bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of non-surgical periodontal treatment plus zinc and magnesium supplementation on oxidative stress and antioxidants enzymes in type 2 diabetes patients: A quasi-experimental study
Authors: Alarcón-Moreno José Carlos , Flores-Muñoz Mónica , Blázquez-Morales María Sobeida L. , García-Rivera Miguel Eric , Rodríguez-Alba Juan Carlos , Castro-López Claudio Rafael , Nachón-García Francisco Javier , Muñoz-Muñoz Víctor Hugo , Nachón-García María Gabriela
Published: June 2024

Background
Periodontal disease associated with T2DM is a chronic condition that affects the oral cavity of people living with T2DM. The mechanisms of the interaction between T2DM and PD are complex and involve multiple pathophysiological pathways related to the systemic inflammatory process and oxidative stress. Non-surgical periodontal treatment is considered the standard for the management of this disease; however, patients with systemic conditions such as T2DM do not seem to respond adequately. For this reason, the use of complementary treatments has been suggested to support non-surgical periodontal treatment (NSPT) to reduce the clinical consequences of the disease and improve the systemic conditions of the patient. The use of zinc gluconate and magnesium oxide as an adjunct to NSPT and its effects on periodontal clinical features and oxidative stress in patients with PD-T2DM is poorly understood.
Methods
A quasi-experimental study was performed in patients with periodontal diseases associated with T2DM. 45 subjects were assigned to a control group [non-surgical periodontal treatment (NSPT)] or experimental group (NSPT + 500 mg of magnesium oxide and 50 mg of zinc gluconate for oral supplementation for 30 days). Sociodemographic characteristics, physiological factors, biochemical parameters, and clinical features of periodontal diseases were assessed.
Results
In this research, the use of zinc and magnesium is suggested as a complement to non-surgical periodontal treatment. A change in periodontal clinical characteristics was observed, which has been associated with disease remission. Additionally, a shift in MDA levels was presented for both groups. Furthermore, the supplementation group showed an increase in antioxidant enzymes when compared to the group that only received NSPT.
Conclusion
zinc gluconate and magnesium oxide can serve as a complementary treatment to NSPT, that supports the remission of PD. As a result of regulation-reduction of oxidative biomarkers and increase in antioxidant enzymes activity. ISRCTN 14092381. September 13º 2023. Retrospective Registration
Trial Registration
https://www.isrctn.com.
Effects of post-aquatic exercise hypotension in older adults: a systematic review with meta-analysis
Authors: Sisconeto Tássia Magnabosco , Mariano Igor Moraes , Garcês Caroline Pereira , Miranda Camila , Zanella Jonas Casagranda , Kanitz Ana Carolina , Puga Guilherme Morais
Published: June 2024

The effects of aquatic exercise on acute blood pressure (BP) responses in older population remain inconsistent. The objective was to review the literature on the effects of aquatic exercises performed in a vertical position on acute BP responses after exercise in the older adults. We conducted a systematic review and meta-analysis of clinical trials, published until August 2023, using digital databases (EMBASE, PUBMED, Lilacs, SPORTDiscus, and Web of Science). Eight studies with 197 individuals were included for qualitative analysis, and seven studies were included in the meta-analysis. The aquatic exercise reduced systolic blood pressure (SBP) by -6.86 mmHg within 1 hour and by -4.14 mmHg for 24 hours post-exercise. However, it did not affect diastolic blood pressure (DBP) responses. Furthermore, subgroup analysis showed that HIIE reduced SBP by -15.50 mmHg and DBP by -5.97 mmHg after the sessions. Already the moderate-intensity continuous exercise reduced SBP by -4.91 mmHg, with no effect on DBP up to 1 hour after the sessions. Subgroup analysis over 24 hours was not possible. Acute aquatic exercise can reduce BP in the older adults, especially SBP. Post-exercise BP reduction is of utmost importance for the older people in preventing cardiovascular diseases, such as arterial hypertension.
Iron chelation as a new therapeutic approach to prevent senescence and liver fibrosis progression
Authors: Fabregat Isabel , Amengual Josep , Vaquero Javier , González-Sánchez Ester , Alay Ania , Bertran Esther , Sánchez Aránzazu , Herrera Blanca , Meyer Kathleen , Maus Mate , Serrano Manuel , Martínez-Chantar María
Published: June 2024

Iron overload and cellular senescence have been implicated in liver fibrosis, but their possible mechanistic connection has not been explored. To address this, we have deepened into the role of iron and senescence in an experimental model of chronic liver injury, analyzing whether an iron chelator would prevent liver fibrosis by decreasing hepatocyte senescence. The model of carbon tetrachloride (CCl4) in mice was used as experimental model of liver fibrosis. Results demonstrated that during the progression of liver fibrosis, accumulation of iron occurs, concomitant with the appearance of fibrotic areas and senescent cells surrounding these areas. Isolated parenchymal hepatocytes from CCl4-treated mice show a gene transcriptomic signature compatible with iron accumulation and senescence, which correlate with induction of Reactive Oxygen Species (ROS)-related genes and activation of the Transforming Growth Factor-beta (TGF-β) pathway. Analysis of the iron-related gene signature in a published single-cell RNA-seq dataset from CCl4-treated livers indicated iron accumulation also in other non-parenchymal liver cells, correlating with senescence in some of them. Treatment with deferiprone, an iron chelator, attenuated the accumulation of iron, fibrosis and senescence, concomitant with relevant changes in the senescent-associated secretome (SASP), which switched towards a more anti-inflammatory profile of cytokines. In vitro experiments in human hepatocyte HH4 cells demonstrated that iron accumulates in response to a senescence inducing reagent, doxorubicin, being deferiprone able to prevent senescence and SASP, attenuating growth arrest and cell death. However, deferiprone did not significantly affect senescence or activation markers in human hepatic stellate LX-2 cells. Transcriptomic data in patients demonstrated the relevance of iron accumulation in the progression of liver fibrosis, correlating with a SASP-related gene signature and pivotal hallmarks of hepatocyte damage. Altogether, our study establishes iron accumulation as a clinically exploitable driver to attenuate pathological senescence in hepatocytes.
Risk of Blood Clots After COVID-19 Vaccination and Infection: A Risk-Benefit Analysis
Authors: Zhao Lili , Tran Huong , Risk Malcolm , Nair Girish
Published: June 2024

We analyzed the risk-benefit of COVID-19 vaccine using a causal model to explain and weigh up possible risk factors of blood clots after vaccination. A self-controlled case series method was used to examine the association between blood clots and COVID-19 vaccination. To avoid bias due to the under-reported infection among non-hospitalized subjects, a case-control study was used to compare the risk of blood clots in infected subjects to control subjects who were hospitalized due to physical injury. We found increased risks of blood clots after vaccination (incidence rate ratio is 1.13, 95% CI: [1.03,1.24] after the first dose and 1.23, 95% CI: [1.13,1.34] after the second dose). Furthermore, vaccination attenuated the increased risk of blood clots associated with infection (odds ratio is 2.16, 95% CI: [1.93,2.42] in unvaccinated versus 1.46, 95% CI: [1.25,1.70] in vaccinated). After accounting for vaccine efficacy against infection and the protection against infection-associated blood clots, receiving the COVID-19 vaccines decreases the risk of blood clots, especially during high infection rate period.
Climate Trauma from Wildfire Exposure Impacts Cognitive Decision-Making
Authors: Nan Jason , Jaiswal Satish , Ramanathan Dhakshin , Withers Mathew , Mishra Jyoti
Published: June 2024

Climate trauma refers to the mental health sequalae of climate disaster events. We have previously shown evidence for climate trauma with high prevalence of trauma, anxiety and depression symptoms after California’s 2018 Camp Fire wildfire. Here, we investigate whether this climate trauma impacts cognitive decision-making and its neural correlates. One year after the wildfire, we recruited three groups - those directly exposed (n = 27), indirectly exposed (who community members who witnessed the wildfire n = 21), versus non-exposed controls from a nearby region (n = 27). Participants performed a decision-making task that led to immediate and cumulative point rewards on each trial with simultaneous electroencephalography (EEG) recordings. We evaluated Win-Stay behavior in choosing to stay with the greater expected value option. Directly-exposed individuals showed significantly reduced Win-Stay behavior relative to the other groups. EEG analyses showed significantly greater parietal alpha activity for the selected choice and ensuing rewards in the directly-exposed individuals, with underlying cortical source in posterior cingulate cortex. Overall, these findings suggest that climate trauma may significantly impact neuro-cognitive processing in the context of value-based decision-making, and may serve as a useful biomarker target for future mental health interventions in climate change impacted communities.
Single-Sheath Inverse Technique via Vertical Puncture in Hemodialysis Arteriovenous Fistula Angioplasty
Authors: Hasegawa Tetsuya , Tsuboi Masahiro , Takahashi Yuki , Endo Akira , Gotoh Yasuo
Published: June 2024

Background: Transvenous percutaneous transluminal angioplasty for dialysis access stenosis is sometimes for both the upstream and downstream side of the approach site. A single sheath inversion has been used in some cases, but there are few reports in the literature. The purpose of this study was to retrospectively evaluate the feasibility of the sheath inverse technique using the vertical puncture approach in PTA for stenosis of arteriovenous fistulas for hemodialysis.
Materials and Methods: Twenty patients (26 cases; 13 males; median age, 74 [range: 50–89] years) who underwent percutaneous transluminal angioplasty using the sheath inverse technique for native arteriovenous fistula stenosis between April 2019 and June 2023 were included. A 4-cm sheath (4Fr, 4 cases; 5Fr, 19 cases; 6Fr, 3 cases) was inserted by vertical puncture through a cutaneous vein in the forearm (20 cases) or upper arm (6 cases). After treating one side of the lesion, the sheath was reversed to treat the lesion on the opposite side. The vessel diameter at the sheath insertion site, the success rate of sheath inversion, the number of percutaneous transluminal angioplasty balloon catheters used, the percutaneous transluminal angioplasty success rate, and adverse events were evaluated.
Results: The median diameter at the sheath indwelling site was 5.2 (range: 3.6–9.5) mm, and sheath inversion was successful in all cases. The number of balloon catheters used was oneand two in 17 (65%) and eight cases (31%), respectively, and three in one case wherein a drug-coated balloon was used. Major complications were not observed. However, in one case wherein a sheath had to be placed at the arterial needle puncture site, the skin was hard, leading to difficulty in inversion, and transient venous spasm occurred post-inversion.
Conclusion: The single-sheath inverse technique for arteriovenous fistulas was feasible without sheath withdrawal.
Comparison of Torque between Different Diameters of Copper Rotor bar slot by Using FEM Software
Authors: tian zhuo
Published: June 2024

This paper presents the comparison of different rotor slot diameter which is designed by using FEM software.The parameter is than taken from 0.5HP AC induction motor with a 10 rotor slot by means of hardware experiment.The Parameter is used as the input for FEM for simulation purposes.The 0.5HP three phase induction motor is investigated by the differences of starting torque.This is because the design with smaller rotor slot can produce high starting torque and this is essential for high-inertia loads such as flywheel-equipped punch press,elevators and hoist as required by NEMA design D.Simulation analysis shows that the 4mm diameter of rotor slots have higher starting torque than the rest of the rotor slots which is 3.4NM.
Voltage Abnormity Prediction method of lithium ion Energy Storage power station using Informer Based on Bayesian Optimization
Authors: Rao Zhibo , Wu Jiahui , Li Guodong , Wang Haiyun
Published: June 2024

Due to the flourishing development in the field of energy storage power station, there has been considerable attention directed towards the prediction of battery system states and faults. Voltage, as a primary indicative parameter for various battery faults, holds paramount importance in accurately forecasting voltage abnormity to ensure the safe operation of battery systems. In this study, a prediction method based on the Informer is employed. The Bayesian optimization algorithm is utilized to fine-tune the hyperparameters of the neural network model, thereby enhancing the accuracy of voltage abnormity prediction in energy storage batteries. With a sampling time interval of 1 minute and a one-step prediction, where the training set constitutes 70% of the total data, this approach reduces the root mean square error, mean square error, and mean absolute error of the prediction results to 9.18 mV, 0.0831mV, and 6.708 mV, respectively. The impact of actual grid operation data on the prediction results at different sampling intervals and data training set ratios is also analysed, resulting in a dataset that balances efficiency and accuracy. The proposed Bayesian optimisation-based method can achieve more accurate voltage anomaly prediction.
Fibration symmetry-breaking supports functional transitions in a brain network engaged in language
Authors: Makse Hernan , Gili Tommaso , Avila Bryant , Pasquini Luca , Holodny Andrei , Phillips David , Boldi Paolo , Gabrielli Andrea , Caldarelli Guido , Zimmer Manuel
Published: June 2024

In his book 'A Beautiful Question' [1], physicist Frank Wilczek argues that symmetry is 'nature's deep design,' governing the behavior of the universe, from the smallest
particles to the largest structures [1-4]. While symmetry is a cornerstone of physics, it has not yet been found widespread applicability to describe biological systems [5], particularly the human brain. In this context, we study the human brain network engaged in language and explore the relationship between the structural connectivity
(connectome or structural network) and the emergent synchronization of the mesoscopic regions of interest (functional network). We explain this relationship through a different kind of symmetry than physical symmetry, derived from the categorical notion of Grothendieck fibrations [6]. This introduces a new understanding of the human brain by proposing a local symmetry theory of the connectome, which accounts for how the structure of the brain's network determines its coherent activity. Among the allowed patterns of structural connectivity, synchronization elicits different symmetry subsets according to the functional engagement of the brain. We show that the resting state is a particular realization of the cerebral synchronization pattern characterized by a fibration symmetry that is
broken [7] in the transition from rest to language. Our findings suggest that the brain's network symmetry at the local level determines its coherent function, and we can understand this relationship from theoretical principles.
Single center analysis of cardiac amyloidosis using 99mTc-HMDP imaging for diagnosis and evaluation after tafamidis treatment
Authors: Egi Ryuta , Matsusaka Yohji , Watanabe Kaho , Seto Akira , Matsunari Ichiro , Arai Takahide , Nakano Shintaro , Kuji Ichiei
Published: June 2024

Background The aims of this study were to evaluate the diagnostic performance of 99mTc-HMDP imaging for cardiac amyloidosis and to demonstrate changes in cardiac uptake of 99mTc-HMDP after tafamidis treatment. Seventy-five patients with suspected for cardiac amyloidosis who underwent 99mTc-HMDP imaging were included. We compared clinical data between visually positive and negative groups. We also compared visual Perugini grades and semi-quantitative H/CL (heart-to-contralateral area) ratios and myocardial SUVmax (maximum standardized uptake value) between cardiac transthyretin amyloidosis (ATTR) and amyloid light-chain amyloidosis (AL). Furthermore, H/CL ratio of 99mTc-HMDP and myocardial SUVmax were compared before and after tafamidis administration for cardiac wild-type ATTR.
Results Among 75 patients, 20 patients (26.7%) were visually positive based on Perugini grade. Fifteen patients and 3 patients were pathologically identified as cardiac ATTR and AL, respectively. ATTR group (n =15) had significantly higher H/CL ratios of 99mTc-HMDP than AL group (n = 3) (P = 0.003). ATTR group (n =15) had significantly higher myocardial SUVmax of 99mTc-HMDP than AL group (n = 2) (P = 0.015). After tafamidis treatment for cardiac wild-type ATTR, three of the eight patients (37.5%) had more than 15% decrease in H/CL ratios and five of the eight patients (62.5%) had more than 15% decrease in myocardial SUVmax.
Conclusions H/CL ratio on planar images and SUVmax on SPECT images in 99mTc-HMDP imaging are useful for diagnosing cardiac ATTR. Myocardial SUVmax might be useful for monitoring changes in cardiac uptake after tafamidis treatment for cardiac ATTR.
Successful occluder removal and reocclusion of an atrial septal defect after occluder detachment: A case report
Authors: Zhang Zaiqiang , Ding Jiawang
Published: June 2024

Background: Atrial septal defect (ASD) is a common congenital heart disease, and currently, transcatheter intervention is the most common clinical treatment method. However, certain complications still occur during the surgical process, among which occluder loss and displacement is a rare but serious complication. Although the probability of occluder loss and displacement is low, severe cases can endanger life.
Case presentation: Here, we report the case of a patient who underwent ASD closure in which the occluder fell off into the aortic arch, the detached occluder was recovered through catheter intervention, and the patient underwent ASD closure again.
Conclusions: In this case report, we highlight that although percutaneous closure of an ASD is regarded as a routine procedure, clinicians should remember the possibility of complications, especially occluder loss and displacement. Therefore, surgeons should carefully evaluate the situation before intervention closure, establish standardized intraoperative procedures, and provide timely postoperative follow-up.
Psychological Resilience Mediates Sense of Professional Mission and Career Success in Chinese Intensive Care Unit Nurses: a Cross-sectional Study
Authors: zhang lating , Jiang Xue , Liang Xinhui , Cheng Na , Han Lin , Jia Yao , Wang Ruahua , Fan Haiyan , Wu Wei
Published: June 2024

Background
The nursing industry's stability and progress are adversely affected by the high attrition rate and shortage of nurses; therefore, it is critical to investigate the variables that influence the professional stability of nurses.The sense of professional mission and career success have positive significance for reducing nurses' job burnout. The purpose of this study is to explore the potential mediating role of resilience in this relationship.
Methods
Self-reported questionnaires were utilized by 335 intensive care unit (ICU) nurses to assess their sense of professional mission, psychological resilience, and career success in this cross-sectional study. A structural equation model was developed to validate the indirect relationship between the variables.
Results
There is a correlation among professional mission, psychological resilience and career success. Significant mediating effect of resilience exists between career success and career mission.
Conclusions
In this study, resilience plays an intermediary role between career mission and career success, which provides support for further understanding the mechanism between career mission and career success and bolstering the case for devising comprehensive intervention strategies for resilience. Nursing managers should focus on nurses' sense of professional mission and psychological resilience, and implement strategies to enhance nurses' psychological resilience in order to boost their career success.
Identification and validation of the shared signature gene MMP9 and ANGPTL4 and its regulatory mechanisms in Type 2 Diabetes combined with Osteoarthritis
Authors: Mao Guangming , Xu Wenhao , Wan Lingli , Wang Hongpin , Xu Shutao , Zhang Liangming , Li Shiyang , Liu Peigen , Lai Zhongming , Lan Yuping , Liu Jianhui
Published: June 2024

Objective
Type 2 Diabetes Mellitus (T2D) and Osteoarthritis (OA) are prevalent diseases significantly impacting patients' quality of life. Increasing evidence suggests a correlation between T2D and OA, yet their molecular mechanisms remain elusive. Our study aims to investigate shared biomarkers and potential molecular mechanisms underlying these diseases.
Methods
Gene expression profiles for T2D and OA were sourced from the Gene Expression Omnibus (GEO) database.We employed bioinformatics to identify differentially expressed genes (DEGs) common to T2D and OA. Subsequently, functional annotation, and protein-protein interaction (PPI) analyses were conducted on these DEGs, leading to the preliminary identification of hub genes. Further validation of these hub genes' mRNA expression was achieved using external T2D and OA datasets, culminating in identifying pivotal genes. Western blotting and qRT-PCR techniques validated the expression of these key genes in clinical case samples. The accuracy of the key genes as predictive biomarkers for T2D and OA were assessed using the receiver operating characteristic curve (ROC). We developed a network of interactions between transcription factors (TFs) and microRNAs (miRNAs) .Finally, we identified the most promising therapeutic agents through molecular docking.
Results
We identified 209 shared DEGs between T2D and OA. Functional analysis revealed that these DEGs were predominantly associated with ossification, regulation of leukocyte migration, extracellular matrix (ECM) structural constituent, PI3K/AKT and Wnt signaling pathways. PPI analysis and external datasets validation highlighted MMP9 and ANGPTL4 as pivotal genes in T2D and OA. ANGPTL4 regulates glucose metabolism, osteoclast-mediated bone resorption, cartilage degradation, whereas MMP9 plays a role in ECM degradation and inflammatory responses. Both qRT-PCR and Western blot analyses confirmed high expression levels of pivotal genes in T2D, OA, T2D combined with OA cases.Analysis of TFs-miRNAs interactions identified 7 TFs and one miRNA that collectively regulate pivotal genes. ROC analysis underscored the strong diagnostic potential of MMP9 and ANGPTL4. Raloxifene, Ezetimibe, and S-3304 were also identified as promising therapeutic agents for patients with T2D and OA.
Conclusion
This study uncovers shared signaling pathways, biomarkers, potential therapeutics, and diagnostic models for T2D and OA. These findings offer novel perspectives on the pathogenesis, diagnosis, and treatment of T2D when co-occurring with OA.
Fishing in Murky Waters: The Challenging Route to Diagnosing Twin-Twin Transfusion Syndrome in a Resource-Limited Humanitarian Setting, A Case Study
Authors: Okot Jerom , Ochola Henry , Aeku Michael Job , Okema James Nelson , Ouma Simple , Pebolo Francis Pebalo
Published: June 2024

Background
Twin-to-twin transfusion syndrome (TTTS), though rare, poses risks for fetal demise if undetected. This late-diagnosed TTTS case from South Sudan demonstrates persistent challenges in identifying high-risk pregnancies in humanitarian settings.
Case presentation:
A 38-year-old multigravida at unknown weeks gestation presented with fever, labour pains, drainage of liquor, and fetal hand prolapse. Her antenatal care only reported non-specific symptoms without most diagnostics. Evaluation revealed malaria, suspected twin pregnancy, and malpresentation. Ultrasound confirmed polyhydramnios and a suspicious intrauterine mass concerning for TTTS. Undiagnosed TTTS became apparent only during emergent cesarean delivery, finding a demised anomalous donor twin. The acute intrapartum decompensation pointed to late-stage V TTTS preventing intervention. While the viable preterm neonate survived, risks from demise were avoidable through earlier detection.
Conclusion
This case reinforces literature on missed screening opportunities to recognize TTTS before Quintero staging with poorer prognoses. Subtle signs like sudden abdominal enlargement during third trimester were likely overlooked due to limited access to comprehensive ultrasound and Doppler surveillance. Strengthening displacement-sensitive antenatal protocols, building frontline imaging capacity, improving provider awareness, and prompt referrals could help mitigate TTTS-related morbidity and mortality in marginalized populations. Global health efforts must address these persisting care gaps in pregnancy surveillance and access to specialty care, especially in humanitarian settings.
Acceptance of an immediate post-partum intrauterine contraceptive device and associated factors among women who gave birth in public hospitals of Addis Ababa, Ethiopia: A cross-sectional study.
Authors: Geberemariam Wondossen Teklesilassie , Mekonnen Baize , Asfaw Hussen Mekonnen
Published: June 2024

Background
Despite the post-partum intrauterine device being highly effective, inexpensive, non-hormonal, and reversible its acceptance is very low in developing countries including Ethiopia. Considering the importance of the use of immediate postpartum intrauterine contraceptives is a valuable means to keep women and children healthy. This study aimed to assess the acceptance of an immediate post-partum contraceptive device and associated factors among women who gave birth in selected public hospitals in Addis Ababa.
Method
A health institution-based cross-sectional survey was conducted among 336 women who gave birth in selected public health facilities in Addis Ababa from the beginning of February to March 2021. Information was gathered by using interviewers administered questionnaires. Data were double entered in Epidata version 4.6 statistical package, cleaned, and exported to IBM SPSS statistics version 25 for analysis. Logistic regression models were used to predict the association of outcome variables and adjusted for possible confounders
Result
Overall, a total of 42 (12.5%) of women accepted to use the immediate use of post-partum intrauterine devices. Woman's employment status such as (Private employees (AOR = 4.269, 95% CI: (1.280-14.234) (P < 0.018), daily laborer (AOR = 7.373, 95% CI: (1.534–35.433) (P < 0.013), student (AOR = 11.004, 95% CI: (1.602–75.572) (P < 0.015)), and monthly income of the mother Birr greater than 7,901.00 (AOR = 6.589, 95%CI: (1.736–25.009) (P < 0.006) were found to accept the immediate post-partum contraceptive device than women with monthly income of less than Birr 3,200 and less.
Conclusion
The acceptance of an immediate intrauterine contraceptive device among women giving birth in the study areas was low. Public Awareness by using different communication menses and tarnishing of health care workers were recommended.
Impact of frequent whole-body CT scans during immune checkpoint inhibitor (ICI) therapy on antitumor immune efficacy
Authors: Dong Jigang , sha Sha , Qi Ying , Fu Chengrui , Li Baosheng
Published: June 2024

Objective:The effect of frequent whole-body CT scanning during immune checkpoint inhibitor (ICI) therapy on the anti-tumor immune effect of ICI.
Methods:We conducted a retrospective clinical study and a basic study in a mouse tumor model, respectively. Retrospective clinical study: We retrospectively analyzed the correlation between the frequency of CT scans during immune checkpoint inhibitor (ICI) treatment and the duration of remission (DOR) of ICI treatment in patients with stage IV non-small cell lung cancer (NSCLC). BASIC RESEARCH: We established a mouse lung adenocarcinoma tumor model and administered ICI to mice, which were irradiated with five whole-body CT scans during ICI treatment in order to observe the effect of frequent whole-body CT scans on the anti-tumor effect of ICI treatment in mice. The effects of frequent whole-body CT scans on the tumor microenvironment of mice were also analyzed by single-cell sequencing and multi-assay flow cytometry.
Results:The more frequent CT scans during ICI treatment in NSCLC patients the longer the DOR of ICI treatment. In the mouse model we observed that the addition of whole-body CT scan radiation had a tendency to inhibit tumor growth in mice compared with the anti-PD-1 group alone.Frequent CT scan radiation during the application of the immune checkpoint inhibitor PD-1 increased the proportion of infiltrating CD8+ T cells in tumor tissues and significantly increased the proportion of IFNγ-secreting CD8+ T cells, and single-cell sequencing of the results also revealed that IFNγ and killing-related genes were significantly upregulated in tumor-infiltrating CD8T cells.
Conclusions:To our knowledge this is the first study worldwide on the effect of multiple CT scan radiation on the anti-tumor immune effect of ICI. Our findings suggest that frequent CT scans during ICI treatment did not promote tumor progression; instead, a trend toward delayed tumor progression was observed.
Treatment of AO/OTA Type 43-C3 Pilon Fractures with a Combination of Miniplate and Main Plate: A Retrospective Analysis
Authors: Zhan Junfeng , Yang Hu , Huai Chaoyue , Yao Yunfeng , Xie Yang , Zhong Qigang
Published: June 2024

Background
Type-C3 pilon fracture is a distal tibial fracture with a high disability rate that is difficult to treat and has many postoperative complications. Effective treatment of type-C3 pilon fracture remains an important research focus. This study proposed to treat type-C3 pilon fractures with a miniplate combined with a main plate and compared it with the traditional treatment.
Methods
This study retrospectively analyzed 64 cases of type-C3 pilon fractures treated at our hospital between June 2018 and June 2022, including a miniature steel plate group (MP group, n = 31) and a traditional treatment group (TT group, n = 33). Hospitalization duration, duration of hand surgery, reduction quality, fracture healing, complications, imaging data, and functional scores of the two groups were analyzed.
Results
The surgery was completed successfully in both groups, and the average follow-up duration was 16.78 ± 3.27 months. There were no significant differences in the duration of preoperative waiting, hospital stay, and weight-bearing between the two groups (P > 0.05). The duration of surgery was significantly shorter in the MP group than in the TT group (P < 0.05). The quality of fracture reduction and healing at 6 weeks after surgery in the MP group was significantly better than that in the TT group (P < 0.05). There was no significant difference in the visual analog scale scores between the two groups. However, at 6 months postoperatively and at the last follow-up, the American Orthopedic Foot and Ankle Society score and ankle fire activity range of motion were significantly better for those in the TT group. There were two cases of ischemic osteonecrosis, two of poor incision healing, and one of severely poor wound healing in the TT group; however, only one patient in the MP group had poor incision healing.
Conclusion
The use of miniplates combined with main plates in the treatment of type-C3 pilon fracture has obvious advantages, which simplifies the difficulty of the surgery, reduces the volume of the ankle joint, reduces postoperative complications, and is beneficial to postoperative exercise and ankle function recovery.
Sclerotherapy for the ranula with Bleomycin: technical considerations and preliminary experience
Authors: Zhang Hong-Yu , Su Li-Wen , Sun Huan , Rui Chao-Chen , Wu Yang
Published: June 2024

Ranula is a mucous cyst that occurs in the floor of the mouth. It can be classified into three types based on origins: accessory (minor) salivary gland cysts, Rivini duct cysts, and sublingual gland cysts. Because of the anatomical characteristics, surgical resection of the cysts not only carries the risk of damaging adjacent tissues but also has a high recurrence rate. Intralesional injection of sclerotherapy may be a better alternative treatment. We summarized 65 cases of ranula treated with intralesional injections of bleomycin(BML). According to the origin of the ranula, 60 cases were from the accessory (minor) salivary glands or the ducts of Rivini, and 5 cases were from the body of the sublingual gland. The results showed that 60 cases of ranula from the accessory (minor) salivary glands and Rivini ducts were 100% cured during the follow-up period. The median number of injections for all patients was 1.16. All 5 cases of ranula from the sublingual gland did not wholly recover. This study confirmed that BLM intralesional injection is a safe and effective treatment modality for cysts from oral floor accessory (minor) salivary glands or the ducts of Rivini rather than sublingual gland cysts. Therefore, before treatment, it is necessary to determine the type and origin of the cyst by characterizing its morphology to ensure the effectiveness of the treatment.
Human Papillomavirus Prevalence and Genotyping in Paraffin-Embedded Cervical Tumor Samples from Women in Kordofan State, Western Sudan
Authors: Hamid Hussien , Eldour Ahmed A. A. , Elamin Elwaleed M.
Published: June 2024

Background
This study aimed to assess HPV prevalence and genotypic distribution in Sudanese cervical tumors, filling a global data gap and aiding screening and prevention efforts.
Methods
121 FFPE blocks of cervical tumors with a mean age of 53 ± 14 years were collected. Despite 41 samples having degraded DNA, all underwent amplification with HPV-specific primers and human HLA-DQA1 gene as an internal control. DNA microarray chips was used to detected 41 HPV genotypes.
Results
A 121 cervical tumor specimens were analyzed using DNA microarray chip techniques to identify 41 HPV genotypes. The majority of age group (46.3%) falling into the ≥ 60 years age group. we found that the most predominant tumor is SCC (69.3%), with a significant age-tumor progression correlation (P = 0.001).
The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, unsupervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.
Authors: Fluet Gerard , Qiu Qinyin , Gross Amanda , Gorin Holly , Patel Jigna , Merians Alma , Adamovich Sergei
Published: June 2024

Background: This parallel, randomized controlled trial examines intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a twelve-week, home-based upper extremity rehabilitation program. Seventeen subjects played games presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally.
Methods: 33 persons 20 to 80 years of age, at least six months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the system. Subjects had the Home Virtual Rehabilitation System [1]systems placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for twelve weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. Classification and Regression Tree (CART) models were generated to predict responders using demographics and baseline measures.
Results: There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ between groups. 21 subjects from both groups, demonstrated clinically important improvements in UEFMA score of at least 4.25 points. Subjects with pre training UEFMA scores below 53.5 averaged a seven-point UEFMA increase. IMI scores were stable pre to post training.
Conclusions: Scaffolding did not have a meaningful impact on adherence or motor function improvement. A sparsely supervised program of game-based treatment in the home was sufficient to elicit meaningful improvements in motor function and activities of daily living. Common factors considered barriers to the utilization of telerehabilitation did not impact adherence or motor outcome.
Trial registration: Clinical Trials.gov - NCT03985761, Registered June 14, 2019.
A Network Analysis of the Associations Between Posttraumatic Stress Symptoms and Posttraumatic Growth Among Lung Cancer Patient
Authors: Gao Jinmiao , Zhang Lan
Published: June 2024

Background: Lung cancer patients who experience a traumatic event may experience two types of psychological changes, positive posttraumatic growth (PTG) or negative posttraumatic stress disorder (PTSD), but the two types of psychological changes can also coexist.
Methods: This study used network analysis to examine the interaction between PTSD and PTG in 350 patients.
Results: The nodes with strong connections were from "Strong Negative Beliefs" to" Feeling Cut of from Others", " Strong Physical Reactions” to” Trouble with Positive Feelings", " More willing to express emotions" to " Ability to handle difficulties" and " Nightmares" to " Strong Physical Reactions". Network centrality showed the highest EI scores for " Nightmares", " Intrusive Memories", " Excessive Blame of Selfor Others", and " Concentration Dificulities". The bridging analysis showed that " lrritability", " Taking Risks", " Trouble with Positive Feelings" and " Accepting the workaround", "Interpersonal closeness", " Greater feeling of self-reliance", " Appreciating each day", and " Changed priorities" were the bridging points connecting the coexistence network, indicating the network coexistence of PTSD and PTG.
Limitations: The data used in this study were cross-sectional, and the temporal nature and causal inferences of associations with symptoms cannot be drawn.
Conclusions: PTSD and PTG are co-existing and non-independent post-traumatic psychological responses in patients with lung cancer.
Body Fat Ratio as a Novel Predictor of Complications and Survival After Rectal Cancer Surgery
Authors: Zhao Haiyuan , Liu Gang , Li Yang , Liu Ben , Lu Feixiang , Yang Nianzhao , Zhao Jun
Published: June 2024

Aim
To investigate the relationship between body fat ratio (BFR), visceral fat area (VFA), body mass index (BMI), and visceral fat density (VFD) and to assess their reliability in predicting the risk of postoperative complications and survival status in patients with rectal cancer (RC).
Methods
The study prospectively included 460 patients who underwent surgical treatment for RC at the First Affiliated Hospital of Wannan Medical College between September 2018 and July 2021. BFR, VFA, BMI, and VFD were measured, and patients' basic information, clinical data, complications, and survival were recorded. Statistical analysis was performed to determine the optimal BFR cutoff and elucidate group differences.
Results
BFR exhibited significant correlations with VFA (R = 0.739), BMI (R = 0.783), and VFD (R = -0.773; all P < 0.05). The area under the receiver operating characteristic curve of BFR, VFA, BMI, and VFD in predicting postoperative complications were all > 0.7, with an optimal BFR cutoff value of 24.3. Patients in the BFR-low group had fewer postoperative complications and lower intraoperative indices, hospitalization times, and costs (P < 0.05) compared to the BFR-high group. BFR predicted complications with high diagnostic significance and was validated by multiple models. Patients in the BFR-high group had better survival than those in the BFR-low group (P < 0.05).
Conclusion
BFR is closely related to BMI, VFA, and VFD. Reasonable control of BFR or a modest increase may help prevent and treat postoperative complications of RC and improve patients’ long-term survival.
Repeated scoring with Adult Appendicitis Score improves the sensitivity and the specificity of appendicitis diagnosis in patients with early equivocal signs of appendicitis: A secondary analysis
Authors: Lastunen Kirsi S. , Leppäniemi Ari K. , Mentula Panu J.
Published: June 2024

Background
The use of computed tomography at the early stage of acute appendicitis can lead to overdiagnosis and predispose patients unnecessarily to ionising radiation. Adult Appendicitis Score (AAS) can be used to select patients for imaging. Observation and re-scoring in the DIAMOND trial reduced the need for imaging. In this study, we wanted to determine if the AAS change (ΔAAS) can be used as a diagnostic tool to select patients for imaging even more precisely.
Methods
Eighty-eight patients with early equivocal appendicitis entered the observation arm in the DIAMOND trial. The data of these patients were reanalysed, and ΔAAS during the observation was calculated. The baseline AAS, final AAS, and the CRP change (ΔCRP) were selected as reference standards.
Results
Eighty-three patients with complete data were analysed. The AUROC values: ΔAAS 0.932 (95%CI 0.868–0.996), baseline AAS 0.629 (95%CI 0.498–0.760), final AAS 0.936 (95%CI 0.886–0.987), and ΔCRP 0.796 (95%CI 0.696–0.897). From receiver operating characteristic curves, we identified the limits for low (ΔAAS ≤ -2), intermediate (ΔAAS − 1 − 0), and high (ΔAAS ≥ 1) probability of appendicitis. The negative predictive value of the low probability group and the positive predictive value of the high probability group for acute appendicitis were 97% and 94%, respectively.
Conclusions
Patients with equivocal signs of appendicitis could benefit from short observation and calculation of ΔAAS to reduce overdiagnosis and exposure to excessive imaging.
Trial registration
The DIAMOND trial was originally registered in ClinicalTrials.gov (NCT02742402) on April 7th, 2016 and approved by the institutional review board and the ethical committee of Helsinki University Hospital (reference number 27/13/03/02/2016).
A high fraction of inspired oxygen does not mitigate atelectasis-induced lung tissue hypoxia or injury in experimental acute respiratory distress syndrome
Authors: Tojo Kentaro , Yazawa Takuya
Published: June 2024

Background
Although alveolar hyperoxia exacerbates lung injury, clinical studies have failed to demonstrate the beneficial effects of lowering the fraction of inspired oxygen (FIO2) in patients with acute respiratory distress syndrome (ARDS). Atelectasis, which is commonly observed in ARDS, not only leads to hypoxemia but also contributes to lung injury through hypoxia-induced alveolar tissue inflammation. Therefore, it is possible that excessively low FIO2 may enhance hypoxia-induced inflammation in atelectasis, and raising FIO2 to an appropriate level may be a reasonable strategy for its mitigation. In this study, we investigated the effects of different FIO2 levels on alveolar tissue hypoxia and injury in a mechanically ventilated rat model of experimental ARDS with atelectasis.
Methods
Rats were intratracheally injected with lipopolysaccharide (LPS) to establish an ARDS model. They were allocated to the low, moderate, and high FIO2 groups with FIO2 of 21, 60, and 100%, respectively, a day after LPS injection. All groups were mechanically ventilated with an 8 mL/kg tidal volume and zero end-expiratory pressure to induce dorsal atelectatic regions. Arterial blood gas analysis was performed every 2 h. After six hours of mechanical ventilation, the rats were euthanized, and blood, bronchoalveolar lavage fluid, and lung tissues were collected and analyzed. Another set of animals was used for pimonidazole staining of the lung tissues to detect the hypoxic region.
Results
Lung mechanics, ratios of partial pressure of arterial oxygen (PaO2) to FIO2, and partial pressure of arterial carbon dioxide were not significantly different among the three groups, although PaO2 changed with FIO2. The dorsal lung tissues were positively stained with pimonidazole regardless of FIO2, and the HIF-1α concentrations were not significantly different among the three groups, indicating that raising FIO2 could not rescue alveolar tissue hypoxia. Moreover, changes in FIO2 did not significantly affect lung injury or inflammation. In contrast, hypoxemia observed in the low FIO2 group caused injury to organs other than the lungs.
Conclusions
Raising FIO2 levels did not attenuate tissue hypoxia, inflammation, or injury in the atelectatic lung region in experimental ARDS. Our results indicate that raising FIO2 levels to attenuate atelectasis-induced lung injury cannot be rationalized.
Criteria for designing integrated diagnosis interventions in low resource settings at the primary care level: A Delphi consensus study
Authors: Gwaza Gamuchirai Pamela , Plüddemann Annette , McCall Marcy , Dittrich Sabine , Heneghan Carl
Published: June 2024

Background:
Integrated diagnosis is crucial for addressing health challenges, particularly in managing comorbidities and chronic conditions. Technological advancements allow for rapid, simultaneous testing and diagnosis of multiple diseases. Integrated diagnosis interventions vary in purpose, models, diseases targeted, populations served, scale, and outcomes, which complicates identifying effective strategies. An effective integrated diagnosis approach can lead to early detection of critical and chronic conditions, improve patient experiences, and ultimately improve disease surveillance. This study aimed to establish core criteria for designing same-day integrated diagnosis interventions in primary care settings to enhance patient experiences and health outcomes in low- and middle-income countries (LMICs).
Methods
A two-round Delphi process engaged an international panel of fifty-five experts from diverse professions to establish consensus on core criteria for effective integrated diagnosis interventions. Predetermined consensus thresholds were set at 70% for critical to include.
Results
A total of 55 experts participated in the first round. Participants represented various geographical regions, including Africa (n = 33), Europe (n = 17), Asia (n = 2), and the Americas (n = 2), and could be categorized into implementers (n = 36), policymakers (n = 7), and academics (n = 12). At the end of Round 1, fourteen of the thirty-three criteria reached a consensus as being critical to include, and nine criteria were removed. In Round 2, a total of 48 out of 55 experts participated and twelve criteria were considered. Four criteria reached a consensus as being critical to include. Through the two rounds of surveys, experts reached a consensus on 18 criteria.
Conclusion
The study provides key criteria for prioritizing and developing integrated diagnosis interventions in primary care, in low-resource settings, particularly in Africa. The guidance is invaluable for policymakers, funders, implementers, and manufacturers. The primary goal of integrated diagnosis is to enhance patient experiences and health outcomes. It is essential to consider all critical success factors during intervention design. The study emphasizes taking a holistic approach that addresses the full spectrum of patient needs and integrates with other aspects of the healthcare system. These criteria may evolve as our understanding of integrated diagnosis advances.