bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated Serum Uric Acid Increases the Risk of Ischemic Stroke Recurrence and Its Inflammatory Mechanism in Older Adults
Authors: Zhu Han-Yu , Zhao Shu-Zhen , Zhang Meng-Li , Wang Yan , Pan Zhi-Ming , Cheng Hao-Ran , Zhao Ke , Wang Zhen 
Published: March 2022

BackgroundSerum uric acid (UA) has been reported to be associated with ischemic stroke and inflammation. However, whether or not UA is related to the recurrence of ischemic stroke, and whether inflammation plays a role in the relationship between them remain inconclusive.ObjectiveWe sought to explore the relationship between UA and the recurrence of ischemic stroke and to define the role of neutrophil-to-lymphocyte ratio (NLR) in the aforementioned relationship.MethodsA total of 8,995 patients were included in this study. Basic information and blood samples were collected, and whether or not each participant experienced ischemic stroke recurrence within 3 years was documented. Patients were stratified into three groups according to their UA level, as follows: ≤ 266, 267–339, and ≥ 340 μmol/L. COX regression and restricted cubic spline regression models were used to evaluate the clinical correlation between UA and ischemic stroke recurrence, mediation analysis and interaction and joint analysis were used to evaluate the role of NLR in the association of UA and ischemic stroke recurrence, and sensitivity and subgroup analyses were performed to test the robustness of the data.ResultsIschemic stroke recurrence was related to male sex, older age, higher UA level, higher NLR, hypertension, diabetes, and cardiovascular disease. Following adjustment for potential confounders, a high level of UA (≥ 340 μmol/L) increased the risk of recurrence by 92.6% in patients with previous ischemic stroke. We also found that NLR affects the association between UA and the recurrence of ischemic stroke in older adults, suggesting that patients with high NLR and high UA levels are at greater risk for ischemic stroke recurrence.ConclusionUA level is non-linearly associated with recurrence, and NLR has an additive interaction between UA and ischemic stroke recurrence.
Effects of Individualized Gait Rehabilitation Robotics for Gait Training on Hemiplegic Patients: Before-After Study in the Same Person
Authors: Guo Zhao , Ye Jing , Zhang Shisheng , Xu Lanshuai , Chen Gong , Guan Xiao , Li Yongqiang , Zhang Zhimian 
Published: March 2022

BackgroundLower-limb exoskeleton robots are being widely used in gait rehabilitation training for patients with stroke. However, most of the current rehabilitation robots are guided by predestined gait trajectories, which are often different from the actual gait trajectories of specific patients. One solution is to train patients using individualized gait trajectories generated from the physical parameters of patients. Hence, we aimed to explore the effect of individual gaits on energy consumption situations during gait rehabilitation training for hemiplegic patients with lower-limb exoskeleton robots.MethodsA total of 9 unilateral-hemiplegic patients were recruited for a 2-day experiment. On the first day of the experiment, the 9 patients were guided by a lower-limb exoskeleton robot, walking on flat ground for 15 min in general gait trajectory, which was gained by clinical gait analysis (CGA) method. On the other day, the same 9 patients wore the identical robot and walked on the same flat ground for 15 min in an individualized gait trajectory. The main physiological parameters including heart rate (HR) and peripheral capillary oxygen saturation (SpO2) were acquired via cardio tachometer and oximeter before and after the walking training. The energy consumption situation was indicated by the variation of the value of HR and SpO2 after walking training compared to before.ResultsBetween-group comparison showed that the individualized gait trajectory training resulted in an increase in HR levels and a decrease in SpO2 levels compared to the general gait trajectory training. The resulting difference had a statistical significance of p &lt; 0.05.ConclusionUsing individualized gait guidance in rehabilitation walking training can significantly improve energy efficiency for hemiplegic patients with stroke.
Linear and Nonlinear Directed Connectivity Analysis of the Cardio-Respiratory System in Type 1 Diabetes
Authors: Sorelli Michele , Hutson T. Noah , Iasemidis Leonidas , Bocchi Leonardo 
Published: March 2022

In this study, we explored the possibility of developing non-invasive biomarkers for patients with type 1 diabetes (T1D) by quantifying the directional couplings between the cardiac, vascular, and respiratory systems, treating them as interconnected nodes in a network configuration. Towards this goal, we employed a linear directional connectivity measure, the directed transfer function (DTF), estimated by a linear multivariate autoregressive modelling of ECG, respiratory and skin perfusion signals, and a nonlinear method, the dynamical Bayesian inference (DBI) analysis of bivariate phase interactions. The physiological data were recorded concurrently for a relatively short time period (5 min) from 10 healthy control subjects and 10 T1D patients. We found that, in both control and T1D subjects, breathing had greater influence on the heart and perfusion with respect to the opposite coupling direction and that, by both employed methods of analysis, the causal influence of breathing on the heart was significantly decreased (p &lt; 0.05) in T1D patients compared to the control group. These preliminary results, although obtained from a limited number of subjects, provide a strong indication for the usefulness of a network-based multi-modal analysis for the development of biomarkers of T1D-related complications from short-duration data, as well as their potential in the exploration of the pathophysiological mechanisms that underlie this devastating and very widespread disease.
Robot Fully Assisted Upper-Limb Functional Movements Against Gravity to Drive Recovery in Chronic Stroke: A Pilot Study
Authors: Caimmi Marco , Giovanzana Chiara , Gasperini Giulio , Molteni Franco , Molinari Tosatti Lorenzo 
Published: March 2022

BackgroundStroke is becoming more and more a disease of chronically disabled patients, and new approaches are needed for better outcomes. An intervention based on robot fully assisted upper-limb functional movements is presented.ObjectivesTo test the immediate and sustained effects of the intervention in reducing impairment in chronic stroke and to preliminarily verify the effects on activity.MethodologyNineteen patients with mild-to-severe impairment underwent 12 40-min rehabilitation sessions, 3 per week, of robot-assisted reaching and hand-to-mouth movements. The primary outcome measure was the Fugl-Meyer Assessment (FMA) at T1, immediately after treatment (n= 19), and at T2, at a 6-month follow-up (n= 10). A subgroup of 11 patients was also administered the Wolf Motor Function Test Time (WMFT TIME) and Functional Ability Scale (WMFT FAS) and Motor Activity Log (MAL) Amount Of Use (AOU), and Quality Of Movement (QOM).ResultsAll patients were compliant with the treatment. There was improvement on the FMA with a mean difference with respect to the baseline of 6.2 points at T1, after intervention (n= 19, 95% CI = 4.6–7.8,p&lt; 0.0002), and 5.9 points at T2 (n= 10, 95% CI = 3.6–8.2,p&lt; 0.005). Significant improvements were found at T1 on the WMFT FAS (n= 11, +0.3/5 points, 95% CI = 0.2–0.4,p&lt; 0.004), on the MAL AOU (n= 11, +0.18/5, 95% CI = 0.07–0.29,p&lt; 0.02), and the MAL QOM (n= 11, +0.14/5, 95% CI = 0.08–0.20,p&lt; 0.02).ConclusionsMotor benefits were observed immediately after intervention and at a 6-month follow-up. Reduced impairment would appear to translate to increased activity. Although preliminary, the results are encouraging and lay the foundation for future studies to confirm the findings and define the optimal dose-response curve.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03208634.
Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy
Authors: Relander Kristiina , Hietanen Marja , Rämö Juhani , Vento Antti , Tikkala Irene , Roine Risto O. , Lindsberg Perttu J. , Soinne Lauri 
Published: March 2022

BackgroundStenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease.MethodsA total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3–8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls.ResultsBefore surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase.ConclusionOur findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.
Optical Coherence Tomography Angiography Biomarkers of Retinal Thickness and Microvascular Alterations in Sjogren's Syndrome
Authors: Liu Ren , Wang Yan , Li Qiuyu , Xia Qiang , Xu Tian , Han Ting , Cai Shuang , Luo Shuilin , Wu Rui , Shao Yi 
Published: March 2022

PurposeTo investigate the differences of retinal thickness (RT) and superficial vascular density (SVD) between patients with Sjogren's syndrome (SS) and healthy controls (HCs) using optical coherence tomography angiography (OCTA).MethodsIndividuals with SS and healthy controls were enrolled (n = 12 per group). An en-face OCTA scan was performed on each eye. Images were segmented into 9 subregions and macular RT and SVD were measured and compared between the 2 groups.ResultsVisual acuity (VA) differed significantly between patients with SS (24 eyes) and controls (24 eyes) (p &lt; 0.001). In patients with SS, inner RT was reduced in the inner superior region, outer RT was reduced in the outer nasal (ON) region, and full RT was reduced in the ON region compared with the control group (p &lt; 0.05). RT was negatively correlated with serum IgG level in the outer and full retina at ON regions (p &lt; 0.05). SVD in the inner nasal, ON, and inner temporal regions was significantly lower in patients with SS than in control subjects (p &lt; 0.05). SVD was positively correlated with full RT in the ON region in patients with SS (p &lt; 0.05). The areas under the receiver operating characteristic (ROC) curves for the diagnostic sensitivity of outer RT and full RT in the ON region for SS were 0.828 (95% CI: 0.709–0.947) and 0.839 (95% CI: 0.715–0.963), respectively.ConclusionsIn patients with SS, retinal thinning in the macular area—which affects vision—can also reflect the severity of dry eyes in SS and has clinical value for assisted imaging diagnosis.
Altered Neuromagnetic Activity in Persistent Postural-Perceptual Dizziness: A Multifrequency Magnetoencephalography Study
Authors: Jiang Weiwei , Sun Jintao , Xiang Jing , Sun Yulei , Tang Lu , Zhang Ke , Chen Qiqi , Wang Xiaoshan 
Published: March 2022

ObjectiveThe aim of our study was to investigate abnormal changes in brain activity in patients with persistent postural-perceptual dizziness (PPPD) using magnetoencephalography (MEG).MethodsMagnetoencephalography recordings from 18 PPPD patients and 18 healthy controls were analyzed to determine the source of brain activity in seven frequency ranges using accumulated source imaging (ASI).ResultsOur study showed that significant changes in the patterns of localization in the temporal-parietal junction (TPJ) were observed at 1–4, 4–8, and 12–30 Hz in PPPD patients compared with healthy controls, and changes in the frontal cortex were found at 1–4, 80–250, and 250–500 Hz in PPPD patients compared with controls. The neuromagnetic activity in TPJ was observed increased significantly in 1–4 and 4–8 Hz, while the neuromagnetic activity in frontal cortex was found increased significantly in 1–4 Hz. In addition, the localized source strength in TPJ in 1–4 Hz was positively correlated with DHI score (r = 0.7085, p &lt; 0.05), while the localized source strength in frontal cortex in 1–4 Hz was positively correlated with HAMA score (r = 0.5542, p &lt; 0.05).ConclusionOur results demonstrated that alterations in the TPJ and frontal cortex may play a critical role in the pathophysiological mechanism of PPPD. The neuromagnetic activity in TPJ may be related to dizziness symptom of PPPD patients, while the neuromagnetic activity in frontal lobe may be related to emotional symptoms of PPPD patients. In addition, frequency-dependent changes in neuromagnetic activity, especially neuromagnetic activity in low frequency bands, were involved in the pathophysiology of PPPD.
Tumor Mutational Burden Associated With Response to Hyperthermic Intraperitoneal Chemotherapy
Authors: Zeng Lisi , Huang Xubo , Tian Yun , Huang Jinxia , Liu Huiyan , Wen Juncai , Liu Kaihua , Shao Yang , Luo Jiali , Tang Hongsheng , Liao Quanxing , Lei Ziying , Cui Weiwen , Xia Qianghua , Guan Tianpei , Li Jin , Cui Shuzhong 
Published: March 2022

BackgroundGastric cancer (GC) is one of the most common cancer types, especially in Asian countries. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve the progression-free survival among gastric cancer patients with peritoneal metastases; however, not all patients demonstrate response to HIPEC.MethodsBiomarkers are needed to select patients for effective treatment of HIPEC. Here, we performed whole-exome sequencing on tumor samples from 18 gastric cancer patients who received HIPEC treatment and assessed the association between genomic mutation features and progression-free survival. Exome sequencing was further conducted on tumor samples from additional 15 gastric cancer patients as a replication study.ResultsThe tumor mutational burden (TMB) was significantly higher in the group of patients with a better response to HIPEC treatment than that of the others. Kaplan–Meier survival curve showed that patients with high TMB had a significantly longer survival time than that in patients with low TMB. This discovery was validated in the replication cohort. Genes bearing mutations recurrently and selectively in patients with better response to HIPEC were found in the two cohorts.ConclusionWe found that higher TMB is significantly associated with better response to HIPEC. Our results provide useful hints for prognostic stratification of HIPEC treatment.
The Role of Primary Tumor Resection in Patients With Pancreatic Neuroendocrine Tumors With Liver Metastases
Authors: Mou Yu , Wang Zi-Yao , Tan Chun-Lu , Chen Yong-Hua , Liu Xu-Bao , Ke Neng-Wen 
Published: March 2022

BackgroundLiver metastases (LMs) are common in advanced pancreatic neuroendocrine tumor (PNET) patients. Currently, the benefit of primary tumor resection (PTR) in the setting of PNET patients with liver metastases is still controversial in several guidelines.MethodsData were extracted from the Surveillance, Epidemiology and End Results (SEER) database to evaluate this issue. The main index of interest in our study was overall survival time.ResultsInformation on 536 PNET patients with liver metastases from the SEER database was identified. A total of 214 patients (PTR group) received primary tumor resection, and more than half of them (132 patients) had synchronous LM resection. The other 322 PNET patients (non-PTR group) with liver metastases did not receive primary tumor resection. A significant survival benefit was gained from PTR when compared with non-PTR patients, both in OS (72.93 ± 2.7 vs. 36.80 ± 2.22 months) and 3- or 5-year survival rates (75.1% vs. 28.9% and 67.9% vs. 22.3%, respectively). No difference was found between PTR alone and PTR with synchronous LM resection. From univariate and multivariate analyses, younger age (&lt;65 years) and good or moderate tumor differentiation may be more important when considering primary tumor resection. However, we found that all grades of tumor differentiation could result in a better overall survival time after primary tumor resection.ConclusionOur study suggested that primary tumor resection in pancreatic neuroendocrine patients with liver metastases could result in a longer survival time. Primary tumor resection with synchronous liver metastasis resection was not related to a better survival benefit. This treatment strategy may routinely be taken into consideration in these patients.
Plan Quality Assessment of Fractionated Stereotactic Radiotherapy Treatment Plans in Patients With Brain Metastases
Authors: Simon Mihály , Papp Judit , Csiki Emese , Kovács Árpád 
Published: March 2022

Background and PurposeThe treatment options available in the management of brain metastases includes fractionated stereotactic radiotherapy (FSRT) and stereotactic radiosurgery (SRS) treatments. FSRT treatments have proved to be useful mainly in the treatment of larger volumes. This study aims to evaluate the FSRT treatment technique used in our department based on various plan quality indices.Methods and Materials24 treatment plans of 23 patients were analyzed. Volumetric modulated arc therapy (VMAT) plans were generated in line with the department protocol. The following parameters were extracted: Radiation Therapy Oncology Group conformity index (RTOG CI), Paddick conformity index (Paddick CI), gradient index (GI), quality index (Q), homogeneity index (HI), and V24.4 volume as a parallel index of V12 used at SRS plan evaluation.ResultsPlan conformity was acceptable, RTOG CI mean was 0.942; Paddick CI mean was 0.824. The mean GI value was 6.146. The mean of HI and Q indices were 1.263 and 0.94, respectively. V24.4 mean was 33.434 cm3. All plans achieved clinically acceptable organs-at-risk (OAR) constraints. PTV volumes were clustered into either 10 cm3 or 15 cm3 bins depending on the plan quality metric we used. The mean values show a balanced distribution of plan indices along the various PTV bins.DiscussionOur results based on the derived indices show that our FSRT approach can achieve clinically acceptable treatment plans. Furthermore, the clustering of PTV volumes show that these plan quality metrics remain acceptable for a wide spectrum of PTV volumes.
Rectal Radiation Dose and Clinical Outcomes in Prostate Cancer Patients Treated With Stereotactic Body Radiation Therapy With and Without Hydrogel
Authors: Kundu Palak , Lin Eric Y. , Yoon Stephanie M. , Parikh Neil R. , Ruan Dan , Kishan Amar U. , Lee Alan , Steinberg Michael L. , Chang Albert J. 
Published: March 2022

BackgroundPatients with prostate cancer treated with stereotactic body radiation therapy (SBRT) may experience gastrointestinal (GI) toxicity. The hydrogel may mitigate this toxicity by reducing the rectal radiation dose. The purpose of this study is to compare rectal radiation dose and GI toxicity in patients receiving prostate SBRT with and without hydrogel.MethodsConsecutive patients treated with SBRT between February 2017 and January 2020 with and without hydrogel were retrospectively identified. Baseline characteristics including prostate volume, rectal diameter, body mass index (BMI), age, pretreatment prostate-specific antigen (PSA), Gleason score, T-stage, and androgen deprivation therapy (ADT) usage were compared. Dosimetric outcomes (V40Gy, V36Gy, V32Gy, V38Gy, and V20Gy), rates of acute (≤90 days) and late (&gt;90 days) GI toxicity, and PSA outcomes were evaluated for patients with and without hydrogel.ResultsA total of 92 patients were identified (51 hydrogel and 41 non-hydrogel). There were no significant differences in baseline characteristics. Rectal V38(cc) was significantly less in the hydrogel group (mean 0.44 vs. mean 1.41 cc, p = 0.0002), and the proportion of patients with V38(cc) &lt; 2 cc was greater in the hydrogel group (92% vs. 72%, p = 0.01). Rectal dose was significantly lower for all institutional dose constraints in the hydrogel group (p &lt; 0.001). The hydrogel group experienced significantly less acute overall GI toxicity (16% hydrogel vs. 28% non-hydrogel, p = 0.006), while the difference in late GI toxicity trended lower with hydrogel but was not statistically significant (4% hydrogel vs. 10% non-hydrogel, p = 0.219). At a median follow-up of 14.8 months, there were no biochemical recurrences in either group.ConclusionHydrogel reduces rectal radiation dose in patients receiving prostate SBRT and is associated with a decreased rate of acute GI toxicity.
Characteristic of Perineural Invasion in Hilar Cholangiocarcinoma Based on Whole-Mount Histologic Large Sections of Liver
Authors: Wang Si-Yuan , Jiang Nan , Zeng Jian-Ping , Yu Shao-Qing , Xiao Ying , Jin Shuo 
Published: March 2022

Background &amp; ObjectivePerineural invasion is an important biological feature of hilar cholangiocarcinoma (HCCA). We developed a whole-mount histologic large sections (WHLS) of the liver to evaluate peripheral nerve invasion (PNI) of HCCA.MethodsUsing sampling, fixation, dehydration, embedding, sectioning, hematoxylin and eosin (H&amp;E) and immunohistochemical (IHC) staining, and scanning, the characteristics of intrahepatic and extrahepatic PNI in 20 patients with Bismuth type III and type IV HCCA were analyzed with WHLS. Correlation between the characteristics of nerve invasion and tumor size, vascular invasion (artery, portal vein), degree of differentiation, microvascular invasion (MVI), carbohydrate antigen19-9 (CA19-9), and differentiation degree of HCCA was statistically evaluated.ResultsThe WHLS of the liver was successfully established, which enabled us to observe intrahepatic and extrahepatic distribution of HCCA and whether surrounding tissues including nervous, blood, and lymph vessels were infiltrated. Extrahepatic and intrahepatic PNI were identified in 20 (100%) patients and 1 (5.0%) patient, respectively. Vessel density decreased in most invaded nerves presented by CD-34, which correlated with 100% of poorly differentiated and 83% of moderately differentiated tumors (P&lt;0.008).ConclusionThis study established a WHLS of the liver that can be used for clinical diagnosis and research, and confirmed that extrahepatic PNI is prevalent, but intrahepatic nerve invasion is rare and does not accompany the invasion scope of bile ducts in types III and IV HCCA. In addition, moderately and poorly differentiated malignant tumors are more prone to PNI, independent of blood supply.