bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparity in Access to Orthopedic Surgery between Public and Private Healthcare Insurance: a nationwide population-based study.
Authors: Lira María Jesús , Pino Paula , Vidal Catalina , Mery Pamela , Irarrazaval Sebastián , Cerda Jaime , Vergara Jorge
Published: August 2024

Background: The aim of this study was to examine the influence of healthcare coverage in the access to orthopedic surgery in a country with a dual (private/public) healthcare system. We hypothesize that differential access would exist according to the type of healthcare coverage. This difference would accentuate when analyzing access to elective orthopedic surgery.
Methods: A cross-sectional, population-based design was used to investigate orthopedic surgery rates in Chile during 2016. The rates of orthopedic surgeries provided under the private and public healthcare systems were calculated per 1,000 beneficiaries, as based on data collected from the Hospital Discharge Registry provided by the Chilean Ministry of Health. ICD-10 diagnoses were classified as urgent or elective, categories into which the public/private surgery rates were also sorted.
Results: The overall rate of orthopedic surgery was 7.54 per 1000 inhabitants in 2018. Patients covered under private insurance had an orthopedic surgery rate 2.23 times higher than patients within the public system. This difference became more accentuated when sorting by elective surgeries, with private healthcare having a rate 2.97 times higher than public healthcare.
Conclusions: Access disparity to orthopedic surgical care existed between the private and public healthcare systems in Chile. Disparity in access became greater when separately analyzing the rates of elective and urgent orthopedic surgeries.
Level of evidence: III
Simulations of Genomic Selection Implementation Pathways in Common Bean (Phaseolus vulgaris L.) Using RRBLUP and Artificial Neural Networks
Authors: Chiaravallotti Isabella , Hoyos-Villegas Valerio
Published: August 2024

In this study, we conducted simulations of a common bean (Phaseolus vulgaris) breeding program to better understand the interplay between different choices a breeder must make when launching a genomic selection (GS) pipeline. GS uses dense marker data to estimate breeding values of selection candidates in a crop breeding program. We complement preceding studies focused on optimizing model parameters and training set makeup by exploring the practical implementation of GS in a common bean breeding program aimed at increasing seed yield. We simulated 24 GS implementation pathways, focusing on (1) what generation to train a new prediction model, (2) what generation to select parents for the next cycle, (3) which generation to collect training data, and (4) whether to use linear regression or a nonparametric model for estimating breeding values (BVs). We found that early-generation parent selections (also called rapid-cycle genomic selection) generally resulted in higher gain over three breeding cycles compared to late-generation parent selections. When it comes to implementing a new parametric genomic prediction model, we found that training data should be as diverse as possible, while also matching testing data in terms of genetic makeup and allele frequency. Parametric models showed more consistent GEBV prediction accuracy, while nonparametric models fluctuated, showing both the highest and the lowest prediction accuracy across all pathways. While there is typically a trade-off between high gains and genetic variance, nonparametric models showed greater balance of allelic diversity and gains. This indicates a potential for their use, but more investigation will be required to stabilize their performance. Employing more robust training sets accumulated over time, or developing more tailored and informative model architectures may help to stabilize the performance of nonparametric models. We observed that the key to sustained gains over time is the renewal of genetic variance, which can be accomplished by making crosses within the existing breeding program germplasm.
Effect of phototherapy on blood pressure, heart rate, and body temperature in early preterm infants with gestational age < 32 weeks
Authors: Shin Taewoo , Choi Hyowon , Lee Eun Jung , Yoo Yeong Myong
Published: August 2024

Background
Phototherapy is a widely used treatment for neonatal hyperbilirubinemia, but the potential risks in early preterm infants are not well known. So it seems to be necessary to find out which parameters should be carefully observed during phototherapy. In this retrospective study, we analyzed mean arterial blood pressure (MAP), heart rate (HR), and body temperature (BT) in preterm infants under 32 weeks of gestational age before and after phototherapy.
Methods
In this study, we analyzed the medical records of 93 early preterm infants with gestational age < 32 weeks and birth weight > 1,000 g admitted to the neonatal intensive care unit, treated with and without phototherapy, at a tertiary center in Korea. Changes in MAP, HR, and BT were analyzed before and after treatment.
Results
A total of 82 patients taking phototherapy and 11 control subjects were enrolled. In the phototherapy (PT) group, phototherapy was started on the second day after birth and lasted for 71 hours. In between-group analysis, HR was higher in the PT group 24 − 3 2hours after starting phototherapy (at 24hour; Median of differences 9bpm, p = 0.001, at 32hour; Median of differences 10bpm, p = 0.001), while there was no significant difference in MAP. The rate of MAP increase was lowered and HR was increased after phototherapy, in the PT group analysis, while HR was decreased in the control group.
Conclusions
After starting phototherapy in preterm infants less than 32 weeks of gestational age, the increasing trend in MAP was lowered and the HR was increased. When phototherapy was not performed, there was no change in MAP, and HR appeared to decrease.
A Case of Autoimmune Fanconi Syndrome Secondary to Ipex Syndrome
Authors: Ochoa-Jimenez Vanesa Amparo , Forrero-Delgadillo Jessica María , Vivas Isabella Montaño , Padilla-Guzmán Alejandro , Gómez Inés Elvira , Buenaventura Ana María Portilla , Restrepo Jaime Manuel
Published: August 2024

Background: IPEX syndrome ir a rare monogenic autoimmune disorder resulting from mutations in the FOXP3 gene. This condition is typified by severe early-onset autoimmunity, typically presenting as a triad encompassing enteropathy, polyendocrinopathy, and eczema. Renal involvement is less common.
Case Description: One-year-old male exhibiting enteropathy, endocrinopathy, Fanconi syndrome-type proximal renal tubular acidosis, and recurrent infections. Given the suspicion of autoimmune multisystemic syndrome versus autoimmune polyendocrine syndrome, exome sequencing was conducted, revealing a pathogenic mutation in the FOXP3 gene (c.227 del; p.Leu76GlnfsTer53) associated with IPEX syndrome. Additionally, a variant of uncertain significance in the MRTFA gene (c.446C>T; p.Ser149Leu) was identified.
Our patient manifested an early presentation of IPEX syndrome, displaying two cardinal features along with recurrent infections and renal involvement in the form of proximal tubular acidosis-type autoimmune Fanconi syndrome. This was characterized by metabolic acidosis with a normal serum anion gap, positive urinary anion gap, hypokalemia, hypophosphatemia, glucosuria and proteinuria, requiring electrolyte replacement and Shohl's solution.
Conclusion: Autoimmune Fanconi syndrome secondary to IPEX syndrome is a rare manifestation, with our identified mutation implicated in the presented phenotype. This case highlights the presentation of Fanconi syndrome to debut in IPEX syndrome, in addition to the classically triad proposed in the literature.
Mapping the Landscape: A Bibliometric Analysis of Music Therapy Applications in Surgery (2009–2023)
Authors: xu xiaoping , Yang Xiaoping , Qiu Qingqun , Zhong Zhenglan , Yi Yong
Published: August 2024

Music therapy, leveraging the profound influence of music on human emotions and physiology, has gained attention for its potential applications in medical settings, particularly in surgery. This study aims to conduct a comprehensive bibliometric analysis of music therapy's application in surgery. Publications related to application of music therapy in surgery from 2009 to 2023 were searched in the Web of Science Core Collection (WoSCC) databases. Bibliometric analysis was conducted using VOSviewer, CiteSpace, Microsoft Excel, and online bibliometrics websites. This study included 479 publications, with a steady increase in annual publications since 2009, peaking in 2021. The USA had the highest number of publications (n = 152, 31.7%), followed by China (85, 17.7%) and Italy (48, 10%). Harvard University emerged as the top research institution, while the Journal of Perianesthesia Nursing was the primary publishing journal, and the Cochrane Database of Systematic Reviews was the highest co-cited journal. Cao Hua had the highest number of studies, and Nilsson U (n = 131) was identified as the most co-cited author. Keyword analysis revealed anxiety, therapy, music therapy, and pain as primary research trends in recent years. This bibliometric study provides a comprehensive summary of the existing research landscape, highlighting progress, challenges, and opportunities in integrating music therapy into surgical practice.
The Impact of Antioxidant-Ciprofloxacin Combinations on the Evolution of Antibiotic Resistance in Pseudomonas aeruginosa Biofilms
Authors: Higazy Doaa , Ahmed Marwa , Ciofu Oana
Published: August 2024

Antibiotic resistance in biofilms is a critical challenge driven by mechanisms such as increased oxidative stress, which could lead to enhanced mutagenesis. Experimental evolution studies have shown that biofilm growth fosters antimicrobial resistance and tolerance. The bactericidal antibiotic ciprofloxacin (CIP) exacerbates oxidative stress, enhancing reactive oxygen species (ROS) production and mutagenesis at sub-inhibitory concentrations. This study tests the hypothesis that antioxidants (AOs) such as N-acetyl-cysteine (NAC), and Edaravone (ED) could serve as anti-evolutionary drugs to prevent or reduce antimicrobial resistance in P. aeruginosa biofilms exposed to sub-inhibitory concentrations of ciprofloxacin (CIP), with Thiourea (THU) used as a control. In vitro experimental evolution studies using the monitor strain PAO1-mCherry-PCD-gfp + were conducted in flow cells and glass beads biofilm models. The harvested biofilm populations underwent population analysis and the flow-cell populations were also whole genome sequenced (WGS). The results showed that the CIP-AO combination of CIP-THU could reduce the fast increase of mutagenic resistance in both biofilm models. The confocal laser microscopy of flow cells biofilms showed a reduction in the percentage of nfxB mutants in biofilms treated with all the three CIP-AO combinations compared to the CIP treatment alone following 24h of treatment. The population analysis revealed a significant reduction of the subpopulations growing on 0.5 mg/L of CIP-supplemented plates in all the combined treatments of CIP-AO as compared to CIP populations. The WGS results showed CIP-specific mutants in the CIP-treated populations including nfxB and nalC mutations which were not observed in CIP-AO-treated ones. Flagellar gene mutations appeared in CIP-ED (fliG) and CIP-NAC (flhA) treatments. Additionally, wspA, which regulates biofilm formation, had a transversion mutation in CIP-ED and a deletion mutation in CIP-NAC. The minimum inhibitory concentrations (MICs) level for CIP-treated isolates was significantly higher than all isolates from CIP-AO treatments in both tested biofilm models of flow cells and glass beads. Overall, these findings suggest that the two clinical antioxidants may have a potential role in mitigating the development of antibiotic resistance in biofilms.
Risk prediction models for chemotherapy-related nausea and vomiting in patients with cancer: A systematic review and meta-analysis
Authors: LUO Mengna , Nie Shan , Yang Qiulan , Ouyang Xuping , Chen Linmin , Wu Liping , Li Jia , Fan Yuying
Published: August 2024

Background: The development of risk prediction models for chemotherapy-related nausea and vomiting (CINV) in cancer patients has been increasing, while the quality and applicability of these models in clinical practice and future research remain unknown.
Objective: To systematically review published studies on risk prediction models for CINV in patients with cancer.
Design: Systematic review and meta-analysis of observational studies and clinical trials.
Methods: We searched nine electronic databases, including SinoMed, PubMed, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), from inception to January 30, 2024. Data from selected studies were extracted, including study design, data source, sample size, predictors, model development, and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was used to assess the risk of bias and applicability.
Results: Twelve studies involving 2215 patients were included. The incidence of CINV in patients with cancer ranged from 17.7 % to 69 %. The most frequently used predictors were age and gender. The reported AUC ranged from 0.66 to 0.85. Twelve studies were found to have a high risk of bias, primarily due to inappropriate reporting of the analysis domain. The pooled AUC value of the six validated models was 0.73 (95 % confidence interval: 0.68–0.79), indicating a fair level of discrimination.
Conclusion: Although the included studies reported a certain level of discrimination in the prediction models of CINV in patients with cancer, all of them were found to have a high risk of bias according to the PROBAST checklist. Future studies should focus on developing new models with larger samples, rigorous study designs, and multicenter external validation.
Registration: The protocol for this study is registered with PROSPERO (registration number: CRD42024507899).
Age-specific patterns of enteropathogenic infections and co-infections among patients with different severity of acute diarrhea in China from 2009 to 2020
Authors: Wang Li-Ping , Li Ting-Ting , Xu Qiang , Liu Yan-Ning , Wang Guo-Lin , Lv Chen-Long , Li Hao , Li Zhong-Jie , Gao George F , Yang Wei-Zhong , Hong Feng , Hay Simon I , Fang Li-Qun , Liu Wei , Team Chinese Centers for Disease Control and Prevention Etiology
Published: August 2024

Background
Acute diarrhea contributes to a significant global burden of disease. However, the infection or co-infection patterns of enteropathogens, along with their age dependence and clinical effects, remain ambiguous.
Methods
A nationwide sentinel surveillance was conducted in all-age patients with acute diarrhea in China from 2009 to 2020. The clinical severity was assessed using a modified Vesikari score method, which categorized cases into moderate-to-severe diarrhea (MSD) or mild diarrhea. The association between clinical severity and age-specific patterns of enteropathogenic infections and co-infections was analyzed through a binary logistic regression model.
Results
A total of 195,988 individuals were enrolled and tested for 17 enteropathogens, among whom 27,358 (13.96%) patients developed MSD. In comparison to patients with mild diarrhea, MSD patients showed significantly higher rates of viral-bacterial co-infection in adults and older adults, as well as higher rates of viral-viral co-infection across almost all age groups except children aged < 6 months. The multivariate analyses revealed a significantly distinct pattern in the infections and co-infections of viral and bacterial enteropathogens associated with MSD between children and adults.
Conclusion
These findings highlight the age-specific patterns of enteropathogen infection among cases of MSD and mild diarrhea and underscore the necessity for age-related strategies in vaccine schedules, clinical diagnosis and treatment.
Impact of the COVID-19 lockdown period on hospital admissions for pediatric injuries: a French nationwide study
Authors: Recher Morgan , Fall Soxna F. K. , Lockhart-Bouron Marguerite , Lacan Laure , Theis Didier , Leteurtre Stéphane , Bruandet Amélie
Published: August 2024

PURPOSE
During the COVID-19 pandemic, lockdown posed a number of unprecedented problems. Injuries to children are a major public health concern. This study sought to determine the impact of France’s 2020 COVID-19 lockdown on hospital admissions for paediatric injuries.
METHODS
This study was a retrospective cohort analysis of data from the French national inpatient database. Children admitted to a French hospital for an injury from January to July 2020 and 2019 were included. The number of admissions for injuries between January and July in 2020 (the study period) vs. the same period (the control period) in 2019 were recorded. Hospital admission rate ratios (HRRs) comparing 2020 with 2019 were calculated for three periods: before lockdown (January 1st to March 15th ), during lockdown (March 16th to May 10th ), and after lockdown (May 11th to July 31st ]).
RESULTS
A total of 72089 children were admitted to hospital for injuries between January and July 2020 (mean (SD) age, 8.7 (5.8)), and 84961 between January and July 2019 (mean (SD) age, 9.2 (5.7)). 12864 children (18%) were admitted during the lockdown period in 2020, and 23098 (27%) during the equivalent period in 2019 (HRR, 0.56; 95% confidence interval (CI), 0.55–0.57; p < .001). During the 2020 lockdown, the risk of injury–related paediatric admissions with critical care lasting for at least 1 day was lower than in 2019 (HRR 0.67; 95%CI, 0.62–0.73; p < .001).
CONCLUSIONS
Further research could usefully examine how parents create a safe home environment for their children.
Integration of Interprofessional Simulation for Safeguarding Children and Families: A Mixed Methods Study
Authors: Menzies Jen , Meller Sophie , Robinson Elaine , Counihan Chris , Clark Emma , Ogle Justine , Dorward Margaret
Published: August 2024

Background
The study aims to evaluate the effectiveness of translational and transformational simulation experience in building student confidence around complex safeguarding decisions.
Methods
The research was framed within an exploratory sequential mix method design [1]. A survey before and after the safeguarding simulation using an author-developed questionnaire ad Likert scale were entered into SPSS (statistical software version 29) for quantitative analysis. Qualitative - student responses directly following the simulation using Mentimeter – a digital technology that collects anonymous comments in real-time and a professional independently facilitated discussion two weeks after the simulation.
Results
The quantitative results revealed a positive correlation between the experience of simulated interprofessional education and their confidence in understanding complex collaborative decision-making. Qualitative findings revealed four categories: (1) Confidence, (2) Information sharing, (3) Communication and (4) interprofessional working, derived from students' expressions of learning.
Conclusion
Interprofessional education (IPE) and simulation can produce a positive learning experience in theory and practice increasing student confidence significantly in complex collaborative decision-making. Understanding the complexities of different roles, alongside the value of information each brings, is imperative for safeguarding children and families.
Analysis of the Clinicopathologic Characteristics of Colorectal Cancer with TSC2 Mutation
Authors: Chen Jianjun , Zhang Guohui , Li Zhulin , Yang Yong , Wei Guanghui , Wang Zhenjun
Published: August 2024

Background: Colorectal cancer (CRC) is the third most prevalent cancer diagnosis and leading the third most cancer mortality worldwide. The TSC2 gene is recognized for its important role in regulating a multitude of biological processes, with some studies suggesting that it may function as a prognostic marker for many types of tumors.
Methods: In our study, we enrolled 102 CRC patients and conducted next-generation sequencing on their tumor tissues to assess mutations of gene. The mutation rate of the TSC2 gene was found to be 7.84%. We investigated the association between TSC2 mutations and the clinicopathological features among CRC patients.
Results: Mutations in TSC2 were significantly associated with low differentiation of tumor, microsatellite instability, and presence of nerve invasion. Bioinformatics analysis provided further insight, revealing that TSC2 in CRC patients is significantly linked to reduced overall and disease-free survival rates. Additionally, we selected 800 co-expressed genes of TSC2, and research gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. The results underscored TSC2 important regulatory function in numerous biological processes.
Conclusions:In conclusion, TSC2 appears to have a potential link to the progression of CRC. The analysis of TSC2 mutations could be used as a effective prognostic tool for patients with CRC, offering a new dimension in the clinical management and therapeutic strategies for this prevalent cancer.
Differentiating the movement of esports players who play different game genres
Authors: Dupuy Antoine , Campbell Mark J. , Toth Adam J.
Published: August 2024

Esports is a fast-growing worldwide phenomenon encompassing hundreds of millions of competitive players. It is well-established that different game genres require distinct cognitive skills, but the biomechanical implications of playing different game genres have received little attention. The purpose of this study was to investigate whether kinematic behaviour differs among players across game genres. 63 esports players played a First Person Shooter (FPS), Multiplayer Online Battle Arena (MOBA), or Adventure game for 10-minutes. Three tri-axial accelerometers, positioned on each participant’s right upper limb (hand, forearm, arm), recorded kinematic data during gameplay. Hand acceleration magnitude, direction change, distance travelled, and displacement area (size and shape) were calculated in addition to forearm, and arm acceleration ratios. There was a marked difference in movement patterns across players of different game genres. FPS players displayed greater hand acceleration, moved their hand through a greater distance, and over a larger displacement area compared to MOBA and Adventure players. MOBA players exhibited greater average hand acceleration, changed direction more and covered more distance compared to Adventure players within a smaller overall area. This is the first study to quantify gamers' kinematic behaviour across genres, demonstrating the importance of physical demands on performance and equipment in esports.
FLT3 inhibitors and hematopoietic cell transplantation prolong survival in patients with FLT3-ITD-positive AML
Authors: Matsukawa Toshihiro , Onozawa Masahiro , Kondo Takeshi , Kanaya Minoru , Hidaka Daisuke , Ota Shuichi , Mori Akio , Shigematsu Akio , Miyagishima Takuto , Kakinoki Yasutaka , Hashiguchi Junichi , Yamamoto Satoshi , Yamamoto Masayo , Wakasa Kentaro , Takahata Mutsumi , Ishihara Toshimichi , Haseyama Yoshihito , Fujimi Akihito , Igarashi Tetsuya , Sarashina Takehiro , Iyama Satoshi , Kobayashi Ryoji , Sakai Hajime , Fujimoto Katsuya , Inamura Junki , Kanisawa Yuji , Hirabayashi Shinsuke , Endo Tomoyuki , Hashimoto Daigo , Teshima Takanori
Published: August 2024

Acute myeloid leukemia (AML) is an aggressive hematological malignancy with genetic alterations. The FMS-like tyrosine kinase 3 (FLT3) gene is frequently mutated in adult de novo AML, with two types of mutations: internal tandem duplication (ITD) and point mutations in the tyrosine kinase domain. This study aimed to investigate the impact of FLT3 inhibitors and hematopoietic cell transplantation (HCT) on survival outcomes in patients with FLT3-ITD AML in a real-world setting. We retrospectively analyzed 139 patients with FLT3-ITD-positive AML between 2012 and 2021. The median age was 63 years. In the propensity score-matched cohort, FLT3 inhibitors improved overall survival (OS) compared with patients treated without FLT3 inhibitors (3-year OS: 33.7% vs. 25.8%, p = 0.021). Patients who underwent HCT had superior outcomes to those without HCT (3-year OS: 45.3% vs. 2.2%, p < 0.0001). The combination of FLT3 inhibitors and HCT resulted in the highest OS and relapse-free survival (RFS) rates (3-year OS: 62.4%; 3-year RFS: 67.2%). Disease status before transplantation did not predict the prognosis, but use of FLT3 inhibitors increased survival in patients without complete remission before HCT. These results demonstrate the clinical impact of FLT3 inhibitors on survival outcomes in patients with FLT3-ITD-positive AML, particularly when combined with HCT. FLT3 inhibitor can improve the prognosis of AML with FLT3 mutations, especially in patients who undergo HCT.
Machine learning constructs a model to predict systemic inflammatory response syndrome after percutaneous nephrolithotomy
Authors: Zhou Guiming , Yang Bin , Zhou Yuan , Zhang Rong , Liu Jianhe
Published: August 2024

Purpose: A prediction model for systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL) was created using a machine learning (ML) algorithm. The model's diagnostic prediction ability and clinical utility for SIRS were examined and analyzed in order to give clinicians a foundation for diagnosing and treating patients' conditions.
Methods: 444 individuals with upper urinary tract calculi who had PCNL were included in this study. Depending on whether SIRS developed after PCNL, the patients were divided into SIRIS and non-SIRS groups, 68 clinical variables were examined. 131 of the 444 patients experienced SIRS. The traditional binary logistic regression (LR) was utilized to create the prediction model after the clinical data from the two groups were compared to assess the risk variables, and the optimal ML algorithm was chosen to create the SIRS prediction model. The ML prediction models were assessed for the prediction model's performance by drawing the receiver operating characteristic curve (ROC) and calculating the area under the curve (AUC).
Results: 24 characteristics showed statistical significance in univariate analysis. By using multivariate analysis, 8 independent risk variables were found, including preoperative nitrite (OR=7.453, P<0.001), history of hypertension (OR=1.93, P=0.021), postoperative urinary white blood cells (OR=1.001, P<0.034), postoperative nitrite (OR=6.775, P<0.001), postoperative interleukin-6 (OR = 1.001, P = 0.028), postoperative C-reactive protein (OR=1.014, P= 0.027) and postoperative nephrostomy (OR=3.004, P<0.001). After determining eight independent risk variables, a binary LR prediction model was created, and its AUC was 0.827. The XGBoost has built a ML prediction model with an AUC of 0.941. The ML model's strong therapeutic advantages are confirmed by the decision analysis curve (DCA).
Conclusion: The ML predictive model is more credible and offers better therapeutic advantages than the traditional LR prediction model, with a higher AUC. In certain instances, ML predictive model might offer additional foundation for clinicians to make timely and precise decisions about the early detection and diagnosis of SIRS.
Exploring the effects of assembly strategies on differential gene expression – A case study in a non-model crustacean species, the wild black tiger prawn (Penaeus monodon)
Authors: Nguyen Minh Thanh , Tran Minh Nhut , Le Thi Hong Tham , Vo Thi Bao Chau , Nguyen Hoang Khue Tu , Tran Thi Hai Yen , Nguyen Thanh Luan , Elizur Abigail , Ventura Tomer , Nguyen Tuan Viet , Vo Thu Thi Minh
Published: August 2024

The Penaeus monodon genome became a subject for extended studies of several aspects of nutrition, growth, and reproduction. In this study, transcriptome from the hepatopancreas and ovary of wild-caught female broodstocks were generated by genome-guided (GG) and de novo (DN) assembly. We compared the effectiveness of these methods in terms of the number of transcripts and their annotations. We analyzed mapping features and differentially expressed genes (DEGs) using three estimation approaches: mapping reads against (i) a genome assembly of P. monodon (reference-based (RB)), transcriptome generated by (ii) GG, and (iii) DN assembly. DN had the highest percentage of mapping rates and annotated aligned reads, leading to 2.09 times more unigenes than GG assembly, with 49% of unigenes matching the blast search, compared to 39.66%. Furthermore, 69% of blasted unigenes from DN assembly were assigned GO terms in DN assembly, compared to 23.9% in GG. Additionally, DEGs identified of the two tissues by DN approach (820) surpassed the total number of DEGs identified by GG (488) and RB (117) approaches. In contrast, the GG approach identified the highest number of DEGs from our genes of interest (93.5%), followed by the DN (82.6%) and the RB (37.3%) approach. The DN assembly is ideal for transcript reconstruction and DEGs recovery, while the GG assembly generated an appropriate database for studying specific genes or sets of genes. We, therefore, recommend using a combination of DN and GG assemblies to improve differential gene expression analysis for non-model organisms with poorly resolved genome annotations.
Which curriculum components do medical students find most helpful for evaluating AI outputs?
Authors: Waldock William J. , Lam George , Baptista Ana V Madeira Teixeira , Walls Risheka , Sam Amir H.
Published: August 2024

Introduction
The risk and opportunity of Large Language Models (LLMs) in medical education both rest in their imitation of human communication. Future doctors working with generative artificial intelligence need to judge the value of any outputs from LLMs to safely direct the management of patients. We set out to evaluate our students’ ability to validate LLM responses to clinical vignettes, identify which prior learning they utilised to scrutinise the LLM answers, and whether they were aware of ‘clinical prompt engineering’.
Methods
A content analysis cohort study was conducted amongst 148 consenting final year medical students at Imperial College London. A survey asked students to evaluate answers provided by GPT 3.5 in response to ten clinical scenarios, five of which GPT 3.5 had answered incorrectly, and to identify which prior training enabled them to determine the accuracy of the GPT 3.5 output.
Results
The overall median student score in correctly judging the answers given by GPT 3.5 was 61%, with 65% demonstrating sound clinical reasoning for their decision. Students reported interactive case-based discussions and pathology teaching to be the most helpful for AI output evaluation. Only 5% were aware of ‘clinical prompt engineering’.
Conclusion
Artificial intelligence is a sociotechnical reality, and we need to validate the new pedagogical requirements for the next generation of doctors. Our data suggest that critical analysis taught by pathology clinical case teaching is currently the self-reported best training for medical students to evaluate the outputs of LLMs. This is significant for informing the design of medical training for future doctors graduating into AI-enhanced health services.
Examining mortality rates over the centuries: Employing a large family-tree analysis in the United States
Authors: Piane GinaMarie , Azubuike Precious Chidozie
Published: August 2024

Background
In an extended family case study approach, analysis of infant mortality, under-five mortality, maternal mortality, and life spans among ancestors have been calculated. This allows for comparisons across centuries and comparison of the health status of immigrant families and their counterparts remaining in Europe.
Methods
Data sources included oral histories verified by US and Italian census records, US immigration records, vital statistics, burial, and military records: n = 2000, sources = 4000 records. The family originated from a 500-acre village in Calabria, Italy.
Results
Infant mortality rates were highest among those born between 1860 and 1869. Ten maternal deaths were identified; 9 in the 1800s and one in the 1900s. Life span varied significantly between immigrants to North America and those who remained in Italy.
Conclusion
This historical research explores the hardship and poverty among immigrants in the United States and examines the parallel experiences of their family members in Italy. In addition, this research serves as a teaching tool in Epidemiology coursework.
Epcoritamab-Induced Fatal Pleural Effusion in Diffuse Large B-Cell Lymphoma: A Case Report and Literature Review
Authors: Takahata Atsushi , Shimada Tomohito , Bando Kana , Toyota Shigeo
Published: August 2024

Epcoritamab, a bispecific T-cell engager (BiTE) antibody targeting CD3 and CD20, has shown significant efficacy in treating refractory diffuse large B-cell lymphoma (DLBCL). However, its use can lead to severe side effects, such as tumor flare. Here, we report the case of an 84-year-old male with relapsed DLBCL who developed fatal unilateral pleural effusion following Epcoritamab treatment. Initially, the patient showed a favorable response, but later developed significant pleural effusion with elevated interleukin-6 (IL-6) levels, indicating a severe inflammatory response. This suggests that Epcoritamab directly affected the pleural lesions and caused a localized cytokine release syndrome (CRS). Despite aggressive management, including tocilizumab and corticosteroids, the patient's condition worsened, leading to his death. This case underscores the importance of regular lab tests and imaging follow-ups to monitor and manage severe inflammatory reactions based on tumor location. Comprehensive monitoring protocols are needed to mitigate risks associated with novel immunotherapies. To our knowledge, this is the first reported case of fatal unilateral pleural effusion in a patient with relapsed DLBCL following Epcoritamab treatment.
The effect of cardiac catheterization on thyroid functions in infants with congenital heart diseases: A prospective observational study
Authors: Elbaz Boshra , Elmarsafawy Hala , Laimon Wafaa Nabil
Published: August 2024

Background
This study aims to determine the incidence, clinical course and risk factors of hypothyroidism following cardiac catheter (CC) in infants with congenital heart diseases (CHD).
Subjects and Methods:
This prospective study involved 115 patients with CHD, all aged 3 years or younger, who underwent CC, as well as 100 healthy age- and sex-matched controls. Baseline thyroid function tests (TFTs) were conducted for both the patients and controls. In the CHD cohort, TFTs were reassessed 3 weeks after the CC, and for those with abnormal TFT values at this time, the tests were repeated 1week later. Levothyroxine was started in patients with persistent thyroid hypofunction at 3- and 4-weeks assessment following CC.
Results
Four weeks after CC, 12% of the studied group exhibited hypothyroidism. Univariate analysis identified significant predictors of hypothyroidism following CC: aortic stenosis (RR = 10.0 (1.49–66.99), P = 0.018), duration of fluoroscopy during CC (RR = 2.12 (0.99–4.26), P = 0.05), and total iodinated contrast media (iCM) during CC (RR = 2.5 (1.35–3.55), P = 0.019). Multivariate analysis indicated that iCM dose was the sole significant predictor of developing hypothyroidism (RR = 2.10 (1.01–3.23), P = 0.04). ROC curve analysis showed that the cut-off point of iCM dose for prediction of hypothyroidism evolution is 8.7 gm/kg (26.1 ml/kg), (sensitivity: 83%, specificity: 65%), while the cut-off point of fluoroscopy duration which predicts development of hypothyroidism is 24 minutes, (sensitivity: 83%, specificity: 66%).
Conclusion
Higher doses of iCM and longer duration of fluoroscope during CC are risk factors for evolution of hypothyroidism post-CC. We recommend assessing thyroid profile 4 weeks after CC, particularly in patients who received an iCM dose greater than 8.7 gm/kg and/or exposed to fluoroscopy for more than 24 minutes.
SARS-CoV-2 variants induce increased inflammatory gene expression but reduced interferon responses and heme synthesis as compared with wild type strains
Authors: Merchant Mariam , Ashraf Javaria , Masood Kiran Iqbal , Yameen Maliha , Hussain Rabia , Nasir Asghar , Hasan Zahra
Published: August 2024

SARS-CoV-2 variants of concern (VOC) have been associated with increased viral transmission and disease severity. We investigated the mechanisms of pathogenesis caused by variants using a host blood transcriptome profiling approach. We analysed transcriptional signatures of COVID-19 patients comparing those infected with wildtype (wt), alpha, delta or omicron strains seeking insights into infection in Asymptomatic cases. Comparison of transcriptional profiles of Symptomatic and Asymptomatic COVID-19 cases showed increased differentially regulated gene (DEGs) of inflammatory, apoptosis and blood coagulation pathways, with decreased T cell and Interferon stimulated genes (ISG) activation. Between SARS-CoV-2 strains, an increasing number of DEGs occurred in comparisons between wt and alpha (196), delta (1466) or, omicron (2313) infections. COVID-19 cases with alpha or, delta variants demonstrated suppression transcripts of innate immune pathways. EGR1 and CXCL8 were highly upregulated in those infected with VOC; heme biosynthetic pathway genes (ALAS2, HBB, HBG1, HBD9) and ISGs were downregulated. Delta and omicron infections upregulated ribosomal pathways, reflecting increased viral RNA translation. Asymptomatic COVID-19 cases infected with delta infections showed increased cytokines and ISGs expression. Overall, increased inflammation, with reduced host heme synthesis was associated with infections caused by VOC infections, with raised type I interferon in cases with less severe disease.
From Ruins to Recovery: Navigating Psychological Impacts of Turkey's 2023 Earthquakes
Authors: Çınaroğlu Metin , Yılmazer Eda , Alpugan Zeynep , Sayar Gökben Hızlı
Published: August 2024

The catastrophic earthquakes that struck Kahramanmaraş, Turkey in February 2023, registering magnitudes of 7.8 and 7.6, caused unprecedented destruction and significant psychological distress among the affected populations. This study engaged over 600 participants from 11 heavily impacted cities to assess the mental health repercussions of the earthquakes, focusing on post-traumatic stress disorder (PTSD), anxiety, depression, resilience, and overall well-being. The results revealed substantial psychological impacts, with 50.2% of the participants reporting a significant worsening of their economic situations, and notable symptoms of PTSD (mean score = 41.3), depression (mean score = 24.7), and anxiety (mean score = 22.4). Resilience scores (mean = 18.6) indicated a moderate capacity to recover from stress. Comparative analysis with other major earthquakes, such as the 2011 Tohoku earthquake in Japan and the 2010 Haiti earthquake, suggests similar patterns of mental health challenges, emphasizing the global and enduring nature of earthquake impacts on human psychology. This study's large scale and extensive participant base provide a robust data set for understanding the full spectrum of psychological responses following a major natural disaster. The study underscores the urgent need for integrated mental health services in disaster responses to support immediate and sustained recovery. The findings advocate for policy enhancements in disaster preparedness and mental health care, emphasizing culturally sensitive approaches tailored to the needs of disaster-affected communities.
Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Type 2 Diabetes: Risk of Heart Failure
Authors: Oh Rosa , Kim Gyuri , Lee Kyu-na , Cho So hyun , Kim Jiyoon , Med Seohyun Kim , Lee You-Bin , Jin Sang-Man , Hur Kyu Yeon , Han Kyungdo , Kim Jae Hyeon
Published: August 2024

BACKGROUND & AIMS
The association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is unclear. This study aimed to investigate the impact of MASLD on the risk of heart failure and cardiovascular (CV) mortality in patients with T2DM.
METHODS
In a nationwide cohort study, 2,745,689 adults with T2DM were followed from 2009–2012 until 2018. Participants were categorized into no steatotic liver disease (no SLD) and SLD groups. The SLD group was stratified based on metabolic risk factors, alcohol consumption, and other liver diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for heart failure (HF) and cardiovascular mortality risk.
RESULTS
The prevalence of MASLD, metabolic alcohol-associated liver disease (MetALD), MASLD with other co-existing liver diseases (Other), and alcohol-associated liver disease with metabolic dysfunction (ALD with MD) was 48.3%, 7.1%, 4.6%, and 2.2%. Individuals with MASLD (adjusted HR [aHR], 1.11), MetALD (aHR, 1.14), ALD with MD (aHR, 1.32) and Other (aHR, 1.23) had a higher risk of developing HF compared with the no SLD group. The risk of CV mortality was increased in those with MASLD, MetALD, ALD with MD and Other compared to those with no SLD. The risk of new-onset HF and cardiovascular mortality showed a J-shaped association with alcohol consumption regardless of SLD status.
CONCLUSION
SLD is independent risk factor of new-onset heart failure and cardiovascular mortality in persons with T2DM, and alcohol consumption has a J-shaped association with risk of HF and CV mortality, regardless of SLD status.
Prevalence of myopia and refractive parameters among children and adolescents in Hi-tech District of Chengdu City (2021-2023)
Authors: Wang Xiaoqin , Zeng Liuzhi , Xian Yiping , Mei Xin , Shan Qingqing , Li Wei-ye , Lv Lixia , Liu Yifeng , Zhang Rui , Song Kejian , Tian Xixi , Luo Honglin , Yang Ling , Zejun Chen , Luo Jun
Published: August 2024

Objective: To analyze the prevalence of myopia among children and adolescents in Chengdu from 2021 to 2023, providing insights for myopia prevention and control.
Methods: This study was a school-based cross-sectional study in children and adolescents aged 3–18 years in Hi-tech District of Chengdu City. All the students underwent comprehensive ocular measurement, including visual acuity (VA),spherical equivalent error (SER) with noncycloplegic autorefraction, axial length (AL) and corneal radius (CR) .
Results:Over the three-year study period from 2021 to 2023, the overall prevalence of myopia was 38.15%, with annual rates of 38.74% in 2021, 38.67% in 2022, and 37.4% in 2023. The prevalence of myopia and high myopia increased significantly with age (P < 0.001). In 2021, myopia prevalence was 37.4% among boys and 40.17% among girls; in 2022, 38.05% among boys and 39.43% among girls; and in 2023, 35.85% among boys and 38.33% among girls, consistently higher in girls each year (P < 0.001). Myopia prevalence increased with school level (P < 0.001). Mild myopia was the most common (24.47%), followed by moderate (10.77%) and severe myopia (2.91%). The SER varied, with mean values of -1.72 ± 1.57 D in 2021, -1.32 ± 1.51 D in 2022, and -1.42 ± 1.36 D in 2023 (P < 0.001), decreasing significantly with age (P < 0.001). Axial length (AL) was stable across most age groups, with total AL values of 23.80 ± 1.02 mm in 2021, 23.79 ± 1.04 mm in 2022, and 23.81 ± 1.04 mm in 2023.
Conclusion: Myopic prevalence among children and adolescents in Hi-tech District of Chengdu City was shown to be steadily decreasing from 2021 to 2023. The prevalence increased with age and school level, indicating a need for targeted interventions. Significant changes in spherical equivalent refraction and axial length underscore the importance of early intervention and regular monitoring to manage myopia effectively.
Effectiveness of Pulse Methylprednisolone in Patients with Non-Human Immunodeficiency Virus Pneumocystis Pneumonia: A Multicentre, Retrospective Registry-based Cohort Study
Authors: Morimoto Yasuhiro , Matsui Hiroki , Fujioka Haruka , Homma Yuya , Nagai Tatsuya , Otsuki Ayumu , Ito Hiroyuki , Ohmura Shin-ichiro , Miyamoto Toshiaki , Shichi Daisuke , Watari Tomohisa , Otsuka Yoshihito , Nakashima Kei
Published: August 2024

Background
A recent database study and meta-analysis reported that adjunctive glucocorticoid therapy reduces mortality in patients with non-human immunodeficiency virus-associated (non-HIV) Pneumocystis jirovecii pneumonia (PCP), having hypoxemia. However, the optimal glucocorticoid dose remains unclear. Our study aimed to evaluate the effectiveness of pulse methylprednisolone compared with mild-to-moderate steroid doses in patients with non-HIV PCP.
Methods
This multicentre retrospective cohort study included adults with non-HIV PCP receiving adjunctive steroids at three Japanese tertiary care hospitals from June 2006 to March 2021. Patients were categorised into pulse methylprednisolone and mild-to-moderate dose groups. Pulse methylprednisolone involved an initial intravenous infusion of 500–1000 mg methylprednisolone daily, while the mild-to-moderate dose was lower. Primary and secondary outcomes were 30-day and 180-day mortality rates from treatment initiation. Patient characteristics were adjusted using propensity score analysis with overlap weighting. Subgroup analysis focused on patients with respiratory failure.
Results
The study included 139 patients with non-HIV PCP: 55 in the pulse methylprednisolone group and 84 in the mild-to-moderate dose group. After adjusting for patient background, 30-day mortality (15.8% vs. 14.1%, P = 0.813) and 180-day mortality (33.7% vs. 25.3%, P = 0.367) did not differ significantly between groups. Subgroup analysis revealed no significant associations among patients with respiratory failure.
Conclusions
After adjusting for patient characteristics, no difference in prognosis was observed between pulse methylprednisolone and mild-to-moderate dose groups in patients with non-HIV PCP. A mild-to-moderate dose of adjunctive corticosteroid may suffice for treating non-HIV PCP.
Artificial dural regeneration matrix as a substitute for autologous tissue in indirect bypass in Moyamoya disease: Investigation of a rat model of chronic cerebral hypoperfusion
Authors: Kameno Koki , Kaku Yasuyuki , Ohmori Yuki , Takemoto Yushin , Uekawa Ken , Mukasa Akitake
Published: August 2024

Objective
Indirect bypass using autologous tissue is effective in Moyamoya disease, especially inpediatric patients. The aim of this study was to evaluate the effectiveness of indirect bypass using DuraGen, an absorbable artificial dura mater composed of collagen matrix, in place of autologous tissue in a rat model of chronic cerebral hypoperfusion.
Methods
Male Wistar rats were subjected to bilateral internal carotid artery occlusion and divided into three groups: control group without bypass surgery, group in which indirect bypass was performed using the temporalis muscle (encephalo-myo-synangiosis [EMS] group), and group in which DuraGen was used (Dura group). The ratio of the number of vascular endothelial cells, detected by antibodies to CD31 and glucose transporter type 1 (Glut-1), on the operative side to that on the non-operative side was measured and compared between the three groups.
Results
The ratio of CD31-positive cells was 1.50 ± 0.13 and 1.92 ± 0.29 in the EMS and Dura groups, and that of Glut-1-positive cells was 1.32 ± 0.1and 1.53 ± 0.18 in the EMS and Dura groups. No significant difference was observed in the ratio of vascular endothelial cells on the bypass side between the EMS and Dura groups.
Conclusion
Indirect bypass with DuraGen resulted in an increased ratio of vascular endothelial cells equivalent to that of indirect bypass with the temporalis muscle in a Rat model.This result indicated that in an actual indirect bypass for patients with MMD, the use of DuraGen may produce the same angiogenesis as using autologous tissue.