bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Artificial Intelligence Based Language Interpretation in Non-Urgent Paediatric Emergency Consultations: A Clinical Performance Test and Legal Evaluation
Authors: Brandenberger Julia , Stedman Ian , Stancati Noah , Sappleton Karen , Kanathasan Sarathy , Fayyaz Jabeen , Singh Devin
Published: August 2024

Objective: To evaluate the effectiveness of Google Translate (GT) in translating low-acuity paediatric emergency consultations involving respiratory symptoms and fever, and to examine legal and policy implications of using AI-based language interpretation in healthcare.
Methods: Based on the methodology used for conducting language performance testing routinely at the Interpreter Services Department of the [Hospital Name], clinical performance testing was completed using a paediatric emergency scenario (child with respiratory illness and fever) on five languages: Spanish, French, Urdu, Arabic, and Mandarin. The study focused on GT's translation accuracy and a legal and policy evaluation regarding AI-based interpretation in healthcare was conducted by legal scholars.
Results: GT demonstrated strong translation performance, with accuracy rates from 83.5% in Urdu to 95.4% in French. Challenges included dialect sensitivity and pronoun misinterpretations. Legal evaluation indicated inconsistent access to language interpretation services across healthcare jurisdictions and potential risks involving data privacy, consent, and malpractice when using AI-based translation tools.
Conclusions: Google Translate can effectively support communication in specific non-critical paediatric emergency scenarios. However, its use necessitates careful monitoring, understanding of its limitations, and attention to dialect and literal translation risks along with equity considerations. Establishing legal and policy frameworks for language interpretation in healthcare is crucial, alongside addressing funding and data security concerns, to optimize the use of AI-based translation tools in healthcare contexts.
Effect of Goal-Directed Perceptual-Motor Exercise on Children with Specific Learning Difficulties: A Randomized Controlled Trial
Authors: Punar Elif , Şevgin Ömer , Altunalan Turgay
Published: August 2024

Background
A comprehensive literature review has demonstrated that incorporating perceptual interventions into motor exercises is beneficial. Although there are several treatment strategies for SLD-diagnosed children, the potential role of goal-directed perceptual-motor exercises has not been studied. This study examined the effectiveness of goal-directed perceptual-motor training on attention, motor skills, and quality of life in children with Specific Learning Disorder (SLD).
Methods
This was a randomized clinical study with 38 children diagnosed with SLD between September 2021 and April 2022. The control group (n = 19) received a standard intervention protocol and the intervention group (n = 19) additionally received a perceptual-motor training program. Burdon Attention Test, the Bruininks-Oseretsky Test 2–Short Form (BOT2- SF), and the Pediatric Quality of Life Inventory (PEDSQL) were used as outcome measures.
Results
The intervention significantly improved attention, fine and gross motor skills, and life quality as evidenced by the within- and between-group comparisons at the end of therapy.
Conclusions
Goal-directed perceptual-motor physical training with cognitive aspects may enhance academic performance, social participation, and life quality for children with SLD by improving basic motor skills. Therefore, the inclusion of physical and task-specific perceptual-motor exercises in educational programs may offer several avenues for cognitive skill development in SLD children.
Trial Registration:
The protocol is registered with http://clinicaltrials.gov/ (16/August/2023, Clinical Trial, NCT05998083).
The association between skin allergy testing and oral squamous cell carcinoma in oral lichen planus: A retrospective cohort study
Authors: Sahni Vikram , Teames Charles , Seifert Rachel , Conley McGuire , deShazo Rosemary , Powell Douglas , Rhoads Jamie L. W. , Clarke Jennie T. , Hansen Christopher B. , Zone John J. , Hull Christopher M. , Hopkins Zachary H.
Published: August 2024

There is a reported association between oral contact allergy and oral lichen planus (OLP). Likewise oral squamous cell carcinoma (oSCC) is associated with OLP. However, risk factors for malignant transformation are unclear and it is not known if oral contact allergy impacts OLP disease severity or subsequent risk of oral squamous cell carcinoma (oSCC). In this study, we aimed to assess the association between allergy testing positivity and oSCC in OLP. We also assessed oSCC prevalence in OLP, allergen prevalence in OLP, and associations between allergy testing and OLP phenotype. To do this, we performed a retrospective cohort evaluation investigating the association between allergy testing positivity, clinical and demographic factors, and the odds of oSCC. Patients were seen at the University of Utah from 2015–2022. The rates of oSCC and allergy testing (patch + scratch testing) results were summarized descriptively and associations between oSCC, disease phenotypes, and allergy testing results were assessed using univariable and multivariable logistic regression. Patients were selected if they had a confirmed diagnosis of oral lichen planus as determined by a dermatologist or a dentist specializing in inflammatory oral disease. Allergy testing was performed by two specialized dermatologists. oSCC diagnosis was identified via chart review and were supported by histologic data. All data was collected via retrospective chart review. Among 587 OLP patients identified, 133 were allergy tested and 77.4% were positive. Of those with a positive allergy test, 10 (25.6%) developed oSCC compared with 2 (5.1%) of patients with a negative allergy test. There was insufficient evidence to support an association between allergy positivity and oSCC (OR = 1.55, 95% CI 0.76–3.15). Of the OLP disease characteristics tracked, only OLP involving the gingiva was associated with positive allergy testing (OR = 2.54,1.11–5.81). Likewise, a higher percent of symptomatic visits was the only clinical factor associated with oSCC (median 87.5% vs 66.7%, p = 0.03). These data suggest that allergy test positivity may not be associated with oSCC. However, it was associated with more pervasive symptomatology, suggesting a possible association with more severe or recalcitrant disease.
Time-series analysis of Leaf Area Index and Land Surface Temperature Association using Sentinel-2 and Landsat OLI data
Authors: Yasin Ali , Ali Abebe , Ahmed Nurhussen
Published: August 2024

Background: Understanding the complex relationship between vegetation dynamics and Land Surface Temperature (LST) is crucial for comprehending ecosystem functioning, climate change impacts, and sustainable land management. Hence, this study conducts a time-series analysis of Leaf Area Index (LAI) and LST derived from Sentinel-2 and Landsat Operational Land Imager (OLI) data. LAI data was generated using Sentinel-2 imagery processed with the SNAP toolbox, while Landsat OLI data was utilized for precise LST calculations. Mann-Kendall test was used to detect trends in the time series data.
Results: The trends of LAI were statistically significant at P-values of 0.05 and 0.1 for annual and seasonal trends, respectively. The mean LST trends were statistically insignificant throughout the study period except for the summer season at a P-value of 0.07. The correlation between LAI and LST was weak (R2 = 0.36) during crop-growing seasons, but moderate in winter (R2 = 0.46) and autumn (R2 = 0.41).
Conclusion: The findings of this research clarify the complex relationships between variations in surface temperature and vegetation growth patterns, providing insight into the environmental mechanisms driving the dynamics of localized ecosystems. The study underscores the implications of these findings for informed decision-making in sustainable land management, biodiversity conservation, and climate change mitigation strategies.
The Clinicopathological Features and Survival Prediction of Gastrointestinal Leiomyosarcoma: A SEER Based Analysis
Authors: Bao Yanan , Yang Xudong , Zhao Quanming , Li Wenliang
Published: August 2024

Background
There is still lacking knowledge and awareness of patients with gastrointestinal leiomyosarcomas (GILMS). This study aimed to clarify the disease features and prognosis of GILMS based on Surveillance, Epidemiology, and End Results (SEER) database.
Methods
Clinicopathological, treatment, survival, and prognostic data of GILMS from 2000–2020 were retrieved. Appropriate statistical approaches were used to evaluate the demographic features and survival outcomes.
Results
A total of 479 GILMS cases conformed the screening criterion. The median age of patients was 64 (15–90) years. Only 7.9% of these cases were diagnosed with lymph node metastasis. 78.1% of patients were diagnosed at T2 or higher primary tumor extension. The 5-year cancer specific survival (CSS) of patients undergone surgery was 66.5%, and 5-CSS for patients without surgery was 0. Multivariate Cox proportional hazards analysis based on both overall survival (OS) and CSS showed Female was significant independent protective factor. Significant independent risk factors included: age at 65–79 years, age ≥ 80, poor differentiation, T2 and higher T stage, distant metastasis, and without surgery. Both chemotherapy and radiotherapy performed no influence on survival and prognosis.
Conclusion
GILMS was commonly diagnosed in old patients with low rate of nodal and distant metastasis. Whereas most GILMS was presented with large tumor size and high extent of tumor invasion. Complete excision was demonstrated to be the unique way to prolong survival outcomes. Chemotherapy and radiotherapy can’t bring benefits on survival and prognosis highlighting the urgent need for exploration of effective systematic treatments.
A Data Science-based approach to Identify Social Determinants of Health Impacting Access to Pediatric Radiology
Authors: Gallo-Bernal Sebastian , Peña-Trujillo Valeria , Briggs Daniel , Machado-Rivas Fedel , Pianykh Oleg , Flores Efren J. , Gee Michael S.
Published: August 2024

Background
Research on healthcare disparities in pediatric radiology is limited, leading to the persistence of missed care opportunities (MCO).
Objective
Evaluate the social determinants of health and sociodemographic factors related to pediatric radiology MCO before, during, and after COVID-19 pandemic.
Materials and Methods
The study examined all outpatient pediatric radiology exams at a pediatric medical center and its affiliate centers from 03/08/19 to 06/07/21, to identify missed care opportunities. Logistic regression with LASSO and Classification and Regression Tree (CART) analysis were used to explore factors and visualize relationships between social determinants and missed care opportunities.
Results
A total of 62,009 orders were analyzed, 30,567 pre-pandemic, 3,205 pandemic, and 28,237 post-pandemic. Median age was 11.34 (IQR: 5.24–15.02), with 50.8% females. MCO increased during the pandemic (33.5%) compared to pre-pandemic (17.1%) and post-pandemic (16.5%). Logistic regression revealed higher odds of MCO in the pre-pandemic period for orders involving fluoroscopy (OR:1.675), MRI (OR:1.991), nuclear medicine studies (OR:1.505), and ultrasound (OR:1.211), along with patients residing outside the state (OR:1.658) and across all age groups compared to adolescents. During the pandemic, increased distance from the examination site (OR:1.1), residing outside the state (OR:1.571), Hispanic (OR:1.492), lower household income ($25,000–50,000 [OR:3.660] and $50,000–75,000 [OR:1.866]), orders for infants (OR:1.43), and fluoroscopy (OR:2.303) had higher odds. In the post-pandemic period, factors such as living outside the state (OR:1.189), orders for children (OR:0.787), and being Hispanic (OR:1.148) correlate with higher odds of MCO.
Conclusion
Applying basic data science-based techniques is a helpful approach to understanding complex relationships between sociodemographic characteristics and disparities.
Construction and validation a Nomogram for Predicting Cancer-Specific Survival for patients with Ependymoma: An Analysis of the Surveillance, Epidemiology, and End Results Database
Authors: Liu Zhizheng , Chen Kang , Yan Shizhen , Chen Yun , Tong Zhigao , Yang Xuanyong
Published: August 2024

Background
The purpose of this study was to Construct and validate a novel nomogram to predict cancer-specific survival (CSS) in patients with ependymoma.
Methods
Clinical data from the Surveillance, Epidemiology, and End Results database spanning 2000 to 2018 were used for the analysis. Data were randomly categorized into development and validation groups in a 7:3 ratio. Univariate and multivariate Cox regression analyses and LASSO regression were conducted to identify independent risk factors for CSS. Predictive models were evaluated using calibration plots, concordance index (C-index), and area under the receiver operating characteristic curve (AUC). Additionally, decision curve analysis and clinical impact curves were conducted.
Results
The final sample comprised 2,340 patients. Multivariate analysis identified race, age, histological type, surgery, and tumor site as independent predictors of CSS. A nomogram incorporating these risk factors was developed to predict CSS in patients with ependymomas. The calibration plot shows strong agreement between predicted and actual values. The C-index for the training cohort was 0.746 (95% CI: 0.715–0.777), and for the validation cohort, it was 0.743 (95% CI: 0.698–0.788). Additionally, both AUC and decision curve analysis analyses indicated robust performance and clinical significance benefits. Kaplan–Meier curves further demonstrated the nomogram’s strong ability to predict patient outcomes.
Conclusions
Our nomogram may be of great value in predicting the prognosis of patients with ependymoma. This predictive model will assist doctors and patients in devising effective clinical strategies.
Hyperuricemia and Elevated Uric Acid/Creatinine Ratio are Associated with a Higher Risk of Periodontitis: A Population- based Cross-Sectional Study
Authors: Chen Yueqi , Lu Peipei , Lin Chuyin , Li Song , Zhu Yufan , Tan Jiaying , Zhou Yinghong , Yu Ting
Published: August 2024

Objectives
To explore the relationship between hyperuricemia and the risk of developing periodontitis.
Materials and Methods
A representative dataset of 10,158 adults was extracted from the National Health and Nutrition Examination Survey (NHANES) 2009–2014. The relationship between hyperuricemia (the primary exposure) and the risk of periodontitis (outcome) were evaluated using weighted logistic regression models. Serum uric acid (UA) levels and the UA to creatinine (UA/Cr) ratio were used as secondary exposures. Their associations with the risk of periodontitis were analyzed using weighted logistic regression or restricted cubic spline regression.
Results
The prevalence of moderate/severe periodontitis was 56.7% among individuals with hyperuricemia and 44.8% among those without. After adjustment, individuals with hyperuricemia had a 26.9% higher risk of developing moderate/severe periodontitis compared to those without hyperuricemia (adjusted OR = 1.269, 95% CI = 1.080 to 1.492, P = 0.006). This increased risk could be explained by a linear relationship with the serum UA/Cr ratio and a U-shaped relationship with serum UA levels. Each unit increase in the serum UA/Cr ratio was associated with a 4.6% higher risk of developing moderate/severe periodontitis (adjusted OR = 1.046, 95% CI = 1.008 to 1.086, P = 0.021). Additionally, each 1 mg/dL increase in serum UA was associated with a 10.2% higher risk (adjusted OR = 1.102, 95% CI = 1.008 to 1.206, P = 0.035) of developing moderate/severe periodontitis when UA levels were greater than 5.5 mg/dL, but a 10.6% lower risk when UA levels were 5.5 mg/dL or lower (adjusted OR = 0.894, 95% CI = 0.800 to 0.998, P = 0.046). Sensitivity analyses validated the robustness of the findings.
Conclusions
This study provides the first direct evidence that hyperuricemia is associated with an increased risk of developing periodontitis, especially the moderate and severe forms.
Clinical Relevance
Individuals with hyperuricemia may represent a subgroup of the population susceptible to periodontitis. It may be prudent to initiate timely systemic and periodontal interventions in patients with hyperuricemia to halt the progression of periodontitis.
Minho Suture Assessment Scale – Development and Validation of a scale using Item Response Theory
Authors: Gonçalves Nuno , Sousa Rita , Collares Carlos , Pereira Vítor , Pêgo José Miguel , Anderson M Brownell
Published: August 2024

Purpose:
This study introduces and validates the Minho Suture Assessment Scale (Minho-SAS), a detailed instrument designed to evaluate fundamental suturing competencies among medical students. Through the application of Item Response Theory (IRT) and a dichotomous yes/no response format, the scale aims to offer a comprehensive yet specific assessment framework for suturing abilities.
Methods:
The development process involved collaboration with multidisciplinary surgical teams and experienced practitioners to ensure content validity. Validation methods incorporated IRT techniques, employing the Rasch model and the 2-PL model, to assess reliability, construct validity, and measurement precision. Data from a cohort of medical students were utilized for rigorous psychometric evaluation.
Results:
The Minho-SAS demonstrated strong internal consistency, reliability, and construct validity across both Rasch and 2-PL models. Item analyses revealed a nuanced understanding of individual item performance, highlighting varying levels of difficulty and discrimination among the 15 assessment components. The scale's focus on fundamental suturing skills was evident in its detailed evaluation, contrasting with broader assessment tools.
Conclusion:
The Minho-SAS emerged as a promising instrument specifically tailored for assessing fundamental suturing skills among medical students. Its rigorous validation through IRT methodologies underscored its precision and reliability, distinguishing it as a valuable addition to existing evaluation scales. While demonstrating considerable promise, further exploration across diverse populations and educational settings is crucial to affirm its broader applicability and impact in medical education and clinical practice.
Rapid detection of Impatiens necrotic spot virus from thrips vectors using reverse transcription-recombinase polymerase amplification
Authors: Zhang Shulu , Hladky Laura J. , Hasegawa Daniel K.
Published: August 2024

The plant virus, Impatiens necrotic spot virus (INSV), is an economically important pathogen of vegetables, fruits, and ornamental crops. INSV is vectored by the western flower thrips, Frankliniella occidentalis, a small insect pest that is globally distributed. In recent years, INSV outbreaks have reached epidemic levels in the Salinas Valley of California – an agriculturally rich region where most of the lettuce (Lactuca sativa) is produced in the United States. Due to the obligate nature in which virus transmission occurs, new tools that could rapidly detect INSV from thrips vectors would enhance our ability to predict where virus outbreaks may occur. Here, we report on the development of a reverse transcription-recombinase polymerase amplification (RT-RPA) assay that can detect INSV from individual thrips. The assay uses crude extraction methods, is performed at a single temperature of 42 °C, can be completed in 25 minutes, and provides sensitivity levels that are comparable to other available detection methods. When the assay was used on field populations of thrips, INSV was successfully identified and quantified from individual larvae and adults. The work provides a new cost-effective surveillance tool that can rapidly detect INSV from its insect vector and from plants.
Soil greenhouse gases emission and nitrogen dynamics under maize straw incorporation and contrasting nitrogen fertilization
Authors: Wang zhengyu , Wang Xuelian , Shang Jiaxin , Ye Rongqi , Li Xiangyu , Yang Yadong , Zhang Hongyu , Gong Xiangwei , Jiang Ying , Qi Hua
Published: August 2024

Background and aims Straw incorporation was widely accepted in the world for conservation agriculture, whereas the effects on greenhouse gases emissions (GHGs) and nitrogen dynamics under soils formed by long-term contrasting nitrogen (N) fertilizer are still unclear.Methodology An incubation experiment was conducted with or without maize straw using soils collected from fields study after 6-year contrasting N fertilization of 0 (low N), 187 (medium N) and 337 kg N ha− 1 (high N).Results Straw amendment significantly stimulated both N2O and CO2 fluxes, and increased cumulative emission by 0.82 and 18.98 times than without straw incorporation on average, respectively. Medium N soil observably weakened N2O emission (23.76 µg kg− 1) than high N soil (162.71 µg kg− 1) and attenuated CO2 emission (1.85 g kg− 1) than Low N soil (2.30 g kg− 1) soils with straw amendment. Soil NH4+-N and NO3−-N dynamics kept the increasing trend with rising soil N, whereas straw accelerated the decrease of NH4+-N from 24.72–78.98%, and reversed the tendency of NO3−-N from enrichment (+ 75.19%) to scarcity (-58.83%) compared to straw removal due to higher soil N fixation capacity. Moreover, partial least squares path modeling and random forest mean predictor importance disentangled straw affected GHGs by altering nitrogen turnover capacity.Conclusion Straw amendment promoted GHGs and enhanced mineral N turnover and diminished the risk of losses. Combing straw with medium N soil could mitigate greenhouse effect and improvement N and C balance in farming system compared to the low and high N soils.
GNSS2TWS_Slepian: A software to recover daily GNSS-inverted terrestrial water storage changes based on Slepian basis functions
Authors: Jiang Zhongshan , Tang Miao , Wen Haiping , Yuan Linguo
Published: August 2024

Changes in terrestrial water storage (TWS) can deform the Earth’s solid surface in the form of geodetically measurable vertical motions. Here, a new open-source Matlab software, named GNSS2TWS_Slepian, is developed to achieve the recovery of daily TWS changes from Global Navigation Satellite System (GNSS) crustal vertical positions. Differing from the widely-used spatial-domain inversion strategy based on Green's function method, our inversion modeling is implemented in the spectral domain based on Slepian basis functions, which aims to infer daily large-scale TWS changes using non-uniformly distributed GNSS vertical data. GNSS2TWS_Slepian is designed with different structured modules and the logic of the program workflow can be easily followed. To obtain daily estimates of TWS changes, the principal component analysis is integrated into our time-varying inversion model. To demonstrate the main functionalities, equivalent water height changes are investigated in the Western United States. This study aims to provide a scientific mathematical tool for resolving large-scale water mass loads, which is instrumental in broadening the applications of GNSS in hydrology.
The Impact of Sense of Loneliness on Geriatric Depression: The Mediating Role of Sense of Mattering and Psychological Adjustment
Authors: Aman Haya
Published: August 2024

Background
Depression is a highly prevalent mental disorder in older adults, and among its highest risk factors is loneliness. Although this relationship is commonly evident, the mechanisms underlying it, such as sense of mattering and psychological adjustment, lack exploration. The current research aims to examine the relationship between loneliness and geriatric depression and explore the mediating roles of sense of mattering and psychological adjustment.
Methods
A sample of 200 older adults (63.5% females; mean age = 75.6; SD = 8.806) was recruited from 24 geriatric homes in Cairo, Egypt. Participants responded to the Arabic versions of the Mini Mental State Examination for excluding the severely demented, Geriatric Depression Scale-15, University of California, Los Angeles Loneliness Scale-version 3, General Mattering Scale, and Brief Adjustment Scale-6. The mediation analysis was conducted using multiple linear regression with Hayes’ process macro on SPSS26 and structural equation modelling on JASP0.18.1.0
Results
Sense of mattering and psychological adjustment showed a significant total effect (β = .051, 95%CI [.045, .056], z = 18.436, p < .001) separated into a significant direct effect (β = .019, 95%CI [.009, .029], z = 3.784, p < .001) and a significant indirect effect (β = .031, 95%CI [.022, .041], z = 6.478, p < .001), indicating simultaneous partial mediation by the two variables. Additionally, sense of mattering accounts for 76% of the impact of loneliness on geriatric depression, and psychological adjustment accounts for 60.1%.
Conclusion
Loneliness significantly impacts geriatric depression through sense of mattering and psychological adjustment. These findings implicate substantial insight for interventions that can be targeted at the reduction of geriatric depression through reducing loneliness feelings and enhancing sense of mattering and adjustment.
The prognostic value of systemic immune-inflammation index in patients with unresectable hepatocellular carcinoma treated with immune-based therapy
Authors: He Tian , Xu Bin , Wang Lu-Na , Wang Zi-Yi , Shi Huan-Chen , Zhong Cheng-Jie , Zhu Xiao-Dong , Shen Ying-Hao , Zhou Jian , Fan Jia , Sun Hui-Chuan , Hu Bo , Huang Cheng
Published: August 2024

This study evaluates the Systemic Immune-Inflammation Index (SII) for predicting immune-based therapy response and prognosis in unresectable hepatocellular carcinoma (HCC) patients.A cohort of 268 HCC patients treated with immune-based therapy from January 2019 to March 2023 was studied. The training group of 93 patients received atezolizumab plus bevacizumab (T+A) treatment, while 175 patients in the validation group were treated with tyrosine kinase inhibitors (TKIs) and anti-PD-(L)1 therapy. SII’s cutoff point was determined using X-tile analysis based on overall survival (OS) in the training cohort. Prognostic factors were identified through univariate and multivariate logistic and Cox regression analyses, with survival outcomes compared using Kaplan-Meier methods. The predictive accuracy of SII was assessed using receiver operating characteristic (ROC) curves.
The optimal cutoff for SII was 752*109. Univariate and multivariate logistic regression indicated that SII was a strong predictor for the objective response rate (ORR). The ORR was significantly different between the low SII and high SII subgroups (34.72% vs. 9.52%, P = 0.019), similar results were validated in the validation group (34.09% vs. 16.28%, P = 0.026). SII also demonstrated prognostic significance in Cox regression and Kaplan-Meier analyses. ROC curves showed that the SII’s predictive function was superior among common clinical indicators, with relevance even in AFP-negative patients. Lower SII was associated with a higher T cell ratio, higher CD8+T cell and GranzymeB+CD8+T cell number in peripheral blood.
SII is a viable predictor of the efficacy and prognosis of various kinds of immune-based therapy in HCC patients, potentially serving aiding therapeutic decisions, thus increasing the likelihood of patients benefiting from immune-based therapy.
Accuracy of Contrast-Enhanced Ultrasound for Hepatocellular Carcinoma post Transcatheter Arterial Chemoembolization
Authors: McGillen Kathryn , Pryor III William , Yee Nelson , Zhu Junjia , Krok Karen , Waybill Peter
Published: August 2024

Purpose
This prospective pilot study was performed to evaluate non-inferiority between CEUS and the clinical gold standard of CECT/MRI in patients with HCC following TACE in a United States population using Lumason® contrast agent and Liver Reporting and Data System (LIRADS).
Methods
Following institutional review board protocols, adult patients with a first-time diagnosis of HCC were identified and consented for inclusion. Follow-up CT/MRI was directed by referring clinicians and CEUS was performed on the same day. CEUS evaluated for treated lesion(s), any new lesion(s), and portal vein thrombus before and after Lumason®. Any subsequent follow-up imaging was reviewed.
Results
In the 26 enrolled patients, 33 target lesions were identified, size ranging between 0.9 and 16.8 cm (mean 3 cm); 26 were LIRADS-5 or -M. CEUS identified 19 cases of residual tumor, 12 with no viable disease; while CT/MRI identified 17 cases of residual tumor, 16 with no viable disease (p = 0.617). Both CEUS and CT/MRI identified 5 portal vein thrombi, 2 lesions were missed or miscategorized on CEUS, while 6 were missed or miscategorized on CT/MRI (p = 0.289). Six new lesions were identified on both CEUS and CT/MRI ranging between 0.7 and 3.3 cm (mean 1.6 cm) on CEUS, and 0.7 and 2.8 cm (mean 1.7 cm) on CT/MRI. Of these new lesions, 4 were identified only on CT/MRI and 3 only by CEUS. Post-TACE, there was no significant difference in detecting residual tumor and no viable tumor between CEUS and CT/MRI (p = 0.617).
Conclusion
CEUS is non-inferior to CT/MRI performed at identical follow-up interval, in evaluating for residual versus treated HCC following first-time TACE. CEUS may represent an option for patients with contrast allergies or contraindications to MRI. CEUS can be used to examine small or isoechoic tumors after treatment.
Clinical significance of peri-appendiceal abscess and phlegmon in acute complicated appendicitis patients undergoing emergency appendectomy: A single-center retrospective study
Authors: Min Lingqiang , Lu Jing , He Hongyong
Published: August 2024

Background
This study aimed to analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon, identify factors influencing the postoperative length of hospital stay (LOS), and improve treatment strategies.
Methods
The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at the Department of Emergency Surgery, Zhongshan Hospital, Fudan University, from January 2016 to March 2023, were retrospectively analyzed.
Results
A total of 234 patients were included in our study. The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis (P < 0.001 and P = 0.015, respectively). Patients with symptoms lasting longer than 72 hours had a significantly longer postoperative LOS compared to those with symptoms lasting 72 hours or less (HR, 1.208; 95% CI, 1.107 to 1.319; P < 0.001). Additionally, patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon (HR, 1.217; 95% CI, 1.095 to 1.352; P < 0.001). The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess: those with abscesses smaller than 5.0 cm (n = 69) and those with abscesses 5.0 cm or larger (n = 82). Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm (P = 0.038).
Conclusion
The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis. Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.
Arthroscopic Transosseous Suture Bridge for Repairing Avulsion Fractures of the Tibial Insertion of the Anterior Cruciate Ligament：A Mini Tunnel Technique
Authors: Pu Jinsong , Zheng Lin , Jian Changchun
Published: August 2024

The study presents a novel arthroscopic transosseous suture bridge technique for repairing avulsion fractures of the tibial insertion of the anterior cruciate ligament (ACL), specifically tailored for adolescent patients. This minimally invasive surgical approach combines elements of both the transosseous tunneling and suture bridge techniques, aiming to reduce impact on the bone bed while ensuring stable fixation. Over a seven-year period, 39 patients with Meyers-Mckeever types II, III, and IV tibial avulsion fractures underwent this procedure. The surgery had an average duration of 52.7 minutes and resulted in decreased swelling and pain within two months postoperatively. All patients achieved full knee extension and over 120° of flexion. X-rays confirmed complete fracture healing within six to 12 months, and negative anterior drawer and Lachman tests indicated stable fixation. Significant improvements were seen in Lysholm and IKDC scores, reflecting enhanced knee function. This technique offers several advantages: it is effective, stable, minimally invasive to growth and development, and particularly suitable for adolescents due to the reduced impact on the bone bed and successful avoidance of epiphyseal plate injury.
Effects of Cardiac Surgery on Heart Rate Variability and Its Correlation with the Quality of Life
Authors: Lee Li-Chiu , Chang Huai-Jen , Hsieh Chih-Cheng , Kuo Terry B.J. , Chen Mei-Yin , Lin Hsin-Wei , Lo Po-Chun
Published: August 2024

Objectives
The purpose of this study is to explore the changes in HRV before and after cardiac surgery and the relationship between HRV and quality of life.
Methods
A total of 21 patients who received cardiac surgery were included in this study. All cases were conducted with a five-minute ECG uploaded by a Bluetooth signal three times. The ECGs were measured before the operation (1st), after the operation (2nd), and one month after the operation (3rd). The parameters of HRV included: standard deviation of normal to normal (SDNN), low frequency (LF), high frequency (HF), normalized low frequency (LF %), and LF/HF. In the third ECG measurement, the patients were also required to answer the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) in the concise Taiwanese version. The parameters of HRV were analyzed with Wilcoxon signed ranked test. The Spearman correlation test analyzed the correlations between the parameters of HRV and quality of life. Informed consent was obtained from all subjects and/or their legal guardian(s).
Results
Compared with the 1st ECG measurement, the SDNN, LF, and LF% decreased significantly in the 2nd ECG. There was a significant increase in SDNN in the 3rd ECG, but there was no significant difference compared with the 1st ECG. There was a significant positive correlation between HRV and the psychological category of quality of life.
Conclusions
Heart rate variability decreased after cardiac surgery, and the slight recovery of heart rate variability one month after surgery was mainly due to the recovery of sympathetic nerves. The psychological category of quality of life after surgery received the lowest score, which may be related to the incomplete recovery of parasympathetic nerve activity after surgery. The objective data of heart rate variability analysis can reflect the subjective psychological category of patients after heart surgery.
Determinants of Child Stunting in Ethiopia: A Longitudinal Analysis of Sociodemographic Factors and Regional Disparities
Authors: Haile Yilikal Tesfaye , Legisso Tesfahun Zewde
Published: August 2024

Stunting remains a critical issue affecting child health in Ethiopia, with significant implications for growth and development. Despite efforts to address stunting, understanding the determinants and trends over time is essential for effective interventions. The objective of this study is to examine the trends and determinants of child stunting in Ethiopia, focusing on sociodemographic factors and regional disparities. This longitudinal observational study utilized data from the Young Lives project covering the period from 2002 to 2016. An ordinal logistic regression model with generalized estimating equation (GEE) was used to analyse 7,680 observations from 1,536 children across Ethiopia. Variables included sociodemographic factors, access to resources, and parental education levels. Over the study period, there were notable improvements in child stunting rates, influenced by variables such as household wealth, maternal education, access to safe drinking water, and urban versus rural residence. Children in households with higher wealth and maternal education levels experienced lower rates of stunting. Regional disparities were evident, with a greater prevalence in Amhara and lower rates in Addis Ababa. The findings underscore the importance of targeted interventions to address socioeconomic disparities and improve resource access. Enhancing maternal education, ensuring access to safe water, and addressing regional disparities are critical to reducing child stunting rates in Ethiopia.
A Qualitative Study of Referral Practices of the Public Healthcare System in Bhopal District of Madhya Pradesh
Authors: M SUSHMA YADAV , Kumar Sanjeev , Dabar Deepti , Prasad Pankaj
Published: August 2024

Background- Referral system is backbone of any healthcare delivery system. Referral defined as the handover of patients from doctor to doctor or from one team to another has been identified as a high-risk area as patient valuable information can be lost or not quantified or recorded properly during the transit. Many referrals are regarded as unnecessary, meaning that the problem could be handled by the General Practitioner (GP). Improving the quality of the referral process is important to facilitate timely access to speciality care.
Objectives- To understand the perceptions, attitude, behaviour, challenges and facilitators of referral policy, practices and pattern from all the stake holders involved in the referral process, i.e., the health policy makers, healthcare providers and users from primary care to higher levels of health care facilities in the public health system of Bhopal district in Madhya Pradesh.
Materials and Methods- 24 in-depth interviews of the health policy or decision makers of the state, doctors, and administrators/ in-charges of the public health system in Bhopal by purposive sampling and exit interviews of a quota sampling of 63 patients were conducted. Thematic framework analysis was done manually and a conceptual framework for the referral system was generated.
Results- Five major themes conceptualised for the continuous process of the referral system were referral policy, roles and responsibilities, implementation, barriers and facilitators, monitoring, feedback and evaluation.
Conclusion- The implementation of the referral policy regarding the maintenance of the referral registers, issuing of referral slips, etc were not up to the required standards. There is a need for a uniform state referral policy and the establishment of a GP system to ensure continuity of care.
Molecular imaging of coronary plaque vulnerability using 18F- fluorocholine PET-MRI in patients with coronary artery disease: validation with optical coherence tomography
Authors: Pol Jochem A.J. van der , Rahel Braim , Cauteren Yvonne J.M. van , Moonen Rik P.M. , Meeder Joan G. , Gerretsen Suzanne C. , Aizaz Mueez , Prieto Claudia , Botnar René M. , Bucerius Jan , Langen Herman van , Wildberger Joachim E. , Holtackers Robert J. , Kooi M. Eline
Published: August 2024

Purpose
18F-fluorocholine is a positron emission tomography (PET) tracer earlier found to be a marker of macrophage content in carotid plaques. We aimed to assess the feasibility of 18F-choline PET-MRI to non-invasively localize vulnerable coronary plaques, using optical coherence tomography (OCT) as reference standard.
Methods
Patients with recent myocardial infarction who were scheduled for a secondary angiography of a non-culprit vessel, underwent 18F-fluorocholine coronary PET-MRI. Subsequently, OCT was performed during the secondary angiography. Maximum target-to-background (TBRmax) values of 18F-fluorocholine uptake were determined in two vessel sections that contained either vulnerable or stable plaques as defined by OCT. The OCT-based definition of a vulnerable plaque was a fibrous cap thickness <70µm. To enhance the detectability of coronary plaques using PET, three different motion-correction strategies were used: multigate respiratory gating motion correction (MRG-MOCO), extended MR-based motion correction (eMR-MOCO), and extended MR-based motion correction with ECG gating (eMR-MOCO-ECG).
Results
Fifteen patients were included in this study, of which eleven entered final analyses. Data of the other four subjects could only be partially analysed. TBRmax values were as follows for three different reconstructions in vulnerable versus stable plaques: MRG-MOCO: mean TBRmax 1.45 vs 1.35, p=0.52; eMR-MOCO mean TBRmax 1.47 vs 1.27, p= 0.26, eMR-MOCO-ECG: mean TBRmax 1.49 vs 1.26, p= 0.21.
Conclusion
18F-fluorocholine uptake in vulnerable atherosclerotic plaques in coronary arteries was not significantly different from uptake in stable plaques even though advanced motion-correction methods were applied. That may be caused by multiple factors, such as small coronary plaque size and remaining cardiac motion.
Prolonged Operative Time Significantly Impacts on the Incidence of Complications in Spinal Surgery
Authors: Monetta Annalisa , Griffoni Cristiana , Falzetti Luigi , Evangelisti Gisberto , Noli Luigi Emanuele , Tedesco Giuseppe , Cavallari Carlotta , Bandiera Stefano , Terzi Silvia , Ghermandi Riccardo , Girolami Marco , Pipola Valerio , Gasbarrini Alessandro , Brodano Giovanni Barbanti
Published: August 2024

Background
In spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient’s outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery.
Methods
We retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications.
Results
A total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 minutes. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events.
Conclusions
This study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient’s safety, without compromising the technical achievement of the procedure
Assessment of Peripheral Neuropathy Using Current Perception Threshold Measurement in Patients with Spinocerebellar Ataxia Type 3
Authors: Liu Xia-Hua , Lin Wei , Xu Hao-Ling , Cui Mao-Lin , Huang Zhuo-Ying , Li Ying , Zhang Nan-Nan , Wang Ning , Wang Zhi-Yong , Gan Shi-Rui
Published: August 2024

Background
Peripheral neuropathy (PN) identified as a significant contributor to disability in SCA3 patients.
Objectives
This study seeks to assess the utility of current perception threshold (CPT) measurements in evaluating PN in individuals with SCA3 and aims to identify factors influencing CPT values in SCA3 and ascertain whether these values correlate with the severity of ataxia.
Methods
Ninety-four patients diagnosed with SCA3 and 44 healthy controls were recruited for this investigation. All participants were performed standard CPT assessments. Comparative analysis was conducted on CPT variables between the groups. Multivariable linear regression models were employed to identify potential risk factors influencing CPT values, and to investigate the association between CPT values and the severity of ataxia in SCA3.
Results
The case group exhibited significantly higher values across all CPT variables compared to the control group (P < 0.01). Peripheral neuropathy was prevalent among SCA3 patients, with lower limb nerves demonstrating greater susceptibility than upper limb nerves. Increasing age at onset (AAO) (β = 17.652, P = 0.01) and heightened ataxia severity (β = 33.47, P = 0.011) as predictors of poorer CPT values. Gender also emerged as a predictor of CPT values. Furthermore, CPT values (β = 0, P = 0.011) and disease duration (β = 0.105, P = 0.000) were found to influence the severity of ataxia.
Conclusion
Our findings suggest that the CPT test holds promise for assessing peripheral neuropathy in SCA3 patients and that CPT values may serve as indicators of disease severity in this population.
Amino Acid Stable Carbon Isotopes in Nail Keratin Illuminate Breastfeeding and Weaning Practices of Mother – Infant Dyads
Authors: Salahuddin Hana , Waters-Rist Andrea L. , Longstaffe Fred J.
Published: August 2024

Compound-specific stable carbon isotope analysis of amino acids (CSIA-AA) is widely used in ecological studies to analyze food-webs and is gaining use in archaeology for investigating past diets. However, its use in reconstructing breastfeeding and weaning practices is not fully understood. This study evaluates the efficacy of stable carbon isotope analysis of amino acids in early life diet reconstruction by analyzing keratin from fingernail samples of three mother-infant pairs during late gestation and early postpartum periods. Our results show that stable carbon isotope ratios (δ13C) of glycine, and to a lesser extent glutamate, effectively trace the onset of exclusive breastfeeding and the end of weaning in infants. We propose that glycine’s ‘conditionally essential’ metabolic pathway during infancy allows it to reflect maternal glycine δ13C, indicating breastmilk consumption. Subtle changes in glutamate δ13C likely result from its ‘non-essential’ status. Additionally, δ13C values of glycine and glutamate indicate maternal physiological and pathological stress due to catabolic effects such as gluconeogenesis. These findings have significant implications for ecological and archaeological research using CSIA-AA for dietary reconstructions. They highlight the need to understand how metabolic pathways affecting δ13C of amino acids may change over an individual's lifespan or be altered due to various forms of stress.
Comprehensive screening of per- and polyfluoroalkyl substances in consumer products using pyrolysis GC-MS
Authors: YANAGISAWA Hiroyuki , OBAYASHI Kenichi , FURUTA Masataka , FUJIMAKI Shigehiko
Published: August 2024

This paper presents a screening method for diverse classes of per- and polyfluoroalkyl substances (PFAS) in consumer products using a Pyrolysis Gas Chromatography Mass Spectrometer (Py-GC-MS). During the pyrolysis process, polar functional groups (carboxylic or sulfonic) are thermally dissociated, allowing the non-polar perfluoroalkyl moieties to elute through the GC column. We successfully detected various classes of PFAS, from non-polymeric forms of different chain lengths to polymeric forms, within 30 minutes, achieving detection limits below 1/100 of the typical intentional use concentrations of PFAS in consumer products. Therefore, the screening method can detect even low levels of intentionally added PFAS within a comfortable margin.