bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incorporation of kiwifruit peel improved the property of carboxymethyl cellulose-gum Arabic active film and its effects on the quality of beef sausages
Authors: Boateng Evans Frimpong , Yang Ziyi , Zhang Jian , Zhou Lei , Xing Lujuan , Zhang Wangang 
Published: February 2025

Abstract
In the present study, different doses of lyophilized kiwifruit peel powder extract (KPE) were incorporated into carboxymethyl cellulose (CMC) and gum Arabic (GA) based polymer matrices to fabricate films CG-CT (control film), CG-KPE1 (1% KPE), CG-KPE2 (2% KPE), and CG-KPE3 (3% KPE) to investigate their effects on active packaging functionality and sliced-beef sausage quality. Consequently, CG-KPE films demonstrated a superior antimicrobial effect on Gram-positive (Staphylococcus aureus and Bacillus cereus) and Gram-negative (Escherichia coli) bacteria and antioxidant efficacy compared to CG-CT films. The scanning electronic microscopy (SEM) of CG-KPE films revealed an enhanced micrograph. Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) evidenced the intramolecular interaction between KPE and CG and the improved thermal stability of film matrix. Film X-ray diffraction (XRD) peaks revealed a good crystallinity. CG-KPE films exhibited better physical and mechanical properties, increased opacity, and better ultraviolet (UV) emission barrier due to KPE addition and pigmentation compared to CG-CT films. The quick biodegradability of CG-KPE film suggested potential for KPE as a biopolymer. Subsequently, sliced-beef sausages were packaged with CG-CT, CG-KPE1, CG-KPE2, and CG-KPE3 (respective to CT, TI, T2, and T3) and stored for 12 d (4 ± 1 °C). The product’s pH and moisture content were controlled due to KPE addition in CG-KPE films. The products revealed that during storage CG-KPE treatments had a positive impact on the textural property, the color stability, and the sensory quality compared to CG-CT treatments. CG-KPE treatments showed antimicrobial effectiveness and lesser TBARS values than CG-CT treatments during storage.

Graphical Abstract
Effect of atrial high-rate episodes (AHREs) on functional status and quality of life (QoL) in heart failure—cardiac resynchronization therapy population
Authors: Allam Lamyaa Elsayed , Moneim Youssef Abdel , Eldamanhoury Hayam Mohammad , Eltoukhy Sherif Mohammad Aziz 
Published: February 2025

Abstract

Background
New type of arrhythmia called atrial high-rate episodes (AHREs) has been discovered thanks to the ability of cardiac electronic implantable devices to track, record, and analyze complex arrhythmias. The aim is to determine factors associated with AHRE in HFrEF/CRT patients and the effect of AHRE on functional capacity and quality of life (QoL).

Results
We interrogated 100 patients' devices to gauge the incidence and burden of AHRE, then assessed their functional capacity using the standard 6-min walk test (6MWT), and evaluated their QoL using the Minnesota Living with HF questionnaire (MLHFQ) score. 34% of patients had AHRE, and 91.2% of them had AF. By multivariate logistic regression analysis, smoking (OR 9.426, 95% CI [1.33, 66.65], P 0.025), higher BMI (OR 1.336, 95% CI [1.09, 1.635], P 0.005), and increased LAVI (OR 1.16, 95% CI [1.063, 1.262], P < 0.001) are independent predictors for AHRE. There was a significant correlation between AHRE and the distance walked during 6MWT when compared to the distance expected for an equivalent healthy individual (82.02 ± 17.22% in the non-AHRE group vs. 75.15 ± 15.78% in the AHRE group, P < 0.001). It was found that AHRE was statistically linked to a higher total MLHFQ score (46.76 ± 9.82 in the AHRE group vs. 36.97 ± 7.76 in the non-AHRE group, P 0.032), with higher physical scores in the AHRE group.

Conclusion
AHRE significantly reduces functional status and perceived quality of life in HFrEF patients receiving CRT. Longer than five minutes of AHRE was associated with a higher MLHFQ score and worse performance on the 6MWT. In that patient population, smoking, obesity, and elevated LAVI were independent predictors of AHRE.
Comparative efficacy of clopidogrel-aspirin combination therapy versus aspirin monotherapy in preventing recurrent events in transient ischemic attack and minor stroke: a systematic review and meta-analysis
Authors: Bhutto Ahmad Mujtaba , Raza Rana Ali , Abbasi Mohammad Bilal , Jauhar Iman , Arbani Naeemullah , Mubashir Muhammad , Raheem Abdul , Ameen Taha Basit , Ali Syed Muhammad Sinaan 
Published: February 2025

Abstract

Background and objective
Stroke is a leading cause of disability and death globally. Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a common intervention for acute ischemic stroke (AIS) and transient ischemic attack (TIA). This meta-analysis aims to evaluate the efficacy and safety of DAPT compared to aspirin monotherapy in preventing recurrent stroke.

Methods
We performed a systematic search of electronic databases including PubMed, MEDLINE, Embase, and Scopus up to April 1, 2024. Eligible studies involved adult patients with acute stroke or TIA receiving either DAPT with clopidogrel and aspirin or aspirin monotherapy, with follow-up durations between 30 and 90 days. Data were extracted on recurrent stroke, hemorrhagic stroke, myocardial infarction, all-cause mortality, and functional outcomes measured by the modified Rankin Scale (mRS). Statistical analyses were conducted using relative risk (RR) and odds ratio (OR) with 95% confidence intervals, and heterogeneity was evaluated using I
2 statistics.

Results
From 2344 articles screened, 33 studies involving 15,376 participants were included. DAPT significantly reduced the risk of recurrent stroke (RR 0.85, 95% CI 0.75–0.97, I
2 = 42%, p = 0.02). However, DAPT was associated with an increased, but not statistically significant, risk of hemorrhagic stroke (RR 1.27, 95% CI 0.55–2.90, I
2 = 51%, p = 0.23). There were no significant differences in the risk of myocardial infarction or all-cause mortality between the two groups. Functional outcomes indicated that DAPT reduced the risk of disability (OR 0.80, 95% CI 0.70–0.92, I
2 = 35%, p = 0.004).

Conclusion
DAPT with clopidogrel and aspirin is more effective than aspirin monotherapy in reducing recurrent strokes but may increase the risk of hemorrhagic stroke. Individualized patient assessment is crucial to balance the benefits and risks of DAPT. Further high-quality, long-term studies are needed to confirm these findings and inform clinical practice.
Shift in the profile and prognostic implications in invasive fungal rhinosinusitis: experience of 10 years in a tertiary center
Authors: Mellidez-Acosta Raúl , Torres-García Lidia , Saro-Buendía Miguel , Jaramillo-Ángel Natalia , Cabrera-Guijo Javier , Bancalari-Díaz Catalina , Muñoz-Fernández Noelia , Fito-Martorell Lucas , Armengot-Carceller Miguel , García-Piñero Alfonso 
Published: February 2025

Abstract

Background
Despite appropriate treatment, mortality of acute invasive fungal rhinosinusitis remains exceedingly high, surpassing 50%. Evidence on how to optimize its management is still limited. We present a case series from our institution aiming to fill the knowledge gap.

Methods
A retrospective descriptive study was conducted, selecting cases treated at our institution between January 2012 and January 2022. The following variables were analyzed: gender, age, underlying conditions, symptoms, histological study outcomes, microbiological study outcomes, administered antifungal treatment, surgical interventions, and survival following diagnosis.

Results
Seventeen patients were included in our study. The mean age was 55 years, with 12 males and 5 females. The most frequents underlying conditions were hematological malignancies (76.5%) and solid organ transplantation (11.8%). Surgical interventions were performed on 15 patients (88%), with 6 patients (35.3%) requiring a second intervention and 2 patients (11.8%) undergoing at least 3 interventions.3% patients succumbed to causes directly related to rhinosinusitis, with an average survival of 22 days, and 52.9% patients subsequently passed away due to complications related to their underlying condition, with an average survival of 171 days. Mid-term overall mortality was 88.2%, with an average survival of 111 days.

Conclusion
A shift in the patient profile was observed. Less fulminant courses have been evidenced, being oncohematotological disease and solid organ transplantation the main predisposing conditions, instead of poorly controlled diabetes. Even if direct mortality rates from AIFR are reduced (around 35%), the overall mortality rate of these patients is close to 90% with a median survival of less than 6 months. Then, an intense focus on the underlying disease and related complications is essential.
Effect of endoscopic sinus surgery on eustachian tube function in adult patients with chronic rhinosinusitis
Authors: Youssef Mahmoud Atef Abdelghaffar , Nassim Nassim Talaat , Alkeeb MohamedNourEddin Bashir , Algarf Tareq Muhammad 
Published: February 2025

Abstract

Background
Chronic rhinosinusitis (CRS) is a frequent chronic heterogeneous inflammatory disease of the upper airways and paranasal sinuses persistent for ≥ 12 weeks causing considerable healthcare expenses and reduction of patients’ quality of life due to severe tiredness and disappointment as well as diminished cognitive function. CRS is commonly associated with eustachian tube (ET) dysfunction.

Aim of the study
To evaluate the effect of endoscopic sinus surgery on ET function in the form of (tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score), in adult patients with CRS.

Method
This non-randomized clinical trial study was conducted at the Otorhinolaryngology department, the Faculty of Medicine, Cairo University, on 40 patients > 18 years old, suffering from CRS with or without sinonasal polyposis who are indicated for endoscopic sinus surgery (ESS) and were recruited from Otorhinolaryngology department’s outpatient clinic in the period from November 2022 to June 2023. All selected patients were subjected to a full history taken, a full general examination, and a local otorhinolaryngology examination. Routine preoperative laboratory investigation including complete blood count (CBC), liver and kidney function tests, and coagulation profile. An electrocardiogram (ECG) examination was done routinely for all patients above 40 years old. Radiological examination included the following: preoperative CT nose and paranasal sinus, axial and coronal soft tissue cuts, and bone windows. Assessment of ET function was done using the ET dysfunction questionnaire (ETDQ-7), Valsalva maneuver, and tympanogram. ET function was reevaluated 6 weeks post-operative in the form of an ETDQ-7, Valsalva maneuver, and tympanogram.

Results
The ages of selected patients ranged from 21 to 45 years old with mean ± SD = 30.98 ± 10.24 years old. 52.5% of patients were males. Our results showed a statistically significant postoperative improvement in the Valsalva maneuver and the tympanogram type of both ears compared to preoperative with a p-value < 0.001. Similar results were found regarding the assessment of ET function using ETDQ-7 items and the total score (15.35 ± 4.92 vs 26.12 ± 7.79 respectively) with p-value < 0.001.

Conclusion
A significant improvement in ET function in the form of tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score, following endoscopic sinus surgery in adult patients with CRS with or without sinonasal polyposis.
5-Aminolevulinic acid activates the MdWRKY71-MdMADS1 module to enhance anthocyanin biosynthesis in apple
Authors: Zhang Liuzi , Tao Huihui , Zhang Jianting , An Yuyan , Wang Liangju 
Published: February 2025

Abstract
5-Aminolevulinic acid (ALA), as a natural plant growth regulator, is well known for promoting red fruit coloring by enhancing anthocyanin accumulation. However, the underlying mechanisms remain elusive. In this study, we firstly demonstrated that ALA upregulates gene expression of the transcription factor MdMADS1, which in turn directly binds to and activates transcription of the key anthocyanin biosynthetic genes, MdCHS and MdUFGT. Then, we identified a novel WRKY transcription factor, MdWRKY71, that interacts with MdMADS1. Through gene manipulation, we revealed that MdWRKY71 plays a pivotal role in ALA-induced anthocyanin accumulation, highlighting its regulatory significance in this process. Further investigation unveiled that MdWRKY71 not only activates MdMADS1 transcription but also enhances its transcriptional activation on its target genes, MdCHS and MdUFGT. Additionally, we discovered that MdWRKY71 independently binds to and activates the transcription of two other anthocyanin biosynthetic genes, MdANS and MdDFR. The protein–protein interaction between MdWRKY71 and MdMADS1 amplifies the transcriptional activation of these genes by MdWRKY71. These findings delineate a fine and complex regulatory framework where MdWRKY71 and MdMADS1 coordinately regulate anthocyanin biosynthesis in apples, providing new insights into the molecular control of fruit coloration and offering potential target genes for breeding aimed at enhancing fruit quality.
Multidisciplinary surgical strategy for an invasive thymoma in an immunocompromised patient: a case of a successful resection and postoperative troubleshooting
Authors: Oki Tomonari , Iizuka Shuhei , Nakamura Toru 
Published: February 2025

Abstract

Background
Robot-assisted thoracoscopic surgery has become prevalent as a feasible approach for anterior mediastinal tumor resections, while conventional open surgery, such as a median sternotomy, remains preferred for a combined resection of adjacent organs. However, an additional thoracotomy may be necessary when tumors extend into one hemithorax. This complex approach can cause significant damage to the osseous thoracic cage, increasing the risk of surgical morbidity especially in immunocompromised patients.

Case presentation
A 77-year-old man presented with an anterior mediastinal thymoma measuring 71 mm, detected during an annual health check with suspected involvement of the left brachiocephalic vein and upper lobe of the left lung. The patient had a medical history of recurrent surgical site infections and fasciitis panniculitis syndrome requiring immunosuppressive therapy. To minimize any thoracic cage destruction, a multidisciplinary approach combining robotic surgery with open surgery according to vascular or pulmonary invasion was planned. The patient, initially placed in the supine position with the robot docked over the right side, underwent a thymic dissection, revealing a firm adhesion to the left brachiocephalic vein. The robot was then undocked, and a transmanubrial osteomuscular sparing approach was initiated, enabling a tumor dissection under the proximal and distal control of the left brachiocephalic vein. As invasion into the proximal upper pulmonary vein and extensive dorsal adhesions were observed, the patient was repositioned to the right lateral decubitus position, and a thoracoscopic left upper segmentectomy with adhesiolysis was performed, achieving an R0 resection. The patient was extubated on day 1 but required non-invasive ventilation until day 5. Mediastinitis, likely due to a sternal wire infection, developed on day 9, necessitating debridement, sternal wire removal, and negative pressure wound therapy. After 17 days of treatment, the infection subsided, allowing for a sequestrectomy and chest wall reconstruction with a pedicled pectoralis major myocutaneous flap. By avoiding a total sternotomy, the extent of the mediastinitis was localized, allowing for a limited sequestrectomy. Wound healing was satisfactory, with no recurrent infection at 12 months and minimal functional impairment.

Conclusions
A multidisciplinary approach offers a feasible option for managing an invasive thymoma to minimize postoperative morbidity, particularly in immunocompromised patients. Preoperative surgical planning is essential for guiding intraoperative decision-making and ensuring optimal outcomes.
Casual associations between frailty and nine mental disorders: bidirectional Mendelian randomisation study
Authors: Zhou Yong , Duan Jiayue , Zhu Jiayi , Huang Yunying , Tu Tao , Wu Keke , Lin Qiuzhen , Ma Yingxu , Liu Qiming 
Published: February 2025

Background
An increasing number of observational studies have reported associations between frailty and mental disorders, but the causality remains ambiguous.

Aims
To assess the bidirectional causal relationship between frailty and nine mental disorders.

Method
We conducted a bidirectional two-sample Mendelian randomisation on genome-wide association study summary data, to investigate causality between frailty and nine mental disorders. Causal effects were primarily estimated using inverse variance weighted method. Several secondary analyses were applied to verify the results. Cochran's Q-test and Mendelian randomisation Egger intercept were applied to evaluate heterogeneity and pleiotropy.

Results
Genetically determined frailty was significantly associated with increased risk of major depressive disorder (MDD) (odds ratio 1.86, 95% CI 1.36–2.53, P = 8.1 × 10−5), anxiety (odds ratio 2.76, 95% CI 1.56–4.90, P = 5.0 × 10−4), post-traumatic stress disorder (PTSD) (odds ratio 2.56, 95% CI 1.69–3.87, P = 9.9 × 10−6), neuroticism (β = 0.25, 95% CI 0.11–0.38, P = 3.3 × 10−4) and insomnia (β = 0.50, 95% CI 0.25–0.75, P = 1.1 × 10−4). Conversely, genetic liability to MDD, neuroticism, insomnia and suicide attempt significantly increased risk of frailty (MDD: β = 0.071, 95% CI 0.033–0.110, P = 2.8 × 10−4; neuroticism: β = 0.269, 95% CI 0.173–0.365, P = 3.4 × 10−8; insomnia: β = 0.160, 95% CI 0.141–0.179, P = 3.2 × 10−61; suicide attempt: β = 0.056, 95% CI 0.029–0.084, P = 3.4 × 10−5). There was a suggestive detrimental association of frailty on suicide attempt and an inverse relationship of subjective well-being on frailty.

Conclusions
Our findings show bidirectional causal associations between frailty and MDD, insomnia and neuroticism. Additionally, higher frailty levels are associated with anxiety and PTSD, and suicide attempts are correlated with increased frailty. Understanding these associations is crucial for the effective management of frailty and improvement of mental disorders.
Epilepsy Genetics
Authors: Kessler Sudha Kilaru 
Published: February 2025

ABSTRACT

OBJECTIVE
This article reviews essential concepts and terminology in epilepsy genetics, discusses current guidance on when and how to pursue genetic evaluation, provides an overview of genetic syndromes, and offers illustrative examples of the effect of genetic diagnosis in epilepsy patient care.

LATEST DEVELOPMENTS
The growing availability of next-generation genetic sequencing methods for clinical use provides an opportunity to make etiologic diagnoses in a larger number of epilepsy patients, which can affect therapeutic management, prognostic counseling, surveillance for comorbid conditions, and other aspects of epilepsy care. Exome and genome sequencing may have high diagnostic yields in patients with unexplained epilepsy. The body of knowledge in epilepsy genetics is growing more complex, not only because of gene discovery but also because of an increasingly nuanced understanding of the varying pathophysiologic effects of specific types of variation within epilepsy genes.

ESSENTIAL POINTS
Genetic testing plays a key role in the evaluation of epilepsy patients. Clinicians caring for patients with epilepsy should understand patient selection, test selection, and result interpretation in genetic testing. The recommended first-line test in most patients is exome or genome sequencing.
EEG in Epilepsy
Authors: Weber Daniel 
Published: February 2025

ABSTRACT

OBJECTIVE
The purpose of this article is to review the fundamentals and limitations of EEG, guide the selection of EEG type to answer clinical questions, and provide instruction on the interpretation of results within the patient's clinical context.

LATEST DEVELOPMENTS
EEG is the single most useful ancillary test to support the clinical diagnosis of epilepsy, but if used incorrectly it can cause great harm. Misapplication of EEG findings can lead to misdiagnosis and long-term mental and physical health sequelae. Although all neurologists may not have sufficient training for independent EEG interpretation, most should be able to review and apply the findings from the report accurately to guide patient care. Longer-term EEGs with similar recording electrodes tend to have higher diagnostic yields. Common EEG findings are described in this article, along with diagnostic limitations of some classically described patterns. There is an updated definition for an epileptiform discharge, along with a consensus on EEG patterns in the critically ill.

ESSENTIAL POINTS
EEG continues to be the most useful ancillary test to assist in the diagnosis of epilepsy. Its application requires proper understanding of its limitations and variability of testing results.
Neuroimaging in Epilepsy
Authors: Skidmore Christopher T. 
Published: February 2025

ABSTRACT

OBJECTIVE
The goal of this article is to review the use of neuroimaging in the treatment of new-onset seizures and epilepsy. The article will focus predominantly on MRI because this is the most common modality, but it will also review others that are often used in individuals being considered for epilepsy surgery. The article also reviews common causes of epilepsy and their appearance on imaging and various imaging tools that can be combined to assist in the care of people with epilepsy.

LATEST DEVELOPMENTS
MRI has revolutionized the ability to diagnose the cause of many forms of epilepsy. However, to maximize the diagnostic power of MRI, it is essential to order the correct imaging sequences. In this article, the harmonized neuroimaging of epilepsy structural sequences (HARNESS) MRI protocol proposed by the International League Against Epilepsy is discussed.

ESSENTIAL POINTS
MRI is the preferred imaging modality to identify lesions associated with epilepsy. Protocols should include thin-cut, no-gap sequences to permit the identification of small epileptogenic lesions, and studies should be reviewed with an understanding of all the clinical information to help guide the identification of potential lesions.
Implementing Guidelines and Measures in Epilepsy Care
Authors: Baca Christine M. 
Published: February 2025

ABSTRACT
People with epilepsy must receive up-to-date, high-quality care that aligns with current understanding of basic disease mechanisms, improved diagnostic testing, and evolving medical and surgical treatments. Varying progress has been made in identifying, measuring, and mitigating epilepsy care gaps. Epilepsy guidelines and quality measures should be developed using rigorous processes informed by systematic reviews of best evidence in conjunction with prioritization of need. Epilepsy measures help operationalize guidelines and practice parameters. Most epilepsy quality indicators are process-based metrics defined by delivering care to the patient. Systematic and reliable tracking and documentation of seizure frequency using consistent language is required as a patient-reported outcome within individuals over time and across populations. Emerging literature has demonstrated gaps in epilepsy care, perhaps highlighting limitations in the dissemination and implementation of guidelines and quality measures in clinical practice. Quality improvement methods applied to clinical data registries and learning health systems may afford new opportunities to iteratively, collaboratively, and feasibly disseminate guidelines and quality measures, measure epilepsy care quality, allow for the testing of interventions to mitigate identified care gaps, and, ultimately, improve care for patients with epilepsy.