bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes following immunosuppressive therapy withdrawal after complete renal response in proliferative lupus nephritis
Authors: Vidal-Montal Paola , Narváez Javier , Fulladosa Xavier , Mitjavila Francesca , Capdevila Olga , Torras Joan , Gomà Montserrat , Nolla Joan M 
Published: January 2025

ObjectiveTo investigate the rate and factors influencing renal relapse (RR) in proliferative lupus nephritis (LN) patients who discontinued immunosuppressive therapy (IST), as well as the long-term renal outcomes following RR.MethodsRetrospective, single-centre study of biopsy-confirmed LN patients who had received IST for at least 36 months and maintained complete renal response (CRR) for a minimum of 12 months before therapy discontinuation.ResultsOf a total of 106 patients meeting the inclusion criteria, 76 with proliferative classes were selected for analysis. The median duration of IST prior to discontinuation was 83.5 months (IQR 25th–75th: 53.5–120). Relapse occurred in 29 patients (38.2%) at a median of 26.5 months (IQR 25th–75th: 9.25–63.5 months) following IST withdrawal. Relapses were classified as severe in 9 cases (31%) and moderate in 16 cases (55.2%). Renal rebiopsy was performed in 25 of these patients (86.2%), with 80% retaining the same histological class.Discontinuation of IST at ≤34 years of age significantly increased the risk of RR (adjusted HR: 3.5). In contrast, an IST duration exceeding 48 months prior to discontinuation (HR: 0.26), maintaining CRR for at least 48 months (HR: 0.32), achieving complete remission per DORIS (definition of remission in systemic lupus erythematosus) criteria at IST withdrawal (HR: 0.21) and gradual IST tapering (HR: 0.09) were associated with a reduced risk of RR.Following reintroduction of IST, 20 out of 29 patients (68.9%) achieved CRR, 5 (17.2%) achieved a partial response and 4 (13.8%) did not respond; of these, 3 patients (10.3%) progressed to end-stage renal disease.ConclusionsSuccessful withdrawal of IST is possible in carefully selected patients with proliferative LN. If an RR occurs, most patients are able to remain in remission after resuming IST.
Pregnancy and cardiovascular outcomes among patients post Fontan surgery: a 25-year single-centre retrospective cohort study
Authors: Yehuda Daniel , Soudry Omri , Schwartz Eyal , Richter Ilan , Dadashev Alexander , Vig Shahar , Kolker Shimon , Houri Ohad , Hadar Eran , Kornowski Ran , Hirsch Rafael , Schamroth Pravda Nili 
Published: January 2025

IntroductionData on the characteristics and outcomes of pregnancy and among patients with Fontan physiology are limited. We aimed to evaluate the immediate and long-term outcomes among these patients who were followed at our centre.MethodsWe included adult patients who had undergone Fontan surgery for congenital heart disease and were pregnant between 1994 and 2021. We examined maternal and obstetric outcomes.ResultsIn a cohort of 109 patients following Fontan procedure, 51 patients were women, and 19 patients (37%) had a pregnancy during the follow-up period, accounting for a total of 46 pregnancies. Intrauterine growth retardation of the fetus was common, observed in 23% of all pregnancies and 50% of live births. The main fetal complication was prematurity, observed in 43% of all pregnancies and 90% of live birth. The maternal complications included pre-eclampsia (one patient), placental detachment (one patient), acute heart failure exacerbation (one patient), arrhythmia (three atrial arrhythmias) and major peripartum haemorrhage (two patients), with no peripartum death.ConclusionsOver one-third of women with Fontan physiology in our cohort had a documented pregnancy. Maternal and obstetric complications were common among these patients, and expanded long-term data is needed. Limitations, including small sample size and survival bias, may have underestimated the risk of adverse outcomes in this cohort.
Role and prognostic value of growth differentiation factor 15 in patient of heart failure with preserved ejection fraction: insights from the PURSUIT-HFpEF registry
Authors: Sakamoto Daisuke , Matsuoka Yuki , Nakatani Daisaku , Okada Katsuki , Sunaga Akihiro , Kida Hirota , Sato Taiki , Kitamura Tetsuhisa , Tamaki Shunsuke , Seo Masahiro , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Yasumura Yoshio , Yamada Takahisa , Hikoso Shungo , Sotomi Yohei , Sakata Yasushi 
Published: January 2025

BackgroundGrowth differentiation factor 15 (GDF15) is a cytokine responding to oxidative stress and inflammation, and it regulates appetite and energy balance. The association between GDF15 and clinical factors and its prognostic value in elderly multimorbid patients with heart failure with preserved ejection fraction (HFpEF) have not been well unknown.MethodsThis exploratory analysis is part of the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction study (N=1231), an ongoing, prospective, multicentre observational study of acute decompensated HFpEF (UMIN000021831). A predefined subcohort of 212 patients underwent multi-biomarker testing. Of these, we analysed 181 patients with available GDF15 data. The primary endpoint was a composite of all-cause death and hospitalisation for HF.ResultsIn this analysis population, the median age was 81 (75–85) years, with 48% male patients. GDF15 significantly correlated with cardiac burden, anaemia, renal dysfunction and inflammation. Notably, poor nutritional status was significantly associated with GDF15. GDF15 was linked to poor prognosis in this elderly multimorbid cohort with HFpEF (adjusted HR for log-transformed GDF15: 13.67, 95% CI: 2.78 to 67.22, p=0.001). Furthermore, GDF15 added significant incremental value to the MAGGIC risk score (net reclassification improvement=0.4955 (95% CI: 0.1367 to 0.8543), p=0.007; integrated discrimination improvement=0.0278 (95% CI: 0.0013 to 0.0543), p=0.040).ConclusionsGDF15 was associated with anaemia, inflammation, renal dysfunction, cardiac burden and malnutrition. It demonstrated prognostic value in elderly multimorbid HFpEF patients, suggesting its potential role as a complementary marker for the prognostic risk assessment of HFpEF patients.Trial registration numberUMIN-CTR ID: UMIN000021831.
Emergency interventions for cardiogenic shock due to decompensated aortic stenosis: a systematic review and meta-analysis
Authors: Kühne Stephanie Gladys , Patrignani Andrea , Elvinger Sebastien , Wein Bastian , Harmel Eva , Penev Damyan , Owais Tamer , Girdauskas Evaldas , Raake Philip W , Chiarito Mauro , Bongiovanni Dario 
Published: January 2025

BackgroundCardiogenic shock (CS) induced by severe aortic stenosis (AS) is a life-threatening condition with high mortality. Despite advancements in emergency interventions, the optimal treatment approach remains uncertain.AimThis study aimed to systematically review and analyse the existing evidence on outcomes of emergency transcatheter aortic valve implantation (eTAVI) and emergency balloon aortic valvuloplasty (eBAV) in CS patients.MethodsA systematic literature review and meta-analysis was performed. The primary endpoint was mortality at 30 days. Secondary endpoints were in-hospital mortality, 1-year mortality, bleeding, major vascular complications, myocardial infarction, stroke, incidence of pacemaker implantation, acute kidney injury and aortic regurgitation.ResultsSeventeen studies were included, totalling 2811 patients. The analysis revealed a 30-day mortality pooled estimated rate for eTAVI of 19% (CI 0.17 - 0.20) and for eBAV 39% (CI 0.32 - 0.46). In-hospital mortality pooled estimated rates were 11% for eTAVI (CI 0.06 - 0.18) and for eBAV 40% (CI 0.28 - 0.54). One-year mortality pooled estimated rates for eTAVI were 29% (CI 0.20 - 0.40) and for eBAV 67% (CI 0.58 - 0.74). Pooled estimated rates of any bleeding were 12% for eTAVI (CI 0.06 - 0.20) and 15% for eBAV (CI 0.10 - 0.21). The rate of major vascular complications for eTAVI was 8% (CI 0.07 - 0.10) and 3% for eBAV (CI 0.0 - 0.23).ConclusionsThis meta-analysis indicates that mortality in CS due to AS remains high despite emergency interventional treatment. These findings offer critical insights for clinical decision-making optimising patient care in this critically ill population.
Novel use of ultrasound-guided high-intensity focused ultrasound (HIFU) may enable the neuroablation of the sacroiliac joint in a swine model: a feasibility study
Authors: Bulat Evgeny , Chaturvedi Rahul , Crowther Jason , Monette Sebastien , Gulati Amitabh 
Published: January 2025

BackgroundSacroiliac joint (SIJ) dysfunction accounts for the etiology of pain in 15%–30% of low back pain cases. Some patients with conservative treatment-refractory SIJ dysfunction undergo radiofrequency (RF) ablation of the SIJ for prolonged pain relief. This procedure involves placing up to 12 RF probes in what is an invasive, resource-intensive, and time-consuming process. High-intensity focused ultrasound is an alternative neuroablative technique that is non-invasive and potentially less cumbersome. MRI-guided high-intensity focused ultrasound (MRgHIFU) had previously been successfully applied to SIJ ablation in a swine model, and more recently had been trialed in humans. However, ultrasound-guided high-intensity focused ultrasound (USgHIFU) of the SIJ may be a more practical and rapid alternative to MRIgHIFU.MethodsThis was a prospective technology efficacy and safety study in a swine model. Three Yorkshire pigs underwent bilateral SIJ ablation using a proprietary USgHIFU prototype. Post procedure, treatment efficacy was assessed using clinical evaluation of pain and changes in ambulation, gross inspection of lumbosacral necropsy and pathology sections, and histology.ResultsPost anesthetic monitoring for 72 hours showed no signs of gait abnormalities or perceived pain in the swine models. Of the primary sacral spine targets, histological specimen review suggested successful lesioning of 37/54 sites (68.5%), specifically in the targeted areas that were visualized under ultrasound. Of the successful lesion zones, 22/37 (59.5%) included nerve lesions, 34/37 (91.9%) included muscle lesions, 34/37 (91.9%) included periosteum lesions, and 20/21 (95.2%) included bony lesions.ConclusionsThe preliminary study thus demonstrates that USgHIFU can create targeted contiguous strip lesions along the SIJ and lead to thermal necrosis of the posterior sacral network without causing additional neurological damage or damage to adjacent muscle tissue or bone outside of target areas.
Chinese stroke association guidelines on reperfusion therapy for acute ischaemic stroke 2024
Authors: Xiong Yunyun , Li Shuya , Wang Chunjuan , Sun Dapeng , Li Zixiao , Gu HongQiu , Jin Aoming , Dong Qiang , Liu Liping , Miao Zhongrong , Wang Yongjun 
Published: January 2025

BackgroundStroke remains a major global health challenge, with China experiencing a significant burden due to its high incidence and severe outcomes. Reperfusion therapies, such as intravenous thrombolysis and endovascular thrombectomy, have shown substantial benefits in improving early outcomes for ischaemic stroke. Recent clinical trials have validated the safety and efficacy of a broader range of thrombolytic agents and expanded the eligible patient populations for both intravenous thrombolysis and mechanical thrombectomy. This guideline aims to provide the latest evidence-based insights in the field of reperfusion therapy.MethodsThe Chinese Stroke Association (CSA) established a writing group to develop updated guidelines on reperfusion therapy for acute ischaemic stroke. A comprehensive search of MEDLINE (via PubMed) was conducted up to 30 September 2024. Experts in the field of stroke engaged in extensive discussions, both online and offline, to evaluate the latest evidence. Each recommendation was graded using the CSA’s class of recommendation and level of evidence in the Guideline Development Manual of the CSA.ResultsThis guideline, reviewed and approved by the CSA Guidelines Writing Group, outlines the criteria for patient selection for thrombolysis and thrombectomy and summarises the latest evidence on various thrombolytic drug options to support decision-making in reperfusion therapy. Additionally, the guideline includes green channel flow charts for intravenous thrombolysis and mechanical thrombectomy, designed to assist clinicians in optimising their clinical decisions.ConclusionThis guideline updates the latest advancements in the field of reperfusion therapy for acute ischaemic stroke. It is anticipated that future clinical research will further advance areas such as innovative thrombolytic agents, expanded indications for thrombolysis and mechanical thrombectomy.
Production and decay of anticharmed pentaquark state with quark content $$\bar{c}sudd$$
Authors: Liu Shi-Dong , Wang Xiao-Yun , Liu Xiao-Hai , Li Gang 
Published: January 2025

Abstract
We use an effective Lagrangian approach to investigate the production of the anticharmed pentaquark state

$$P_{\bar{c}s}^{(*)-}$$

P

c

¯

s

(

∗
)
-

with the minimal quark content

$$\bar{c}sudd$$

c

¯

s
u
d
d

in the

$$\Lambda _b^0$$

Λ
b
0

decay. In our calculation, the

$$P_{\bar{c}s}^{(*)-}$$

P

c

¯

s

(

∗
)
-

is considered as the molecule state of the

$$nD_{s0(s1)}^{-}$$

n

D

s
0
(
s
1
)

-

in an S wave, and its production and decay occur via triangle loops at the hadron level. With the moderate model parameters, the computed results suggest that the branching fractions of

$$\Lambda _b^0\rightarrow P_{\bar{c}s}^{(*)-} D^+ $$

Λ
b
0

→

P

c

¯

s

(

∗
)
-

D
+

can reach approximately

$$10^{-4}$$

10

-
4

. The possible decay modes

$$ P_{\bar{c}s}^{(*)-} \rightarrow \Lambda D^{(*)-}$$

P

c

¯

s

(

∗
)
-

→
Λ

D

(

∗
)
-

and

$$ P_{\bar{c}s}^{(*)-} \rightarrow \Sigma D^{(*)-}$$

P

c

¯

s

(

∗
)
-

→
Σ

D

(

∗
)
-

are also investigated. It is hoped that these predictions could be helpful in searching for the anticharmed-strange pentaquark candidates in future LHCb experiments.
What is the evidence on immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis? – A Cochrane Review summary with commentary
Authors: Moretti Antimo 
Published: January 2025

Background Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system, and a leading cause of neurological disability in adults. Many drugs with different mechanisms of action and potentially serious harms are available so far, thus requiring an evidence-based decision-making for clinicians managing MS patients. Objective To compare the efficacy and safety of immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis (RRMS). Methods A systematic search was performed in CENTRAL, MEDLINE, Embase, and trials registers on 8 august 2022, including RCTs comparing immunomodulators and immunosuppressants versus placebo or another drug. Results The network meta-analysis (NMA) included 50 RCTs (with 36,541 participants). High-certainty evidence suggests that natalizumab largely reduces relapses at 12 (RR 0.52, 95% CI 0.43 to 0.63) and 24 months (RR 0.56, 95% CI 0.48 to 0.65), and cladribine (RR 0.53, 95% CI 0.44 to 0.64) and alemtuzumab (RR 0.57, 95% CI 0.47 to 0.68) largely reduce relapses at 24 months. Moreover, natalizumab probably reduces disability worsening over 2 years (RR 0.59, 95% CI 0.46 to 0.75). For what concern safety, moderate-certainty evidence suggests that alemtuzumab probably results in a slight reduction of treatment discontinuation due to adverse events (AEs), while daclizumab, fingolimod, teriflunomide, interferon beta-1a. laquinimod, natalizumab, and glatiramer acetate probably result in a slight increase in treatment discontinuation treatment due to AEs. Conclusions Compared with placebo, two-year treatment with natalizumab, cladribine, or alemtuzumab decreases relapses more than with other DMTs. Natalizumab likely results in a large reduction of disability worsening after two years of treatment. People taking fingolimod, teriflunomide, glatiramer acetate, interferon beta-1a, laquinimod, natalizumab and daclizumab are more likely to discontinue the drug because of unwanted effects. Lack of data for treatment effects beyond two years and poor reporting of adverse events in short-term trials limit the applicability of these findings.
Association of daily step counts and step intensity with mortality among US adults: a cross–sectional study of NHANES 2005–2006
Authors: Peng Tianzhou , Liu Changhao , Yang Ti , Liao Leyi , Li Qingping , Liang Hanbiao , Zhang Jiapeng , Xie Chen , Wang Kai , Li Chuanjiang 
Published: January 2025

Abstract

Background & aims
We aimed to describe the dose–response relationship between daily step counts and intensity with respect to all–cause mortality among US adults diagnosed with metabolic dysfunction–associated steatotic liver disease (MASLD).

Methods
Using data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2005 to 2006, a cross–sectional study included 1,108 participants was performed to assess the relationship between daily step counts and step intensity with mortality.

Results
A total of 1,108 participants from the NHANES study were included, with a mean age of 49.5 ± 0.9 years. The sample consisted of 533 (48.1%) women, 809(73%) non–Hispanic whites, 122 (10.8%) non–Hispanic blacks, 133 (12.0%) Hispanic, and 44 (4.2%) individuals of other racial backgrounds. Using multivariable–adjusted Cox proportional hazards models, we found that compared to participants in the light–step group, there was significantly lower risk of mortality in the moderate (hazard ratio [HR], 0.47 [95% CI, 0.32–0.69]), high (HR, 0.35 [95% CI, 0.21–0.61]) and vigorous (HR,0.45 [95% CI, 0.22–0.93]) step groups. Sensitivity and subgroup analyses confirmed that the association between step count and mortality remained robust. However, after adjusting for all covariates, greater step intensity was not significantly associated with lower mortality. Further analysis revealed that age, BMI, and self–rated health could have confounded the relationship between step intensity and survival, potentially obscuring any direct effect of step intensity on mortality.

Conclusions
Accumulating a higher number of daily steps, rather than focusing on step intensity, was associated with a lower risk of all–cause mortality in individuals with MASLD. Our findings suggest that achieving 10,000 steps per day may be optimal for reducing the risk of all–cause mortality risk in this population.
Early onset neonatal bloodstream infections in South African hospitals
Authors: Theron Genevieve , Bekker Adrie , Bolton Larisse , Whitelaw Andrew , Engelbrecht Arnoldus , Erasmus Louisa , Fataar Aaqilah , Geldenhuys Chandre , Kunneke Marlize , Roux Dave Le , O’Connell Natasha , Reddy Kessendri , Rhoda Natasha , Tooke Lloyd , Wates Mark , Wessels Thandi , Dramowski Angela 
Published: January 2025

Abstract

Background
Neonatal sepsis is a leading cause of death in low- and middle- income countries (LMIC). Increasing antibiotic resistance in early onset (< 72 h of life) bloodstream infection (EO-BSI) pathogens in LMIC has reduced the effectiveness of the recommended empiric antibiotic regimen (ampicillin plus gentamicin).

Methods
We retrospectively analysed blood culture-confirmed EO-BSI episodes at nine neonatal units from three central and six peripheral hospitals in the Western Cape Province, South Africa between 1 January 2017 and 31 December 2018. Clinical and electronic laboratory records were reviewed to determine pathogen profile, empiric antibiotic coverage rates and factors associated with EO-BSI attributable mortality, stratified by hospital type.

Results
Of the 8252 blood culture specimens submitted for the investigation of suspected EO-BSI, 136 EO-BSI episodes yielding 141 pathogens were identified with an EO-BSI rate of 1.3 and 0.5 episodes/1000 live births at central and peripheral hospitals respectively. Preterm (93/136; 68.3%) and low birth weight (84/136; 61.8%) neonates were most affected. The predominant pathogens were Streptococcus agalactiae (46/136; 34%), Klebsiella pneumoniae (17/136; 13%), Listeria monocytogenes (11/136; 8%), Acinetobacter baumannii (11/136; 8%) and Escherichia coli (11/136; 8%). The empiric antibiotic (ampicillin plus gentamicin) coverage rate was 64% (95% CI 51–74) at central hospitals and 84% (95% CI 74–94) at peripheral hospitals. Neonates with Gram-negative EO-BSI and discordant empiric antibiotic therapy had almost four-fold and three-fold higher odds of death respectively.

Conclusion
Preterm and low birth weight neonates are most vulnerable to EO-BSI and have higher odds of death with Gram-negative pathogens and discordant empiric antibiotic therapy.
International expert consensus on micronutrient supplement use during the early life course
Authors: Cetin Irene , Devlieger Roland , Isolauri Erika , Obeid Rima , Parisi Francesca , Pilz Stefan , van Rossem Lenie ,   Maternal Nutrition Delphi Study Group, Steegers-Theunissen Régine 
Published: January 2025

Abstract

Background
Growing evidence demonstrates that maternal nutrition is crucial for the health of the mother-to-be, and early life course of the offspring. However, for most micronutrients, guidelines are inconsistent. This Delphi study aimed to investigate the level of expert consensus on maternal nutrition and micronutrient needs during preconception, pregnancy and lactation.

Methods
We conducted a two-round web-based Delphi survey on various topics including general approaches to diet and supplement use, and existing guidelines. For the periods of preconception, pregnancy and lactation, questions focused on the importance and strength of evidence for supplement use with the following micronutrients for low- and high-risk populations: folic acid, choline, iodine, magnesium, calcium, iron, selenium, docosahexaenoic acid (DHA), and vitamins B1, B2, B6, B12, D and K.

Results
Thirty-five experts participated in the panel, who were healthcare professionals (HCPs), researchers and joint HCP-researchers with expertise in nutrition, gynaecology and/or obstetrics. Panellists reached consensus on the importance of diet and dietary supplement use during pregnancy and agreed on the lack of clarity and consistency in current guidelines, and the need for education in these areas for HCPs, pregnant people and the general population. For general low-risk populations, there was consensus on the importance of supplement use with iron and vitamin D from preconception through lactation, with folic acid and iodine from preconception through the second and third trimesters, respectively, with DHA from the first trimester through lactation and with calcium during lactation. Panellists agreed that the evidence for supplement use with each of these micronutrients during these phases to improve outcomes and/or foetal development is strong, except for vitamin D (preconception), DHA (first trimester), and iron (both periods). There was also consensus that supplement use advice should be tailored for people following vegan/vegetarian diets, restricted diets due to food intolerances, obesity, polycystic ovary syndrome, diabetes mellitus, and previous nutrition-related pregnancy complications.

Conclusion
The findings revealed robust consensus on various aspects of maternal nutrition, including the need for education, the lack of consistency in current guidelines on supplement use, the importance of supplement use across specific phases of pregnancy and the at-risk groups requiring tailored approaches.