bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine Learning-Based Prediction of Intellectual Disability in Children with Autism Spectrum Disorder: Using Behavioral Observation Techniques
Authors: Liu Xiaolin , Han Ting , Jiang Zhongquan , Hu Lifei , Li Wenhao , Song Chao
Published: October 2024

To construct and evaluate a LightGBM prediction model for intellectual disabilities in children with Autism Spectrum Disorder (ASD), a total of 384 ASD children who completed the Wechsler Intelligence Test were included in the analysis. The LightGBM model was trained using behavioral observation data and underwent hyperparameter tuning and feature selection. Among the ASD children, 32.9% had comorbid intellectual disabilities. The model achieved an AUC of 0.747, with overall quality of relationships, unusual sensory interests, and gestures/postures being the top predictive features. The results demonstrate the potential clinical application of the LightGBM model in predicting comorbid intellectual disabilities in children with ASD.
Identifying biomarkers distinguishing sepsis after trauma from trauma-induced SIRS based on metabolomics data: A retrospective study
Authors: Gou Yi , Liu Jing-jing , Zhang Jun-fei , Yang Wan-peng , Yang Jian-Zhong , Feng Ke
Published: October 2024

Background
Sepsis after trauma and trauma-induced SIRS may present with similar symptoms, so it is a great challenge to distinguish sepsis after trauma from trauma-induced SIRS. Besides, trauma-induced SIRS uncovers the occurrence of sepsis after trauma. Thus, there is a need for biomarkers to distinguish them. We hypothesized that sepsis after trauma leads to different changes in blood metabolism than trauma-induced SIRS and searched for metabolite biomarkers in blood to distinguish between the two conditions.
Methods
This study retrospectively analyzed the existing blood metabonomics data from the patients with severe trauma (100 cases), patients with sepsis after trauma (50 cases), and the non-trauma controls (50 cases). We screened out 40 patients with trauma-induced SIRS from the 100 severe trauma patients and then used a pairwise comparison between patients with sepsis after trauma and trauma-induced SIRS to screen the differential metabolites as biomarkers distinguishing sepsis after trauma from trauma-induced SIRS.
Results
In total, 413 metabolites could differentiate sepsis after trauma patients from the trauma-induced SIRS. Using partial least‑squares discriminant analysis, we showed that sepsis after trauma patients was metabolically distinct from the trauma-induced SIRS. The main distinguishing metabolites were LPC O-22:1, uric acid, 23-Norcholic acid, PC O-38:1, and PC O-42:3 (AUC: 0.875 to 0.910).
Conclusions
Our study has identified the potential of employing metabolic biomarkers for differentiation of sepsis after trauma from trauma-induced SIRS. In particular, LPC O-22:1, uric acid, 23-Norcholic acid, PC O-38:1, and PC O-42:3 demonstrated potential as important biomarkers for distinguishing sepsis after trauma from trauma-induced SIRS. These biomarkers provide a basis for further research on identifying biomarkers distinguishing sepsis after trauma from trauma-induced SIRS based on targeted metabolomics.
Eco-Friendly Synthesis of Non-Isocyanate Polyurea Using PET and CO2 Upcycling: A Double Green Approach
Authors: Shojaei Behrouz , Najafi Mohammad
Published: October 2024

From the perspective of sustainability, this research explored both the recycling of polyethylene terephthalate (PET) and the conversion of carbon dioxide (CO2) into polymer materials. To this end, a series of copolyurea specimens were synthesized through the polycondensation of carbon dioxide with hexamethylenediamine (HDA) and terephthalic dihydrazide (TDH), where TDH was derived from the chemical recycling of PET via the aminolysis method. FTIR spectroscopy, 1HNMR, DSC, and TGA characterized the products of PET recycling and synthesized copolyureas. Additionally, we sought to identify the optimal parameters for both the recycling and copolymerization processes. The results of identification analyses for both the recycling and copolymerization reactions confirmed the formation of the desired structures. An increase in the hard segment (TDH) led to discrepancies between the intended and actual monomer ratios in the synthesis, possibly due to dimethyl sulfoxide (DMSO) solubility issues or unreacted TDH. Furthermore, the TGA analysis indicated that the initial degradation temperature (Td,5%) of the copolymer increased with the proportion of aromatic rings in the hard segment, underscoring the complex interactions within the copolymer matrix affecting its thermal and structural properties. The DSC results revealed that for copolyureas with the formula HDAxTDH100–x (where x = 50, 60, 70, 80, 90), reducing the x fraction or increasing the TDH content lowered the melting temperature. Furthermore, at a high percentage of TDH, the melting point disappeared entirely due to the destruction of the crystalline structure, indicating a critical threshold where the copolymer transitions from a semi-crystalline to an amorphous state.
Molecular Dynamics Simulation and Docking Studies Reveals Inhibition of NF-kB signaling as a Promising Therapeutic Drug Target for reduction in Cytokines Storms
Authors: Kumar Abhishek , Bharadwaj Tharun , Muthuraj Likith , Kumar Jitendra , R Pravin Kumar , Lalitha Roopa , Sigamani Gladstone , Ahmad Shaban , Bhanu Piyush , Pathak Ravi Kant , Uttarkar Akshay , Niranjan Vidya , Mishra Vachaspati
Published: October 2024

Nuclear factor-kappa B (NF-kB) plays a crucial role in numerous cellular processes, such as inflammation, immunological responses to infection, cell division, apoptosis, and the development of embryos and neurons. Cytokines, plays an important role in positive feedback loop and leads to inflammatory cell death through the release of pathogenic cytokine known to be cytokine storm which causes diseases like Acute Respiratory Disorder (ARD), multi-organ disorder, Hyperinflammation syndrome and may cause death. This cytochrome storm was identified in the people severely affected by covid-19. NF-kB presents a promising therapeutic opportunity to mitigate covid-19-induced cytokine storm and reduce the risk of severe morbidity and mortality resulting from the diseases. This paper therefore explores the modulation of the NF-kB pathway by inhibiting the binding of the transcription factor as a potential strategy to mitigate the morbidity and mortality caused by cytokine storms. To identify small molecule inhibitors of NF-kB signaling, we screened approximately 101 molecules in two identified pockets of NF-kB (p50/p65)-DNA complex. Each molecule was virtually screened in two pockets (A1 and A2). The focus library was developed starting from chemical structures obtained from the literature (Angelicin and Psolaren) which shows the inhibition of NF-kB signaling, as well as using artificial intelligence (WADDAICA) and rationally designed molecules. Among the 3 highest-scored ligands (NFAI64, NF30 and NF49) selected from the docking studies and further molecular dynamic investigations. The identified compound NF30 showed significantly higher binding affinity (ΔGbinding) in A2 pocket (60.92 ± 1.83 kJ/mol) as compared to the rest of the molecules, making it a promising molecule for the inhibition of NF-kB. The discovered novel compounds by computational studies could be of relevance to identify more potent inhibitors of NF-kB dependent biological functions beneficial to control the cytokine storm occurring in the patients affected with Covid-19.
Impact of appetite stimulants on growth parameters in children with cystic fibrosis
Authors: Sunman Birce , Emiralioglu Nagehan , Gülşen Hayriye Hızarcıoğlu , alboğa didem , atan raziye , yavuz burcu capraz , Gumus Ersin , Demir Hulya , Saltik-Temizel Inci , Ozen Hasan , yalçın ebru , doğru deniz , özçelik uğur
Published: October 2024

Objectives Malnutrition is prevalent among children with cystic fibrosis (CF),often resulting from frequent pulmonary exacerbations and intestinal malabsorption.In addition to providing sufficient calorie intake through enteral formulas, appetite stimulants may help address nutritional deficiencies and improve overall prognosis.Methods This retrospective study included children who received CH as an appetite stimulant for at least three consecutive months.Data on CH-related adverse effects, z-scores for weight,height,body mass index(BMI), and percentage of forced expiratory volume in 1 second(FEV1%)were collected from medical records.Z-scores of growth parameters were calculated at baseline(CH initiation),three months before baseline,and three and six months after treatment.Results The study included 45 children with a mean age of 11 years.Only one patient was on modulator therapy and another was being monitored for pancreatic insufficiency,while one had diabetes.All but one were using formula diet simultaneously.Significant improvements in weight and BMI z-scores were observed from baseline to three months of CH therapy(p = 0.004 and p = 0.006,respectively),with no significant changes noted in the three months before treatment.A modest increase in weight and BMI z-scores was seen from three to six months of therapy.Additionally,FEV1 z-scores significantly increased from baseline to three months of therapy, with no further improvement observed in the subsequent three months.Conclusion Six months of CH therapy was associated with significant improvements in weight and BMI z-scores,particularly within the first three months.No adverse effects were reported.Given the deceleration in the rate of increase in anthropometric z-scores from the third to sixth month, a three-month duration of CH therapy appears to be optimal and sufficient for children with CF.
Artificial Intelligence-based chatbots in providing space maintainer related information for pediatric patients and parents: A comparative study
Authors: BAL Cenkhan , AKSOY Merve , TOPSAKAL Kübra Gülnur , Görgülü Serkan
Published: October 2024

Background
Artificial Intelligence-based chatbots have phenomenal popularity in various areas including spreading medical information. To assess the features of two different chatbots on providing space maintainer related information for pediatric patients and parents.
Methods
12 space maintainer-related questions were formed in accordance with the current guidelines and were directed to ChatGPT-3.5 and ChatGPT-4. The answers were assessed regarding the criteria of quality, reliability, readability, and similarity with the previous papers by recruiting the tools EQIP, DISCERN, FRES, FKRGL calculation, GQS, and the Similarity Index.
Results
ChatGPT-3.5 and 4 revealed that both tools have similar mean values regarding the assessed parameters. ChatGPT-3.5 revealed an outstanding quality and ChatGPT-4 revealed a good quality with mean values of 4.58 ± 0.515 and 4.33 ± 0.492, respectively. The tools also performed high reliability with mean values of 3.33 ± 0.492 and 3.58 ± 0.515 (ChatGPT-3.5, ChatGPT-4; respectively). The readability scores seemed to require an education of a college degree and the similarity levels were lesser than 10% for both chatbots whit a high originality.
Conclusions
The outcome of this study shows that recruiting AI-based chatbots, ChatGPT for receiving space maintainer-related information can be a useful attempt for those who are seeking medical information regarding pediatric space maintainers on the internet.
Ambulatory general anesthetic experience in a child with Lesch Nyhan syndrome: a case report and literature review
Authors: Peng Qing , Pan Ling , Lei Xiaofeng
Published: October 2024

Background
Lesch-Nyhan syndrome (LNS) is a rare congenital disorder, characterized by self-aggression, self-mutilation, choreoathetosis, and intellectual abnormalities. Ambulatory general anesthesia in LNS children presents a range of challenges. We report a child with LNS who received dental treatment in our ambulatory dental center.
Case presentation
A 6-year-old boy with LNS was scheduled to undergo treatment for multiple dental caries under ambulatory general anesthesia. To ensure a smooth process, we implemented specific measures for difficult airway management, prevented nausea, vomiting, and pulmonary aspiration, and balanced the use of anesthetic drugs. Post-treatment, the serum uric acid, serum creatinine, and blood urea nitrogen levels remained normal. The entire anesthesia process was complication-free and the child was discharged on the same day. Additionally, we conducted a review and analysis of relevant literature from PubMed and Google Scholar to summarize the anesthetic management experiences in such cases.
Conclusion
This report details the first successful ambulatory dental general anesthesia for a child with LNS. The management of ambulatory anesthesia for LNS cases is challenging. Despite achieving a positive recovery through comprehensive perioperative management, individualized anesthetic selection and the long-term recovery of the child demand further exploration and research to provide more effective guidance for future clinical practice.
Effects of compounded polyethylene glycol electrolyte powder taken inalt ernation with iced tea beverage before colonoscopy: a prospective randomised controlled study
Authors: Xu Qin , Zhang Min , Gu Shuiqin , Xu Jianping
Published: October 2024

Background
Colonoscopy is considered to be an important tool for early diagnosis of colorectal lesions, screening for colorectal cancer, and to perform treatment of early colorectal lesions. Adequate bowel preparation is a prerequisite for high-quality colonoscopy and is closely related to the diagnostic accuracy and therapeutic safety of colonoscopy.Taking PEGs with sports drinks to regulate flavors, etc. May improve patient compliance and quality of bowel preparation. The aim of this study was to compare patient adherence and efficacy of the bowel cleanser PEG alternating with iced tea drink with the mixture of PEG and iced tea drink.
Methods
This is a prospective randomised controlled study conducted in a tertiary care hospital in Jiaxing, Zhejiang Province, China. A total of 300 patients who underwent painless gastroenteroscopy at the endoscopy center from July 2023 to June 2024 were selected and randomly divided into three groups, A,B,C. Each group consisted of 100 patients, all of whom were given 3 L of Polyethylene Glycol Electrolyte Dispersions (PEG) regimen in divided doses, i.e., 1 L 10 ~ 12 h prior to the intestinal examination, and 4–6 h prior to the examination on the day of the examination Group A was given 3 L of PEG all in lukewarm water, Group B was given PEG 1.5 L of warm water + 1.5 L of iced tea drink mixture, Group C took PEG 1.5 L of warm water while alternating with 1.5 L of iced tea drink. The number of patient's bowel movements, nature of bowel movements, whether they vomited or not, whether they took all of them or not, evaluation of the taste of PEG purgative, and willingness to be re-examined were carried out in the three groups. The endoscopic medical staff objectively evaluated the clarity of bowel vision and bowel preparation scores and statistically analyzed them.
Results
In this study, there was no significant difference in defecation frequency and defecation characteristics among the three groups of patients (P > 0.05). However, in terms of whether the PEG solution was drunk, whether there was vomiting, and the taste of the bowel cleansing agent, group C performed significantly better than groups A and B (P < 0.01). Compared with Group A, Group B also performed better in these aspects. Group C also performed well in terms of Bowel Preparation Quality, Check willingness again, Clear view of intestines, and whether there were polyps, which was significantly higher than the other two groups (P < 0.05).
Conclusion
The overall evaluation of complex polyethylene glycol electrolyte powder taken alternately with iced tea beverage before colonoscopy was superior and clinical promotion is recommended.
Registration:
ChiCTR2300075025(2023-10-08).
An Association between Gestational Diabetes Mellitus and Neurodevelopmental Outcomes in Infants: A Retrospective Single Hospital-Based Cohort Study
Authors: MKWAMBE MAIKO Charles , Youping Deng , Zhao Dongchi
Published: October 2024

Background
Gestational diabetes mellitus (GDM), a condition characterized by high blood sugar levels during pregnancy, is increasingly prevalent globally. While resolving after delivery, GDM can have lasting implications for the developing fetus, particularly regarding neurodevelopmental outcomes. This association is garnering significant attention within the medical community, driving research into the underlying mechanisms and potential interventions. We aimed to investigate the prevalence and association between gestational diabetes mellitus (GDM) and neurodevelopmental outcomes in infants.
Methods
This Retrospective Single Based cohort study utilized data from 2018 to 2022 at Zhongnan Hospital of Wuhan University. A total of 1430 for gestational diabetic mothers and 1430 infants aged 0 to 12months were recruited in the study. Inclusion criteria: Mothers with confirmed diagnosis of Gestational Diabetes Mellitus, no pre-gestational diabetes mellitus. Infants aged 0 to 12months, born from gestational diabetic mothers.
Results
A total of 1430 infants, male 832(58.18%); Female 598(41.82%). Prevalence of gestational diabetes mellitus was 75.61%. The overall Denver II Developmental Screening Test Results were; Normal 1370(95.80%), Abnormal 8(0.56%), Suspicious 44(3.10%) and Unable to Judge 8(0.56%). The probability of finding abnormal findings on DDST was higher on primiparity, p < 0.001; on normal head circumference, p = 0.002; on earliest infants’ age less than six months, p = 0.043; and on normal anterior fontanelle, p < 0.001. Mental response; infants with [(normal head circumference and microcephaly showed poor mental responses compared to macrocephaly infants p < 0.001); infants with low weight level, birth weights between 1-1.5k, 1.5-2.5kg and 2.5-4kg and normal anterior fontanelle showed abnormal mental responses; all p < 0.001]. Gender, maternal age, Gestational age, Delivery method, and Birth length, showed no statistically significant on mental response; p > 0.05.
Conclusion
The findings from this study underscore the significant impact of gestational diabetes mellitus on neurodevelopmental outcomes in exposed infants to GDM. Infants born to mothers with GDM showed varied neurodevelopmental and mental response impairments, with certain levels being more susceptible.
Performance Evaluation of Biopolymer-treated Black cotton soil
Authors: kirtimayee B , Dash Sabita , Rout Manasmita
Published: October 2024

This paper investigates the effect of biopolymers i.e xanthan gum (XG) and gaur gum (GG) for stabilizing black cotton soil. In recent years, it was observed that the usage of biopolymers has significantly reduced environmental effects due to traditional stabilization process. Biopolymers are synthesized products of microorganisms and plants emerging as a suitable alternative to ground improvement. In the current experimental work individual and collective performance of xanthan gum and gaur gum has been observed. The variation of xanthan gum and gaur gum was kept as 2%, 3% and 5% of dry soil weight. The results showed a significant improvement in strength properties of soil. The OMC-MDD relation was assessed through both light and heavy compaction. Maximum dry density showed a noteworthy increment where as the optimum moisture content was found to decrease in case of heavy compaction. The trend was exactly opposite for OMC and MDD in case of light compaction. An increasing trend was observed in consistency limit values with increase in additive percentage. Overall it was observed that xanthan gum showed comparatively better performance than Gaur Gum.
Population-level effect of COVID-19 full vaccination coverage on transmission and mortality during Omicron variant dominance: a global longitudinal analysis
Authors: Ogbodo Stephen Chukwuma , Damba Joseph Junior , Olaoye Omotayo , Ofili Divine-Favour Chichenim
Published: October 2024

Aim
Given the higher transmissibility of the SARS-CoV2 Omicron variant and associated concerns about reduced vaccine effectiveness, we assessed the population-level impact of COVID-19 vaccination on viral transmission and mortality during the period of global Omicron dominance.
Subject and Methods
: We used a longitudinal dataset of 110 countries over 16 months (January 2022 to April 2023), representing the period of global Omicron dominance. Applying country-level random effects regression models, we assessed the effect of lagged monthly full vaccination coverage on the monthly rates of new confirmed COVID-19 cases and deaths across these countries, adjusting for a wide range of country characteristics and policy interventions. We obtained the data from open-access databases, including the WHO COVID-19 Dashboard and the Oxford COVID-19 Government Response Tracker.
Results
On average, each 1 percentage point increase in full vaccination coverage was associated with a 1.4% reduction (95% confidence interval [CI]: 0.1–2.8%, p = 0.035) in the rate of new cases and a 5% reduction (95% CI: 3.6–6.4%, p < 0.001) in the rate of deaths. This protective effect was graded across levels of vaccination coverage: compared to countries with vaccination coverages < 50%, countries with coverages of 50–59%, 60–69%, 70–79% and ≥ 80% had 20.5% (95% CI: -16.4–45.7%, p = 0.20), 53.8% (22.6–72.5%, p = 0.003), 54.3% (15.5–75.3%, p = 0.01), and 69.6% (38.7–84.9%, p < 0.001) lower rates of new cases respectively, on average.
Conclusion
Our findings underscore the crucial role of vaccination in mitigating the impact of pandemics, particularly during the emergence of highly transmissible variants like Omicron.
Predictors of mortality in emergency admissions screened for sepsis as part of the Commissioning for Quality and Innovation (CQUIN) sepsis indicator: a secondary analysis of a national linked dataset
Authors: Robinson Carla , Packer Simon , Howkins Joshua , Mulchandani Ranya , Lamagni Theresa , Brown Colin , Oliver Isabel , Reynolds Rosy
Published: October 2024

Background
The Commissioning for Quality and Innovation (CQUIN) indicator on sepsis was introduced in 2015 to incentivise screening eligible emergency admissions for sepsis, with the aim to improve patient outcomes through early identification and timely treatment. The CQUIN sepsis indicator provides an alternative source of data which has potential in improving our understanding of sepsis epidemiology in England and for surveillance and monitoring purposes. Our objectives were to describe 30-day mortality when using CQUIN sepsis indicator data compared to Hospital Episode Statistics (HES) data, determine whether the CQUIN sepsis screen result was a good predictor of mortality, and identify other independent predictors of mortality in emergency admissions being screened for sepsis in CQUIN.
Methods
This study was a secondary analysis of a national linked dataset which contains CQUIN sepsis indicator data for financial year 2017/18 from a random sample of 30 NHS hospital trusts in England, linked to HES data and Office for National Statistics mortality data. Descriptive and univariable analyses were conducted to explore differences in mortality for admissions who screened positive or negative for sepsis in CQUIN. A multivariable logistic regression analysis was conducted to identify independent predictors of 30-day mortality.
Results
30-day mortality for emergency admissions who screened positive for sepsis in CQUIN was 17% compared to 11% for admissions who screened negative. 30-day mortality differed when using CQUIN sepsis indicator data compared to HES data. We identified some evidence to suggest that the CQUIN sepsis screen result may be an independent predictor of 30-day mortality (adjusted OR, 1.27; 95% CI: 1.03–1.57). Other predictors of mortality included: age, respiratory infection, and the presence of comorbidities such as cancer, dementia, renal disease, liver disease and cardiovascular disease.
Conclusion
CQUIN sepsis screen identified emergency admissions who were more likely to have poor outcomes, though evidence was limited. Other independent predictors of mortality were identified. Variability in how the CQUIN sepsis indicator was applied limits use of the CQUIN sepsis indicator data, however, this study provides a foundation for further research to improve understanding of sepsis epidemiology in England and inform development of future indicators for clinical and surveillance purposes.
XBP1 activation elevates abnormal synthesis of polyunsaturated fatty acids in hepatocytes to promote liver injury during anti-tuberculosis drug metabolism
Authors: Qian Yulan , JIANG YU , Son Quan , Guo Yuqing , Zhang Jianping , Wu Meiying , Pan Yunzhi , Ma Sai
Published: October 2024

Objective
This study aimed to explore new mechanistic insight into the link between abnormal lipid metabolism and ATB-DILI.
Methods
We performed integrative analyses of RNA-Seq, ChIP-Seq, lipids mass spectrometry, in vivo and in vitro experiments, and clinical samples to identify the key pathways and molecules involved in the process of ATB-DILI.
Results
Our study revealed that the cellular polyunsaturated fatty acids (PUFAs) synthesis was abnormally activated in hepatocytes during anti-TB drug metabolism. The levels of phosphatidylethanolamine substrates, ferroptosis-related arachidonic acid, and key enzyme Acyl-CoA synthetase long-chain family member 4 (ACSL4) were significantly up-regulated in ATB-DILI. Further exploration indicated that this phenomenon was linked to the endoplasmic reticulum stress factor X-box binding protein 1 (XBP1). XBP1 activation significantly enhanced the synthesis of PUFAs, thereby increasing the level of lipid peroxidation and ferroptosis, ultimately resulting in ATB-DILI. Moreover, serum Apolipoprotein levels in A-IV (APOA4) and triglyceride were elevated and may serve as early warning biomarkers for ATB-DILI.
Conclusions
These results systematically revealed the importance of XBP1 as a therapeutic target, and clarified the feasibility of using APOA4 and triglyceride as novel early warning biomarkers for ATB-DILI.
Social determinants of youth with mild intellectual disability in outpatient care for mental health problems: a case-control study
Authors: Storm M. M.C. , Giltay E. J. , Eldik W. M. , Palstra E. C. , Duin E. D.A. , Berg D. , Vermeiren R. R.J.M.
Published: October 2024

This study examined the unique role of diverse social determinants of mental health (SDOMH) associated with mental health problems (MHP) for children with mild intellectual disability (MID), compared to peers with and without MHP. This population-based case-control study included four groups aged 0–17 years (Mage = 10.6, 35.6% female). Two groups of children receiving outpatient mental health care for MHP with MID (n = 505) and without MID (n = 2,767), each with a matched control group from the general population (n = 2,525 and n = 13,835, respectively), were studied. Through multivariate logistic regression analyses, both MHP groups were compared to their control group and each other to examine the likelihood of a SDOMH associated with receiving mental health care for MHP in children with and without MID. Children with MID receiving mental health care showed significant differences in multiple domains compared to their control group and to children receiving mental health care without MID. They were less likely to have European-born mothers, more likely to have parents with moderate or low education levels, and tended to live in smaller, single-parent, lower-income households. Similar, though less deviant, patterns were observed for children without MID receiving mental health care compared to the general population, except for parental education. Our study highlights that diverse SDOMH are associated with the likelihood of receiving care for MHP in children. Moreover, children with MID face disproportionate disadvantages, particularly regarding low parental education and household income. Thus, interventions should not only target the child but also their family and environmental context.
Molecular characterization and prognostic relevance of m6A regulators in pancreatic adenocarcinoma
Authors: Liu Mei , Chen Chuwen , Zhang Xiao , Shen Junyi , Peng Wei , Zhang Xiaoyun , Wen Tianfu , Li Chuan
Published: October 2024

Background
RNA N6-methyladenine (m6A) modification played an essential role in the occurrence and development of malignant tumors. m6A modification patterns in immune response and tumor microenvironment (TME) remains an enigma.
Methods
25 m6A regulators were collected, the molecular alterations and clinical relevance of which were explored. The mutation landscape of the pancreatic adenocarcinoma (PAAD) patients was explored by using TCGA data. The expression difference of the m6A regulators was identified by TCGA and HPA data. The prognosis value of the m6A regulators was measured by TCGA and ICGC data. Consensus clustering analysis was used for different m6A modification patterns identification. CIBERSORT and ESTIMATE algorithms were used to explore the landscape of TME cell infiltration. DEG analysis was used for m6A-related gene identification. m6A-score signature was established by using univariate Cox regression analysis and PCA.
Results
CNV amplification of m6A regulators led to up-regulated of them in tumor tissues in comparison with normal tissues. 13 of the 25 regulators showed oncogenic features. Two distinct m6A modification patterns were defined. PAAD patients in m6Acluster A occupied better survival compared to m6Acluster B. The relationships between the two m6A patterns and different types of immune infiltrating cells were further identified. A consolidated scoring system to quantify the m6A modification pattern of individual patients was established. Patients in low m6A-score group had better OS compared with these in high m6A-score group. Subsequent analysis proved that m6A methylation modification patterns was associated with response to anti-PD-L1 immunotherapy.
Conclusions
The molecular alterations and prognostic implications of m6A regulators were analyzed. The distinct m6A modification patterns are crucial for understanding the heterogeneity and complexity of individual tumor microenvironments (TMEs). A comprehensive assessment of m6A modification in tumors enhances our understanding of TME infiltration characteristics and facilitates more effective immunotherapy strategies.
Exploring the Potentials and Pitfalls of Work Experience and Widening Participation through Narrative Interviews
Authors: Green Alice , Jackson Dawn , Ward Derek
Published: October 2024

Background Applicant work experience (WE) is a non-academic criteria considered by many medical schools in their admissions processes. Concerns have been raised within the literature that access to some WE opportunities may be more elusive for students from less advantaged socioeconomic backgrounds (LA-SDBs). Few qualitative studies exist which explore applicant experiences of WE, and its contribution to the widening access agenda. Our qualitative research explores the WE of applicants from a variety of socio-demographic backgrounds, and draws on Bourdieu’s concepts of ‘capital’ and ‘habitus’ as tools which enable critical analysis of the role work experience may play in the reproduction of inequality.Methods Narrative telephone interviews were undertaken with 23 applicants to a large United Kingdom medical school in the 2017-18 admissions cycle, purposively sampled backed on school background, age, gender and widening participation experience. Framework analysis was applied to interview data, and themes and subthemes identified.Results WE remains a key step in the preparation process for applicants when applying to medical school. Participants suggested WE has the potential to confirm career choice and deepen understanding about the realities of a career in medicine. At times, applications from LA-SDB’s were provided with application support from healthcare professionals through WE which may have otherwise been inaccessible. Access to WE opportunities depended on access to information networks or school support, typically a barrier for those from LA-SDB’s, and myths and misinformation about WE were more commonly evident in this group.Conclusion Meaningful and equitable engagement in WE requires a consideration of more than just access to WE opportunities. Our results suggest that applicants require timely and transparent information on how best to engage with WE opportunities. Additionally, communication with under-represented schools, directed at dispelling myths and fostering meaningful reflection, may go some way to mitigate the risk of social and cultural disadvantage in applicants from LA-SDBs. .
Effect of Fluorometholone on the Pre-operative Tear Cytokine Profile and Post- trabeculectomy Outcomes of Medicated Asian Glaucoma Patients
Authors: Huang Olivia S. , Sim Jackie Jia Lin , Htoon Hla M. , Chew Annabel C Y , Chong Rachel S , Husain Rahat , Perera Shamira , Wong Tina T.
Published: October 2024

Aim: To determine if a 2-weeks pre-operative course of fluorometholone (FML) eyedrops in chronically medicated glaucoma patients reduces pro-inflammatory cytokines levels pre-operatively and improves early post-operative outcomes after trabeculectomy or phaco-trabeculectomy.
Methods: Asingle-center, unmasked, prospective pilot interventional case series of 36 FML-pretreated glaucoma patients, who received a 2-week pre-operative course of FML eyedrops, and 307 glaucoma patients without FML pre-treatment on chronic IOP-lowering topical medications undergoing trabeculectomy or phaco-trabeculectomy. Multiplex bead assay was used to quantify the presence of pro-inflammatory cytokines in tear samples before and after the use of FML eyedrops, prior to surgery. Clinical outcome measures of post-operative outcomes included IOP and additional post-operative interventions (i.e. needling, glaucoma medications and surgery) required to achieve desired IOP at 6 months.
Results: After excluding patients with a low MCP-1 level (<250pg/ml/mg) at baseline, propensity score matched analysis showed that the mean age for the FML group (n=17) was 71.88 years and the non FML group (n=17) was 73.71 years (p=0.449). The mean duration of glaucoma medications used pre-operatively was 31.29 months (FML group) and 34.79 months (non-FML group) (p=0.763). Patients with FML treatment had a lower odds of requiring any post-operative intervention (including needling, surgery or IOP-lowering medications) (OR 0.22, CI 0.049-0.95, p=0.042) compared to patients who did not have pre-operative FML treatment.
Conclusions: In patients with higher levels of MCP-1 pre-operatively, the use of FML for 2 weeks pre-operatively improved their early post-operative outcomes following trabeculectomy or phaco-trabeculectomy.
Evaluating Effectiveness of sEMG Biofeedback for Posture Training and Scoliosis Management
Authors: Wong Yiu Hong , Cheung Mei-chun , Lei Qiwen Emma , Yip Joanne
Published: October 2024

The vast majority of the global population uses digital devices, in particular, smartphones and tablets. Their use causes the head to tilt forward, and the posture exerts a significant amount of strain onto the neck and shoulders of users. This would normally have adverse effects on a healthy population but poor posture especially exacerbates the spinal deformation of scoliosis patients. As such, this study evaluates the effectiveness of a 30-session surface electromyography (sEMG) biofeedback posture training program for managing the progression of spinal curvature in adolescents with mild scoliosis. The program is designed to reduce imbalanced paraspinal muscle activity and control the progression of the curvature. Prior to the training, significant imbalance is observed in the muscle activity. However, post-training, the muscle activity increases in balance with significant improvements noted in the trapezius and lumbar erector spinae muscles. The study also finds that the training effectively controls the progression of scoliosis. These findings suggest that sEMG biofeedback posture training can be an effective intervention for adolescents with mild scoliosis. Further research is however needed to confirm the findings and explore the long-term effects of the intervention.
Cryoablation in male patients with breast cancer: two first-time case reports
Authors: Sanvido Vanessa Monteiro , Holmes Dennis R. , Bromberg Silvio Eduardo , Waitzberg Angela Flávia Logullo , Gomes Jackeline Oliveira , Barbante Leticia Galvão , Junior Antonio Rahal , Tachibana Bruna Mayumi T , Socolowski Luis Ricardo , Silva Leonard Medeiros , Cavalcanti Alexandre Biasi , Nazário Afonso Celso Pinto
Published: October 2024

Background
The rarity of male breast cancer often relies on data extrapolated from its female counterpart for treatment guidance. Among the promising local treatment modalities for breast cancer, cryoablation stands out.
Case presentation
These meticulous cases confirm the importance of cryoablation and its transformative role in the treatment of early-stage breast cancer, including cases of male breast carcinoma. The main objective of this study was to describe the first two clinical cases involving the interventional protocol, the imaging attributes of the postcryoablation breast, and the feasibility of cryoablation as a specific surgical alternative for male breast cancer patients. To our knowledge, these are the first reported cases of cryoablation in the literature in this setting.
Conclusions
Cryoablation presents an attractive option to treat male patients with breast cancer, providing better therapeutic options.
Impact of maternal hypothyroidism on fetal thyroid gland: a prospective longitudinal cohort study
Authors: Feng Xinyuan , Sun Huijie , Liu Tianci , Li Liang
Published: October 2024

Background
Maternal hypothyroidism has been associated with impaired offspring neurodevelopment but the underlying mechanisms are unclear now. We hypothesize that maternal hypothyroidism influences the development of fetal hypothalamic-pituitary-thyroid axis and thyroid tissue, and thereby indirectly affects postnatal cognitive development.
Methods
This prospective cohort study included singleton pregnancies with hypothyroidism before 14 weeks of gestation. Ultrasound measurements of fetal thyroid size were performed at 21–24 and 28–32 weeks. The primary outcome was fetal thyroid volumes at two time points, and the secondary outcomes were pregnancy and neonatal outcomes, including birthweight, delivery weeks, preterm birth, stillbirth or miscarriage, and neonatal thyroid functions on the third postnatal day.
Results
A total of 136 women participated in this study, comprising 68 with hypothyroidism and 68 with uncomplicated pregnancies. There was no significant difference between the hypothyroidism and control group of fetal thyroid volumes measured at gestation of 21–24 weeks (230.58 ± 63.75mm3 vs 230.15 ± 75.69mm3, P = 0.98 ) and 28–32 weeks (491.55 ± 154.88mm3 vs 450.16 ± 136.13mm3, P = 0.059). Additionally, the incidence of adverse events was also similar between groups. These findings remained unchanged in subgroup analyses.
Conclusions
The results of this study suggest that well-controlled maternal hypothyroidism may not significantly influence the fetal hypothalamic-pituitary-thyroid axis. And further randomized controlled trials and fundamental studies are warranted to confirm the underlying mechanism and long-term clinical consequences of the potential effect.
Comparison of the TEG 6s thrombelastograph with conventional coagulation parameters in infants and toddlers during craniosynostosis surgery - a prospective observational clinical study
Authors: Fideler Frank , Beck Franziska , Feng You-Shan , Drexler Berthold , Magunia Harry , Schuhmann Martin U , Rosenberger Peter , Straub Andreas
Published: October 2024

Background: Craniosynostosis surgery (CS) is associated with severe diffuse perioperative bleeding which can result in a significant coagulopathy. The Thrombelastograph Coagulation Analyzer TEG 6s is a modern point of care (POC) device for rapid detection of perioperative coagulation disorders and for the guidance of coagulation factor substitution. By now little is known about changes in TEG 6s values in infants and toddlers with perioperative coagulopathies. The aim of this study was to monitor, compare and relate TEG 6s parameters with conventional coagulation parameters (CCP) during pediatric CS.
Methods: In this prospective clinical observational study 29 infants and toddlers (median age 6 months, median weight 8.5 kg) undergoing CS were enrolled. Blood was sampled pre- and perioperatively. Samples were analyzed by TEG 6s and using CCP (prothrombin time, aPTT, INR, fibrinogen, factor XIII, and antithrombin III). The TEG 6s parameters (reaction time “R”, coagulation time “K”, maximum amplitude “MA”) and CCP were related using linear regression analyses.
Results: Regarding the linear relationship of “R”, “MA”, and “K” of the TEG 6s assays CK, CRT, CKH, and CFF with CCP highest R2 values were obtained for the CK-R – aPTT relationship (R2 = 0.448), for the CK-MA – fibrinogen relationship (R2 = 0.47) and for the CK-K - aPTT relationship (R2=0.631).
Conclusions: The relationship between TEG 6s and conventional coagulation assays is rather low in the perioperative setting of CS in infants. This may be explained by the fact that TEG 6s and conventional coagulation assays do not employ identical methods and do not measure the same coagulatory substrates and dynamics. Our results may contribute to the establishment of reference ranges for TEG6s parameters.
Further studies should evaluate which method may be preferred and should establish algorithms and treatment thresholds to guide coagulation management in the pediatric population.
Trial registration: not applicable (observational data only, no trial interventions)
Evaluating Sensitivity, Specificity, and Optimal Cutoff Scores of the Montreal Cognitive Assessment Using U.S. National Alzheimer Coordinating Centre Uniform Data Set: A Retrospective Analysis of 16,309 Participants
Authors: Ismail Youssef A. , Auf Huda A. , Sadik Shahd A. , Ahmed Nada M.
Published: October 2024

Background: Neurodegenerative diseases (NDDs) like Alzheimer's disease and Mild Cognitive Impairment are characterized by progressive cognitive decline, with limited effective treatments available. Several screening tools are available for diagnosing MCI and dementia, including the Rapid Cognitive Screen, the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Dementia Rating Scale (DRS).
Objective: This study aims to evaluate the sensitivity and specificity of MoCA to determine its suitability as a diagnostic tool in screening programs.
Methods: The study analyzed data from participants aged 55 and older, recruited from U.S. Alzheimer's Disease Research Centers (ADRCs), using a National Alzheimer Coordinating Center Uniformed Data Set (NACC-UDS). Participants had an initial diagnosis and complete records, focusing on MoCA and then was followed by evaluations to classify MCI, dementia, or no impairment. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC).
Results: The study utilized an initial dataset of 188,700 participant records from NACC. After applying inclusion criteria, 16,309 participants were included. The participants had complete diagnostic information, clinician-conducted cognitive assessments, and MoCA scores. The participants were categorized into three groups: 7,624 with no cognitive impairment (NoCI), 4,893 with MCI, and 3,792 with dementia. The study focused on MoCA scores, revealing significant differences among diagnostic groups (P< 0.001). ROC analysis demonstrated the MoCA's strong diagnostic capability, with AUC values significantly above 0.5 (P < 0.001). Sensitivity and specificity were calculated at the recommended cutoff scores of 26 and 21, while the "optimal" cutoff scores were identified as (< 24) for detecting MCI and (< 21) for dementia based on the Youden index in reference to individuals with no cognitive impairment. Although PPV was generally low, the high NPV across comparisons underscores the MoCA's effectiveness in ruling out cognitive impairment.
Conclusion: The study confirms MoCA as an effective tool for detecting dementia, showing 83% sensitivity and 82% specificity at a cutoff value of 21. With a high NPV of 94%, MoCA is particularly reliable for ruling out dementia. However, its ability to identify MCI is limited, with a sensitivity of 52.7%. Despite this, MoCA's 87% specificity helps reduce false positives for MCI, supporting its overall validity as a cognitive assessment tool.
Video-based Coaching Improves Trainee Robotic Technical Performance
Authors: Clanahan Julie M. , Gerull William D. , Williamson Andrea J.H. , Ohman Kerri A. , Yee Andrew , Awad Michael M.
Published: October 2024

Purpose
While video-based surgical coaching (VBC) can improve operative performance, it is not widely utilized in surgical training due to limited video access. New robotic platforms enable automated access to operative video and performance metrics. The aim of this study is to evaluate the effect of structured robotic VBC on technical skills of surgical trainees.
Methods
Surgical resident participants were randomized to control or coaching groups over a 1-year intervention period. Both groups obtained operative assessments (RO-SCORE) during rotations, and active control time (ACT) robotic case participation metric was also analyzed. The coaching group received 1-hour VBC with trained robotic faculty coaches between operative assessments. Wilcoxon, paired t-tests, and descriptive statistics were applied.
Results
Fourteen residents completed the study (6 control, 8 coaching). Overall technical performance on RO-SCORES improved for coached residents (median 2.0 v 3.0, p = 0.031) with greatest improvement in procedural efficiency and flow (median 3.0 v 4.0, p = 0.0156). Overall technical performance did not change for the control (median 3.0 v 3.0, p = 0.50). Although mean percent ACT increased for the coaching group (44 ± 9.0 v 49 ± 20, p = 0.42) this was not statistically significant. Mean percent ACT was unchanged for control (49 ± 12 v 48 ± 38, p = 0.92). Most coached residents (88%) found VBC very or extremely valuable and were highly satisfied with coaching feedback.
Conclusions
This study demonstrates that VBC within robotic surgery can accelerate resident technical skill development. Residents who received coaching reported high value and satisfaction compared to traditional teaching. With improved video access, training programs should implement VBC to support competency development in minimally invasive technologies.