bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kaempferol Protects Against Apoptosis in PC12 Cells Exposed to Hydrogen Peroxide by Activating Akt1
Authors: Li Erliang , Yan Kang , Zhang Rui , Zou Peng , Li Shuang , Ma Qiong , Liao Bo 
Published: April 2023

Objective Spinal cord injury (SCI) is a debilitating disease that cannot be cured at present. Kaempferol (KPL) has proven neuroprotective, antioxidant, and antibacterial properties. However, the neuroprotective effect of KPL on SCI and its potential mechanism are still unclear. Methods Network pharmacology and molecular docking were used to determine the potential mechanisms of KPL on SCI. In vitro studies were used to validate the results. Hydrogen peroxide (H2O2)-exposed PC12 cells were pretreated with or without KPL. The safe concentrations of KPL, H2O2, and MK2206 in PC12 cells were determined via cell counting kit-8 assays. Then, terminal deoxynucleotidyl transferase dUTP nick end labeling staining and Annexin V-FITC/PI double staining were used to detect apoptotic cells. In addition, Western blotting was utilized to measure apoptosis-related gene and protein expression levels. Results Network pharmacology and molecular docking data demonstrated an interaction between KPL and Akt1 and identified apoptosis as a potential target of the KPL/Akt1 complex. The data verified that KPL could inhibit mitochondrial apoptosis in vivo by inducing Akt1 phosphorylation. Subsequently, MK2206, a pharmacological Akt1 inhibitor, was used to assess the role of Akt1 in this process, and we found that MK2206 attenuated the antiapoptotic effect of KPL on PC12 cells. Conclusion This study demonstrates that KPL could inhibit mitochondrial apoptosis by inducing the phosphorylation of Akt1, suggesting that KPL is a very promising candidate for SCI treatment.
Matrixmidface Preformed Orbital Implants for Three-Dimensional Reconstruction of Orbital Floor and Medial Wall Fractures: A Prospective Clinical Study
Authors: Chodankar Neha Umakant , Dhupar Vikas , Akkara Francis , Vijay Vathsalya 
Published: April 2023

Study Design Prospective Interventional study Objective To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures. Methods This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of orbital floor and medial wall fracture defects using Matrixmidface Preformed Orbital plates and open reduction and internal fixation of associated fractures. The following parameters were studied preoperative and postoperative enophthalmos, hypoglobus, orbital volume; correction of diplopia, intraoperative and postoperative complications. Results All 14 patients were males aged between 19 and 42 years. The most common mode of injury was found to be road traffic accidents (RTAs) followed by self-fall and trauma at workplace. Orbital fractures were associated with other concomitant maxillofacial fractures in 12 patients (85.7%) while 2 patients (14.3%) had pure blowout fractures. Significant improvement of enophthalmos was noted from preoperative period to 1 week, 6 weeks, and 6 months postoperatively ( P value .02, .01, and .01, respectively). Out of 11 patients with preoperative hypoglobus, 5 patients (45.45%) had persistent hypoglobus in the immediate postoperative period which reduced to 4 patients (36.36%) at 6 weeks postoperatively (p value .00). The postoperative orbital volume of fractured side ranged from 20.3 cm3 to 26.76 cm3 with a mean of 23.50 cm3 ± 1.74. The mean difference between the volumes of the repaired and uninjured sides was found to be .27 cm3 ± .39 ( P value .02) denoting that the reconstruction of the orbit closely approximated that of the uninjured side. Conclusions The Matrixmidface Preformed Orbital plate provides exceptional reconstruction of the orbital blowout fracture defects and ensures satisfactory results clinically and radiographically. The plate ensures an approximate recreation of topographical anatomy of the orbit and adequately restores the orbital volume. It provides adequate correction of asymmetry, hypoglobus, enophthalmos and attempts to restore eye movements, without causing any significant postoperative complication.
Medicinal Cannabis and Implications for Workplace Health and Safety: Scoping Review of Systematic Reviews
Authors: O’Neill Veronica , Karanikas Nektarios , Sav Adem , Murphy Patricia 
Published: April 2023

Purpose: Although medicinal cannabis is prescribed for conditions such as pain, epilepsy, nausea and vomiting during cancer treatment, evidence about associated adverse side effects is still evolving. Because adverse events (AEs) might impact the performance of workers, it is important to consider their implications on workplace health and safety (WHS). This study aimed to map the types and prevalence of the AEs associated with medical cannabis and articulate how those events could impact WHS. Methods: A scoping review of systematic reviews and/or meta-analyses published between 2015 and March 2021 was performed to identify the AEs of medicinal cannabis in adults. Publications in English and full text available online were collected from Embase, MEDLINE, PsychINFO, PubMed, Scopus, and Web of Science. Results: Of 1,326 papers identified from the initial search, 31 met the inclusion criteria and were analyzed. The studies reported various AEs with the most predominant being sedation, nausea/vomiting, dizziness, and euphoria. Acute and chronic pain was the most prevalent disorder under review. Conclusions: Adverse events associated with the use of medicinal cannabis could increase workplace risks, including decreased alertness and reaction times, increased absenteeism, reduced ability to safely drive or operate machinery and an increased probability of falling. Focused research into the risk to workers and workplaces from the use of medical cannabis and related human performance impairment is urgently warranted.
Serial Quantitative Assessment of Load Redistribution After Medial Open-Wedge High Tibial Osteotomy
Authors: Jeong Ho Won , Song Yoo Sung , Kim Joo Sung , Nam Hee Seung , Lee Won Woo , Lee Yong Seuk 
Published: April 2023

Background: The maximum standardized uptake value (SUVmax), as determined on combined single-photon emission computed tomography and conventional computed tomography (SPECT/CT), can be an indicator of biomechanical changes due to the load redistribution effect after medial open-wedge high tibial osteotomy (MOW-HTO). Purpose/Hypothesis: The purposes of this study were to (1) analyze serial changes in the SUVmax in the medial, lateral, and patellofemoral compartments after MOW-HTO and (2) identify the contributing factors that affect changes in the SUVmax. The hypotheses were that (1) an elevated SUVmax in the medial compartment would be transferred to the lateral compartment because of the load redistribution effect and (2) there would be contributing factors that cause SUVmax changes. Study Design: Case series; Level of evidence, 4. Methods: Included were 67 knees that were treated with biplanar MOW-HTO between March 2019 and December 2020. SPECT/CT was performed immediately after surgery and at 3 months and 1 year postoperatively to determine the serial load redistribution effect of MOW-HTO. The Pearson correlation coefficient was used to evaluate the relationship between SUVmax and radiological parameters, and subgroup analyses were conducted to compare the SUVmax according to associated cartilage procedures and the weightbearing line ratio (WBLR). Results: The SUVmax in the medial and lateral compartments increased at 3 months but decreased at 1 year postoperatively. The load redistribution effect was most prominent in the anterior zones of the femur (medial: P = .041; lateral: P = .012). In the patella, the SUVmax decreased in both the medial and the lateral zones at all follow-up times ( P < .001 for all). The SUVmax in the anterolateral and posterolateral articular zones of the femur increased with a greater preoperative WBLR ( r = 0.256, P = .039; and r = 0.261, P = .036, respectively). Patients who underwent an associated cartilage procedure had a significantly higher SUVmax in the anteromedial and posteromedial articular zones of both the femur and the tibia at 1 year postoperatively ( P ≤ .002 for all). Conclusion: After MOW-HTO, the unloading effect in the anteromedial articular zone of the femur was the most significant. A greater SUVmax in the lateral zones of the femur was observed in cases of overcorrection. The SUVmax in the medial zones was higher postoperatively in patients with associated cartilage procedures.
Esophageal Perforation Etiologies, Management, and Outcomes at a Tertiary Academic Medical Center
Authors: Nguyen Madison , Clayton Steven 
Published: April 2023

Background: Esophageal perforations can occur spontaneously, but most are iatrogenic and related to procedures. The literature reports death rates from 10% to 26%. Our goals were to summarize demographics, comorbidities, managing services, perforation sites, outcomes, and complications of esophageal perforations at a tertiary academic medical center. Methods: This was a retrospective chart review. ICD and CPT codes were used to identify 89 subjects who experienced esophageal perforation from 2008 to 2020. Patients under age 18 were excluded from the study. Results: Patients diagnosed with esophageal perforation averaged 67 years. Perforations affected more males than females. Most perforations were contained and referred from outside hospitals. Thoracic esophageal perforations predominated followed by cervical and abdominal. Iatrogenic causes were identified in 56% of cases. The most common underlying diseases were gastrointestinal, cardiac, and cancer. Most patients were managed by a multidisciplinary team. The most common complication was empyema managed with chest tubes. Conclusions: We report an esophageal perforation mortality rate of 9%. Approximately 1% of perforations directly led to death. All uncontained thoracic perforations were complicated by empyema and managed with chest tubes. We observed more contained versus uncontained perforations, which may have contributed to higher survival rate. Our institution’s multidisciplinary approach to managing perforations potentially contributed to better outcomes and increased survival. Esophageal perforation remains a medical emergency, but perhaps with prompt recognition and interdisciplinary management, outcomes may not be as dreadful as previously reported.
Residual risk identified in routine noninvasive follow-up assessments in pulmonary arterial hypertension
Authors: Ostermann Jonna , Pott Julian , Hennigs Jan K. , Roedl Kevin , Sinning Christoph , Harbaum Lars , Klose Hans 
Published: April 2023

BackgroundThe 2022 ESC/ERS guidelines on pulmonary hypertension recommend noninvasive risk assessments based on three clinical variables during follow-up in patients with pulmonary arterial hypertension (PAH). We set out to test whether residual risk can be captured from routinely measured noninvasive clinical variables during follow-up in PAH.MethodsWe retrospectively studied 298 incident PAH patients from a German pulmonary hypertension centre who underwent routine noninvasive follow-up assessments including exercise testing, echocardiography, electrocardiography, pulmonary function testing and biochemistry. To select variables, we used least absolute shrinkage and selection operator (LASSO)-regularised Cox regression models. Outcome was defined as mortality or lung transplant after first follow-up assessment.Results12 noninvasive variables that were associated with outcomes in a training sub-cohort (n=208) after correction for multiple testing entered LASSO modelling. A model combining seven variables discriminated 1-year (area under the curve (AUC) 0.83, 95% confidence interval (CI) 0.68–0.99, p=8.4×10−6) and 3-year (AUC 0.81, 95% CI 0.70–0.92, p=2.9×10−8) outcome status in a replication sub-cohort (n=90). The model's discriminatory ability was comparable to that of the guideline approach in the replication sub-cohort. From the individual model components, World Health Organization functional class, 6-min walking distance and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio were sensitive to treatment initiation. Addition of TAPSE/sPAP ratio to the guideline approach numerically increased its ability to discriminate outcome status.ConclusionOur real-world data suggest that residual risk can be captured by noninvasive clinical procedures during routine follow-up assessments in patients with PAH and highlights the potential use of echocardiographic imaging to refine risk assessment.
Comprehensive analysis and expression profiles of the AP2/ERF gene family during spring bud break in tea plant (Camellia sinensis)
Authors: Liu Yujie , Chen Si , Chen Jiedan , Wang Junyu , Wei Mengyuan , Tian Xiaomiao , Chen Liang , Ma Jianqiang 
Published: April 2023

Abstract
Background
AP2/ERF transcription factors (AP2/ERFs) are important regulators of plant physiological and biochemical metabolism. Evidence suggests that AP2/ERFs may be involved in the regulation of bud break in woody perennials. Green tea is economically vital in China, and its production value is significantly affected by the time of spring bud break of tea plant. However, the relationship between AP2/ERFs in tea plant and spring bud break remains largely unknown.

Results
A total of 178 AP2/ERF genes (CsAP2/ERFs) were identified in the genome of tea plant. Based on the phylogenetic analysis, these genes could be classified into five subfamilies. The analysis of gene duplication events demonstrated that whole genome duplication (WGD) or segmental duplication was the primary way of CsAP2/ERFs amplification. According to the result of the Ka/Ks value calculation, purification selection dominated the evolution of CsAP2/ERFs. Furthermore, gene composition and structure analyses of CsAP2/ERFs indicated that different subfamilies contained a variety of gene structures and conserved motifs, potentially resulting in functional differences among five subfamilies. The promoters of CsAP2/ERFs also contained various signal-sensing elements, such as abscisic acid responsive elements, light responsive elements and low temperature responsive elements. The evidence presented here offers a theoretical foundation for the diverse functions of CsAP2/ERFs. Additionally, the expressions of CsAP2/ERFs during spring bud break of tea plant were analyzed by RNA-seq and grouped into clusters A-F according to their expression patterns. The gene expression changes in clusters A and B were more synchronized with the spring bud break of tea plant. Moreover, several potential correlation genes, such as D-type cyclin genes, were screened out through weighted correlation network analysis (WGCNA). Temperature and light treatment experiments individually identified nine candidate CsAP2/ERFs that may be related to the spring bud break of tea plant.

Conclusions
This study provides new evidence for role of the CsAP2/ERFs in the spring bud break of tea plant, establishes a theoretical foundation for analyzing the molecular mechanism of the spring bud break of tea plant, and contributes to the improvement of tea cultivars.
Postoperative pulmonary complications after sugammadex reversal of neuromuscular blockade: a systematic review and meta-analysis with trial sequential analysis
Authors: Liu Hong-Mei , Yu Hong , Zuo Yi-Ding , Liang Peng 
Published: April 2023

Abstract
Background
Sugammadex has been reported to lower the incidence of postoperative residual neuromuscular blockade. Despite the advantages, until recently the effects of sugammadex on postoperative pulmonary complications (PPCs) were controversial. We conducted a systematic review and meta-analysis to determine whether reversal with sugammadex was associated with a lower risk of PPCs compared with neostigmine.

Methods
PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to May 2022. Randomized controlled trials (RCTs) and observational studies comparing PPCs in patients receiving sugammadex or neostigmine as reversal agent at the end of surgery were included. The primary outcomes focused on PPCs including desaturation, pneumonia, atelectasis, noninvasive ventilation (NIV) and reintubation. Trial sequential analysis was performed on the primary outcomes to confirm whether firm evidence was reached.

Results
Meta-analysis of included studies showed that the rate of desaturation (43.2% vs 45.0%, RR = 0.82; 95% CI 0.63 to 1.05; p = 0.11) were comparable between the two groups. When looking at other primary outcomes, significantly lower risk of pneumonia (1.37% vs 2.45%, RR = 0.65; 95% CI 0.49 to 0.85; p = 0.002), atelectasis (24.6% vs 30.4%, RR = 0.64; 95% CI 0.42 to 0.98; p = 0.04), NIV (1.37% vs 2.33%, RR = 0.65; 95% CI 0.43 to 0.98; p = 0.04) and reintubation (0.99% vs 1.65%, RR = 0.62; 95% CI 0.43 to 0.91; p = 0.01) in the sugammadex group were detected compared with the neostigmine group.

Conclusions
We concluded that sugammadex is more effective at reducing the incidence of PPCs including pneumonia, atelectasis, NIV and reintubation compared with neostigmine. Further evidence, preferably from RCTs, is required to confirm these findings.
Predicting hypertension by obesity- and lipid-related indices in mid-aged and elderly Chinese: a nationwide cohort study from the China Health and Retirement Longitudinal Study
Authors: Li Yuqing , Gui Jiaofeng , Zhang Xiaoyun , Wang Ying , Mei Yujin , Yang Xue , Liu Haiyang , Guo Lei-lei , Li Jinlong , Lei Yunxiao , Li Xiaoping , Sun Lu , Yang Liu , Yuan Ting , Wang Congzhi , Zhang Dongmei , Wei Huanhuan , Li Jing , Liu Mingming , Hua Ying , Zhang Lin 
Published: April 2023

Abstract
Background
Currently, the study outcomes of anthropometric markers to predict the risk of hypertension are still inconsistent due to the effect of racial disparities. This study aims to investigate the most effective predictors for screening and prediction of hypertension (HTN) in the Chinese middle-aged and more elderly adult population and to predict hypertension using obesity and lipid-related markers in Chinese middle-aged and older people.

Methods
The data for the cohort study came from the China Health and Retirement Longitudinal Study (CHARLS), including 4423 middle-aged and elderly people aged 45 years or above. We examined 13 obesity- and lipid-related indices, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). To compare the capacity of each measure to forecast the probability of developing HTN, the receiver operating characteristic curve (ROC) was used to determine the usefulness of anthropometric indices for screening for HTN in the elderly and determining their cut-off value, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related anthropometric indicators with HTN was performed using binary logistic regression analysis.

Results
During the four years, the incident rates of HTN in middle-aged and elderly men and women in China were 22.08% and 17.82%, respectively. All the above 13 indicators show a modest predictive power (AUC > 0.5), which is significant for predicting HTN in adults (middle-aged and elderly people) in China (P < 0.05). In addition, when WHtR = 0.501 (with an AUC of 0.593, and sensitivity and specificity of 63.60% and 52.60% respectively) or TYg-WHtR = 4.335 (with an AUC of 0.601, and sensitivity and specificity of 58.20% and 59.30% respectively), the effect of predicting the incidence risk of men is the best. And when WHtR = 0.548 (with an AUC of 0.609, and sensitivity and specificity of 59.50% and 56.50% respectively) or TYg-WHtR = 4.781(with an AUC of 0.617, and sensitivity and specificity of 58.10% and 60.80% respectively), the effect of predicting the incidence risk of women is the best.

Conclusions
The 13 obesity- and lipid-related indices in this study have modest significance for predicting HTN in Chinese middle-aged and elderly patients. WHtR and Tyg-WHtR are the most cost-effective indicators with moderate predictive value of the development of HTN.
Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study
Authors: Wee Andrew Kien Han , Sultana Rehena 
Published: April 2023

Abstract
Background
Like many developed nations, the prevalence of both older people and type-2 diabetes mellitus (T2DM) in Singapore is rising. This demographic shift predisposes the population to greater risks of both frailty and its complications that can be further aggravated by vitamin B12 deficiency —a highly prevalent associated variable that is potentially modifiable.
Indeed, B12 deficiency adversely impacts the neuro-cognitive, haematological, and even the immune systems; jeopardizing our aspirations for successful aging. Despite this, many patients with T2DM in primary care remain unscreened due to a lack of clear guidelines for regular B12 screening. We therefore investigated the determinants of B12 deficiency in community-dwelling patients with T2DM, with the aim of profiling patients most in need of B12-deficiency screening.

Methods
B12 deficiency was evaluated using a retrospective cross-sectional cohort of 592 primary-care patients with T2DM, recruited from 2008 to 2011 from a Polyclinic in Singapore.

Results
B12 deficiency (serum B12 < 150 pmol/L) was present in 164 (27.7%) patients and was associated with a higher “metformin daily dose” (OR = 2.79; 95% CI, 2.22–3.48, P < 0.001); “age ≥ 80 years” (OR = 2.86; 95% CI, 1.31–6.25, P = 0.008); “vegetarianism” (OR = 21.61; 95% CI, 4.47–104.44, P < 0.001); and “folate deficiency” (OR = 2.04; 95% CI, 1.27–3.28, P = 0.003). Conversely, “Prescribed B12 supplementation” was associated with a lower odds of B12 deficiency (OR = 0.37; 95% CI: 0.22–0.61, P < 0.001). The area under the receiver operating characteristic curve was 0.803 (95% CI: 0.765–0.842).
“Metformin daily dose” correlated interchangeably with “Metformin 1-year cumulative dose” (r = 0.960; P < 0.01), and also associated linearly with “duration of diabetes” (B = 0.113, P < 0.0001).
Independent of the duration of T2DM, 29.3% of the B12-deficient patients needed > 1 screening test before the detection of B12 deficiency.

Conclusions
Primary-care screening for B12 deficiency should be part of the annual laboratory review of patients with T2DM regardless of the duration of T2DM —especially when they are prescribed ≥ 1.5 g/day of metformin; ≥ 80 years old; vegetarian; and not prescribed B12 supplementation. Concurrent evaluation for associated folate (vitamin B9) deficiency is essential when addressing T2DM-associated B12 deficiencies.
Current “Metformin daily dose” is an accurate proxy of both cumulative metformin exposure and duration of T2DM.