bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a nomogram risk prediction model for PICC-related thrombosis in children with hematological malignancies
Authors: Fu Maoling , Yang Qiaoyue , Yuan Quan , Wu Xiao , Yang Ting , Li Xinyu , Jiang Lexue , Qin Xiuli , Yan Huiping , Yu Genzhen
Published: October 2024

Background
Early recognition and prevention are of great significance in reducing the incidence of Peripheral Intravenous Central Catheter (PICC)-related thrombosis. This study aimed to develop and validate a clinical risk prediction tool for PICC-related thrombosis in children with hematological malignancies.
Methods
Retrospectively selected children with hematological malignancies receiving PICC catheterization from January 2018 to December 2023 in Tongji Hospital as the study subjects and randomly divided into the training and validation sets according to the ratio of 7:3. A total of 54 possible predictor variables were collected from the hospital’s electronic medical record system and subjected to univariate and multivariate analyses. Logistic regression models were used to establish nomograms, which were evaluated by discrimination, calibration degree, and clinical applicability.
Results
519 children were enrolled, of whom 98 (18.9%) were diagnosed with PICC-related thrombosis during retention. The final nomogram model incorporated six independent risk factors, including leukemia, number of catheters, history of catheterization, total parenteral nutrition, post-catheterization D-dimer, and post-catheterization fibrinogen. The area under the receiver operating characteristic curve was 0.844 (95% CI: 0.787 ~ 0.900) and 0.794 (95% CI: 0.698 ~ 0.890) for the training and validation sets, respectively, indicating that the model had good discrimination. All calibration curves showed that the model was well calibration degree. The decision curve analysis showed better net benefit of our model in predicting PICC-related thrombosis risk over a range of threshold probabilities from 5–87% and 91–97% in the training set, and from 4–85% in the validation set.
Conclusions
This nomogram model can be used as an effective tool to predict the risk of PICC-related thrombosis in children with hematological malignancies. It will facilitate pediatricians in early diagnosis, which is critical to reducing the incidence of PICC-related thrombosis.
Efficacy and safety of dexamethasone sparing for the prevention of nausea and vomiting associated with moderately emetogenic chemotherapy: A systematic review and meta-analysis of Clinical Practice Guidelines for Antiemesis 2023 from Japan Society of Clinical Oncology
Authors: Nakashima Kazuhisa , Yokomizo Ayako , Murakami Michiyasu , Okita Kenji , Wada Makoto , Iino Keiko , Akechi Tatsuo , Iihara Hirotoshi , Imamura Chiyo K. , Okuyama Ayako , Ozawa Keiko , Kim Yong-il , Sasaki Hidenori , Satomi Eriko , Takeda Masayuki , Tanaka Ryuhei , Nakajima Takako Eguchi , Nakamura Naoki , Nishimura Junichi , Noda Mayumi , Hayashi Kazumi , Higashi Takahiro , Boku Narikazu , Matsumoto Koji , Matsumoto Yoko , Yamamoto Nobuyuki , Aogi Kenjiro , Abe Masakazu
Published: October 2024

Background
Palonosetron, a second-generation 5-HT3 receptor antagonist (5-HT3RA), is more effective than first-generation 5-HT3RA. Several studies have investigated whether dexamethasone (DEX), when combined with palonosetron as a 5-HT3RA, can be spared in the delayed phase after moderately emetogenic chemotherapy (MEC). In this systematic review, we aimed to determine which between 1- and 3-day DEX administration, when combined with palonosetron, is more useful in patients receiving MEC.
Methods
The PubMed, Cochrane Library, and Ichushi-Web databases were searched for relevant studies published between 1990 and 2020. We included studies that compared the efficacy of 1- and 3-day DEX administration in preventing nausea and vomiting associated with MEC. Outcomes were “prevention of vomiting (complete response rate and no vomiting rate),” “prevention of nausea” (complete control rate, total control rate, no nausea rate, and no clinically significant nausea rate)” in the delayed phase, “prevention of blood glucose level elevation,” and “prevention of osteoporosis.”
Results
Eight studies were included in this systematic review. The no vomiting rate was significantly higher in the 3-day DEX group than in the 1-day DEX group. However, the other efficacy items did not significantly differ between the two groups. Meanwhile, insufficient evidence was obtained for “prevention of blood glucose level elevation” and “prevention of osteoporosis.”
Conclusions
No significant differences in most antiemetic effects were found between 1- and 3-day DEX administration. Thus, DEX administration could be shortened from 3 days to 1 day when used in combination with palonosetron.
Dissecting biological heterogeneity in major depressive disorder based on neuroimaging subtypes with multi-omics data
Authors: Wang Fei , Tang Lili , Tang Rui , Dong Shuai , Zheng Junjie , Zhao Pengfei , Zhang Xizhe , Zhu Rongxin , Tang Yanqing , Gong Xiaohong
Published: October 2024

Background
The heterogeneity of Major Depressive Disorder (MDD) has been increasingly recognized, challenging traditional symptom-based diagnostics and the development of mechanism-targeted therapies. This study aims to identify neuroimaging-based MDD subtypes and dissect their predominant biological characteristics using multi-omics data.
Method
A total of 807 participants were included in this study, comprising 327 individuals with MDD and 480 healthy controls (HC). The amplitude of low-frequency fluctuations (ALFF), a functional neuroimaging feature, was extracted for each participant and used to identify MDD subtypes through machine learning clustering. Multi-omics data, including profiles of genetic, epigenetics, metabolomics, and pro-inflammatory cytokines, were obtained. Comparative analyses of multi-omics data were conducted between each MDD subtype and HC to explore the molecular underpinnings involved in each subtype.
Results
We identified three neuroimaging-based MDD subtypes, each characterized by unique ALFF pattern alterations compared to HC. Multi-omics analysis showed a strong genetic predisposition for Subtype 1, primarily enriched in neuronal development and synaptic regulation pathways. This subtype also exhibited the most severe depressive symptoms and cognitive decline compared to the other subtypes. Subtype 2 is characterized by immuno-inflammation dysregulation, supported by elevated IL-1β levels, altered epigenetic inflammatory measures, and differential metabolites correlated with IL-1β levels. No significant biological markers were identified for Subtype 3.
Conclusion
Our results identify neuroimaging-based MDD subtypes and delineate the distinct biological features of each subtype. This provides a proof of concept for mechanism-targeted therapy in MDD, highlighting the importance of personalized treatment approaches based on neurobiological and molecular profiles.
Early Predictive nomogram of Ventricular Fibrillation after Percutaneous Coronary Intervention in Acute Myocardial Infarction using LASSO-Logistic regression
Authors: Liu Jianghong , Fan Jihong , Sun Huina , Liu Ruifeng
Published: October 2024

Objective
Ventricular fibrillation (VF) is a serious complication of acute myocardial infarction (AMI) that can occur after percutaneous coronary intervention (PCI). This study aimed to identify early predictors of VF and develop a nomogram to predict VF risk in this patient population.
Methods
This single-center retrospective cohort study included 162 AMI patients who underwent PCI at Beijing Friendship Hospital between 2018 and present. Patients were divided into VF and non-VF groups (1:3 matched) based on the occurrence of VF after PCI. Baseline demographics, medical history, laboratory results, medications, and in-hospital outcomes were compared between groups. LASSO regression analysis, followed by univariable and multivariable logistic regression, identified predictors of VF. A nomogram incorporating significant predictors was constructed and validated using ROC curve analysis, calibration curves, and the Hosmer-Lemeshow goodness-of-fit test.
Results
Significant differences in baseline characteristics (Table 1A), clinical data including coagulation parameters and complications (Table 1B), and in-hospital prognoses (Table 1C) were observed between VF and non-VF groups. LASSO regression analysis identified key predictors, and multivariable analysis confirmed diabetes, metabolic acidosis, anemia, hypokalemia, and ventricular premature beats as independent predictors of VF (Table 2). The nomogram incorporating these factors showed excellent discrimination (AUC = 0.942, 95% CI: 0.882-1.000) and good calibration (Hosmer-Lemeshow test p = 0.898).
Conclusion
This study identified several readily available clinical parameters as independent predictors of VF in AMI patients undergoing PCI. The developed nomogram based on these predictors showed promising predictive accuracy and calibration, potentially assisting clinicians in early risk stratification and guiding proactive management strategies to improve outcomes in this high-risk population.
Minimally Invasive Approach to Managing Brachiocephalic Trunk Cannulation Complicating Central Venous Catheterization: A Case Report
Authors: Deng Haihui , Chen Bin , Peng Deti , Pang Fuwen
Published: October 2024

Background
Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment.
Case presentation
A 74-year-old woman with a cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography and digital subtraction angiography. Due to high surgical risks, catheter replacement was chosen instead of surgery or endovascular treatment. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was removed without complications. Follow-up scans showed no leakage, and the patient’s vitals remained stable. Three months later, no abnormalities were observed.
Conclusion
This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety.
Altered brain dynamic functional network connectivity in heavy smokers
Authors: Qiu Xianxin , Wu Guangyao , Zhu Ling , Lin Fuchun
Published: October 2024

Cigarette smoking is associated with altered static functional connectivity, however, studies on functional connectivity dynamics may provide new insightful perspectives for understanding the neural mechanisms of smoking addiction. The aim of this study was to investigate the characteristics of dynamic functional network connectivity (dFNC) in heavy smokers. DFNC analysis based on sliding window approach and k-means clustering was performed to the resting-state functional magnetic resonance imaging data of 34 heavy smokers and 36 healthy non-smokers. The between-group differences in temporal properties of dFNC states were assessed, followed by a correlation analysis of these differences with smoking-related factors in heavy smokers. Compared to non-smokers, heavy smokers showed a lower occurrence rate and mean dwell time in state 2, characterized by negative connectivity between the default-mode network and the other networks. Heavy smokers also had a trend toward higher occurrence rate and mean dwell time in state 1, characterized by global weak connectivity. Network-based statistics identified cognitive control and cerebellar domains played an important role in the impaired subnetworks. Correlation analyses demonstrated that in heavy smokers, both the occurrence rate and the mean dwell time were negatively associated with the duration of smoking in state 2, characterized by high connectivity within the sensory domains. Our findings suggest that dFNC abnormalities in heavy smokers may become new neuroimaging biomarkers and provide a deeper understanding of the pathophysiological mechanisms of smoking addiction.
Retrospective, single center evaluation of perineal prostate biopsy omitting antibiotic prophylaxis and omitting periinterventional screening for bacteriuria
Authors: Leboutte Francois , Schykowski Tim , de Plas Jeroen van , Lemmer Oscar , Neisius Andreas
Published: October 2024

Purpose
The pursuit of effective and safe early detection methods for prostate cancer has led to advancements in non-invasive tools, yet the annual performance of one million prostate biopsies in the EU underscores the challenges. The transperineal approach, recommended by the EAU, offers reduced infectious complications compared to transrectal biopsies. The role of antibiotic prophylaxis in transperineal biopsies remains ambiguous, necessitating investigation due to concerns about antibiotic resistance and the impact on public health.
Methods
This retrospective study analyzed 636 patients who underwent transperineal prostate biopsies between January 2019 and August 2020. The primary endpoint was postinterventional infectious complications, with secondary endpoints including the general complication rate and associated risk factors.
Results
Among the cohort (median age 68), 12 complications were recorded, yielding a 1.9% complication rate. Infectious complications requiring hospitalization and antibiotic treatment occurred in 1.1% of cases. No identified risk factors were associated with infectious complications or post-interventional bleeding. Complications included gross hematuria, urinary retention requiring catheterization, and one case necessitating intensive care. Notably, the cohort did not systematically screen for bacteriuria, and patients with high risk for complications were not excluded. The complication rate appeared lower than reported for transrectal biopsies with antibiotic prophylaxis.
Conclusion
This study supports the safety of omitting antibiotic prophylaxis in transperineal prostate biopsies, showcasing a minimal infectious complication rate. The findings contribute to the ongoing discourse on antibiotic stewardship, emphasizing the need for judicious use to mitigate resistance.
Aortic Angulation Distribution and Effects on the Outcome and Complications of Self-expanding Transcatheter Aortic Valve Replacement
Authors: Li Ruitao , Yu Yuanyuan , Xiong Tianyuan , Chen Fei , Zhao Zhengang , Chen Zhicheng , He Qianbei , Yu Zhixiang , Li Yijian , Feng Yuan
Published: October 2024

Aims
To investigate the effect of aortic angulation (AA) on clinical outcomes and related complications in patients with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with self-expanding (SE) valve.
Background
AA is defined as the angle between the horizontal plane on the coronal plane and the plane of the aortic valve annulus, and is an important anatomical factor in TAVR. Whether AA affects the early clinical outcomes and complications in SE-TAVR procedure is still controversial.
Methods and Results
This was a retrospective cohort study of 519 consecutive patients who underwent SE-TAVR in our center from January 2016 to January 2021.The range of AA in patients undergoing SE-TAVR in this study was 25°~ 93°, with an average angle of 55.4 ± 9.7°. There was a statistically significant difference in technique success between AA ≤ 55° and AA > 55° group (87.3% vs. 79.1%, P = 0.011), which was mainly due to the proportion of second-valve implantation was implanted during TAVR (8.8% vs. 19.6%, P < 0.001). Among patients with TAV, those with an AA > 55°were more likely to require second-valve implantation compared to those with an AA ≤ 55° (8.8% vs. 29.8%, P < 0.001), whereas this trend did not show significant statistical differences among patients with BAV (9.6% vs. 7.3%, P = 0.345).
Conclusions
Larger angulation of aortic valve has significant lower technique success of TAVR which was mainly due to increasing of second-valve implantation events in SE-TAVR patients. AA mainly affects the incidence of second-valve implantation during SE-TAVR in TAV group, rather than BAV group.
Lactobacillus paracasei ZJUZ2-3 suppresses gastric tumorigenesis by inhibiting NF-κB pathway via metabolite 3-IAA
Authors: Yang Rui , Yang Yan , Wu Lin , He Kaikai , Bi Dexi , Teng Lisong
Published: October 2024

BACKGROUND & AIMS: Lactobacillus paracasei is known to confer health benefits to human and has been found depleted in gastric tumor tissues. Here, we aimed to investigate the potential role of this bacterium as a prophylactic for gastric cancer (GC).
METHODS: Isolation of L. paracasei from normal gastric tissues followed by whole genome sequencing was conducted. Antitumor effects of a L. paracasei isolate and its tumor-suppressive metabolite were assessed with gastric cancer cell lines and cell line-derived xenograft models.
RESULTS: We validated that L. paracasei was depleted in GC tumor tissues in a cohort of 90 patients. A L. paracasei strain ZJUZ2-3 was then isolated. Intratumoral injection of ZJUZ2-3 suppressed GC tumourigenesis in nude mice. Coincubation with ZJUZ2-3 or its conditioned medium inhibited the proliferation of GC cells. But heat-killed ZJUZ2-3 lost the tumor-suppressive effect. Indole-3-acetic acid (IAA) was identified as a ZJUZ2-3-derieved metabolite mediating the antitumor effect. IAA inhibited proliferation and colony formation of GC cells as well as subcutaneous tumor growth in nude mice. Mechanically, as an aryl hydrocarbon receptor (AHR) ligand, IAA activated AHR, which could competitively bind MTDH to inhibit its phosphorylation, thus inhibiting nuclear factor kB (NF-kB) signaling pathway in GC cells. Consistently, inhibition or knockdown of AHR abolished the antitumor effect of IAA.
CONCLUSION: L. paracasei ZJUZ2-3 inhibit GC proliferation and may be used as adjuvant therapy for gastric cancer. The tumor-suppressive effect is mediated by its metabolite IAA.
Reliability and Reproducibility of CBCT Assessment of craniomaxillary Changes Before and After Treatment for Class III Growing Patients – An convenient and intuitively Way for Evaluation
Authors: Hu XiaoYing , Gary Shun Pan Cheung , Zhang YiYang , Sun RuoNan , Dong Fusheng
Published: October 2024

Objectives
To evaluate reliability and reproducibility of 3-dimensional (3D) assessment of maxillary protraction treatment using voxel-based superimposition of cone-beam computed tomography (CBCT) models of the anterior cranial base in growing patients with skeletal class III malocclusion.
Methods
CBCT scans were performed before and after maxillary protraction treatment for Class III malocclusion. Three observers independently constructed 162(27*2*3) 3D virtual models from CBCT scans, which had been reoriented 3D models before treatment to natural head posture, of 27 patients in software. The anterior cranial base was used to register the 3D models pre- and port- treatment. Three observers independently identified 9 landmarks(Including those in the contralateral side)and recorded in three-dimensional coordinates in the 3D models. Each observers performed this three times on the pre- and post-treatment model. The mean value of the 3 sets of coordinates at different times was taken as the coordinates for each landmark. The intraobserver reliability and inter-observer reproducibility of the method for craniomaxillary changes were analyzed.
Results
The ICCs was > 0.90 for 25 (92.6%) out of the total 27 intraobserver assessments. The precision of the measurement method was within 0.3 mm in 21 (77.8%) cases. The interobserver reproducibility errors were < 0.3 mm in 21 of the 27 cases (77.8%).
Conclusions
The reliability and reproducibility of the method for assessment of maxillary protraction treatment in growing patients with skeletal Class Ⅲ malocclusion were judged to be excellent.
Coke Zero for the Zero: A randomized controlled trial examining Coke Zero consumption on night call inpatient course and mortality
Authors: Kwan Yu Heng , Tang Haoming , Qi Lihua , Yap Angela Frances Hui Wen , Yan Linxuan , Li Yi Xin , Lee Andrea Zhe Ern , Fong Antoinette Shui Wen , Chan Yarn Kit , Low Feng Yi , Sum Charmaine Wai Yan , Seng Benjamin Jun Jie , Yoon Sungwon , Østbye Truls , Gan Sheryl Shien Wen , Lee Haur Yueh , Fong Warren
Published: October 2024

PURPOSE
Coca-Cola and Cola-Cola Zero Sugar are commonly consumed beverages by healthcare professionals. Medical superstitions abound about whether Cola-Cola Zero sugar consumption affects night call outcomes. The current study aimed to determine whether Coca-Cola Zero Sugar, compared to regular Coca-Cola, is associated with any differences in inpatient admissions and mortality of patients on night calls.
METHODS
A double-blinded randomized controlled trial was conducted in the Division of Medicine, Singapore General Hospital, Singapore involving junior doctors from January 2024 to February 2024.The primary outcome was the number of ward admissions under the night call doctor’s care. Secondary outcomes involved the number of inpatient deaths, high-dependency or intensive care admissions, the number of hours slept by the doctor, the number of steps walked by the doctor, and the level of sleepiness of the doctor on call.
RESULTS
203 participants consented and were randomized (44.9%). The data of 198 participants were included for analysis (97.5%). No significant differences were detected in the number of ward admissions between the Coca-Cola Zero Sugar group and the regular Coca-Cola group. For secondary outcomes, a significant difference was present between the two groups in the Karolinska Sleepiness Scale score (p-value = 0.0413). Other secondary outcomes did not demonstrate significant differences between the two groups.
CONCLUSIONS
No convincing evidence was present to support the consumption of Coca-Cola Zero Sugar versus the regular Coca-Cola had significant differences in the number of inpatient admissions and mortality in night call duties.
Predictive role of exteroceptive and interoceptive bodily dimensions to schizotypal personality traits
Authors: Pasciucco Maria Rosaria , Perrucci Mauro Gianni , Croce Pierpaolo , Costantini Marcello , Ferri Francesca
Published: October 2024

The phenomenological approach to schizophrenia emphasizes the role of bodily experiences in the onset and manifestation of positive, negative and disorganized psychotic symptoms. According to the dimensional approach to psychosis, there exists a continuum ranging from individuals with low levels of schizotypy to diagnosed schizophrenia patients, with schizotypy encompassing positive-like, negative-like, and disorganized-like symptoms of schizophrenia. Empirical evidence suggests that along this continuum, both exteroceptive (external sensory) and interoceptive (internal bodily) dimensions might be distorted. Understanding the contribution of these bodily dimensions in the manifestation of psychotic symptoms, even in schizotypy, might help target early interventions for individuals at risk of developing psychotic disorders. This study investigated the potential contribution of exteroceptive and interoceptive bodily dimensions to schizotypal personality traits, such as cognitive-perceptual traits (positive-like symptoms), interpersonal traits (negative-like symptoms), and disorganization traits (disorganized-like symptoms). Partial Least Squares Regression was used to integrate several bodily dimensions to understand their impact on schizotypy, revealing specific and non-specific contributions of exteroceptive and interoceptive dimensions to different traits. The findings indicate that exteroceptive bodily dimensions generally predicted all schizotypal traits, with specific associations to positive-like symptoms, while interoceptive dimensions mostly predicted interpersonal-like and disorganized-like symptoms. These results suggest a difference in how exteroceptive and interoceptive bodily dimensions contribute to the three schizotypal traits. This highlights specific aspects of interoceptive and exteroceptive body representations that could serve as targets for early intervention. Particularly, interoception emerges as a potential prodromal marker, suggesting that early intervention in this area could be crucial.
Multifactor nomogram predicts bone metastasis in patients initially diagnosed with prostate cancer
Authors: Wu Mao , Liu Ji , Gao Shang , Ye Jinghe , Li Shilin , Liu Hongtao , Li Tian Ren
Published: October 2024

Objectives
To explore the correlation between prostate-specific antigen density (PSAD), Cystatin C (CysC), systemic immune-inflammatory index (SII), and bone metastasis in initially diagnosed prostate cancer patients, and to develop a predictive nomogram model.
Methods
A retrospective analysis was conducted on 208 newly diagnosed prostate cancer patients, divided into a modeling group (146 cases) and a validation group (62 cases). Logistic regression analyses identified independent risk factors for bone metastasis, which were used to construct a nomogram. Model accuracy was assessed using AUC and calibration curves.
Results
Gleason score (GLS), PSAD, CysC, fibrinogen (FIB), SII, and pelvic lymph node metastasis were identified as independent risk factors for bone metastasis (OR > 1, P < 0.05). The model showed an AUC of 0.897 (95% CI: 0.845–0.948) in the modeling group and 0.840 (95% CI: 0.741–0.940) in the validation group.
Conclusion
PSAD, CysC, SII, FIB, GLS, and pelvic lymph node metastasis are significant risk factors for bone metastasis in newly diagnosed prostate cancer patients. The nomogram model can assist in clinical diagnosis, especially in hospitals lacking bone scanning equipment. This study aimed to explore the clinical correlation among PSAD, CysC, SII, and bone metastasis in initial prostate cancer patients. Additionally, a nomogram incorporating relevant risk factors was developed.
Ti- Mn based Bimetallic Alloy Electrocatalyst for Improve Hydrogen Evolution Reaction
Authors: Jain Riya , Raj Ritu , Ram Mange , Rani Anju , Dhayal Rajendra , Haldar Krishna
Published: October 2024

Developing electrocatalysts that are highly efficient and durable is essential for creating high-performance water-splitting devices, which are crucial for clean energy conversion. Unfortunately, existing electrocatalysts are inefficient and necessitate high overvoltage to facilitate the water-splitting reactions effectively. In this study, we are introducing a titanium-manganese alloy as a promising catalyst for the hydrogen evolution reaction (HER). We evaluated the electrocatalytic activity of the TiMn2 alloy for the production of hydrogen in acidic electrolytes. Our results demonstrate that the TiMn2 electrocatalyst exhibits a low overpotential of 139 mV for HER in 0.5 M H2SO4 and a low Tafel slope of 68 mV/dec at a current density of 10 mA/cm2 and a scan rate of 10 mV/s.In addition to this remarkable activity, the catalyst demonstrates excellent stability as a HER electrode over 24 hours of continuous operation, with minimal activity loss (13.2%).
Difference and connection of clinical features and antinuclear antibody patterns in new-onset Systemic Lupus Erythematosus cross age groups
Authors: Gong Muxue , Li Ning , Sun Chao , Hong Dengxiao , Wang Xin , Ye Ming , Wang Tao , Li Zhijun , Xie Changhao
Published: October 2024

To investigate the differences in clinical features, and the relationship between antinuclear antibody (ANA) patterns, autoantibodies, and symptoms among different age groups in new-onset Systemic Lupus Erythematosus (SLE), we conducted a retrospective cohort study involving 556 patients diagnosed with SLE. These patients were classified into three groups: Group 1: juvenile-onset SLE (< 18 years); Group 2: early-onset adult SLE (18-50 years); and Group 3: late-onset SLE (≥ 50 years). We utilized a clustering heatmap to identify variations and associations of autoantibodies among the groups. The Kruskal-Wallis test was performed to compare clinical feature across the groups. The correlation heatmap were used to analyze the relationship of ANA patterns with symptoms. We found late-onset SLE patients exhibited more severe kidney damage and a higher likelihood of infection. ;Late-onset patients with a speckled ANA pattern were more prone to developing Raynaud's phenomenon. It is important for early-onset adult SLE patients with a homogeneous ANA pattern to be vigilant about the possibility of renal disorders and skin involvement. It is the first Chinese JSLE, early-onset ASLE and late-onset SLE study for ANA patterns, which enrolled a large number of newly diagnosed patients. These novel findings contribute to the diagnosis and prevention of SLE.
Painful left bundle branch block after interventional treatment of right coronary artery stenosis：A case report and literature review
Authors: Zhao Zihan , Wang Ranran , Zhang Meijing , Sun Mingzhuang
Published: October 2024

Objective
To report the diagnosis and treatment process of a rare case of coronary atherosclerotic heart disease complicated with painful left bundle branch block.
Methods
A retrospective analysis was conducted on a patient admitted to the Aerospace Center Hospital in July 2023, whose primary symptom was recurrent angina. The diagnosis and treatment process, as well as its special features, were summarized and analyzed.
Results
The patient was an elderly male presenting primarily with angina. Coronary angiography revealed severe stenosis of the right coronary artery. After interventional treatment of the right coronary artery, the patient developed different characteristics of chest pain compared to previous episodes. Through dynamic electrocardiogram monitoring and treadmill exercise testing, he was ultimately diagnosed with Painful Left Bundle Branch Block Syndrome. Following the administration of oral beta-blockers, the patient's symptoms significantly improved during follow-up.
Conclusion
Painful Left Bundle Branch Block Syndrome commonly occurs in patients without coronary artery disease. However, it can be overlooked in some patients with concomitant coronary heart disease due to the presence of the primary condition. This case diagnosed coronary heart disease complicated by painful left bundle branch block syndrome, where intervention on the right coronary artery may serve as a triggering factor for exacerbating painful left bundle branch block syndrome. It is hoped that this case report will provide new insights for future clinical diagnosis and treatment related to this condition.
Enhancing Disaster Surge Capacity Through Reverse Triage in Addis Ababa Hospitals: a Cross-sectional Study
Authors: Seyoum Tsion , Adal Ousman , Beza Lemlem , Bell Sue Anne , Azazh Aklilu
Published: October 2024

Introduction:During disasters and emergencies, hospitals are pivotal in response efforts, particularly through the early discharge of inpatients who can be safely released to free up capacity. Reverse triage helps hospitals efficiently allocate resources and prioritize patient care based on medical necessity.
Objective: This study investigates the impact of reverse triage on surge capacity in public hospitals in Addis Ababa, Ethiopia, during disaster scenarios.
Methods: This cross-sectional study was conducted in three public hospitals using convenience sampling. Data were collected from September 1 to 30, 2023. Descriptive statistics and binomial logistic regression were used to identify factors associated with hospital surge capacity.
Results: A total of 296 participants were included, with 45.9% aged 13-34 years and 55% female. Of the participants, 69.3% were admitted through the Emergency Department. The Reverse Triage Tool Leuven was used to assess patients for early discharge, with 58.4% (95% CI 52.6% -64.1%) of patients qualifying. The percentages of patients eligible for early discharge were approximately 66.7% (95% CI 54% - 77.8%) at Zewditu Memorial Hospital, 57.6% (95% CI 49.5% - 65.4%) at Tikur Anbessa Specialized Hospital (TASH), and 52.8% (95% CI 40.7% - 64.7%) at St. Paul Hospital Millennial Medical College.
Conclusion: The study underscores the effectiveness of reverse triage in identifying patients suitable for early discharge during disasters, thereby enhancing surge capacity and resource management in public hospitals.
Semaglutide Reverses the Chronic Myopathy of Hyperkalemic Periodic Paralysis: A Case Report
Authors: Brand Kenneth , Landry Daniel , Mulhern Jeffrey , Braden Gregory
Published: October 2024

Background: Hyperkalemic Periodic Paralysis (HPP) is an autosomal dominant genetic disorder where high extracellular potassium depolarizes skeletal muscle and triggers painful sustained contractions that lead to permanent myopathy. Interventions have typically relied on acetazolamide and diclofenamide with limited success.
Case Presentation: The patient is a 48 year old man with HPP from a familial autosomal dominant sodium channel point mutation in the SCN4A gene at position 704 with symptoms starting in early childhood. By age 30 he developed permanent muscle weakness and no intervention had improved his myopathy.
In the spring of 2023, semaglutide was initiated for weight loss. Before the semaglutide he could not rise out of a chair without help and his gait was very slow. Over the next year his strength and quality of life returned to levels he had not had in decades.
Conclusion: This is the first effective treatment for HPP. By directly acting on skeletal muscle both dependent and independent of insulin, GLP-1s are an excellent and novel option that treat not just the hyperkalemic periodic paralysis but also the skeletal muscle atrophy in a multimodal way.
Prognostic value of G8 for functional decline and 1-year mortality in older patients with cancer: A multicenter prospective study
Authors: Sifón María del Rosario , Garrido María José Molina , Okassova Ainur , Recondo Gonzalo , Perazzo Florencia , Greco Martín , Mandó Pablo
Published: October 2024

Purpose
Geriatric 8 (G8) is a screening tool to identify frail older patients with cancer. Functional decline (FD) is a determinant in quality of life and survival. We aim to determine the predictive value of G8 for FD in patients with cancer after a new treatment, and its prognostic value for 1-year mortality, severe adverse events, and hospitalizations.
Methods
Prospective multicenter cohort study of patients ≥ 65 years old receiving oncologic treatment in two hospitals assessed with baseline G8. Cut-off value of G8: ≤14. Functional status was assessed using Instrumental Activities of Daily Living (IADL). Primary objective was FD, defined as a decrease of 1 point on IADL after two months of treatment.
Results
226 patients were included, 222 started treatments. After two months, IADL was available for 210; twelve patients (5,4%) died before second evaluation. 66.2% (147) presented an altered G8 score. In those with altered G8, 39.3% (53) had FD and in patients with normal G8, only 13.3% (10) (p < 0.001). At final analysis 222 were available for 1-year mortality and 37.8% (84) had died. After one year of treatment beginning, 48.3% (71) of those with altered G8 had died compared with 17.3% (13) of those with normal G8 (p = 0.001).
Conclusion
FD has an important prognostic value in older patients with cancer and this data shows a strong association of baseline G8 with FD and mortality; supporting the routine use of this tool in the management of older patients with cancer.
Case Report: A Case of Epstein Barr Virus-related Glial Fibrillary Acidic Protein Astrocytopathy Refractory to Conventional Immunotherapy
Authors: Ju Shaowen , Liu Yixue , Zhang Tingfang , Song Donglei , Heng Dongyang , Zhang Wenli
Published: October 2024

Background
Epstein-Barr virus (EBV) infection has been associated with the development of glial fibrillary acidic protein astrocytopathy (GFAP-A), with most cases responding favorably to steroids and/or intravenous immunoglobulin (IVIG). We report a case of EBV-related GFAP-A exhibiting a poor response to conventional immunotherapy.
Case presentation
A 62-year-old Chinese male presented with dysuria, fever, and headache, rapidly progressing to paraparesis. Initial investigations indicated pulmonary infection and viral encephalitis. Despite intensive care and antiviral treatment, his condition deteriorated, necessitating tracheostomy and intubation. Upon transfer to a tertiary neurology center, he had reduced tone, power, and areflexia in the lower limbs, and a loss of sensation below the T6 level. Cerebrospinal fluid (CSF) analysis revealed markedly elevated cell counts and protein levels. MRI showed leptomeningeal enhancement in the left frontal lobe, cervical and thoracic spines. EBV DNA and GFAP-IgG were detected in the CSF, suggesting a diagnosis of EBV-related GFAP-A. Treatment with IV acyclovir, high-dose steroids, and IVIG was administered with no clinical improvement.
Conclusions
This report presents a case of EBV-related GFAP-A refractory to treatments with steroids and IVIG. It suggests that higher levels of CSF protein and cell count may predict worse outcomes and a poorer prognosis.
ACSL4-Associated Lipid Metabolism is a Distinct Therapeutic Vulnerability in KMT2A-Rearranged Acute Myeloid Leukemia
Authors: Wurm Alexander , Schäfer Silvia , Schmitz-Hübsch Lola , Shaikh Mehak , Brilloff Silke , Rahimian Elahe , Kufrin Vida , Küchler Sandra , Fedorova Maria , Kusebauch Natalie , Ni Zhixu , Helm Dominic , Schewe Denis , Ball Claudia , Bornhaeuser Martin , Glimm Hanno , Alberich-Jorda Meritxell , Bill Marius
Published: October 2024

Deregulation of lipid metabolism has been shown to be involved in leukemogenesis and disease progression of acute myeloid leukemia (AML), yet vulnerabilities within the lipidome remain largely unexplored. Through comprehensive analysis of CRISPR-Cas9 screening data, we identified a specific dependency of a subset of AML cell lines on the gene acyl-CoA synthetase long chain family member 4 (ACSL4). Particularly those AML cell lines with chromosomal rearrangements involving the gene lysine methyltransferase 2A (KMT2A) showed an increased dependency on ACSL4. Using CRISPR interference (CRISPRi)- and shRNA-mediated knockdown of ACSL4 in both KMT2A-rearranged (KMT2Ar) and non-KMT2Ar AML cells, we confirmed the dependency of KMT2Ar AML on ACSL4. The knockdown of Acsl4 in a KMT2Ar mouse model resulted in reduced colony-forming capacity ex vivo and signiﬁcantly delayed leukemia onset in vivo. To understand molecular differences between ACSL4-dependent and non-dependent AML cells upon ACSL4 knockdown, we performed a multi-omics approach, including transcriptomics, proteomics, and lipidomics. Integration of these data revealed an upregulation of lipid metabolism pathways exclusively in ACSL4-dependent cell lines. We generated a 12 gene-containing KMT2Ar-ACSL4 dependency signature (KRADS12) and confirmed its association with KMT2Ar and survival in AML patients. Collectively, our findings highlight an unknown vulnerability in the aggressive KMT2Ar AML subtype.
The effect of Orem’s theory of interventional education on self-care, worry and health practices of pregnant women aged 35 years or above, referring to health service centers in Gonabad county, 2024
Authors: Kheibari Zahra Hasannia , Mohammadzadeh Fatemeh , Bahri Narjes , Askari Fariba
Published: October 2024

Background:Self-care during pregnancy requires special attention, particularly among women aged 35 and above. This study aimed to determine the impact of an educational intervention based on the Orem theory on self-care, worry, and health practices among pregnant women aged 35 and older referred to comprehensive health service centers in Gonabad County.
Methods: This randomized controlled trial was conducted in 2023 among 53 pregnant women aged 35 and above referred to comprehensive health service centers in Gonabad County. Participants were randomly assigned to the intervention or control group. Data was collected using questionnaires on demographic and obstetric characteristics, the Cambridge worry Scale, Hart's prenatal care actions, and Health Practices in Pregnancy Questionnaire-II. The intervention group received a theory-based educational intervention in three sessions, while the control group received no intervention. Research staff completed questionnaires before, immediately, and one month after the intervention. Data analysis was performed using generalized estimating equations (GEE) with a significance level 0.05.
Results: Based on the GEE model, there were no statistically significant differences in mean scores for self-care, health practices, and worry between the two groups prior to the intervention (p > 0.05). Post-intervention, both groups exhibited an increase in mean scores for self-care and health practices, but the intervention group demonstrated a steeper increase, which was statistically significant. In contrast, the intervention group experienced a more pronounced decrease in mean worry scores than the control group (p < 0.05).
Conclusion: The findings suggest that a self-care educational program based on the Orem's theory can be effective in enhancing self-care and health practices and reducing worry among pregnant women. Therefore, it is recommended that this educational program be implemented for pregnant women aged 35 and above.
Trial registration and ethics code: IRCT registration number: IRCT20231107059980N1 and ethics code: IR.GMU.REC.1402.
Registration date: 30/11/2023
Study on the Correlation Between Physical Activity During Pregnancy and Delivery Mode in Nulliparous Patients：A prospective cohort study
Authors: Ren Shu-Qun , Zhang Xiao-Ming , Zhao Qian , Li Lei-E
Published: October 2024

BACKGROUND: Physical activity during pregnancy is a beneficial behavioral intervention aimed at enhancing pregnancy outcomes. Nevertheless, the association between prenatal physical activity and mode of delivery remains contentious. This study seeks to investigate whether physical activity during pregnancy correlates with the mode of delivery, with the ultimate objective of bolstering pregnant women's self-efficacy regarding physical activity and ameliorating pregnancy outcomes.
OBJECTIVE: This study aims to test the hypothesis that physical activity during pregnancy is associated with a reduced risk of cesarean delivery.
STUDY DESIGN: This prospective cohort study surveyed women with singleton pregnancies, free from contraindications to physical activity, utilizing the Chinese version of the Pregnancy Physical Activity Questionnaire. This instrument categorizes and quantifies physical activity by type and intensity. The primary outcome of interest is the mode of delivery. Univariate and multivariate binary logistic regression models were employed to ascertain the relationship between prenatal physical activity and mode of delivery.
RESULTS: A total of 217 women participated in the physical activity survey during pregnancy and subsequently gave birth at our hospital. The median energy expenditure from physical activity during pregnancy was 145.70 (111.92, 181.69) MET-h·wk⁻¹. The mean age of the participants was 30.20±3.71 years. Among the 217 primiparas, 131 experienced vaginal deliveries, while 86 underwent cesarean sections. After comprehensive adjustment for covariates, the risk of cesarean delivery was found to be reduced by 60% in the group that adhered to the recommended levels of physical activity during pregnancy compared to the group that did not (OR: 0.40, 95% CI: 0.20 to 0.83, P=0.0130).
CONCLUSION: Elevated levels of physical activity during pregnancy are associated with a reduced risk of cesarean delivery. Physical activity need not be confined to structured exercise programs; routine activities such as cleaning, shopping, and commuting on foot are effective means of increasing energy expenditure and achieving recommended physical activity levels.
Atrial Fibrillation Is Associated with Increased In-Hospitality Mortality During Chimeric Antigen Receptor T-cell Therapy Hospitalizations: A Retrospective Cohort Study in the United States.
Authors: Baral Nischit , Karki Nabin R. , Ladin Daniel A. , Zaghlol Raja , Ibrahim Mahmoud , Rabadi Alexander , Elajami Tarec K. , Mechanic Olivia , Kunadi Arvind , Mitchell Joshua D.
Published: October 2024

Background: Chimeric Antigen Receptor (CAR) T-cell therapy (CAR-T) has emerged as a promising treatment for specific hematological malignancies. While some studies suggest an association between CAR-T and atrial fibrillation (AF), more data are needed on the impact of AF on CAR-T outcomes.
Methods: This retrospective cohort study utilized the National Inpatient Sample (NIS) 2017-2020 to explore in-hospital outcomes in cancer patients with AF while undergoing CAR-T. Comparisons were drawn between patients with and without AF (occurring at any time), assessing various parameters including mortality rates, length of hospital-stay, and occurrences of acute heart failure, pulmonary edema, and gastrointestinal (GI) bleeding.
Results: Of the 236,270 cancer-related hospitalizations, 1,030 cases (0.44%) received CAR-T. The average age of CAR-T recipients was 55.6 years ±18.1 years, and females constituted 40.5% of the total CAR-T recipients. Of the 1030 patients receiving CAR-T, 97 (9.4%) had an associated diagnosis of AF (occurring at any time) during their hospitalization. A multivariable logistic regression analysis, adjusted for age, sex, race, comorbidity, and income, revealed that cancer hospitalizations who underwent CAR-T therapy with AF had increased odds of in-hospital mortality (adjusted odds ratio, aOR: 3.87), acute pulmonary edema (aOR: 3.29), GI bleeding (aOR: 5.46), acute heart failure (aOR: 10.2), and extended hospital stays (Beta coefficient: 0.18) compared to hospitalizations with CAR-T but without AF. Similar results were seen in a sensitivity analysis limited to diffuse large B cell lymphoma patients receiving CAR-T.
Conclusions: In cancer patients receiving CAR-T, AF is independently associated with a higher risk of in-hospital mortality, acute pulmonary edema, gastrointestinal bleeding, acute heart failure, and prolonged hospitalization.
A relatively accurate prediction model for the risk of developing mild cognitive impairment in patients with sarcopenia: Evidence from the CHARLS
Authors: Liu Xinyue , Ni Jingyi , Wang Baicheng , Yin Rui , Tang Jinlin , Chu Qi , You Lianghui , Wu Zhenggang , Cao Yan , Ji Chenbo
Published: October 2024

Background
Sarcopenia significantly raises the risk of cognitive impairments in older adults. Early warning of mild cognitive impairment (MCI) in those with sarcopenia is crucial for timely intervention.
Aims
To construct an accurate prediction model for screening MCI in sarcopenia population.
Methods
We combined machine learning and deep learning techniques to analyze data from 597 sarcopenia patients in the China Health and Retirement Longitudinal Study (CHARLS). Our model predicts MCI incidence over the next four years, categorizing patients into low, intermediate, and high-risk groups based on their risk levels.
Results
The model was constructed using CHARLS data from 2011–2015 and included seven validated variables. It performed superior to logistic regression, achieving an Area Under the Curve (AUC) of 0.808 (95% CI: 0.704–0.899) for the test set and accurately classifying patients' risk in the training set. The deep learning model demonstrated a low false-positive rate of 1.63% for MCI in higher-risk groups. Independent validation using 2015–2018 CHARLS data confirmed the model’s efficacy, with an AUC of 0.76 (95% CI: 0.67–0.83). A convenient online tool to implement the model was developed at http://47.115.214.16:5000/.
Conclusions
This deep learning model effectively predicts MCI risk in sarcopenia patients, supporting early interventions. Its accuracy helps identify high-risk individuals, potentially improving patient care.