bluuebunny/crossref_metadata_2025_split huggingface dataset:
Starters and non-starters soccer players in competition: is physical performance increased by the substitutions?
Authors: Castillo-Rodríguez Alfonso , González-Téllez José Luis , Figueiredo Antonio , Chinchilla-Minguet José Luis , Onetti-Onetti Wanesa 
Published: March 2023

Abstract
Background
Non-starters soccer players have a great role within the team, being indispensable to reduce fatigue, as well as to maintain and increase the team’s performance during the match.

Objective
This study aimed to analyze the physical performance of the starter and non-starters players during competitive soccer matches.

Methods
Twenty-two soccer players participated in this study, divided into two groups according to the role in the match (starters or non-starters). WIMU Global Positioning System devices were used in order to record physical performance metrics. Independent samples t-test and one-way ANOVA tests were performed to compare starters and non-starters, and the playing position, respectively, and two-way ANOVA test was perform with these factors too.

Results
There were no differences in the main physical performance metrics between starters and non-starters players during competition, although there were differences in physical performance metrics according to the playing position. Midfielders performed highest distance per minute, player load, and distance covered between 12 and 21 km·h− 1 (p < .05). Finally, distance covered at speeds greater than 24 km·h− 1 was predicted by the playing role (starters and non-starters) and playing position factors with 88% of explained variance (ηp2 = 0.772).

Conclusion
The main findings of this study showed that non-starter players had a similar physical performance during competitive matches as the starter players for whom they are substituted. In addition, the playing position determined different physical performance, contributing in this manuscript that behavior and decision-making of the players could be affected by their position in the field. More studies are needed on non-starter player performance and contextual factors that could influence the physical responses of these players.
Are the digit ratio (2D:4D) and hand grip strength related to Parkinson disease in elderly males?
Authors: Arazi Hamid , Birak Olia Roghayeh Bavafa , Eghbali Ehsan 
Published: March 2023

Abstract
Background
Sex hormones affect the pathogenesis of Parkinson patients and it has been suggested that gender is the most important factor in the development and progression of Parkinson’s disease. Studies have shown that the second to fourth digit ratio (2D:4D) is affected by the prenatal testosterone and estrogen levels and can predict predisposition to disease. In addition, decreased muscle strength in people with Parkinson’s has been repeatedly reported. Hand grip strength (HGS) is a suitable measure to evaluate the musculoskeletal system among the elderly and it is considered as an indicator of the overall strength of the body. This study aimed at investigating the relationship between Parkinson’s disease and HGS and 2D:4D ratio.

Methods
In this study 117 elderly men with Parkinson disease (mean age of 61.66 ± 11.28 years) and 156 healthy control subjects (mean age of 61.86 ± 6.29 years) participated. After determining the level of disability of Parkinson patients by a neurologist (level of disability in the range of 1–4), anthropometric indices (height, weight, length of the second and fourth fingers) and maximum HGS were measured.

Results
Although 2D:4D ratios (right and left hand) of male patients with Parkinson’s disease were higher than those of healthy males, this difference was not statistically significant (P = 0.12, P = 0.40; respectively). Conversely, HGS for the right and left hands of Parkinson patients were significantly lower than those of healthy males (P = 0.02, P = 0.03; respectively). The results showed a significant negative relationship between Parkinson disease and the right and left HGS (R = -0.16, P = 0.005; R = -0.17, P = 0.003; respectively). Parkinson disease had no significant relationship with 2D:4D of the right hand, left hand, mean finger ratio and DR−L 2D:4D (P > 0.05). The regression results showed that the right and left HGS were not able to predict Parkinson disease (P = 0.25, P = 0.16; respectively).

Conclusion
We concluded that HGS was negatively associated with the Parkinson disease, but conversely, 2D:4D may not be a valuable biomarker of elevated risk of Parkinson in elderly males.
Effect of a four-week isocaloric ketogenic diet on physical performance at very high-altitude: a pilot study
Authors: Chiarello Nicolas , Leger Bertrand , De Riedmatten Mathieu , Rossier Michel F. , Vuistiner Philippe , Duc Michael , Rapillard Arnaud , Allet Lara 
Published: March 2023

Abstract
Background
A ketogenic diet (KD) reduces daily carbohydrates (CHOs) ingestion by replacing most calories with fat. KD is of increasing interest among athletes because it may increase their maximal oxygen uptake (VO2max), the principal performance limitation at high-altitudes (1500–3500 m). We examined the tolerance of a 4-week isocaloric KD (ICKD) under simulated hypoxia and the possibility of evaluating ICKD performance benefits with a maximal graded exercise bike test under hypoxia and collected data on the effect of the diet on performance markers and arterial blood gases.

Methods
In a randomised single-blind cross-over model, 6 recreational mountaineers (age 24–44 years) completed a 4-week ICKD followed or preceded by a 4-week usual mixed Western-style diet (UD). Performance parameters (VO2max, lactate threshold [LT], peak power [Ppeak]) and arterial blood gases (PaO2, PaCO2, pH, HCO3−) were measured at baseline under two conditions (normoxia and hypoxia) as well as after a 4-week UD and 4-week ICKD under the hypoxic condition.

Results
We analysed data for all 6 participants (BMI 19.9–24.6 kg m−2). Mean VO2max in the normoxic condition was 44.6 ml kg−1 min−1. Hypoxia led to decreased performance in all participants. With the ICKD diet, median values for PaO2 decreased by − 14.5% and VO2max by + 7.3% and Ppeak by + 4.7%.

Conclusion
All participants except one could complete the ICKD. VO2max improved with the ICKD under the hypoxia condition. Therefore, an ICKD is an interesting alternative to CHOs dependency for endurance performance at high-altitudes, including high-altitude training and high-altitude races. Nevertheless, decreased PaO2 with ICKD remains a significant limitation in very-high to extreme altitudes (> 3500 m).
Trial registration Clinical trial registration Nr. NCT05603689 (Clinicaltrials.gov). Ethics approval CER-VD, trial Nr. 2020-00427, registered 18.08.2020—prospectively registered.
Metabolic syndrome biomarkers relate to rate of cognitive decline in MCI and dementia stages of Alzheimer’s disease
Authors: Pillai Jagan A. , Bena James , Bekris Lynn , Kodur Nandan , Kasumov Takhar , Leverenz James B. , Kashyap Sangeeta R. ,   on behalf of the Alzheimer’s Disease Neuroimaging Initiative
Published: March 2023

Abstract
Background
The relationship between biomarkers of metabolic syndrome and insulin resistance, plasma triglyceride/HDL cholesterol (TG/HDL-C) ratio, on the rate of cognitive decline in mild cognitive impairment (MCI) and dementia stages of Alzheimer’s disease (AD) is unknown. The role of peripheral and cerebrospinal fluid (CSF) levels of Apolipoprotein A1 (ApoA1), a key functional component of HDL, on cognitive decline also remains unclear among them. Here we evaluate baseline plasma TG/HDL-C ratio and CSF and plasma ApoA1 levels and their relation with cognitive decline in the MCI and Dementia stages of AD.

Patients and methods
A retrospective longitudinal study (156 participants; 106 MCI, 50 AD dementia) from the Alzheimer’s Disease Neuroimaging Initiative, with an average of 4.0 (SD 2.8) years follow-up. Baseline plasma TG/HDL-C, plasma, and CSF ApoA1 and their relationship to inflammation and blood–brain barrier (BBB) biomarkers and longitudinal cognitive outcomes were evaluated. Multivariable linear mixed effect models were used to assess the effect of baseline analytes with longitudinal changes in Mini-Mental State Exam (MMSE), Clinical Dementia Rating–Sum of Boxes (CDR-SB), and Logical Memory delayed recall (LM) score after controlling for well-known covariates.

Results
A total of 156 participants included 98 women, 63%; mean age was 74.9 (SD 7.3) years. At baseline, MCI and dementia groups did not differ significantly in TG/HDL-C (Wilcoxon W statistic = 0.39, p = 0.39) and CSF ApoA1 levels (W = 3642, p = 0.29), but the dementia group had higher plasma ApoA1 than the MCI group (W = 4615, p = 0.01). Higher TG/HDL-C ratio was associated with faster decline in CDR-SB among MCI and dementia groups. Higher plasma ApoA1 was associated with faster decline in MMSE and LM among MCI, while in contrast higher CSF ApoA1 levels related to slower cognitive decline in MMSE among MCI. CSF and plasma ApoA1 also show opposite directional correlations with biomarkers of BBB integrity. CSF but not plasma levels of ApoA1 positively correlated to inflammation analytes in the AGE-RAGE signaling pathway in diabetic complications (KEGG ID:KO04933).

Conclusions
Biomarkers of metabolic syndrome relate to rate of cognitive decline among MCI and dementia individuals. Elevated plasma TG/HDL-C ratio and plasma ApoA1 are associated with worse cognitive outcomes in MCI and dementia participants. CSF ApoA1 and plasma ApoA1 likely have different roles in AD progression in MCI stage.
Comparison of OX40 expression in patients with multiple sclerosis and neuromyelitis optica as an approach to diagnosis
Authors: Manian Mostafa , Motallebnezhad Morteza , Nedaeinia Reza , Salehi Rasoul , Khani Leila , Ferns Gordon A. , Jazayeri Mir Hadi 
Published: March 2023

Abstract
Background
Previous studies have shown that CD134 (OX40) co-stimulation is involved in the pathogenesis of experimental autoimmune encephalomyelitis (EAE) models and the antigen is expressed within multiple sclerosis lesions in humans. OX40 (CD134) is thought to be a secondary co-stimulatory immune checkpoint molecule that is expressed by T cells. This study aimed to evaluate the mRNA expression of OX40 and its serum levels in the peripheral blood of patients with Multiple Sclerosis (MS) or Neuromyelitis Optica (NMO).

Methods
Patients with MS (n = 60), NMO (n = 20), and 20 healthy subjects were recruited from Sina Hospital, Tehran, Iran. The diagnoses were confirmed by a specialist in clinical neurology. Peripheral venous blood was obtained from all subjects, and mRNA quantification of OX40 was conducted using real-time PCR. Serum samples were also obtained and the concentration of OX40 was determined using an enzyme-linked immunosorbent assay (ELISA).

Results
There was a significant correlation between the mRNA expression and serum levels of OX40 and disability as assessed using the expanded disability status scale (EDSS) in the patients with MS, but not in the patients with NMO. Expression of OX40 mRNA was significantly higher in the peripheral blood of MS patients compared to healthy individuals and NMO patients (*P < 0.05). In addition, serum OX40 concentrations were also significantly higher in patients with MS patients compared with healthy subjects (9.08 ± 2.48 vs. 1.49 ± 0.54 ng/ml; P = 0.041).

Conclusions
It appears that an increased expression of OX40 may be associated with the hyperactivation of T cells in patients with MS, and this may play a role in the pathogenesis of the disease.
B cells and T cells abnormalities in patients with selective IgA deficiency
Authors: Bagheri Yasser , Moeini Shad Tannaz , Namazi Shideh , Tofighi Zavareh Farzaneh , Azizi Gholamreza , Salami Fereshteh , Sadani Somayeh , Hosseini Ali , Saeidi Mohsen , Pashangzadeh Salar , Delavari Samaneh , Mirminachi Babak , Rezaei Nima , Abolhassani Hassan , Aghamohammadi Asghar , Yazdani Reza 
Published: March 2023

AbstractBackgroundSelective IgA deficiency (SIgAD) is the most prevalent inborn errors of immunity with almost unknown etiology. This study aimed to investigate the clinical diagnostic and prognostic values of lymphocyte subsets and function in symptomatic SIgAD patients.MethodsA total of 30 available SIgAD patients from the Iranian registry and 30 age-sex-matched healthy controls were included in the present study. We analyzed B and T cell peripheral subsets and T cell proliferation assay by flow cytometry in SIgAD patients with mild and severe clinical phenotypes.ResultsOur results indicated a significant increase in naïve and transitional B cells and a strong decrease in marginal zone-like and switched memory B-cells in SIgAD patients. We found that naïve and central memory CD4+T cell subsets, as well as Th1, Th2 and regulatory T cells, have significantly decreased. On the other hand, there was a significant reduction in central and effector memory CD8+T cell subsets, whereas proportions of both (CD4+and CD8+) terminally differentiated effector memory T cells (TEMRA) were significantly elevated in our patients. Although some T cell subsets in severe SIgAD were similar, a decrease in marginal-zone and switched memory B cells and an increase in CD21lowB cell of severe SIgAD patients were slightly prominent. Moreover, the proliferation activity of CD4+T cells was strongly impaired in SIgAD patients with a severe phenotype.ConclusionSIgAD patients have varied cellular and humoral deficiencies. Therefore, T cell and B cell assessment might help in better understanding the heterogeneous pathogenesis and prognosis estimation of the disease.
Long-term efficacy of HDM-SCIT in pediatric and adult patients with allergic rhinitis
Authors: Ren Lei , Wang Chengshuo , Xi Lin , Gao Yunbo , Zhang Yuan , Zhang Luo 
Published: March 2023

Abstract
Background
Subcutaneous immunotherapy (SCIT) is a well-validated and effective disease modification treatment for house dust mites (HDM)-induced allergic rhinitis (AR). Long-term post-treatment comparisons in children and adults treated with SCIT have rarely been published. This study aimed to evaluate the long-term efficacy of HDM-SCIT administered under a cluster schedule in children compared to adults.

Methods
This was an open-design, observational, long-term clinical follow-up study on children and adults with perennial AR treated with HDM-SCIT. The follow-up consisted of a three-year treatment duration plus a post-treatment follow-up of over three years.

Results
Patients in the pediatric (n = 58) and adult (n = 103) groups completed a post-SCIT follow-up of over three years. The total nasal symptom score (TNSS), combined symptom medication score (CSMS), and rhinoconjunctivitis quality-of-life questionnaire (RQLQ) score decreased significantly at T1 (three-year SCIT completed) and T2 (follow-up completed) in the pediatric and adult groups. In both groups, the improvement rate of TNSS (T0-T1) was moderately correlated with the baseline TNSS (r = 0.681, p < 0.001 and r = 0.477, p < 0.001 for children and adults, respectively). Only in the pediatric group, TNSS was significantly lower at T2 compared with that right after SCIT cessation (T1) (p = 0.030).

Conclusions
Children and adults with HDM-induced perennial AR could achieve a sustainable post-treatment efficacy for over three years (up to 13 years) following a three-year SCIT. Patients with relatively severe nasal symptoms at baseline may benefit more from SCIT. Children who have completed an adequate course of SCIT may gain further improvement in nasal symptoms after SCIT cessation.
New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles’ operation
Authors: Park Byung Kwan , Chung Jae Hoon , Song Wan , Kang Minyong , Sung Hyun Hwan , Jeon Hwang Gyun , Jeong Byong Chang , Seo Seong Il , Jeon Seong Soo , Lee Hyun Moo , Kwon Ghee Young 
Published: March 2023

Abstract
Objectives
Currently, a prostate biopsy is guided by transrectal ultrasound (US) alone. However, this biopsy cannot be performed in men without an anus. The aim of this study was to show the outcomes of a new transperineal US (TPUS)-guided biopsy technique in patients who underwent Miles’ operation.

Methods
Between April 2009 and March 2022, TPUS-guided biopsy was consecutively conducted in 9 patients (median, 71 years; range, 61–78 years) with high prostate-specific antigen values (22.60 ng/mL; 6.19–69.7 ng/mL). Their anuses were all removed due to rectal cancer. TPUS-guided biopsy was performed according to information on prostate magnetic resonance imaging. The technical success rate, cancer detection rate, and complication rate were recorded. Tumor sizes were compared between benign and cancer groups using an unpaired t-test with Welch’s correction.

Results
The new TPUS-guided biopsy was successfully performed in all patients. Cancer was detected in 77.8% (7/9) of the patients. These were all categorized as PI-RADS 5. Among them, the detection rate of significant cancer (Gleason score 7 or higher) was 66.7% (6/9). The median tumor size was 2.4 cm (1.7–3.1 cm). However, two patients were diagnosed with benign tissue with PI-RADS 3 or PI-RADS 4. Their median tumor size was 1.0 cm (0.8–1.2 cm). There was significant difference between the cancer and benign groups (p = 0.037) in terms of tumor size. Neither post-biopsy bleeding nor infections occurred.

Conclusions
New TPUS-guided biopsy technique may contribute to detecting large PI-RADS 5 prostate cancer in men after Miles’ operation.
Does deep learning software improve the consistency and performance of radiologists with various levels of experience in assessing bi-parametric prostate MRI?
Authors: Arslan Aydan , Alis Deniz , Erdemli Servet , Seker Mustafa Ege , Zeybel Gokberk , Sirolu Sabri , Kurtcan Serpil , Karaarslan Ercan 
Published: March 2023

Abstract
Objective
To investigate whether commercially available deep learning (DL) software improves the Prostate Imaging-Reporting and Data System (PI-RADS) scoring consistency on bi-parametric MRI among radiologists with various levels of experience; to assess whether the DL software improves the performance of the radiologists in identifying clinically significant prostate cancer (csPCa).

Methods
We retrospectively enrolled consecutive men who underwent bi-parametric prostate MRI at a 3 T scanner due to suspicion of PCa. Four radiologists with 2, 3, 5, and > 20 years of experience evaluated the bi-parametric prostate MRI scans with and without the DL software. Whole-mount pathology or MRI/ultrasound fusion-guided biopsy was the reference. The area under the receiver operating curve (AUROC) was calculated for each radiologist with and without the DL software and compared using De Long’s test. In addition, the inter-rater agreement was investigated using kappa statistics.

Results
In all, 153 men with a mean age of 63.59 ± 7.56 years (range 53–80) were enrolled in the study. In the study sample, 45 men (29.80%) had clinically significant PCa. During the reading with the DL software, the radiologists changed their initial scores in 1/153 (0.65%), 2/153 (1.3%), 0/153 (0%), and 3/153 (1.9%) of the patients, yielding no significant increase in the AUROC (p > 0.05). Fleiss’ kappa scores among the radiologists were 0.39 and 0.40 with and without the DL software (p = 0.56).

Conclusions
The commercially available DL software does not increase the consistency of the bi-parametric PI-RADS scoring or csPCa detection performance of radiologists with varying levels of experience.
Macroprolactinoma with secondary resistance to dopamine agonists: a case report and review of the literature
Authors: Tng Eng-Loon , Teo Ada Ee Der , Aung Aye Thida 
Published: March 2023

Abstract
Background
Resistance to dopamine agonists is not uncommonly seen in prolactinomas. However, development of resistance to dopamine agonists after an initial period of robust treatment response is rare, and only 39 cases have been reported in the past four decades. We describe a Chinese man with this rare condition and explored the postulated mechanisms that may explain this phenomenon. We compiled similar cases that were previously reported and compared their etiology, progress, and response to treatment. On the basis of these cases, we derived a list of differential diagnoses to consider in patients with secondary resistance to dopamine agonists.

Case presentation
A 63-year-old Chinese man presented with blurred vision and was subsequently diagnosed with a macroprolactinoma. He had initial response to cabergoline but developed secondary resistance to it after 5 years. The prolactinoma continued to grow, and his serum prolactin remained markedly elevated despite adherence to escalating dosages of cabergoline up to 6 mg/week. The patient finally underwent transsphenoidal surgery and was found to have a sparsely granulated lactotroph tumor with Ki-67 index of 5%. Postoperatively, there was improvement in his serum prolactin level, although he still required treatment with cabergoline at 6 mg/week.

Conclusions
Surgery can facilitate disease control in patients with prolactinomas that develop secondary resistance to dopamine agonists. Malignant prolactinoma is an important differential diagnosis in this group of patients, especially when serum prolactin remains markedly elevated despite resolution or stability of the primary pituitary lesion, suggesting a metastatic source of prolactin secretion.
Polycythemia with elevated erythropoietin production in a patient with a urinary stone and unilateral hydronephrosis: a case report
Authors: Hajika Yuriko , Kawaguchi Yuji , Hamazaki Kenji , Kumeda Yasuro 
Published: March 2023

Abstract
Background
Absolute polycythemia can be primary or secondary. Erythropoietin-producing diseases (for example, hypoxia) are the major cause of secondary polycythemia. There are reports of polycythemia secondary to hydronephrosis. However, to our knowledge, there is no report on polycythemia secondary to hydronephrosis due to a urinary stone. Herein, we present a case of polycythemia with an elevated erythropoietin level in a patient with a urinary stone and unilateral hydronephrosis.

Case presentation
A 57-year-old Japanese man presented with polycythemia and an elevated erythropoietin level. Erythropoietin accumulation was not due to erythropoietin secretion by a tumor as no obvious lesions were detected on contrast-enhanced computed tomography. Abdominal ultrasonography revealed a stone in the left urinary tract and renal hydronephrosis, and 2 weeks later, the patient underwent transurethral ureterolithotripsy without complications. Blood tests 2 weeks after transurethral ureterolithotripsy showed that the erythropoietin level had declined. Hemoglobin concentration decreased from 20.8 mg/dL before and immediately after transurethral ureterolithotripsy to 15.8 mg/dL 3 months after transurethral ureterolithotripsy. This case was diagnosed as erythropoietin elevation due to unilateral hydronephrosis with a urinary stone, resulting in polycythemia.

Conclusions
Hydronephrosis is a common disease but is not often associated with polycythemia. Further studies are required to elucidate the mechanism and implications of elevated erythropoietin production in hydronephrosis.