bluuebunny/crossref_metadata_2025_split huggingface dataset:
Targeted multidomain intervention for complex mTBI: protocol for a multisite randomized controlled trial in military-age civilians
Authors: Elbin R. J. , Trbovich Alicia , Womble Melissa N. , Mucha Anne , Fedor Sheri , Stephenson Katie , Holland Cyndi , Dollar Christina , Sparto Patrick , Durfee Kori , Patterson Charity G. , Smith Clair N. , Huppert Theodore J. , Okonkwo David O. , Collins Michael W. , Kontos Anthony P. 
Published: June 2023

BackgroundMild traumatic brain injury (mTBI) affects ~18,000 military personnel each year, and although most will recover in 3–4 weeks, many experience persisting symptoms and impairment lasting months or longer. Current standard of care for U.S. military personnel with complex mTBI involves initial (&lt;48 h) prescribed rest, followed by behavioral (e.g., physical activity, sleep regulation, stress reduction, hydration, nutrition), and symptom-guided management. There is growing agreement that mTBI involves different clinical profiles or subtypes that require a comprehensive multidomain evaluation and adjudication process, as well as a targeted approach to treatment. However, there is a lack of research examining the effectiveness of this approach to assessing and treating mTBI. This multisite randomized controlled trial (RCT) will determine the effectiveness of a targeted multidomain (T-MD) intervention (anxiety/mood, cognitive, migraine, ocular, vestibular; and sleep, autonomic) compared to usual care (behavioral management) in military-aged civilians with complex mTBI.MethodsThis study employs a single-blinded, two-group repeated measures design. The RCT will enroll up to 250 military-aged civilians (18-49 yrs) with a diagnosed complex mTBI within 8 days to 6 months of injury from two concussion specialty clinics. The two study arms are a T-MD intervention and a usual care, behavioral management control group. All participants will complete a comprehensive, multidomain clinical evaluation at their first clinical visit. Information gathered from this evaluation will be used to adjudicate mTBI clinical profiles. Participants will then be randomized to either the 4-week T-MD or control arm. The T-MD group will receive targeted interventions that correspond to the patient’s clinical profile (s) and the control group will receive behavioral management strategies. Primary outcomes for this study are changes from enrollment to post-intervention on the Neurobehavioral Symptom Inventory (NSI), Patient Global Impression of Change (PGIC), and functional near-infrared spectroscopy (fNIRS). Time to return to activity (RTA), and healthcare utilization costs will also be assessed.DiscussionStudy findings may inform a more effective approach to treat complex mTBI in military personnel and civilians, reduce morbidity, and accelerate safe return-to-duty/activity.Ethics and disseminationThe study is approved by the University of Pittsburgh Institutional Review board and registered at clinicaltrials.gov. Dissemination plans include peer-reviewed publications and presentations at professional meetings.Clinical Trial Registration:www.clinicaltrials.gov, identifier: NCT04549532.
Automatic risk prediction of intracranial aneurysm on CTA image with convolutional neural networks and radiomics analysis
Authors: Xie Yuan , Liu Shuyu , Lin Hen , Wu Min , Shi Feng , Pan Feng , Zhang Lichi , Song Bin 
Published: June 2023

BackgroundIntracranial aneurysm (IA) is a nodular protrusion of the arterial wall caused by the localized abnormal enlargement of the lumen of a brain artery, which is the primary cause of subarachnoid hemorrhage. Accurate rupture risk prediction can effectively aid treatment planning, but conventional rupture risk estimation based on clinical information is subjective and time-consuming.MethodsWe propose a novel classification method based on the CTA images for differentiating aneurysms that are prone to rupture. The main contribution of this study is that the learning-based method proposed in this study leverages deep learning and radiomics features and integrates clinical information for a more accurate prediction of the risk of rupture. Specifically, we first extracted the provided aneurysm regions from the CTA images as 3D patches with the lesions located at their centers. Then, we employed an encoder using a 3D convolutional neural network (CNN) to extract complex latent features automatically. These features were then combined with radiomics features and clinical information. We further applied the LASSO regression method to find optimal features that are highly relevant to the rupture risk information, which is fed into a support vector machine (SVM) for final rupture risk prediction.ResultsThe experimental results demonstrate that our classification method can achieve accuracy and AUC scores of 89.78% and 89.09%, respectively, outperforming all the alternative methods.DiscussionOur study indicates that the incorporation of CNN and radiomics analysis can improve the prediction performance, and the selected optimal feature set can provide essential biomarkers for the determination of rupture risk, which is also of great clinical importance for individualized treatment planning and patient care of IA.
Trends in deaths and disability-adjusted life-years of stroke attributable to high body-mass index worldwide, 1990–2019
Authors: Guo Xiucai , Li Junxiao , Yin Xueyan , Zhang Ziping , Zhong Qiongqiong , Zhu Feng 
Published: June 2023

BackgroundHigh body mass index (HBMI) is an independent risk factor for stroke. Previous studies on the incremental burden of the rapid growth of stroke attributable to HBMI are incomplete and lag behind. We aim to assess the global burden of stroke attributable to HBMI based on a public database online.Materials and methodsStudy data were taken from the Global Burden of Disease, Injuries, and Risk Factors Study; deaths, the Disability-Adjusted Life-Years (DALYs), and their age-standardized rates were screened. The join point regression was used, wherein age-standardized rates were referred to as temporal trends in disease burden.ResultsDeaths from stroke attributable to HBMI worldwide were on the rise during 1990–2019, with an increase of 88.75%. Age-standardized DALYs were on the rise during 1990–2003 but declined during 2003–2013, with a turning point in 2013 and an increasing trend since then [the Annual Percentage Change (APC) = 0.30%, p &lt; 0.05]. China, India, Indonesia, the Russian Federation, and the United States of America shared in sequence the rate of leading deaths and DALYs in 2019. The Socio-Demographic Index (SDI) was associated with an increasing trend in age-standardized deaths (R = −0.24, p &lt; 0.001) and age-standardized DALYs (R = −0.22, p = 0.0018).ConclusionA range of indicators for the global burden of stroke attributable to HBMI have been on the rise for the past three decades. Tremendous efforts worldwide should be in place to control and treat stroke attributable to HBMI, especially in regions with high-middle and middle SDIs and among middle-aged and aged populations.
Transcranial direct current stimulation over left dorsolateral prefrontal cortex facilitates auditory-motor integration for vocal pitch regulation
Authors: Chang Yichen , Peng Danhua , Zhao Yan , Chen Xi , Li Jingting , Wu Xiuqin , Liu Peng , Liu Hanjun 
Published: June 2023

BackgroundA growing body of literature has implicated the left dorsolateral prefrontal cortex (DLPFC) in the online monitoring of vocal production through auditory feedback. Specifically, disruption of or damage to the left DLPFC leads to exaggerated compensatory vocal responses to altered auditory feedback. It is conceivable that enhancing the cortical excitability of the left DLPFC may produce inhibitory influences on vocal feedback control by reducing vocal compensations.MethodsWe used anodal transcranial direct current stimulation (a-tDCS) to modulate cortical excitability of the left DLPFC and examined its effects on auditory-motor integration for vocal pitch regulation. Seventeen healthy young adults vocalized vowel sounds while hearing their voice pseudo-randomly pitch-shifted by ±50 or ±200 cents, either during (online) or after (offline) receiving active or sham a-tDCS over the left DLPFC.ResultsActive a-tDCS over the left DLPFC led to significantly smaller peak magnitudes and shorter peak times of vocal compensations for pitch perturbations than sham stimulation. In addition, this effect was consistent regardless of the timing of a-tDCS (online or offline stimulation) and the size and direction of the pitch perturbation.ConclusionThese findings provide the first causal evidence that a-tDCS over the left DLPFC can facilitate auditory-motor integration for compensatory adjustment to errors in vocal output. Reduced and accelerated vocal compensations caused by a-tDCS over left DLPFC support the hypothesis of a top–down neural mechanism that exerts inhibitory control over vocal motor behavior through auditory feedback.
A systematic literature review on the role of glial cells in the pathomechanisms of migraine
Authors: Zhang Shanshan , Azubuine Justin , Schmeer Christian 
Published: June 2023

BackgroundThe pathomechanisms underlying migraine are intricate and remain largely unclear. Initially regarded as a neuronal disorder, migraine research primarily concentrated on understanding the pathophysiological changes within neurons. However, recent advances have revealed the significant involvement of neuroinflammation and the neuro-glio-vascular interplay in migraine pathogenesis.MethodsA systematic search was conducted in PubMed, Scopus, and Web of Science databases from their inception until November 2022. The retrieved results underwent a screening process based on title and abstract, and the full texts of the remaining papers were thoroughly assessed for eligibility. Only studies that met the predetermined inclusion criteria were included in the review.ResultsFifty-nine studies, consisting of 6 human studies and 53 animal studies, met the inclusion criteria. Among the 6 human studies, 2 focused on genetic analyses, while the remaining studies employed functional imaging, serum analyses and clinical trials. Regarding the 53 animal studies investigating glial cells in migraine, 19 of them explored the role of satellite glial cells and/or Schwann cells in the trigeminal ganglion and/or trigeminal nerve. Additionally, 17 studies highlighted the significance of microglia and/or astrocytes in the trigeminal nucleus caudalis, particularly in relation to central sensitization during migraine chronification. Furthermore, 17 studies examined the involvement of astrocytes and/or microglia in the cortex.ConclusionGlial cells, including astrocytes, microglia, satellite glial cells and Schwann cells in the central and peripheral nervous system, participate both in the development as well as chronic progression of migraine in disease-associated regions such as the trigeminovascular system, trigeminal nucleus caudalis and cortex, among other brain regions.
The relationship between ultra processed food consumption and premature coronary artery disease: Iran premature coronary artery disease study (IPAD)
Authors: Ansari Shakila , Mohammadifard Noushin , Haghighatdoost Fahimeh , Zarepur Ehsan , Mahmoudi Shirin , Nouri Fatemeh , Nouhi Fereidoon , Alikhasi Hassan , Sharifianjazi Fariborz , Tavamaishvili Ketevan , Shirani Shahin , Kazemi Tooba , Azdaki Nahid , Salehi Nahid , Lotfizadeh Masoud , Solati Kamal , Ghaffari Samad , Javanmardi Elmira , Salari Arsalan , Dehghani Mostafa , Cheraghi Mostafa , Assareh Ahmadreza , Haybar Habib , Namayandeh Seyedeh M. , Madadi Reza , Sarrafzadegan Nizal 
Published: June 2023

BackgroundUltra-processed foods (UPF) consumption may affect the risk of PCAD through affecting cardio metabolic risk factors. This study aimed to evaluate the association between UPFs consumption and premature coronary artery disease (PCAD).MethodsA case–control study was conducted on 2,354 Iranian adults (≥ 19 years). Dietary intake was assessed using a validated 110-item food frequency questionnaire (FFQ) and foods were classified based on the NOVA system, which groups all foods according to the nature, extent and purposes of the industrial processes they undergo. PCAD was defined as having an stenosis of at least single coronary artery equal and above 75% or left main coronary of equal or more than 50% in women less than 70 and men less than 60 years, determined by angiography. The odds of PCAD across the tertiles of UPFs consumption were assessed by binary logistic regression.ResultsAfter adjustment for potential confounders, participants in the top tertile of UPFs were twice as likely to have PCAD compared with those in the bottom tertile (OR: 2.52; 95% CI: 1.97–3.23). Moreover, those in the highest tertile of the UPFs consumption had more than two times higher risk for having severe PCAD than those in the first tertile (OR: 2.64; 95% CI: 2.16–3.22). In addition, there was a significant upward trend in PCAD risk and PCAD severity as tertiles increased (P-trend &lt; 0.001 for all models).ConclusionHigher consumption of UPFs was related to increased risk of PCAD and higher chance of having severe PCAD in Iranian adults. Although, future cohort studies are needed to confirm the results of this study, these findings indicated the necessity of reducing UPFs intake.
Pea hull fiber supplementation does not modulate uremic metabolites in adults receiving hemodialysis: a randomized, double-blind, controlled trial
Authors: Fatani Asmaa M. N. , Suh Joon Hyuk , Auger Jérémie , Alabasi Karima M. , Wang Yu , Segal Mark S. , Dahl Wendy J. 
Published: June 2023

BackgroundFiber is a potential therapeutic to suppress microbiota-generated uremic molecules. This study aimed to determine if fiber supplementation decreased serum levels of uremic molecules through the modulation of gut microbiota in adults undergoing hemodialysis.MethodsA randomized, double-blinded, controlled crossover study was conducted. Following a 1-week baseline, participants consumed muffins with added pea hull fiber (PHF) (15 g/d) and control muffins daily, each for 4 weeks, separated by a 4-week washout. Blood and stool samples were collected per period. Serum p-cresyl sulfate (PCS), indoxyl sulfate (IS), phenylacetylglutamine (PAG), and trimethylamine N-oxide (TMAO) were quantified by LC–MS/MS, and fecal microbiota profiled by 16S rRNA gene amplicon sequencing and specific taxa of interest by qPCR. QIIME 2 sample-classifier was used to discover unique microbiota profiles due to the consumption of PHF.ResultsIntake of PHF contributed an additional 9 g/d of dietary fiber to the subjects’ diet due to compliance. No significant changes from baseline were observed in serum PCS, IS, PAG, or TMAO, or for the relative quantification of Akkermansia muciniphila, Faecalibacterium prausnitzii, Bifidobacterium, or Roseburia, taxa considered health-enhancing. Dietary protein intake and IS (r = −0.5, p = 0.05) and slow transit stool form and PCS (r = 0.7, p &lt; 0.01) were significantly correlated at baseline. PHF and control periods were not differentiated; however, using machine learning, taxa most distinguishing the microbiota composition during the PHF periods compared to usual diet alone were enriched Gemmiger, Collinsella, and depleted Lactobacillus, Ruminococcus, Coprococcus, and Mogibacteriaceae.ConclusionPHF supplementation did not mitigate serum levels of targeted microbial-generated uremic molecules. Given the high cellulose content, which may be resistant to fermentation, PHF may not exert sufficient effects on microbiota composition to modulate its activity at the dose consumed.
Global estimates of rehabilitation needs and disease burden in tracheal, bronchus, and lung cancer from 1990 to 2019 and projections to 2045 based on the global burden of disease study 2019
Authors: Lai Xigui , Li Conghui , Yang Yao , Niu Mingyuan , Yang Yujie , Gu Shanshan , Hou Weiqian , Chen Lili , Zhu Yi 
Published: June 2023

BackgroundThe global cancer burden is substantial and spiraling. Although rehabilitation specialists could offer assistance, oncologic rehabilitation is still underutilized and not a routine part of clinical oncology guidelines worldwide. Global investigations of disease prevalence and years lived with disability (YLDs) for tracheal, bronchus, and lung (TBL) cancer are valuable for facilitating clinical practice improvement and health resource management. The objective of this study is to report the global estimates of rehabilitation needs and disease burden of TBL cancers from 1990 to 2019 and provide predictions for 2045.MethodsTo estimate the need for rehabilitation, the data used from the Global Burden of Disease Study 2019 to calculate the prevalence, YLDs, and the attributable risk factors of TBL cancer. The Bayesian age-period-cohort model and Auto-Regressive Integrated Moving Average model were established to forecast the future health burden. All analyses were done at the global level and then some in the aggregation with the seven World Bank regions. All the data were analyzed by R software (x64 version 4.2.1) and Microsoft Excel (version 2019).ResultsGlobally in 2019, 3,212,307 cases of TBL cancer (95% UI 2,937,037-3,488,346) could have benefitted from rehabilitation, contributing to 544,215 (95% UI 396,134-700,099) YLDs. Over the past 30 years, the age-standardized rate (ASR) of prevalence (EAPC = 0.51) and YLDs (EAPC = 0.03) increased. Throughout this period, the global prevalence and YLDs counts were greater in males than females. The ASR of prevalence and YLDs are projected to show a slight downward trend by 2045 on the global scale, the overall prevalence and YLDs due to TBL cancer are likely to increase further, but all indicators show a growing trend in females.ConclusionTBL cancer remains one of the major public health issues globally. According to the forecasted results, the burden of YLDs due to TBL cancer will continue to rise, and the increment is higher in females than males. A rising number of patients worldwide will benefit from rehabilitation services in the future to achieve precise control and management throughout the TBL cancer patient lifecycle.
Risk-adjusted chemoradiation according to human papilloma viral status for anal cancer: a pilot study
Authors: Chu William , Taggar Amandeep , Ung Yee , Chan Kelvin K. W. , Earle Craig C. , Karotki Aliaksandr , Pasetka Mark , Presutti Joe , Wong John , Zhang Liying , Wong C. Shun 
Published: June 2023

Background and purposeHPV-associated or positive (HPV+) anal cancer patients may have better outcome compared to those with HPV negative (HPV−) disease. We report a planned interim analysis of a prospective registry study that tailors chemoradiation (CRT) for anal cancer according to HPV status.Materials and methodsHPV+ patients received de-escalated radiation doses of 45, 50.4 and 55.8 Gy, while HPV− received 50.4, 55.8 and 63 Gy for T1, T2 and T3/T4 disease respectively. Chemotherapy consisted of a single dose of mitomycin-C and oral capecitabine on days of RT. All patients were planned by VMAT following CT, PET/CT and MR simulation. This cohort (n = 24) had a minimum 24-month follow-up. Disease free survival (DFS) and local failure rates (LFR) were compared with 180 patients managed by standard CRT (2 cycles of mitomycin-C and 5-fluorouracil, radiation doses 50.4-63 Gy based on T-category) from 2011-2018. Propensity score comparison was performed using a retrospective to prospective 2 to 1 match based on tumor size and N-category.ResultsIn the HPV+ cohort (n = 20), there were 2 local failures. Two of 4 HPV− patients failed locally. The 30-month DFS and LFR were 79% and 17% respectively. Similar DFS and LFR were observed in the retrospective (80% and 15% respectively) and matched patients (76% and 16% respectively). No grade ≥3 neutropenia and febrile neutropenia were observed in the registry cohort whereas 19% and 14% respectively were seen in the retrospective patients.ConclusionDe-escalation of CRT for HPV+ anal cancer may result in decreased acute toxicities and similar cancer outcomes compared to standard CRT.
Regional transarterial chemoembolization combined with chemoradiotherapy for locally advanced rectal cancer: a retrospective study of a new combination
Authors: Meng Wen-Jun , Liu Chun-Hua , Zheng Ru-Jun , Li Chun-Xue 
Published: June 2023

ObjectivesLocally advanced rectal cancer (LARC) has a high risk of distant metastasis (DM). Currently, many treatment courses of LARC have arisen, but patients’ DM status has not significantly improved. This study was designed to compare the effect between preoperative regional transarterial chemoembolization combined with neoadjuvant chemoradiotherapy and standard neoadjuvant therapy on preventing DM in patients with LARC.MethodsA total of 81 LARC patients between July 2013 and May 2018 were enrolled in this retrospective study. Among them, 44 patients received preoperative regional transarterial chemoembolization combined with concurrent chemoradiotherapy (the interventional group), and 37 patients received only neoadjuvant chemoradiotherapy (the control group). The baseline data; preoperative toxicities; postoperative DM rate within 1, 2, and 3 years; and postoperative complications were compared between the two groups.ResultsAll patients successfully completed their treatments. There were no significant differences between the two groups in age, gender, tumor size, distance between the tumor and anal verge, CEA level, lymphovascular invasion, or tumor stage before treatment. The pathological T staging post-treatment in the interventional group was significantly reduced compared to that of the control group (p = 0.025). There were no significant differences between groups in DM rates within 1 and 2 years after surgery. In terms of DM rate within 3 years after surgery, the interventional group was significantly lower than that of the control group (9.1% vs. 29.7%, p = 0.036).ConclusionPreoperative regional transarterial chemoembolization combined with concurrent chemoradiotherapy may play an important role in reducing postoperative DM in LARC.
The effect of physical exercise on disordered social communication in individuals with autism Spectrum disorder: a systematic review and meta-analysis of randomized controlled trials
Authors: Jia Shuqi , Guo Chengcheng , Li Shufan , Zhou Xiaojing , Wang Xing , Wang Qiang 
Published: June 2023

ObjectiveThe aim of this systematic review and meta-analysis was to systematically investigate the intervention effect of physical exercise on disordered social communication in patients with autism spectrum disorders.MethodsThis systematic review and meta-analysis used the PubMed, Web of Science, the Cochrane Library, and Embase electronic databases to conduct a systematic search of literature describing randomized controlled trials (RCTs) on the effect of physical exercise on disordered social communication in autistic patients from the first year of inclusion to 21 January 2023.ResultsA total of 14 RCTs including 460 autistic patients were analyzed. A meta-analysis showed that physical exercise had a positive effect on social communication disorder (SMD = 0.45, 95% CI: 0.15, 0.74, p &lt; 0.05) in autistic patients. Subgroup analysis showed that exercise programs with multiple components (SMD = 0.73, 95% CI: 0.39, 1.06, P &lt; 0.001), a moderate duration (SMD = 0.73, 95% CI: 0.38, 1.08, P &lt; 0.001), a moderate-high frequency (SMD = 0.84, 95% CI: 0.53, 1.14, P &lt; 0.001), and a long duration (SMD = 0.77, 95% CI: 0.36, 1.18, P &lt; 0.001) led to significant improvement.ConclusionPhysical exercise can improve disordered social communication in patients with autism spectrum disorders. Specifically, early intervention, multi-component exercise, a moderate period, moderate and high frequency, long duration, and multi-participant programs were most effective.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/ RecordID= CRD42023422482.