bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the use of the HIS-based BOPPPS teaching model in medical imaging experimental course instruction
Authors: Yang Ziqing , Zhen Siyu , Pan Ben , Wei Hanyu , Li Qiang , Yue Junyan , Hu Ying , Liang Changhua
Published: October 2024

Background
The efficacy of traditional teaching medical imaging experimental courses is not optimal due to a number of flaws. This study's main goal was to find out how well the Bridge-In, Outcomes, Pre-Assessment, Participatory Learning, Post-Assessment, and Summary (BOPPPS) teaching model, which is based on the Hospital Information System (HIS), works when teaching medical imaging experimental courses to undergraduate students pursuing five years of medical imaging education.
Methods
117 medical imaging students who were interning at the First Affiliated Hospital of Xinxiang Medical University in the academic year 2021–2022 made up the research subjects. During the first semester, the first group was instructed using the BOPPPS teaching model based on HIS, while the second group was instructed using the standard teaching model. The two student groups swapped instructional models in the second semester. After the course, questionnaire surveys and closed-book exams were used to evaluate the effectiveness of the instruction.
Results
Compared to the group using the traditional teaching model, the BOPPPS teaching model group scored significantly higher on case reading and overall final test outcomes, and this difference was statistically significant (In the first semester, the scores of case reading questions were 39.27 ± 3.39 VS 35.31 ± 2.77,P < 0.001; the total scores were 77.47 ± 6.61 VS 74.33 ± 4.17,P = 0.003. In the second semester, the scores of case reading questions were 39.79 ± 3.45 VS 35.47 ± 3.15,P < 0.001; the total scores were 78.36 ± 5.11 VS 74.53 ± 5.68, P < 0.001). On multiple-choice questions, however, there was no statistically significant difference in the scores between the standard teaching model group and the BOPPPS teaching model group. Over 80% of the students rated questions 1–9 with a score of 4 or 5, indicating that students' evaluations of the BOPPPS teaching model in terms of learning efficiency, interest, clinical reasoning ability, and course satisfaction were all consistently positive.
Conclusion
The BOPPPS teaching model based on HIS system is a supplement, perfection and optimization of traditional medical imaging experimental courses teaching, and is helpful to improve the effectiveness and satisfaction of medical imaging experimental courses teaching.
The mediating role of depression in the relationship between fatigue and sleep quality in kidney transplant patients
Authors: Yang Jing-Hua , Zhang Ping , Du Zhen , Tian Tian , Zhou Wei , Zhang Rong-Mei
Published: October 2024

Objective: The purpose of this study was to explore the mediating role of depression between fatigue and sleep quality in patients after renal transplantation.
Methods: The general information questionnaire, Pittsburgh Sleep Quality Index (PSQI), Multidimensional Fatigue Inventory (MFI-20) and Patient Health Questionnaire 9 (PHQ-9) were used to evaluate 200 kidney transplant patients in our department from May 2019 to November 2020.
Results: The total PSQI score is (5.31±2.47) points. This study shows that the total score of PSQI is positively correlated with the total score of PHQ and MFI (r=0.422/0.468, P<0.01 for both). Depression partially mediates the relationship between fatigue and sleep quality in kidney transplant patients. The indirect effect is 0.130, accounting for 29.8% of the total effect.
Conclusion: Fatigue may not only directly affect the sleep quality of patients after renal transplantation, but also indirectly affect sleep quality through the mediating effect of depression.
Investigating the Profile of Patients with Idiopathic Inflammatory Myopathies in the Post-COVID-19 Period: Emphasizing Myocardial Injury
Authors: Cheng Lu , Li Yan-hong , Wu Yin-lan , Luo Yu-bin , Zhou Yu , Ye Tong , Liang Xiu-ping , Wu Tong , Huang De-ying , Zhao Jing , Liu Yi , Liang Zongan , Tan Chunyu
Published: October 2024

Introduction: The 2019 coronavirus disease (COVID-19) pandemic has changed the characteristics of many diseases. It remains unclear whether idiopathic inflammatory myopathies (IIMs) exhibit distinct phenotypes in the context of COVID-19.
Methods: This retrospective study included 171 IIMs patients with a history of COVID-19 (prior COVID-19, PC) and 121 without (no-prior COVID-19, NPC). Medical histories, lab tests, and echocardiography data were compared.
Results: PC group exhibited a greater incidence of cardiac damage, including a greater proportion of clinical diagnosis of myocarditis (p=0.02), palpitation (p=0.031), and MYOACT/MITAX cardiovascular involvement scores (all p＜0.001), and elevated levels of myoglobin (MYO, p=0.03), creatinine kinase MB (CK-MB, p=0.015), cardiac troponin T (cTnT, p=0.011), N-terminal pro-B-type natriuretic peptide (NT-proBNP, p=0.028), lactate dehydrogenase (LDH, p=0.033), and hydroxybutyrate de-hydrogenase (HBDH, p=0.019). Echocardiographic analysis revealed greater diameter of left atrium (LA, p=0.040), left ventricle (LV, p=0.013), greater thicknesses of interventricular septum (IVS, p=0.043), and greater end-diastolic volume (EDV, p=0.036) in the PC group than in the NPC group. Transcriptional data analysis based on public databases indicated that various mechanisms, including collagen matrix proliferation, calcium ion pathway regulation, oxidative stress, cell proliferation, and inflammatory molecules, collectively contribute to the pathogenesis of myocardial damage in patients with IIMs and COVID-19.
Conclusion: The study serves as a crucial reminder for clinicians to remain vigilant regarding the enduring cardiovascular consequences associated with IIMs subsequent to COVID-19.
A point prevalence survey of antimicrobial use in two hospitals in Western Kenya
Authors: Nyaboke Emmah , Ogola Joseph , Okumu Mitchel , Wasike Joan , Naliaka Carolyne , Lusweti Victor , Anyanzwa Lydia , Kamau Peter , Omesa Eunice , Kimani Tabitha , Omani Ruth
Published: October 2024

Background
Information from point prevalence surveys can guide antimicrobial stewardship programs (ASPs). The aim of the present study was to document the use of antimicrobial agents at two hospitals in Western Kenya, namely Bungoma County Referral Hospital (BCRH) and Webuye County Hospital (WCH).
Methods
The World Health Organization (WHO) Global Point Prevalence Survey (G-PPS) tool was used to collect sociodemographic information of study participants, the type of antimicrobial agents used, indications for antimicrobial use, and diagnostic tests conducted on participants. Files were selected over 24 hours, data was abstracted between July and October 2022, and analysis was carried out on SPSS version 26.
Results
Among the 361 patients, 223 (61.8%) were on antibiotics. The most common antibiotics used were ceftriaxone (123/237; 34.5%), metronidazole (89/237; 24.9%), and flucloxacillin (36/237; 10.1%). Most (60/237; 25.4%) antibiotics at the WCH were prescribed empirically, while most (46/237; 19.5%) antibiotics at the BCRH were prescribed for prophylaxis. Pneumonia was the leading indication for antibiotic prescriptions at BCRH (18/169, 9.5%), while clinical sepsis (17/169;9.9%) was the leading indication for antibiotic prescriptions at the WCH. 16/237 (6.8%) of the patients who had an antibiotic prescribed were subjected to culture and sensitivity testing, but only 9/16 (81.8%) received the results of the antimicrobial susceptibility tests within the study period.
Conclusions
Penicillins and Cephalosporins were widely used, prescribing/clinical practices vary from one hospital to another, and microbiological tests were underutilized in the study area. There is a need for enhanced antimicrobial and diagnostic stewardship in the study area.
Effective Second-line b/tsDMARDs for Patients with Rheumatoid Arthritis Unresponsive to First-line b/tsDMARDs From the FIRST Registry
Authors: Kanda Ryuichiro , Miyazaki Yusuke , Nakayamada Shingo , Fukuyo Shunsuke , Kubo Satoshi , Miyagawa Ippei , Yamaguchi Ayako , Satoh-Kanda Yurie , Ohkubo Naoaki , Todoroki Yasuyuki , Ueno Masanobu , Nagayasu Atsushi , Kusaka Katsuhide , Sakai Hidenori , Matsunaga Satsuki , Nohara Hirotsugu , Tanaka Yoshiya
Published: October 2024

Background For patients with rheumatoid arthritis (RA) unresponsive to first-line biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), the selection of second-line b/tsDMARDs is crucial to prevent progression to difficult-to-treat rheumatoid arthritis (D2TRA). However, indicators for selection are lacking. This study aimed to identify optimal second-line b/tsDMARDs among the Phase III treatment strategies based on European League Against Rheumatism Rheumatoid Arthritis management recommendations (EULAR RA management recommendations).Methods 687 RA patients treated with second-line b/tsDMARDs (Tumour necrosis factor inhibitor [n = 246], Anti-interleukin-6 receptor antibody [n = 195], Cytotoxic T-lymphocyte associated protein 4 immunoglobulin [n = 119], Janus kinase inhibitor [n = 127]) were enrolled between October 2013 and April 2023. Rates of patients achieving Clinical Disease Activity Index (CDAI) remission and CDAI Low Disease Activity (LDA), changes in CDAI, persistence rates, and adverse events within 24 weeks after treatment initiation were compared among the four groups. Propensity score-based inverse probability of treatment weighting (PS-IPTW) was used to minimise selection bias.Results After PS-IPTW adjustment, the janus kinase inhibitor (JAKi) group had the highest persistence rate among the four groups. At 24 weeks, the JAKi group showed the greatest improvement in CDAI and the highest CDAI remission rate. Among patients treated with JAKi as second-line b/tsDMARDs, upadacitinib (UPA) was most likely to achieve CDAI remission at 24 weeks. The comparison between the UPA group (n = 32) and the Non-UPA JAKi group (tofacitinib and baricitinib [n = 95]) showed comparable persistence rates but significantly lower CDAI scores and higher CDAI remission rate at 24 weeks in the UPA group. No significant difference was noted in the overall incidence of adverse events among the four groups treated with b/tsDMARDs or between the groups treated with JAKi.Conclusions Selecting JAKi, especially UPA, may effectively improve the disease activity for RA patients unresponsive to first-line b/tsDMARDs. However, the number of patients treated with UPA was relatively small in this study. Further large-scale studies are needed to clarify the efficacy and safety of UPA.
The mediating role of family burden in the association between family functioning and post-traumatic stress symptoms among parents of children with leukemia in Xinjiang, China: a cross-sectional study
Authors: Liu Zixuan , Ma Guiyuan , Xiao Yuqiao , Yan Ping , Zhang Hong , Liu Li , Xu Jia , Zhang Tianruixue , Gu Can
Published: October 2024

Purpose
To analyze the current levels of post-traumatic stress symptoms (PTSS) among parents of children with leukemia in Xinjiang, China, and to explore the mediating role of family burden in the association between family function and PTSS.
Methods
A cross-sectional survey was conducted with 209 parents of children with leukemia from a tertiary hospital in Xinjiang, China. Participants completed a social demographic questionnaire, the Family APGAR Index, the Family Burden Scale of Disease, and the post-traumatic stress disorder Checklist for DSM-5 (PCL-5). Multiple linear regression analysis was performed to identify factors associated with PTSS. Structural equation modeling was used to verify the mediating effect of family burden.
Results
Family income, disease duration, family function, and family burden were significantly associated with PTSS. PTSS was negatively associated with family function (r = -0.571, P < 0.001) and positively associated with family burden (r = 0.523, P < 0.001). Family burden mediated the relationship between family functioning and PTSS. Family function had an indirect effect on PTSS through family burden (β = −0.173, 95% confidence interval: -0.296, -0.088, P = 0.001).
Conclusion
Our findings emphasize the mediating role of family burden in the relationship between family function and PTSS among parents of children with leukemia. Health professionals should develop targeted family-centered care measures to ameliorate family function and decrease family burden, thus improving parents’ mental health.
Interactive Segmentation of Compressed Spinal Canal and Cord in Degenerative Cervical Myelopathy
Authors: Park Sung Bae , Han Sangmin , Cho Woonwoo , Kim Chi Heon
Published: October 2024

Study Design: Retrospective Diagnostic Study
Objective: We aim to develop an interactive segmentation model that can offer accuracy and reliability for the segmentation of the compressed spinal cord in degenerative cervical myelopathy (DCM).
Setting:Boramae Medical Center, Korea.
Methods: A dataset of 1,444 frames from 294 MRI records of DCM patients was used and we developed two different segmentation models for comparison: autosegmentation and interactive segmentation. The former was based on U-Net and utilized a pretrained ConvNeXT-tiny as its encoder. For the latter, we employed an interactive segmentation model structured by SimpleClick, a large model that utilizes a vision transformer as its backbone, together with simple fine-tuning. The segmentation performances of the two models were compared in terms of their DICE scores. The efficiency of the interactive segmentation model was evaluated by the number of clicks required to achieve a target mean intersection over union (mIoU).
Results: The auto and interactive segmentation models with 10 clicks returned a 0.8226 and 0.9537 DICE score for cases involving canal segmentation and a 0.7363 and 0.7767 DICE score for cases involving cord mask segmentation alone, respectively. The required clicks for the interactive segmentation model to achieve a 90% mIoU for spinal canal with cord cases and 80% mIoU for spinal cord cases were 11.71 and 11.99, respectively.
Conclusions: We found that the interactive segmentation model outperformed the autosegmentation model. Simple manual inputs can help the model identify a region of interest in the irregular shape of spinal cord.
Sponsorship: No sponsorship
Clinical diagnosis of Tuberculosis with atypical manifestations involving Liver, and spleen with spontaneous subscapular hematoma: A Case Report and Review of Literature
Authors: Ayen Addisu Assfaw , Genetu Abere , Belay Bekalu Mekonen , Fekadie Mengistu Melak , Kassa Belayneh Dessie
Published: October 2024

Background
Isolated liver and spleen involvement of Tuberculosis (TB) is a rare presentation.
Case presentation
A 60-year-old male patient from Bahir Dar city in the Amhara region of Ethiopia presented with a four-month history of low-grade fever, significant weight loss, drenching night sweating, poor appetite, exertional shortness of breath, and easy fatigability. Two weeks before his presentation, all the above symptoms worsened, and also started to feel left upper quadrant (LUQ) abdominal pain with a dragging sensation. He had hepatosplenomegaly. Abdominal ultrasound showed hepatosplenomegaly with linear hypoechoic area seen at the upper pole of the spleen, likely infarctions, and also there was a few small periportal Lymphadenopathy. An abdominal CT scan showed a sub-capsular hematoma on the upper pole of the spleen. extrapulmonary tuberculosis (Hepatosplenic TB) was considered and anti-TB medications started. On his 6th month of follow-up and evaluation, his symptoms were improved with normal physical findings and normal investigation findings.
Conclusion
even though isolated hepatosplenic TB is a rare condition, it has to be considered especially in low socio-economic communities after excluding other alternative diagnoses.
Factors influencing the age of first hospitalization in patients with chronic schizophrenia: Role of clinical features and blood parameters
Authors: Hao Qingling , Yang Yuan , Yang Shutong , Ding Yu , Li Cui , Luo Guoshuai , Zhang Xiangyang
Published: October 2024

Background
This study aims to identify the factors influencing the age of first hospitalization in patients with chronic schizophrenia, focusing on clinical features and blood parameters.
Methods
A total of 1271 patients diagnosed with chronic schizophrenia were recruited from 17 psychiatric hospitals across China. Demographic and clinical data, including age of first hospitalization, were collected. The study also included assessments of psychiatric symptoms, duration of untreated psychosis (DUP), and various blood parameters. Statistical analyses were conducted to examine the relationships between these factors and the age of first hospitalization.
Results
The average age of first hospitalization was 28.07 ± 9.993 years. Single patients and those with a family history of mental illness were hospitalized at a younger age. Patients with suicidal ideation or behavior also had an earlier hospitalization age compared to those without such history. Regression analysis revealed that marital status (single), family history of mental illness, and suicide ideation or behavior were significant risk factors for earlier hospitalization age. Conversely, DUP, total protein (TP), and low-density lipoprotein (LDL) levels were positively correlated with the age of first hospitalization, while antipsychotic medication dosage and albumin (ALB) levels were negatively correlated.
Conclusions
The study identifies significant demographic, clinical, and biochemical factors associated with the age of first hospitalization in chronic schizophrenia patients in China. These findings underscore the importance of early intervention and targeted support for high-risk groups to improve treatment outcomes.
The Clinical Significance of Elastic Lamina Invasion in Patients with pStage II Colorectal Cancer: A Notable Prognostic Indicator
Authors: Shirouzu Kazuo , Hisaka Toru , Fujita Fumihiko , Yoshida Takefumi , Koushi Kenichi
Published: October 2024

Background
Some colorectal cancers (CRCs) are clinically diagnosed as cT4a with serosal invasion (SI). However, the cT4a is most often underdiagnosed pathologically as pT3 without SI by hematoxylin-eosin (H&E) staining alone. Using Elastica-Van Gieson (EVG) staining, some pT3 tumors invade the elastic lamina (EL), which extends just below the serosal layer. Recently, EL invasion (ELI) has been described as a poor prognostic factor for disease-free (DFS) and overall survival (OS) in patients with pStage II CRC. However, its clinicopathological significance remains unclear due to the limited number of studies and poor understanding of ELI.
Objective
This study investigated the association between ELI and prognosis.
Methods
After 1982, pathological diagnosis was routinely performed using H&E and EVG staining methods and long-term follow up was performed until 2016. All clinicopathological features including ELI were prospectively registered into our computer and 605 patients with pStage II CRC were collected from the database. Based on ELI status, pT3 was divided into pathological three categories; pT3ELI − was defined as pT3a, pT3ELI + as pT3b and unidentified EL (pT3EL−) as pT3u.
Results
Using H&E staining alone, gross cT4a was most often pathologically underdiagnosed as pT3 (93.4%) and very rarely as pT4a, resulting in a large diagnostic discrepancy. Using EVG staining, 59.2% of cT4a cases were diagnosed as pT3b. The 10-year DFS and OS rates were similar for pT3a and pT3u. However, the 10-year DFS and OS rates of pT3b were significantly lower than that of pT3a (76.8% vs. 95.8%, p < 0.001 and 58.7% vs. 69.3%, p = 0.003, respectively) but did not differ from that of pT4a (74.3%, p = 0.771 and 51.5%, p = 0.157, respectively). Multivariate analysis identified ELI as the strongest independent risk factor for recurrence and CRC-specific death (p < 0.0001).
Conclusions
A better understanding of ELI allows us to reconsider the diagnostic discrepancy of serosal invasion, i.e., pT3b should be considered pT4a. The ELI-based subclassification of pT3 is expected to be incorporated into the TNM staging system in the future. ELI is a notable prognostic indicator in patients with pStage II CRC.
Comparing Soft Tissue Outcomes in Skeletal Class II Malocclusion: Anterior Segmental Osteotomy vs. Non-Surgical Orthodontic Treatment
Authors: Choo Hyunhee , Kim Young Ho , Hong Pureum , Choi Young-Jin , Kim Reuben , Chae Hwa Sung
Published: October 2024

Objectives: Temporary anchorage devices (TAD) has reduced the need for anterior segmental osteotomy (ASO) in patients with Class I malocclusion. Previous studies were mostly published before the widespread use of TADs. Therefore, new guidelines are required to determine the optimal approach between surgery and orthodontic treatment. The purpose of this study is to establish guidelines on the choice between ASO and non-ASO (NASO) based on soft tissue considerations.
Materials and Methods: Sixty-seven patients diagnosed with skeletal Class II malocclusion were divided into ASO (n = 31) and NASO (n = 36) groups. Cephalometric analyses were used to compare the initial and final records to assess the impact of treatment on soft tissue. The interlabial gap, upper lip to E-line, lower lip to E-line, H-angle, UL to N-perpendicular line, and nasolabial angle were evaluated. Specially a proportional difference indicator between the upper and lower lips relative to the Pog (CKHA) was presented, followed by statistics analyses. A P-value of less than 0.05 indicated statistical significance.
Results: Both groups showed normal proportion between the upper and lower lips, although significant differences favoring ASO over NASO in soft tissue changes were observed in several variables.
Conclusions: If the required adjustment for the upper and lower lips is -4.0 mm and -5.0 mm, respectively, ASO is advised. For modifications of -2.0 mm, NASO is preferred.
Clinical Relevance: This study provides clinical guideline for choosing between ASO and NASO treatments based on required lip movement measurements.
Antibacterial effect of silver nanoparticles against Bacillus sp. under plasmon resonance condition
Authors: Lozovski Valeri , Rybalchenko Nataliya , Petrik Iryna , Kryvokhyzha Kostiantyn , Vasiljev Anatoliy , Vasyliev Taras
Published: October 2024

The interaction between the silver nanoparticles colloidal solutions and bacteria Bacillus sp. under plasmon resonance conditions is studied in the present work. The resonance conditions are realized by irradiating the bacteria/nanoparticles suspension with external light of resonant wavelength. Three types of nanoparticles are used - nanoparticles obtained with the method of chemical reduction (type I), thermal recovery method (type II), and photoreduction method (type III). For all three types of colloids, the antibacterial effect is not revealed in the case of simple mixing of the nanoparticle colloid with the bacteria solution. The antibacterial effect appears under irradiation by the light of resonance wavelength. In particular, the effect of external irradiation of resonant wavelength leads to a decrease in the infection activity of bacteria by 15–25% for all types of nanoparticles. The antibacterial effect is due to the action of ponderomotive forces on the bacterium membrane after the adsorption of the nanoparticle on it. The strength of the antibacterial effect depends on the thickness of the quercetin shell of the silver nanoparticle. In the case of a thick quercetin shell, the local field is smaller. Therefore, ponderomotive forces acting on the bacterial membrane are smaller.
Basement structural control in urban fracturing, a case study in Zacatecas, Mexico
Authors: Escalona-Alcázar Felipe de Jesús , García-Paniagua Estefanía , Pineda-Martínez Luis Felipe , Rodríguez-González Baudelio , Reveles-Flores Sayde María Teresa , Valle-Rodríguez Santiago
Published: October 2024

In this groundbreaking research we present a novel methodology for systematic fracture measurement in streets, sidewalks and walls. This approach, which incorporates both urban fracture data and geologic fault data, is a significant step forward in our understanding of the relationship between urban fractures and geologic faults. By calculating the paleostress axis, we were able to determine if fractures follow the urban area street array or if geologic faults control fracturing, leading to parallel data. The result reveals reverse faults dispersed in the NW and SE quadrants, while the normal faults have a clear tendency towards the NW and, to a lesser extent, to the NE, with the extension axis directed to the NE-SW. The orientation of the normal faults is parallel to that observed in the fractures in sidewalks, streets, and walls, as well as to the distribution of slopes and to that of the basement deformation. Moreover, the main drainage is also directed towards the WNW-ESE, it is, fault controlled. The parallelism between the urban fracturing and basement deformation suggests a close relationship between them, despite the construction process or materials quality.
Effect of Autism on Overweight in Children from a Socio-ecological Perspective
Authors: Kim Taeeung , Kwon Eun Hye
Published: October 2024

Background Although autism spectrum disorder (ASD) is known to be correlated with chronic physical conditions such as gastrointestinal disorders, musculoskeletal problems, and sensory processing disorders, a nationwide nonclinical sample of overweight children with ASD is limited. We aimed to use a large nationally representative non-clinical sample to explore the relationship between ASD and childhood adjusted for socio-ecological factors.Methods This cross-sectional data analysis from the 2021 National Survey of Children’s Health was conducted with the modified ecological systems theory model as the guiding framework. A propensity-score matching analysis helped isolate the factors affecting the weight status (i.e., being overweight) in children with ASD, controlling for demographic characteristics, physical activity habits, and familial and environmental circumstances.Results Among the 20,091 individuals (mean age, 13.77 years; girls, 48.59%; equivalent to 32,211,963 individuals in the general population) identified for this study, 1,348 individuals (mean age, 13.94 years; girls, 22.55%; representing 1,904,381 individuals from the general population) were examined in our final matched model to determine the link between ASD and being overweight in children. ASD had a statistically significant effect on being overweight. Notably, children with ASD and those with similar socio-ecological factors showed a higher risk of being overweight if they were Hispanic, had less healthy parents, or were involved in more structured activities (all p-values < .05).Conclusions Our findings underscore a pronounced association between autistic children and being overweight. This underscores the necessity for careful attention towards preventing excessive weight gain and for tailored management in children who experience the neuropsychological difficulties associated with ASD.
Development of Predictive Models for Pathological Response Status in Breast Cancer after Neoadjuvant Therapy Based on Peripheral Blood Inflammatory Indexes
Authors: Liu Shuqiang , Jiang Cong , Wu Danping , Zhang Shiyuan , Qiao Kun , Yang Xiaotian , Yu Boqian , Huang Yuanxi
Published: October 2024

Background.
Achieving a pathological complete response (pCR) after neoadjuvant therapy (NAT) is considered to be a critical factor for a favourable prognosis in breast cancer. However, discordant pathological complete response (DpCR), characterised by isolated responses in the breast or axillary, represents an intermediate pathological response category between no response and complete response. This study aims to investigate predictive factors and develop models based on peripheral blood inflammatory indexes to more accurately predict NAT outcomes.
Method.
A total of 789 eligible patients were enrolled in this retrospective study. The patients were randomized into training and validation cohort according to a 7:3 ratio. Lasso and uni/multivariate logistic regression analysis were applied to identify the predictor variables. Two Nomograms combining clinico-pathologic features and peripheral blood inflammatory indexes were developed.
Result.
Molecular Subtype, HALP, P53, and FAR were used to construct the predictive models for traditional non-pCR (T-NpCR) and total-pCR (TpCR). The T-NpCR group was divided into DpCR and non-pCR (NpCR) subgroups to construct a new model to more accurately predict NAT outcomes. cN, HALP, FAR, Molecular Subtype, and RMC were used to construct the predictive models for NpCR and DpCR. The receiver operating characteristic (ROC) curves indicate that the model exhibits robust predictive capacity. Clinical Impact Curves (CIC) and Decision Curve Analysis (DCA) indicate that the models present a superior clinical utility.
Conclusion.
HALP and FAR were identified as peripheral blood inflammatory index predictors for accurately predicting NAT outcomes.
Analyzing Trends in Socioeconomic Disparities in Oral Health Services: A concentration index decomposition approach (2005- 2021)
Authors: Liu Jie , Huang Xiangyu , Fan Weihua , Liu Zhi’e , Huang Shaohong , Qin Yuandong
Published: October 2024

Background
This study aims to (a) examine trends in socioeconomic-related inequalities in the utilization of oral health services among adults in Guangdong Province from 2005 to 2021, and (b) decompose these trends to identify the underlying factors influencing these inequalities.
Methods
Three cross-sectional studies were conducted among adults aged 35–44 and 65–74 in Guangdong Province during 2005–2006 (OHES I), 2015–2016 (OHES II), and 2021–2022 (OHES III). Participants underwent oral health examinations and completed questionnaires about their oral health. The study employed concentration curves and the Erreygers-corrected concentration index (EI) to measure trends in socioeconomic-related inequality in the utilization of oral health services. Additionally, the horizontal inequity index (HI) was calculated to assess the degree of inequity in oral health care utilization after accounting for need factors (self-rated oral health, DMFT, and number of teeth). Decomposition analyses were conducted to evaluate the contributions of income level, need factors, and other variables (age, gender, education, and medical insurance coverage) to overall inequality in dental care utilization.
Results
The findings reveal a growing trend of inequality in dental care utilization, with a marked concentration among wealthier individuals. Decomposition analysis highlighted that household income, education level, and medical insurance coverage are significant contributors to this inequality. Specifically, higher income and educational attainment exacerbated disparities, while the current medical insurance systems were insufficient in mitigating these gaps. Universal basic education was found to promote more equitable access to dental care, but overall, medical insurance did not effectively address the inequality.
Conclusions
The study underscores an increasing concentration of dental care utilization among higher-income groups and identifies critical areas for healthcare reform. Enhancing subsidies for lower-income individuals and improving medical insurance coverage are essential steps to reduce socioeconomic disparities in dental care access. These findings provide valuable insights for policymakers aiming to achieve greater equity in oral health services.
Midkine promotes tumor growth and attenuates the effect of cisplatin in small cell lung cancer
Authors: Ito Shotaro , Sakakibara-Konishi Jun , Sato Mineyoshi , Shoji Tetsuaki , Furuta Megumi , Takahashi Hirofumi , Tsuji Kosuke , Morinaga Daisuke , Kashima Masahiro , Kitai Hidenori , Kikuchi Junko , Kikuchi Eiki , Hatanaka Kanako C , Hatanaka Yutaka , Hida Kyoko , Noguchi Takuro , Konno Satoshi
Published: October 2024

Purpose
Small cell lung cancer (SCLC) is a highly aggressive disease with poor survival. Nevertheless, the addition of an anti-programmed death ligand 1 antibody to platinum combination chemotherapy can improve its prognosis. However, only a few patients achieve a long-term response; thus, establishing new therapies for SCLC is crucial. Midkine (MDK) is a heparin-binding growth factor that plays a role in various biological processes such as cell proliferation and chemotherapy resistance in diverse cancers. MDK has garnered attention as a therapeutic and diagnostic target for several cancers; however, studies evaluating its expression and function in SCLC are scarce.
Methods
The MDK expression was analyzed in vitro and in vivo by ELISA, immunohistochemistry, western blotting. The effect of MDK on cell proliferation and the effect of cisplatin was evaluated by MTT assay.
Results
MDK was expressed pathologically in human SCLC tumor tissues but not in normal lung tissues. Human serum MDK concentration in patients with SCLC reflected the SCLC tumor burden and was correlated to the response to treatment. Moreover, MDK induced cell proliferation and attenuated the effect of cisplatin in SCLC cell lines. The combination of an MDK inhibitor and cisplatin exerted synergistic antitumor effects both in vitro and in vivo. Additionally, MDK positively regulated the AKT pathway.
Conclusion
The present results indicate that MDK contributes to cell proliferation and chemotherapy resistance by activating the AKT pathway in SCLC. Therefore, MDK may be a potential therapeutic and diagnostic target for SCLC.
Collagen turnover biomarkers to predict outcome of patients with biliary cancer
Authors: Kaps Leonard , Genc Muhammed A. , Moehler Markus , Grabbe Stephan , Schattenberg Jörn M. , Schuppan Detlef , Pedersen Rasmus Sund , Karsdal Morten A. , Mildenberger Philipp , Maderer Annett , Willumsen Nicholas
Published: October 2024

Background
The collagen-rich tumor stroma plays a crucial role in biliary tract cancer (BTC). Circulating collagen turnover markers of type I collagen (reC1M), type III collagen (PRO-C3), type IV collagen (C4G), type VIII collagen (PRO-C8), type XI collagen (PRO-C11), type XVII collagen (PRO-C17) and type VIII collage (TUM) may be used as potential non-invasive biomarkers.
Methods
We measured the seven biomarkers of collagen turnover in sera of 72 patients with BTC at baseline and after first and second chemotherapy cycle (CTX). Markers were also assessed in sera of 50 healthy donors and compared to levels of patients at baseline. The diagnostic and prognostic value of the markers was evaluated for overall survival (OS) and progression-free survival (PFS).
Results
Except C4G, all collagen turnover markers were significantly (p < 0.001) increased in serum from patients with BTC compared to healthy controls. PRO-C3 was the best marker to discriminate between patients with BTC and controls, reaching an AUROC of 0.98 (95% CI 0.95; 0.99) with a sensitivity (92%) and specificity (94%) balanced cutoff of 77.3 ng/ml. Patients with high levels (cohort separated by median split) of PRO-C8 (HR 2.85, 95% CI 1.42; 5.73) followed by C3M (HR 2.33, 95% CI 1.2; 4.5), PRO-C3 (HR 3.09, 95% CI 1.5; 6.36) and CA 19 − 9 (HR 2.52, 95% CI 1.37; 4.64) as reference biomarker had a shorter OS. Notably, only the novel marker PRO-C8 was also predictive of PFS (HR 3.26, 95% CI 1.53; 6.95). Associations with survival outcomes remained significant after adjusting for relevant risk factors (CA 19 − 9 and CEA at baseline, age, presence of metastases, weight, height and gender).
Conclusion
The collagen turnover markers PRO-C8, C3M, PRO-C3 and the established biomarker CA 19 − 9 were prognostic for OS in patients with BTC while only PRO-C8 was also predictive for PFS. PRO-C3 showed the best diagnostic performance to discriminate between patients with BTC and controls.
Dynamic changes in maternal cardiac function in pregnancy
Authors: Wang Xiu-Juan , Chen Ling-Ling , Kong Ling-Yun , Xiang Wei , Fu Li , Li Xiao-Wei , Hong Ming-Huan , Liu Fang
Published: October 2024

Background
Pregnant women experience a number of physiologic changes that, if uncompensated, may result in varied degrees of cardiac function impairment. Left ventricular (LV) global longitudinal strain (GLS) and P-wave to A’ duration on tissue Doppler imaging (PA-TDI) are more sensitive and can identify changes in cardiac function early on.
Methods
The study was a cross-sectional study. A total of 165 healthy pregnant women were enrolled in this study, including 48 women in early pregnancy (before 13 weeks' gestation), 37 in mid-pregnancy (14–27 weeks’ gestation), 80 in late pregnancy (after 28 weeks' gestation), while 142 age, height, and weight matched healthy nonpregnant women were included. The clinical data and echocardiographic parameters concerning left atrial and left ventricular function were assessed.
Results
PA-TDI was prolonged in late pregnancy [121.11 (113.03-129.18)] compared to the first trimester [117.65 (107.27-121.11); P = 0.041] and the second trimester of pregnancy [114.19 (105.54-117.65); P = 0.043]. The inclusion of week of gestation, heart rate, pre-pregnancy body mass index (BMI), and hemoglobin to construct a multifactorial regression equation showed a significant difference in the effect of week of gestation on PA-TDI (b = 0.391, t = 3.960, P < 0.001). Left ventricular ejection fraction was lower in late gestation than in early gestation. The absolute value of LV-GLS gradually decreased with increasing gestational weeks (early gestation: 19.49% ± 3.69%; mid-gestation: 18.15% ± 4.00%; late gestation: 15.23% ± 3.87%; P < 0.001). The multifactor regression analysis revealed a significant difference in the influence of gestational week on LV-GLS (b = 0.149, t = 5.618, P < 0.001). LV mass (LVM) was higher in late pregnancy. Additionally, mitral valve E peak, E/A, and e' were lower than in early pregnancy. E/e' was not statistically different in early, middle and late pregnancy.
Conclusion
Healthy pregnant women showed a trend of reduced left atrial function, left ventricular systolic function and diastolic function, but not to the extent of left heart dysfunction. Moreover, PA-TDI and LV-GLS can be used to evaluate early changes in left cardiac function in pregnant women, and PA-TDI measurements are simple, convenient, accurate and reproducible.
The impact of forced internal displacement on cognitive and executive skills in Colombian adolescents: protocol for an observational case-control study
Authors: Valencia Angélica , García-Sánchez Efraín , Vernaza María Alejandra , Bejarano-Valencia Yamileth , Jiménez-Polania Amparo , Provasi Joëlle
Published: October 2024

BackgroundInternal displacement, where individuals are forced to flee their homes but remain within their country of origin, is a significant issue in conflict-affected countries like Colombia. Internally displaced (ID) adolescents experience disrupted living conditions, ongoing conflict exposure, and elevated rates of post-traumatic stress disorders (PTSD). Despite the impact of these factors on neurocognitive development, this area remains underexplored in ID adolescents. This study aims to evaluate the cognitive ability and executive functioning of Colombian ID adolescents compared to non-ID adolescents, and also examine how household income, parental education levels, and area of residence moderate the association between ID status and these skills.MethodThis observational case-control study will recruit two groups of adolescents (aged 12 to 16) from six high schools in a Colombian municipality affected by armed conflict. ID adolescents (n = 130) and non-ID adolescents (n = 130) will complete the Wechsler Intelligence Scale for Children-V (WISC-V) to assess cognitive ability and the 'Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales-3' (BANFE-3) to assess executive functioning. Socioeconomic data will be collected from the municipal school database and a self-administered parental questionnaire. Regression analysis will be used to address the study objectives.DiscussionThis study will address the critical need for data on the impact of internal displacement on the cognitive and executive skills of ID adolescents. The findings will inform targeted interventions to mitigate the potential risk of cognitive impairments in these adolescents, thereby promoting their well-being, as encouraged and emphasized by international guidelines. Although this study will focus on Colombian ID adolescents, our results could benefit a broader panel of victims of internal displacement, the number of which has doubled globally in the last decade.Trial registrationThe study is preregistered on the Open Science Framework.
Polyploid cancer cells reveal signatures of chemotherapy resistance
Authors: Hicks James , Schmidt Michael , Nahgdloo Amin , Prabakar Rishvanth , Kamal Mohamed , Cadaneanu Radu , Garraway Isla , Lewis Michael , Aparicio Ana , Zurita Amado , Corn Paul , Kuhn Peter , Pienta Kenneth , Amend Sarah
Published: October 2024

Therapeutic resistance in cancer significantly contributes to mortality, with many patients eventually experiencing recurrence after initial treatment responses. Recent studies have identified therapy-resistant large polyploid cancer cells in patient tissues, particularly in late-stage prostate cancer, linking them to advanced disease and relapse. Here, we analyzed bone marrow aspirates from 44 advanced prostate cancer patients and found the presence of CTC-IGC was significantly associated with poorer progression-free survival. Single cell copy number profiling of CTC-IGC displayed clonal origins with typical CTCs, suggesting complete polyploidization. Induced polyploid cancer cells from PC3 and MDA-MB-231 cell lines treated with docetaxel or cisplatin were examined through single cell DNA sequencing, RNA sequencing, and protein immunofluorescence. Novel RNA and protein markers, including HOMER1, TNFRSF9, and LRP1, were identified as linked to chemotherapy resistance. These markers were also present in a subset of patient CTCs and associated with recurrence in public gene expression data. This study highlights the prognostic significance of large polyploid tumor cells, their role in chemotherapy resistance, and their expression of markers tied to cancer relapse, offering new potential avenues for therapeutic development.
Investigating metabolic control and complications in type 2 diabetic patients with low income in northwest of Iran, 2023
Authors: Yarahmadi Shahin , Nikkhoo Bahram , Miraki Paria , Rahmani Khaled
Published: October 2024

Background and aim: Socioeconomic factors are very important in non-communicable diseases (NCD) and their complications as a risk factor or as a barrier to receive
effective health care. This study aimed to determine the prevalence of diabetes complications and factors related to glycemic control in type 2 diabetic patients with low income in Kurdistan Province, Iran.
Method: This cross-sectional study was conducted on 608 diabetic patients supported by the Imam Khomeini Relief Foundation in 2023 in the province of Kurdistan, northwest of Iran. In addition to collecting demographic data, major complications of diabetes were specified by clinical examination by specialist physicians and paraclinical data. Data analysis was performed in Stata version 16 using descriptive statistics and logistic regression modeling.
Results: A total of 608, 76.6% female, with mean age 62.7 years were investigated. Prevalence of retinopathy, nephropathy, neuropathy, and diabetic foot ulcers were 42.9%, 6.9%, 3.3% and 4.3%, respectively. HbA1C levels were favorable (≤7.5) in only 231 (38.0%) patients. Longer duration of diabetes was associated with worse glycemic control, whereas comorbidity of DM and hypertension was significantly associated with good glycemic control.
Conclusion: Based on the results obtained, the health care and glycemic control status of low-income diabetic patients is not favorable. Considering the vulnerability of this group due to their low-risk perception and low income, it is recommended to teach self-care behaviors and plan routine care to prevent disease complications and, if necessary, fully cover the cost of care for these patients by the national health system.
Early Robotic Gait Training After Stroke (ERA Stroke): study protocol for a randomized clinical trial
Authors: Areas Fernando Zanela da Silva , Baltz Sara , Gillespie Jaime , Ochoa Christa , Gilliland Taylor , Dubiel Rosemary , Bennett Monica , Driver Simon , Swank Chad
Published: October 2024

Background: Walking impairment after stroke is associated with substantial limitations in functional independence, quality of life, and long-term survival. People in the subacute phase after stroke who are unable to walk are most likely to benefit the greatest from use of overground robotic gait training (RGT). This study will provide preliminary evidence regarding the clinical use and efficacy of RGT during the subacute phase of stroke recovery as well as observational findings associated with the safety, tolerability, feasibility, and cost of delivering RGT during inpatient stroke rehabilitation.
Methods: This prospectively registered randomized controlled trial will enroll 54 patients admitted to inpatient rehabilitation within six months of stroke. Admitted patients will be screened at admission to inpatient rehabilitation for eligibility. Consented patients will be randomized based on stroke severity to receive either RGT or usual care for 90 minutes per week of gait training intervention during inpatient rehabilitation length of stay. Patients will complete assessments on walking and health outcomes at admission and discharge from inpatient rehabilitation and at 1- and 3-month follow-up. Intent-to-treat and per protocol analysis will be performed to evaluate safety [rate of adverse events, visual analog scale, and treatment completion rate], walking function [gait speed via 10-Meter Walk Test, Functional Ambulation Category, gait endurance via 6-Minute Walk Test] and health outcomes [Modified Rankin Scale, Stroke Rehabilitation Assessment of Movement, Continuity Assessment Record and Evaluation Tool, 5 Times Sit-to-Stand Test, Berg Balance Scale, and Stroke Impact Scale–16], and cost-analysis.
Discussion: This study will provide foundational evidence regarding the clinical use and efficacy of a RGT program during the subacute phase of stroke recovery with specific findings associated with the safety, tolerability, feasibility, and cost-analysis of delivering RGT during inpatient stroke rehabilitation.
Trial registration: NCT06430632