bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urine kidney injury molecule-1 predicts subclinical kidney disease among persons living with HIV initiating tenofovir disoproxil fumarate-based ART in Zambia
Authors: Chabala Freeman W. , Siew Edward D. , Wester C. William , Brennan Alana T. , Phiri Masauso M. , Vinikoor Michael J. , Masenga Sepiso K. , Aliyu Muktar H. 
Published: January 2025

IntroductionAntiretroviral therapy (ART) increases the life expectancy of persons living with HIV (PLWH), but not without potentially serious adverse effects. Tenofovir disoproxil fumarate (TDF) can cause nephrotoxicity, manifesting as acute kidney injury (AKI) that may persist after treatment discontinuation. Kidney injury biomarkers such as kidney injury molecule-1 (KIM-1), retinol-binding protein-4 (RBP-4), interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) can aid early diagnosis and predict TDF-associated nephrotoxicity. This study aimed to determine whether the change from baseline in urine KIM-1 (δKIM-1) and NGAL (δNGAL) following 2 weeks of TDF use could predict subclinical TDF-associated nephrotoxicity before the overt manifestation as acute kidney disease after 3 months.MethodsA prospective cohort study of 205 PLWH was conducted at the Adult Center for Infectious Disease Research (AIDC) in Lusaka, Zambia. ART-naïve PLWH who were starting treatment with TDF with intact kidney function [estimated glomerular filtration rate (eGFR)&gt; 60 mL/min/1.73m2] were followed at initiation, 2 weeks, and approximately 3 months to determine the incidence of TDF-associated nephrotoxicity. We measured urine KIM-1 and NGAL at baseline and after 2 weeks of treatment to determine if it predicted subclinical nephrotoxicity. The presence of TDF-associated nephrotoxicity was defined according to the established acute kidney disease and disorders criteria (AKD) as having either 1) one or more episodes of eGFR&lt; 60ml/min/1.73m2 within 3 months, 2) a reduction in eGFR of greater than 35% (from baseline) within 3 months, and/or 3) an increase in serum creatinine of more than 50% (from baseline) within 3 months.ResultsThe incidence of TDF-associated nephrotoxicity was 22%. Baseline eGFR, creatinine, age, female sex, and BMI predicted the risk of overt TDF-associated nephrotoxicity. The median baseline KIM-1-to-creatinine and NGAL-1-to-creatinine ratios of the participants who developed overt TDF-associated nephrotoxicity and those who did not were not significantly different. However, every 1 pg/mg increase in δKIM-1 was associated with a 41% higher risk of TDF-associated nephrotoxicity. No association was observed with δNGAL.ConclusionsThe incidence of TDF-associated nephrotoxicity was high. Change in KIM-1 level within 2 weeks of the initiation of TDF treatment predicted subclinical TDF-associated nephrotoxicity before overt manifestation as acute kidney disease while δNGAL within the same period did not predict subclinical TDF-associated nephrotoxicity.
Ankle joint position sense acuity differences among stroke survivors at three walking ability levels: a cross-sectional study
Authors: Xu Jinyao , Witchalls Jeremy , Preston Elisabeth , Pan Li , Zhang Gengyuan , Waddington Gordon , Adams Roger David , Han Jia 
Published: January 2025

BackgroundDespite the importance of lower limb sensation in walking highlighted in systematic reviews, there is limited research investigating the effect of proprioceptive deficits after stroke and any relationship with walking ability.ObjectivesWith stroke survivors of different walking ability, this study aimed to (1) explore side (affected/unaffected) and movement direction (inversion/plantar flexion) effects in ankle joint position sense (JPS) acuity, and (2) compare ankle JPS acuity between groups of stroke survivors with different walking ability.MethodsSeventy subacute stroke survivors were recruited and divided into three groups based on walking ability, as determined by their gait speed on the 10-Meter Walking Test: household (&lt;0.4 m/s), limited community (0.4–0.8 m/s) and community (&gt;0.8 m/s). Ankle JPS acuity was measured by the active movement extent discrimination apparatus (AMEDA).ResultsA significant difference was found between sides, with the AMEDA scores for the unaffected side significantly higher than for the affected side (F1.67 = 22.508, p &lt; 0.001). The mean AMEDA scores for plantar flexion were significantly higher than for inversion (F1.67 = 21.366, p &lt; 0.001). There was a significant linear increase in ankle JPS acuity with increasing walking ability among stroke survivors (F1.67 = 17.802, p &lt; 0.001).ConclusionAfter stroke, ankle JPS acuity on the affected side was lower than the unaffected side. Stroke survivors had higher ankle JPS acuity in plantar-flexion movements, compared with inversion movements. Overall, stroke survivors with higher ankle JPS acuity tended to have higher walking ability, highlighting the importance of ankle JPS acuity in walking ability after stroke. These findings provide new insights into proprioceptive deficits after stroke and their relevance in neurorehabilitation.
Clinical and analytical monitoring of patients with multiple sclerosis on anti-CD20 therapeutics: a real-world safety profile study
Authors: Fernandes André Aires , Neves Ana Lídia , Ferro Daniela , Seabra Mafalda , Mendonça Teresa , dos Reis Ricardo Soares , Sá Maria José , Guimarães Joana , Abreu Pedro 
Published: January 2025

BackgroundAnti-CD20 monoclonal antibodies are a class of immunosuppressive drugs widely used in the treatment of central nervous system (CNS) inflammatory diseases, with well-established efficacy and safety. Although rare, these therapies can be associated with serious adverse events including hematological and infectious complications. This study aims to evaluate their safety and tolerability profile in real-world clinical practice.MethodsWe conducted a retrospective cohort study comprising patients diagnosed with multiple sclerosis (MS) treated with anti-CD20 drugs since 2016 followed in the Demyelinating Diseases clinic of a tertiary center. Clinical and paraclinical parameters were evaluated, including complete blood count and immunoglobulins measurements.ResultsA total of 160 with multiple sclerosis (pwMS) were included in our study, of whom 110 (68.8%) were female and 147 are currently receiving anti-CD20 therapies. Half of the patients were diagnosed with relapsing–remitting MS, while the remaining had progressive forms, including 23 with primary-progressive MS and 57 with secondary-progressive MS. Eighty-three patients were on ocrelizumab, 48 on rituximab, and 29 on ofatumumab. The mean follow-up duration from the start of anti-CD20 therapy was 30.5 ± 21.3 months. During this period, serious adverse events were observed in 9 patients, including SARS-CoV-2 infection (resulting in one death), urinary tract infection, febrile neutropenia, severe diarrhea, and acute hepatitis. The rate of serious infections in the ocrelizumab subgroup was consistent with the literature, although a higher rate was observed in the rituximab subgroup. A positive correlation was found between serious infectious complications and lower IgG levels. Additionally, longer exposure to anti-CD20 therapy in our cohort was associated with an increased risk of IgG deficiency and a higher incidence of serious infections. Lymphopenia was detected in 25 patients, though it was not directly linked to the occurrence of serious infections.ConclusionOur work confirms the tolerability and safety of anti-CD20 drugs in a real-world clinical practice MS cohort, despite their frequent association with analytical changes such as lymphopenia and hypogammaglobulinemia. To better understand the clinical significance of hypogammaglobulinemia secondary to anti-CD20 treatment and to develop strategies for mitigating the associated potential infection risk, future studies with larger populations are essential.
Association between serum albumin and severe impairment of activities of daily living in patients with stroke: a cross-sectional study
Authors: Bi Ranran , Shi Yupeng , Li Manrong , Liu Xiaochen , Ma Zhenchao , Huang Yiqing , Liang Bingyin , Cui Fang 
Published: January 2025

PurposeThe relationship between serum albumin levels and severe limitations in ADLs among stroke patients remains unclear. Specifically, the dose–response relationship between the two needs further exploration. This study aims to provide further results.Materials and methodsThis study examined cross-sectional data from patients aged 18 years or older with a diagnosis of stroke confirmed by cranial CT or MRI within 24 h of admission, gathered from January 2020 to August 2022. Data included serum albumin levels, Barthel Index scores recorded after admission, and other essential variables.ResultsThe study comprised 2,393 stroke patients. After adjusting for confounding factors, the multivariate analysis revealed a 7% decrease in severe impairment of ADL after stroke for every unit (g/L) increase in serum albumin levels. Compared with individuals with lower serum albumin levels (Q1: ≤ 37.4 g/L), the adjusted odds ratios (OR) for severe of ADL impairment among stroke patients in Q2 (37.4–40.21 g/L), Q3 (40.21–42.80 g/L), and Q4 (≥42.8 g/L) were 0.68 (95% CI: 0.4–1.15, p = 0.148), 0.55 (95% CI: 0.32–0.97, p = 0.04), and 0.64 (95% CI: 0.37–1.15, p = 0.139), respectively. The relationship between serum albumin and severe impairment of ADLs in stroke patients showed an L-shaped curve (non-linear, p = 0.002), with an inflection point at 38.0 g/L. The OR for significant impairment of ADLs was 0.680 (95% CI: 0.568–0.814, p &lt; 0.001) in participants with serum albumin levels &lt;38.0 g/L. However, when serum albumin levels were greater than or equal to 38.0 g/L, the severe impairment of ADLs no longer decreased with rising serum albumin levels.ConclusionIn summary, an L-shaped connection with an approximate inflection point of 38.0 g/L was found between blood albumin levels and significant ADL impairment in stroke patients. The results of this study suggest that increasing serum albumin levels can significantly help improve the severity of ADL impairment in stroke patients, particularly those with serum albumin levels below 38.0 g/L.
Immediate effects of Vojta Therapy on gait ability in down syndrome patients: a pilot study
Authors: Qian Guoping , Perzanowska Ewelina , Kozakiewicz Mirela , Ewertowska Paulina , Yu Hongli , Ossowski Zbigniew 
Published: January 2025

BackgroundVojta Therapy (VT) is a neurorehabilitation approach that targets ontogenetic postural function and automatic body posture control. Research has shown its potential to enhance gait ability. However, limited evidence exists regarding its immediate effects on individuals with Down syndrome (DS).ObjectivesThis study aimed to assess the immediate effects of one session VT on spatiotemporal gait parameters in individuals with DS.DesignA non-randomized pilot study was conducted.MethodsSixteen individuals with DS (mean age: 17.88 ± 4.57 years, 8 males) participated in this study. Each received a single VT session administered by an experienced physiotherapist. Spatiotemporal gait parameters before and after VT were analyzed using the Vicon motion capture system.ResultsSignificant improvements were observed in walking speed (m/s), cadence (steps/min), right step time (s), step length (cm), stride length (cm), and double support time (%GC) following the VT session (P &lt; 0.05). These findings suggest that VT may offer immediate benefits in improving gait parameters for individuals with DS.ConclusionsFuture large-scale studies with more robust designs are necessary to explore the long-term effects of extended VT programs.
Case report: a 3-year follow-up on nodal marginal zone lymphoma coexisting with disseminated Talaromyces marneffei infection in a non-endemic area
Authors: Yu Xiping , Xu Houyun , Zhou Junjie , Zhu Zhiqiang , Li Baizhou 
Published: January 2025

This case report presents the details of an elderly man in Zhejiang Province of China, who tested human immunodeficiency virus (HIV) negative and subsequently developed Nodal Marginal Zone Lymphoma (NMZL) along with T. marneffei disseminated infection. The study focuses on analyzing the distinct clinical symptoms and pathological manifestations in order to offer precise diagnosis and effective treatment for patients. A 76-year-old male patient was admitted to our hospital due to recurrent fever. An enhanced CT of the abdomen revealed bilateral renal and adrenal mass, along with multiple enlarged lymph nodes in the retroperitoneum. A chest un-enhanced CT showed flaky high-density shadows in the left lung, along with multiple enlarged lymph nodes in the lung hilar, mediastinal regions, and the left supraclavicular side. Subsequently, we conducted a biopsy of the left supraclavicular lymph node and confirmed the NMZL combined with T. marneffei infection. Over 3 years follow-up, there was no recurrence of T. marneffei infection and the lymphoma remained stable. Clinicians and pathologists should remain vigilant about the possibility of T.marneffei infection in non-prone areas. When encountering patients with unexplained fever, swollen lymph nodes, and multiple systems involvement, it is crucial to consider the possibility of lymphoma and fungal infections coexisting.
Diagnostic accuracy of MRI-based radiomic features for EGFR mutation status in non-small cell lung cancer patients with brain metastases: a meta-analysis
Authors: Long Yuqin , Zhao Rong , Du Xianfeng 
Published: January 2025

ObjectiveThis meta-analysis aims to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) based radiomic features for predicting epidermal growth factor receptor (EGFR) mutation status in non-small cell lung cancer (NSCLC) patients with brain metastases.MethodsWe systematically searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, Wanfang, and China National Knowledge Infrastructure (CNKI) for studies published up to April 30, 2024. We included those studies that utilized MRI-based radiomic features to detect EGFR mutations in NSCLC patients with brain metastases. Sensitivity, specificity, positive and negative likelihood ratios (PLR, NLR), and area under the curve (AUC) were calculated to evaluate the accuracy. Quality assessment was performed using the quality assessment of prognostic accuracy studies 2 (QUADAS-2) tool. Meta-analysis was conducted using random-effects models.ResultsA total of 13 studies involving 2,348 patients were included. The pooled sensitivity and specificity of MRI-based radiomic features for detecting EGFR mutations were 0.86 (95% CI: 0.74-0.93) and 0.83 (95% CI: 0.72-0.91), respectively. The PLR and NLR were calculated as 5.14 (3.09, 8.55) and 0.17 (0.10, 0.31), respectively. Substantial heterogeneity was observed, with I² values exceeding 50% for all parameters. The AUC for the receiver operating characteristic analysis was 0.91 (95% CI: 0.88-0.93). Subgroup analysis indicated that deep learning models and studies conducted in Asian showed higher diagnostic accuracy compared to their respective counterparts.ConclusionsMRI-based radiomic features demonstrate a high potential for accurately detecting EGFR mutations in NSCLC patients with brain metastases, particularly when advanced deep learning techniques were employed. However, the variability in diagnostic performance across different studies underscores the need for standardized radiomic protocols to enhance reproducibility and clinical utility.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024544131.
Integration of machine learning and experimental validation to identify the prognostic signature related to diverse programmed cell deaths in breast cancer
Authors: Li Longpeng , Zhao Jinfeng , Wang Yaxin , Zhang Zhibin , Chen Wanquan , Wang Jirui , Cai Yue 
Published: January 2025

BackgroundProgrammed cell death (PCD) is closely related to the occurrence, development, and treatment of breast cancer. The aim of this study was to investigate the association between various programmed cell death patterns and the prognosis of breast cancer (BRCA) patients.MethodsThe levels of 19 different programmed cell deaths in breast cancer were assessed by ssGSEA analysis, and these PCD scores were summed to obtain the PCDS for each sample. The relationship of PCDS with immune as well as metabolism-related pathways was explored. PCD-associated subtypes were obtained by unsupervised consensus clustering analysis, and differentially expressed genes between subtypes were analyzed. The prognostic signature (PCDRS) were constructed by the best combination of 101 machine learning algorithm combinations, and the C-index of PCDRS was compared with 30 published signatures. In addition, we analyzed PCDRS in relation to immune as well as therapeutic responses. The distribution of genes in different cells was explored by single-cell analysis and spatial transcriptome analysis. Potential drugs targeting key genes were analyzed by Cmap. Finally, the expression levels of key genes in clinical tissues were verified by RT-PCR.ResultsPCDS showed higher levels in cancer compared to normal. Different PCDS groups showed significant differences in immune and metabolism-related pathways. PCDRS, consisting of seven key genes, showed robust predictive ability over other signatures in different datasets. The high PCDRS group had a poorer prognosis and was strongly associated with a cancer-promoting tumor microenvironment. The low PCDRS group exhibited higher levels of anti-cancer immunity and responded better to immune checkpoint inhibitors as well as chemotherapy-related drugs. Clofibrate and imatinib could serve as potential small-molecule complexes targeting SLC7A5 and BCL2A1, respectively. The mRNA expression levels of seven genes were upregulated in clinical cancer tissues.ConclusionPCDRS can be used as a biomarker to assess the prognosis and treatment response of BRCA patients, which offers novel insights for prognostic monitoring and treatment personalization of BRCA patients.
Astragaloside IV alleviates GDM via regulating gut microbiota and gut microbiota metabolomic
Authors: Wang Fengge , Zhu Yongning , Shu Hua , Zhang Xiaoyun , Duan Liting , Man Dongmei , Wang Yanping 
Published: January 2025

BackgroundGestational diabetes mellitus (GDM), a severe pregnancy disorder, is a temporary form of diabetes that occurs during gestation. Astragaloside IV (AS IV), a natural and effective composition of Astragalus membranaceus, shows pharmacological effects against diabetes. On the contrary, the effects of AS IV on GDM development are still not clear. This study aims to investigate the role of AS IV in alleviating GDM in rats and determine whether AS IV exerts its anti-GDM properties through the regulation of gut microbiota and metabolite modulation.MethodsThere were six pregnant SD rats in each of the four groups. First, the GDM model was induced by the streptozotocin (STZ, 45 mg/kg) injection on gestational days (GDs) 1–4, and AS IV intervention (10 mg/kg/d) was administered from 6 days before pregnancy until delivery. The measurements of relevant indicators pertaining to GDM symptoms and reproductive outcomes, along with the 16S rRNA sequencing data and LC-MS-based metabolomic profiles, were assessed across all groups.ResultsAfter the 25-day intervention, the GDM model + AS IV group showed significantly decreased fasting blood glucose levels (p = 0.0003), mean insulin levels (p = 0.0001), and insulin resistance index (p = 0.0001). AS IV treatment also decreased the malformation rate (p = 0.0373) and increased the average fetal weight (p = 0.0020) of GDM rats. Compared to the control rats, GDM rats showed a significantly higher abundance of Blautia and Anaerobiospirillum. However, the dramatically elevated abundance of these microorganisms was markedly decreased by AS IV treatment. In contrast, compared to GDM rats without treatment, GDM rats treated with AS IV showed a significantly higher abundance of bacteria (p &lt; 0.05), such as Methanobrevibacter, Dubosiella, and Romboutsia, which are beneficial to the rats. Additionally, we observed dramatically elevated production of metabolites, such as N-acetyl-l-leucine and lithocholic acid, after AS IV treatment through metabolomics analysis (p &lt; 0.05). Furthermore, significant associations between most genera of gut bacteria and the altered levels of the metabolites connected to gut microbiota were also discovered.ConclusionOur study demonstrated that AS IV could be an effective nutritional intervention strategy for targeting gut microbiota and metabolome profiles in GDM and provided experimental evidence supporting the use of AS IV to treat GDM.
Comparing efficacy and safety of low-dose versus standard-dose antiplatelet therapy in stroke patients: a meta-analysis
Authors: Ren Zhao , Li Chunxing , Zhang Xin , Sun Lichaoyue , Zhu Hui , Wang Dongxiao , Wang Yumin , Liang Shuo , Wang Guanchun 
Published: January 2025

BackgroundStroke is the leading cause of disability globally, with antiplatelet therapy being crucial for secondary prevention but also increasing bleeding risks. This requires careful dosage adjustments to balance thrombosis and bleeding risks.ObjectiveThis study compared the efficacy and safety of low-dose versus standard-dose antiplatelet therapy in stroke patients.MethodsWe conducted a comprehensive search across multiple databases, including PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, CNKI, and the Wanfang Medical Database, up to March 2024. Only randomized controlled trials assessing low-dose antiplatelet therapy in stroke patients were considered. The Cochrane Risk of Bias Tool (RoB 2) was used for quality. Performed meta-analysis using Stata 15.0, with relative risk (RR) and 95% confidence interval (CI) as effect estimates.ResultsTen studies involving 7,703 Asia participants, mainly from China and Japan, were analyzed. The meta-analysis revealed that low-dose reduces the risk of bleeding (RR 0.51; 95% CI 0.27, 0.98) compared to standard dose, with similar risks for stroke (RR 1.04; 95% CI 0.69, 1.55), myocardial infarction (MI) (RR 1.91; 95% CI 0.88, 4.12), all-cause death (ACD) (RR 1.17; 95% CI 0.38, 3.62), and major bleeding (RR 0.74; 95% CI 0.16, 3.30). Subgroup analysis revealed that compared to standard-dose clopidogrel, low-dose clopidogrel increased the risk of MI. Notably, this increased risk was observed specifically within the Chinese population but not in the Japanese population. Low-dose clopidogrel and low-dose prasugrel reduce the risk of bleeding compared to standard-dose clopidogrel, but there is no statistically significant difference. Low-dose aspirin significantly reduces the risk of bleeding compared to standard-dose aspirin.ConclusionIn patients with stroke in Asia, low-dose antiplatelet therapy significantly reduces the risk of bleeding compared to standard doses, with consistent risks of stroke, MI, ACD, major bleeding, and discontinuation due to bleeding.