bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the association of clinical cardiovascular parameters and metabolic indices with levels of cystatin C in early middle age
Authors: Ashour Laith , Jarrar Zeid , Alzoubi Ghada , Hamdan Samar , Heramas Rima , Alakhdar Dima , Abu Jeries Julie , Mishleb Areen , Marar Maher , Ayesh Layan , Abu Sirhan Lina A. 
Published: February 2025

Background:
The pathophysiology of renal dysfunction requires population-based study. It is debatable in the literature whether cardiovascular metrics have an impact on cystatin C levels.

Methods:
using public-use biomarkers data of The National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave 5 data, we tested, after adjusting for age (range: 32–42), anthropometrics (Body Mass Index (BMI), waist circumference, and arm circumference), HbA1C, Low-Density Lipoprotein (LDL), triglyceride, smoking, and sex, the association of five clinical cardiovascular measures (systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, and pulse rate) with cystatin C levels. Multiple linear regression analysis with a design-based approach was employed for data analysis after log-transformation of cystatin C levels.

Results:
Our findings showed that there was no significant association between cystatin C levels and any of the previously mentioned cardiovascular parameters in this age group (P > 0.05). However, there was a significant association between cystatin C levels and age (Exponentiated estimate (EE) (percent increase per unit) =1.21; 95% CI=[0.97, 1.103], P < 0.0001), BMI and waist circumference (EE= 0.702; 95% CI=[0.7, 0.705], P < 0.0001), triglycerides level (EE=0.02; 95% CI=[0.0199, 0.0201], P = 0.01), smoking status (EE (compared to nonsmokers)=8.98, 95% CI=[8.95, 9.01], P < 0.0001), and female sex (EE (compared to males)= -5.92; 95% CI=[-5.94, -5.89], P < 0.0001).

Conclusions:
Our findings clarify the impact of confounding factors, particularly age, on cystatin C levels. They also demonstrate how the significant correlation between cardiovascular parameters and cystatin C levels that seen in earlier studies is largely affected by the age. Anthropometrics, age, lipid indices, and smoking should all be considered in clinical practice as possible reasons for increased cystatin C levels in otherwise healthy middle-aged individuals.
Transcriptional Profiling of Patients With Fuchs Endothelial Corneal Dystrophy With and Without Trinucleotide Repeat Expansion in TCF4
Authors: Nakagawa Tatsuya , Tokuda Yuichi , Nakano Masakazu , Tateishi Ayana , Yasunaga Mari , Tourtas Theofilos , Schlötzer-Schrehardt Ursula , Kruse Friedrich , Tashiro Kei , Koizumi Noriko , Okumura Naoki 
Published: February 2025

Purpose:
To investigate transcriptomic differences between patients with Fuchs endothelial corneal dystrophy (FECD) with and without trinucleotide repeat (TNR) expansion in the transcription factor 4 gene, as the genetic basis for patients with FECD lacking TNR expansion remains unclear.

Methods:
Bulk RNA sequencing was performed on corneal endothelial cells from 17 subjects: 10 patients with FECD [4 with repeat expansion lengths <50 (RE−) and 6 with expansions of 50 or more (RE+)] and 7 controls. Differential gene expression analysis was conducted using DESeq2. Principal component analysis (PCA), correlation matrix analysis, and heatmap visualization were used to evaluate gene expression patterns. Gene Ontology enrichment analysis was performed on differentially expressed genes (DEGs).

Results:
Analysis identified 509 DEGs (281 upregulated, 228 downregulated) between RE− and controls, and 640 DEGs (292 upregulated, 348 downregulated) between RE+ and controls. PCA revealed distinct gene expression patterns in both RE− and RE+ groups compared with controls. Between RE− and RE+ groups, only 10 DEGs were identified: ALDH3A1, ENSG00000286252, RNU6-645P, SNORD113-7, RNU6-429P, SNORA16A, COCH, EGFL6, SEMA3E, and ENSG00000228463. PCA, correlation matrix analysis, and heatmap visualization demonstrated high similarity in overall gene expression patterns between RE− and RE+ groups.

Conclusions:
Contrary to expectations, gene expression profiles showed remarkable similarity between patients with FECD with and without TNR expansion. Further investigation of the identified DEGs may provide insights into the role of TNR expansion in FECD pathophysiology.
Laparoscopic simulation training improves operating room performance of surgical residents: a multicenter randomized trial (NOVICE)
Authors: Thomaschewski Michael , Vonthein Reinhard , Keck Tobias , Laubert Tilman , Benecke Claudia 
Published: February 2025

Background:
Learning basic laparoscopic skills can be efficiently performed ex vivo in a safe environment using simulation devices. However, in many countries, the broad and mandatory implementation of ex vivo laparoscopic simulation training in surgical residency is still lacking. The aim of the study was to evaluate the efficacy of laparoscopic basic skills simulation training on the surgical performance of residents during their first laparoscopic procedures in the operating room.

Methods:
This was a multicenter, prospective, randomized, two-arm, single-blind trial. The study recruited first-year surgical residents (NOVICE) with no previous personal experience in laparoscopic surgery. After the participants had performed their first laparoscopic cholecystectomy, they were randomized into two groups: the intervention group underwent six weeks of standardized laparoscopic basic skills simulation training (Lübeck Toolbox Curriculum), whereas the control group did not. After six weeks, both groups performed a second cholecystectomy. The videotapes of the first and second cholecystectomies were evaluated blinded based on the Global Operative Assessment of Laparoscopic Skill (GOALS) score. The primary endpoint was the changes in the GOALS scores between the first and second cholecystectomies.

Results:
22 surgical residents from 11 surgical clinics in Germany were included, and 4 residents dropped out. The median improvement in the LTB-Curriculum group between CHE I and CHE II was 8.5 GOALS score points in contrast to 2 points in the control group. This difference was statistically significant (95%CI: 1–15 points, P = 0.013).

Conclusion:
Ex-vivo training in basic laparoscopic skills significantly improved the surgical performance of residents during their first laparoscopic cholecystectomies in the operating room.
Augmented reality guided versus computed tomography guided percutaneous lung nodule localization: a noninferiority randomized clinical trial
Authors: Song Zuodong , Li Yin , Tian Qing , Sun Chao , Liu Hongfeng , Chong Kongyong , Zhang Qian , Chen Jianeng , Li Pengchong , Song Liwei , Tosi Davide , Kim Min P. , Zhebing Lin , Luo Qingquan , Yu Lingming , Cheng Xinghua 
Published: February 2025

Hypothesis:
This study hypothesized that augmented reality (AR) technology has comparable accuracy and safety to conventional CT localization in guiding percutaneous transthoracic lung puncture (PTLP) to localize small pulmonary nodules.

Methods:
This study was a prospective, non-inferiority randomized clinical trial. Patients were randomly assigned between 23 May 2023, and 26 September 2023. Patients with small peripheral lung nodules (≤2 cm) were recruited.

Patients were randomly assigned to either the CT-guided PTLP group or the AR-guided PTLP group, with a 1:1 allocation ratio. The primary outcome was the accuracy of lung nodule localization measured by localization error. The secondary outcomes included procedure duration, radiation exposure dosage and complications.

Results:
A total of 70 patients underwent either CT- or AR-guided lung nodule localization and subsequent surgeries. Localization error was smaller in the AR-guided group than in the CT-guided group (mean ± SD, 3.1 ± 4.0 mm vs. 5.4 ± 4.2 mm, P = 0.026). The mean difference of localization errors was −2.3 mm (95% CI: − 4.2 to −0.3 mm, P < 0.001 for non-inferiority). Compared to the CT-guided group, the AR-guided group demonstrated significantly lower radiation exposure (mean ± SD, 421 ± 168 vs. 694 ± 229 mGy × cm, P < 0.001) and shorter localization procedure duration (mean ± SD, 8.8 ± 2.3 vs. 14.1 ± 1.8 minutes, P < 0.001), with no statistical difference in complications.

Conclusions:
The accuracy of the AR-guided approach is comparable to that of the CT-guided approach in localizing small lung nodules. Furthermore, the utilization of AR technology has been demonstrated to reduce procedural time and minimize radiation exposure for patients.
Real-world Effectiveness of Dupilumab in Eosinophilic Esophagitis
Authors: Garg Archit , Moond Vishali , Velpari Sugirdhana , Broder Arkady , Mohan Babu P. 
Published: February 2025

Background:
Dupilumab is the only FDA-approved medication for eosinophilic esophagitis (EoE). Clinical trials have shown its effectiveness in alleviating symptoms and decreasing inflammation associated with EoE. However, real-world data on its efficacy is still limited.

Methods:
We searched multiple databases for articles reporting the outcomes of dupilumab for the treatment of EoE and conducted a meta-analysis.

Results:
Five retrospective studies including 209 subjects (mean age: 22.12±12.01 y and 61.24% males) were analyzed. The pooled outcome for symptom improvement with dupilumab was 89.2% [95% Cl: 68.0%-97.0%; I
2=58%]. Peak eosinophil count improved markedly postdupilumab [pre: 47.13 (95% Cl: 45.5-48.67; I
2=98%) vs. post: 6.44 (95% Cl: 0.72-13.60; I
2=98%) eos/hpf, P<0.001]. There was a significant reduction in Endoscopic Reference Score (EREFS) [pre: 4.10 (95% Cl: 1.74-6.43; I
2=95%) vs. post: 0.77 (95% Cl: 0.14-1.7; I
2=95%), P<0.001]. The mean duration of treatment and follow-up was 5.66±1.14 months. The most common adverse event reported was a pain due to injection, which was controlled with local anesthetics.

Conclusion:
Our study shows that in a real-world scenario, administration of dupilumab for EoE induces histologic and endoscopic remission and symptomatic improvement. Hence, dupilumab can be considered a treatment option for EoE, especially in resistant cases. Future studies should evaluate its long-term effectiveness for preventing esophageal fibrosis/stricture and long-term side effect profile. Furthermore, cost-effectiveness analysis is warranted to help establish its role as a potential first-line treatment strategy.
Lean Metabolic Dysfunction-Associated Steatotic Liver Disease
Authors: Desai Chaula , Lohani Sweta , Sharma Anuj R. , Schwartz Lucas , Gujjula Saigopal R. , Baskar Adhithya , Baskar Udhaya , Baskar Suriya , Vasikaran Anush 
Published: February 2025

Goals:
To compare outcomes of MASLD in obese and nonobese populations.

Background:
MASLD is emerging as one of the leading causes of liver failure and liver-related morbidity and mortality, with an increasing prevalence in the nonobese or lean population. The purpose of this study is to compare hepatic and oncological outcomes between MASLD patients with lean BMI and nonlean BMI.

Study:
The National Inpatient Sample (NIS) was queried from 2016 to 2020 for adult hospitalizations with MASLD. Exclusion criteria included concurrent diagnoses of viral hepatitis, alcoholic hepatitis, primary biliary cholangitis, hereditary hemochromatosis, autoimmune hepatitis, or Wilson disease. Outcomes of MASLD and its complications were compared between the lean and nonlean subgroups.

Results:
Patients with lean BMI had higher mortality rates (odds ratio: 2.10, P<0.001). The lean cohort also had higher odds of cirrhosis, portal hypertension, SBP, and ascites. The lean subgroup had higher odds of gastrointestinal malignancies including esophageal cancer, gastric cancer, pancreatic cancer, and colorectal cancer.

Conclusions:
Hospitalized lean MASLD patients had higher odds of mortality, ​​hepatic morbidities, and gastrointestinal malignancies. These results challenge the use of BMI as a predictor of morbidity and mortality for MASLD patients. Future studies should focus on therapeutic options for MASLD and compare their efficacies between lean and nonlean populations.
The Study of Anorectal Function Using High-resolution Anorectal Manometry in Patients With Fecal Impaction
Authors: Ciriza de los Ríos Constanza , Aparicio Cabezudo Marta , Zatarain Valles Ana , García Pravia Laura , Rey Díaz Rubio Enrique 
Published: February 2025

Aim:
This study aims to evaluate anorectal function through high-resolution anorectal manometry (HRAM) in patients with constipation and fecal impaction, considering the limited information available on this subject.

Materials and Methods:
HRAM conducted between January 2021 and November 2023 (785 procedures) were reviewed. Patients were identified as individuals who experienced at least one episode of hard stools in the last year that were unable to evacuate. They were compared with constipated patients without fecal impaction episodes (control group). HRAM was performed using solid-state equipment (Medtronic). Logistic regression analysis was done to identify demographic-clinical factors and manometric variables associated with fecal impaction.

Results:
Fecal incontinence was independently associated with fecal impaction [adjusted odds ratio (aOR): 20.4, 95% CI: 2.5-167.8] after adjusting for demographic and clinical variables. Severe rectal hyposensitivity (no perception of urgency from a volume of 200 mL) was present in 38.2% of patients with fecal impaction and 5.9% of controls (P=0.001). Defecatory dyssynergia was diagnosed in 29.4% of patients with fecal impaction. Lower squeeze pressure and severe rectal hyposensitivity were independently associated with fecal impaction with an aOR of 0.98 (95% CI: 0.98-0.99) and aOR of 10.4 (2-54.1), respectively, and after adjusting for all manometric parameters. Hypotonia and hypo-contractility of the anal canal were found in 53.8% and 46.2% of patients with fecal impaction and incontinence, respectively.

Conclusion:
Patients with fecal impaction often show rectal hyposensitivity and anal hypo-contractility, which are independent risk factors for impaction. Fecal incontinence is linked to fecal impaction, and their coexistence is associated with reduced anal canal pressures.
The clinical challenge of managing patients after sustained virological response with direct-acting antivirals for Hepatitis C
Authors: Pocurull Anna , Lens Sabela 
Published: February 2025

Purpose of review
This review highlights the critical considerations for monitoring patients who achieve sustained virological response (SVR) after direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection. Despite the remarkable success of DAAs, challenges persist in managing long-term risks, including hepatocellular carcinoma (HCC), liver decompensation, and extrahepatic manifestations, necessitating a tailored follow-up approach.

Recent findings
Recent studies emphasize that SVR does not eliminate risks for complications, particularly in patients with advanced fibrosis or cirrhosis. Advances in noninvasive tools, such as transient elastography and blood-based markers, have improved assessment of portal hypertension and liver function dynamics post-SVR. HCC surveillance remains critical for high-risk groups. Additionally, SVR improves extrahepatic conditions like mixed cryoglobulinemia and non-Hodgkin lymphoma, though careful monitoring for recurrence or associated risks is advised. Reinfection in high-risk populations underscores the importance of structured prevention and retreatment strategies.

Summary
Tailored follow-up of post-SVR patients remains essential. Future research should focus on refining predictive tools for late complications and optimizing surveillance strategies, balancing cost-effectiveness with clinical outcomes.
Panenteric capsule endoscopy in gastrointestinal bleeding – time to change old habits?
Authors: Segatta Francesco , Paggi Silvia , Radaelli Franco , Rondonotti Emanuele 
Published: February 2025

Purpose of review
Capsule endoscopy (CE) is an effective tool for small bowel evaluation. Recent technical advancements, including long-lasting batteries and enhanced optics, have enabled featured capsules (panenteric capsules, PCs) to potentially assess the entire gastrointestinal (GI) tract. The PC provides a potential easy-to-use, comprehensive, single-device approach for evaluating GI bleeding patients. This review critically examines the potential role of PC in patients with GI bleeding by highlighting benefits, limitations, open issues, and future challenges.

Recent findings
Evidence on PC for GI bleeding patients remains limited. Two retrospective studies and one recent prospective trial consistently show that when used in the workup of GI bleeding patients, PC is safe, feasible, achieves high diagnostic yield (both in the small and large bowel), and potentially reduces the need for unnecessary colonoscopies. Nevertheless, current challenges include the need for extensive bowel preparation, incomplete colon evaluation, and limited access to trained readers.

Summary
The PC holds promise for optimizing the diagnostic workup of GI bleeding patients. However, significant challenges remain. Robust clinical trials comparing standard diagnostic methods to PC-based workup are needed before the adoption of PC in managing bleeding patients in clinical practice.
Portal hypertension in pregnancy
Authors: Pint Dorien , Chung Yooyun , Heneghan Michael A. 
Published: February 2025

Purpose of review
This review highlights the management, maternal and fetal outcomes, and the critical role of prepregnancy counseling for women with portal hypertension (PHT), a topic of growing clinical relevance as pregnancies in women with PHT have increased over the last two decades.

Recent findings
Pregnancy exacerbates PHT due to physiological changes that increase blood flow and vascular resistance, raising the risk of life-threatening complications like variceal bleeding. The distinction between noncirrhotic (NCPH) and cirrhotic portal hypertension (CPH) is essential, as maternal risks vary significantly.

Summary
Optimal care for women with PHT requires preconception counseling to assess risks, adjust medications, and plan necessary investigations such as variceal and splenic artery aneurysm screening and, if necessary, plan additional interventions. A multidisciplinary team – including hepatologists, obstetricians, anesthetists, and radiologists – is crucial for personalized management, addressing both the mode of delivery and peripartum care. While PHT complicates pregnancy, favorable outcomes are achievable with proactive planning and close follow-up during pregnancy.
A metric-based image-formation model explains the improvement in subjective refraction using temporal defocus waves
Authors: Rodriguez-Lopez Victor , Dorronsoro Carlos , de Castro Alberto 
Published: February 2025

SIGNIFICANCE
Direct subjective refraction (DSR) is a novel method for refractive error measurements that uses temporal changes in defocus and a flicker minimization task. The computational models developed here are a framework for improving this clinical method.

PURPOSE
This study aimed to model the measurement of refractive error with the DSR method, which uses rapid changes in optical power and a bichromatic (red/blue) stimulus.

METHODS
The polychromatic point spread function of the eye was used to simulate the retinal image projected in DSR method, and an image quality (IQ) metric was defined based on the spatial frequencies of the retinal image. Three tasks were modeled: blur minimization (BM), monochromatic flicker minimization (MFM), and polychromatic flicker minimization or DSR. A metric was defined for each task and studied through focus in a ±3-D range. Whereas BM was modeled using only the IQ of the projected images, MFM and DSR metrics were a function of the IQ of the average retinal image and a metric to quantify the similarity (flicker) in the image. The width of the through-focus peak was used to compare between tasks, and different values of pupil size and spherical aberration were studied.

RESULTS
The through-focus 90% peak width was 0.48, 0.16, and 0.19 D for BM, MFM, and DSR tasks, respectively, which agreed well with previous experimental data. The 90% peak width increased for small pupils and with increasing values of spherical aberration in BM and MFM, but it remained relatively constant in DSR model.

CONCLUSIONS
The developed models explained previous experimental findings that reported a higher repeatability of the DSR compared with the traditional refraction method.
Knowledge, Awareness, Practices, and Perceptions of Risk and Responsibility Related to Extreme Heat:
Authors: Tetzlaff Emily J. , Meade Robert D. , O’Connor Fergus K. , Kenny Glen P. 
Published: February 2025

Objectives:
Knowledge and risk perception are driving factors for initiating appropriate health-protective actions during extreme heat events (EHEs). We sought to examine the (1) current knowledge of heat as a health threat, (2) perception of personal vulnerability to heat, (3) role of heat warnings and heat alert and response systems in initiating heat mitigating practices, and (4) opinions of community preparedness among heat-vulnerable older adults, as well as explore factors that may influence these concepts.

Design:
Cross-sectional survey.

Setting:
Canada.

Participants:
Individuals aged 50 years or older.

Main Outcome Measures:
The number of respondents and percentage of the total sample were calculated based on individual response rates to each question. To explore factors that may have influenced the respondents’ understanding of heat health knowledge, awareness, and risk perception, a bootstrapped least absolute shrinkage and selection operator regression was conducted.

Results:
1027 respondents (69% female, median age: 68 years) from 10 provinces/territories. Most felt knowledgeable about heat stress (74%), but many indicated that greater effort is needed to increase public awareness of EHE (64%). Self-reported responsiveness to heat alerts was also high (88%) despite many respondents reporting a low level of self-perceived risk (66%) and characteristics of heat susceptibility (eg, age, comorbidities).

Conclusions:
In our sample of older Canadians, various factors influenced knowledge, perceived heat vulnerability, responsiveness to heat alerts, and perception of community preparedness. These findings can help inform public heat preparedness initiatives to ensure they align with the needs of older Canadians.