization behavior” module to enhance patient feelings.ConclusionThis model elaborated a policy feedback mechanism for healthcare improvement. This research provided theoretical and practical support for health authorities to formulate and apply various policies or initiatives to improve healthcare. Theoretically, the model innovated the development of patient feelings in the policy feedback for healthcare improvement. On the practical level, we generated specific strategies for hospitals to enhance healthcare and patient experience.