bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nomogram based on clinical and brain computed tomography characteristics for predicting more than 5 cerebral microbleeds in the hypertensive population
Authors: Wang Xin-Bin , Dong Hao , Qiu Yong-Gang , Lou Cun-Cheng , Huang De-Yun , Zhang Jing , Chen Di-Hong , Feng Han , Fang Xu 
Published: September 2022

BackgroundCerebral microbleeds (CMBs) are common in the hypertensive population and can only be detected with magnetic resonance imaging (MRI). The anticoagulation and thrombolytic regimens for patients with &gt;5 CMBs are different from those for patients with ≤ 5 CMBs. However, MRI is not suitable for evaluating CMBs in patients with MRI contraindications or acute ischemic stroke urgently requiring thrombolysis. We aimed to develop and validate a nomogram combining clinical and brain computed tomography (CT) characteristics for predicting &gt;5 CMBs in a hypertensive population.Materials and methodsIn total, 160 hypertensive patients from 2016 to 2020 who were confirmed by MRI to have &gt;5 (77 patients) and ≤ 5 CMBs (83) were retrospectively analyzed as the training cohort. Sixty-four hypertensive patients from January 2021 to February 2022 were included in the validation cohort. Multivariate logistic regression was used to evaluate &gt;5 CMBs. A combined nomogram was constructed based on the results, while clinical and CT models were established according to the corresponding characteristics. Receiver operating characteristic (ROC) and calibration curves and decision curve analysis (DCA) were used to verify the models.ResultsIn the multivariable analysis, the duration of hypertension, level of homocysteine, the number of lacunar infarcts (LIs), and leukoaraiosis (LA) score were included as factors associated with &gt;5 CMBs. The clinical model consisted of the duration of hypertension and level of homocysteine, while the CT model consisted of the number of LIs and LA. The combined model consisted of the duration of hypertension, level of homocysteine, LI, and LA. The combined model achieved an area under the curve (AUC) of 0.915 (95% confidence interval [CI]: 0.860–0.953) with the training cohort and 0.887 (95% CI: 0.783–0.953) with the validation cohort, which were higher than those of the clinical model [training cohort: AUC, 0.797 (95% CI: 0.726, 0.857); validation cohort: AUC, 0.812 (95% CI: 0.695, 0.899)] and CT model [training cohort: AUC, 0.884 (95% CI: 0.824, 0.929); validation cohort: AUC, 0.868 (95% CI: 0.760, 0.940)]. DCA showed that the clinical value of the combined model was superior to that of the clinical model and CT model.ConclusionA combined model based on clinical and CT characteristics showed good diagnostic performance for predicting &gt;5 CMBs in hypertensive patients.
Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study
Authors: Duan Yu , Xu Binbin , Qin Xuanfeng , Mao Renling , Hu Yuanyuan , Zhou Bin , Li Jian , Chen Gong 
Published: September 2022

Background and purposeThe treatment of aneurysms located in the posterior and distal anterior circulations remains a challenge. Leo stents with a flow diversion (FD) effect may be a potential option, which needs to be clearly studied.MethodsFrom January 2016 to October 2021, 133 patients with 145 aneurysms in the posterior and distal anterior circulations, treated with Leo stents, were retrospectively analyzed in three neurosurgical centers. Data on demographic information, aneurysm characteristics, procedural outcomes, postoperative course, and aneurysm occlusion were retrospectively analyzed.ResultsAfter immediate surgery, 90 aneurysms (60.1%) were in complete occlusion [Raymond-Ray Occlusion Class (RROC) 1 and O'Kelly Marotta (OKM) grade D], 29 aneurysms (20%) in good occlusion (RROC 2 and OKM grade C), 17.9% in incomplete occlusion (RROC 3a or OKM grade B), and no aneurysms in invalid occlusion (RROC 3b and OKM grade A). A total of 112 patients with 117 aneurysms received angiographic follow-up (mean 11.4 months), and the degree of occlusion showed a significant improvement (Z = 3.900, p &lt; 0.001). The complete occlusion rate increased to 84.6% (99/117), while good and incomplete occlusion decreased to 6.8% (8/117) and 8.6% (10/117), respectively. A total of 14 cases (10.5%) presented narrowing of the parent artery, and nine cases (6.8%) had injured side branches. Cerebral hemorrhage occurred in four patients (3.0%), and symptomatic ischemic infarction occurred in six patients (4.5%). The final permanent morbidity (mCS ≥3) and mortality were 2.8% (3/133) and 0.8% (1/133), respectively. For 82 aneurysms treated by stent-assisted with coiling (SAC), large-sized, ruptured aneurysms (χ2 = 7.767, p = 0.005) occurred. For 63 aneurysms treated by LEO stent monotherapy (LSM), multiple aneurysms, fusiform aneurysms (χ2 = 18.958, p &lt; 0.01), and/or small-sized aneurysms (Z = −2.692, p = 0.007) occurred.ConclusionsLeo stents are safe and effective for aneurysms located in the posterior and distal anterior circulations. The overall degree of occlusion improved during a follow-up because of the FD effect of Leo stents. Aneurysms in these areas should be treated with personalized measures.
High-risk screening of late-onset Pompe disease: A different early portrait in China
Authors: Jiao Kexin , Dong Jihong , Luo Sushan , Yu Liqiang , Ke Qing , Wang Zhiqiang , Luan Xinghua , Zhang Xiaojie , Guo Junhong , Chen Yan , Li Xihua , Tan Song , Qian Fangyuan , Jiang Jianming , Yu Xuen , Yue Dongyue , Liu Changxia , Luo Lijun , Li Jianping , Qu Yanzhou , Chen Lan , Tu Jianglong , Sun Chong , Yan Chong , Song Jie , Xi Jianying , Lin Jie , Lu Jiahong , Zhao Chongbo , Zhu Wenhua , Fang Qi 
Published: September 2022

IntroductionThe lack of knowledge regarding the differences between Chinese and other ethnicities in the early manifestation of late-onset Pompe disease (LOPD) prohibits the development of an effective screening strategy. We conducted a multicenter screening study to determine LOPD prevalence in high-risk populations and define the early manifestation of LOPD in China.MethodsBetween August 2020 and April 2021, the participants were prospectively identified through medical examination at 20 centers from inpatient departments and outpatient neuromuscular clinics in China. The inclusion criteria were as follows: (1) age ≥ 1 year and (2) either one of the following conditions: (a) persistent hyperCKemia, (b) muscle weakness of the axial and/or limb-girdle muscles, or (c) unexplained restrictive respiratory insufficiency (RI). Enzymatic activity of acid α-glucosidase (GAA) was measured in a dried blood spot (DBS) using a tandem mass spectrometry (MS/MS) assay. Next-generation sequencing (NGS) was used to evaluate all samples with decreased GAA activity, searching for GAA mutations and pseudodeficiency alleles.ResultsAmong the 492 cases, 26 positive samples (5.3%) were detected in the DBS test. Molecular studies confirmed a diagnosis of LOPD in eight cases (1.6%). Using MS/MS assay, GAA activities in individuals with pseudodeficiency could be distinguished from those in patients with LOPD. The median interval from the onset of symptoms to diagnosis was 5 years. All patients also showed RI, with a mean forced vital capacity (FVC) of 48%, in addition to axial/proximal muscle weakness. The creatine kinase (CK) level ranged from normal to no more than 5-fold the upper normal limit (UNL). LOPD with isolated hyperCKemia was not identified.ConclusionLess frequent hyperCKemia and predominant RI depict a different early portrait of adult Chinese patients with LOPD. A modified high-risk screening strategy should be proposed for the early diagnosis of Chinese patients with LOPD.
Cognitive recovery in patients with post-stroke subjective cognitive complaints
Authors: Ji Shaozhen , Sun Hong , Jin Xianglan , Chen Baoxin , Zhou Jing , Zhao Jiayi , Liang Xiao , Shen Wei , Zhang Yunling , Chan Piu 
Published: September 2022

Background and purposeThe objective cognitive trajectory in patients with post-stroke subjective cognitive complaints (SCC) over time remained unknown. We investigated cognitive outcomes in patients with SCC within 1 year after stroke, and determined factors associated with cognitive recovery.MethodsThis study included 599 patients with a clinical diagnosis of post-stroke SCC and evidence of cognitive deficits including Clinical Dementia Rating Scale (CDR) = 0.5, Montreal Cognitive Assessment (MoCA) score &lt;26, and Mini–Mental State Examination score &gt;17 (illiterate) or &gt;20 (primary school) or &gt;24 (junior school or above). Neuropsychological assessment was performed at baseline (2 weeks to 6 months after stroke) and 6-month follow-up visit. Cognitive recovery was operationalized as unimpaired cognition (MoCA score ≥26 and CDR = 0) after 6 months. Factors associated with recovery were defined through logistic regression analysis.ResultsAfter 6 months, 583 patients completed the follow-up with 80 (13.72%) presenting cognitive recovery, among which, 22 (9.48%) cases reported SCC within 2 weeks after stroke, six (10%) at 15–30 days, 13 (15.12%) at 31–60 days, 10 (16.13%) at 61–90 days, five (10.42%) at 91–120 days, nine (23.08%) at 121–150 days, and 15 (26.79%) at 151–180 days. Compared to those reported cognitive complaints at 151–180 days after stroke, patients with early post-stroke SCC had poorer cognitive recovery, which was only significant in individuals with high level of education. Male sex, higher baseline MoCA scores, coffee intake and thalamus lesions were independently associated with high chance of cognitive recovery.ConclusionsAlthough post-stroke SCC contributes to persisting objective cognitive deficits, some patients presented cognitive recovery within 1 year after stroke. Patients with a high education level reporting SCC at earlier stage after stroke had poorer cognitive recovery. Male, higher baseline MoCA scores, coffee intake and thalamus lesions appear to independently predict cognitive recovery.
Blood-based protein biomarkers for the diagnosis of acute stroke: A discovery-based SWATH-MS proteomic approach
Authors: Misra Shubham , Singh Praveen , Nath Manabesh , Bhalla Divya , Sengupta Shantanu , Kumar Amit , Pandit Awadh K. , Aggarwal Praveen , Srivastava Achal K. , Mohania Dheeraj , Prasad Kameshwar , Vibha Deepti 
Published: September 2022

Background and purposesRecent developments in high-throughput proteomic approach have shown the potential to discover biomarkers for diagnosing acute stroke and to elucidate the pathomechanisms specific to different stroke subtypes. We aimed to determine blood-based protein biomarkers to diagnose total stroke (IS+ICH) from healthy controls, ischemic stroke (IS) from healthy controls, and intracerebral hemorrhage (ICH) from healthy control subjects within 24 h using a discovery-based SWATH-MS proteomic approach.MethodsIn this discovery phase study, serum samples were collected within 24 h from acute stroke (IS &amp; ICH) patients and healthy controls and were subjected to SWATH-MS-based untargeted proteomics. For protein identification, a high-pH fractionated peptide library for human serum proteins (obtained from SCIEX) comprising of 465 proteins was used. Significantly differentially expressed (SDE) proteins were selected using the following criteria: &gt;1.5-fold change for upregulated, &lt; 0.67 for downregulated, p-value &lt; 0.05, and confirmed/tentative selection using Boruta random forest. Protein–protein interaction network analysis and the functional enrichment analysis were conducted using STRING 11 online tool, g:Profiler tool and Cytoscape 3.9.0 software. The statistical analyses were conducted in R version 3.6.2.ResultsOur study included 40 stroke cases (20 IS, 20 ICH) within 24 h and 40 age-, sex-, hypertension-, and diabetes-matched healthy controls. We quantified 375 proteins between the stroke cases and control groups through SWATH-MS analysis. We observed 31 SDE proteins between total stroke and controls, 16 SDE proteins between IS and controls, and 41 SDE proteins between ICH and controls within 24 h. Four proteins [ceruloplasmin, alpha-1-antitrypsin (SERPINA1), von Willebrand factor (vWF), and coagulation factor XIII B chain (F13B)] commonly differentiated total stroke, IS, and ICH from healthy control subjects. The most common significant pathways in stroke cases involved complement and coagulation cascades, platelet degranulation, immune-related processes, acute phase response, lipid-related processes, and pathways related to extracellular space and matrix.ConclusionOur discovery phase study identified potential protein biomarker candidates for the diagnosis of acute stroke and highlighted significant pathways associated with different stroke subtypes. These potential biomarker candidates warrant further validation in future studies with a large cohort of stroke patients to investigate their diagnostic performance.
Single-cell sequencing and establishment of an 8-gene prognostic model for pancreatic cancer patients
Authors: Yu Xiao , Zhang Qiyao , Zhang Shuijun , He Yuting , Guo Wenzhi 
Published: September 2022

BackgroundSingle-cell sequencing (SCS) technologies enable analysis of gene structure and expression data at single-cell resolution. However, SCS analysis in pancreatic cancer remains largely unexplored.MethodsWe downloaded pancreatic cancer SCS data from different databases and applied appropriate dimensionality reduction algorithms. We identified 10 cell types and subsequently screened differentially expressed marker genes of these 10 cell types using FindAllMarkers analysis. Also, we evaluated the tumor immune microenvironment based on ESTIMATE and MCP-counter. Statistical enrichment was evaluated using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis. We used all candidate gene sets in KEGG database to perform gene set enrichment analysis. We used LASSO regression to reduce the number of genes in the pancreatic risk model by R package glmnet, followed by rtPCR to validate the expression of the signature genes in different pancreatic cancer cell lines.ResultsWe identified 15 cell subpopulations by dimension reduction and data clustering. We divided the 15 subpopulations into 10 distinct cell types based on marker gene expression. Then, we performed functional enrichment analysis for the 352 marker genes in pancreatic cancer cells. Based on RNA expression data and prognostic information from TCGA and GEO datasets, we identified 42 prognosis-related genes, including 5 protective genes and 37 high-risk genes, which we used to identified two molecular subtypes. C1 subtype was associated with a better prognosis, whereas C2 subtype was associated with a worse prognosis. Moreover, chemokine and chemokine receptor genes were differentially expressed between C1 and C2 subtypes. Functional and pathway enrichment uncovered functional differences between C1 and C2 subtype. We identified eight genes that could serve as potential biomarkers for prognosis prediction in pancreatic cancer patients. These genes were used to establish an 8-gene pancreatic cancer prognostic model.ConclusionsWe established an 8-gene pancreatic cancer prognostic model. This model can meaningfully predict prognosis and treatment response in pancreatic cancer patients.
Hepatic arterial infusion chemotherapy combined with PD-1 inhibitors and tyrosine kinase inhibitors for unresectable hepatocellular carcinoma: A tertiary medical center experience
Authors: Luo Laihui , Xiao Yongqiang , Zhu Guoqing , Huang Aihong , Song Shengjiang , Wang Tao , Ge Xian , Xie Jin , Deng Wei , Hu Zhigao , Wen Wu , Mei Haoran , Wan Renhua , Shan Renfeng 
Published: September 2022

BackgroundUnresectable hepatocellular carcinoma (u-HCC) still accounts for the majority of newly diagnosed HCC which with poor prognosis. In the era of systemic therapy, combination therapy with programmed cell death protein-1 (PD-1) inhibitors and tyrosine kinase inhibitors (TKIs) has become mainstream. Hepatic arterial infusion chemotherapy (HAIC) as a local treatment has also shown a strong anti-tumor effect. This study aimed to investigate the efficacy and safety of HAIC, PD-1 inhibitors plus TKIs for u-HCC.MethodsThis retrospective study included patients with initially u-HCC between October 2020 to April 2022 who had received at least one cycle of therapy with HAIC, PD-1 inhibitors plus TKIs. The primary outcome included overall response rate (ORR), the disease control rate (DCR), surgical conversion rate, progression-free survival (PFS) and treatment-related adverse events.ResultsA total of 145 patients were included in the study. The median treatment cycle of HAIC and PD-1 inhibitors were 3 and 4, respectively. According to the modified RECIST criteria, the best ORR was 57.2% (83/145), 9 had achieved complete response (CR), DCR was 89.7% (130/145). Median time to achieve CR or PR was 65 days. Surgical conversion rate was 18.6% (27/145), seven patients (7/27,25.9%) achieved pathological complete response (pCR). The median follow-up was 12.5 months (4.5-20 months), and the median PFS was 9.7 months. Subgroup analysis showed that Child-pugh A patients had higher DCR (92.2% vs 79.3%, p=0.041) than Child-pugh B patients, as well as increased successful conversion rate (22.4% vs 3.4%, p=0.019). Patients without vascular invasion and extrahepatic metastases showed higher PR (63.4% vs 43.3%, p&lt;0.05) and ORR (73.2% vs 50.0%, p&lt;0.05) than those with vascular invasion. The ORR (73.2% vs 45.5%, p&lt;0.05) and DCR (95.1% vs 78.8%, p&lt;0.05) were also significantly better than those of patients with extrahepatic metastases. HAIC regimen was not related to efficacy (All p&gt;0.05). The incidence rate of grade 3/4 treatment-related AEs was 17.7% without fatal events.ConclusionThe triple combination therapy of HAIC and PD-1 inhibitors plus TKIs for patients with initially unresectable HCC exhibited satisfactory efficacy with tolerable toxicity.
The clinical relevance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic obstructive pulmonary disease with lung cancer
Authors: Ma Aiping , Wang Guangdong , Du Yan , Guo Weixi , Guo Jiaxi , Hu Yi , Bai Dongyu , Huang Huiping , Zhuang Lianjin , Chen Jinhan , Liu Qun 
Published: September 2022

BackgroundChronic obstructive pulmonary disease (COPD) coexisting with lung cancer is associated with severe mortality and a worse prognosis. Inflammation plays an important role in common pathogenic pathways and disease progression. However, a few studies have identified the clinical value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in COPD with lung cancer, which are systemic inflammatory response markers in the blood. This study aimed to determine the association of the NLR or PLR with clinical characteristics and whether NLR or PLR can be diagnostic markers for COPD with lung cancer.MethodsBetween 2015 and 2021, we conducted a retrospective analysis of 236 COPD patients with lung cancer and 500 patients without lung cancer (control group). Clinical information, blood routine examination, and spirometry results were collected and analyzed. The receiver operating characteristic (ROC) curve was used to identify the best cutoff point of NLR or PLR. Multivariate logistic regression analysis was performed to evaluate the association of NLR or PLR with the diagnosis and prognosis of COPD with lung cancer.ResultsCompared to patients in the COPD-only group, patients in the lung cancer group had a higher percentage of current smoking and emphysema, and it was found that NLR or PLR was significantly higher in the lung cancer group. Multivariate analysis showed that age, smoking status, FEV1%pred, emphysema, NLR, and PLR were independent risk factors for lung cancer development in COPD. Furthermore, the high level of NLR or PLR was associated with age over 70 years old, current smoking status, and ineligible surgery treatment. The level of PLR or NLR markedly increased with hypercoagulation status, the severity of airflow limitation, and advanced progression of lung cancer. Additionally, the ROC analysis also revealed that elevated NLR or PLR was an independent predictor of COPD in lung cancer patients, TNM stages IIIB–IV at first diagnosis in lung cancer, and ineligible surgery in lung cancer patients.ConclusionIncreased NLR or PLR values might be an important and easily measurable inflammation biomarker to predict the diagnosis and severity of lung cancer with COPD.
Effect of pulmonary rehabilitation on heart rate recovery in adult individuals with asthma or chronic obstructive pulmonary disease
Authors: Zampogna Elisabetta , Ambrosino Nicolino , Oliva Federico Mattia , Rudi Monica , Sotgiu Giovanni , Saderi Laura , Spanevello Antonio , Visca Dina 
Published: September 2022

Introduction: Heart rate recovery (HRR) after exercise is a marker of disease severity and prognosis in cardiovascular and respiratory disorders. More than 30% of adult individuals with asthma may show a slow HRR. Pulmonary rehabilitation improves exercise capacity in individuals with asthma or chronic obstructive pulmonary disease (COPD).Aim: The study aimed to evaluate the effect of pulmonary rehabilitation on HRR in individuals with asthma as compared to those with COPD.Methods: Retrospective analysis of HRR one minute after the six-minute walking test (6MWT) was performed before and after an exercise training program. The COPD Assessment Test (CAT), Barthel Index-Dyspnea (BI-D), Medical Research Council (MRC) score for dyspnea, and the Five-Times-Sit-to-Stand test (5STS) were also assessed as secondary outcome measures.Results: Slow HRR prevalence was significantly lower in individuals with asthma than with COPD (29.1 vs. 46.7%, respectively: p = 0.003). Post-program HRR did not change in more than 70% of individuals in either population and improved in 16% of both populations, whereas it actually worsened in 12 and 10% of individuals with asthma and COPD, respectively. The outcome measures significantly improved in both populations, irrespective of baseline HRR.Conclusion: In individuals with asthma or COPD, exercise training does not significantly improve HRR.
VariScreen secures the screening of high-risk varices in patients with hepatitis B virus-related cirrhosis beyond Baveno VI criteria
Authors: Tan Min , Zhang Wuxiang , Zhou Hong , Liu Yujuan , Lu Tao , Zhang Yin , Li Chuan , Yang Yanyan , Wu Yunchong , Hu Han , Li Ying , Yang Fangwan , Lin Shide 
Published: September 2022

We aimed to validate the performance of the ratio of the platelet count (PLT) to liver stiffness measurement (LSM) in excluding high-risk varices (HRVs) in patients with hepatitis B virus (HBV)-related compensated cirrhosis beyond Baveno VI criteria. A total of 310 patients were assessed. The performances of the PLT:LSM ratio (PLER), PLER adjusted for the international normalized ratio, etiology, age, and sex (PLEASE), and the sequential algorithm for HRV screening (VariScreen) in excluding HRVs were evaluated and compared with those of expanded Baveno VI criteria (LSM &lt;25 kPa and PLT &gt;110×109/L, EB6C); PLT &gt;150×109/L and model for end-stage liver disease score = 6 (P150M6 criterion); PLT &gt;120×109/L and albumin &gt;36 g/L (P120A36 criterion); and albumin-bilirubin (ALBI) grade and PLT score (ALBI-PLT score). Among the enrolled patients, 43 (13.9%) had HRVs. The area under the receiver operating characteristic curve of PLER for predicting HRVs (0.771, 95% confidence interval, 0.720–0.817) was significantly higher than that for PLT and LSM (p &lt; 0.01). PLER was an independent risk factor for HRVs. VariScreen, PLEASE, and PLER could spare 20 (6.5%), 91 (29.4%), and 60 (19.4%) endoscopies, with 0, 3 (3.3%), and 1 (1.7%) HRVs missed, respectively. The EB6C and P120A36 criteria could spare 45 (14.5%) and 36 (11.6%) endoscopies, with 1 (2.2%) and 1 (2.8%) HRVs missed, respectively. The P150M6 criterion and ALBI-PLT score missed 6.8% and 10.3% of HRVs, respectively. We found that PLER performed better than other non-invasive tests. VariScreen secured the screening of HRVs in patients with HBV-related cirrhosis beyond Baveno VI criteria.