bluuebunny/crossref_metadata_2025 huggingface dataset:
DETERMINANTS OF FAT CONTENT AND FATTY ACID COMPOSITION IN MILK OF COWS OF DIFFERENT BREEDS. PART 2: EFFECT OF COWS’ AGE
Authors:   Department of Cattle Breeding and Milk Production, Wroclaw University of Environmental and Life Sciences, Poland, PRZYBYLSKA Paulina , KUCZAJ Marian ,   Department of Cattle Breeding and Milk Production, Wroclaw University of Environmental and Life Sciences, Poland
Published: December 2024

The aim of the study was to analyze the effect of cows’ age on the fat content and fatty
acid profile in milk of cows of three breeds: Polish Red-White (ZR), Polish Red (RP) and Polish Holstein-Friesian Red-White (RW). The study included 473 cows kept on 17 farms. The cows studied
were of different ages, this is in 1st, 2nd, 3rd, ≥4th lactation. Milk samples were collected from each
cow during a test milking. The study showed that the milk of younger cows (1st–3rd lactation) of the
RP breed and older cows (≥4th lactation) of the ZR breed was characterized by the most favorable
fatty acid profile. In the milk fat of both groups of cows, significantly (p < 0.05) and highly significantly
(p < 0.01) the highest contents of many of the tested monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) were found, as well as highly significantly (p < 0.01) the lowest concentration of
some of the tested saturated fatty acids SFA. Milk from RW cows (regardless of the age of the animals)
was the milk with the lowest nutritional value in terms of fatty acid composition – significantly (p < 0.05) and
highly significantly (p < 0.01) the lowest concentration of many health-promoting MUFA and PUFA acids
and significantly (p < 0.05) and highly significantly (p < 0.01) the highest content of some SFA acids that
are unfavourable to the health of consumers. The lowest fat concentration was determined in the milk of
older cows from the ZR breed (≥4th lactation), while the highest fat concentration was noted in the milk of
younger cows from the RP breed (1st–3rd lactation). The obtained results provide important information
on the health-promoting values of milk produced by cows of the three breeds studied. Moreover, they can
become valuable information for both raw milk producers and consumers of so-called functional food.
The impact of breeding and farming conditions on the welfare of alpacas (Vicugna pacos)
Authors:   West Pomeranian University of Technology, Department of Animal Reproduction Biotechnology and Environmental Hygiene, Faculty of Biotechnology and Animal Husbandry, Klemensa Janickiego 29, 71-270 Szczecin, Poland, Pilarczyk Bogumiła , Pilarczyk Renata ,   West Pomeranian University of Technology, Department of Ruminant Science, Klemensa Janickiego 29, 71-270 Szczecin, Poland, Sablik Piotr ,   West Pomeranian University of Technology, Department of Ruminant Science, Klemensa Janickiego 29, 71-270 Szczecin, Poland
Published: December 2024

The welfare of alpacas in farming varies and is influenced by various factors, including environmental conditions,
nutrition, interactions with humans, and grooming and breeding practices. It is crucial to provide adequate space
for the animals both indoors and in outdoor areas due to their herd-oriented nature. Interactions with humans play
a significant role in alpaca farming. Proper handling and gentle treatment positively affect their behavior. However,
excessive contact at a young age may lead to undesirable behaviors such as Berserker syndrome. Processes such as
birthing, weaning, shearing, as well as other breeding practices, impact the welfare of alpacas. Understanding the
animals’ natural needs and minimizing stress are essential to providing optimal living conditions for them.
The effect of partial replacement of protein concentrate in the diet with legume seeds on the fattening and slaughter value of pigs
Authors:   Department of Animal Breeding and Nutrition, Faculty of Animal Breeding and Biology, Bydgoszcz University of Science and Technology, Mazowiecka 28, 85-084 Bydgoszcz, Poland, Cebulska Aleksandra , Jankowiak Hanna ,   Department of Animal Breeding and Nutrition, Faculty of Animal Breeding and Biology, Bydgoszcz University of Science and Technology, Mazowiecka 28, 85-084 Bydgoszcz, Poland, Weisbauerová Eva ,   Institute of Animal Science, Prague-Uhˇríneves, Komenského 1239, Kostelec nad Orlicí, 517 41 Czech Republic
Published: December 2024

Pig production profitability is dependent on a number of factors that determine the extent of expenses incurred,
taking into account the prices of slaughter animals, the production system and the prices of cereals included in
compound feed. However, the most crucial factor is the cost of pig feeding. The aim of this work was to assess
the impact of partial replacement of protein concentrate with legume seeds in complete feeds on pig growth rate
and fattening efficiency under rearing conditions of a conventional farm. The polish breed crossbred fatteners were
divided into two groups with different composition of the fed feed mixture. The analysis covered fattening characteristics and slaughter characteristics. In addition, the value of sales and cost of pig feeding were analysing. In this
study, the fatteners fed a feed mixture with legume seeds had higher warm carcass weights, thinner backfat, and
higher carcass meat content compared to pigs from control group, which ultimately translated into higher profit on
fattener production. A minimum proportion of legume seeds in a feed mixture for pigs has been shown to have a
significant impact on growth rate and slaughter value.
THE CHARACTERISTICS OF COAT COLOR OF SANDOMIERSKA GOATS
Authors:   Department of Animal Breeding and Agricultural Consulting, University of Life Sciences in Lublin, Akademicka 13, 20-950, Lublin, Poland, Greguła-Kania Monika , Urbanska Daria M. ,   Department of Animal Breeding and Agricultural Consulting, University of Life Sciences in Lublin, Akademicka 13, 20-950, Lublin, Poland
Published: December 2024

The Sandomierska goat is one of three native breeds of goats living in Poland. A characteristic feature of Sandomierska goats is their colorful coat. Currently, four types of coat color are distinguished: gray-piebald, black-piebald,
brown-piebald and three-colored. The color of the skin and fur is one of the forms of adaptation to relevant climate, because the thermoregulatory reaction varies depending on the color of the coat. Therefore, the aim of the
study is to analyze the frequency of types of coat color in Sandomierska goats, and the general characterization of
goat hair. Both sexes of the Sandomierska goat are dominated by black-piebald color. The least common color is
brown-piebald. In turn, the three-colored coat was identified only in females registered in breed registry. The hair
analyzed showed the presence of an intermittent, fragmented and a spongy medulla. Hair scale pattern are regular
and unregular wave with rippled scales margin in Sandomierska goats.
Penerapan Model Teams Games Tournament (TGT) Untuk Meningkatkan Hasil Belajar Matematika Siswa Kelas V-B Sekolah Dasar
Authors: Agustin Dwi , Regina Belinda Dewi , Wardani Rini Setyo
Published: December 2024

This study aimed to improve the mathematics learning outcomes of fifth-grade students at SDN Klojen through the implementation of the Teams Games Tournament (TGT) learning model. The background of this research was the low learning outcomes caused by monotonous teaching methods that failed to actively engage students. This research employed a Classroom Action Research (CAR) approach, consisting of planning, implementation, observation, and reflection stages. The subjects were 22 fifth-grade students. Data were collected through observation, tests, and documentation, then analyzed descriptively using qualitative and quantitative methods. The results showed that the TGT model created a more interactive, enjoyable, and collaborative learning experience. The game-based approach and group discussions motivated students to learn and actively participate. Initially, students struggled to understand the material on whole-number operations. However, after the implementation of TGT, their comprehension improved gradually. In the second cycle, improvements such as simpler language usage and the addition of interactive quizzes significantly enhanced student engagement and learning outcomes. Beyond improving academic achievement, the TGT model also supported the development of students' social skills, such as communication, teamwork, and critical thinking, which align with the demands of modern education.
 
Abstrak
Penelitian ini dilakukan untuk meningkatkan hasil belajar matematika siswa kelas V-B SDN Klojen melalui penerapan model pembelajaran Teams Games Tournament (TGT). Latar belakang penelitian ini adalah rendahnya hasil belajar siswa akibat model pembelajaran yang monoton dan kurang melibatkan siswa secara aktif. Penelitian ini menggunakan pendekatan Penelitian Tindakan Kelas (PTK), yang terdiri dari tahapan perencanaan, pelaksanaan, observasi, dan refleksi. Subjek penelitian adalah 22 siswa kelas V-B. Data dikumpulkan melalui observasi, tes, dan dokumentasi yang dianalisis secara deskriptif kualitatif dan kuantitatif. Hasil penelitian menunjukkan bahwa model TGT mampu menciptakan pembelajaran yang lebih interaktif, menyenangkan, dan kolaboratif. Pendekatan berbasis permainan dan diskusi kelompok membuat siswa lebih termotivasi untuk belajar dan aktif dalam pembelajaran. Pada tahap awal penelitian, siswa mengalami kesulitan dalam memahami materi operasi bilangan cacah. Namun, setelah penerapan TGT, pemahaman siswa terhadap materi meningkat secara bertahap. Pada siklus kedua, perbaikan seperti penggunaan bahasa yang lebih sederhana dan penambahan kuis interaktif terbukti meningkatkan keterlibatan siswa dan hasil belajar mereka secara signifikan. Selain meningkatkan hasil belajar akademik, model TGT juga mendukung pengembangan keterampilan sosial siswa, seperti komunikasi, kerja sama, dan berpikir kritis, yang relevan dengan tuntutan pendidikan di era modern.
Beyond Single Accreditation: Exploring Factors Influencing Selection of Osteopathic Medical Students in the Orthopaedic Surgery Residency Match
Authors: Hartman Hayden , Randall Shea E. , Mansour Julia , Tung Wei Shao , Gianakos Arianna L. , Rumps Mia V. , Mulcahey Mary K.
Published: December 2024

Introduction:

The purpose of this study was to evaluate DO orthopaedic surgery residents compared with their MD counterparts in traditionally allopathic programs, assessing research productivity, number of departmental DO faculty and alumni, and geographical ties to the residency program.

Methods:

The Fellowship and Residency Electronic Interactive Database was used to retrospectively identify traditionally allopathic ACGME-accredited orthopaedic surgery residency programs for the 2023 to 2024 year. Residency program websites Scopus, PubMed, and Doximity were used to collect data.

Results:

A total of 150 orthopedic surgery residency programs were identified, with 3,712 residents. Of these residents, 58 (1.6%) were DOs and 3,654 (98.4%) were MDs. MDs had a median H-index of 2 (interquartile range [IQR] 1-4) and median 4 publications (IQR 2-10), whereas DOs had a median H-index of 0 (IQR 0-1) and median 1 publication (IQR 1-3). Sixty-one programs (40%) had DO faculty (138), with 65% (38) matching at a program with ≥1 DO faculty member (20 programs; 13.3%).

Conclusions:

Despite a unified accreditation system, this study demonstrates that orthopaedic surgery continues to favor allopathic applicants, with 1.6% of traditionally allopathic program residents being DOs. The presence of DO faculty, alumni, or residents in a program does not significantly impact DO match rates, emphasizing the multifactorial nature of resident selection. Understanding these dynamics is crucial for addressing selection biases and promoting equity in orthopaedic surgery resident selection.
Evaluación y caracterización in vitro de la pulpa de aceituna como ingrediente en piensos de caprino lechero
Authors: Sanchez-Garcia Alberto M. , Romero Huelva Manuel , Martin-Garcia A. Ignacio
Published: December 2024

El uso de subproductos agroalimentarios en alimentación animal supone una oportunidad para la transición a la bioeconomía. En España, la industria del olivar genera cerca de 612.000 toneladas/año de subproductos, en su mayoría pulpa de aceituna (PA), cuyas características y composición permiten que pueda ser usada frecuentemente como biomasa para la producción de energía o como ingrediente para la obtención del aceite de orujo, entre otros. Sin embargo, su utilización dentro del sector de la nutrición animal no está del todo definida ya que es un elemento que depende de factores coyunturales como las variaciones en la cosecha de la aceituna y la volatilidad de los precios de la alimentación animal y de la energía. Este estudio evaluó el valor nutritivo de una variante de PA (parcialmente deshuesada y desecada, pero sin reextractacción) mediante el análisis de su composición nutritiva y la realización de cultivos in vitro de microorganismos ruminales para estudiar la fermentación ruminal (FR) tanto de la PA frente a otras materias primas comúnmente utilizadas en la elaboración de piensos para rumiantes, como de diferentes proporciones de incorporación de PA en un pienso comercial. La PA, a pesar de presentar una capacidad limitada para aportar nutrientes por su elevado contenido en lignina y bajo en proteína digestible, destacó por su contenido y composición en grasa. La ausencia de efectos negativos sobre la FR indicó la viabilidad de su empleo en la alimentación de rumiantes hasta en un 15 % de inclusión.
THE EFFECT OF BALANCE SHEET CLEANING ON THE RELATIONSHIP OF NPL AND COST EFFICIENCY (BAD LUCK? OR BAD MANAGEMENT?) CASE OF TURKIYE
Authors: Teke İlhan Sibel , Hazar Adalet , Babuşcu Şenol
Published: December 2024

The study investigates whether balance sheet cleaning provides a benefit to the cost-effectiveness of banks. In this context, the study is based on the “bad luck” and “bad management” hypotheses developed by Berger and DeYoung (1997). Hypotheses; it was developed based on the assumption that there is a negative relationship between the increase in non-performing loans (NPL) and cost-effectiveness. Quarterly data of 10 deposit banks operating in Turkey in the 2012-2021 period were used. Stochastic Boundary Analysis (Batesse & Coelli (1995) was used as cost-effectiveness analysis method and Dumitrescu-Hurlin Panel Causality Test (Dumitrescu, E. I. & Hurlin, C. 2012) was used in causality research. While the results of the analysis supported the “bad management” hypothesis before the balance sheet cleaning, it supported the “bad luck” hypothesis after the balance sheet cleaning. According to this result; balance sheet cleaning reduces the “bad management” effect in banks. Banks have been advised to clean up their balance sheets. Our study is the first to investigate the effect of balance sheet cleaning on bank cost effectiveness under "bad luck" and "bad management" hypotheses and contributes to the literature in this sense. Moreover; in the study, hypotheses were tested using the Dumitrescu-Hurlin Panel Causality Test (2012) and this is also the first in the literature.
Empowering Equity: The Impact of Tax Policies on Inclusive Growth in Turkey
Authors: Akar Sevda
Published: December 2024

This study uses the ARDL model to analyze whether the general tax structure affects inclusive growth in Turkey by investigating the 2006:1–2021:4 periods offering growth-friendly and inclusive tax policy reform proposals for Turkey. The Turkish economy is a notably fragile economy that is significantly affected by global shocks. Especially in recent years, the Turkish Lira has experienced a period of stable depreciation against other currencies, adversely affecting macroeconomic indicators such as inflation and economic confidence. Tax revenues are a basic building block in financing public expenditures. Turkey receives significantly lower tax revenues than most OECD countries; its tax structure is mainly based on consumption taxes and personal income tax and corporate tax are largely inadequate. Although this situation increases Turkey’s economic growth, it also greatly deteriorates inequality in income distribution. The results of this study suggest that, in Turkey, property tax is more effective in promoting inclusive growth. However, Turkey’s tax system is insufficient in terms of access to opportunities to allow Turkish society to benefit from economic growth. To foster inclusive growth in Turkey, it is strongly recommended that a thorough redesign of the tax structure be undertaken, aimed at ensuring equitable opportunities for the entire society.
Bitcoin Crypto-Asset Prediction: With an Application of Linear Autoregressive Integrated Moving Average Method, and Non-Linear Multi-Layered and Feedback Artificial Neural Network Models
Authors: Sünbül Ersın , Özyürek Hamide
Published: December 2024

The aim of the study is to evaluate two commonly used time series methods for forecasting Bitcoin (BTC) prices: the Autoregressive Integrated Moving Average (ARIMA) and the Multilayer Perceptron (MLP) Neural Network. The dataset consists of weekly BTC values from the period between 2020 and mid-2022, containing a total of 135 observations. The analyses were conducted using R-Studio software. The stationarity of the data was checked using ADF, PP, and KPSS unit root tests. For predictions, a linear method, ARIMA, and a nonlinear method, the MLP Neural Network model, were utilized. Although the MLP model demonstrated better performance, it is challenging to indicate a definitive superiority due to its limitations. The relatively low performance of both models may be attributed to the extreme volatility and speculative nature of cryptocurrencies, along with their tendency to behave independently of their underlying structures.
Spexin is a Reliable Predictor of Diabetes Postmenopausal Iraqi ‎Women: A Case-Control Study
Authors: Shareef Mustafa.s. , Roomi Ali B. , Charfeddine Bassem
Published: December 2024

ببتيد سبكسين (‏SPX‏) ينظم نسبة الجلوكوز في الدم واستقلاب الدهون. ركزت على مسببات مرض السكري من النوع 2 ‏‏(‏T2DM‏) لدى النساء بعد انقطاع الطمث، ودراسة علاقتها بمستويات ‏SPX‏ في الدم. الطريقة: دراسة الحالات والشواهد تطوعت ‏‏180 امرأة بعد انقطاع الطمث من ذي قار. تم تسجيلها في الدراسة الحالية. تم تشخيص إصابة 90 امرأة بالسكري في مرحلة ما بعد ‏انقطاع الطمث، في حين أن الـ 90 الأخرى غير مصابات بالسكري بعد انقطاع الطمث. تم جمع عينات الدم ‏لقياس ‏HbA1c و ‏SPX و ‎ MDAو SOD و CRP ، ‏‎‏جلوكوز الدم الصائم ‏‎‏‎‎‏‎(FSG‎‏)، الأنسولين، ‏‎‏ ‏‎ ‎lipid Profile‏ والإنترلوكين ( IL-6 ). ‏النتائج: ارتفاع بقيم ‏FSG، وHbA1c، والأنسولين، مقاومة الأنسولين (‏HOMA-IR‏) بشكل ملحوظ (‏P ‎‎<0.001‎‏) في النساء بعد انقطاع الطمث من النوع ‏T2DM‏. كما أن مستويات ‏MDA‏ وCRP‏ وIL-6‎‏ كانت مرتفعة بشكل كبير، ‏كما انخفضت مستويات ‏SPX‏ وSOD‏ بشكل ملحوظ (‏P<0.001‎‏). وقد لوحظت تغييرات كبيرة في الدهون في النساء ‏ ‏ بعد انقطاع الطمث و T2DM.أظهر الارتباط في ‏T2DM‏ لدى النساء بعد انقطاع الطمث علاقة سلبية بين ‏SPX‏ ‏مع نسبة الخصر إلى الطول، ‏SPX‏ مع ‏FSG، ‏SPX‏ مع ‏HOMA-IR، ‏MDA‏ مع ‏SPX، وجود علاقة إيجابية ‏بين ‏‎SPX‏ وMDA، ‏SPX‏ والعمر، ‏CRP‏ وIL-6‎، ‏CRP‏ والعمر، ‏IL-6‎‏ وFSG، ‏SOD‏ والأنسولين. الاستنتاج: لقد ثبت أن انخفاض ‏SPX‏ مهم في التسبب في مرض ‏T2DM‏ لدى النساء بعد انقطاع الطمث. ، قد يوفر استهداف ‏SPX‏ استراتيجية جديدة للحفاظ على التحكم في الجلوكوز.‏
Antibiotic Resistance and Molecular Characteristics of Upcoming Pathogenic Kocuria spp. Isolated from Iraq and Egypt
Authors: Al-Khamesi Maisam B. , Ibrahim Mohamed Khaled , EL-Shatoury Einas Hamed , El Kholy Iman Mohamed Amin , Mikawye Eslam ES , Tolba Sahar
Published: December 2024

تم جمع المعزولات البكتيريةمن عينات سريرية مختلفة من مختبرات مدينة الطب التعليمية في بغداد ومستشفى عين شمس التخصصي في القاهرة. وقد تم تعريف هذه المعزولات بواسطةنظام VITEK2 الآلي المدمج. كما تم فحص الحساسية للمضادات الحيوية، وتكوين الأغشية الحيوية، والتقصي عن جينات مقاومة الماكروليدات ermA، وermB، وermC، وmsrA & mef، وintegron intI1، وintI2. حيثتم جمع 60 عزلة من البلدين (42عزلة من العراق، و18 عزلة من مصر). تم تشخيص العزلات البكتيرية من خلال صفاتها المورفولوجية والكيميائية الحيوية. كانت العزلات حساسة للبيبراسيللين/تازوباكتام والفانكومايسين، ومقاومة للإريثرومايسين والأزيثروميسين والأوفلوكساسين. وقد تباينت قدرة بكتريا الكوكورياعلى تكوين الأغشية الحيوية، حيث كانت Kocuria kristinae منتجة قوية للأغشية الحيوية، بينما تراوحت Kocuria rhizophila بين غيرمنتجة في عزلات العراق ومنتجة ضعيفة في عزلات مصر، وأظهرالكشف عن جينات مقاومة الماكروليدات أن جين mef كان موجودا في العزلات من العراق بنسبة 7.14% فقط بينما وجد جين ermA في العزلات من مصر بنسبة 6.66% فقط، كما ثبت بالكشفعن integron أن intI1 كان موجودا في العزلات من العراق ومصر بينما تم اكتشاف intI2 في العزلات من العراق فقط. على حد علمنا، هذه هي أول دراسة مقارنة أجريت للتحقيق في وجود Kocuria spp.. في العراق ومصر. تسلط الدراسة الضوء على أهمية Kocuria spp.. والتي تعتبر من مسببات الأمراض الانتهازية، حيث أنها مسؤولة عن حالات العدوى البشرية المختلفة.
Assessment of myocardial work in sarcomere gene mutation carriers, healthy controls and overt nonobstructive hypertrophic cardiomyopathy
Authors: Pires Carla Marques , Joy George , Triantafyllou Miltiadis , Monteiro Ricardo Prista , Ferreira Ana , Savvatis Konstantinos , Lopes Luís da Rocha
Published: December 2024

Background Hypertrophic cardiomyopathy (HCM) is defined by unexplained hypertrophy and often characterized by diastolic and systolic dysfunction. HCM patients are known to have impaired left ventricular (LV) myocardial work (MW), a more load-independent parameter compared to global longitudinal strain (GLS). We hypothesized that impaired MW might occur in sarcomere mutation carriers without LV hypertrophy.Methods and Results A single centre study with a case-control design. Patients with overt nonobstructive HCM and a causal sarcomere gene variant (n = 44), carriers (n = 51) and age and sex matched (to the carriers) healthy controls (n = 32) underwent a transthoracic echocardiogram including myocardial deformation analysis to calculate GLS and MW. Global work index (GWI) (1695 ± 332mmHg% vs 1881.50 ± 490mmHg%, p = 0.001) and global constructive work (GCW) (2017.78 ± 323.05mmHg% vs 2329.31 ± 485.44 mmHg%, p = 0.002) were lower in sarcomere mutation carriers compared to controls. LVEF and GLS were similar between these two groups. GWI (1209 ± 735mmHg% vs 1695 ± 332mmhg%, p < 0.001), GCW (1456 ± 703mmHg% vs 1993 ± 389mmHg%, p < 0.001), global wasted work (GWW) (117 ± 148mmHg% vs 96 ± 69mmHg%, p = 0.006) and global work efficiency (GWE) (89 ± 7% vs 95 ± 3%, p < 0.001)] were also significantly worse in overt non obstructive HCM patients.Conclusion We show for the first time that MW indexes were significantly worse in sarcomere mutation carriers compared to controls, suggesting that MW is more sensitive to early changes than GLS and could play a major role in the evaluation and follow-up of carriers.
The Influence and Sustainability of Traditional Chinese Ethnic Medicine: A Case Study of Ninglang Yi Ethnic Medicine
Authors: Dong Zi-Juan , Chen Xiao-Long , Li Na , Tan Kun , Xiao Wen
Published: December 2024

To study the significance of ethnic medicine, specifically the current influence and sustainability of Yi medicine, this research was conducted in Liangshan Yi Autonomous Prefecture, an important Yi-populated area in southwestern China. Data collection involved 698 households across 13 townships, focusing on their diagnostic and treatment choices when ill, with particular attention to their use and trust in the two branches of Yi medicine, Bimo and Suni. The results indicate that Yi medicine remains a crucial complement to contemporary medical practices, with 87.4% of Yi households having conducted Bimo rituals in the past year. Although higher education levels correlate with reduced trust, the overall trust in Bimo remains high. The Bimo system shows potential for sustainable development due to its structured inheritance, reasonable age distribution, and sufficient income levels. In contrast, the Suni system faces decline due to older practitioners and lack of systematic transmission. The recorded ritual, which combines ceremony and herbal medicine, performed by the Bimo to treat a young girl's knee infection, has been acknowledged as effective through a reinterview. Policy analysis reveals that support for traditional medicine has grown, especially at the provincial level, with a focus on platform construction, scientific research, and education dissemination. However, more emphasis is needed on funding and raw material protection. The study concludes that integrating valuable aspects of Yi medicine into modern practices and increasing support for research and education in ethnic areas can enhance the sustainability of ethnic medicine and improve health contributions to economically underdeveloped regions.
Retrieval Augmented Generation for 10 Large Language Models and its Generalizability in Assessing Medical Fitness
Authors: Ke Yuhe , Jin Liyuan , Elangovan Kabilan , Abdullah Hairil Rizal , Liu Nan , Sia Alex , Soh Chai Rick , Tung Joshua Yi Min , Ong Jasmine , Kovacheva Vesela P. , Ting Daniel Shu Wei , Kuo Chang-Fu , Wu Shao-Chun
Published: December 2024

Purpose: Large Language Models (LLMs) offer potential for medical applications, but often lack the specialized knowledge needed for clinical tasks. Retrieval Augmented Generation (RAG) is a promising approach, allowing for the customization of LLMs with domain-specific knowledge, well-suited for healthcare. We focused on assessing the accuracy, consistency and safety of RAG models in determining a patient’s fitness for surgery and providing additional crucial preoperative instructions.
Methods: We developed LLM-RAG models using 35 local and 23 international preoperative guidelines and tested them against human-generated responses, with a total of 3682 responses evaluated.
Clinical documents were processed, stored, and retrieved using Llamaindex. Ten LLMs (GPT3.5, GPT4, GPT4-o, Llama2-7B, Llama2-13B, LLama2-70b, LLama3-8b, LLama3-70b, Gemini-1.5-Pro and Claude-3-Opus) were evaluated with 1) native model, 2) with local and 3) international preoperative guidelines.
Fourteen clinical scenarios were assessed, focusing on 7 aspects of preoperative instructions. Established guidelines and expert physician judgment determined correct responses. Human-generated answers from senior attending anesthesiologists and junior doctors served as a comparison. Comparative analysis was conducted using Fisher’s exact test and agreement for inter-rater agreement within human and LLM responses.
Results: The LLM-RAG model demonstrated good efficiency, generating answers within 20 seconds, with guideline retrieval taking less than 5 seconds. This performance is faster than the 10 minutes typically estimated by clinicians. Notably, the LLM-RAG model utilizing GPT4 achieved the highest accuracy in assessing fitness for surgery, surpassing human-generated responses (96.4% vs. 86.6%, p=0.016). The RAG models demonstrated generalizable performance, exhibiting similarly favorable outcomes with both international and local guidelines. Additionally, the GPT4 LLM-RAG model exhibited an absence of hallucinations and produced correct preoperative instructions that were comparable to those generated by clinicians.
Conclusions: This study successfully implements LLM-RAG models for preoperative healthcare tasks, emphasizing the benefits of grounded knowledge, upgradability, and scalability for effective deployment in healthcare settings.
Effects of ultrasound-guided subserratus anterior plane block combined with rectus sheath block on postoperative analgesia, inflammatory factors and immune function in patients undergoing laparoscopic gastric cancer surgery
Authors: Ye Xiaoming , Xing Zhen , Zhao Jibo , Liu Hui , Wang shaowei , Yao Jie
Published: December 2024

Objective
To evaluate the impact of ultrasound-guided subserratus anterior plane block (SAPB) in conjunction with rectus sheath block (RSB) on postoperative analgesia, inflammatory markers,and immune function in patients undergoing laparoscopic surgery for gastric cancer.
Methods
A total of 60 patients who underwent laparoscopic gastrectomy under general anesthesia at the First Affiliated Hospital of Hebei North University were selected and randomly assigned to two groups: Group C and Group R, with 30 patients in each group. In Group R,a bilateral low-position SAPB combined with rectus sheath block (RSB) was performed using 60 ml of 0.25% ropivacaine following the induction of general anesthesia; whereas Group C received only general anesthesia.Patients in Group C and Group R received postoperative intravenous patient-controlled analgesia (PCIA). Visual analogue scale (VAS) pain scores were assessed at various time points postoperatively for both groups. The utilization of analgesic medications during the perioperative period was compared between the two groups. Additionally, levels of inflammatory factors (IL-6, IL-8, and IL-10) as well as immune markers (CD3+, CD4+, CD8+, and CD4+/CD8+) were evaluated at different time intervals and analyzed comparatively between the two groups.
Results
Group R exhibited significantly lower VAS scores during both resting and coughing activities at time points t1 to t4 compared to Group C (P < 0.05). The total dosage of analgesic medications administered intraoperatively and postoperatively in Group R was significantly lower (P < 0.05). Relative to t0, the levels of IL-6, IL-8, and IL-10 were significantly elevated at t4 and t6 in both patient groups (P < 0.05), Notably, the levels of IL-6 and IL-8 in Group R were significantly lower than those observed in Group C (P < 0.05), whereas the level of IL-10 in Group R was markedly higher than that in Group C (P < 0.05). Relative to t0, the levels of immune function indicators CD8+ and CD4+/CD8+ in both groups exhibited a decline at the t4 and t6 time points. (P < 0.05); In comparison to Group C, Group R exhibited higher levels of immune function indicators CD3+, CD4+, and CD8+ at t4 (P < 0.05). Additionally, the level of CD3+ in Group R was significantly elevated compared to that in Group C at t6 (P < 0.05), whereas no statistically significant differences were found for other immune function indicators between the two groups (P > 0.05).
Conclusion
Ultrasound-guided inferior Subserratus anterior plane block combined with rectus sheath block effectively alleviates postoperative pain in patients undergoing laparoscopic gastrectomy for gastric cancer, reduces the inflammatory response during the perioperative period, and promotes the recovery of immune function
Poor Sleep Quality Associated with Impaired Postoperative Outcomes and Frailty Incidence after Total Hip Arthroplasty: A Severity Matched Case-control Study
Authors: Zhao Le , Wu Haoran , Wu Zhen , Li Feng-ying , Yan Jian-feng
Published: December 2024

Objective
Sleep quality of patients has a complex association with postoperative total hip arthroplasty (THA), yet its impact on recovery of hip function and frailty occurrence is still not uniformly recognized. The purpose of this study is to assess the impact of preoperative sleep quality on the prognosis of patients undergoing a first-time THA and its relationship to chronic pain, anxiety, depression, and frailty.
Methods
In this project, 45 patients each with good and poor sleep quality who underwent THA for the first time were included according to the PSQI index, with PSQI index surpassing 5 considered as poor sleep quality. Patients in the study group and the control group were matched according to their age, gender and American Society of Anesthesiologists (ASA) scores, and intra-operative complications, blood loss, surgery duration, postoperative analgesic use, and length of hospital stay were analyzed. Also, changes of sleep quality, HHS index, pain value, anxiety, depression and frailty occurrence were compared before and 6 months after surgery. The demographics of the comparison cohorts were analyzed by paired t-tests or paired Wilcoxon signed-rank tests, and independent t-tests and nonparametric tests were adopted to screen risk factors of postoperative frailty. Multivariate logistic regression analysis was introduced for independent risk factors calculation. A p-value less than 0.05 was considered as statistically significance.
Results
Poor sleep quality was associated with poorer recovery, including longer postoperative hospitalization after THA, more pronounced chronic pain 3 months after surgery, higher anxiety, depression index and frailty index 6 months after surgery. Older age, diabetes, osteoporosis, BMI lower than the normal and poor sleep quality were potential factors of postoperative frailty, among which poor sleep quality represented an independent risk factor related to postoperative frailty.
Conclusions
Poor sleep quality registers association with postoperative frailty after THA, emphasizing the importance of preoperative identification for patients, which may guide clinicians in developing perioperative strategies and provide patients with potential risks.
Association between estimated glucose disposal rate and the risk of MAFLD in American adults: a cross-sectional study
Authors: Zhou Yuhang , Wang Bang , Wu Miaoxin , Hong Han , Li Gaochao , Xu Minhui
Published: December 2024

The estimated glucose disposal rate (eGDR), as a novel metric of insulin resistance (IR), has been demonstrated to correlate with hepatic steatosis in patients with diabetes. Although IR is considered as a factor affecting lipid metabolism, the correlation between eGDR and metabolic associated fatty liver disease (MAFLD) is still unclear. Data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES) were employed in this cross-sectional study designed to examine the association between eGDR and MAFLD through the application of weighted multivariate logistic regression model. The nonlinear relationship was described utilizing restricted cubic spline (RCS) regression. Subgroup analysis was performed to assess the consistency of the results and causal mediation analysis was employed to explore potential mediators. The study included 5,805 participants, 3,253 of whom diagnosed MAFLD, with a prevalence rate of 56.1%. After adjusting for all confounding factors, the risk of MAFLD decreased by 51% with each unit increase in the eGDR (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.40, 0.61, p < 0.0001). Analysis of eGDR in quartiles further supported this trend (P = 0.001). The smooth curve fitting also showed a negative correlation between eGDR and MAFLD. Causal mediation analysis indicated that the relationship between eGDR and MAFLD was partially mediated by Atherogenic index of plasma (AIP), with a mediation ratio of 18.6%. Our result demonstrated that eGDR has a significant nonlinear negative association with the prevalence of MAFLD, in which AIP plays a mediating role, providing new insights into the prevention and management of MAFLD.
Comparison of clinical outcomes following small incision lenticule extraction performed with the Visumax 800 versus Visumax 500 femtosecond laser
Authors: Kim Bu Ki , Chung Young Taek
Published: December 2024

This study compared clinical outcomes between small incision lenticule extraction (SMILE) procedures performed with the Visumax 800 and Visumax 500 femtosecond lasers. We compared the clinical outcomes of 100 eyes of 50 patients who underwent SMILE using the Visumax 800 (SMILE Pro group) and 100 eyes of 50 patients who underwent SMILE using the Visumax 500 femtosecond laser (SMILE group). Outcomes were assessed at a 3-month follow-up, including standard visual outcomes, optic zone decentration, and corneal higher-order aberrations (HOAs). The mean lenticule creation time was significantly shorter in the SMILE Pro group (10.33 ± 0.82 seconds) than the SMILE group (28.27 ± 2.34 seconds, P < 0.001). At 3 months postoperatively, the groups had no significant differences in uncorrected or corrected distance visual acuity, residual refractive errors, or corneal HOAs. However, the optic zone decentration was significantly smaller in the SMILE Pro group than in the SMILE group (P < 0.001), and the vertical coma induction was significantly lower in the SMILE Pro group compared with the SMILE group (P = 0.034), suggesting that the Visumax 800 provides enhanced centration accuracy, reduced vertical coma induction, and faster lenticule creation, demonstrating comparable efficacy, safety, and predictability to the Visumax 500.
Venous thromboembolic risk in hematological hospitalized patients: a retrospective study
Authors: Cordella Stefano , Coluccio Valeria , Costantini Riccardo Cuoghi , D'Amico Roberto , Luppi Mario , Marietta Marco
Published: December 2024

Although patients with hematological malignancies carry a non-negligible risk of venous thromboembolic events (VTE), no risk assessment models (RAMs) have been developed and validated to predict this risk during their hospital stay. Moreover, the performance of RAMs developed to predict the thromboembolic and hemorrhagic risk in hospitalized medical patients has never been assessed in this specific population.
In this observational study we sought to assess the incidence of VTE and hemorrhagic events (HE), to evaluate pharmacological prophylaxis use, and to test existing RAMs for TE and HE (Padua Predictions Score, PPS, and Improve Bleeding Score, IBS, respectively) in a population of 514 hematological patients at their first hospital admission.
165 patients were foundto be at high thromboembolic and 114 at high hemorrhagic risk according to PPS and IBS; a total of 148 patients received pharmacological prophylaxis with low-molecular weight heparin (LMWH).
An incidence of VTE (3.11%) and HE (1.75%) was found, with most thrombotic(15/16) and hemorrhagic (8/9) events occurring in patients not receiving prophylaxis.
At the univariate analysis, the diagnosis of acute leukemia was significantly associated with an increased risk of VTE, whereas prophylaxis was found to be protective. However, at the multivariate analysis the statistical significance was lost for both of these variables (HR=4.61, P=0.170 and HR=0.36, P=0.218, respectively). PPS poorly performed in this population, but no other factors associated with VTE were found.
Larger, multicenter studies to develop better RAMs tailored to HM patientsare needed to improve VTE management in this population.
A mixed methods study on the barriers and facilitators of implementing HIV re-testing guidelines on pregnant women at a referral hospital in Kenya
Authors: Njuki Justina , Wamalwa Dalton , Kumar Rashmi , Macharia Anne-Marie
Published: December 2024

Background
The Ministry of Health-Kenya developed guidelines on HIV testing for pregnant women at different points in time as a mitigative measure against mother-to child-transmission (MTCT) of HIV. However, the barriers and facilitators in the implementation of HIV re-testing guidelines among pregnant women in Kenya are not well understood. The aim of the present study was to evaluate the barriers and facilitators of HIV testing guidelines among pregnant women at the Pumwani Maternity Hospital.
Methods
This was a mixed methods study. Qualitative data on the barriers and facilitators of HIV re-testing among pregnant women was collected by interviewing key informants (healthcare workers). Quantitative data was collected from pregnant women who had been recruited into the study. Women with an initial HIV negative result at the antenatal clinic (ANC) were recruited at the labor/postnatal ward and at six weeks postnatal review. Quantitative data was analyzed using descriptive statistics while qualitative data was audio recorded, transcribed, and themes were identified.
Results
There were 242 women who participated in the interview 97 of whom were followed up at 6 weeks via a telephone interview. There were 170 women interviewed at labor ward. The retesting rate was 116 (69.5%). Majority of the women 114 (67.5%) lacked awareness on the need for HIV retesting. Of the 97 women followed up at 6 weeks postpartum, 72 (75%) were retested for HIV. Of the 15 HCWs who were interviewed, 14 (93.3%) had received HTS training. There was varied knowledge on repeat testing guidelines for HIV and the team relied on mentor mothers and prevention of mother to child transmission (PMTCT) nurses to implement the guideline.
Conclusion
These findings suggest that there were more missed opportunities for HIV re-testing at the labor ward relative to re-testing. There is a need to improve HIV screening at the labor ward to minimize lost opportunities for HIV screening.
Association between triglyceride-glucose-body mass index (TyG-BMI) and in-stent restenosis after coronary interventions: a retrospective cross-sectional study
Authors: Tong Zhuoyan , Hu Mengyao , Cai Zhiyuan , Li Shiyu , Yang Dongwei
Published: December 2024

Background
Insulin resistance has been confirmed to be an independent predictor of cardiovascular diseases. Earlier research have confirmed that triglyceride glucose body mass index (TyG-BMI) can be used as an alternative factor of insulin resistance, and there is a significant correlation between TyG-BMI and cardiovascular diseases. However, the correlation between TyG-BMI and in-stent restenosis (ISR) is still unclear. The purpose of this study was to investigate the correlation between TyG-BMI index and in-stent restenosis after coronary intervention.
Methods
This study was a retrospective cohort study, which included patients with confirmed coronary artery disease undergoing percutaneous coronary intervention (PCI) in Zhengzhou Central Hospital Affiliated to Zhengzhou University and was followed up. TyG-BMI at baseline was divided into three equal parts to analyze the baseline characteristics under different TyG-BMI groupings. Univariate and multivariate Cox proportional risk regression models were used to assess the correlation between TyG-BMI and in-stent restenosis, and restricted cubic spline (RCS) was used to identify whether there was a linear correlation or nonlinear correlation between TyG-BMI and in-stent restenosis.
Results
Of the 818 participants, 588 (71.9%) were men; Median [Q1,Q3] age was 62.0 [53.0,69.0] years. A total of 110 cases of ISR occurred during follow-up. After grouping according to TyG-BMI levels, the number of cases of ISR was significantly smaller in the low TyG-BMI group than in the other two groups.The results of Cox proportional risk modeling suggested that the risk ratio of ISR was significantly higher in the medium and high TyG-BMI groups compared with the low TyG-BMI group. The results of restricted cubic plots suggested a linear correlation between TyG-BMI and the risk of developing ISR (linear P < 0.001,nonlinear P = 0.0670). The risk of ISR was significantly higher when TyG-BMI > 211.47 mmo/L.
Conclusions
This study suggests that there is a significant correlation between TyG-BMI and the occurrence of ISR, and that the level of TyG-BMI indexes needs to be paid attention to in the clinic during the prevention of ISR, especially in female, elderly, overweight or obese patients.
Neonatal Pain Management Practice and Associated Factors among Nurses Working in Public Hospitals of Southern Ethiopia: A Multicenter Cross- sectional study
Authors: Urmale Addisu , Getie Asmare , Degeifa Nega , Bante Agegnehu
Published: December 2024

Background: Neonatal pain management is an integral part of nurse’s practices working in neonatal intensive care units. Improper neonatal pain management can have negative consequence for the health and development of newborns. In Ethiopia, neonatal pain management practices among nurses working in neonatal intensive care unit were not well known. Hence, this study assessed neonatal pain management practice and associated factors among nurses working in the neonatal intensive care units of public hospitals in Southern Ethiopia.
Methods: An institution-based cross-sectional study design was conducted among 369 randomly selected nurses working in the neonatal intensive care units of public hospitals in southern Ethiopia. Data were collected using a pre-tested, structured, and self-administered questionnaire accompanied with an observation checklist. The collected data were reviewed, coded and entered using Epi-data version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were used to identify the associations between outcome and predictor variables. The degree of association was estimated with odds ratio with 95% confidence level and P-values < 0.05 were considered to detect statistical significance.
Results: The study revealed that 18.3% (95%CI: 14.4, 22.7) of the nurses had good neonatal pain management practice. On observation 16.2% (95%CI: 6.2, 32.0) of nurses were practicing proper neonatal pain management. Respondents with age ≤ 30 years [AOR = 3.02, 95%CI (1.30, 7.01)], married nurses [AOR = 4.90, 95%CI(2.09, 9.49)],availability of anti-pain drug in the unit [AOR = 7.24, (2.66, 11.69)], shortage of nursing staff at each shift [AOR = 0.097, (0.034, 0.279), and poor knowledge about neonatal pain [AOR = 0.23, (0.08, 0.62)] were factors significantly associated with good neonatal pain management practice.
Conclusions: The overall practice of neonatal pain management is relatively low. Improving practice of neonatal pain management requires; hiring of adequate nursing staff, improving acess to anti-pain drugs in the unit, and enhancing nurse’s knowledge regarding neonatal pain management.
Succinate Dehydrogenase Inhibitors as Triggers of Azole Resistance in Aspergillus fumigatus: The Role of sdh1 and Efflux Pathways
Authors: Zhang Heng , Zhu Zhangling , Gong Xiao , Cheng Wenxu , Liao Weizu , Ma Tianyan , Hu Qingwen , Li Linyun , Dun-zhu Zha-xi , Drol-ga Lha-zom , Sun Yi
Published: December 2024

Background
Aspergillus fumigatus is a major cause of invasive aspergillosis in immunocompromised patients. The rise in antifungal resistance is linked to the use of succinate dehydrogenase inhibitors (SDHIs).
Objective
This study investigates the mechanism of acquired azole resistance in A. fumigatus, triggered by SDHIs, which are widely used agricultural fungicides.
Methods
Conidia of A. fumigatus were co-cultured with four SDHIs (Boscalid, Thifluzamide, Fluopyram, Carboxin) to assess sensitivity to three azole drugs: voriconazole, itraconazole, and posaconazole. RT-qPCR identified genes related to resistance, focusing on sdh1, a gene encoding a succinate dehydrogenase subunit. A sdh1 knockout strain was created to evaluate its impact on growth, azole sensitivity, ATP levels, superoxide dismutase (SOD) activity, and ergosterol biosynthesis.
Results
SDHI exposure increased resistance to azoles, with 4.12% of 2,496 strains showing higher minimum inhibitory concentration (MIC). Four strains had an eightfold MIC increase and reduced sdh1 expression. The sdh1 knockout strain showed impaired growth, increased azoles resistance, and lower reactive oxygen species (ROS), ATP production (P < 0.001), and SOD activity (P < 0.05). RNA sequencing indicated that sdh1 deletion upregulated efflux pump genes and enhanced ergosterol synthesis.
Conclusion
SDHIs may induce azole resistance in A. fumigatus by downregulating sdh1. The findings highlight a potential new resistance mechanism, providing insights for managing A. fumigatus infections and azole resistance.