bluuebunny/crossref_metadata_2025_split huggingface dataset:
In Vitro Potentiation of Doxorubicin Cytotoxicity Utilizing Clarithromycin Loaded-PEGylated Liposomes
Authors: Alfreahat Islam , Nsairat Hamdi , Aldeeb Ibrahim Deeb , Al-Samydai Ali , Alshaer Walhan 
Published: January 2025

Background Doxorubicin (DOX) is a potent chemotherapeutic agent for breast cancer, but its effectiveness is often diminished by resistance mechanisms, particularly through p-glycoprotein (P-gp) mediated drug efflux. Clarithromycin (CAM), a macrolide antibiotic, inhibits multiple metabolic pathways including CYP3A and P-gp, potentially countering DOX resistance. Objective This study aimed to evaluate the potentiation of DOX and its effectiveness against the MCF-7 breast cancer cell line by encapsulating both DOX and CAM in PEGylated liposomes. Methods PEGylated liposomes containing DOX and CAM were prepared using the thin film hydration method. The physicochemical properties of the liposomes, including average particle size, polydispersity index (PDI), and zeta potential, were characterized. Encapsulation efficiencies for CAM and DOX were assessed, and stability of the liposomes was evaluated over 9 days at room temperature. Cell viability was measured using an IC50 assay, and P-gp expression levels were determined by ELISA. Results The CAM/DOX-PEGylated liposomes exhibited optimal average particle size (238 ± 26.7 nm), PDI (0.29 ± 0.107), and zeta potential (−20.9 ± 2.17 mV). These liposomes maintained good stability regarding size and charge over 9 days. Encapsulation efficiencies were 81.05% for CAM and 78.13% for DOX. The IC50 value for CAM/DOX-PEGylated liposomes was 0.13 µM, representing a significant reduction compared to the physical mixture of CAM and DOX (0.25 µM) and free DOX (0.21 µM) against MCF-7 cells. ELISA analysis showed a reduction in P-gp expression of approximately 5% with CAM/DOX-PEGylated liposomes compared to 1.61% with free DOX. Conclusion The results indicate that CAM encapsulated in PEGylated liposomes enhances the effectiveness of DOX against breast cancer cells, likely through the inhibition of p-glycoprotein. This approach may offer a promising strategy to overcome DOX resistance and improve chemotherapy outcomes.
Overweight yet Undernourished: A Common Juxtaposition in the Specialist Diabetes Foot Service
Authors: Martin Wrivu Niezel , Wigmore Hayley Katherine , Gregory Leanne Caroline , Lum Cheryl Mei Yee , Lasschuit Joel Willem Johan 
Published: January 2025

Aims To describe the nutritional status of people with diabetes-related foot complications and explore the association between nutrition and ulceration healing. Methods This retrospective cohort study included attendees of a diabetes foot service who completed a dietary questionnaire. Diet was compared to guideline recommendations and biochemical measures were recorded. Associations between dietary intake and biochemical measures were analysed using non-parametric tests, and their relationship with being ulcer-free at 12 weeks analysed by binary logistic regression. Results Of 102 participants, 83% were men, mean age 68 (SD 12), body mass index 28.6 (SD 6.1) kg/m2, and 86% had type 2 diabetes. Complications included 154 ulcerations and 7 active Charcot feet. Recommended fruit, vegetable and protein intake was seldom attained. Common insufficiencies were 25-hydroxy-vitamin D (40%), zinc (27%), iron (23%) and vitamin C (21%). Vitamin C was higher in the upper (vs lower) tertile of fruit/vegetable intake (62 [95%CI 33–88] vs 30 [13–46] umol/L, p = 0.04), and zinc higher in those meeting protein requirements (12.3 [95%CI 11.1–12.8] vs 10.6 [9.8–11.5] umol/L, p = 0.04). Haemoglobin was the only predictor of becoming ulcer-free (OR 1.03 [95%CI 1.00–1.06], p = 0.03). Conclusion Nutritional inadequacies are common in people with diabetes-related foot complications; however, the benefit of assessing nutrition remains uncertain.
The Relevance of Thyroid Nodules in Vascular Ultrasound: A Case-Based Literature Review
Authors: Williams David M. , Wooster Elizabeth M. , Wooster Douglas L. 
Published: January 2025

Thyroid nodules are found by ultrasound in up to 67% of the population, of which 1% to 15% are malignant. As the thyroid may be imaged during a carotid study, vascular technologists should be aware of normal and abnormal thyroid appearances. Interpreting physicians need this information to report on incidentally found thyroid nodules. Such reports could lead to further referral, detailed thyroid ultrasound, or other diagnostic modalities guiding further management. A literature review was conducted regarding thyroid findings on ultrasound. Illustrative images were collated to demonstrate thyroid findings that may be encountered by vascular technologists during carotid duplex studies. Vascular technologists are not usually trained in thyroid scanning. Thyroid findings on a carotid duplex are “incidental” but may identify important pathology. Thyroid nodule characterization such as size, shape, contour, consistency, echogenicity, texture, blood flow pattern, and calcification may be needed by interpreting physicians in combination with additional images. Definitive assessment requires a dedicated thyroid study with application of the TI-RADS (Thyroid Imaging Reporting & Data SystemTM) classification. Identifying thyroid pathology on a carotid ultrasound study can reveal important information and lead to further investigation. Early identification of such pathology by a vascular technologist can be lifesaving. Characteristics of thyroid lesions can be readily demonstrated by the vascular technologist, assessed by the interpreting physician, and reported to the referring provider for definitive work-up and treatment.
Persistent penumbral profiles indicate a potentially good outcome in acute stroke patients without major reperfusion
Authors: Hong Lan , Lin Longting , Chen Chushuang , Bivard Andrew , Levi Christopher R , Su Ya , Ling Yifeng , Parsons Mark W , Cheng Xin , Dong Qiang 
Published: January 2025

Background: It is acknowledged that penumbra can exist beyond 24 h after stroke onset. Aims: The aim of this study was to explore the association between penumbral persistence at 24–72 h and clinical outcomes in patients who did not achieve major reperfusion. Methods: Eligible patients participating in the International Stroke Perfusion Imaging Registry with repeated 24–72 h perfusion imaging were retrospectively included in this study. Persistent penumbra was evaluated as the volume of hypoperfusion lesion on repeated perfusion imaging divided by infarct volume on the follow-up imaging at 24–72 h post arrival. Short-term clinical outcomes were defined as neurological deterioration at 24–72 h and modified Rankin Scale (mRS) 0–2 at discharge. Long-term outcome was defined as mRS 0–2 at 3 months. The association between persistent penumbra and clinical outcomes was explored using multivariable-adjusted logistic regression models. Results: A total number of 203 patients were included in this study. Persistent penumbra was associated with decreased odds of neurological deterioration at 24–72 h (multivariable-adjusted odds ratio (OR) = 0.3, 95% confidence interval (CI) = 0.1–0.8, p = 0.01) and increased odds of mRS 0–2 at 3 months (multivariable-adjusted OR = 2.7, 95% CI = 1.1–6.8, p = 0.03). Persistent penumbra was not associated with mRS 0–2 at discharge (multivariable-adjusted OR = 2.5, 95% CI = 0.4–14.7, p = 0.30). Conclusions: Persistent penumbra in acute stroke patients without major reperfusion was generally associated with a better clinical outcome. This evidence suggested that there were patients with persistent hemodynamic support, for whom major reperfusion might not be pivotal to achieve a good clinical outcome. How to identify these patients and what treatment strategy can be made to stabilize the hemodynamics need future investigation. Data access statement: Anonymized data not published within this article will be made available at the request of qualified investigators whose proposal of data use has been approved by an independent review committee.
Trends in anterior shoulder instability procedures over the last decade in the United States
Authors: Thakkar Akshar P , Reyes Samuel G , Jadidi Shaheen , Bhatia Sanjeev , Bare Aaron A 
Published: January 2025

Background The treatment algorithm for traumatic shoulder instability has evolved, emphasizing the significance of glenoid bone loss and the glenoid track, addressing humeral, and glenoid vault bone deficiencies. This study examines trends and demographics of anterior shoulder instability procedures in the United States from 2010 to 2020. Methods PearlDiver database was queried for patients who underwent traumatic anterior shoulder instability procedures. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis ( P < 0.05 significant). Results Arthroscopic anterior labral repair showed an annual decline of approximately 10% compared to the substantial growth of Latarjet coracoid transfer procedures in the first half of the decade (2010–2015), followed by a plateau in the second half (2016–2020). Arthroscopic anterior labral repair was most prevalent in the 15 to 19 age range, while Latarjet was most prevalent in the 20 to 24 age group. Latarjet procedures were three times more common in males than females, whereas arthroscopic anterior labral repairs occurred approximately twice as frequently in males compared to females. Discussion Latarjet procedures showed a general increase in annual growth rate, while arthroscopic anterior labral repairs have consistently declined. Open anterior capsulorrhaphy with bone block, open capsular shift, and open capsulolabral repairs have shown a steady decrease in incidence.
Impact of #PCOSweightloss: A global X hashtag analysis study of weight loss narratives in the PCOS community
Authors: Afaq Munaza , Vashisht Kumar , Al-Dhoon Areen , Abraham Divya , Atanasov Atanas G. , Matin Maima , Arshad Zara , Kashyap Rahul , Nawaz Faisal A. 
Published: January 2025

Introduction Social media plays a significant role in fostering communities around health and wellness. The hashtag #PCOSweightloss has become a pivotal forum on the platform X, where individuals exchange experiences, share information, and motivate each other concerning weight loss strategies connected with Polycystic Ovary Syndrome (PCOS). Objective This study aims to analyze the trends of #PCOSweightloss on X to gain insights into the social media metrics, including overall hashtag reach, key themes, and potential influence on management practices of PCOS. Methods Fedica research analytics tool ( https://fedica.com ) was utilized to automatically evaluate quantitatively the posts on the platform X containing #PCOSweightloss from July 1st, 2017 to July 1st, 2023. Results During the defined period, 1570 users shared 12,200 posts on X, gathering 2,967,001 views. The highest number of posts originated from the United States (38.6%), followed by India (30.6%) and the United Kingdom (10.6%). Top co-occurring hashtags associated with #PCOSweightloss included #PCOS, #healthyfood, #pcosmood and #diabetes. Physicians were key contributors to the discourse, contributing to 30% of the ten most engaging posts and 20% of the top ten influencers. Sentiment analysis revealed a predominant neutral sentiment (98%), while 1% each revealed positive and negative sentiments. Conclusion Our study affirms the substantial presence of #PCOSweightloss in the PCOS discourse on X. The involvement of physicians is particularly noteworthy, as it emphasizes the importance of expert-guided discussions in the online health discourse. On the background of geographical variances and the challenge of engaging a wider audience due to the limited follower counts of many participants, there is a clear opportunity for further community engagement and outreach. The prevailing neutral tone showcases a community engaged primarily in an informational exchange, setting the stage for more profound discussions of novel PCOS weight loss strategies.
A Multilevel Analysis of Farmers’ Adoption of Water-saving Irrigation Technology: Evidence From the North China Plain
Authors: Guo Yibei , Zhang Kunpeng , Jia Xiaohu 
Published: January 2025

Agricultural water scarcity poses a significant threat to food security and sustainable development. Farmers’ adoption of agricultural water-saving irrigation technologies (WSIT) is essential for addressing this challenge. However, decisions to adopt such technologies are shaped by both individual and structural factors across multiple levels. This study investigated the multilevel determinants of WSIT adoption in the North China Plain (NCP) through a field survey conducted from late 2012 to early 2013. We collected retrospective data from 818 households spanning 2010 to 2012. Initially, we employed a binomial logistic regression model to identify significant household- and village-level factors influencing WSIT adoption. Recognizing the nested nature of adoption decisions within individual and village contexts, and the importance of multilevel interactions, we further utilized a multilevel mixed-effects logistic model. Our findings indicated that household-level factors, such as farm size, access to irrigation resources, education, input costs, and village leadership, were the primary drivers of WSIT adoption. Approximately 22.7% of the variation in adoption was attributable to differences between villages. At the village level, larger village size decreased the likelihood of adoption, while the presence of Water User Associations (WUAs) had a positive influence. Mechanism analysis suggested that household-level characteristics affected farmers’ adoption behavior through possible channels such as technical training, farmers’ perception of climate change, and the availability of alternative technologies. These findings highlight the importance of considering multiple contextual factors in studying farmers’ adoption behavior and provide important policy implications for decision-makers. JEL classification: D1; Q16; Q25
Correlation Between Facet Tropism and Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
Authors: Zhou Hao , Wang Jianxi , Zhang Wenyu , Gao Chenfei , Hu Bo , Zhen Genjiang , Li Xingyu , Wang Hui , Yuan Wen , Chen Huajiang , Liang Lei 
Published: January 2025

Study Design Retrospective cohort study. Objectives To explore the correlation between Facet Tropism (FT) and OPLL in cervical spine. Methods One-hundred patients with OPLL of cervical spine and one-hundred normal participants without OPLL or cervical disc herniation were included in this study, the patients were matched to the normal participants respectively based on the same sex and similar age (±5). For patients, the cervical levels with and without OPLL were categorized into “OPLL group” and “patient control group,” respectively. Bilateral facet joint angles at C2/3-C6/7 were measured on sagittal, coronal, and axial planes on CT. Results On every planes at the level of C2/3-C6/7,the mean difference between left and right facet angles and FT incidence in the most levels of the OPLL group were significantly greater than those in the control groups ( P < 0.001). At the most cervical levels, there was no significant difference in mean difference of facet angles and FT incidence between the 2 control groups. On the axial plane, the incidence of FT in segmental type OPLL patients was significantly higher than that in continuous type OPLL patients ( P = 0.036). On the coronal plane, the incidence of FT in segmental type OPLL was significantly higher than that in the other OPLL types ( P < 0.001), and local type OPLL had a higher incidence of FT compared to mixed type OPLL ( P = 0.016). On the sagittal plane, the incidence of FT in segmental type OPLL was higher than that in continuous type OPLL ( P = 0.019) and mixed type OPLL ( P = 0.036). Conclusions There is a significant correlation between OPLL of cervical spine and FT. There are significant differences in the incidence of FT among different cervical OPLL types.
Impact of Antiplatelet Medication Continuation on Surgical Outcomes after Minimally Invasive Posterior Lumbar Decompression Surgery: Retrospective Cohort Study
Authors: Sawada Yuta , Tamai Koji , Toyoda Hiromitsu , Kato Minori , Suzuki Akinobu , Takahashi Shinji , Iwamae Masayoshi , Okamura Yuki , Kobayashi Yuto , Nakamura Hiroaki , Terai Hidetomi 
Published: January 2025

Study Design Retrospective cohort study. Objectives Spinal surgeons face a dilemma regarding the continuation or discontinuation of antiplatelet agents during the perioperative period. Guidelines recommend considering the balance between thrombotic and bleeding risks. However, no consensus exists for the use of these agents for patients who undergo minimally invasive lumbar decompression. This study aimed to assess the effect of continued antiplatelet medication on minimally invasive posterior lumbar decompression surgery outcomes, focusing on perioperative outcomes and 1-year postoperative clinical results. Methods This study included 106 patients who underwent minimally invasive posterior lumbar decompression between 2017 and 2022 and were taking antiplatelet medications before spinal surgery. Patient characteristics, antiplatelet medication type, and perioperative data were analyzed. Patients were divided into “continuation” and “discontinuation” groups based on preoperative antiplatelet medication status. Univariate and multivariate linear regression analyses were performed. Results No significant differences were observed between groups in terms of surgical time, intraoperative blood loss, postoperative drain volume, complication rates, and Japanese Orthopedic Association scores and EuroQoL-5 dimensions 5-level at 1 year postoperatively. Similar results were noted in groups focusing exclusively on patients treated with aspirin. Multivariate linear regression revealed that surgical time per level was significantly associated with total blood loss, whereas antiplatelet medications did not show a significant relationship (operative time per level, P < 0.01; antiplatelet drugs, P = 0.459). Conclusions This study suggests that minimally invasive posterior lumbar spine decompression can be performed safely and effectively under continuous antiplatelet medication. Further studies with more evidence are required to validate our findings.
Characterization of swallowing biomechanics and function in untreated infants with spinal muscular atrophy: A natural history dataset
Authors: McGrattan Katlyn Elizabeth , Graham Robert J , Mohr Alicia Hofelich , Miles Anna , Allen Jacqui , Ochura Juliet , Hernandez Kayla , Walsh Katie , Rao Vamshi , Stevens Melanie , Alfano Lindsay , Coker Mackenzi , Leon-Astudillo Carmen , Smith Leann Schow , Brandsema John , Farah Hiba , Welc Julia , Levy Deborah Salle , Clements Miranda , Tang Whitney J , Duong Tina , Rocha Carolina Tesi , Schenck Graham , McGhee Heather , Nichols Keeley , Brown Ashley , Brown Allison , Castro Diana , Darras Basil T 
Published: January 2025

Background: Spinal Muscular Atrophy (SMA) is a progressive neuromuscular disorder that in its most severe form, causes profound swallowing deficits. There remains a paucity of research systematically elucidating the biomechanical and functional correlates. This void limits the ability to evaluate the effects of disease-modifying treatments on swallowing. Objective: Elucidate characteristics of swallowing biomechanics and function among untreated patients with SMA. Methods: Infants with SMA who had not received disease modifying therapy when they underwent a videofluoroscopic swallow study (VFSS) were retrospectively identified from 13 international children's hospitals. Infants were eligible if they exhibited symptoms by six months old, or in cases where they detected prior to symptom onset, if they had two copies of SMN2. Eligible infants underwent medical record review to gather oral intake status and need for suctioning for secretion management. Digital files of VFSS’ were extracted and analyzed using BabyVFSSImP™. Non-parametric t-tests were used to compare swallowing biomechanics based on viscosity and the presence of dysphagia symptoms. Results: 62 infants were included in this investigation with average age at initial VFSS 4.4 ± 3.11 months. A high proportion of infants exhibited profound deficits in swallowing biomechanics that impeded extraction of the bolus from the nipple, clearance of the bolus from the pharynx, and prevention of the bolus from entering the airway. Deficits were significantly more prevalent in infants referred for VFSS due to dysphagia symptoms than asymptomatic infants referred as part of high-risk referral (t ≤ 2.5, p ≤ 0.03). A high proportion of infants relied on suctioning for secretion management (34%; N = 21) and alternative nutrition (39%; N = 24), with those relying on these supports exhibiting significantly worse swallowing biomechanics than those who did not (t ≤ 2.8, p ≤ 0.01). Conclusions: Profound deficits in swallowing biomechanics and function are common in infants with SMA. Though clinical symptoms may aid in identifying infants with the most profound swallowing deficits, their absence in cases of more mild deficits inhibits the ability to use these clinical markers as a valid metric of swallowing integrity.
Ranking Surgeon Performance After ACL Reconstruction Using the Knee Injury and Osteoarthritis Outcome Score (KOOS) Subscales
Authors: Floyd Sarah B. , Ahearn Briggs , Kissenberth Michael J. , Brooks John M. , Thigpen Charles A. 
Published: January 2025

Background: Patient-reported outcomes (PROs) are considered the gold standard for evaluating value-based care in orthopaedics. However, there is little evidence to guide implementation of PROs for surgeon performance evaluation. Purpose: To develop a risk-adjusted surgeon performance measure using the Knee injury and Osteoarthritis Outcome Score (KOOS) for patients undergoing anterior cruciate ligament reconstruction (ACLR). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients (N = 1248; 662 men; mean age, 30 ± 13 years) who underwent ACLR performed by 40 surgeons between 2010 and 2018 were identified from a large, nationally representative sports medicine clinical data registry. Linear regression was used to predict change scores for each KOOS subscale (Pain, Symptoms, Activities of Daily Living [ADL], Function in Sports and Recreation, and Knee-Related Quality of Life) while adjusting for patient baseline characteristics. A risk-adjusted performance measure was calculated for each KOOS subscale as the difference between the unadjusted and the risk-adjusted predicted change score across all patients treated by a single surgeon. Surgeon-relative quartile ranking was compared across outcome subscale scores. Results: One-third of the patients (34%) displayed acute cartilage damage, and 56% had a meniscal injury. In the risk adjustment models, older age, presence of diabetes, current smoking status, acute cartilage damage, concurrent cartilage treatment, lower baseline Veterans RAND 12-Item Health Survey mental and physical component scores, and lower baseline Marx and KOOS subscale values all had a significant negative influence on the predicted KOOS subscale change values ( P < .05 for all). Surgeon performance, ranked in quartile groups, was the same for 10 surgeons but varied by 1 to 2 quartiles for the other 30 surgeons across the different KOOS subscales. Conclusion: These results showed that surgeon performance varies widely when evaluated using different KOOS subscales for patients undergoing ACLR. Based on the preliminary results and clinical perspective, the authors recommend the ADL and Symptoms subscales as the best options to differentiate surgeon performance for these patients. However, evaluation of surgeon performance may require consideration or use of a set of PROs or the development of a single index PRO that is sensitive to the range of outcome dimensions important to patients.