bluuebunny/crossref_metadata_2025 huggingface dataset:
Analyzing the Relationship Between Cerebral Aneurysms and Non- Oculomotor Cranial Nerve Palsies: A Systematic Review
Authors: Badary Amr , Helal Amer , Azab Mohammed A. , Almealawy Yasser F. , Alibraheemi Mohammed Q. , Jawed Noyan , Abdulbaki Arif , Brandes Santiago Pastrana , Awuah Wireko Andrew , Omer Mazin , Atallah Oday
Published: August 2024

Objectives
This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function.
Methodology:
Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27.
Results
The analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%).
Conclusion
Intracerebral aneurysms are significantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.
Comparison of cerebral blood flow during general anesthesia in elderly patients with and without dementia: a prospective controlled clinical trial
Authors: Morimoto Yoshinari , Hayashi Megumi , Tanaka Yohei , Nishizaki Hitomi , Mikuzuki Lou
Published: August 2024

Maintenance of cerebral blood flow (CBF) by maintaining blood pressure and brain cell activity and avoiding hypocapnia is important when administering anesthesia in patients with dementia. This study aimed to evaluate CBF during general anesthesia in elderly patients with severe dementia while maintaining their physiological parameters in the adequate range. The patients were anesthetized under a setting range of parameters without affecting CBF (mean arterial pressure [MAP] > 50 mmHg; bispectral index [BIS] > 20; percutaneous arterial oxygen saturation [SpO2] > 95%; end-tidal CO2 [etCO2] 35–40 mmHg). The normalized tissue hemoglobin index (nTHI), which reflects CBF, was measured using near-infrared spectroscopy. The parameters were compared between patients with severe dementia (n = 13) and those without cognitive impairment (n = 12). There were no differences in patient background. A similar decline in MAP and BIS values was observed in both groups, but the values remained within the setting range. The nTHI decreased significantly to 0.60 in the dementia group and to 0.75 in the non-dementia group after the start of treatment (P = 0.047). Even when the MAP, BIS, SpO2, and etCO2 values were maintained in their adequate ranges during general anesthesia, the nTHI decreased by 40% in the dementia group.
Barriers and Facilitators to High-Volume Evidence-Based Innovation and Implementation in a Large, Community-Based Learning Health System
Authors: Durojaiye Cimone , Prausnitz Stephanie , Schneider Jennifer L. , Lieu Tracy A. , Schmittdiel Julie A. , Rouillard Smita , Chen Yi-Fen , Lee Kristine , Corley Douglas A.
Published: August 2024

Background
Broad-scale, rapid health care change is critically needed to improve value-based, effective health care. Health care providers and systems need to address common barriers and facilitators across the evidence to implementation pathway, across diverse specialties. However, most evidence translation / implementation research evaluates single topic areas, and may be of limited value for informing comprehensive efforts. This project’s objective was to identify, characterize, and illustrate common trans-topic facilitators and barriers of translating new health care evidence results to clinical implementation across multiple medical specialties.
Methods
This study was an evaluation of all evidence-based innovation projects completed during 2019–2021. Each project was created with medical group clinical leaders and was intended to inform clinical care. The evaluation took place in a large community-based integrated health care system, and an embedded delivery science and applied research program. Clinical investigators, scientific investigators, and clinical operational leaders received structured questionnaires regarding barriers and facilitators for the operational implementation of new research findings for each project. Responses were mapped to the Consolidated Framework for Implementation Research to identify perceived implementation barriers and facilitators.
Results
All 48 projects completed between 2019–2021 were evaluated; responses were received for 45 (94%) and 34 had comments mappable to framework domains. Potential barriers and facilitators to clinical implementation of new research results were identified across all five framework domains and, within these, the 38 constructs or sub-constructs. Among 245 total comments, the most commonly cited facilitators were how the new research evidence generated compelled change (n = 29), specialty communication networks for disseminating results and initiating change (n = 20), leadership engagement in the project (n = 19), and the innovation’s relative advantage over existing practices (n = 11). The most commonly cited barriers were inadequate resource commitment for next-step implementation (n = 15), insufficient learning/implementation culture (n = 5), and insufficient individual-level willingness/ability for change (n = 5).
Conclusions
A novel large-scale evaluation of barriers and facilitators across the evidence to implementation pathway identified common factors across multiple topic areas and specialties. These common potentially replicable facilitators and modifiable barriers can focus health systems and leaders pursuing large-volume evidence-to-implementation initiatives on those areas with the likely greatest benefit-for-effort, for accelerating health care change.
Downregulation of polygalacturonase (PG) gene expression caused significant changes in gene expression in sesame (Sesamum indicum L.) false septa tissues.
Authors: Sultan Esraa A. A. , Oweda Mariam , Elarabi Nagwa I. , El-Hadidi Mohamed , Abdelhadi Abdelhadi A. , Abdallah Naglaa A. , Tawfik Mohamed S.
Published: August 2024

Sesame (Sesamum indicum L.) is one of the oldest cultivated oil crops worldwide and struggles with low yield, which could be attributed to capsule dehiscence and seed shattering just before and during full maturation. The present study addresses the seed-shattering in sesame via downregulating the endo-polygalacturonase (endo-PG) gene activity “known as the ripening enzyme”. Five lines of sesame plants using an RNAi transformation strategy via a non-tissue culture-based transformation technique. Individual transformants were tested using BASTA leave-painting and spraying over mature plants, as well as conducting PCR, RT-PCR, and real-time PCR tests on T1 plants. The transgenics exhibited a significant reduction in endo-PG levels and showed delays in leaves, organ senescence, and a delay in capsule opening. A transcriptome profiling study was conducted to understand the effect of downregulating the endo-PG expression levels on the genetic expression profile of false septa tissues excised from sesame capsules. Different comparisons between the expression profile of the false septa in transgenic vs non-transgenic control were conducted, yet we are reporting one of the comparisons in this study. A total of 24,468 unigenes were annotated, and 514 differentially expressed genes (DEGs) were detected in the selected comparison, including 349 up-regulated and 165 down-regulated unigenes. Nineteen DEGs for genes directly involved in plant hormones, cell wall modification, and capsule shattering were selected. Our results indicate that silencing the endo-PG gene caused changes in the expression of a wide range of genes, eventually leading to a dramatic reduction in seed-shattering in transgenic sesame capsules.
WITHDRAWN: Development and Validation of an Integrated Traditional Chinese Medicine and Western Medicine Early Screening Model for Coronary Heart Disease in the Community of Tianjin, China: A Simple and Practical Risk Model for Community Physicians
Authors: yang ji , ZHANG Yao , GAO Shengwei , zhao Yingqiang
Published: August 2024

Objective
To explore the influencing factors of coronary heart disease in Tianjin and construct a suitable early screening model for coronary heart disease in the Tianjin community population that integrates traditional Chinese and Western medicine.
Methods
Utilizing annual physical examination data from the electronic health records of community residents participating in the national basic public health service project as the data source and modeling index. The propensity score matching method (PSM) was applied to match age and gender, establishing a standard database. Data were randomly divided into training (8:2 ratio) and test sets using R 4.1.3 software. The training set was used to build the model, and the test set was used to verify the model's discrimination and calibration. Univariate and multivariate Logistic analysis methods were employed to screen predictors and build the model. The model was evaluated through internal and external validation, including goodness of fit, ROC curve analysis, sensitivity, specificity, accuracy, likelihood ratios, and AUC. The "caret" package in R software was used for internal validation via the Bootstrap method, and clinical decision curve analysis (DCA) was applied to assess clinical efficacy.
Results
A total of 24,792 community individuals with complete archives were screened, including 3,487 cases of coronary heart disease. After propensity matching, 3,487 cases each for the coronary heart disease and non-coronary heart disease groups were matched. The training set consisted of 5,580 cases, and the test set of 1,394 cases, with no significant baseline data differences (P > 0.05). A joint early screening model of traditional Chinese and Western medicine was established, incorporating variables such as residential area, waist circumference, diastolic blood pressure, auscultation murmur, dietary salt preference, coexisting conditions like stroke and anemia, and TCM constitution types. The Hosmer-Lemeshow test indicated a good model fit (χ²=14.519, P = 0.065 > 0.05), with an AUC of 0.796. The model demonstrated predictive efficacy and clinical value, suggesting its potential for quantitatively evaluating the risk of coronary heart disease in community residents without reliance on biochemical indicators.
Conclusions
The early screening model for coronary heart disease, based on annual physical examination data of the community population, shows good clinical predictive efficiency. It can quantitatively evaluate the risk of coronary heart disease in community residents, assist community doctors in screening high-risk populations, and is valuable for early diagnosis.
Relapsed/refractory classical Hodgkin lymphoma treated with pulsed Boom-Boom radiotherapy combined with a PD-1 inhibitor and decitabine: Two case reports
Authors: Wang Chen , Xue Zhuang , Zou Benkui , Shi Pengyue , Yue Jinbo
Published: August 2024

Hodgkin lymphoma (HL), characterized by cancerous Reed-Sternberg cells within an inflammatory milieu, poses challenges in relapsed or refractory cases. Current standard treatments, including salvage chemotherapy and autologous stem cell transplantation (ASCT), have limitations in achieving long-term remission. Herein, we present two cases of nodular sclerosing relapsed/refractory Hodgkin's lymphoma treated with personalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR) in combination with a PD-1 inhibitor and Decitabine. Patients underwent PULSAR (2Gy/dose x 2f D1-2 q3w) for recurrent lesions along with PD-1 monoclonal antibody (200mg D0 q3w) and Decitabine (10mg D1-5 q3w) for six cycles. Both patients achieved complete remission (CR) post-treatment, enabling subsequent ASCT and PD-1 maintenance therapy. Follow-up revealed prolonged survival without recurrence. PULSAR, by delivering radiation pulses at longer intervals, allows for tumor adaptation and immune response, potentially enhancing treatment efficacy and minimizing toxicity. Combined with immunotherapy and Decitabine, PULSAR shows promise in managing relapsed/refractory HL, warranting further investigation through clinical trials. This approach signifies a paradigm shift towards precision tumor therapy and immunomodulation in HL management.
Comparative Impact of Sleeve Gastrectomy and One Anastomosis Gastric Bypass on Glycemic Control and Abdominal Adiposity:ARandomized Controlled Study
Authors: Hamouda Haitham Hassan , Sabry Hany maurice , El-mekawy Mohamed serag , Arfaat Noha Wael , Saied Sami Mufeed
Published: August 2024

Background
Abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) depots are implicated in the interplay between obesity and metabolic complications. The present study aimed to compare the impact of sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB) on weight loss and glycemic control and to assess the potential role of VAT in type 2 diabetes mellitus (DM) remission.
Patients and methods
Patients with obesity and DM participated in this randomized controlled study were randomly allocated to the SG and OAGB groups. Computed tomography was used to assess VAT and SAT. Patients were followed up one year after surgery.
Results
At the 12-month follow-up, the two groups showed significant weight loss and improvement in the metabolic profile. The OAGB group showed a statistically significant higher percentage reduction in HbA1c. The incidence of complete remission was 76.0% in the SG group and 87.0% in the OAGB group (p = 0.331). The OAGB group showed significantly lower mean VAT/SAT and higher mean reduction rates. DM duration and VAT/SAT still significantly predicted DM remission.
Conclusion
Both SG and OAGB procedures are effective in achieving weight loss and improving metabolic performance at 12 months postoperatively. The OAGB group showed superior glycemic control and a higher reduction in the VAT area relative to abdominal fat.
Latency to delivery and incidence of adverse obstetric and perinatal outcomes inpreterm premature rupture of membranes before 32 weeks
Authors: Seravalli Viola , Colucci Chiara , Chiara Di Cencio , Morucchio Anna , Barsanti Federica , Tommaso Mariarosaria Di
Published: August 2024

Purpose
The aim of this study was to evaluate the average latency to delivery, obstetric outcomes and neonatal survival in pregnancies complicated by preterm premature rupture of membranes (PPROM) before 32 weeks.
Methods
A retrospective study was conducted on pregnant women admitted for PPROM before 32 weeks. Patients were categorized into three groups based on gestational age (GA) at PPROM (< 24, 24 to 28, 28 to 31+ 6 weeks). Latency to delivery, obstetric outcomes and neonatal survival were analyzed.
Results
86 women who had PPROM before 32 weeks were identified. The mean GA at PPROM was 26.1 weeks and the median latency to delivery was 16 days (IQR 4, 27). The median latency to delivery was 22 days for previable PPROM, 11 days for PPROM between 24 and 28 weeks, and 16 days for PPROM between 28 and 32 weeks (p = 0.29). All cases of placental abruption (7/86, 8%) and cord prolapse (6/86, 7%) occurred in women with PPROM before 28 weeks. In 44% of PPROM, placental histology demonstrated chorionamnionitis. Neonatal survival at discharge was significantly lower in previable PPROM (< 24 weeks) compared to PPROM at 24–26 weeks (58% vs 92%, p = 0.04), and it reached 100% in cases of PPROM after 28 weeks.
Conclusion
In PPROM occurring before 32 weeks the median latency to delivery ranged between 11 and 22 days. Neonatal survival improves with higher GA at PPROM, and it increases by more than 33% when PPROM occurs after 24 weeks of gestation. These data may be valuable for patient counselling.
The protective role of basophil against sepsis mortality
Authors: Pang Mingmin , Fan Shaohua , Zhang Shihan , Li Yanan , Wang Hao
Published: August 2024

Objective: The role of basophils on sepsis prognosis remains understudied and we aimed to investigate the effects of basophil on sepsis mortality.
Methodology: Initially, a prospective local cohort was conducted to establish primary connection between basophil count and 28-day mortality. In addition, sepsis patients from Medical Information Mart for Intensive Care (MIMIC) database were extracted for validation purposes. Thirdly, 2-sample Mendelian randomization (MR) was applied from UK Biobank cohort to confirm the causative link between basophil and sepsis death. Lastly, prognostic effect of human granulocyte colony-stimulating factor (G-CSF) by ameliorating basopenia was assessed utilizing MIMIC data.
Findings: Independent verification from both MIMIC and local cohort revealed basophil count as a protective factor against mortality (HR = 0.35, 95% CI = 0.28 - 0.42; HR = 0.40, 95% CI = 0.30–0.52). The MR analysis substantiated the causal relationship between basophil and death (OR=0.776, 95% CI [0.637,0.946], P=0.002). Administration of human G-CSF led to an increase in basophil counts and resulted in a notable decrease in mortality among patients with basopenia (HR = 0.74, 95% CI = 0.58 - 0.93).
Conclusion: Basophils significantly contribute to protecting against sepsis mortality, and bolstering basophil numbers may be a feasible strategy in reducing mortality.
Risk assessment and transmission of fluoroquinolone resistance in drug-resistant pulmonary tuberculosis in South India: a retrospective genomic epidemiology study
Authors: Prakash Vijayalakshmi , Joes Maria , Usharani Bramacharry , Venkateswari Ramachandra , Gunavathy Pradhabane , Balasundaram Revathi Mani , VN Azger Dusthackeer , Muthuraj Muthaiah
Published: August 2024

Fluoroquinolone resistance is a significant global challenge in treating multidrug-resistant tuberculosis. The WHO-endorsed GenoType MTBDRsl Ver 2.0 was used for a retrospective analysis of the molecular characterization of fluoroquinolone resistance. The FQ resistance rates in MDR-TB, RR-TB, and non-MDR-TB cases were 33%, 16.5%, and 5.4%, respectively. The most common mutation in fluoroquinolone-resistant isolates was D94G (49.5%) in the gyrA gene. In MDR-TB isolates, the prevalence of XDR-TB and pre-XDR-TB was 1.33% and 30% respectively. Among the 139 rifampicin-monoresistant tuberculosis isolates, pre-XDR-TB prevalence was 15.8%. The fluoroquinolone resistance rate was 5.12% among the 1230 isoniazid-monoresistant isolates. The study found that MDR-TB has a significantly higher risk (RR = 4.03; 95%CI: 2.94-5.53) of having fluoroquinolone resistance compared to non-MDR (RR = 0.26; 95%CI: 0.19-0.35) and rifampicin-monoresistant tuberculosis (RR=1.85; 95%CI: 1.22-2.80). Rifampicin-resistant isolates with a mutation at codon S450L have a higher risk (RR = 3.97; 95%CI: 2.90-5.44) for fluoroquinolone resistance than isolates with mutations at other codons in the rpoB gene. The study concludes that rapid diagnosis of fluoroquinolone resistance before starting treatment is urgently needed to prevent the transmission and amplification of resistance and achieve better treatment outcomes, especially in South India, where fluoroquinolone resistance is higher.
Tooth mobility revealing a brown tumor associated with normocalcemic tertiary hyperparathyroidism: case report and literature review
Authors: Boukssim Sara , Damiri Amal , Chami Bassima
Published: August 2024

Background
Brown tumors are rare non neoplastic lesions resulting from abnormal bone metabolism in hyperparathyroidism. They are rarely observed in tertiary hyperparathyroidism. Tertiary hyperparathyroidism is a very rare condition that arises in the setting of renal disease. It is the autonomous secretion of parathyroid hormone leading to persistent hypercalcemia and elevated serum parathormone despite resolution of the underlying problem.
Case presentation:
we report an unusual case of tooth mobility revealing the presence of a brown tumor located in the mandible in a north African 41 year old male with chronic kidney disease and a history of parathyroidectomy. Clinical examination revealed firm vestibular swelling. Radiographic assessment showed a well-defined periapical radiolucent lesion, consistent with a giant cell lesion. Elevated parathyroid hormone levels (3283.0 pg/ml), normocalcemia, and hyperphosphatemia supported the diagnosis of a brown tumor due to tertiary hyperparathyroidism. The treatment of brown tumor consists of addressing the underlying hyperparathyroidism. The unusual observation is that the patient presented with elevated parathormone level associated with normocalcemia raising the question on the indication for parathyroidectomy in this case.
Conclusion
The patient initially benefited from a parathyroidectomy with a reduction in serum parathormone by over 50% and tumor regression. However, 2 months later, we observed a recurrence of parathormone levels ,while calcium levels remained normal, necessitating the use of high dose calcimemitic agents. This case highlights the importance of thorough evaluation in patients with chronic kidney disease and persistent hyperparathyroidism, and also the question of the indication of parathyroidectomy in normocalcemic tertiary hyperparathyroidism
The value of the proportion of perfused vessels change rate in the evaluation of early organ function deterioration in septic shock and ARDS
Authors: Huang Shu-Ya , Dong Rui , Li Xiao-Yan , Zhang Gen-Sheng , Gao Yan-Qiu
Published: August 2024

This study explores the relationship between the proportion of perfused vessels change rate (ΔPPV), the shedding of the glycocalyx marker syndecan-1 (SDC-1), and the utility of ΔPPV in assessing early organ function deterioration in septic shock and acute respiratory distress syndrome (ARDS) patients.Patients were categorized into two groups based on the change in their Sequential Organ Failure Assessment (SOFA) score over 24 hours: the organ function deterioration group (SOFA24h-0h score ≥ 1) and the non-deterioration group (SOFA24h-0h score < 1). Sublingual microcirculation, lactic acid levels, and SDC-1 were evaluated at 0 and 6 hours. The primary endpoint was the area under the curve (AUC) for ΔPPV and its combination with lactate clearance rate (LCR). Secondary endpoints included the correlation between ΔPPV and SDC-1, hospital mortality, and survival analysis.The study included 67 patients. The AUC for ΔPPV was 0.813 (95% CI: 0.707-0.919), and when combined with LCR, it was 0.871 (95% CI: 0.785- 0.957). Additionally, a negative correlation between ΔPPV and SDC-1 was observed. Patients who met the criteria of ΔPPV≥7.6% and LCR≥14.6% demonstrated a higher survival rate compared to other groups (Log-rank test: χ²=6.489, P<0.011).Microcirculatory disorders are closely linked to glycocalyx shedding. ΔPPV, particularly when combined with LCR, can effectively predict early organ function deterioration and has significant prognostic value for hospital mortality.
Dysregulated Maternal and Newborn Fatty Acid, Sugar and Amino Acid Metabolism Associated with High Birth Weight
Authors: Chen Zhanghua , Qiu Chenyu , Liao Jiawen , Gheissari Roya , Li Claire , Kapai Anika , Conti David , Jones Dean , Bastain Theresa , Breton Carrie
Published: August 2024

Objective
This study focuses on identifying maternal and neonatal metabolomic profiles linked to adverse birthweight, while also exploring how altered metabolomic signatures influence the underlying pathophysiological mechanisms connecting maternal risk factors and adverse birthweight.
Methods
Ninety-six pregnant women and their newborns from the MADRES prospective cohort were studied. Maternal serum at third trimester and newborn cord blood were assayed for untargeted metabolomics using mass-spectrometry. Metabolome-wide association analysis was conducted to assess maternal and newborn metabolomic features association with birth weight Z-score, followed by network analysis of maternal and newborn metabolomics. Lastly, the contribution of maternal and newborn metabolomics to associations between maternal risk factors and newborn birthweight was assessed.
Results
Maternal gestational weight gain and parity were positively associated with newborn birthweight. Maternal glucose and amino acid metabolism pathways and newborn’s fatty acid, glucose metabolism and C21-steroid hormone biosynthesis were significantly enriched with high birth weight Z-score. Dysregulation in these pathways linked maternal factors such as gestational weight gain and parity with high birth weight Z-score.
Conclusion
Our findings indicate that altered maternal sugar and energy metabolism, newborn sugar and amino acid metabolism, and newborn C21-steroid hormone biosynthesis associated with high birth weight. These alternations may reflect the increased susceptibility to the effects of greater gestational weight gain and multiparity on high birth weight.
Efficacy and Safety of Durvalumab Rechallenge in Advanced Hepatocellular Carcinoma Patients Refractory to Prior Anti-PD-1 Therapy
Authors: Lai Kuan-Chang , Chen Yen-Hao , Hung Yi-Ping , Chiang Nai-Jung , Chen Ming-Huang , CHEN SAN-CHI
Published: August 2024

Background/Purpose:
Recently, anti-programmed cell death protein-1 (anti-PD-1) and anti-PD-L1 therapies were approved for hepatocellular carcinoma (HCC). However, the effectiveness of rechallenging with one immune checkpoint inhibitor (ICI) after failure of another remains unclear. This study explores the efficacy and safety of anti-PD-L1 rechallenge in patients who failed anti-PD-1 therapy.
Methods:
From January 2016 to December 2023, 65 advanced HCC patients previously treated with anti-PD-1 therapy were retrospectively enrolled and rechallenged with durvalumab (480 mg IV every two weeks).
Results:
Overall, 86.2% of patients received nivolumab and 13.8% pembrolizumab as prior anti-PD-1 therapy. The overall response rate (ORR) to durvalumab was 13.8%. Patients who responded to prior anti-PD-1 had a higher ORR compared to non-responders (31.3% vs. 8.7%, p = 0.04). Patients with any grade of immune-related adverse events (irAEs) from durvalumab had a higher ORR than those without irAEs (35.3% vs. 6.7%, p = 0.01). The median PFS was 5.4 months, and the median OS was 9.6 months. Responders to prior anti-PD-1 showed longer OS (33.9 vs. 8.2 months, p < 0.01) and a trend toward longer PFS (13.8 vs. 4.9 months, p = 0.07) compared to non-responders. Multivariate analysis identified prior anti-PD-1 response (HR: 0.31) as the only protective factor for death. Common irAEs were skin toxicity (13.8%) and hepatitis (7.7%); no correlation was found between irAEs from prior anti-PD-1 and durvalumab treatment.
Conclusion:
This study provides the first, concrete evidence that durvalumab rechallenge is effective for HCC patients who are refractory to anti-PD-1 therapy, especially for those who previously responded to anti-PD-1 treatment.
Practical Classification approach for newly diagnosed diabetes onset with ketosis or ketoacidosis in children and adolescent patients
Authors: Liu Hongxia , Wang Yan , Wang Miao , Zhang Bo , Ma Caixia , Cui Lianlian , Wang Qianhan , Cao Zhenfeng , Yang Zhongwen , Shi Changsong
Published: August 2024

Background
Distinguishing diabetes diagnosis is fundamental to ensuring proper management of patients, but has been challenging, especially in newly diagnosed diabetes onset with ketosis or ketoacidosis.
Methods
A retrospective analysis was conducted on medical records from 2017/1/1 to 2020/4/30 among children and adolescents with new-onset diabetes accompanied with ketosis or ketoacidosis. Data was collected at diabetes onset and 2 years after discharge. Patients were classified as type 1 or 2 diabetes (T1DM; T2DM) based on the patient's medication and final diagnosis. The best diagnostic cut-off point was determined using receiver operating characteristic curves (ROCs) between T1DM and T2DM.
Results
Among 153 children and adolescents, 78 patients (51.0%) were diagnosed as T1DM and 75 patients (49.0%) were diagnosed as T2DM after 2 years of follow-up. There were significant differences in sex, age, family history, BMI, systolic and diastolic blood pressure, lipids, uric acid (UA), C-peptide, combined fatty liver ratio and any islet autoantibody-positive ratio at the time of onset (P < 0.05). In the ROC analysis, fatty liver, SBP, BMI, fasting/1-h/2-h C peptide at the time of onset performed well on diagnostic typing (ROC AUC = 0.79, 0.83, 0.92, 0.94, 0.96, and 0.95 respectively; Optimal cut point = 1.5, 110.5, 21.0, 0.5, 1.0 and 2.0).
Conclusions
This study provides a practical clinical approach to the diagnosis and classification of diabetes. Caution is needed in C-peptide, BMI, SBP and fatty liver at the time of onset, which have effective diagnostic values.
Development of a complex intervention to strengthen municipality-based breastfeeding support to reduced social inequity in breastfeeding
Authors: Nilsson Ingrid , Busck-Rasmussen Marianne , Villadsen Sarah Fredsted
Published: August 2024

Background
Breastfeeding is the ideal nutrition for infants and protects infants and mothers from a range of adverse health outcomes during their lifespan. In Denmark, while the breastfeeding initiation rate is high, only 14% of mothers meet the World Health Organization’s recommendation of exclusive breastfeeding at six months. Furthermore, a notable social inequity exists among those who achieve this recommendation. Knowledge of effective interventions to reduce breastfeeding inequity is limited. A previous hospital-based intervention succeeded in increasing breastfeeding duration. However, most breastfeeding support is provided in Danish municipalities by health visitors. This called for adapting the intervention to the health visiting program and developing an intensified intervention addressing the social inequity in breastfeeding. This article describes the adaptation and development process of the intervention ‘Breastfeeding – a good start together’.
Methods
During a 15-month period in 2020-21, the municipal intervention was iteratively developed using a three-stage framework for developing complex health interventions described by Hawkins et al. The three stages were 1) need assessment and stakeholder consultation, 2) co-production and 3) prototyping. The process was inspired by O’Cathain et al.’s principles for a user-centred, co-created and theory- and evidence-based approach, involving parents and health visitors.
Results
In stage 1, we identified the needs and priorities of the target groups of the intervention. In stage 2, the intervention was developed through action research design and inspired by Duus’ ‘learning cycles’ as the method to enhance motivation and ownership and to strengthen the implementation process by creating a joint room for learning and reflection with health visitors and developers. In stage 3, the intervention was tested for feasibility and usefulness during a 2.5-month period accompanied by monthly dialogue meetings with health visitors and developers. In this period, the intervention was refined based on the gathered experiences and was subsequently prepared for evaluation.
Conclusion
The description of the development of this complex intervention, aimed at increasing breastfeeding duration and reducing inequity, offers breastfeeding practitioners and researchers a transparent foundation for continuously improving breastfeeding support and a methodology for complex intervention development.
Trial registration
Registered at Clinical Trials NCT05311631.
Overexpression of GADD45g inhibits proliferation and invasion of acute myeloid leukemia cell lines with FLT3-ITD+ by downregulating the JNK pathway
Authors: Li Feifan , Dong Huiyun , Yang Yanli
Published: August 2024

To Explore the effects of overexpression of GADD45g inhibits proliferation and invasion of acute myeloid leukemia (AML) cell lines with FLT3-ITD+ by downregulating the JNK pathway. A total of 30 bone marrow specimens from patients with initial diagnosis of AML were selected, of which 10 were FLT3-ITD+, and the expression level of GADD45G mRNA was detected by Real-time PCR in bone marrow single nuclei from patients with primary AML, FLT3-ITD+ AML patients, as well as FLT3-ITD+ AML cell lines. GADD45G overexpression lentivirus was constructed and infected FLT3-ITD+ AML cell lines, and the effects of GADD45G overexpression on FLT3+ AML cell lines were analyzed by CCK-8 assay, invasive migration, colony formation and flow assay. The effect on biological functions after using the JNK pathway inhibitor SP600125. The expression level of GADD45G was significantly lower in FLT3-ITD+ AML patients and cell lines (P< 0.001). Overexpression of GADD45G in FLT3-ITD+ AML cell lines inhibited cell proliferation, migration and invasion, clone formation (P<0.001) and induced apoptosis (P<0.001), and significantly increased the expression levels of P-JNK/JNK and P-P38/P38 proteins (P<0.001). The use of JNK pathway inhibitor SP600125 promoted proliferation, migration invasion, clone formation, inhibited apoptosis (P<0.001) and decreased expression of related proteins (P<0.001) compared with the overexpression of GADD45G group. The GADD45G gene is lowly expressed in bone marrow and cell lines of FLT3-ITD+ AML patients, which inhibits their biological functions, and the overexpression of GADD45G may induce apoptosis by downregulating the JNK pathway.
Taiwanese population prevalence of frontal sinus architecture variations and relationships with frontal sinusitis in comparison to worldwide prevalence
Authors: Chang Ting-Wei , Chao Pin-Zhir , Wang Hsing-Won
Published: August 2024

Background: Because of its intricate and varied structure, the frontal sinus is difficult to surgically access. In order to improve surgical precision, the International Frontal Sinus Anatomy Classification (IFAC) presents a standardized nomenclature of cells in the frontal sinus and frontal recess. This study examines frontal sinus cell prevalence in Taiwanese and worldwide populations.
Methods: In total, 284 sides were gathered from 142 computed tomography (CT) scans in this retrospective analysis during January 2019 to April 2019, with independent assessments for the left and right sides. The IFAC was used to determine the prevalence of each kind of frontal sinus cells. Frontal rhinosinusitis was diagnosed through CT scans and evaluated using the Lund-Mackay score. In addition, the PubMed databases was used to search for articles analyzing the prevalence of frontal sinus cells based on the IFAC. A total of 11 articles were analyzed, including our analysis of the prevalence in the Taiwanese population. (Trial registration: N202305004. Registered 19 May 2023.)
Results: With an appearance in 90.5 percent of the patients in the Taiwanese population and 92.5 percent in worldwide, the agger nasi cells were the most frequently occurring cell in both Taiwanese and global populations. In 17.3 percent of instances, frontal sinusitis was present; in 82.8 percent of cases, it was missing. None of the frontal cell variations were shown to be significantly associated with the development of frontal sinusitis (all p > 0.05).
Conclusion: This study documents the prevalence of frontal cell types based on the IFAC system in a Taiwanese and the global population. While this article did not establish a direct association between frontal sinus cells and frontal sinusitis, these frontal sinus cells do indeed influence the drainage of frontal sinus secretions. Therefore, comprehensively categorizing frontal sinus cells through the IFAC system can provide valuable insights for future surgeries and related research.
WITHDRAWN: Combination of ultrasound-guided pectoral nerve block I (PECS I) and serratus anterior plane block (SAP) for attenuation of surgical stress response during modified radical mastectomy: a prospective interventional randomized controlled trial
Authors: Pramanik Monotosh , Chaudhuri Shalini , Banerjee Sandipan , Chattopadhyay Uddalak , Hussain Syed Sadaqat , Singh Nikhil Kumar , Kirtania Jyotirmay
Published: August 2024

Background and Aims
General anesthesia with multimodal analgesia is the standard anesthetic management during modified radical mastectomy. In this study, a combined ultrasound-guided pectoral nerve block (PECS I) and serratus anterior plane block (SAP) were used for surgical stress response attenuation and postoperative analgesia.
Methods
Thirty-six consenting patients were randomized into two groups. After induction of general anesthesia, Group B patients received ultrasound-guided PECS I and SAP block whereas Group C patients received intravenous analgesics only. Intraoperative fentanyl dosage to keep the systolic blood pressure (SBP) and heart rate (HR) within 20% of baseline was the primary outcome variable. Secondary outcome variables were intraoperative vitals, postoperative pain score, analgesic requirement, and nausea and vomiting. Wilcoxon rank-sum test (non-parametric data), Student's t-test (parametric data), and Chi-square test (categorical data) were used for comparison. P value <0.05 was considered statistically significant.
Results
Surgical stress response attenuation was achieved with a lower dosage of fentanyl in Group B compared to Group C [intraoperative fentanyl (mean±SD), 116.11±25.70 µg vs. 134.44±20.07 µg, P = 0.023]. Compared to Group C, intraoperative reduction in SBP and HR was higher in Group B [SBP reduction (mean±SD), 24.03±12.5 mm of Hg vs. 15.2±13.05 mm of Hg, P = 0.045 and HR reduction (mean±SD), 18.61±6.6 beats/min vs. 10.73±10.03 beats/min, P = 0.009 respectively]. The apparently higher pain scores in the control group were statistically insignificant.
Conclusion
A combined PECS I and SAP block attenuates intraoperative autonomic stress response due to the surgical stimulus with significantly less opioid requirement.
Trial Registration: CTRI/2023/03/050487. This trial is registered with the Clinical Trial Registry of India ON 09/03/2023. https://ctri.nic.in/Clinicaltrials/login.php
Factors associated with the implementation of Dialectical Behavior Therapy by Spanish speaking mental health professionals who treat suicide risk
Authors: Navarro-Haro María V. , Abanades Alba , Peris-Baquero Óscar , Gagliesi Pablo , Rodante Demián , García-Palacios Azucena , Osma Jorge
Published: August 2024

Background
The lack of training for professionals on how to manage suicide risk is an important barrier to effective intervention. Dialectical Behavior Therapy Intensive Training™ (DBT-IT) includes specific training for suicide and has shown promising results to enhance implementation of DBT. To our knowledge, no published studies have evaluated the effect of DBT-IT on therapists’ attitudes towards treating suicide risk and among Spanish-speaking mental health professionals. The main aim of this study was to evaluate the effect of DBT-IT on therapists’ attitudes regarding treating suicide risk and its relationship with the implementation of DBT before and after receiving DBT-IT.
Methods
A total of 242 mental health workers (76.4% women, mean age 35.38, SD = 9.17; 77.7% from Latin America; 22.3% from Spain) who had received a DBT-IT participated in the study. Self-efficacy (Efficacy in Assessing and Managing Suicide Risk Scale) and concerns (Concerns about Treating Suicidal Clients Scale) in treating suicide, perceived burnout (Copenhagen Burnout Inventory), confidence to apply DBT (Behavioral Anticipation and Confidence Questionnaire), barriers to implementation (Barriers to Implementation Inventory), implementation of DBT and reach were measured via online survey at parts 1 (beginning) and 2 (after 9 months of implementation) of the DBT-IT.
Results
Differences between part 1 and part 2 (n = 61) indicated statistically significant improvements in self-efficacy, concerns about the lack of training and competence in treating suicide, and confidence to apply DBT. Statistically significant increases in the rates of DBT treatment modes implementation (except for individual therapy) and mindfulness practice, as well as the number of team members and consultation team hours, were also found. Findings also indicated statistically significant positive correlations between burnout and concerns about treating suicidal clients, as well as with structural and administrative implementation barriers, and between self-efficacy in managing suicide, confidence to apply DBT and implementation of DBT treatment modes. Participants with more implementation barriers reported lower rates of consultation team and phone coaching implementation.
Conclusions
DBT-IT could be an adequate training model to increase self-efficacy and confidence in treating suicide risk as well as to facilitate implementation of DBT treatment modes by Spanish-speaking mental health professionals.
Risk of Dementia in Nepal: A Cross-Sectional Survey in Mountainous, Hilly, and Lowland Regions
Authors: Simkhada Bibha , Magar Sanju Thapa , Simkhada Padam , Tamang Pasang , Stephenson John
Published: August 2024

Introduction
Globally dementia is a growing public health problem, with over 135,000 people in Nepal living with dementia. Nepal lacks national and community-based data on dementia prevalence. This study aims to determine the dementia risk in Nepal and assess the effects of age, sex, and geographical location on disease prevalence. It also intends to inform policy makers about the burden of dementia, prompting them to plan and prepare appropriate health and social care services for individuals affected by dementia.
Methods
A cross-sectional survey with total 1152 individuals (933 older people, aged 60 and over and 219 carers of 60 years and older people) was conducted to determine the prevalence of dementia risk in three geographical regions of Nepal. The Rowland Universal Dementia Assessment Scale (RUDAS) and Memory First Aid Informant Questionnaire adapted from Community Screening Interview for Dementia (CSI-D) for informant were used to measure cognitive impairment. The study evaluated the overall prevalence of cognitive impairment or risk of dementia and subgroups by region, age group, and sex. Chi-squared tests and multiple logistic regression analyses were conducted to assess the effects.
Results
For the RUDAS test, 53.7% (501) participants had cognitive impairment, with slightly higher rates in women (56.5%) than men (51.7%). For the Memory First Aid Informant Questionnaire/CSI-D for informant, 155 participants had cognitive impairment at a rate of 70.8%, with slightly higher rates in men. Cognitive impairment prevalence increases with age and region, with hilly and mountainous areas and low-lying regions having a greater geographic effect.
Conclusions
There is high risk of dementia in Nepal. The risk is influenced by age and geographical regions, necessitating early diagnosis and tailored interventions for older people and who are residing in higher altitude areas. National-level studies and exploration of factors affecting early dementia diagnosis are needed.
Evaluation of split renal function using MR-derived structure and arterial spin-labeled perfusion features in obstructive nephropathy
Authors: Cai Yu-Qing , Wang Lei , Guan Wen-Hao , Yang Jinzhi , Dong Yang , Li Xiancheng
Published: August 2024

Objectives To explore the value of renal arterial spin-labeled (ASL) and structural MRI in evaluating split renal function (SRF) by renal scintigraphy (RS) in obstructive nephropathy.
Materials and methods Consecutive patients with obstructive hydronephrosis were recruited for a 3.0-T conventional and ASL examination from January 2022 to August 2023 prospectively. The 92 independent kidneys were classified into normal renal function, mild to moderate renal impairment, severe renal impairment, or no function groups. Renal blood flow (RBF), renal parenchymal thickness (RPT), and renal pelvic dilatation (RPD) were assessed based on ASL and T1WI maps. One-way analysis of variance (ANOVA) and Kruskal-Walli’s test were used to analyze the differences. Pearson and Spearman rank correlation analysis approaches were adopted to analyze the correlation between RBF, RPT, RPD, and glomerular filtration rate (GFR) by RS. The ROC curve was used to compare their performance in SRF evaluation.
Results Renal cortical RBF, RPT, and RPD could distinguish SRF pairwise subgroups with different renal function impairments (p<0.001), with correlation coefficients of 0.767, 0.635, and -0.589, respectively (all p<0.001). RBF combined with RPT and RPD achieved the best efficacy in distinguishing between normal and mild, mild and severe, normal and severe renal dysfunction, with AUCs of 0.869 (95% CI, (0.768-0.937)), 0.883 (95% CI, (0.756-0.959)) and 0. 994 (95% CI, (0.931-1.00)).
Conclusions MR structural features and ASL imaging enable quantitative measurements of RPT, RPD, and renal cortical RBF, which were correlated with RS-GFR. MR combination demonstrated clinical potential in noninvasive evaluation of SFR in obstructive nephropathy.
Discovering a specialized programmed-cell death patterns for prognostic model of pancreatic ductal carcinoma via machine learning
Authors: Wu Zhaowei , Huang Kun , Jiang Shiming , Chen Yong
Published: August 2024

Substantial evidence implicates programmed cell death (PCD) in pancreatic ductal adenocarcinoma (PDAC) pathophysiology. Through advanced machine learning paradigms, our study identified 103 PCD-relevant hub genes. Employing a comprehensive panel of 167 algorithmic configurations, spanning 15 unique machine learning approaches, we analyzed the prognostic relevance of these PCD-linked features across diverse cohorts. Our systematic analysis yielded a groundbreaking prognostic indicator, the Cell Death Index (CDI), poised to markedly improve PDAC outcome predictions. Demonstrating notable accuracy in both prognosis and immunotherapy response forecasting, the CDI facilitated the development of an enhanced nomogram. Additionally, we pinpointed targeted therapeutic agents for PDAC patients classified according to specific CDI profiles, advancing personalized medicine strategies. MYOF, identified as a central hub gene, exhibited markedly heightened expression in PDAC tissues versus adjacent non-malignant tissues, as evidenced by quantitative PCR. Further probing revealed MYOF's critical role in mediating proliferation, viability, invasion, and migration in PDAC cells, underscoring its potential significance as a therapeutic target warranting further investigation.