bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between serum GDF-15 level and pulmonary vascular morphological changes and prognosis in patients with pulmonary arterial hypertension
Authors: Maimaiti Yasenjiang , Cheng Hui , Guo Zitong , Yu Xiaolin , Tuohuti Adilijiang , Li Guoqing 
Published: May 2023

ObjectiveTo investigate how serum GDF-15 concentration affects pulmonary artery hemodynamics and pulmonary vascular morphological changes in patients with pulmonary arterial hypertension.MethodsA total of 45 patients admitted to our hospital from December 2017 to December 2019, were selected for the study. Pulmonary vascular hemodynamics and pulmonary vascular morphology were detected by RHC and IVUS. Serum GDF-15 levels were detected by enzyme-linked immunosorbent assay (ELISA). Based on the concentration of GDF-15, the patients were divided into two groups—the normal GDF-15 group (GDF-15 &lt;1,200 pg/ml, 12 cases) and the elevated GDF-15 group (GDF-15 ≥1,200 pg/ml, 33 cases). A statistical analysis was performed to compare the effects of normal blood GDF-15 levels and high serum GDF-15 levels on hemodynamics and pulmonary vascular morphology in each group of patients.ResultsThe average levels of RVP, sPAP, dPAP, mPAP, and PVR in patients with elevated GDF-15 levels were higher than those in patients with normal GDF-15 levels. The difference between the two groups was statistically significant (P &lt; 0.05). The average levels of Vd, elastic modulus, stiffness index β, lesion length, and PAV in the normal GDF-15 group were lower than those in the elevated GDF-15 group. The average levels of compliance, distensibility, and minimum l umen area were higher than those in the elevated GDF-15 group. The difference between the two groups was statistically significant (P &lt; 0.05). The survival analysis results showed that the 1-year survival rate of patients with normal GDF-15 levels and elevated GDF-15 levels was 100% and 87.9%, respectively, and that the 3-year survival rate of patients with normal GDF-15 levels and elevated GDF-15 levels was 91.7% and 78.8%, respectively. The survival rates of the two groups were compared by the Kaplan Meier method, and the difference was not statistically significant (P &gt; 0.05).ConclusionPatients with pulmonary arterial hypertension with elevated GDF-15 levels have higher pulmonary arterial pressure, higher pulmonary vascular resistance, and more serious pulmonary vascular lesions, which are potentially more harmful. There was no statistically significant difference in survival rates among patients with different serum GDF-15 levels.
Effects of inspiratory muscle training in patients with hypertension: a meta-analysis
Authors: Zheng ShuQi , Zhang Qi , Li ShuiYan , Li Shilin , Yao Qiuru , Zheng Xiaoyan , Li Gege , Zeng Yuting , Chen Ling , Chen Shuping , He Longlong , Zou Jihua , Zeng Qing 
Published: May 2023

ObjectiveTo explore the effects of inspiratory muscle training (IMT) on hypertension and provide guidance for its clinical application as an auxiliary approach.MethodsArticles published prior to July 2022 were searched in Cochrane Library, Web of Science, PubMed, Embase, CNKI, and Wanfang databases. Included were randomized controlled studies that used IMT to treat individuals with hypertension. The mean difference (MD) was computed using the Revman 5.4 software. In individuals with hypertension, the effects of IMT on systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and pulse pressure (PP) were compared and studied.ResultsThere were found to be eight randomized controlled trials totaling 215 patients. According to a meta-analysis, the IMT reduced the SBP (MD: −12.55 mmHg, 95% CI: −15.78, −9.33), DBP (MD: −4.77 mmHg, 95% CI: −6.00, −3.54), HR (MD: −5.92 bpm, 95% CI: −8.72, −3.12), and PP (MD: −8.92 mmHg, 95% CI: −12.08, −5.76) in patients with hypertension. In subgroup analyses, low-intensity IMT showed a better reduction in SBP (MD: −14.47 mmHg, 95% CI: −17.60, −11.34), DBP (MD: −7.70 mmHg, 95% CI: −10.21, −5.18).ConclusionIMT may become an auxiliary means to improve the four hemodynamic indexes (SBP, DBP, HR and PP) in patients with hypertension. In subgroup analyses, low-intensity IMT was more effective in regulating blood pressure than medium-high-intensity IMT.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022300908.
Acute stress response of the HPA-axis in children with Prader-Willi syndrome: new insights and consequences for clinical practice
Authors: Grootjen Lionne N. , Kerkhof Gerthe F. , Juriaans Alicia F. , Trueba-Timmermans Demi J. , Hokken-Koelega Anita C. S. 
Published: May 2023

BackgroundPrader-Willi syndrome (PWS) is associated with hypothalamic dysfunction. It has been reported that the HPA axis might show a delayed response during acute stress, and it is unknown whether the response of the HPA-axis during acute stress changes with age in children with PWS.AimTo investigate the HPA-axis response during an overnight single-dose metyrapone (MTP) test in children with PWS and to assess if the response changes with age, whether it is delayed and if it changes with repeated testing over time. In addition, we evaluated different cut-off points of ACTH and 11-DOC levels to assess stress-related central adrenal insufficiency (CAI).MethodsAn overnight single-dose MTP test was performed in 93 children with PWS. Over time, 30 children had a second test and 11 children a third one. Children were divided into age groups (0-2 years, 2-4 years, 4-8 years and &gt; 8 years).ResultsMost children did not have their lowest cortisol level at 7.30h, but at 04.00h. Their ACTH and 11-DOC peaks appeared several hours later, suggesting a delayed response. When evaluated according to a subnormal ACTH peak (13-33 pmol/L) more children had an subnormal response compared to evaluation based on a subnormal 11-doc peak (&lt; 200 nmol/L). The percentage of children with a subnormal ACTH response ranged from 22.2 to 70.0% between the age groups, while the percentage of a subnormal 11-DOC response ranged from 7.7 to 20.6%. When using the ACTH peak for diagnosing acute-stress-related CAI, differences between age groups and with repeated testing over time were found, whereas there was no age difference when using the 11-DOC peak.ConclusionEarly morning ACTH or 11-DOC levels are not appropriate to determine acute stress-related CAI in children with PWS, thus multiple measurements throughout the night are needed for an accurate interpretation. Our data suggest a delayed response of the HPA-axis during acute stress. Using the 11-DOC peak for the test interpretation is less age-dependent than the ACTH peak. Repeated testing of the HPA-axis over time is not required, unless clinically indicated.
Case Report: Nine-year-old with parathyroid adenoma within the piriform sinus
Authors: Zenno Anna , Ramamoorthy Bhavishya , Hammoud Dima A. , Quezado Martha , Zeiger Martha A. , Jha Smita 
Published: May 2023

We present the case of a 9-year-old girl who presented with symptomatic hypercalcemia from primary hyperparathyroidism (PHPT). Laboratory results revealed elevated serum calcium 12.1 mg/dl (ref: 9.1–10.4), elevated ionized calcium 6.8 (ref: 4.5–5.6) mg/dl, phosphorus 3.8 (ref: 3.3–5.1) mg/dl, 25-OH vitamin D 20.1 (30–100) ng/ml, and elevated intact PTH 70 (15-65) pg/ml, consistent with the diagnosis of PHPT. She had persistent hyperparathyroidism after bilateral neck exploration, left thyroid lobectomy, and transcervical thymectomy. Neither inferior gland was identified. No parathyroid tissue was seen on histology. Repeat preoperative imaging identified a 7-mm × 5-mm adenoma on 4DCT not seen on 99Tc-sestamibi parathyroid scan. The patient then underwent a successful redo parathyroidectomy with removal of a submucosal left parathyroid adenoma at the superior aspect of the thyroid cartilage in the piriform sinus. Her biochemical work-up remains consistent with surgical cure 6 months after surgery. Herein, we also review common locations for ectopic parathyroid adenomas.Clinical Trial RegistrationNCT04969926.
YuNü-Jian attenuates diabetes-induced cardiomyopathy: integrating network pharmacology and experimental validation
Authors: Wang Wei , Liu Ruixia , Zhu Yingying , Wang Lina , Tang Yu , Dou Baolei , Tian Shuo , Wang Furong 
Published: May 2023

IntroductionDiabetic cardiomyopathy (DCM) is one of the most prevalent complications of diabetes with complex pathogenesis. YuNü-Jian (YNJ) is a traditional Chinese medicinal formula widely used for diabetes with hypoglycemic and cardioprotective effects. This study aims to investigate the actions and mechanisms of YNJ against DCM which has never been reported.MethodsNetwork pharmacology approach was used to predict the potential pathways and targets of YNJ on DCM. Molecular docking between hub targets and active components of YNJ was performed and visualized by AutoDock Vina and PyMOL. Then type 2 diabetic model was employed and intervened with YNJ for 10 weeks to further validate these critical targets.ResultsFirst, a total of 32 main ingredients of YNJ were identified and 700 potential targets were screened to construct herb-compound-target network. Then 94 differentially expressed genes of DCM were identified from GEO database. After that, PPI network of DCM and YNJ were generated from which hub genes (SIRT1, Nrf2, NQO1, MYC and APP) were assessed by topology analysis. Next, functional and pathway analysis indicated that the candidate targets were enriched in response to oxidative stress and Nrf2 signaling pathway. Furthermore, molecular docking revealed strong affinity between core targets and active components of YNJ. Finally, in rats with type 2 diabetes, YNJ obviously attenuated cardiac collagen accumulation and degree of fibrosis. Meanwhile, YNJ significantly upregulated protein expression of SIRT1, Nrf2 and NQO1 in diabetic myocardium.DiscussionCollectively, our findings suggested that YNJ could effectively ameliorate cardiomyopathy induced by diabetes possibly through SIRT1/Nrf2/NQO1 signaling.
Elevated serum levels of human epididymis protein 4 in adult patients with proliferative lupus nephritis
Authors: Li Liubing , Xu Huiya , Le Yuting , Li Runzhao , Shi Qiong , Zhu Hongji , Xu Hongxu , Li Laisheng , Liu Min , Wang Fen , Zhang Hui 
Published: May 2023

BackgroundThis study aimed to access whether serum human epididymis protein 4 (HE4) level could identify lupus nephritis (LN) pathological classes in adults and children.MethodsThe serum HE4 levels of 190 healthy subjects and 182 patients with systemic lupus erythematosus (SLE) (61 adult-onset LN [aLN], 39 childhood-onset LN [cLN], and 82 SLE without LN) were determined using Architect HE4 kits and an Abbott ARCHITECT i2000SR Immunoassay Analyzer.ResultsSerum HE4 level was significantly higher in the aLN patients (median, 85.5 pmol/L) than in the patients with cLN (44 pmol/L, P &lt; 0.001) or SLE without LN (37 pmol/L, P &lt; 0.001), or the healthy controls (30 pmol/L, P &lt; 0.001). Multivariate analysis showed that serum HE4 level was independently associated with aLN. Stratified by LN class, serum HE4 level was significantly higher in the patients with proliferative LN (PLN) than in those with non-PLN, and this difference was found only in aLN (median, 98.3 versus 49.3 pmol/L, P = 0.021) but not in cLN. Stratified by activity (A) and chronicity (C) indices, the aLN patients with class IV (A/C) possessed significantly higher serum HE4 levels than those with class IV (A) (median, 195.5 versus 60.8 pmol/L, P = 0.006), and this difference was not seen in the class III aLN or cLN patients.ConclusionSerum HE4 level is elevated in patients with class IV (A/C) aLN. The role of HE4 in the pathogenesis of chronic lesions of class IV aLN needs further investigation.
Spike count and morphology in the classification of epileptiform discharges
Authors: Aanestad Eivind , Gilhus Nils Erik , Olberg Henning Kristian , Kural Mustafa Aykut , Beniczky Sándor , Brogger Jan 
Published: May 2023

PurposeThe purpose of this study is to investigate the impact of Bergen Epileptiform Morphology Score (BEMS) and interictal epileptiform discharge (IED) candidate count in EEG classification.MethodsWe included 400 consecutive patients from a clinical SCORE EEG database during 2013–2017 who had focal sharp discharges in their EEG, but no previous diagnosis of epilepsy. Three blinded EEG readers marked all IED candidates. BEMS and IED candidate counts were combined to classify EEGs as epileptiform or non-epileptiform. Diagnostic performance was assessed and then validated in an external dataset.ResultsInterictal epileptiform discharge (IED) candidate count and BEMS were moderately correlated. The optimal criteria to classify an EEG as epileptiform were either one spike at BEMS &gt; = 58, two at &gt; = 47, or seven at &gt; = 36. These criteria had almost perfect inter-rater reliability (Gwet’s AC1 0.96), reasonable sensitivity of 56–64%, and high specificity of 98–99%. The sensitivity was 27–37%, and the specificity was 93–97% for a follow-up diagnosis of epilepsy. In the external dataset, the sensitivity for an epileptiform EEG was 60–70%, and the specificity was 90–93%.ConclusionQuantified EEG spike morphology (BEMS) and IED candidate count can be combined to classify an EEG as epileptiform with high reliability but with lower sensitivity than regular visual EEG review.
Stimulation enhancement effect of the combination of exoskeleton-assisted hand rehabilitation and fingertip haptic stimulation
Authors: Li Min , Chen Jing , He Bo , He Guoying , Zhao Chen-Guang , Yuan Hua , Xie Jun , Xu Guanghua , Li Jichun 
Published: May 2023

IntroductionProviding stimulation enhancements to existing hand rehabilitation training methods may help stroke survivors achieve better treatment outcomes. This paper presents a comparison study to explore the stimulation enhancement effects of the combination of exoskeleton-assisted hand rehabilitation and fingertip haptic stimulation by analyzing behavioral data and event-related potentials.MethodsThe stimulation effects of the touch sensations created by a water bottle and that created by cutaneous fingertip stimulation with pneumatic actuators are also investigated. Fingertip haptic stimulation was combined with exoskeleton-assisted hand rehabilitation while the haptic stimulation was synchronized with the motion of our hand exoskeleton. In the experiments, three experimental modes, including exoskeleton-assisted grasping motion without haptic stimulation (Mode 1), exoskeleton-assisted grasping motion with haptic stimulation (Mode 2), and exoskeleton-assisted grasping motion with a water bottle (Mode 3), were compared.ResultsThe behavioral analysis results showed that the change of experimental modes had no significant effect on the recognition accuracy of stimulation levels (p = 0.658), while regarding the response time, exoskeleton-assisted grasping motion with haptic stimulation was the same as grasping a water bottle (p = 0.441) but significantly different from that without haptic stimulation (p = 0.006). The analysis of event-related potentials showed that the primary motor cortex, premotor cortex, and primary somatosensory areas of the brain were more activated when both the hand motion assistance and fingertip haptic feedback were provided using our proposed method (P300 amplitude 9.46 μV). Compared to only applying exoskeleton-assisted hand motion, the P300 amplitude was significantly improved by providing both exoskeleton-assisted hand motion and fingertip haptic stimulation (p = 0.006), but no significant differences were found between any other two modes (Mode 2 vs. Mode 3: p = 0.227, Mode 1 vs. Mode 3: p = 0.918). Different modes did not significantly affect the P300 latency (p = 0.102). Stimulation intensity had no effect on the P300 amplitude (p = 0.295, 0.414, 0.867) and latency (p = 0.417, 0.197, 0.607).DiscussionThus, we conclude that combining exoskeleton-assisted hand motion and fingertip haptic stimulation provided stronger stimulation on the motor cortex and somatosensory cortex of the brain simultaneously; the stimulation effects of the touch sensations created by a water bottle and that created by cutaneous fingertip stimulation with pneumatic actuators are similar.
Triple-network analysis of Alzheimer’s disease based on the energy landscape
Authors: Li Youjun , An Simeng , Zhou Tianlin , Su Chunwang , Zhang Siping , Li Chenxi , Jiang Junjie , Mu Yunfeng , Yao Nan , Huang Zi-Gang ,   Alzheimer’s Disease Neuroimaging Initiative
Published: May 2023

IntroductionResearch on the brain activity during resting state has found that brain activation is centered around three networks, including the default mode network (DMN), the salient network (SN), and the central executive network (CEN), and switches between multiple modes. As a common disease in the elderly, Alzheimer’s disease (AD) affects the state transitions of functional networks in the resting state.MethodsEnergy landscape, as a new method, can intuitively and quickly grasp the statistical distribution of system states and information related to state transition mechanisms. Therefore, this study mainly uses the energy landscape method to study the changes of the triple-network brain dynamics in AD patients in the resting state.ResultsAD brain activity patterns are in an abnormal state, and the dynamics of patients with AD tend to be unstable, with an unusually high flexibility in switching between states. Also , the subjects’ dynamic features are correlated with clinical index.DiscussionThe atypical balance of large-scale brain systems in patients with AD is associated with abnormally active brain dynamics. Our study are helpful for further understanding the intrinsic dynamic characteristics and pathological mechanism of the resting-state brain in AD patients.
Circulating hsa-miR-5096 predicts 18F-FDG PET/CT positivity and modulates somatostatin receptor 2 expression: a novel miR-based assay for pancreatic neuroendocrine tumors
Authors: Bocchini Martine , Tazzari Marcella , Ravaioli Sara , Piccinini Filippo , Foca Flavia , Tebaldi Michela , Nicolini Fabio , Grassi Ilaria , Severi Stefano , Calogero Raffaele Adolfo , Arigoni Maddalena , Schrader Joerg , Mazza Massimiliano , Paganelli Giovanni 
Published: May 2023

Gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) are rare diseases encompassing pancreatic (PanNETs) and ileal NETs (SINETs), characterized by heterogeneous somatostatin receptors (SSTRs) expression. Treatments for inoperable GEP-NETs are limited, and SSTR-targeted Peptide Receptor Radionuclide Therapy (PRRT) achieves variable responses. Prognostic biomarkers for the management of GEP-NET patients are required. 18F-FDG uptake is a prognostic indicator of aggressiveness in GEP-NETs. This study aims to identify circulating and measurable prognostic miRNAs associated with 18F-FDG-PET/CT status, higher risk and lower response to PRRT.MethodsWhole miRNOme NGS profiling was conducted on plasma samples obtained from well-differentiated advanced, metastatic, inoperable G1, G2 and G3 GEP-NET patients enrolled in the non-randomized LUX (NCT02736500) and LUNET (NCT02489604) clinical trials prior to PRRT (screening set, n= 24). Differential expression analysis was performed between 18F-FDG positive (n=12) and negative (n=12) patients. Validation was conducted by Real Time quantitative PCR in two distinct well-differentiated GEP-NET validation cohorts, considering the primary site of origin (PanNETs n=38 and SINETs n=30). The Cox regression was applied to assess independent clinical parameters and imaging for progression-free survival (PFS) in PanNETs. In situ RNA hybridization combined with immunohistochemistry was performed to simultaneously detect miR and protein expression in the same tissue specimens. This novel semi-automated miR-protein protocol was applied in PanNET FFPE specimens (n=9). In vitro functional experiments were performed in PanNET models.ResultsWhile no miRNAs emerged to be deregulated in SINETs, hsa-miR-5096, hsa-let-7i-3p and hsa-miR-4311 were found to correlate with 18F-FDG-PET/CT in PanNETs (p-value:&lt;0.005). Statistical analysis has shown that, hsa-miR-5096 can predict 6-month PFS (p-value:&lt;0.001) and 12-month Overall Survival upon PRRT treatment (p-value:&lt;0.05), as well as identify 18F-FDG-PET/CT positive PanNETs with worse prognosis after PRRT (p-value:&lt;0.005). In addition, hsa-miR-5096 inversely correlated with both SSTR2 expression in PanNET tissue and with the 68Gallium-DOTATOC captation values (p-value:&lt;0.05), and accordingly it was able to decrease SSTR2 when ectopically expressed in PanNET cells (p-value:&lt;0.01).Conclusionshsa-miR-5096 well performs as a biomarker for 18F-FDG-PET/CT and as independent predictor of PFS. Moreover, exosome-mediated delivery of hsa-miR-5096 may promote SSTR2 heterogeneity and thus resistance to PRRT.
How well are Brazilian mastologists (breast surgeons) trained in breast reconstruction and oncoplastic surgery? A study of the impact of a breast reconstruction and oncoplastic surgery improvement course
Authors: Businaro Fernandes João Thais , de Oliveira Vilmar Marques , Bagnoli Fábio , Bastos Maria Carolina Soliani , Rinaldi José Francisco , Brenelli Fabrício Palermo , Mateus Evandro Fallaci 
Published: May 2023

IntroductionThe breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons’ technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients’ management by the surgeons enrolled in the Course, as well as to characterize their profile.MethodsAll students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded.ResultsTotal students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course.ConclusionThe Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists’ management of patients. New training centers worldwide can help a lot of women with breast cancer.