bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel attentional gait index reveals a cognitive ability-related decline in gait automaticity during dual-task walking
Authors: Liu Shuqi , Rosso Andrea L. , Baillargeon Emma M. , Weinstein Andrea M. , Rosano Caterina , Torres-Oviedo Gelsy 
Published: January 2024

IntroductionGait automaticity refers to the ability to walk with minimal recruitment of attentional networks typically mediated through the prefrontal cortex (PFC). Reduced gait automaticity (i.e., greater use of attentional resources during walking) is common with aging, contributing to an increased risk of falls and reduced quality of life. A common assessment of gait automaticity involves examining PFC activation using near-infrared spectroscopy (fNIRS) during dual-task (DT) paradigms, such as walking while performing a cognitive task. However, neither PFC activity nor task performance in isolation measures automaticity accurately. For example, greater PFC activation could be interpreted as worse gait automaticity when accompanied by poorer DT performance, but when accompanied by better DT performance, it could be seen as successful compensation. Thus, there is a need to incorporate behavioral performance and PFC measurements for a more comprehensive evaluation of gait automaticity. To address this need, we propose a novel attentional gait index as an analytical approach that combines changes in PFC activity with changes in DT performance to quantify automaticity, where a reduction in automaticity will be reflected as an increased need for attentional gait control (i.e., larger index).MethodsThe index was validated in 173 participants (≥65 y/o) who completed DTs with two levels of difficulty while PFC activation was recorded with fNIRS. The two DTs consisted of reciting every other letter of the alphabet while walking over either an even or uneven surface.ResultsAs DT difficulty increases, more participants showed the anticipated increase in the attentional control of gait (i.e., less automaticity) as measured by the novel index compared to PFC activation. Furthermore, when comparing across individuals, lower cognitive function was related to higher attentional gait index, but not PFC activation or DT performance.ConclusionThe proposed index better quantified the differences in attentional control of gait between tasks and individuals by providing a unified measure that includes both brain activation and performance. This new approach opens exciting possibilities to assess participant-specific deficits and compare rehabilitation outcomes from gait automaticity interventions.
Mild traumatic brain injury, PTSD symptom severity, and behavioral dyscontrol: a LIMBIC-CENC study
Authors: Stromberg Kelsee M. , Martindale Sarah L. , Walker William C. , Ou Zhining , Pogoda Terri K. , Miles Shannon R. , Dismuke-Greer Clara E. , Carlson Kathleen F. , Rowland Jared A. , O’Neil Maya E. , Pugh Mary Jo 
Published: January 2024

BackgroundBehavioral dyscontrol occurs commonly in the general population and in United States service members and Veterans (SM/V). This condition merits special attention in SM/V, particularly in the aftermath of deployments. Military deployments frequently give rise to posttraumatic stress disorder (PTSD) and deployment-related mild TBI traumatic brain injury (TBI), potentially leading to manifestations of behavioral dyscontrol.ObjectiveExamine associations among PTSD symptom severity, deployment-related mild traumatic brain injury, and behavioral dyscontrol among SM/V.DesignSecondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium – Chronic Effects of Neurotrauma Consortium prospective longitudinal study among SM/V (N = 1,808).MethodsUnivariable and multivariable linear regression models assessed the association and interaction effects between PTSD symptom severity, as assessed by the PTSD Checklist for the Diagnostic and Statistical Manual, 5th edition (PCL-5), and deployment-related mild TBI on behavioral dyscontrol, adjusting for demographics, pain, social support, resilience, and general self-efficacy.ResultsAmong the 1,808 individuals in our sample, PTSD symptom severity (B = 0.23, 95% CI: 0.22, 0.25, p &lt; 0.001) and deployment-related mild TBI (B = 3.27, 95% CI: 2.63, 3.90, p &lt; 0.001) were significantly associated with behavioral dyscontrol in univariable analysis. Interaction effects were significant between PTSD symptom severity and deployment mild TBI (B = −0.03, 95% CI: −0.06, −0.01, p = 0.029) in multivariable analysis, indicating that the effect of mild TBI on behavioral dyscontrol is no longer significant among those with a PCL-5 score &gt; 22.96.ConclusionResults indicated an association between PTSD symptom severity, deployment-related mild TBI, and behavioral dyscontrol among SM/V. Notably, the effect of deployment-related mild TBI was pronounced for individuals with lower PTSD symptom severity. Higher social support scores were associated with lower dyscontrol, emphasizing the potential for social support to be a protective factor. General self-efficacy was also associated with reduced behavioral dyscontrol.
Genetically predicted chronic rhinosinusitis and the risk of stroke: a two-sample Mendelian randomization study
Authors: Hu Jingjing , Wang Hui , Zhou Yidan 
Published: January 2024

ObjectiveThe causal association between chronic rhinosinusitis (CRS) and stroke remains uncertain due to the susceptibility of observational studies to confounding and the possibility of reverse causality. This study aims to examine the potential causal relationship between CRS and the risk of stroke, encompassing various subtypes.MethodsIn this research, we utilized genome-wide association study (GWAS) data for CRS from FinnGen. We identified significant single-nucleotide polymorphisms (SNPs) associated with CRS and used them as instrumental variables (IVs). GWAS data for any ischemic stroke (AIS), ischemic stroke (IS), large-artery atherosclerotic stroke (LAS), small-vessel strokes (SVS), cardioembolic strokes (CES), intracerebral hemorrhage (ICH), lobar ICH, and non-lobar ICH came from multi-ancestry GWAS datasets. We conducted two-sample Mendelian randomization (MR) analyses using inverse variance weighting (IVW), weighted median, and MR-Egger regression methods to investigate potential causal relationships between CRS and stroke. Both heterogeneity and pleiotropy were evaluated by sensitivity analyses.ResultThe IVW analysis revealed no significant associations between CRS and AIS (OR = 0.99, 95% CI [0.93–1.05], p = 0.73), IS (OR = 0.97, 95% CI [0.81–1.17], p = 0.09), SVS (OR = 0.96, 95% CI [0.82–1.12], p = 0.58), LAS (OR = 0.91, 95% CI [0.77–1.08], p = 0.09), CES (OR = 0.97, 95% CI [0.81–1.17], p = 0.79), ICH (OR = 1.28, 95% CI [0.74–2.22], p = 0.28), lobar ICH (OR = 1.22, 95% CI [0.60–2.50], p = 0.28), and non-lobar ICH (OR = 1.25, 95% CI [0.65–2.40], p = 0.79). Sensitivity analysis found no evidence of horizontal pleiotropy.ConclusionAccording to genetic evidence, this Mendelian randomization (MR) study does not indicate a causal relationship between CRS and stroke in European populations. However, further studies are necessary to comprehensively evaluate the potential association between CRS and stroke.
Effects of modified external ventricular drainage vs. an Ommaya reservoir in the management of hydrocephalus with intracranial infection in pediatric patients
Authors: Chen Liuyin , He Mingzhe , Shi Lei , Yue Yanke , Luo Pengyuan , Fang Jiangshun , Wang Na , Cheng Zhenghai , Qu Yi , Yang Zhiguo , Sun Yaning 
Published: January 2024

BackgroundHydrocephalus with intracranial infection (HII) may cause pathological changes in brain tissue structure and irreversible damage to the nervous system. However, intracranial infection is a contraindication to ventriculo-peritoneal (VP) shunt surgery, and the prognosis is improved by early infection control and intracranial pressure reduction. This study evaluated the safety and efficacy of the Ommaya reservoir vs. modified external ventricular drainage (M-EVD) in the management of HII in pediatric patients.MethodsThis retrospective controlled study included 45 pediatric patients with HII treated with an Ommaya reservoir (n = 24) or M-EVD (n = 21) between January 2018 and December 2022. Clinical outcomes, cerebrospinal fluid (CSF) test results, complications, and outcomes were compared between the Ommaya reservoir and M-EVD groups.ResultsNo patient died during the follow-up period. The two groups were similar regarding age, sex, admission temperature, weight, preoperative serum protein and albumin concentrations, CSF analysis (white blood cell count, glucose concentration, and protein content), and clinical symptoms (P &gt; 0.05). Both groups had significant changes in the CSF test results postoperatively compared with preoperatively (P &lt; 0.05). In the M-EVD group, the median days for 13 children to remove the external drainage tube and receive VP shunt was 19 days. The longest drainage tube retention time was 61 days, and there was no intracranial infection or serious complication related to the drainage tube. After the placement of the Ommaya, the median time required for CSF to return to normal was 21 days, and a total of 15 patients underwent VP shunt surgery.ConclusionThe Ommaya reservoir and M-EVD are safe and effective for pediatric patients with HII. Both methods reduce the intracranial pressure and alleviate the symptoms of hydrocephalus, although there are differences between the two methods.
Predictive value of ApoB/ApoA-I for recurrence within 1 year after first incident stroke
Authors: Lin Jie , Si Zhihua , Wang Aihua 
Published: January 2024

BackgroundApoB/ApoA-I ratio is a reliable indicator of cholesterol balance, particularly in the prediction of ischemic events risk. The aim of this study was to investigate the prognostic value of ApoB/ApoA-I for stroke recurrence within 1 year after the first incident.MethodsWe retrospectively included patients who were first diagnosed with acute (&lt;7 days after onset) ischemic stroke. Blood samples were collected on admission, and serum ApoB and ApoA-I concentrations were measured. We analyzed the relationship between ApoB/ApoA-I ratio and ischemic stroke recurrence within 1 year.ResultsA total of 722 patients with acute ischemic stroke were included, of whom 102 experienced stroke recurrence within 1 year, with a recurrence rate of 14.1%. Serum ApoB/ApoA-I concentrations on admission were higher in patients with stroke recurrence at 1 year compared with those with a good prognosis (P &lt; 0.001). The Kaplan-Meier survival curve revealed a significant difference in cumulative stroke recurrence rates across ApoB/ApoA-I tertiles (log-rank P-value &lt; 0.001). A positive correlation between the ApoB/ApoA-I ratio and the risk of stroke recurrence within 1 year was demonstrated using Cox regression analysis, which remained significant after adjusting for traditional risk factors [hazard ratio (HR) 4.007, 95% confidence interval (CI) 1.661–9.666]. This relationship was particularly strong in patients with LAA stroke (HR 4.955, 95% CI 1.591–15.434). Subgroup analysis further revealed that a high ApoB/ApoA-I ratio was strongly associated with stroke recurrence regardless of whether patients had high or low LDL-C levels.DiscussionApoB/ApoA-I ratio, measured during the acute phase of the first stroke, was positively correlated with the risk of stroke recurrence within 1 year.
The outcome and risk factors associated with central and peripheral nervous system involvement in hospitalized COVID-19 patients: a retrospective cohort study
Authors: Hanganu Andreea Raluca , Niculae Cristian-Mihail , Dulămea Adriana Octaviana , Moisă Emanuel , Constantin Rareș , Neagu Georgiana , Hristea Adriana 
Published: January 2024

IntroductionSARS-CoV-2 infection can affect any organ, including both the central nervous system (CNS) and peripheral nervous system (PNS). The aim of this study was to explore the outcome and risk factors associated with the involvement of either CNS or PNS in a cohort of hospitalized COVID-19 patients.MethodsWe performed a retrospective observational cohort study of hospitalized adult patients with COVID-19, between May 2020 and December 2022, presenting with new onset neurological disabilities any time after admission.ResultsWe included 115 patients, 72 with CNS manifestations and 43 with PNS involvement. The CNS manifestations were COVID-19-associated encephalopathy, headache, neurovascular events, and seizures in 80.5, 43, 31.9, and 11.1% of patients, respectively. The neurovascular events were ischemic stroke in 17 (23.6%) patients, hemorrhagic stroke in 6 (8.3%) patients, venous thrombosis in 1 (1.4%) patient, and subarachnoid hemorrhage in 1 (1.4%) patient. Cranial nerve involvement was the most frequent PNS manifestation in 34 (79%) cases, followed by mononeuritis in 5 (11.6%) patients and polyneuropathy in 4 (9.3%) patients. The affected cranial nerves were the vestibulocochlear nerve in 26 (60.5%) patients, the olfactory nerve in 24 (55.8%) patients, the oculomotor nerves in 5 (11.6%) patients, and the facial nerve in 1 (2.3%) patient. Two patients (9.3%) presented with polyneuritis cranialis. Older age (HR = 1.02, 95% CI: 1.003–1.037, p = 0.01), COVID severity (HR = 2.53, 95% CI: 1.42–4.5, p = 0.002), ischemic cardiac disease (HR = 2.42, 95% CI: 1.05–5.6, p = 0.03), and increased D-dimers (HR = 1.00, 95% CI: 1.00–1.00, p = 0.02) were independently associated with the development of CNS manifestations. The factors associated with in-hospital mortality were age (HR = 1.059, 95% CI: 1.024–1.096, p = 0.001), C-reactive protein (HR = 1.006, 95% CI: 1.00–1.011, p = 0.03), CNS involvement (HR = 9.155, 95% CI: 1.185–70.74, p = 0.03), and leucocyte number (HR = 1.053, 95% CI: 1.026–1.081, p &lt; 0.001).ConclusionCOVID-19-associated encephalopathy was the most common CNS manifestation in our study, but neurovascular events are also important considering the overlap between inflammatory and prothrombotic pathways, especially in severe cases. CNS involvement was associated with in-hospital all-cause mortality. PNS findings were various, involving mostly the cranial nerves, especially the vestibulocochlear nerve.
The causal effect of HbA1c on white matter brain aging by two-sample Mendelian randomization analysis
Authors: Tian Cheng , Ye Zhenyao , McCoy Rozalina G. , Pan Yezhi , Bi Chuan , Gao Si , Ma Yizhou , Chen Mo , Yu Jiaao , Lu Tong , Hong L. Elliot , Kochunov Peter , Ma Tianzhou , Chen Shuo , Liu Song 
Published: January 2024

BackgroundPoor glycemic control with elevated levels of hemoglobin A1c (HbA1c) is associated with increased risk of cognitive impairment, with potentially varying effects between sexes. However, the causal impact of poor glycemic control on white matter brain aging in men and women is uncertain.MethodsWe used two nonoverlapping data sets from UK Biobank cohort: gene-outcome group (with neuroimaging data, (N = 15,193; males/females: 7,101/8,092)) and gene-exposure group (without neuroimaging data, (N = 279,011; males/females: 122,638/156,373)). HbA1c was considered the exposure and adjusted “brain age gap” (BAG) was calculated on fractional anisotropy (FA) obtained from brain imaging as the outcome, thereby representing the difference between predicted and chronological age. The causal effects of HbA1c on adjusted BAG were studied using the generalized inverse variance weighted (gen-IVW) and other sensitivity analysis methods, including Mendelian randomization (MR)-weighted median, MR-pleiotropy residual sum and outlier, MR-using mixture models, and leave-one-out analysis.ResultsWe found that for every 6.75 mmol/mol increase in HbA1c, there was an increase of 0.49 (95% CI = 0.24, 0.74; p-value = 1.30 × 10−4) years in adjusted BAG. Subgroup analyses by sex and age revealed significant causal effects of HbA1c on adjusted BAG, specifically among men aged 60–73 (p-value = 2.37 × 10−8).ConclusionPoor glycemic control has a significant causal effect on brain aging, and is most pronounced among older men aged 60–73 years, which provides insights between glycemic control and the susceptibility to age-related neurodegenerative diseases.
The added value of color parameter imaging for the evaluation of focal liver lesions with “homogenous hyperenhancement and no wash out” on contrast enhanced ultrasound
Authors: Liang Zi-Nan , Wang Song , Yang Wei , Wang Hong , Zhao Kun , Bai Xiu-Mei , Zhang Zhong-Yi , Wu Wei , Yan Kun 
Published: January 2024

ObjectiveThe purpose of this study was to investigate the added value of color parameter imaging (CPI) in the differential diagnosis of focal liver lesions (FLLs) with “homogeneous hyperenhancement but not wash out” on contrast-enhanced ultrasound (CEUS).MethodsA total of 101 patients with 108 FLLs were enrolled in this study. All the FLLs received US and CEUS examinations. The stored CEUS clips of target lesions were postprocessed with CPI analysis by radiologists. The receiver operator characteristic (ROC) curve was used to evaluate the added value of CPI. The McNamara test was used to compare the diagnostic sensitivity, specificity, and accuracy between CEUS and CPI patterns. Univariate and multivariate logistic regression analyses were used to develop a CPI nomogram. The C index and calibration curve were used to evaluate the predictive ability of the nomogram. The intraclass correlation coefficient was used to test the reproducibility and reliability of CPI. Decision curve analysis (DCA) was used to evaluate the added value of applying CPI.ResultsThe following CPI features were more frequently observed in malignant FLLs: eccentric perfusion (malignant: 70.0% vs. benign: 29.2%, p &lt; 0.001), feeding artery (51.7% vs. 4.2%, p &lt; 0.001), mosaic (63.3% vs. 6.3%, p &lt; 0.001), red ingredients &gt;1/3 (90.0% vs. 14.6%, p &lt; 0.001). In addition, centripetal (43.8% vs. 18.3%, p = 0.004), peripheral nodular (54.2% vs. 1.7%, p &lt; 0.001), subcapsular vessel (12.5% vs. 0.0%, p = 0.004), spoke-wheel vessels (25.0% vs. 5.0%, p = 0.003), branched vessels (22.9% vs. 5.0%, p = 0.006), blue and pink ingredients &gt;2/3 (85.4% vs. 10.0%, p &lt; 0.001) were more observed in benign FLLs. A nomogram incorporating peripheral nodular, spoke-wheel vessels, and red ingredients &gt;1/3 was constructed. The model had satisfactory discrimination (AUC = 0.937), and the optimal diagnostic threshold value was 0.740 (0.983, 0.850). By the DCA, the model offered a net benefit over the treat-all-patients scheme or the treat-none scheme at a threshold probability 5%–93%.ConclusionUsing CPI can detect and render subtle information of the main features of FLLs on CEUS; it is conducive to the radiologist for imaging interpretation, and a combining read of the CEUS and CPI of the FLLs with features of “homogenous hyperenhancement and no washout” can improve significantly the diagnostic performance of CEUS for FLLs.
Deep-learning models for image-based gynecological cancer diagnosis: a systematic review and meta- analysis
Authors: Taddese Asefa Adimasu , Tilahun Binyam Chakilu , Awoke Tadesse , Atnafu Asmamaw , Mamuye Adane , Mengiste Shegaw Anagaw 
Published: January 2024

IntroductionGynecological cancers pose a significant threat to women worldwide, especially those in resource-limited settings. Human analysis of images remains the primary method of diagnosis, but it can be inconsistent and inaccurate. Deep learning (DL) can potentially enhance image-based diagnosis by providing objective and accurate results. This systematic review and meta-analysis aimed to summarize the recent advances of deep learning (DL) techniques for gynecological cancer diagnosis using various images and explore their future implications.MethodsThe study followed the PRISMA-2 guidelines, and the protocol was registered in PROSPERO. Five databases were searched for articles published from January 2018 to December 2022. Articles that focused on five types of gynecological cancer and used DL for diagnosis were selected. Two reviewers assessed the articles for eligibility and quality using the QUADAS-2 tool. Data was extracted from each study, and the performance of DL techniques for gynecological cancer classification was estimated by pooling and transforming sensitivity and specificity values using a random-effects model.ResultsThe review included 48 studies, and the meta-analysis included 24 studies. The studies used different images and models to diagnose different gynecological cancers. The most popular models were ResNet, VGGNet, and UNet. DL algorithms showed more sensitivity but less specificity compared to machine learning (ML) methods. The AUC of the summary receiver operating characteristic plot was higher for DL algorithms than for ML methods. Of the 48 studies included, 41 were at low risk of bias.ConclusionThis review highlights the potential of DL in improving the screening and diagnosis of gynecological cancer, particularly in resource-limited settings. However, the high heterogeneity and quality of the studies could affect the validity of the results. Further research is necessary to validate the findings of this study and to explore the potential of DL in improving gynecological cancer diagnosis.
Cost-effectiveness analysis of serplulimab combination therapy versus chemotherapy alone for patients with extensive-stage small cell lung cancer
Authors: Zheng Zhiwei , Chen Hongcai , Cai Hongfu 
Published: January 2024

BackgroundSerplulimab has shown promising results in the treatment of extensive-stage small cell lung cancer (ES-SCLC). This study aimed to evaluate the cost-effectiveness of serplulimab combination therapy compared to chemotherapy alone in patients with ES-SCLC from the Chinese healthcare system perspective.MethodsA partitioned survival model was developed to simulate the costs and outcomes of patients receiving serplulimab combination therapy or chemotherapy alone over a time horizon of 10 years. Data on overall survival, progression-free survival, and adverse events were obtained from the ASTRUM-005 randomized clinical trial. Costs were estimated from a healthcare system perspective and included drug acquisition, administration, monitoring, and management of adverse events. One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty on the results.ResultsThe base-case analysis showed that the combination of serplulimab and chemotherapy has demonstrated a significant increase in QALYs of 0.626 compared to chemotherapy alone. This improved outcome is accompanied by an additional cost of $10893.995. The ICER for incorporating serplulimab into the treatment regimen is $17402.548 per QALY gained. One-way sensitivity analysis confirmed the robustness of the findings. Probabilistic sensitivity analysis demonstrated that serplulimab combination therapy had a 97.40% high probability of being cost-effective compared to chemotherapy alone at the WTP thresholds.ConclusionIn contrast to chemotherapy as a standalone treatment, the addition of serplulimab to chemotherapy is believed to offer potential cost-effectiveness as a preferred initial therapeutic approach for patients with ES-SCLC in China.