bluuebunny/crossref_metadata_2025 huggingface dataset:
Aldehyde exposure induces axonal damage through inflammatory response
Authors: Lanling Lin
Published: August 2024

The potential neurological effects of low-concentration aldehydes in the human body remain largely unexplored. To address this, we conducted a study involving 331 participants from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. Utilizing logistic regression model, bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) regression models, we examined the combined impact of serum aldehydes on the overall risk of axonal damage. Through bioinformatics and mediation analyses, we unraveled the mechanisms underlying aldehyde-induced axonal damage. In our logistic regression model, we found associations between isopentanaldehyde and hexanaldehyde with neurofilament light chain (NfL) levels (fourth vs. first quartile). BKMR analysis demonstrated a significant overall effect of aldehydes on NfL levels when all chemicals were at or above the 55th percentile, compared to the 50th percentile. Additionally, WQS regression analysis revealed a positive association between the WQS index and NfL concentrations(OR = 2.46, 95%CI: 1.27–4.73). In terms of pathways and hub genes, inflammatory response and TNF emerged as the top-ranking enrichment pathway and hub gene. Notably, mediation analysis indicated that WBC, MONO, and NEUT played significant roles in mediating the relationships between isopentanaldehyde and NfL concentrations. Collectively, the current evidence suggests that aldehyde exposure may elevate the risk of axonal damage through inflammatory response.
The transition from passive to active learner: medical student experiences of Case-Based Learning (CBL) at a multicultural medical school: Structured Group Feedback Study
Authors: Bruen Catherine , Illing Jan , Daly Ronan , Meagher Frances , Delany Caroline , Offiah Gozie , Doherty Sally , Stuart Ellen , Crehan Martina , Kelly Helen
Published: August 2024

Background
Educational research highlights that active approaches to learning are more effective in knowledge retention and problem-solving. Yet lectures are still the dominant form of teaching in most medical schools. For international students, active learning approaches can be both more challenging and less familiar. Gaining student engagement with active learning can be a significant challenge when there is an expectation for students to participate in a discussion or voice an opinion. Case-based learning (CBL), with its scaffolded form of learning, is an approach that could provide the support needed to help international learners adapt to their new learning environment in a low-stakes learning environment. The research question in this study was: what are the features of CBL that support active learning in an international student cohort familiar with a more passive approach?
Methods
Data was collected using Structured Group Feedback Sessions (SGFS) from 36 students in eight Structured Group Feedback Sessions, a method that facilitates structured discussions and is effective in curriculum evaluation and feedback. The experience-based Learning model was used as the conceptual framework to guide the analysis, which was completed using framework analysis.
Results
Themes were derived from the Experience Based Learning model: affective, pedagogical, and organisational and analysed according to the research question. The findings illustrated that students enjoyed the CBL teaching method but needed to feel psychologically safe to participate. They welcomed the facilitator's role in enabling them to participate and role model teamwork and problem-solving. They valued organisational support, the authenticity of the case, and the patient-centred approach to the clinical cases.
Conclusions
The students valued the transition to active learning using CBL. Prior learning was essential to providing the context, knowledge, and confidence to engage actively in the case discussion. Having a facilitator to summarise the session and provide assurance were important learning points.
Replaced posterior cerebral artery with early branching temporal artery diagnosed by magnetic resonance angiography
Authors: Uchino Akira , Tsuzuki Nobusuke
Published: August 2024

Purpose
To describe a case of replaced posterior cerebral artery (PCA) in which all branches of the PCA arose from the anterior choroidal artery (AChA) with an early branching temporal artery.
Methods
An 83-year-old man with cerebral infarctions underwent cranial magnetic resonance (MR) imaging and MR angiography using a 3-Tesla scanner. MR angiography was performed using a standard 3-dimensional time-of-flight technique.
Results
A large anomalous artery arose from the supraclinoid segment of the right internal carotid artery (ICA) and supplied all branches of the right PCA, mimicking fetal-type PCA. The temporal branch arose from the proximal segment of this artery and followed a course similar to that of the AChA in its proximal segment. In MR angiographic source images, a tiny artery arose from the right ICA proximal to the origin of the anomalous artery, indicating a hypoplastic right posterior communicating artery (PCoA). Thus, we concluded that the anomalous artery was a replaced PCA; all branches of the PCA arose from the AChA.
Conclusion
We present a case involving a replaced PCA with an early branching temporal artery, as seen on MR angiography. Careful observation of MR angiographic source images is useful for identifying small arteries. To our knowledge, this is the first report of this combined variation in the relevant English-language literature.
Structural–Functional Coupling of Network Communication Predicts Mild Cognitive Impairment in Patients with End Stage Renal Disease: A Longitudinal Machine Learning Study
Authors: Yu Ziyang , Pang Huize , Li iaolu , Liu Yu , Bu Shuting , Wang Juzhou , Zhao Mengwan , Du Yinke , Yao Li
Published: August 2024

Purpose
Cognitive decline is a common brain injury associated with End-Stage Renal Disease (ESRD). The purpose of this study is to investigate the alterations in cognitive impairment structure and functional brain network topology in patients with ESRD.
Methods
This study analyzed predialysis diffusion and functional MRI data on 90 ESRD patients. Patients were diagnosed into mild cognitive impairment based on MoCA and MMSE scores after a two-year follow-up. By utilizing the topological properties of functional networks, structural networks, and structural functional coupling networks, we developed a machine learning model to predict cognitive impairment in patients.
Results
Machine learning models utilizing multimodal brain network topology properties show the highest accuracy in predicting MCI in ESRD patients, with an AUC of 0.928 in the training set and 0.903 in the test set. The SHAP analysis indicates that the main cognitive impairment pattern in ESRD patients involves a decrease in hippocampal SFC.
Conclusion
This study demonstrated that structural and functional damage to the hippocampus was the main mechanism for ESRD leading to cognitive decline. Furthermore, our results have provided a novel and reliable SFC-based machine learning model to precisely predict the cognitive changes in ESRD patients.
Non-restraint in pediatric ankle sprain: A non-inferiority randomized clinical trial.
Authors: Suarez-Cabezas Sara , Perez-Moneo Begoña , Ortiz Maria Cabrerizo , Aparicio Monica Hortiguela , Gerez Carmen Gomez , Molanes-Lopez Elisa M. , Larrainzar-Garijo Ricardo , Lopez Paula Vazquez
Published: August 2024

Purpose
Ankle sprains are common injuries in pediatric populations, yet current literature lacks consensus on optimal management strategies. This study aimed to compare the effectiveness of non-restraint treatment versus bandaging in children with mild ankle sprains, focusing on functional recovery and pain management.
Methods
A single-center, open-label, non-inferiority randomized clinical trial was conducted at a pediatric emergency service. Patients aged 5–16 years with mild ankle sprains were included. Participants were randomized in a 1:1 ratio to receive either a standardized functional bandage or only general measures with non-restraint. The primary endpoints were a 10-point difference in the OXAFQ-C and a 2-point difference in pain intensity at day 5 after discharge.
Results
A total of 113 participants were randomly assigned to receive a functional bandage (n = 51) or non-restraint measures (n = 62). At day 5, the OXAFQ-C score in the non-restraint group was 76.59 (SD 15.51) and 69.71 (SD 15.24) in the restraint group, with a mean difference of 6.295 (90% CI -0.058 to 12.647). The mean difference in pain intensity was 0.048 (90% CI -0.741 to 0.838). No differences were observed in the OXAFQ-C scores or pain intensity at 14 and 30 days.
Conclusions
This single-center, randomized clinical trial demonstrates that non-restraint is non-inferior to bandaging for functional recovery and short- to medium-term pain management in pediatric patients with mild ankle sprains. The treatment was very well accepted among patients and no adverse effects were reported.
Retrospectively registered in January 2024 on clinicaltrials.org with identifier: NCT06189625.
Influence of recipient KRAS gene rs712 polymorphisms on the overall survival rate of Hepatocellular carcinoma after hepatic transplantation
Authors: Chu Tiancheng , Zhang Rulin , Liu Xiaolei , Lin Li , Li Yanning , Niu Ziguang , Quan Heng , Zhao Yingying , Li Yaohua
Published: August 2024

Background
Hepatocellular carcinoma (HCC) recurrence appears commonly after liver transplantation (LT), and it severely affected the long-term survival of patients. Previous studies have proved that Rap1A is involved in hepatocarcinogenesis and metastasis, and demonstrated the significant association between KRAS rs712 polymorphism and HCC. However, the relationship between KRAS rs712 polymorphism and HCC recurrence after LT remained unclear.
Methods
A total of 93 HCC patients who underwent LT from March 2008 to Dec 2015 was analyzed. The genotypes of both donors and recipients had been confirmed as KRAS rs712. The independent risk factors that associated with HCC recurrence were investigated with univariate and multivariate logistic regression analysis. The recurrence-free (RFS) and overall survival (OS) were calculated with Cox regression analysis. The KRAS rs712 genotype frequencies were determined using the Χ² test and the minor allele frequencies (MAFs) of KRAS rs712 genotypes were calculated by Hardy-Weinberg equilibrium.
Results
We found that the recipient KRAS rs712 polymorphism was significantly associated with HCC recurrence after LT. Moreover, the Milan criteria, microvascular invasion and recipient KRAS rs712 genotype were proved to be independent risk factors for HCC recurrence after LT. Patients with donor TG/TT genotypes had a significantly higher RFS and OS than TT genotype. The TNM stage, Milan criteria, microvascular invasion, Milan criteria, treatment and recipient KRAS rs712 genotype were independent factors for the RFS of LT patients.
Conclusions
Recipient KRAS rs712 polymorphism is associated with HCC recurrence after liver transplantation and plays as a promising bio-predictor of overall survival rate of HCC risks after hepatic transplantation.
Genetic Analysis of Preaxial Polydactyly: Identification of Novel Mutations and the Role of ZRS Duplications in a Chinese Cohort of 102 cases
Authors: Pu Siyu , Wang Zhibo , Tang Xueyang , Wang Daoxi , Yang Xiaodong , Jiang Jun , Deng Yifan , Xiang Bo , Yang Jiayin , Wang Bin , Chen Jing
Published: August 2024

Background:
Preaxial polydactyly (PPD) is a congenital limb malformation, previously reported to be caused primarily by mutations in the ZRS and upstream preZRS regions. This study investigated genetic variations associated with PPD, focusing on point mutations and copy number variations (CNVs) in the ZRS and preZRS regions.
Methods:
Comprehensive genetic analyses were conducted on 102 patients with PPD, including detailed clinical examinations and Sanger sequencing of the ZRS and preZRS regions. Additionally, real-time quantitative PCR (qPCR) was used to detect CNVs in the ZRS region. The evolutionary conservation and population frequencies of identified mutations were also evaluated.
Results:
Six point mutations were identified, including four novel mutations with potential pathogenicity, namely, 93G > T (chr7:156584477), 106G > A (chr7:156584464), 278G > A (chr7:156584292), and 409A > C (chr7:156585378). Additionally, qPCR analysis revealed that 66.67% of patients exhibited ZRS duplications. Notably, these duplications were also present in cases with newly identified potential pathogenic point mutations. These findings suggest the possible interaction of point mutations in ZRS and preZRS through a common pathogenic mechanism, leading jointly to PPD.
Conclusion:
The findings expand the mutation spectrum associated with non-syndromic polydactyly and highlight that, despite different classifications, anterior polydactyly caused by mutations in ZRS and nearby regions may share common pathogenic mechanisms. The incorporation of various mutation types in genetic screening can effectively enhance the rate of pathogenic mutation detection and contribute to the cost-effectiveness of genetic testing for limb developmental defects, thereby promoting healthy births.
Is Ketamine Efficacious for Rapid Treatment of Acute Suicidal Ideation in an Emergency Setting? Lessons Learned from A Pilot Randomized Controlled Trial
Authors: Barzkar Maryam , Alavi Kaveh , Malakouti Kazem , Khajeh-Azad Mohamad-Amin , Barzkar Farzaneh , Jalali-Nadoushan Amirhossein , Lahiji Mohammad Niakan
Published: August 2024

Background Ketamine has emerged as a promising agent for the rapid reduction of suicidal thoughts. However, its efficacy across a broader spectrum of psychiatric disorders remains underexplored.Objective This study aimed to evaluate the efficacy of a single infusion of ketamine in inducing rapid remission of severe suicidal ideation, compared to Midazolam, in a population with acute suicidal thoughts.Methods In a double-blind randomized controlled trial conducted in Tehran, Iran, from January to July 2022 (IRCT20220118053756N1), 36 inpatients with acute severe suicidal ideation were enrolled. Participants were randomly assigned to receive either a single dose of ketamine (0.5 mg/kg) or Midazolam (0.02 mg/kg). Suicidality was assessed using the Beck Scale for Suicide Ideation (BSSI) and the Suicide-Visual Analog Scale (S-VAS) before the intervention and at 12 and 24 hours post-administration.Results At baseline, the Midazolam group exhibited significantly higher BSSI scores and a higher rate of borderline personality disorder than the Ketamine group. Mean BSSI and S-VAS scores at 12 and 24 hours after the treatment in both groups. Despite these observations, no statistically significant differences were found between the groups in terms of BSSI and S-VAS scores.Conclusions The findings suggest that ketamine may reduce suicidal ideation, but its efficacy varies by psychiatric diagnosis. The groups were not significantly different in the main study outcomes.
Study on biological characteristics of meridian points and efficacy of intradermal acupuncture treatment for diminished ovarian reserve: study protocol for a case-control experiment and a single-blinded randomized controlled trial
Authors: Liu Hanyu , Zhang Yajun , Sun Haomin , Huang Mei , Chen Siqi , Ma Jing , Chen Qin , Fang Jianqiao , Shao Xiaomei
Published: August 2024

Background
Diminished ovarian reserve (DOR) is characterized by decreased female fertility, menstrual disorders and perimenopausal symptoms due to sex hormone deficiency or fluctuations. For now, there are no uniform diagnostic criteria or an ideal single detection index for DOR. Acupuncture has been extensively used to treat female infertility. This study is aim to discover the biological characteristics of the DOR-related acupoints and explore the efficacy of intradermal acupuncture treatment on DOR patients.
Methods/design:
To discover which acupoints are associated with DOR,there will be 50 DOR patients and 50 healthy participants included to detect the biological characteristics of certain acupoints. The primary outcome will be pain threshold and infrared thermal temperature. In the following randomized controlled trial, 106 patients with DOR will be randomly divided into intradermal acupuncture or sham intradermal acupuncture in a 1:1 ratio to achieve treatment for 12 weeks. The primary outcomes will be the changes in serum follicle-stimulating hormone(FSH) and Anti-Müllerian Hormone (AMH) level from baseline to the end of treatment(week 12). the secondary outcomes include the changes of biological characteristics of treated acupoints, the modified Kupperman Index (KI), Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS).
Discussion
The purpose of this study is to observe whether there is regularity in the biological characteristics of meridian points under the disease state, and consider these changes as an auxiliary detection means for DOR diagnosis. It also helps to screen out DOR-sensitive acupoints as a reference for treatment selection, and is expected to explore the efficacy of intradermal acupuncture and sham intradermal acupuncture in treating DOR.
Trial registration:
Registered in ClinicalTrials.gov NCT06395623(Registered on 3 may, 2024), NCT06223178(Registered on 28 January, 2024)
Mixed epithelial and stromal tumor of the kidney treated with Robotic-assisted partial nephrectomy: A case report
Authors: Huang Qianhao , Ding Meixuan , Chen Yuedong , Wang Tao
Published: August 2024

MESTK is a Unique and rare renal neoplasm with malignant transformation potential. MESTK is predominantly identified in female, especially peri-menopausal women or women with a history of prolonged estrogen exposure.Most patients appear asymptomatic initially, while progression of the mass results in urinary symptoms such as hematuria, abdominal pain, recurrent urinary tract infections or renal calculi.Preoperative diagnosis of MESTK is challenging due to the lack of characterization of its clinical presentation.Most of the cases reported so far have presented as benign, with no recurrence or metastasis, so complete surgical removal of the tumor is vital. In this case, we have presented a female patient of MESTK treated with Robotic-assisted partial nephrectomy (RAPN) to provide clinical evidence of diagnosis and treatment for MESTK.
Inflammation drives tumor growth in an immunocompetent implantable metastasis model
Authors: Giles Connor , Lee Jungwoo
Published: August 2024

Nearly 90% of cancer deaths are due to metastasis. Conventional cancer therapeutics including chemotherapy, surgery, and radiotherapy, are effective in treating primary tumors, but may aggravate disseminated tumor cells (DTCs) into regaining a proliferative state. Models isolating the post dissemination environment are needed to address the potential risks of these therapies, however modeling post dissemination environments is challenging. Often, host organisms become moribund due to primary tumor mass before native metastatic niches can evolve. Implantable tissue engineered niches have been used to attract circulating tumor cells independent of the primary tumor. Here, we serially transplant such tissue engineered niches with recruited DTCs in order to isolate the post dissemination environment. After transplantaion, 69% of scaffolds developed overt post-dissemination cancer growth, however 100% of scaffolds did not grow to a life-threatening critical size within twelve weeks. Adjuvant chemotherapy, while initially effective, did not prevent long-term DTC growth in scaffolds. Subjecting these transplanted niches to surgical resection via biopsy punch enhanced CD31, MMP9, Ly6G, and tumor burden compared to control scaffolds. Biopsy punching was able to rescue tumor incidence from prior chemotherapy. This model of serial transplantation of engineered DTC niches is a highly controllable and flexible method of establishing and systematically investigating the post-dissemination niche.
Phosphate Supplementation and Target Serum Levels in Sepsis: Impact on Patient Outcomes
Authors: Li Zhaoyang , Shen Tingwen , Yue Zhen , Li Jinhai , Zhang Qun , Chen Xufeng
Published: August 2024

Objectives
There is no clinical protocol for the management of serum inorganic phosphate (Pi) in critically ill patients until now. We aimed to assess the effect of phosphate supplementation on the in-hospital mortality of septic patients with hypophosphatemia and explore the optimal threshold level of serum Pi in patients with sepsis.
Methods
A retrospective analysis of septic patients selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database was carried out. Adjusted OR was used to examine the impact of phosphate supplementation on the hospital mortality. Serum Pi levels were divided into 6 bands. Multivariable logistic regression model was established for each band to investigate the optimal threshold Pi level.
Results
8067 admissions were enrolled and 88967 recorded Pi measurements were collected. The incidence of hypophosphatemia was 26.4% in septic patients. After adjusting for confounding factors, it was found that with phosphate supplemented, mortality tended to increase in septic patients with hypophosphatemia, though not significantly (OR 1.28, 95%CI 0.98–1.66, p = 0.33 in Model 2). The regression models indicated that the hospital mortality benefit accrues within the serum Pi level of 1.5–3.5 mg/dl.
Conclusions
Our findings suggest that phosphate supplementation without a standard protocol did not improve the prognosis of septic patients with hypophosphatemia. Target serum Pi level appears to be the dominant factor influencing the risk of hospital mortality. The optimal level was lower than the normal range in septic population in our study. Randomized studies are needed to improve the knowledge of management for serum Pi in septic patients.
Pre-alerts from critical care ambulance to trauma centers: a quantitative survey of trauma team leaders in Ontario, Canada
Authors: Williams Tara , Nolan Brodie , McGowan Melissa , Johnston Tania , Maria Sonja , von Vopelius-Feldt Johannes
Published: August 2024

Introduction
Pre-alerts from paramedics to trauma centers are important for ensuring the highest quality of trauma care. Despite this, there is a paucity of data to support best practices in trauma pre-alert notifications. Within the trauma system of Ontario, Canada, the provincial critical care transport organization, Ornge, provides pre-alerts to major trauma centers, but standardization is currently lacking. This study examined the satisfaction of trauma team leaders' (TTLs) satisfaction with current trauma pre-alerts and their preferences for logistics, content, and structure.
Methods
This was a quantitative survey of TTLs at adult and pediatric trauma centers across Ontario, Canada. Recruitment was through email to trauma directors, with follow-up efforts to target low-response sites to achieve good geographical representation. The survey was completed online and contained a combination of single or multiple-choice questions, Likert scales and free text options.
Results
In total, 79 TTLs from adult and pediatric lead trauma centers across Ontario responded to the survey, which took place over a 120-day period. The survey achieved good geographical representation. Given the current processes, TTLs describe moderate satisfaction with room for improvement (median score 3, IQR 3–4 on a 5-point Likert scale). Their overall preference was for timely and direct communication, with some concerns about multiple channels of communication around logistics. Most TTLs agreed on the important and less important content details found in common standardized framework tools. For structure, 28/79 TTLs strongly preferred the cognitive aid ATMIST, 13/79 preferred IMIST-AMBO, and 8/79 preferred MIST or SBAR as the most useful.
Conclusions
There is room for improvement through standardizing communication and streamlined pre-alert channels. Some disagreements exist between TTLs, particularly regarding logistics. Further research should examine TTL satisfaction after implementing the change in the pre-alert notification framework, which can address localized issues through stakeholder meetings with individual TTLs.
GDP-mannose 4,6-Dehydratase is a Key Driver of MYCN-amplified Neuroblastoma Core Fucosylation and Tumorigenesis
Authors: Rellinger Eric , Zhu Beibei , Pitts Michelle , Buoncristiani Michael , Bryant Lindsay , Lopez-Nunez oscar , Gurria Juan , Shedlock Cameron , Ribas Roberto , Keohane Shannon , Liu Jinpeng , Wang Chi , Gentry Matthew , Shelman Nathan , Allison Derek , Evers B. Mark , Sun Ramon
Published: August 2024

MYCN-amplification is a genetic hallmark of ~ 40% of high-risk neuroblastomas (NBs). Altered glycosylation is a common feature of adult cancer progression, but little is known about how genetic signatures such as MYCN-amplification alter glycosylation profiles. Herein, matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) revealed increased core fucosylated glycan abundance within human MYCN-amplified NB tumors. GDP-mannose 4,6-dehydratase (GMDS) is responsible for the first committed step of de novo GDP-fucose synthesis. High GMDS expression was found to be associated with poor patient survival, advanced stage disease, and MYCN-amplification in human NB tumors. Chromatin immunoprecipitation and promoter reporter assays demonstrated that N-MYC directly binds and activates the GMDS promoter in NB cells. When GMDS was blocked through either genetic or pharmacological mechanisms, NBs were found to be dependent upon de novo GDP-fucose production to sustain cell surface and secreted core fucosylated glycan abundance, as well as adherence and motility. Moreover, when de novo fucose synthesis was inhibited in vivo, tumor formation and progression were blocked. These critical findings identify de novo GDP-fucose production as a novel metabolic vulnerability that may be exploited in designing new treatment strategies for MYCN-amplified NBs.
Factors linked to early adverse neonatal outcomes in diabetic pregnant women at selected Ugandan hospitals: A prospective cohort study
Authors: Namutebi Sharifah , Kasujja Musa , Bagambe Silver , Bwaga Ibrahim , Damulira Adam , Okello Peter , Baluku Asanairi
Published: August 2024

Background
Diabetes mellitus during pregnancy is associated with increased risks of adverse neonatal outcomes. Understanding the incidence and factors contributing to these outcomes is crucial for improving maternal and neonatal health in low-resource settings.
Methods
This prospective cohort study enrolled 150 pregnant women with diabetes mellitus delivering at Jinja, Hoima, and Lira Regional Referral Hospitals in Uganda. Data on socio-demographic characteristics, obstetric history, and neonatal outcomes were collected using standardized protocols. Logistic regression analyses were performed to assess associations between maternal characteristics and adverse neonatal outcomes.
Results
The incidence of adverse neonatal outcomes was 69.3%. Specific outcomes included macrosomia (45.3%), low APGAR scores (4–6: 28.0%, < 3: 7.3%), NICU admission (27.3%), hypoglycaemia (25.3%), respiratory distress (20.7%), early neonatal death (14.0%), birth injuries (7.3%). Significant factors associated with adverse outcomes included unemployment (aOR = 5.94, 95%CI = 1.70-20.67, p = 0.005), fewer than four antenatal care visits (aOR = 1.63, 95%CI = 1.24–16.49, p = 0.035), preterm delivery (aOR = 3.57, 95%CI = 1.06–12.03, p = 0.040), and not receiving treatment for maternal diabetes (aOR = 1.93, 95%CI = 1.05–4.36, p = 0.016). In contrast, a monthly income of ≥ 150,000 was protective against adverse outcomes (aOR = 0.18, 95%CI = 0.06–0.57, p = 0.004).
Conclusions
The study revealed a high incidence of adverse neonatal outcomes among mothers with diabetes, highlighting the urgent need for improved care. Key factors linked to these adverse outcomes included unemployment, fewer antenatal care visits, preterm delivery, and lack of maternal diabetes treatment, while higher monthly income was protective. Targeted interventions, such as enhanced antenatal care and effective diabetes management, are essential to reduce adverse neonatal outcomes. Future research should focus on evaluating specific interventions to mitigate these risks and improve maternal and neonatal health in similar low-resource settings.
Single‑cell and bulk RNA sequencing identifes T cell marker genes to predict the prognosis of ovrian caner
Authors: Sun Hengzi , Huo Xiao , Li Shuhong , Guo Liyuan
Published: August 2024

Background: Ovarian cancer, with high mortality and often late diagnosis, shows high recurrence despite treatment. The variable effectiveness of immunotherapy highlights the urgent need for personalized, advanced therapeutic strategies.
Methods: To investigate T-cell marker genes, single-cell RNA-sequencing (scRNA-seq) data were sourced from the Gene Expression Omnibus (GEO) database. Additionally, bulk RNA-sequencing data along with clinical information from ovarian cancer patients were retrieved from the Cancer Genome Atlas (TCGA) database to establish a prognostic signature. This study involved survival analysis to evaluate associations between different risk groups, and explored cellular communication and relevant pathway analyses, including metabolic pathways.
Results: We identified 41 genes showing varied expression between two T-cell subclusters, marking subcluster 0 with CCL5 and GZMA, and attributing the rest to subcluster 1. These markers delineate four prognostic groups within the TCGA OV dataset, with T-cluster 2 exhibiting the poorest survival, in contrast to T-cluster 3, which shows the best. Analysis suggests subcluster 1 T-cells might be dysfunctional, potentially exacerbating ovarian cancer progression. We also developed a T-cell scoring model using eight significant genes, showing improved survival in the low-score group. Moreover, cellular and metabolic pathway analyses underscored the importance of CCL, IL2 and MGMT pathways in these subclusters.
Conclusions: The study identifies CCL-5 as a biomarker for T-cell subtypes in ovarian cancer using scRNA-seq and bulk RNA-seq data. A T-cell scoring model based on eight genes predicts survival and progression rates, independent of clinical features. This model could be a prognostic indicator and CCL-5 a potential immunotherapy target in ovarian cancer.
Prediction of Early Mortality in Patients Undergoing Right Hemicolectomy Using Machine Learning Algorithms
Authors: Kement Metin , Alkan Murat , Irmak Deniz , Uzun Huseyin , Tasdogan Bagiş , Kuçuk Hasan Fehmi
Published: August 2024

Aim:This study aims to determine whether early mortality in patients undergoing right hemicolectomy can be predicted using artificial intelligence (machine learning) algorithms.
Method:The study included all cases of right hemicolectomy or extended right hemicolectomy performed in our clinic between January 2019 and December 2023. Data were collected retrospectively from a prospectively maintained database. Patients undergoing surgeries other than right hemicolectomy were excluded. A database was created using basic clinical data and processed in the Google Colab environment using TensorFlow, Keras, Pandas, Numpy, and Scikit-learn libraries. The TensorFlow. Keras Sequential model was used with “Dense” layers, and the “Adam” optimizer was chosen for optimization. Eighty percent of the database was used for training, and 20% was used for testing.
Results:The database included 410 patients, of whom 258 (62.9%) were male, and 152 (37.1%) were female, with a mean age of 63.5±14.2 years. Early mortality occurred in 39 (9.5%) patients. Data from 307 patients were used for machine learning training, and data from 103 patients were used for testing. The machine-learning model predicted early mortality with an accuracy range of 91% to 95% using basic clinical parameters..
Conclusion:This study demonstrates that early mortality in patients undergoing right hemicolectomy can be predicted with high accuracy using machine learning algorithms. The above 90% accuracy rate achieved using basic clinical parameters indicates the potential of this algorithm as a supportive tool in clinical decision-making processes.
The Effect of Retinal Structure on Surgical Success in Macular Holes
Authors: SOMUNCU AHMET MEHMET , KOLA MEHMET , ERDÖL HİDAYET , BÜSRA  , ESENÜLKÜ CENAP
Published: August 2024

Purpose: To evaluate the effects of preoperative hole structure and size on postoperative anatomical and functional success in patients with macular holes and determine the changes in retinal layers using optical coherence tomography (OCT).
Methods: This study included 48 eyes of 45 patients who underwent surgery with the diagnosis of macular hole between January 1, 2013, and August 1, 2019, and were followed up for at least six months in the postoperative period.
Results: Forty-five patients, 23 (51.1%) female and 22 (48.9%) male, were included in the study.
There was a statistically significant difference between the preoperative visual acuity and the postoperative third-month and sixth-month visual acuity values. After surgery, visual acuity significantly increased for up to six months. When examining the relationship between hole edge parameters and preoperative visual acuity, a negative correlation was detected between the minimum hole diameter, basal hole diameter and the visual acuities measured at the postoperative. The macular hole index (MHI) and The tractional hole index (THI) had a positive correlation with the postoperative visual acuities.
The assessment of the effect of the integrity of the outer limiting membrane (OLM) and the ellipsoid zone (EZ) on postoperative visual acuity at the third and sixth months revealed that visual acuity was higher in patients with OLM and/or EZ integrity at these evaluation times.
Conclusion: The surgical closure of macular holes provides anatomical and functional recovery. This study showed that the minimum hole diameter and basal hole diameter, as well as MHI and THI, among the edge parameters measured by preoperative OCT, had a significant effect on functional success.
Mortality and antidepressants among individuals with autism spectrum disorder: A population-based cohort study
Authors: Chen Vincent Chin-Hung , Huang Yu-Hsin , Chen Yi-Lung , Dewey Michael E. , Wu Shu-I
Published: August 2024

Aim
High risk of premature mortality has been identified among individuals with autism spectrum disorder (ASD). Although possible risk factors, such as epilepsy or other comorbidities, have been described, studies investigating the association between the use of antidepressants and different causes of mortality are scarce.
Methods
This retrospective population-based cohort design used Taiwan’s National Health Insurance Research Database. 31,458 individuals with ASD between 2001 to 2017 were identified. Among them, 4,659 ASD patients with antidepressant use and 4,659 propensity score (PS)- matched ASD patients without antidepressant use were selected. Main outcomes of this study are all-cause mortality, and mortality due to accident, suicide, or natural causes.
Result
Antidepressant exposure in individuals with ASD was associated with a significantly lower all-cause mortality (aOR = 0.65, 95%CI: 0.52 ~ 0.83), as reflected in accident mortality (aOR = 0.63, 95%CI: 0.47 ~ 0.82). Among those aged 18 and above, antidepressant use was associated with a significantly decreased risk of natural cause mortality.
Conclusions
This study revealed that antidepressant use in patients with ASD was associated with a decreased risk of all-cause mortality, in particular, mortality from accidents or natural causes. These results may demonstrate the importance of early detection and treatments for comorbid psychiatric disorders in patients with ASD.
A unique case of benign notochord cell tumor in which the cervical vertebral body and its accessories were eroded by the tumor
Authors: Huang Yao , Xue Jingbo , Tan Jinghua , Ouyang Xueqian , Meng Zhenyu , Ma Xiuwen , Yan Yiguo
Published: August 2024

Background Benign notochordal cell tumor is an extremely rare benign tumor. Usually, the central axis of the human body is found. we describe a rare case of BNCT involving the cervical vertebral body and its appendages, mainly focusing on its imaging and pathological features. To our knowledge, no similar cases have been previously reported.
Case presentation
The patient, a 50-year-old woman, had experienced neck pain and discomfort for 10 years. Radiography and computed tomography revealed a scattered high-density shadow located in the C4 vertebral body and its attachment area. Plain magnetic resonance imaging showed that the T1-weighted images had a uniformly low signal. Conversely, T2-weighted magnetic resonance imaging displayed a constantly high signal intensity, with no unmistakable enhancement signal observed in the enhanced images. Under a microscope, the cells from resected tissue had a lamellar structure with homogeneous adipocyte-like vacuolated and less-vacuolated eosinophils. Immunohistochemical staining showed positivity to immunohistochemical markers, such as AE1 / AE3 (CK-pan) and brachyury. Because of the rare nature of benign intraosseous chordal cell tumors, it is necessary to record and review them. This is a rare manifestation of BNCT.
Conclusion
BNCT can exist in the vertebral body and its appendages of the cervical spine at the same time or may suggest that BNCT has a certain degree of intraosseous erosion ability. For patients diagnosed with BNCT, the most appropriate treatment plan should be selected to avoid the adverse effects of overtreatment.
Optimizing Electrical Stimulation Parameters to Enhance Visual Cortex Activation in Retina Degeneration Rats
Authors: Xie Hui , Ye Zixin , Chan Leanne Lai Hang
Published: August 2024

In patients with degenerative diseases of the retina, such as retinitis pigmentosa and age-related macular degeneration, retinal prostheses offer a possible method of restoring partial vision. Epiretinal prosthesis remain the need for optimal stimulation parameters for better efficiency and power saving while showing encouraging preliminary clinical efficacy. In this study, we investigate the effects of retinal electrical stimulation parameters, including phase duration, frequency, and interphase interval, on the visual cortical electrically evoked potentials (EEPs) in both healthy (LE) and retinal degenerated (F1) rats. Our in vivoexperiments on both LE and F1 rats suggest that shorter phase durations (500 μs) activate the primary visual cortex (V1) at a lower charge threshold and result in a larger activated area. Our results also show that response to repetitive stimulation decreases profoundly at high frequencies (10 and 20 Hz) compared to low frequency (1 Hz). Additionally, we observe that the inclusion of an interphase interval enhances the level of cortical response but does not contribute to an increase in the activation ratio. The present work suggests epiretinal stimulation using shorter phase durations without interphase intervals as the optimal strategy to safely activate the target region in V1 in both LE and F1 rats.
No Smoke Left Behind- Knowledge, Attitudes and Usage of Smokeless Tobacco from the Lens of the Public: A Nationwide Cross-Sectional Study from Pakistan
Authors: Irshad Hammad Atif , Raja Sajjan , Jehanzeb Hamzah , Shaikh Wamiq Ali , Saleem Umair , Malik Shahzil Abdur Rehman , Shahzad Akmal , Shaikh Mamoon , Iqbal Nousheen , Khan Javaid Ahmed
Published: August 2024

Background Smokeless tobacco (SLT) encompasses products that are not burnt but instead consumed orally or nasally. One-third of tobacco is consumed in the smokeless form in South Asia. Despite its widespread usage, there has been limited empirical research on the prevalence of and factors influencing SLT consumption in Pakistan. This study aimed to provide an assessment of SLT knowledge, attitudes, and usage in Pakistan. Methods Using an online questionnaire, a cross-sectional survey was conducted across Pakistan. Convenience sampling was used to disseminate, and expert approval was sought followed by a pilot study to validate the questionnaire. A comprehensive questionnaire was developed using elements from the Global Adult Tobacco Survey and other tools which had previously been utilized within Pakistan. Participants' responses were described using descriptive statistics, and SPSS version 26 was used to perform linear and logistic regression. A p-value of less than 0.05 was considered statistically significant. Results Data was collected from 1,195 participants among which 85.86% of participants had heard of SLTs prior to the survey. Sex, province, household income and previous doctor visits were significant determinants to product knowledge through which 72.55% agreed that these products can lead to serious illnesses but 30% noted a lack of knowledge on legality. General attitudes agreed to a belief that it makes one unwell (44.1%), sense of guilt (43.85%) and more research is needed on it (54.39%). Negative health effects were the biggest deterrent from pursuing these products for 60.33% of participants. Among significant factors influencing the use of SLTs, the greatest odds of use were found with use as an alternative to cigarettes (OR 4.45) and secondly, due to its availability in a liked flavor (OR 2.27). About 31% reported to have used the product once, with 69.82% of current users expressing a desire to quit. Conclusions Although adequate knowledge and aligning attitudes exist for SLTs, light is shed in the face of a sustaining public health problem. We offer important insights that can guide the creation of focused interventions meant to lower SLT use, and the health hazards associated with it in the Pakistani community by highlighting important myths, incentives, and deterrents.
Construction of a clinical prediction model for complications after femoral head replacement surgery
Authors: Li Kewei , Rong Shuai , Li Hao
Published: August 2024

Background: While femoral head replacement is widely used with remarkable efficacy, the complexity and diversity of postoperative complications pose a serious prognostic challenge.There is an urgent need to develop a clinical prediction model that can integrate multiple factors and accurately predict the risk of postoperative complications to guide clinical practice and optimize patient management strategies.
Objective: This study is dedicated to constructing a postoperative complication prediction model based on big data and machine learning techniques,in order to provide patients with a safer and more effective treatment experience.
Methods: A total of 186 patients who underwent femoral head replacement in the orthopedic department of our hospital were collected in this study.Forty-two of the patients had at least one postoperative complication, and 144 had no complications.The preoperative and postoperative data of patients were collected separately and medical history was collected to study the correlation factors affecting the occurrence of postoperative complications in patients and to establish a prediction model.
Results: Possibly relevant factors were included in a one-way logistic regression, which included the patient's gender, age, BMI, preoperative diagnosis of the mode of injury,osteoporosis or lack thereof, as well as medical history,surgical-related information, and laboratory indices.After analyzing the results, it was concluded that operation time, glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase, white blood cell count, serum albumin, and osteoporosis, were the risk factors affecting the development of complications after femoral head replacement in patients (P < 0.2);The data obtained were further included in a multifactorial regression, and the results showed that operation time,glutamic-oxaloacetic transaminase, white blood cell count, serum albumin, and osteoporosis were independent risk factors for complications after the patients underwent femoral head replacement (P < 0.05).
Conclusion: Based on the results of this study, five factors, including duration of surgery, glutamine aminotransferase, white blood cell count, serum albumin, and osteoporosis, were identified as independent risk factors for complications after patients underwent femoral head replacement;In addition, the prediction model developed in this study has a high scientific and clinical application value, providing clinicians and patients with an important tool for assessing the risk of complications after affected femoral head replacement.
Role of the alpha-1 antitrypsin towards progression and severity of COVID- 19 infection among Saudi patients
Authors: Ali Rabab A. , Mohammedsaeed Walaa A. , Fakher Hesham A. , Noor Hala K. , Qurashi Yasir M. Al
Published: August 2024

Background Alpha-1 antitrypsin (A1AT) is involved in pathophysiology of severe COVID-19, including thrombosis expansion. A1AT has anti-inflammatory, tissue-protective, and anticoagulant capabilities. We aimed to screen frequencies of A1AT gene polymorphism among COVID-19 Saudi patients and its relation to severity.
Methods Through cross-sectional study, we examined 100 COVID-19 Saudi patients to explore possible correlation between A1AT/interleukin 6 (IL-6) ratio and COVID-19 severity. The COVID-19 patients grouped as severe (31 patients) and non-severe (69 patients) cases. A1AT gene polymorphism was conducted using the PCR technique (ARMS) and ELISA.
Results A1AT, IL-6, and vitamin D (VIT-D) showed extreme statistical significance among COVID-19 patients (severe, mild, and asymptomatic). The prevalence of A1AT gene mutation was higher among COVID-19 cases compared with non-mutated patients (56% vs. 44%). Moreover, serum A1AT levels were lower while serum IL-6 levels were higher than reference range and highly significant among mutated cases compared with non-mutated cases. Also, IL-6/A1AT ratio in severe COVID-19 patients (mean 1.4) was significantly higher compared with asymptomatic or moderate patients (0.16, 0.21; respectively). Strictly, all COVID-19 patients have severed deficiency of VIT-D level significant among mutated and non-mutated cases (p<0.04 and p<0.03; respectively). The frequency of MM (wild type) was substantially high among asymptomatic cases compared with severe cases (67.2% vs.16.1%). Heterozygous MS+MZ genotypes showed lower frequency among asymptomatic cases compared with severe and mild cases (27.6% vs.48.4% and 72.7%; respectively). On the other hand, the more severe forms of SS+ZZ+SZ genotypes were all relatively rare with lower frequency among asymptomatic compared with mild and severe COVID-19 cases (5.2%, 27.3% and 35.5%; respectively). Interestingly, homozygous SS genotype elicited higher frequency among severe cases compared with mild or asymptomatic cases (22.6% vs.0% and 5.2%). The more severe forms homozygous ZZ genotype vanished among asymptomatic and mild cases. This extensively illuminated that, severe COVID-19 patients have diminished A1AT response towards inflammation.
Conclusion Two haplotypes (S) and (Z) alleles of A1AT have higher frequency and were clearly recognized among severe COVID-19 cases suggesting that SS and ZZ genotypes may be associated with an increased risk, while MM genotype may be protective against severe COVID-19 infection.