bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Infection, Predictors of Severe Disease, and Antibody Response to COVID-19 in Patients With Inflammatory Rheumatic Diseases in Portugal—A Multicenter, Nationwide Study
Authors: Cruz-Machado Ana Rita , Barreira Sofia C. , Bandeira Matilde , Veldhoen Marc , Gomes Andreia , Serrano Marta , Duarte Catarina , Rato Maria , Miguel Fernandes Bruno , Garcia Salomé , Pinheiro Filipe , Bernardes Miguel , Madeira Nathalie , Miguel Cláudia , Torres Rita , Bento Silva Ana , Pestana Jorge , Almeida Diogo , Mazeda Carolina , Cunha Santos Filipe , Pinto Patrícia , Sousa Marlene , Parente Hugo , Sequeira Graça , Santos Maria José , Fonseca João Eurico , Romão Vasco C. 
Published: September 2022

ObjectiveTo identify risk factors for SARS-CoV-2 infection and for severe/critical COVID-19, and to assess the humoral response after COVID-19 in these patients.MethodsNationwide study of adult patients with inflammatory RMDs prospectively followed in the Rheumatic Diseases Portuguese Register—Reuma.pt—during the first 6 months of the pandemic. We compared patients with COVID-19 with those who did not develop the disease and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. IgG antibodies against SARS-CoV-2 were measured ≥3 months after infection and results were compared with matched controls.Results162 cases of COVID-19 were registered in a total of 6,363 appointments. Patients treated with TNF inhibitors (TNFi; OR = 0.160, 95% CI 0.099–0.260, P &lt; 0.001) and tocilizumab (OR 0.147, 95% CI 0.053–0.408, P &lt; 0.001) had reduced odds of infection. Further, TNFi tended to be protective of severe and critical disease. Older age, major comorbidities, and rituximab were associated with an increased risk of infection and worse prognosis. Most patients with inflammatory RMDs (86.2%) developed a robust antibody response. Seroconversion was associated with symptomatic disease (OR 13.46, 95% CI 2.21–81.85, P = 0.005) and tended to be blunted by TNFi (OR 0.17, 95% CI 0.03–1.05; P = 0.057).ConclusionsTNFi and tocilizumab reduced the risk of infection by SARS-CoV-2. Treatment with TNFi also tended to reduce rates of severe disease and seroconversion. Older age, general comorbidities and rituximab were associated with increased risk for infection and worse prognosis, in line with previous reports. Most patients with RMDs developed a proper antibody response after COVID-19, particularly if they had symptomatic disease.
Lateral elbow tendinopathy and artificial intelligence: Binary and multilabel findings detection using machine learning algorithms
Authors: Droppelmann Guillermo , Tello Manuel , García Nicolás , Greene Cristóbal , Jorquera Carlos , Feijoo Felipe 
Published: September 2022

BackgroundUltrasound (US) is a valuable technique to detect degenerative findings and intrasubstance tears in lateral elbow tendinopathy (LET). Machine learning methods allow supporting this radiological diagnosis.AimTo assess multilabel classification models using machine learning models to detect degenerative findings and intrasubstance tears in US images with LET diagnosis.Materials and methodsA retrospective study was performed. US images and medical records from patients with LET diagnosis from January 1st, 2017, to December 30th, 2018, were selected. Datasets were built for training and testing models. For image analysis, features extraction, texture characteristics, intensity distribution, pixel-pixel co-occurrence patterns, and scales granularity were implemented. Six different supervised learning models were implemented for binary and multilabel classification. All models were trained to classify four tendon findings (hypoechogenicity, neovascularity, enthesopathy, and intrasubstance tear). Accuracy indicators and their confidence intervals (CI) were obtained for all models following a K-fold-repeated-cross-validation method. To measure multilabel prediction, multilabel accuracy, sensitivity, specificity, and receiver operating characteristic (ROC) with 95% CI were used.ResultsA total of 30,007 US images (4,324 exams, 2,917 patients) were included in the analysis. The RF model presented the highest mean values in the area under the curve (AUC), sensitivity, and also specificity by each degenerative finding in the binary classification. The AUC and sensitivity showed the best performance in intrasubstance tear with 0.991 [95% CI, 099, 0.99], and 0.775 [95% CI, 0.77, 0.77], respectively. Instead, specificity showed upper values in hypoechogenicity with 0.821 [95% CI, 0.82, −0.82]. In the multilabel classifier, RF also presented the highest performance. The accuracy was 0.772 [95% CI, 0.771, 0.773], a great macro of 0.948 [95% CI, 0.94, 0.94], and a micro of 0.962 [95% CI, 0.96, 0.96] AUC scores were detected. Diagnostic accuracy, sensitivity, and specificity with 95% CI were calculated.ConclusionMachine learning algorithms based on US images with LET presented high diagnosis accuracy. Mainly the random forest model shows the best performance in binary and multilabel classifiers, particularly for intrasubstance tears.
Clinical manifestation and treatment of small intestinal lymphangioma: A single center analysis of 15 cases
Authors: Wang Zhen-zhen , Shen Ling-yan , Zhou Jing-jing , Tang Jia-li , Ye Li-ping , Shen Chen-bo , Li Shao-wei , Zhou Xian-bin 
Published: September 2022

BackgroundSmall intestinal lymphangioma is a very rare benign lesion. Thus far, the literature on small intestinal lymphangioma has mainly involved case reports. The present study retrospectively examined the clinical features of patients with a pathological diagnosis of small intestinal lymphangioma.Materials and methodsFrom January 2010 to January 2021, 15 patients were pathologically diagnosed with small intestinal lymphangioma. The age, gender, clinical manifestation, computed tomography (CT) findings, endoscopic findings, localization of the lesion, treatment method, complications, and follow-up were retrospectively analyzed.ResultsMost of the patients had no symptoms, and those with symptoms had melena or abdominal pain. Lymphangioma was located in the duodenum in nine cases (60.0%), jejunum in two (13.3%), jejunal-ileal junction with mesentery involvement in one (6.7%) and ileum in three (20.0%). Three cases (20.0%) had multiple lesions, and the other 12 (80.0%) had single lesions. The median size of the lesions was 0.8 cm. Thirteen cases were found by endoscopy, and nine cases of them had white-colored spots on the surface. Ten cases (66.7%) underwent endoscopic treatment, three (20.0%) underwent surgical treatment, and two (13.3%) were followed up. Postoperative acute pancreatitis developed in one patient after endoscopic resection of duodenal papillary lymphangioma; postoperative abdominal bleeding occurred in one patient with jejunal lymphangioma who underwent partial small bowel resection.ConclusionSmall intestinal lymphangioma is extremely rare, and its clinical manifestations are non-specific. Endoscopy is of great value in the diagnosis of small intestinal lymphangioma. Depending on the clinical manifestations, the size, location and scope of the lesions, follow-up, endoscopic treatment and surgery can be selected.
Role of ARRB1 in prognosis and immunotherapy: A Pan-Cancer analysis
Authors: Ye Yingquan , Jiang Haili , Wu Yue , Wang Gaoxiang , Huang Yi , Sun Weijie , Zhang Mei 
Published: September 2022

Background: β-arrestin1 (ARRB1), was originally identified as a multifunctional adaptor protein. Although ARRB1 has recently been shown to also play an important role in tumor growth, metastasis, inflammation, and immunity, its relationship with distinct tumor types and the tumor immune microenvironment remains unclear.Methods: We analyzed the ARRB1 expression profile and clinical characteristics in 33 cancer types using datasets from The Cancer Genome Atlas (TCGA) database. Clinical parameters such as patient survival, tumor stage, age, and gender were used to assess the prognostic value of ARRB1. The Human Protein Atlas (HPA) database was used to explore ARRB1 protein expression data. ESTIMATE and CIBERSORT algorithms were performed to assess immune infiltration. Furthermore, putative correlations between ARRB1 and tumor-infiltrating immune cells, the signatures of T-cell subtypes, immunomodulators, the tumor mutation burden (TMB), Programmed cell death ligand 1 (PD-L1), and microsatellite instability (MSI) were also explored. Gene functional enrichment was determined using GSEA. GSE40435 and GSE13213 cohorts were used to validate the correlation of ARRB1 with KIRC and LUAD clinicopathological parameters. Finally, the relationship between ARRB1 and immunotherapeutic responses was assessed using three independent immunotherapy cohorts, namely, GSE67501, GSE168204, and IMvigor210.Results: We found that ARRB1 expression levels were lower in 17 tumor tissues than in the corresponding normal tissues. We further found that ARRB1 expression was significantly correlated with tumor stage in BRCA, ESCA, KIRC, TGCT, and THCA, while in some tumors, particularly KIRC and LUAD, ARRB1 expression was associated with better prognosis. ARRB1 expression was also positively correlated with the stromal score or the immune score in some tumors. Regarding immune cell infiltration, ARRB1 expression in DLBC was positively correlated with M1 macrophage content and negatively correlated with B-cell infiltration. Additionally, there was a broad correlation between ARRB1 expression and three classes of immunomodulators. Furthermore, high ARRB1 expression levels were significantly correlated with some tumor immune-related pathways. Finally, ARRB1 expression was significantly associated with MSI, PD-L1, and TMB in some tumors and with the efficacy of immune checkpoint inhibitors (ICIs) in melanoma.Conclusion: ARRB1 has prognostic value in malignant tumors, especially in KIRC and LUAD. At the same time, ARRB1 was closely correlated with the tumor immune microenvironment and indicators of immunotherapy efficacy, indicating its great potential as a reliable marker for predicting the efficacy of immunotherapy.
Sum of boxes of the clinical dementia rating scale highly predicts conversion or reversion in predementia stages
Authors: Tzeng Ray-Chang , Yang Yu-Wan , Hsu Kai-Cheng , Chang Hsin-Te , Chiu Pai-Yi 
Published: September 2022

BackgroundThe clinical dementia rating (CDR) scale is commonly used to diagnose dementia due to Alzheimer’s disease (AD). The sum of boxes of the CDR (CDR-SB) has recently been emphasized and applied to interventional trials for tracing the progression of cognitive impairment (CI) in the early stages of AD. We aimed to study the influence of baseline CDR-SB on disease progression to dementia or reversion to normal cognition (NC).Materials and methodsThe baseline CDR &lt; 1 cohort registered from September 2015 to August 2020 with longitudinal follow-up in the History-based Artificial Intelligence Clinical Dementia Diagnostic System (HAICDDS) database was retrospectively analyzed for the rates of conversion to CDR ≥ 1. A Cox regression model was applied to study the influence of CDR-SB levels on progression, adjusting for age, education, sex, neuropsychological tests, neuropsychiatric symptoms, parkinsonism, and multiple vascular risk factors.ResultsA total of 1,827 participants were analyzed, including 1,258 (68.9%) non-converters, and 569 (31.1%) converters with mean follow-up of 2.1 (range 0.4–5.5) and 1.8 (range 0.3–5.0) years, respectively. Conversion rates increased with increasing CDR-SB scores. Compared to a CDR-SB score of 0, the hazard ratios (HR) for conversion to dementia were 1.51, 1.91, 2.58, 2.13, 3.46, 3.85, 3.19, 5.12, and 5.22 for CDR-SB scores of 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, and ≥4.5, respectively (all p &lt; 0.05 except for CDR-SB score = 0.5). In addition, older age, lower education, lower cognitive performance, and a history of diabetes also increased conversion rates. Furthermore, reversions to NC were 12.5, 5.6, 0.9, and 0% for CDR-SB scores of 0.5, 1.0–2.0, 2.5–3.5 and ≥4.0, respectively (p &lt; 0.001).ConclusionCDR-SB in predementia or very mild dementia (VMD) stages highly predicts progression to dementia or reversion to NC. Therefore, CDR-SB could be a good candidate for tracing the effectiveness of pharmacological and non-pharmacological interventions in populations without dementia.
Impact of Pre-operative Embolization With Onyx for Brain Arteriovenous Malformation Surgery
Authors: Izumo Tsuyoshi , Okamura Kazuaki , Takahira Ryotaro , Matsunaga Yuki , Sadakata Eisaku , Maeda Hajime , Yamaguchi Susumu , Baba Shiro , Morofuji Yoichi , Hiu Takeshi , Horie Nobutaka , Anda Takeo , Kitagawa Naoki , Tokunaga Yoshiharu , Hayashi Kentaro , Matsumoto Yasushi , Nagata Izumi , Matsuo Takayuki 
Published: September 2022

ObjectiveTo clarify the safety and efficacy of pre-operative embolization using Onyx liquid embolic agent (Onyx; ev3) compared with N-butyl cyanoacrylate (NBCA; Cordis Neurovascular, Inc.) or coils in cerebral arteriovenous malformation (AVM) surgery.MethodsThis was a retrospective review of a prospectively collected clinical database of brain AVMs treated at our institute from January 2005 to March 2021. A total of 38 consecutive patients who underwent AVM resection after pre-operative embolization were included. Based on pre-operative embolization materials, the patients were divided into the pre-Onyx group (n = 16), in which NBCA or coils were used for embolization, and the Onyx group (n = 22). Patient characteristics and treatment results were compared between the two groups.ResultsPatient characteristics were comparable between the two groups in terms of age, sex, and rupture status. While the Spetzler–Martin grade was also similar between the two groups, the location of the AVM nidus in the eloquent area was slightly higher in patients in the Onyx group (72.7%) than in patients in the pre-Onyx group (43.8%) (P = 0.09). The embolization rate was higher in the pre-Onyx group (mean: 63.0%; range: 12.7–100%) than in the Onyx group (mean: 50.0%; range: 15.8–100%), but the difference was not statistically significant (P = 0.06). The time needed for surgical removal was shorter in the Onyx group (mean: 354.8 min; range: 144–884 min) than in the pre-Onyx group (mean: 457.9 min; range: 240–1,294 min); however, this difference was not statistically significant (P = 0.13). The amount of intraoperative bleeding was significantly lower in the Onyx group (mean: 129.8 ml; range: 20–540 mL) than in the pre-Onyx group (mean: 448.8 mL; range: 120–1,550 ml) (P = 0.0008). The surgical complication rates were comparable between the two groups (pre-Onyx group, 18.8%; Onyx group, 4.5%; P = 0.29).ConclusionsPre-operative embolization with Onyx can significantly reduce the amount of intraoperative bleeding in AVM resection and may contribute to safe AVM surgery.
Intra- and post-operative acute hemorrhagic complications of Onyx embolization of brain arteriovenous malformations: A single-center experience
Authors: Chen Xuan , Wang Yiheng , Yu Jinlu 
Published: September 2022

BackgroundThe intra- and post-operative acute (within 72 h) hemorrhagic complications of endovascular treatment (EVT) for a brain arteriovenous malformation (BAVM) are disastrous. Thus, further experiential summaries are required to fully understand them.Materials and methodsThis was a retrospective study of 25 patients with consecutive BAVM who were treated via EVT with Onyx embolization and suffered intra- and post-operative acute hemorrhage. The clinical and imaging data of the patients were recorded, analyzed, and discussed.ResultTwenty-five patients were aged 11–70 years (mean, 37.2 ± 16.1 years), of whom 12 were female (48%, 12/25). Of the 25 hemorrhagic complications, 17 (68%, 17/25) were intraoperative, and 8 (32%, 8/25) were post-operative and occurred between 1 and 12 h after EVT. Of 17 intraoperative hemorrhages, 13 (76.5%, 13/17) were due to high-pressure Onyx casting. Of eight post-operative hemorrhages, six (75%, 6/8) were attributed to normal perfusion pressure breakthrough. The degree of nidus Onyx embolization was more than 2/3 or complete in seven (87.5%, 7/8) BAVMs. Draining vein occlusion was observed in eight (32%, 8/25) of 25 BAVMs. After hemorrhage, conservative treatment was administered in 12 (48%, 12/25) cases, and surgical management was performed in other cases. There were eight cases of mortality; the remaining 17 patients had follow-up data. Among them, 15 patients had good outcomes, with Glasgow Outcome Scale scores of 5 and 4, accounting for 60% (15/25).ConclusionIn EVT for BAVMs, intra- and post-operative acute hemorrhagic complications are disastrous; only 60% of patients have a good outcome. Therefore, high-pressure Onyx casting or casting too much Onyx at one time to pursue a high degree of nidus embolization should be performed cautiously, and primary draining vein occlusion should be avoided. In short, EVT needs to be performed carefully.
Reducing delay to endovascular reperfusion after relocating a thrombolysis unit
Authors: Laugesen Nicolaj Grønbæk , Hansen Klaus , Højgaard Joan , Iversen Helle Klingenberg , Truelsen Thomas 
Published: September 2022

Background and aimsFunctional outcome following mechanical thrombectomy (MT) in patients with acute ischemic stroke and large vessel occlusion is time-dependent and worsens with increasing delay. Time to endovascular reperfusion is potentially modifiable with changes in organizational structure. We investigated the changes in time to reperfusion of relocating the intravenous thrombolysis (IVT) services from a non-MT center to a MT-capable center.MethodsWe present an observational, consecutive, retrospective, single-center cohort study of 253 stroke patients treated with MT, 2017–2019. The observation period was divided into before and after the relocation of IVT services in 2018, period 1 and period 2, respectively. The two hospitals were located 13 km apart in an urban area, and following the relocation, IVT was administered at the MT-capable center. Time metrics were registered and divided into two main intervals, namely, ambulance departure from stroke onset location to imaging (ambulance-imaging) and imaging to reperfusion (imaging-reperfusion). The interval imaging-reperfusion included inter-hospital transfer to the MT-capable center in period 1. The association of the imaging-reperfusion duration and functional outcome at 90 days was analyzed using ordinal logistic regression.ResultsNo significant change in ambulance-imaging was observed from a median of 27 min (interquartile range [IQR] 22–37) in period 1 to 30 min (IQR 23–40) in period 2, p = 0.19, while the median time of imaging-reperfusion decreased from 173 min (IQR 137–230) to 114 min (IQR 84–152), p &lt; 0.001. The largest absolute time reduction from imaging to reperfusion was seen from imaging to arrival at the angio suite from 89 min (IQR 76–111) to 42 min (IQR 28–63), p &lt; 0.001, which included inter-hospital transfer in period 1. In multivariate analysis, every 10 min of increased delay from imaging to reperfusion was associated with poorer functional outcome with an adjusted odds ratio of 0.95 (95% CI: 0.95–0.98), p &lt; 0.001.ConclusionRelocation of IVT services to an MT-capable center was the main cause of reduced time to reperfusion for patients treated with MT and was implemented without affecting prehospital transportation time. These results suggest that patient outcome can be improved by optimizing the organization of IVT and MT services in urban areas.
Development and validation of mathematical nomogram for predicting the risk of poor sleep quality among medical students
Authors: Ding Jiahao , Guo Xin , Zhang Mengqi , Hao Mingxia , Zhang Shuang , Tian Rongshen , Long Liting , Chen Xiao , Dong Jihui , Song Haiying , Yuan Jie 
Published: September 2022

BackgroundDespite the increasing prevalence of poor sleep quality among medical students, only few studies have identified the factors associated with it sing methods from epidemiological surveys. Predicting poor sleep quality is critical for ensuring medical Students’ good physical and mental health. The aim of this study was to develop a comprehensive visual predictive nomogram for predicting the risk of poor sleep quality in medical students.MethodsWe investigated medical Students’ association with poor sleep quality at JiTang College of North China University of Science and Technology through a cross-sectional study. A total of 5,140 medical students were randomized into a training cohort (75%) and a validation cohort (25%). Univariate and multivariate logistic regression models were used to explore the factors associated with poor sleep quality. A nomogram was constructed to predict the individual risk of poor sleep quality among the medical students studied.Results31.9% of medical students in the study reported poor sleep quality. We performed multivariate logistic analysis and obtained the final model, which confirmed the risk and protective factors of poor sleep quality (p &lt; 0.05). Protective factors included the absence of physical discomfort (OR = 0.638, 95% CI: 0.546–0.745). Risk factors included current drinking (OR = 0.638, 95% CI: 0.546∼0.745), heavy study stress (OR = 2.753, 95% CI: 1.456∼5.631), very heavy study stress (OR = 3.182, 95% CI: 1.606∼6.760), depressive symptoms (OR = 4.305, 95% CI: 3.581∼5.180), and anxiety symptoms (OR = 1.808, 95% CI: 1.497∼2.183). The area under the ROC curve for the training set is 0.776 and the area under the ROC curve for the validation set is 0.770, which indicates that our model has good stability and prediction accuracy. Decision curve analysis and calibration curves demonstrate the clinical usefulness of the predictive nomograms.ConclusionOur nomogram helps predict the risk of poor sleep quality among medical students. The nomogram used includes the five factors of drinking, study stress, recent physical discomfort, depressive symptoms, and anxiety symptoms. The model has good performance and can be used for further research on and the management of the sleep quality of medical students.
Amblyopia is associated with impaired balance in 3–6-year-old children in China
Authors: Brin Taylor A. , Xu Zixuan , Zhou Yusong , Feng Lei , Li Jinrong , Thompson Benjamin 
Published: September 2022

PurposeSchool-age children in China have more advanced motor development than their North American counterparts. This is likely due to cultural differences in children’s regular motor activities. It is unknown whether the motor function impairments associated with binocular visual disorders (BVDs) such as amblyopia in children raised in North America exist for children raised in China.DesignProspective case-control study.MethodsA major tertiary eye hospital in China tested children aged 3 to &lt;7 (n = 63) belonging to three groups: anisometropic or strabismic amblyopia (n = 22), anisometropia or strabismus without amblyopia (n = 20), or controls (n = 21). The main outcome measure was motor function scores (Movement Assessment Battery for Children 2nd edition).ResultsBalance scores varied significantly across groups (F2,61 = 4.2, p = 0.02) with the amblyopia group (mean ± SD: 12.5 ± 3.0) exhibiting significantly poorer scores than controls (14.8 ± 2.3). The no-amblyopia BVD group (12.8 ± 3.1) did not differ significantly from the other groups. Manual dexterity, catching and throwing and total scores did not vary significantly across the three groups. A separate pre-planned comparison of only the amblyopia and control groups revealed significantly poorer total motor scores in the amblyopia group (10.1 ± 3.2) vs. controls (12 ± 2.4). A linear regression model was unable to significantly predict associations between total motor score and binocular function score (standardized β = −0.09, 95%, p = 0.7), amblyopia etiology (standardized β = 0.14, 95%, p = 0.4), or inter-ocular acuity difference (standardized β = −0.18, 95%, p = 0.4), in the amblyopia group.ConclusionAmblyopia is associated with motor function impairment in children raised in China. Motor deficits that may impact everyday activities have been observed in patients with amblyopia across multiple cultures.