bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smoking-related epigenetic modifications are associated with the prognosis and chemotherapeutics of patients with bladder cancer
Authors: Ling Ya , Li Jindong , Zhou Lijuan 
Published: April 2023

Objective Epidemiologic studies have linked smoking to various malignancies, including bladder cancer, but its underlying biological functions remain elusive. Currently, we aimed to identify the smoking-related epigenetic modifications and disclose their impacts on prognosis and therapies in bladder cancer. Methods DNA methylation, transcriptome, and clinical profiles were acquired from The Cancer Genome Atlas (TCGA) using “TCGAbiolinks” Differential expression analyses were performed with “limma” and visualized by the “pheatmap” package. Smoking-related interactions were displayed using Cytoscape. Least absolute shrinkage and selection operator (LASSO) algorithm was for generation of a smoking-related prognostic model. Kaplan–Meier analysis with log-rank test was for survival analysis, followed by a prognostic nomogram. The Gene Set Enrichment Analysis (GSEA) was used for functional analysis. The “oncoPredict” package was applied for drug sensitivity analysis. Results We recruited all types of bladder cancers and found that smoking was involved in poor prognosis, with the hazard ratio (HR) of 1.600 (95%CI: 1.028–2.491). A total of 1078 smoking-related DNA methylations (526 hypermethylation and 552 hypomethylation) were identified and 9 methylation-driven genes differentially expressed in bladder cancer. Also, 506lncRNAs (448 upregulated and 58 downregulated lncRNAs) and 102 miRNAs (74 upregulated and 28 downregulated miRNAs) were determined as smoking-related ncRNAs. We then calculated the smoking-related risk score and observed that cases of high risk were predicted with poor prognosis. We constructed a prognostic nomogram to predict the 1-, 3-, and 5-year overall survival rates. Several cancer-related pathways were enriched in the high-risk group, and patients with high-risk were more sensitive to Gemcitabine, Wnt-C59, JAK1_8709, KRAS (G12C) Inhibitor-12, and LY2109761. Whereas, those with low-risk were more sensitive to Cisplatin, AZ960, and Buparlisib. Conclusions Totally, we initially identified the smoking-related epigenetic modifications in bladder cancer and constructed a corresponding prognostic model, which was also linked to disparate sensitivities to chemotherapeutics. Our findings would provide novel insights into the carcinogenesis, prognosis, and therapies in bladder cancer.
Medial patellofemoral ligament reconstruction using a digital tensiometer to determine graft tension: Surgical technique and mid-term follow-up
Authors: Zhang Wenhao , Mou Limin , Deng Yingjie , Xiang Wenyuan , Zhang Shiping , Aimaiti Remila , Yuan Zhiyu , Fang Rui 
Published: April 2023

Purpose The optimal method for achieving proper graft tension during patellofemoral ligament reconstruction is a topic of debate. In the past, a digital tensiometer was used to simulate the knee structure, and a tension of approximately 2N was identified as suitable for restoring the patellofemoral track. However, it is unclear whether this tension level is sufficient during the actual surgery. The objective of this study was to verify the efficacy of graft tension using a digital tensiometer for medial patellofemoral ligament (MPFL) reconstruction and to conduct a mid-term follow-up. Methods The study enrolled 39 patients who had experienced recurrent patellar dislocation. Preoperative computed tomography scans and X-rays confirmed patellar instability, patellar tilt angle patellar congruence angle and the history of dislocation and patellar apprehension test. Knee function was evaluated using preoperative and postoperative Lysholm and Kujala scores. Results The study included 39 knees, comprising 22 females and 17 males, with an average age of 21.10 ± 7.26. The patients were followed up for at least 24 months through telephone or face-to-face questionnaires. All patients had a preoperative history of ≥2 patellar dislocations, none of which were surgically treated. During surgery, all patients underwent isolated MPFL reconstruction and lateral retinacula release. The mean Kujala and Lysholm scores were 91.28 ± 4.90 and 90.67 ± 5.15, respectively. The mean PTA and PCA were 11.5 ± 2.63 and 2.38 ± 3.58, respectively. The study found that a tension of approximately 27.39 ± 5.57N (14.3–33.5N) was required to restore the patellofemoral track in patients with recurrent patellar dislocation. No patients required reoperation during the follow-up period. Overall, 36 out of 39 patients (92.31%) reported no pain when completing daily activities at the last follow-up. Conclusion In conclusion, a tension level of approximately 27.39 ± 5.57N is necessary to restore normal patellofemoral relationships during clinical practice, which indicates that using a tension of 2N is too low. The use of a tensiometer during patellofemoral ligament reconstruction is a more accurate and reliable surgical procedure for treating recurrent patellar dislocation.
Favorable Appendicular Skeletal Muscle Mass Changes in Older Patients With Type 2 Diabetes Receiving GLP-1 Receptor Agonist and Basal Insulin Co-Therapy
Authors: Osaka Takafumi , Hamaguchi Masahide , Fukui Michiaki 
Published: April 2023

Background And Aims: Maintaining appendicular skeletal muscle mass is important for maintaining the quality of life of elderly patients with type 2 diabetes. The possibility of GLP-1 receptor agonists for maintaining appendicular skeletal muscle mass has previously been reported. We investigated changes in appendicular skeletal muscle mass, measured by body impedance analysis, in elderly patients who were hospitalized for diabetes self-management education. Methods: The study design was a retrospective longitudinal analysis of the changes in appendicular skeletal muscle mass in hospitalized patients over the age of 70 years. The study subjects consisted of consequential patients who received GLP-1 receptor agonist and basal insulin co-therapy or received basal insulin therapy. Body impedance analysis was performed on the day after admission and on the ninth day of admission. All patients received standard diet therapy and standard group exercise therapy 3 times per week. Results: The study subjects consisted of 10 patients who received GLP-1 receptor agonist and basal insulin co-therapy (co-therapy group) and 10 patients who received basal insulin (insulin group). The mean change in appendicular skeletal muscle mass was 0.78 ± 0.7 kg in co-therapy group and −0.09 ± 0.8 kg in the insulin group. Conclusions: This retrospective observational study suggests the possibility of favorable effects of GLP-1 receptor agonist and basal insulin co-therapy for maintaining appendicular skeletal muscle mass during hospitalization for diabetes self-management education.
Mechanical thrombectomy versus medical management for acute basilar artery occlusions: A meta-analysis of randomized trials
Authors: Bouslama Mehdi , Kuo Cathleen C , Monteiro Andre , Lim Jaims , Turner Ryan , Raygor Kunal , Lai Pui Man Rosalind , Baig Ammad A , Davies Jason M , Snyder Kenneth V , Levy Elad I , Siddiqui Adnan H 
Published: April 2023

Background Basilar artery occlusion (BAO) stroke is a catastrophic clinical event that results in significant morbidity and mortality. Whether MT is superior in improving outcomes remains largely inconclusive. We performed a meta-analysis of randomized controlled trials (RCTs) to better understand the efficacy and safety of MT in treating BAO compared to medical management (MM). Methods PubMed and EMBASE were searched to identify RCTs that directly compared the safety and efficacy of MT versus MM for patients with BAO. The primary outcome was modified Rankin scale (mRS) 0–3 at 3 months, and secondary outcome variables included National Institutes of Health Stroke Scale (NIHSS) at 24 hours, mRS 0–2 at 3 months, symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results Four RCTs with 988 patients (432 in the MM arm and 556 in the MT arm), were included. Patients receiving MT had significantly higher rate of mRS 0–2 (OR = 1.994, 95% CI: 1.319–3.012) and mRS 0–3 (OR = 2.259, 95% CI: 1.166–4.374) at 3 months in comparison to patients receiving MM. Mortality was also significantly reduced in the MT group (OR = 0.640, 95% CI: 0.493–0.831). However, increased odds of sICH were found in the MT group compared to the MM group (OR = 8.193, 95% CI: 2.451–27.389). No difference was observed in terms of NIHSS at 24 hours between the two arms. Conclusions Despite the higher risk of sICH, MT was associated with superior functional outcomes and reduced mortality compared to MM in BAO patients. A revision of current guidelines for treatment of acute ischemic stroke from basilar artery occlusion should be considered.
Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated?
Authors: Amen John , Perkins Oliver , Kafchitsas Konstantinos , Reed Daniel , Norman-Taylor Fabian , Kokkinakis Michail 
Published: April 2023

Purpose: Decisions for postoperative immobilization after bony hip reconstructive surgery in cerebral palsy are controversial in current practice. The aim of this study was to check if choosing not to use any kind of postoperative immobilization is a safe practice. Methods: A retrospective cohort study was conducted in a pediatric orthopedic tertiary referral center. The study included 148 patients (228 hips) with cerebral palsy, who had bony hip surgery. Medical records were reviewed for incidence of complications, methods of pain control, and length of hospital stay. Three radiographic measures (neck-shaft angle, Reimers migration index, and acetabular index) were performed on preoperative and postoperative X-rays. X-rays were also checked for mechanical failure of implant, recurrent dislocation/subluxation, and fractures in the first 6 months postoperatively. Results: In total, 94 (64%) were male and 54 (36%) were female. Seventy-seven (52%) were Gross Motor Function Classification System V, mean age at surgery was 8.6 years (2.5–18.4 years). Length of hospital stay was 6.25 days (SD 4.64 days). Medical complications that may have prolonged hospital stay occurred in 41 patients (27.7%). Radiological measurements showed significant improvement postoperatively ( p = 0.001). Seven patients (4.7%) had another surgery in first 6 months (three for recurrent dislocation/subluxation, three for implant failure, and one for ipsilateral femur fracture). Conclusion: Avoiding postoperative immobilization following bony hip surgery in cerebral palsy is a safe practice and associated with reduced rate of medical and mechanical problems compared to the current literature. This approach should be utilized with optimal pain and tone management.
Kidney function while on immune checkpoint inhibitors: Trends in incidence of acute kidney injury, and its causes and outcomes
Authors: Garcia Pablo , Stedman Margaret R , Merlo Shayli , Kaghazchi Aydin , Reddy Sunil , Katsumoto Tamiko R , Anand Shuchi 
Published: April 2023

Background and objectives: Immune checkpoint inhibitor (ICI) use is increasing in the United States, real world data on acute kidney injury (AKI) in the expanding population are sparse. We evaluated trends in AKI incidence, and causes and management of AKI among 1914 persons receiving ICIs in a single center over a period of 5 years. Methods: We included all adults who received ICIs at the Stanford Healthcare System from July 1, 2015 to June 30, 2020. We defined AKI as an increase in serum creatinine to 1.5 times the baseline or an increase of ⩾0.3 mg/dL, and determined mean cumulative incidence of first and repeated episodes of AKI over three time periods. Results: Among the 1914 patients treated with ICIs, mean age was 64.9 (SD 14.3) years, 43% were women, 25% had baseline chronic kidney disease (CKD), 34% had lung and 23% had skin cancer as the indication. The overall cumulative incidence of any AKI and immune-related AKI at 1 year after initiating immunotherapy was 32% and 1.3% respectively. Among 586 cases of AKI, the most common cause was volume depletion (64%). Although 4% of AKI was immune-related, ICI therapy was discontinued in 14% of patients with AKI. Nephrology was consulted in 6%. The risk for AKI was higher among patients with a comorbidity index ⩾3 (vs CMI 0, HR 1.65 [95% CI 1.26–2.17]), digestive system cancer (vs skin cancer, 1.65 [1.13–2.43]), and lower baseline estimated glomerular filtration rate (30–59 and <30 vs >60) (HR 1.69 [1.32–2.16] and 1.85 [1.16–2.97] respectively). Conclusions: AKI occurs in up to 1 in 3 patients, and 1 in 10 will have repeated episodes during the first year of ICI therapy. Incidence of AKI has remained similar over 5-year time span. The cause of AKI while on ICI is rarely an immune-related adverse event.
Nudging General Practitioners to explore suicidal thoughts among depressed patients
Authors: Elzinga Elke , de Beurs Derek P. , Beekman Aartjan T.F. , Maarsingh Otto R. , Gilissen Renske 
Published: April 2023

Abstract
Background
While frank discussion of suicidal thoughts in patients with depression is important for the prevention of suicide, suicide exploration of General Practitioners (GPs) is suboptimal. This study aimed to assess whether an intervention that prompts pop-up screens nudges GPs to more frequently explore suicidal thoughts over the course of two years.

Methods
From January 2017 to December 2018, the intervention was incorporated in the information system of the Dutch general practice sentinel network. New registration of an episode of depression triggered a pop-up screen referring to a questionnaire about GPs’ behaviour with regard to exploring suicidal thoughts. In two years, 625 questionnaires were completed by GPs and analysed using multilevel logistic regression analyses.

Results
Compared to the first year, GPs were 50% more likely to explore suicidal thoughts among patients in the second year (OR 1.48; 95%CI 1.01–2.16). When adjusting for patients’ gender and age we found that the effect of the pop-up screens disappeared (OR 1.33; 95% CI 0.90–1.97). Suicide exploration occurred less frequently in women than in men (OR 0.64; 95% CI 0.43–0.98) and in older compared to younger patients (OR 0.97; 95% CI 0.96–0.98 per year older). In addition, 26% of variation in suicide exploration was because of differences in general practice. There was no evidence that general practices developed differently over time.

Conclusions
Although low cost and easy to administer, the pop-up system was not effective in nudging GPs to explore suicidality more frequently. We encourage studies to test whether implementing these nudges as part of a multifaceted approach will lead to a stronger effect. Moreover, we recommend researchers to include more variables, such as work experience or previous mental health training, to better understand the effects of the intervention on GPs’ behaviour.
Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda
Authors: Arach Anna Agnes Ojok , Nakasujja Noeline , Rujumba Joseph , Mukunya David , Odongkara Beatrice , Musaba Milton W. , Napyo Agnes , Tumwine James K. , Nankabirwa Victoria , Ndeezi Grace , Kiguli Juliet 
Published: April 2023

AbstractBackgroundPerinatal death has profound psychosocial effects on women and their families. Sociocultural contexts influence the burden, rituals and bereaved’s support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death.MethodsThis study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identified through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes.ResultsStillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes.ConclusionStillbirth or early neonatal death is viewed as the death of a child, different from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.
Time-dependent recurrence and resolution of pigment epithelial detachment in central serous chorioretinopathy
Authors: Meng Yang , Chen Liao , Li Lu , Xu Yishuang , Su Yu , Zhang Lu , Yi Zuohuizi , Chen Changzheng 
Published: April 2023

Abstract
Background
Cortisol plays a role in the pathogenesis of central serous chorioretinopathy (CSC). CSC patients have abnormal time-dependent changes in cortisol levels. Here we report a rare case of a patient with central serous chorioretinopathy whose pigment epithelial detachment (PED) exhibited time-dependent recurrence and resolution.

Case presentation
A 47-year-old man presented in 2016 for vision loss in the left eye related to recurrent CSC. During follow-up, his PED was observed to resolve spontaneously while he was still in our clinic and recurred the next morning. Such time-dependent changes of the PED were observed in several next follow-ups without any intervention. After excluding possible external factors, the abnormal diurnal variation of cortisol was considered as the internal factor affecting PED.

Conclusions
This is the first article that described the spontaneous time-dependent recurrence and resolution of PED without external interference, where endogenous cortisol may be responsible. Interventions against the abnormal cortisol level might be a potential treatment strategy for CSC. More research is urged to explore the impact of the diurnal change in cortisol levels on eyes with CSC.
Decreased insight, but not self-stigma or belief about medicine, is associated with greater severity of delusions in a sample of long-stay patients with schizophrenia: a cross-sectional study
Authors: Beainy Christina , Haddad Chadia , Fekih-Romdhane Feten , Hallit Souheil , Haddad Georges 
Published: April 2023

AbstractBackgroundThere are, to date, limited and inconsistent findings concerning the relationship between insight and psychotic symptoms, despite some evidence in favor of the clinical and therapeutic relevance of the insight construct. We aimed to add to the pool of the available data in this area, by examining the correlations between the severity of insight and positive psychotic symptoms (delusions and auditory hallucinations), while accounting for self-stigma and attitudes towards medication, in a sample of long-stay inpatients with schizophrenia.MethodsA cross-sectional study was conducted at the Psychiatric Hospital of the Cross, between July and October 2021. A total of 82 patients diagnosed with schizophrenia (aged 55.55 ± 10.21 years, 54.9% males) were enrolled. The semi-structured psychotic symptom rating scales, the Birchwood Insight Scale, the Belief About Medicine Questionnaire, and the Internalized Stigma of Mental Illness were used.ResultsThe mean duration of illness in years was 30.15 ± 11.73, and the mean duration of hospitalization in years was 17.56 ± 9.24. Sixteen out of the 82 patients (19.5%) were considered as having poor insight. Bivariate analyses showed that higher chlorpromazine equivalent dose was significantly associated with more delusions, whereas higher insight was significantly associated with lower delusions. Multivariable analyses revealed that Higher chlorpromazine equivalent dose (Beta = 0.004) was significantly associated with more delusions, whereas higher insight (Beta = − 0.89) was significantly associated with less delusions. No significant associations were found between insight, self-stigma and hallucinations.ConclusionOur results imply that more impaired insight is associated with greater severity of delusions, above and beyond the effects of self-stigma and medication doses. These findings are valuable to aid clinicians and researchers improve their understanding of the relationship insight-psychotic symptoms, and could help personalize prevention and early intervention strategies in schizophrenia.
Comparison of staged LLIF combined with posterior instrumented fusion with posterior instrumented fusion alone for the treatment of adult degenerative lumbar scoliosis with sagittal imbalance
Authors: Lai Oujie , Li Hao , Chen Qixing , Hu Yong , Chen Yunling 
Published: April 2023

Abstract
Background
To retrospectively compare the clinical and radiological outcomes of staged lateral lumbar interbody fusion (LLIF) combined with posterior instrumented fusion(PIF)with PIF alone for the treatment of adult degenerative lumbar scoliosis (ADLS) with sagittal imbalance.

Methods
ADLS patients with sagittal imbalance underwent corrective surgery were included and divided into staged group (underwent multilevel LLIF in the first-stage and PIF in the second-stage) and control group (PIF alone). The clinical and radiological outcomes were evaluated and compared between the two groups.

Results
Forty-five patients with an average age of 69.7±6.3 years were enrolled, including 25 in the staged group and 20 in the control group. Compared with preoperative values, patients in both groups achieved significant improvement in terms of ODI, VAS back, VAS leg and spinopelvic parameters after surgery, which were maintained well during the follow-up period. Compared with control group, total operative time in the staged group was longer, but the amounts of blood loss and blood transfusion were reduced. The average posterior fixation segments were 6.20±1.78 in the staged group and 8.25±1.16 in the control group (P<0.01), respectively. Posterior column osteotomy (PCO) was performed in 9 patients (36%) in the staged group, while PCO and/or pedicle subtraction osteotomy were performed in 15 patients (75%) in the control group (P<0.01). There was no difference in complications between the two groups.

Conclusion
Both surgical strategies were effective for the treatment of ADLS with sagittal imbalance. However, staged treatment was less invasive, which reduced the number of posterior fixation segments and osteotomy requirement.