bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of heavy metals concentration and health risk assessment in corn (Zea mays) agricultural field in the southwest of Iran
Authors: Gholami Zeinab , Ruzbahani Maryam Mohammadi , Payandeh Khoshnaz , Sabzalipour Sima
Published: November 2024

Corn is one of the most important grains in the human food basket, which is also widely cultivated in Iran. This research was conducted with the aim of evaluating the status of arsenic, lead and chromium contamination in corn (Zea mays) samples grown in Dezful and Behbahan cities from Khuzestan province. In this research, 5 farms were randomly selected in each city and from each field, 5 soil samples and 5 corn samples were prepared in the summer season. For the autumn season, the same sampling was done as in the summer season. Therefore, a total of 50 soil samples and 50 corn samples were collected from the two study areas of Dezful and Behbahan cities in 2022. The average concentration of Pb, As and Cr in corn samples was 1.84, 1.57 and 4.92 mg kg− 1 and in soil samples 11.91, 4.02 and 76.86 mg kg− 1 respectively. The concentration of As and Cr in the soil of the agricultural fields of Dezful was higher in the fall season and in the corn samples in the summer season. The amount of Pb in corn and soil samples of agricultural fields in Behbahan was higher in autumn than in Dezful. According to the non-carcinogenic risk index (THQ) and carcinogenic risk index (CR), metals can be dangerous for human health, but the non-carcinogenic hazard index (THQ) for Cr does not cause problems for adults and children.
Association of composite dietary antioxidant index with age of menopause and reproductive lifespan: A cross-sectional study of NHANES Data, 1999-2018
Authors: Zhao Xiaoxuan , Huang Zanche , Shi Nan , Lin Fangxuan , Zhang Qin
Published: November 2024

Objectives
Accumulated evidence has shown that the antioxidant diet exhibits protective effects on women’s reproductive health. The Composite Dietary Antioxidant Index (CDAI) serves as a crucial indicator for assessing antioxidant-rich diets. However, the relationship between CDAI and menopause age as well as reproductive lifespan remains undefined, thus motivating this cross-sectional study to investigate these connections.
Methods
This study analyzed post-menopausal women participating in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Information on age at menopause and reproductive lifespan was derived from questionnaire data. The CDAI was calculated based on the intake of selenium, zinc, carotenoid, Vitamin A, C and E. Multiple linear regression, smooth curve fitting, threshold effect analysis, and subgroup analysis were used to investigate the association between the CDAI and age at menopause as well as reproductive lifespan.
Results
A total of 4514 patients were enrolled in the study. After adjusting for confounding factors, the results revealed that individuals with a higher CDAI typically had a later age at menopause (β = 0.08, 95% CI = 0.03–0.13, P < 0.01) and longer reproductive lifespan (β = 0.06, 95% CI = 0.01–0.11, P = 0.01). And each standard deviation increase in CDAI was associated with a 4% decrease in early menopause risk (OR = 0.96, 95% CI = 0.94–0.99, P = 0.01). Besides, the use of oral contraceptives and female hormones could impact these relationships.
Conclusions
Our research highlighted a positive non-linear association between CDAI and age at menopause, as well as reproductive lifespan.
Targeted long-read sequencing enables higher diagnostic yield of ADPKD by accurate PKD1 genetic analysis in an assisted reproductive center
Authors: Gao Yuan , Sun Qian , Xu Peiwen , Mao Aiping , Huang Sexin , Li Jie , Chen Libao , Kan Haopeng , Li Jing , Huang Ju , Ji Wenkai , Si Dayong , Yan Junhao , Gao Xuan
Published: November 2024

Autosomal dominant polycystic kidney disease (ADPKD) is mainly caused by disease-causing variants in two large multi-exon genes of PKD1 and PKD2. Genetic diagnosis of ADPKD has been challenging due to the variant heterogeneity, presence of duplicated segments, and high GC content of exon 1 in PKD1. In our reproductive center, a total of 312 patients with ADPKD phenotype have been genetically tested using a next-generation sequencing (NGS) panel. Among all the cases, 40 patients were either genetically undiagnosed or diagnosed without single-nucleotide resolution. Therefore, a combination of long-rang PCR and long-read sequencing (LRS) approach for PKD1 and PKD2 was performed on these 40 ADPKD patients. LRS additionally identified 10 pathogenic or likely pathogenic PKD1 variants, including eight single-nucleotide variants (SNVs) and insertions/deletions (indels) and two large deletions. Among the eight SNV/indels, LRS identified four patients with microgene conversion (c.160_166dup, c.2180T>C, and c.8161+1G>A) between PKD1 and its pseudogenes, three patients with indels (c.-49_43del, c.2985+2_2985+4del, and c.10709_10760dup), and one patient with likely pathogenic deep intronic variant c.2908-107G>A. In addition, LRS identified nine PKD1 CNVs including eight large deletions and one duplication, and meanwhile LRS can precisely determine the breakpoints; while NGS had failed to identify two of these CNVs. In conclusion, target LRS enables higher diagnostic yield of ADPKD by accurate and precise PKD1 genetic analysis, which could provide significant benefits for genetic counseling and assisted reproductive treatments.
Prognostic difference between early breast cancer patients with HER2-low and HER2-zero status: A multicenter cohort study using propensity-score matched analysis
Authors: Chung Min Sung , CHA Chihwan , Kim Kyung Eun , Kim Jungbin , Um Eunhae , Choi Nayeon , Lee Jungsun , Gwak Geumhee , Kim Jae Il
Published: November 2024

Background
Since the approval of the trastuzumab deruxtecan for human epidermal growth factor receptor 2 (HER2)-low breast cancer, evidence suggests that low-HER2 expression may affect prognosis; however, it remains unclear how HER2-low subtype affects outcomes. Thus, this study aimed to investigate the differences in prognosis between patients with HER2-low and HER2-zero status.
Methods
This retrospective cohort study conducted at multi-institution included 1,627 patients diagnosed with HER2-low or HER2-zero breast cancer (stages I–III). For comparing outcomes between two groups, the survival analysis after propensity score matching was used. Survival outcomes including distant recurrence-free survival, and overall survival were evaluated using the Kaplan–Meier analyses.
Results
After propensity score matching, 445 patients with HER2-low and 707 patients with HER2-zero status were included. Among them, 914 (79.3%) and 238 (20.7%) patients had hormone receptor-positive and -negative disease. Median follow-up was 92.7 months. Locoregional recurrence-free survival and distant recurrence-free survival were comparable between patients with HER2-low and HER2-zero status (p = 0.872, p = 0.746, respectively). HER2-low status did not affect overall survival. However, in a subgroup with lymph node metastases, patients with HER2-low status showed better recurrence-free survival compared with that of patients with HER2-zero status (p = 0.033).
Conclusions
In this study, survival outcomes were comparable between patients with HER2-low and HER2-zero breast cancer. Additionally, patients with HER2-low status showed better survival outcomes compared with those with HER2-zero in the subgroup with lymph node metastasis. Further studies are needed to examine the biological mechanism underlying these prognostic differences.
Partial sternotomy as an alternative surgical approach for atrioventricular valves and interatrial septal diseases
Authors: Coutinho Henrique , Bittencourt Gabriel , Kikiuta Gustavo , Jazbik Pedro Ricardo , Sant'Anna Zely , Brasil Bernardo , Coutinho Joaquim Henrique Souza Aguiar , Saito Eduardo Haruo , Nunes Rodolfo Acatauassú
Published: November 2024

Introduction: Since its inception, cardiovascular surgery has posed numerous technical challenges for surgeons. In a continuous quest for enhancement, cardiovascular surgeons have sought to reduce surgical trauma through the refinement of minimally invasive techniques. Therefore, this study aims to introduce a novel approach among partial sternotomies, preserving both the manubrium and the xiphoid process. Our objective was to evaluate the feasibility of this surgical technique, the stability of the sternum bone in the postoperative period, the incidence of surgical wound infection, and the potential for patients to resume their regular activities within a 21-day timeframe.
Methods: This prospective, single-center, single-arm study was conducted to assess the safety of a surgical approach involving partial sternotomy for atrioventricular valve pathologies and septal defects. A total of 20 patients were evaluated and presented with the following: mitral insufficiency (n=8, 40%); mitral stenosis (n=5, 25%); ostium secundum-type interatrial communication (n=3, 15%); sinus venosus interatrial communication–superior vena cava (n=2, 10%); and myxoma (n=2, 10%). Patients underwent one of the following procedures: mitral valve replacement (n=13, 65%), atrial septal defect repair (n=5, 25%) or atrial myxoma resection (n=2, 10%).
Results: Three (15%) patients required conversion to full median sternotomy, and there were no cases of surgical wound infection. The mean length of stay was 5.4 days.
Conclusion: The results of this study revealed a technically feasible procedure, with no significant increase in surgical duration, and excellent outcomes regarding the absence of surgical site infection, sternal stability, and aesthetic considerations. Most patients resumed their usual activities within the proposed time. However, further extensive case studies and comparative analyses are needed to validate these outcomes in comparison with those of conventional sternotomy procedures.
DEPTH2 score was associated with cell proliferation and immune cell infiltrations but not with systemic treatment response in breast cancer
Authors: Chida Kohei , Wu Rongrong , Roy Arya Mariam , Ishikawa Takashi , Hakamada Kenichi , Takabe Kazuaki
Published: November 2024

Intratumoral genomic heterogeneity (ITGH), the existence of genotypic and phenotypic variation within an individual tumor, is known to be a key mechanism in treatment resistance. Deviating gene Expression Profiling Tumor Heterogeneity 2 (DEPTH2) algorithm was developed to estimate ITGH using solely RNA expression data unlike the others that require both DNA- and RNA-expression data. Total of 6,500 breast cancer patients from multiple independent cohorts were analyzed using DEPTH2. High DEPTH2 score patients were associated with worse overall survival consistently across all subtypes in METABRIC, but not in TCGA and SCAN-B cohort. Higher DEPTH2 score was linked to increased cell proliferation, as evidenced by elevated Nottingham histological grades and Ki67 gene expression, as well as enrichment of the cell proliferation-related gene sets, and immune cell infiltrations. DEPTH2 score was significantly higher in triple negative breast cancer among the subtypes but did not reflect with lymph node and distal metastasis. DEPTH2 scores decreased in two but showed no change in another two cohorts after neoadjuvant chemotherapy (NAC). DEPTH2 score was not associated with pathologic complete response after NAC in any subtypes across 3 cohorts. DEPTH2 score may not capture the entire biological aspects of ITGH in breast cancer patients.
The male sling implantation for urinary incontinence after prostate surgery: a real world multi-center study in China
Authors: Wang Lei , Chen Yin , Sun Weihao , Ren Guanyu , Piao Shuguang , Pan Tiejun , Liao Limin , Liu Zhiyong
Published: November 2024

Purpose
Urinary incontinence after prostate treatment (IPT) is a distressing phenomenon. The aim of this real-world study was to evaluate the efficacy of the male sling in treating IPT in China.
Methods
A total of 66 patients (83.8% with moderate and severe urinary incontinence) with IPT underwent male sling implantation in four medical centers. Incontinence was assessed using pad weight, pad usage per day (PPD), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Surgical efficacy, surgical modalities, BMI and complications were evaluated.
Results
Median follow-up was 23 months. Of 66 patients with transobturator (2-arm) and transobturator and anterior pubic (4-arm), 16 (24.2%) were cured, 40 (60.6%) improved and 10 (15.1%) failed according to PPD. In terms of 24-h pad weights, 16 (24.2%) and 24 (36.3%) achieved continence (dry pad) or mild incontinence (< 100 mL/day); 22 (33.3%) and 4 (6%) were still with moderate (100–400 mL/day) or severe (> 400 mL/day) incontinence. 4 (100.0%) patients preoperatively with mild incontinence were not cured ,but all improved in terms of PPD; Of 39 patients preoperatively with moderate incontinence, 9 (23.1%) were cured, 24 (61.5%) improved and 6 (35.8%) failed; Of 23 patients preoperatively with severe incontinence, 7 (30.4%) were cured, 12 (52.1%) improved and 4 (17.4%) failed. The improvement rate for patients with three different level incontinence were 100%, 84.6% and 82.6% respectively. There was no significant correlation between the degree of recovery and BMI. Common postoperative complications include pain, incision infection, foreign body sensation and urinary retention or dysuria.
Conclusion
The majority of patients receiving male urethral sling implantation are moderate and severe patients .Real-world studies show that male urethral suspension is more often used to treat male urinary incontinence than AUS in China, medical insurance policies and economic costs are important influencing factors. The utilization of this intervention has yielded a considerable rate of amelioration for IPT. It must also be admitted comparative analysis indicates that male slings confer a superior overall prognostic improvement for patients presenting with mild urinary incontinence relative to those with moderate and severe manifestations of the condition, especially for severe urinary incontinence has improved, but a large proportion of patients still have symptoms.
Anterior-plane Retroperitoneoscopic Resection of Adrenal Tumor: a Clinical Study Based on Propensity Score with Inverse Probability of Treatment Weighting
Authors: Hu Deng , Li Xiang , Wang Yaodong , He Kai , Jiang Shichun , Wang Decai
Published: November 2024

To investigate the clinical efficacy, safety and economy of anterior-plane retroperitoneoscopic c adrenalectomy in treating ≤ 5cm benign adrenal tumors.From January 2019 to August 2023,276 patients undergoing anterior-plane or three-plane retroperitoneoscopic resection of adrenal tumors were retrospectively analyzed. Propensity score with inverse probability of treatment weighting (PS-IPTW) was used to adjust the balance of baseline characteristics and linear regression was conducted to compare the weighted outcomes between the two groups.After PS-IPTW, standardized mean difference (SMD) of the baseline data less than 0.1. In anterior-plane group, operation time decreased by 39.16 minutes (P < 0.05), intraoperative blood loss decreased by 12.18 ml (P < 0.05), postoperative gastrointestinal function recovery time accelerated by 6.24 hours (P < 0.05), postoperative 24-hour blood drainage decreased by 18.06 ml (P < 0.05), postoperative extubation time shortened by 15.99 hours (P < 0.05), postoperative length of hospital stay shortened by 0.77 days (P < 0.05), and total hospitalization costs reduced by 2,379.30 Chines yuan (P < 0.05).Anterior-plane retroperitoneoscopic adrenalectomy is effective, safe, and economy in treating ≤ 5cm benign adrenal tumors.Therefore, this method is expected to promote enhanced recovery after surgery (ERAS) program for urological tumors. Specifically, obese people may benefit more from this surgical approach.
Nutrient Profiles of Enteral Feeds in Two Selected Hospitals in Accra, Ghana.
Authors: Adom Rosa , Mensah Daniel , Nortey Eunice , Asante Matilda , Boateng Laurene
Published: November 2024

Background
Hospital-prepared enteral feeds have demonstrated significant benefits for critically ill patients, primarily by maintaining gut integrity, reducing stress, and supporting immunity. These feeds are often preferred over commercial formulas due to their cost-effectiveness and patient tolerability. However, despite these advantages, hospital-prepared enteral feeds can exhibit inconsistent energy and nutrient values, which may impact their effectiveness. In Africa, and specifically in Ghana, there is a notable gap in documented research regarding the nutrient profiles of these feeds. This lack of data makes it challenging to standardize and optimize enteral nutrition practices across hospitals. Recognizing this gap, our study aims to assess the nutrient profiles of hospital-prepared enteral feeds in two selected hospitals in Accra
Methods
Twenty-one (21) dietitians and six (6) diet cooks were interviewed. Three (3) hospital-prepared enteral feed samples were collected from the two hospitals on three different days and their energy and nutrient values were analysed. The recipes used in the preparation of the feeds were collected through interviews with diet cooks. Energy and nutrient values obtained from chemical analyses of hospital-prepared enteral feeds, were compared to a commercial formula using one sample t-test.
Results
Most dietitians in both hospitals (90% in Hospital A and 73% in Hospital B) utilized hospital-prepared enteral feeds, such as fortified porridges and soups. However, the energy and nutrient values of these feeds were significantly lower compared to a commercial formula (Ensure original). When enteral feeds from the 2 hospitals were compared, statistically significant differences were found for all nutrients except energy, carbohydrate, vitamin C, and sodium.
Conclusions
The study highlighted differences in the nutritional profiles of hospital-prepared enteral feeds between the 2 hospitals, and significantly lower energy and nutrient content compared to a commercial formula, Ensure Original. Low energy and nutrient content in hospital-prepared feeds could lead to suboptimal patient outcomes, including slower recovery times and increased susceptibility to infections. Further research is needed to explore ways to improve the nutrient profiles of hospital-prepared feeds and develop enteral feeding protocols in hospitals in Ghana.
BMI, Waist Circumference, and Waist-to-hip Trajectories and All-cause, CVD, and Cancer Mortality by Sex in Nondiabetic People
Authors: Alman Amy , Xing Zailing , Schocken Douglas , Zgibor Janice
Published: November 2024

Objective: We examined the associations of BMI, waist circumference, and waist-to-hip ratio trajectories with mortality in non-diabetic people.
Methods:We analyzed 7 601 nondiabetic people from the Atherosclerosis Risk in Communities Study. We used latent class analysis to identify trajectory patterns for BMI, waist circumference, and waist-to-hip. We employed propensity score matching to enhance the balance of covariates and used Cox proportional hazards regression models to examine the associations.
Results: In females, the high trajectory of BMI was associated with higher cancer mortality risks than the low group, with HRs and 95% CIs of 1.76(1.14-2.73). The high waist circumference trajectory was related to increased all-cause, CVD, and cancer mortality risks in males. The moderate and high waist-to-hip ratio trajectories were associated with elevated all-cause and CVD mortality risks in females, and the high trajectory was associated with high all-cause mortality risks in males. The mean lifespan of deceased females did not significantly differ across the trajectories. However, the mean lifespan of males in the waist circumference high group (73.0 years) was shorter than the low group (75.3 years).
Conclusion: Sex differences were observed in the long-term impact of high BMI, waist circumference, and waist-to-hip ratio on mortality risks and lifespan in non-diabetic people.
Comparison of the sustainability of the impact of team-based versus individual clinician-focused training of primary care professionals in serious illness conversations on caregiver burden of care: a secondary analysis of a cluster randomized trial
Authors: Lokossou Kouessiba Lorielle , Assan Odilon Quentin , Gadio Souleymane , Uwizeye Claude-Bernard , Dofara Georgina Suelene , Bouba Dalil Asmaou , Guay-Bélanger Sabrina , Michaels LeAnn , Archambault Patrick , Paquette Jean-Sébastien , Izumi Seiko , Totten Annette , Rivest Louis-Paul , Légaré France
Published: November 2024

Background: Training health professionals in serious illness conversations is important for patients with serious illnesses and for their caregivers. However, most training focuses on individual clinicians rather than on healthcare teams. We aimed to compare the sustainability of the impact of a team-based training program in serious illness conversations with that of an individual clinician-focused training program on the burden of care of caregivers of patients with serious illnesses.
Methods:We performed a secondary analysis of caregivers’ data from a preliminary cluster randomized trial in the USA and Canada in which 42 primary care clinics were randomized to an interprofessional team-based training arm (intervention) or an individual clinician-focused training arm (control). Seriously ill patients who had had a serious illness conversation with the trained clinicians were asked to refer a caregiver. We used the Zarit Burden Interview (range: 0-48) to assess caregiver burden immediately after the serious illness conversation (T1), six months later (T2) and 12 months later (T3). Statistical analysis using a linear mixed model were performed to compare caregiver burden between the two arms at the three times.
Results: We included 192 caregivers from 42 primary care clinics. Most were female (67.8%); aged 65-74 (28.6%). The mean caregiver burden scores were low, and similar in both the arms at the three times. The difference in mean burden between the two study arms was 1.05 (95% CI -1.47 to 3.59; p=0.40), -0.24 (95% CI -2.57 to 2.08; p=0.82), and 0.09 (95% CI -2.61 to 2.81; p=0.94) at T1, T2 and T3 respectively. The p-value of the interaction term between study arm and time was p=0.47. Mean difference between arms after performing a model with time effect and after adjusting was 0.90 (95% CI -0.76 to 2.57; p=0.28). Various other factors such as caregivers feeling anxious or depressedwere associated with caregiver burden.
Conclusion:Analysis showed that there was no difference between perceived caregiver burden after the interprofessional team-based training approach and after the individual clinician-focused training approach. Our study did however underline the importance of recognizing other factors influencing caregiver well-being.
Trial registration: ClinicalTrials.gov (ID: NCT03577002).
Circulating Tumor DNA Determinants of Response and Outcome in Relapsed/Refractory Mantle Cell Lymphoma
Authors: Meriranta Leo , Jørgensen Rasmus , Pasanen Annika , Kolstad Arne , Hutchings Martin , Niemann Carsten , El_Galaly Tarec , Riise Jon , Haaber Jacob , Sonnevi Kristina , Pedersen Lone Bredo , Wader Karin , Glimelius Ingrid , Leppä Sirpa , Jerkeman Mats
Published: November 2024

Clinical tools to guide treatment decisions in relapsed and refractory mantle cell lymphoma (R/R MCL) are limited, and the translational potential of circulating tumor DNA (ctDNA) has remained largely undemonstrated. We designed and applied panel-based duplex sequencing to uncover molecular determinants of response and outcome in the ctDNA of R/R MCL patients treated with venetoclax, lenalidomide, and rituximab (Ven-R2). Genetic analysis revealed molecular predictors of response and outcome that were independent of clinical prognostic factors with SMARCA4-mutated R/R MCLs responding to therapy whereas TP53 mutations conferred resistance. Pretreatment ctDNA captured spatial heterogeneity and its concentration associated with clinicopathological disease features and survival independently of molecular predictors. Dynamic ctDNA assessment for minimal residual disease complemented clinical response evaluation and uncovered refractoriness in select patients with molecular remission according to contemporary real-time quantitative PCR assay. Features of clonal hematopoiesis (CH) at baseline were associated with hematological toxicity during treatment and poor outcome. Positive selection of TP53-related CH during treatment did not compromise specificity of ctDNA response analysis, and fragmentation signatures allowed discrimination of MCL ctDNA and CH. Taken together, we report novel features in the MCL ctDNA that unlock new minimally invasive tools to potentially transform clinical decision-making in R/R MCL.
Multi-component and multi-phase field modelling of solidification microstructural evolution in Inconel 625 alloy during laser powder bed fusion additive manufacturing
Authors: Maji Soma , Amirthalingam Murugaiyan
Published: November 2024

Inconel 625 alloy, known for exceptional mechanical properties and corrosion resistance, is widely used in aerospace, power generation, and marine applications. Laser powder bed fusion (LPBF) excels in manufacturing complex geometries with good surface finish. However, LPBF printed microstructure is highly heterogeneous due to the rapid and complex thermal cycles, necessitating careful parameter selection to prevent the stabilisation of detrimental phases. Experimental parametric optimization of LPBF is challenging due to the cost, and complex inter-playing process variables. Therefore, mathematical modelling is advantageous for optimizing LPBF parameters. \\A 3D-heat source model was developed using finite-element-method (FEM) to analyse thermal cycles with bed-preheating and varying laser parameters in LPBF of IN625. The model focused on a simplified thermal cycle method, where all elements in a layer were set to melt at once to reduce the computational time. A multi-phase-field method (MPFM) was developed to simulate the microstructural evolution as a function of FEM-generated thermal boundary conditions. The morphological and elemental segregation behaviour of evolving microstructure was simulated. Numerical and experimental analyses of primary dendritic arm spacing (PDAS) and elemental segregation agreed well with the experiments. Optimal LPBF conditions were identified for defect-free printing of IN625 parts from this work.
Integrating AI in Clinical Education: Evaluating General Practice Residents’ Proficiency in Distinguishing AI-Generated Hallucinations and Its Impacting Factors
Authors: Zhou Jiacheng , Zhang Jintao , Wan Rongrong , Cui Xiaochuan , Liu Qiyu , Guo Hua , Shi Xiaofen , Fu Bingbing , Meng Jia , Yue Bo , Zhang Yunyun , Zhang Zhiyong
Published: November 2024

OBJECTIVE To evaluate the ability of general practice residents to detect AI-generated hallucinations and assess the influencing factors.METHODS This multi-center study involved 142 general practice residents, all of whom were undergoing standardized general practice training and volunteered to participate. The study evaluated AI’s accuracy and consistency, along with the residents’ response time, accuracy, sensitivity(d’), and standard tendencies (β). Binary regression analysis was used to explore factors affecting the residents' ability to identify AI-generated errors.RESULTS 137 participants ultimately included had an mean (SD) age 25.93 ± 2.10, with 46.72% male, 81.75% undergraduates, and 45.26% from Jiangsu. Regarding AI, 52.55% were unfamiliar with it, 35.04% had never used it. ChatGPT demonstrated 80.8% overall accuracy, including 57% in professional practice. 87 AI-generated hallucinations were identified, primarily in the level of application and evaluation. The mean (SD) accuracy was 55% ±4.3%, and the mean (SD) sensitivity (d') was 0.39 ± 0.33. The median response bias (β) was 0.74 (0.31). Regression analysis revealed that shorter response times (OR = 0.92, P = 0.02), higher self-assessed AI understanding (OR = 0.16, P = 0.04), and frequent AI use (OR = 10.43, P = 0.01) were associated with stricter error detection criteria.CONCLUSIONS The study concluded that residents struggled to identify AI errors, particularly in clinical cases, emphasizing the importance of improving AI literacy and critical thinking for effective integration into medical education.
Novel Gene expression-based Risk Stratification tool predicts recurrence in Non-muscle invasive Bladder cancer
Authors: N Srivatsa , S Hari P , P Rahul , Paul Lista , Veeraiyan Durgadevi , Narikot Ambili , Veldore Vidya , Tanwar Nishtha , P Srikanthreddy , Goswami Hitesh , Kumar Rekha V , S Srinath B , Korlimarla Aruna
Published: November 2024

Bladder cancer is a heterogeneous disease that has a very unique challenge in treatment and management. The disease at the start could be indolent and slow growing and display low potential for further progression to muscle-invasive. Once it is frankly muscle invasive, there is a high risk of distant metastasis. NMIBC can be managed with conservative treatment with the procedure TURBT (Transurethral resection of bladder tumor) whereas an aggressive surgical intervention is required if it is muscle invasive. Risk stratification, traditionally used, like the EORTC score, employs clinicopathologic features of the disease to provide prognostic information that assists in choosing the best therapy for each individual patient. Most important decisions to be made are type of intravesical therapy and whether or not to administer neoadjuvant chemotherapy. Though the EORTC scores are of great utility in making these decisions, they frequently fall short and are successful only 70% of the time and results in local recurrence as well as muscle invasion. Much of the research in the recent past has adopted tumor genetic sequencing and correlated with clinical outcomes. In the current study we have explored a transcriptomics-based mRNA score that successfully predicts early NMIBC recurrence with median 90% accuracy and arrived at a comprehensive gene set. The gene set demonstrates a comparable and higher predictive trend as compared to other score based predictive tools. We clearly demonstrate that risk score-based sub stratifications by mRNA expression could potentially reduce over investigation and improve surveillance costs after TURBT in patients with primary high-risk NMIBC.
Mapping the Landscape of Hospital at Home (HaH) Care: A Validated Taxonomy for HaH Care Model Classification
Authors: Denecke Kerstin
Published: November 2024

Background: Hospital at home (HaH) care models have gained significant attention due to their potential to reduce healthcare costs, improve patient satisfaction, and lower readmission rates. However, the lack of a standardized classification system has hindered systematic evaluation and comparison of these models. Taxonomies serve as classification systems that simplify complexity and enhance understanding within a specific domain.
Objective: This paper introduces a comprehensive taxonomy of HaH care models, aiming to categorize and compare the various ways HaH services are delivered as an alternative to traditional hospital care.
Methods: We developed a taxonomy of characteristics for HaH care models based on scientific literature and by applying a taxonomy development framework. To validate the taxonomy, and to analyze the current landscape of HaH models we matched the taxonomy to HaH care models described in literature. Finally, to identify archetypes of care models, we applied the k-means clustering method to the care models described using the taxonomy.
Results: Our taxonomy consists of 12 unique dimensions structured into 5 perspectives following the progression from triaging, through care delivery, operational processes, and metrics for success: Persons and roles (2 dimensions), Target population (1 dimension), Service delivery and care model (6 dimensions), outcomes and quality metrics (2 dimensions),and training and education (1 dimension). Each dimension aggregates between 1 and 20 characteristics. We identified three clusters within a dataset of 34 HaH care approaches.
Conclusions: The developed taxonomy offers a valuable framework for healthcare providers, policymakers, and researchers to systematically evaluate and implement HaH care models. The challenges encountered in collecting information on different characteristics of the taxonomy underscore the urgent need for more comprehensive and standardised reporting in scientific papers on HaH interventions.
The biomechanical study of different fixation techniques for combination fractures of atlas and axis: a finite element analysis.
Authors: Liu Chao , Huang Kai , Dai Lei , Huang Xiaogang , Zhang Xinjun
Published: November 2024

Combination atlas-axis fractures are less studied but relatively common with a higher incidence of neurological deficits than isolated C1 or C2 fractures. Several authors focused on the treatment strategies, but there is no study to compare the stability of different fixation methods; neither not yet cleared which technique represents the best choice and whether stabilization devices can be efficient and beneficial for complex atlantoaxial fractures. The aim of this study was to compare the biomechanical properties of three fixation techniques: atlantoaxial pedicle screws fixation(PSF), occipital-cervical fusion(OCF) and transarticular screw fixation(TSF) based on combination factures model. Our results showed the range of motion(ROM) of fracture model increased obviously than intact model. The ROM in flexion/extension and rotation of C0-C1 in PSF and TSF models were increased. The ROM of C1-C2 in all conditions in PSF, OCF and TSF models were decreased. The ROM of C2-C3 was decreased in OCF but remain the same stage in PSF and TSF. These suggested that three surgical methods are effective for the combination fractures of atlas and axis, which can ensure good stability. It can properly increase the ROM of C0-C1 when use PSF. These findings would aid in the treatment of this complex fractures.
Experimental Modeling and Process Optimization of Laser Transmission Welding with Fiber Optic Laser for Polymethyl Methacrylate in Zigzag Path
Authors: Rahmaninia Milad , Ghoreishi Majid
Published: November 2024

This study experimentally evaluated Laser Transmission Welding (LTW) between two transparent and identical Polymethyl Methacrylate (PMMA) sheets using a fiber optic laser following a zigzag path. The research focused on the effects of laser power, welding speed, and distance between scan lines on lap-shear force, weld-seam width, and changes in weld morphology. Pyrometry was used to measure the welding temperature and determine input parameters. Analysis of Variance (ANOVA) and Response Surface Methodology (RSM) were employed to analyze and optimize the input parameters for maximum lap-shear force and minimal weld-seam width. The findings indicated that higher laser power, slower welding speed, and a reduced distance between scan lines increased heat input, leading to enhanced polymer melting and improved weld strength, reflected by higher lap-shear force and broader weld-seam width. Conversely, lower heat input decreased both lap-shear force and weld-seam width. Optimal values for lap-shear force and weld-seam width were determined to be 886.4 N and 26.37 mm, respectively, through multi-objective optimization. The zigzag welding path contributed to uniform heat distribution, even mixing of melted materials, and better structural integrity in the weld zone. Morphological analysis revealed that the weld strength was enhanced due to the presence of smaller, evenly distributed bubbles in the weld pool, attributed to the zigzag path. These findings highlight the significance of controlling welding parameters to optimize strength and seam quality in laser transmission welding of PMMA.
Global Trends in Polycystic Ovarian Syndrome Over 30 Years: An Age-Period-Cohort Study of 204 Countries and Territories (1990- 2021)
Authors: Lin Lanxiang , Li Wenhui , Xu Baozhu , Li Yuefeng , Li Jin , Kong Xiangjun , Du Xin
Published: November 2024

Objective
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women globally, with significant increases in incidence over the past three decades. Despite the rising prevalence, limited data exist on the global incidence trends of PCOS, especially across diverse socio-demographic contexts.
Methods
This study analyzed PCOS incidence trends from 1990 to 2021 across 204 countries using an age-period-cohort (APC) analysis. Data were sourced from the Global Burden of Disease Study 2021, focusing on crude and age-standardized incidence rates, disaggregated by region and socio-demographic index (SDI).
Results
The global incidence of PCOS increased from 1.48 million cases in 1990 to 2.3 million in 2021. The age-standardized incidence rate in 2021 was 63.26 per 100,000 population (95% CI: 45.41 to 87.28). High SDI regions recorded the highest incidence rates, with a rate of 90.13 per 100,000 (95% CI: 66.94 to 122.36). In contrast, low SDI regions had the lowest incidence rates at 36.8 per 100,000 (95% CI: 25.83 to 52.19). The APC model revealed a global net drift of 0.18 (95% CI: -0.02 to 0.37), with significant age and period effects, particularly among younger age groups.
Conclusion
The study underscores a significant global rise in PCOS incidence, particularly in high SDI regions and among younger age groups. These findings highlight the need for targeted public health interventions and further research to address the growing burden of PCOS.
Superiority of photon-counting computed tomography for detecting high-risk unstable angina patients: two case reports
Authors: Ho Thuong Dung , Nguyen Duong Quoc Anh , Tran Thi Quynh Huong , Mai Hoang Dil , Nguyen Duc Chinh
Published: November 2024

Coronary artery disease is the leading cause of death among non-communicable diseases. The management strategy prioritizes early detection and optimal treatment, with emerging roles for imaging approaches. Photon-counting computed tomography is a new non-invasive diagnostic imaging tool that can detect high-risk plaques in coronary artery disease patients. Using photon-counting computed tomography in screening and intravascular ultrasound later in verifying diagnosis and intervention guidance could be a new technique to swiftly discover unstable plaques, prepare lesions for surgery, and determine the optimal percutaneous intervention strategy. However, there is no documentation available for this new approach. We reported two acute coronary syndromes managed with a combination of two imaging methods. Despite receiving medical therapy, the first case continued to experience chest pain, leading to the detection of plaque ulceration in the left anterior descending artery. On the other hand, two PCCT screenings within 6 months revealed plaque progression in the second case. We then used IVUS to confirm the lesions and proceed to intervention. We successfully discharged both cases, and they showed no symptoms 6 months after discharge.
Modified End-Expiratory Occlusion Test in Older Adults during Intraoperative Lung-Protective Ventilation: A Randomized Two-period Crossover Trial
Authors: Chen Han , Li Xiao-Xiao , Zhou Jian-Wen , Zhu Yu-Jing , Zhang Tan , Tang Jun
Published: November 2024

Background
The end-expiratory occlusion (EEO) test is a valuable tool for predicting fluid responsiveness, yet its efficacy during lung-protective ventilation remains debated. This study aimed to evaluate the efficacy and safety of a modified 30-second EEO in older patients undergoing surgery.
Methods
This randomized, controlled, two-period crossover trial included 66 patients receiving elective general anesthesia. Patients were randomized into two groups. Group A received a 15-second EEO followed by a 30-second EEO, while Group B received the tests in reverse order. A fluid challenge of 250 ml 0.9% saline was administered to identify fluid responders, defined as an increase in stroke volume index (ΔSV) ≥ 10%. Hemodynamic parameters were recorded using pulse contour analysis.
Results
Of the 63 patients analyzed, 41 were classified as responders. A 6% increase in ΔSV after the 15-second EEO identified responders with an AUC of 0.86, while a 10% increase after the 30-second EEO had an AUC of 0.91. Although both EEO durations effectively predicted fluid responsiveness, the 30-second EEO showed higher specificity (100%) compared to the 15-second EEO (82%).
Conclusion
Stroke volume changes induced by the EEO test can predict fluid responsiveness in older adults undergoing lung-protective ventilation. Extending the occlusion time improves the specificity of the test. The modified 30-second EEO may offer a practical and reliable method to enhance intraoperative safety.
Trial Registration
The study was retrospectively registered at Chictr.org.cn with the number ChiCTR2100049587 on 08/05/2021.
Intraoperative hypotension and postoperative risks in non-cardiac surgery: A meta- analysis
Authors: Qin Guanchao , Du Ming-cheng , Yi Ke-xin , Gong Yuan
Published: November 2024

Background
Postoperative complications are often associated with the severity and duration of intraoperative hypotension. However, the optimal approach to manage hypotension during surgery remains controversial. The aim of this meta-analysis of randomized controlled trials was to compare the incidence of common postoperative complications with different levels of hypotension management.
Methods
We searched PubMed, the Cochrane Database, and Embase from August 2014 to August 2024 for studies comparing different levels of hypotension management (low [mean arterial pressure < 60 mmHg], moderate [60–75 mmHg], and high levels [> 75 mmHg]). Only randomized controlled trials conducted during 2014–2024 were included in this meta-analysis without language restrictions. Studies with the following characteristics were included: randomized controlled study; involved non-cardiac, non-obstetric surgery; included different blood pressure management strategies; evaluated major postoperative complications; and included acute kidney injury, myocardial injury, altered consciousness, or infection. Data included patient age, type of surgery, group criteria, and adverse events. Mantel–Haenszel method was used for analysis. The primary outcomes were postoperative complications, including acute kidney injury. The secondary outcomes included length of hospital stay and all-cause mortality.
Results
Of the 2160 studies identified, eight randomized controlled trials with 9108 participants were included. No significant differences in postoperative complications were observed between the moderate and high mean arterial pressure management groups (risk ratio = 1.0, 95% confidence interval = 0.86–1.18, P = 0.96). Sensitivity analysis confirmed these findings. Length of hospitalization was not significantly different between the groups (standardized mean difference = -0.39; 95% confidence interval = -0.69 to 1.31; P = 0.03). Limited data prevented meta-analysis of mean arterial pressure management at lower levels.
Conclusion
Moderate hypotension management may reduce the length of hospital stay. However, the available evidence suggests no significant differences in postoperative complications between moderate and high levels of hypotension management.
The level of routine health information system data quality and associated factors at public hospitals in the Silte Zone, Central Region, Ethiopia, 2023: A mixed study
Authors: Dukamo Nigussie , Tamiso Alemu , Adane Adugnaw , Asefa Abriham , Misganaw Samuel , Belayneh Mehretu
Published: November 2024

Background
Routinely collected data of poor quality can compromise the validity of effectiveness evaluations and lead to poor decision-making, inappropriate resource allocation, and a loss of trust in the health system. Routine health information system data are seen as poor in quality, are not used for decisions in Ethiopia, and continue to be a significant problem.
Methods and materials:
A facility-based mixed-method study with an embedded design was conducted. A total of four public hospitals, 32 departments or units, 605 healthcare workers, and 12 key informant interviews were selected. Simple random sampling and purposive sampling techniques were used for selecting study participants in the quantitative and qualitative studies, respectively. The data were entered into Epi-data version 4.4, Open Code version 4.03, and exported to SPSS version 26, and descriptive statistics were used to assess the level of data quality. Binary logistic regression and thematic analysis were run to identify factors affecting data quality. Adjusted odds ratios with 95% confidence intervals and themes or subthemes were reported.
Results
The overall facility data quality level was 90.84%; and the completeness and consistency of the data were 85.5% and 85.3%, respectively. Easy understandability of registration and report formats [AOR 1.92; CI 1.11–3.33], receiving training [AOR 1.62; CI 1.07–2.44], receiving supervision [AOR 1.66; CI 1.05–2.61], providing regular feedback [AOR 1.72; CI 1.07–2.75], the team's work being appreciated and valued by supervisors [AOR 1.61; CI 1.04–2.75] and making decisions and follow-up actions identified in performance monitoring team meetings [AOR 1.73; CI 1.12–2.67] were significantly associated with data quality; and thematic analysis was performed and categorized into four themes and twelve subthemes.
Conclusion and recommendation:
The level of data quality at the public hospital in the Silte Zone is almost equal to the national expected level of data quality, but the completeness and consistency of the data were lower than the national expected level. The Minister of Health and other supporting organizations should intervene in the identified gaps, especially to reduce incompleteness and inconsistency of data.
A New Scoring System to Predict Febrile Urinary Tract Infection After Retrograde Intrarenal Surgery
Authors: Senel Cagdas , Erkan Anil , Keten Tanju , Aykanat İbrahim Can , Ozercan Ali Yasin , Tatlici Koray , Basboga Serdar , Saracli Sinan , Guzel Ozer , Tuncel Altug
Published: November 2024

Purpose: To determine the risk factors and define a new scoring system for predicting febrile urinary tract infection (F-UTI) following retrograde intrarenal surgery (RIRS) by using machine learning methods.
Methods: We retrospectively analyzed the medical records of patients who underwent RIRS and 511 patients were included in the study. The patients were divided into two groups: Group 1 consisted of 34 patients who developed postoperative F-UTI, and Group 2 consisted of 477 patients who did not. We applied feature selection to determine the relevant variables. Consistency subset evaluator and greedy stepwise techniques were used for attribute selection. Logistic regression analysis was conducted on the variables obtained through feature selection to develop our scoring system. The accuracy of discrimination was assessed using the receiver operating characteristic curve.
Results: Five of the 19 variables, namely diabetes mellitus, hydronephrosis, administration type, a history of post-ureterorenoscopy (URS) UTI, and urine leukocyte count, were identified through feature selection. Binary logistic regression analysis showed that hydronephrosis, a history of post-URS UTI, and urine leukocyte count were significant independent predictors of F-UTI following RIRS. These three factors demonstrated good discrimination ability, with an area under curve value of 0.837. In the presence of at least one of these factors, 32 of 34 patients who developed postoperative F-UTI were successfully predicted.

Conclusion: This new scoring system developed based on hydronephrosis, a history of post-URS UTI, and urine leukocyte count can successfully discriminate patients at risk of F-UTI development after RIRS.