bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of failure to rescue in surgical rescue
Authors: Ogawa Katsuhiro , Miyamoto Yuji , Hisano Yuki , Maeda Yuto , Ohuchi Mayuko , Hiyoshi Yukiharu , Ida Satoshi , Iwatsuki Masaaki , Baba Yoshifumi , Baba Hideo
Published: October 2024

Purpose: To determine the current status of surgical rescue (SR) and examine the predictors of failure to rescue (FTR). In acute care surgery, predictors of FTR have only been reported in patients with trauma, not in SR.
Methods: This retrospective study included 142 patients who underwent emergency surgery at our institution between April 2019 and March 2023. The primary outcome was the identification of the FTR predictors using logistic regression analysis. The secondary outcome was the development of a Surgical Rescue Severity Score (SRSS) using these SR predictors and long-term outcomes.
Results: The patients were divided into survival and mortality groups (122 and 20, respectively). American Society of Anesthesiologists Physical Status (ASA-PS) and quick sequential organ failure assessment (qSOFA) scores were higher in the mortality group. In contrast, the survival group included more cases of SR necessitated by surgical treatment. In multivariate analysis, ASA-PS ≥ 3 (odds ratio [OR], 5.3; 95% confidence interval [CI] 1.2–36), complications caused by non-surgical therapy (OR, 5.5; 95% CI 1.8–19), and qSOFA score ≥ 2 (OR, 4.5; 95% CI 1.3–17) were independent prognostic factors. The total risk factors for FTR obtained in the multivariate analysis were calculated and established as the SRSS. The long-term prognosis of SR was examined and stratified by the SRSS (P = 0.0001).
Conclusion: Predictors of FTR in SR were ASA-PS ≥ 3, qSOFA score ≥ 2, and complications caused by non-surgical therapy. The SRSS stratified the short- and long-term prognoses of SR and predicted prognoses preoperatively.
Transbronchial Lung Cryobiopsy for Interstitial Lung Disease: Early Experience, Learning Curve, and the Impact of Sedation on Complication Rates at a Single Centre in Japan
Authors: Kaburaki Shota , Tanaka Toru , Kamio Koichiro , Tanaka Yosuke , Kasahara Kazuo , Seike Masahiro
Published: October 2024

Background
Transbronchial lung cryobiopsy (TBLC) has emerged as a promising diagnostic tool for interstitial lung disease (ILD). This study aimed to assess the initial experience, procedural learning curve, and influence of sedative medications on complication rates, particularly bleeding and pneumothorax, in the implementation of a TBLC program for ILD diagnosis.
Methods
In this retrospective cohort study, we analysed 119 patients who underwent TBLC at Nippon Medical School Hospital from April 2021 to March 2024. Procedural times, complication rates, and histopathological outcomes were evaluated. The learning curve was assessed using cumulative sum (CUSUM) analysis, focusing on procedure time and biopsy yield. The association between sedative medication dosages and bleeding risk was also examined.
Results
The overall diagnostic yield was high, with alveolar tissue obtained in 97.5% of cases and a definitive pathological diagnosis achieved in 81.5% of patients. CUSUM analysis revealed a proficiency threshold at approximately 56 cases, with improved efficiency and biopsy yield in the consolidation phase. Fentanyl dosage was significantly associated with reduced bleeding complications (OR 0.51, 95% CI 0.27–0.97, p = 0.041).
Conclusions
TBLC is a safe and effective diagnostic tool for ILDs, with a manageable learning curve for procedural efficiency. Sedation, particularly fentanyl dosage, plays a crucial role in minimizing complications. These findings support the adoption of TBLC as a standard diagnostic approach for ILD and highlight the importance of adequate training and optimized sedation protocols to ensure safety and efficacy in clinical practice.
Demographic and clinical features of extremity crush injuries resulting from entrapment under the rubble: An orthopedic perspective
Authors: Gümüşoğlu Ender , Asfuroğlu Zeynel Mert , Eskandari Metin Manouchehr
Published: October 2024

Background:
We aimed to contribute to the literature by reporting the demographic and clinical characteristics of patients who suffered extremity crush injuries as a result of being trapped under rubble following the earthquake that occurred in Turkey on February 6, 2023.
Methods:
In total, 65 patients, including 33 females and 32 males, were enrolled. The mean age of the patients was 32.2 ± 20.45 years. Patients were categorized into four treatment groups, including nonoperative (n = 13), fasciotomy/debridement (n = 20), fracture fixation (n = 5), and amputation (n = 27) groups. Demographic and clinical information were analyzed.
Results:
The lower extremities were the most frequently affected anatomical regions. Upon hospital admission, all patients exhibited significant elevations in serum potassium and creatinine kinase levels; however, these levels decreased significantly within 24 h of the initiation of operative or nonoperative treatment (p < 0.05). The rate of crush syndrome development was 54%, 60%, and 59% in the nonoperative, fasciotomy/debridement, and amputation groups, respectively. Similarly, the rate of hemodialysis was 15%, 35%, and 22% in the nonoperative, fasciotomy/debridement, and amputation groups, respectively. The reoperation rate was 75% and 30% in the fasciotomy/debridement and amputation groups, respectively. Furthermore, the incidence of infection was 40% in fracture fixation group, 40% in the fasciotomy/debridement group, and 33% in the amputation group. The mortality rate was 5% in the fasciotomy/debridement group and 7% in the amputation group. The mean duration of hospitalization for all treatment groups was 10.9 ± 10.41 days, with the fasciotomy/debridement group having the longest duration of hospitalization (14.5 ± 9.8 days).
Conclusion:
During the acute treatment phase, a significant increase in crush syndrome and wound infection rates, accompanied by a greater need for hemodialysis and prolonged hospitalization, were frequently observed. We hypothesize that the findings of studies on earthquake-related experience could provide a reference for future investigations.
Effect of Western-based and five-element music therapy on patients undergoing maintenance hemodialysis: study protocol for a randomized controlled trial
Authors: Zhang Jing-yi , Wu Wen-min , Zhang Li-ping , Zhou Su-jin , Ye Xuan-ying , Zeng Hui-ping , Gao Yun
Published: October 2024

Background
Music therapy has emerged as a significant complementary approach to psychotherapy. However, due to the intricate interplay between music and culture, the comparative effectiveness of five-element music therapy and Western music therapy for Chinese patients undergoing maintenance hemodialysis warrants further investigation.
Methods
In this prospective randomized controlled trial, 87 patients on maintenance hemodialysis will be recruited and randomly assigned in a 1:1:1 ratio to the five-element music group, Western music group, and control group. Participants in the Five-element music group and Western music group will receive eight weeks of five-element music therapy and Western music therapy, respectively, for 60 min per session, three times per week. All outcome indicators will be measured at baseline, week 4 of the intervention, week 8 of the intervention, and after a follow-up period of 4 weeks at the end of the intervention. The primary outcome indicator will be the Hospital Anxiety and Depression Scale (HADS). Secondary outcome indicators will include the Pittsburgh Sleep Quality Index (PSQI), the Dialysis Symptom Index (DSI) and the Positive and Negative Emotions Schedule (PANAS).
Discussion
The trial will evaluate the effects of Western music and traditional Chinese five-element music on emotion, sleep and symptoms of patients undergoing maintenance hemodialysis. This study is expected to provide a more personalized and effective music therapy program for patients on maintenance hemodialysis which can be added to the treatment of patients on maintenance hemodialysis as a non-invasive complementary and alternative therapy to help improve the quality of life of patients on maintenance hemodialysis.
Trial registration:
The trial was registered with the Chinese Clinical Trial Registry on 14 June 2024 under registration number ChiCTR2400085665.
Implementation strategies: Lessons learned during an e-learning intervention to improve dietary behaviors and feeding practices in Early Childhood Education and Care
Authors: Lian Henrik , Øverby Nina Cecilie , Vik Frøydis Nordgård , Medin Anine Christine , Osorio Natalie Garzon , Helle Christine , Bjørkkjaer Tormod , Love Penelope , Rutter Harry , Barker Mary Elizabeth , Hillesund Elisabet Rudjord , Helland Sissel H.
Published: October 2024

Background:
Early Childhood Education and Care (ECEC) centers play an important role in fostering healthy dietary habits. The Nutrition Now project focusing on improving dietary habits during the first 1000 days of life. Central to the project is the implementation of an e-learning resource aimed at promoting feeding practices among staff and healthy dietary behaviours for children aged 0–2 years in ECEC. Implementing new interventions often presents challenges. This study explores ECEC staff views and experiences with selected strategies for implementing Nutrition Now in ECEC centers in a municipality in Norway.
Methods:
The study is a part of the Nutrition Now study, a hybrid type 1 non-randomized controlled trial. The implementation process followed the Dynamic Integrated Evaluation Model (DIEM). Implementation strategies were selected from the Expert Recommendations for Implementing Change (ERIC) project and included identify and prepare champions, conduct educational meetings, distribute educational materials, create a learning collaborative, and remind clinicians. ECEC teachers from participating ECEC centers in the intervention municipality were recruited as champions. Short phone interviews were conducted with the champions every three weeks over six months. The interviews were analysed using qualitative thematic analysis.
Results:
In total, 29 of the invited ECEC centers (53%) participated, and 260 brief interviews (88%) were conducted with champions (n = 37). An evaluation of the feedback from the champions suggests that the five selected implementation strategies were acceptable. Five main themes were developed by qualitative analysis: 1) Being a champion resembles what I already do. 2) Educational meetings are fine but take time. I prefer when peers share experiences. 3) Newsletters were helpful and reminded me, but I do not always have enough time to read. 4) Evaluations have increased my awareness, and we do them informally and formally. 5) The regular phone calls reminded me I could receive support and express my opinion.
Conclusion:
This study’s findings suggest that several implementation strategies are acceptable for stakeholders in an ECEC e-learning healthy eating intervention. However, time constraints among champions may hinder deep engagement. While the results can inform the scale-up of this and similar interventions, these findings are likely context-dependent, and further investigations are required.
Trial registration on June 6, 2022:ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967
Higher sperm H3K4me3 levels are associated with idiopathic recurrent pregnancy loss
Authors: Irani Delna , Tandon Deepti , Bansal Vandana , Patil Anushree , Singh Dipty
Published: October 2024

Background:
During fertilization, spermatozoa contribute genetic and epigenetic factors such as chromatin packaged with protamines and histones; DNA methylome, micro RNAs etc. Human sperm chromatin retains 5–15% nucleosomes which can play a key role in embryonic development. Recurrent Pregnancy loss (RPL) is a condition mainly attributed to defects in embryo and placenta development. Majority of the known RPL factors are of maternal contribution while ~ 50% RPL cases are termed idiopathic (iRPL). Besides paternal genetic factors, epigenetic factors via sperm could also be responsible for iRPL. Hence, we investigated alterations in retained nucleosome content of iRPL sperm (n = 46) as compared to fertile male population (n = 40).
Results:
We measured the relative abundance of core histone H4 and Protamine-2 content along with the modified histones H4Ac, H3K4me3, H3K27me3 and H3K9me3 by flow cytometry. Enrichment of these modified histones at regulatory loci have either transcription activating or repressing roles and Protamine-2 contributes to sperm chromatin compaction. H4 and Protamine-2 levels were comparable in both groups and showed significant negative correlation. The iRPL group was found to have significantly higher levels of sperm H3K4me3 as compared to the fertile control group. The other modified histones and protamine levels showed no alterations among the two groups. Furthermore, we analyzed possible correlation of sperm DNA fragmentation index (DFI) and 5-mC content with the relative sperm core histone H4 levels. Sperm DFI was found to be significantly positively correlated with H4 MFI in both control and iRPL sperm.
Conclusion:
A fraction of the H3K4me3 enrichment is now known to resist embryonic epigenetic reprogramming; and hence, such elevated levels in the sperm would question its developmental competence requiring its implications to be explored further in RPL pathology. Also, incidence of sperm DNA fragmentation is associated with increased histone retention in both fertile and iRPL cases.
Pregnancy, delivery, and neonatal outcomes among women with beta-thalassemia major: A population-based study of a large US database
Authors: St-Georges Juliette , Alnoman Abdullah , Badeghiesh Ahmad , Baghlaf Haitham
Published: October 2024

Purpose:
We explored the effect of beta-thalassemia major on pregnancy and delivery outcomes in non-endemic area, utilizing USA population database.
Methods:
This is a retrospective study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A cohort of all deliveries between 2011 and 2014 was created using ICD-9 codes. Patients with beta-thalassemia major were identified and matched to patients without beta-thalassemia based on age, race, income quartile and type of health insurance at a ratio of 1:20. Baseline characteristics were compared between the groups using Chi-square and Fischer's exact tests, as appropriate. Univariate and multivariate analyses were conducted for pregnancy, delivery and neonatal outcomes to estimate the unadjusted and adjusted odds ratio, respectively.
Results:
Out of 3,070,656 pregnancies over the study period, beta-thalassemia major complicated 445 pregnancies. Patients with beta-thalassemia were more likely to have thyroid disorders and previous C-section (p-value < 0.05). There were no differences in pregnancy outcomes such as gestational hypertension, preeclampsia, gestational diabetes, and placenta previa. C-section was 30% more likely to be the method of birth (aOR 1.30, 95%CI 1.03–1.63) and there was more than three-fold increased in rate of blood transfusion (aOR 4.69, 95% CI 3.02–7.28) among participants with beta-thalassemia major. Mothers with Beta-thalassemia, almost, were 70% more likely to have a neonate small for gestational age (aOR 1.68, 95%CI 1.07–2.62).
Conclusions:
Women with beta-thalassemia major are more likely to give birth by C-section, require blood transfusion and have small for gestational age neonates. Counseling patients with beta-thalassemia about these risks and increased antenatal surveillance is advised.
Extreme heat and pediatric health in a warming world: a space-time stratified case-crossover investigation in Ontario, Canada
Authors: Kassem Hallah , Lavigne Eric , Weinberger Kate , Brauer Michael
Published: October 2024

Background
Globally, climate change is causing frequent and severe extreme heat events (EHEs). A large body of literature links EHEs to multiple health endpoints. While children’s physiology and activity patterns differ from those of adults in ways that are hypothesized to increase susceptibility to such endpoints, research gaps remain regarding the specific impacts of EHEs on child health. This study evaluated pediatric emergency healthcare utilizations associated with EHEs in Ontario.
Methods
Applying a space-time stratified case-crossover design, associations between EHEs (same-day or lagged exposure to consecutive days of daily maximum temperatures above percentile thresholds) and 15 causes of pediatric emergency healthcare use in Ontario, Canada from 2005–2015 were analysed using conditional quasi-Poisson regression. In primary analyses, EHEs were defined as two or more consecutive days with temperatures above the 99th percentile of temperature within each respective forward sortation area (FSA). Healthcare use was measured using hospital admissions as an indicator of severe outcomes, and emergency department (ED) visits as a sensitive measure of outcomes.
Results
EHEs increased the risk of pediatric hospital admissions for respiratory illnesses by 26% (95% CI: 14%-40%), asthma by 29% (16%-44%); infectious and parasitic diseases by 36% (24%-50%), lower respiratory infections by 50% (36%-67%), and enteritis by 19% (7%-32%). EHEs also increased the risk of ED visits for lower respiratory infections by 10% (0%-21%), asthma by 18% (7%-29%), heat-related illnesses by 211% (193%-230%), heatstroke by 590% (550%-622%), and dehydration by 35% (25%-46%), but not for other causes. Admissions and ED visits due to injuries and transportation related injuries were negatively associated with EHEs. Neither all-cause hospital admissions nor ED visits were associated with EHEs.
Conclusions
In Ontario, EHEs decreased the risk of pediatric emergency healthcare utilization for injuries and increased the risk of respiratory illnesses, asthma, heat-related illnesses, heatstroke, dehydration, infectious and parasitic diseases, lower respiratory infections, and enteritis. Tailored policies and programs that reflect the specific heat-related vulnerabilities of children to respiratory and infectious illnesses are warranted in the face of a rapidly warming climate.
Validation of the Arabic versions of the long (15 items) and short (4 items) forms of the Distress Tolerance Scale (DTS)
Authors: Noureddine Amir , Malaeb Diana , Sawma Toni , Sakr Fouad , Dabbous Mariam , Obeid Sahar , Hallit Souheil , Fekih-Romdhane Feten
Published: October 2024

Background: Distress tolerance, defined as the capacity to endure and manage negative emotional states, is an important construct in comprehending various psychological conditions, including anxiety, depression, and substance use disorders. The Distress Tolerance Scale (DTS) and its Short Form (DTS-SF) are widely used tools for measuring distress tolerance. Still, their applicability in non-Western, Arabic-speaking populations has not been validated. Our study aims to examine the psychometric properties of an Arabic translation of the DTS and DTS-SF among Arabic-speaking general population adults.
Methods: A sample of 507 participants was recruited from diverse community settings. Participants completed the Arabic translations of the DTS and DTS-SF, alongside other relevant psychological measures, through an online survey. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of both scales, and their reliability was assessed using McDonald’s omega and Cronbach’s alpha. Sex invariance was tested, and correlations with other psychological constructs, such as anxiety and child abuse, were examined to establish concurrent validity.
Results: CFA supported the four-factor structure of the DTS, especially after removing one item with low factor loading. Both the DTS and DTS-SF demonstrated strong internal consistency (DTS: ω = .91, α = .91; DTS-SF: ω = .77, α = .77) and good fit indices, confirming their reliability. Sex Invariance was established at the configural, metric, and scalar levels for both long and short versions. The DTS and DTS-SF scores showed significant correlations with anxiety and child abuse, supporting the scales' concurrent validity, while no significant correlation was found with pain, suggesting a differentiation between emotional distress and physical pain tolerance.
Conclusion: The study indicates that the Arabic versions of the DTS and DTS-SF are reliable and valid tools for assessing distress tolerance in Arabic-speaking populations. These scales are valuable for both clinical and research applications, enabling the identification of individuals at risk for psychological distress and guiding the development of culturally relevant interventions. Future research should explore the use of these psychometric instrument in other cultural contexts.
Is the Family Doctor Contract Service Program widely and equitably known among Chinese community residents? A national cross-sectional survey
Authors: Wang Yang , Wu Yibo , Jin Hua , Yu Dehua
Published: October 2024

Background:
The Family Doctor Contract Service Program in China aims to enhance the accessibility and continuity of primary care by fostering ongoing, patient-centered relationships between residents and primary care physicians. This study examines nationwide awareness levels of the program in 2023, with a focus on disparities across different economic development levels, socioeconomic strata, and urban versus rural areas.
Methods:
A stratified, quota-sampled national survey was conducted from June to August 2023, targeting Chinese residents aged 18 and older across 800 communities in 32 provinces. The survey assessed awareness of the Family Doctor Contract Service Program along with related sociodemographic and health characteristics. Statistical analysis included estimating awareness rates, adjusted for age and gender weighting, and examining the association between sociodemographic factors and awareness using multilevel modeling, with provinces as the first level and residents as the second.
Results:
The survey included 12,403 respondents, with an overall awareness rate of 49.75%. Awareness rates were 63.7%, 53.24%, and 48.28% in high-, middle-, and low-income provinces, respectively, and 57.23%, 49.42%, and 44.69% across high-, middle-, and low-socioeconomic status (SES) groups. Urban residents had a higher awareness rate (56.78%) compared to rural residents (45.50%). Residents in provinces where the average annual income is less than 40,000 yuan were significantly less likely to be aware of the program (OR=1.70, 95% CI: 1.24-2.31, P=0.001) compared to those in provinces with an average annual income of 60,000 yuan or more. Similarly, individuals in SES levels 1-2 were more likely to be unaware of the program compared to those in SES levels 6-7 (OR=1.47, 95% CI: 1.27-1.71, P≤0.001). Rural residency was also associated with a higher likelihood of being unaware of the program (OR=1.13, 95% CI: 1.03-1.22, P=0.006).
Conclusion:
Nine years after its implementation, only about half of mainland China's community residents are aware of the Family Doctor Contract Service Program, with particularly low awareness among economically disadvantaged provinces, lower socioeconomic groups, and rural areas. There is a critical need to enhance the dissemination of information about the program and enhance primary care to meet the health service needs of these vulnerable populations.
Aberrant bcl6 protein expression in patients with EMZL following recurrence or progression: case report of two cases
Authors: Zhang Ming , Qu Jianli , Guo Weiwei , Liu Yi , Zhang Wei
Published: October 2024

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL) is an indolent B-cell lymphoma that can involve various anatomic sites. EMZL is derived from post-germinal center marginal zone B cells and typically lacks bcl-6 expression. Herein, we report two post-treatment cases of EMZL where unexpected bcl-6 protein expression was observed in specimens obtained following recurrence or progression. This contrasts with the primary specimens, which were negative for the bcl-6. Additionally, we confirm that the altered bcl6 expression observed in relapsed EMZL cases is independent of BCL6 gene rearrangement, as demonstrated by fluorescence in situ hybridization analysis. Relevant literature was reviewed and summarized to enhance the understanding of this phenomenon, particularly for pathologists.
18F-FDG PET for the differential diagnosis of Alzheimer's disease and Frontotemporal lobar degeneration: a multicenter prospective study in Japan
Authors: Ito Kengo , Washimi Yukihiko , Kato Takashi , Suzuki Keisuke , Ouchi Yasuomi , Watanabe Chigusa , Sunada Yoshihide , Kutoku Yumiko , Ishii Kazunari , Ishii Kenji , Kitayama Michio , Matsubara Etsuro , Kimura Noriyuki , Takano Harumasa , Adachi Hiroaki , Hara Kazuhiro , Kawarabayashi Takeshi , Shoji Mikio , Sugimoto Norio
Published: October 2024

Background: 18F-fluoro-2-deoxy-2-D-glucose positron emission tomography (18F-FDG PET) is a biomarker of neuronal injury, according to the revised National Institute on Aging-Alzheimer's Association criteria. This multicenter prospective cohort study aimed to evaluate the value of 18F-FDG PET for differential diagnosis of Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) in comparison with phosphorylated tau protein (p-tau181) in cerebrospinal fluid (CSF).
Methods: In total, 138 patients (AD, 119; FTLD, 19) from 11 participating institutions underwent clinical and neuropsychological examinations, magnetic resonance imaging (MRI), CSF examination, and 18F-FDG PET at baseline. The cases were visually classified into predefined dementia patterns using 18F-FDG PET by three experts. A region-of-interest (ROI)-based automated analysis of 18F-FDG PET was also performed. The participants were followed up for 12 months, and the clinical diagnosis of dementia was re-evaluated.
Results: The sensitivity, specificity, and accuracy of the visual reading of 18F-FDG PET were 94%, 78%, and 92%, respectively. In contrast, those of p-tau181 in CSF were 62%, 79%, and 65%, respectively. The sensitivity, the primary endpoint, was 32% higher for 18F-FDG PET than for p-tau181 in CSF. Additionally, the accuracy, the secondary endpoint, was 27% higher for 18F-FDG PET than for p-tau181 in CSF. In addition to the visual reading of 18F-FDG PET, the Z-score summation analysis method (ZSAM) showed a sensitivity, specificity, and accuracy of 81%, 79%, and 81%, respectively. Regarding adverse events during the study, of the 135 patients who underwent 18F-FDG PET, 19 had 22 adverse events; however, there was no causal relationship with the 18F-FDG PET study, except for one case of unknown cause. In addition, two patients experienced two serious adverse events; however, both were due to CSF sampling and were judged to have no causal relationship with the 18F-FDG PET study.
Conclusion: This study showed that the diagnostic performance of 18F-FDG PET in differential diagnosis of AD and FTLD was higher than that of p-tau181 in CSF, and there were no safety concerns with 18F-FDG PET.
Trial registration: UMIN-CTR (UMIN 000016427) and Japan Registry of Clinical Trials (jRCTs041180098)
Influence of sedentary behavior and physical activity in leisure and work on sleep duration: Data from NHANES 2017-2018
Authors: Paixão Luciene Teixeira , Neves Layana Amaral , Danese Marina Viana , de Menezes-Júnior Luiz Antônio Alves
Published: October 2024

Objective
To evaluate the association between sedentary behavior (SB), moderate to vigorous physical activity (MVPA), and sleep duration.
Methods
Data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) was analyzed. SB was assessed based on the average daily sitting time, while MVPA was estimated by the frequency and duration of leisure and work-related activities. The ratio of time spent in MVPA to time in SB was analyzed, and a threshold of ≥ 2.5 minutes of MVPA per sedentary hour was used to determine sufficiency for mitigating the effects of a sedentary lifestyle. Sleep duration was measured by the average hours slept on weekdays and weekends, classified according to National Sleep Foundation guidelines. Descriptive statistics were used to characterize the sample, and multivariate logistic regression was applied to assess the associations between movement behaviors and sleep duration.
Results
The study included 5,533 participants, with 51.7% women, predominantly aged 26–64 years (61.8%). Insufficient physical activity was reported by 59.6% at work and 62.5% during leisure time. Sleep duration was considered recommended or acceptable in 84.4% of the sample. Adjusted multivariate analysis revealed that individuals engaging in ≥ 2.5 minutes of MVPA during leisure-time for each sedentary hour were 37.0% less likely to experience short sleep duration. Conversely, those who performed the same amount of MVPA at work were 32% more likely to have short sleep spells.
Conclusion
Meeting the MVPA threshold during leisure-time reduces the likelihood of short-term sleep, while higher MVPA levels at work increase the likelihood of short-term sleep.
High incidence of radiation-induced brain necrosis in the periventricular deep white matter: Stereotactic radiotherapy for brain metastases using volumetric modulated arc therapy
Authors: Ohguri Takayuki , Itamura Hirohide , Tani Subaru , Shiba Eiji , Yamamoto Junkoh
Published: October 2024

Purpose
In this retrospective study, we aimed to evaluate the efficacy and incidence of radiation-induced brain necrosis (RBN) after volumetric modulated arc therapy (VMAT)-based stereotactic irradiation (STI) for brain metastases.
Methods
In the 220 brain metastatic lesions included between January 2020 and June 2022, there were 1–9 concurrently treated lesions (median 1). A biologically effective dose (BED10) of 80 Gy and a reduced BED10 of 50 Gy were prescribed to the gross tumor volume (GTV) and planning target volume (PTV = GTV + 3 mm) margins, respectively. The number of fractions was adjusted from 3–15 to accommodate different GTV sizes; for larger tumor volumes, this was increased while maintaining the BED10 values comparable to those for GTV and PTV margins.
Results
Of the total patients, 16 (7%) exhibited locally progressive lesions; local tumor recurrence was observed in 2 (1%) patients, while RBN was noted in 14 (6%) patients. RBN was significantly more prevalent in the deep white matter around the lateral ventricles (DWM-LV) than in other sites, occurring in 9/22 (41%) lesions of metastases in the DWM-LV. The 2-year actuarial incidence risk of developing RBN was significantly higher in the DWM-LV (69%) than at other sites (5%).
Conclusion
The recurrence rate of brain metastases was low, and the incidence of RBN was lower in tumor sites other than the DWM-LV. However, the frequency of RBN was significantly higher in the DWM-LV region. Additional VMAT-STI-prescribed dose protocols are necessary to reduce RBN incidence in DWM-LVs.
Integrating Single-Cell Sequencing and Machine Learning to Uncover the Role of Mitophagy in Subtyping and Prognosis of Esophageal Cancer
Authors: Tian Feng , He Xinyang , Wang Saiwei , Liang Yiwei , Wang Zijie , Hu Minxuan , Gao Yaxian
Published: October 2024

Globally, esophageal cancer stands as a prominent contributor to cancer-related fatalities, distinguished by its grim prognosis. Mitophagy has a significant impact on the process of cancer progression. This study investigates the prognostic significance of mitophagy-related genes (MRGs) in esophageal carcinoma (ESCA) with the aim of elucidating molecular subtypes. By analyzing RNA-seq data from The Cancer Genome Atlas (TCGA), 6451 differentially expressed genes (DEGs) were identified. Cox regression analysis narrowed this list to 14 MRGs with notable prognostic implications. ESCA patients were classified into two distinct subtypes (C1 and C2) based on these genes. Furthermore, leveraging the differentially expressed genes between Cluster 1 and Cluster 2, ESCA patients were classified into two novel subtypes (CA and CB). Notably, patients in C2 and CA subtypes exhibited inferior prognosis compared to those in C1 and CB (p < 0.05). Functional enrichments and immune microenvironments varied significantly among these subtypes, with C1 and CB demonstrating higher immune checkpoint expression levels. Employing machine learning algorithms like LASSO regression and Random Forest, alongside multivariate COX regression analysis, two core genes: HSPD1 and MAP1LC3B were identified. A robust prognostic model based on these genes was developed and validated in two external cohorts. Additionally, single-cell sequencing analysis provided novel insights into esophageal cancer microenvironment heterogeneity. Through Coremine database screening, Icaritin emerged as a potential therapeutic candidate to improve esophageal cancer prognosis. Molecular docking results indicated favorable binding efficacies of Icaritin with HSPD1 and MAP1LC3B, enhancing the comprehension of the underlying molecular mechanisms of esophageal cancer and offering therapeutic avenues.
Incidence of death and its predictors among/HIV co-infected adult patients on anti-retro viral therapy at Gambelia referral hospital, Southwest, Ethiopia
Authors: Habtamu Endeshaw , Hiruy Endalk Getasew , Mulatu Kebadnew , Mohammed Asiya
Published: October 2024

Background: In patients who have tuberculosis and the human immunodeficiency virus, tuberculosis is the most prevalent opportunistic illness and the main killer. However, little is currently known about time to death and its predictors, particularly among individuals with coinfection in the study area. Therefore, this study was aimed at filling this gap in the region. Objective: To assess incidence of death and its predictors among tuberculosis and human immunodeficiency virus co-infected adult patients on anti-retroviral therapy in Gambella Referral Hospital, Southwest Ethiopia, 2023.
Methods: Retrospective cohort study was conducted in 320 co-infected adult patients on antiretroviral therapy from June 2017 to June 2022. Data were extracted from the document by using structured checklist those adapted and prepared based on the charts. Death is the event, whereas not having experienced death is censored. Data was entered in to Epi-data version 3.1 then export to STATA version 14. Kaplan Meier curve and log rank test was used to compare the survival curves and estimate survival time. Cox regression model was used to identify significant predictors of death. Cox-Snell residual plot was used to measure cox model goodness of fit.
Results: A total of 320 co-infected patients were followed with cumulative incidence of death are 14.7% and 6.7 deaths per 1000 person-months as the incidence rate (95%CI: 5.0-8.9). Patients who are being female (AHR 2.1, 95%CI: 1.05-4.21), with poor adherence to ART (AHR=5.88, 95%CI: 2.69-12.86), non-cotrimoxazole therapy users (AHR=4.03, 95%CI: 1.99- 8.16) and viral load >1000copes/ml (AHR: 3.18, 95%CI: 1.19-8.52) were at higher risk of death.
Conclusion and Recommendation: In the study area, the incidence rate of mortality was high compared to incidence rate of mortality in Ethiopia 2021. Patients on ART who are being female, had poor ART adherence, had an opportunistic infection other than tuberculosis, had a viral load value between 50 and 1000 copies per milliliter and greater than 1000 copies per milliliter, and non-cotrimoxazole prophylaxis therapy users were increased risk of deaths. As a result, patients with viral loads >000copes/ml, non-CPT users, who are being female, and who had poor ART adherence can benefit from intensive monitoring and counseling.
Spatiotemporal Analysis of Plasmodium falciparum Erythrocyte Binding Antigen (Pf EBA) 175 Gene Dimorphism in Ghana
Authors: Kpirikai Abraham Y. , Ofosu Belinda , Okai Josie , Kornu Victor , Kassim Abdul Rashid , Donkor Esther , Malm Frederica , Ahmed Osumanu , Sakyi Mona-Liza E. , Saiid Samirah , Kudakpo Albert Yao , Mensah Charles , Dzabeng Francis , Morang’a Collins , Awandare Gordon A. , Aniweh Yaw , Amenga-Etego Lucas N.
Published: October 2024

Background Malaria remains a leading cause of death worldwide, claiming over 600,000 lives each year. Over 90% of these deaths, mostly among children under five years, occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The merozoites stage of the parasite, crucial for asexual development invade erythrocytes through ligand-receptor interactions. Erythrocyte binding antigen (EBA)-175 is one of the key ligands facilitating invasion via interaction with glycoprotein A (GpA) receptors on the erythrocytes. EBA-175 is known to exist in two dimorphic allelic (F and C) forms with each found to infer different virulence. There is paucity of data on the prevalence of these alleles and their epidemiology in the Ghanaian malaria landscape and hence this study.Methods Parasite gDNA was extracted from archived Dried Blood Spots (DBS) prepared from 700 confirmed malaria-infected individuals and analysed for Pf EBA-175 dimorphism. Selective EBA-175 gene amplification via nested PCR and allele scoring using agarose gel electrophoresis for F, C and F/C alleles.Results Of the total 632 successfully genotyped samples, we found a prevalence of F, C, and F/C allelic forms were 61.2% (n = 387), 20.7% (n = 131), 18.0% (n = 114) respectively. Seasonality analysis did not reveal a statistically significant difference in the prevalence of dimorphic forms between the wet (n = 475) and dry (n = 157) seasons (p = 0.051). The prevalence ratio (wet/dry) for C, F and F/C were determined to be 1.0, 1.1 and 1.4 respectively. Between 2019 and 2022, the prevalence of the alleles changed significantly (χ² = 6.5427, p = 0.03). Geometric mean parasite density for the C, F, and F/C alleles were 21477.1 [95%CI: 15749.2 -29288.1], 18308.0 [95%CI: 15149.9-22124.5] and 22690.4[95% CI: 16891.9–30479.2] respectively.Conclusion The F-allele was the most prevalent form across all age groups, followed by the C allele and mixed F/C alleles. No significant difference in allele prevalence was observed between the high malaria season (wet) and low malaria season (dry). However, we observed a statistically significant difference (p = 0.03) in the temporal prevalence of pure alleles (F & C) between two time points.
Assessment of Health-related Quality of Life of Children with Idiopathic Nephrotic Syndrome and their caregivers in China
Authors: Wang Xia , Tan Danny Junyi , Guan Lejing , Shao Yifei , Wang Jingjing , Feng Chunyue , Fu Haidong , Shen Huijun , Zhu Xiujuan , Rafay Abdul , Mao Jianhua , Bai Guannan
Published: October 2024

Aims: The primary aim of this study was to characterize the health-related quality of life (HRQoL) and identify the associated factors among children aged 2 to 18 years in China diagnosed with idiopathic nephrotic syndrome (INS). Additionally, the study aimed to evaluate the HRQoL and caregiving burden of their caregivers, as well as to investigate the correlation between the HRQoL of the children and that of their caregivers.
Methods: This study recruited 181 children with a diagnosis of INS from Children’s Hospital, Zhejiang University School of Medicine in China. The proxy-reported PedsQL Generic Core Module (PedsQL GCM) was used to measure the HRQoL of children, and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was applied to measure caregivers’ HRQoL. Differences in scale scores and total scores of PedsQL GCM were assessed using t tests and one-way ANOVA. Multivariate linear regression analysis was used to identify the associated factors of children’s HRQoL. Pearson correlation analysis was performed to assess the correlation between children’s HRQoL and caregiver’s HRQoL.
Results: HRQoL of Children with INS declines with increasing age, and children aged 5-18 years had lower scores in physical functioning, emotional functioning, school functioning, psychosocial health summary score, and total PedsQL GCM score compared to healthy children. Various factors, including the mother filling out the questionnaire, the father being unemployed, and use of other medications except for steroids were associated with worse HRQoL of children (p values < 0.05). Additionally, there is a correlation between children's HRQoL and their caregivers' HRQoL.
Conclusion: This study evaluated the HRQoL of children aged 2-18 years diagnosed with INS in China, along with the HRQoL of their caregivers. HRQoL of children was potentially influenced by multiple factors. A significant correlation was observed between the HRQoL of the children and that of their caregivers, who frequently experienced varying levels of caregiving burden. Therefore, it is recommended that healthcare professionals prioritize the optimization of HRQoL for both children with INS and their caregivers.
Using Bivariate Latent Growth Model to Better Understand the Anxiety Symptom in Parkinson's Patients
Authors: wang qiushuang , Li Pugang , Sun Yi , Shi YaoZhou , Bian Jing , Zhao Hua-Shuo
Published: October 2024

Objective
This study utilizes the Bivariate Latent Growth Model to explore the developmental trajectories of trait anxiety and state anxiety, as well as the interrelationships between the trait anxiety and state anxiety.
Methods
We obtained six-year follow-up data from 475 Parkinson's disease patients through the Parkinson's Progression Markers Initiative. We employed latent growth models to explore the trajectories of anxiety, trait anxiety, and state anxiety. Subsequently, we used the Bivariate Latent Growth Model to investigate the longitudinal relationships between state anxiety and trait anxiety.
Results
The trajectories of anxiety, trait anxiety, and state anxiety were best described by a linear growth model. The intercept and slope of each were significantly correlated with the intercept, and the variance of both intercepts and the correlation between them were all significant (P < 0.05). Only the slopes of the total anxiety score and state anxiety were not significant, but the variance of their slopes was significant, indicating significant variability among individuals. The variance of the trait anxiety slope was also significant. The results of the Bivariate Latent Growth Model show significant associations among all intercept and slope factors (P < 0.018). Specifically, the intercept of trait anxiety is positively correlated with the intercept of state anxiety, and the slope of trait anxiety is positively correlated with the slope of state anxiety. The remaining path covariances between intercepts and slopes are negative.
Conclusion
Our research results indicate that among individuals with Parkinson's disease, those showing a higher growth trend in trait anxiety are more likely to experience a higher growth trend in state anxiety at a particular time point. Individuals scoring higher on trait anxiety are more likely to experience elevated levels of state anxiety at a specific time point. Individuals with higher initial levels may undergo smaller growth. For instance, individuals with higher levels of trait anxiety may exhibit lower growth in state anxiety or vice versa. It is evident that there is a close and reciprocal relationship between trait anxiety and state anxiety, with mutual influences.
AI and Entrepreneurship: Facial Recognition Technology Detects Entrepreneurs, Outperforming Human Experts
Authors: Obschonka Martin , Fisch Christian , Fernando Tharindu , Fookes Clinton
Published: October 2024

Occupational outcomes like entrepreneurship are generally considered personal information that individuals should have the autonomy to disclose. With the advancing capability of artificial intelligence (AI) to infer private details from widely available human-centric data, such as social media, it is crucial to investigate whether AI can accurately extract private occupational information from such data. In this study, we demonstrate that deep neural networks can classify individuals as entrepreneurs based on a single facial image with high accuracy in data sourced from Crunchbase, a premier source for entrepreneurship data. Utilizing a dataset comprising facial images of 40,728 individuals, including both entrepreneurs and non-entrepreneurs, we trained a Convolutional Neural Network (CNN) and evaluated its classification performance. While human experts (n = 650) and trained participants (n = 133) were unable to classify entrepreneurs with accuracy above chance levels (> 50%), the AI model achieved a classification accuracy of 79.51%. Several robustness tests show that this high level of accuracy is maintained under various conditions.
Inter-Center Variations in Inpatient Outcomes for Infants with Gastroschisis from the Children's Hospitals Neonatal Consortium
Authors: Ling Con Yee , Zaniletti Isabella , Riddle Stefanie , Jacobson Elizabeth , Korff Stephanie , Chandler Angela , Downey L , Padula Michael , Evens Jacquelyn , Grover Theresa , Murthy Karna
Published: October 2024

Objective:
To estimate inter-center variation (ICV) in hospital length of stay (LOS) and oral feeding at discharge among infants with gastroschisis.
Study Design:
Children's Hospitals Neonatal Consortium's (CHNC) database was used to identify hospitalized survivors with gastroschisis. Two outcomes were evaluated: LOS and discharge without tube feedings. Hospital outcomes were evaluated in unadjusted and adjusted analyses. Generalized linear models with log link for gamma distribution was used to model LOS and logistic regression for discharge without tube feeds.
Results:
For 3987 surviving infants with gastroschisis, LOS and discharge within 70 days with exclusively oral feeding, both exhibited significant ICV. Differences persisted in multivariable analyses. Risk adjusted LOS (68% difference) and oral feeding at discharge (6.4-fold difference) varied significantly between centers.
Conclusion:
Hospital of care was independently associated with LOS and exclusive oral feeding at discharge rates for infants with gastroschisis. Management differences, potentially influenced by parental preferences, contributed to variation.
Integrated the analysis of single-cell and bulk RNA-sequencing to predict renal cell carcinoma by identifying signature based on Mitophagy-related Genes
Authors: Tang Guanbao , Li Shuai , Yang Jiwei , Chen Dongdong , Guo Xuewen , Chen Hao , wang Lizhun , Men Tongyi
Published: October 2024

Background
The features of resistance to mitophagy contribute significantly to invasion, malignancy and cell survival. But the mechanism of mitophagy in clear cell renal cell carcinoma (ccRCC) remains unclear It is valuable to estimate mitophagy molecular characters as a clinical factor for prognosis and immune phenotypes in ccRCC.
Methods
Clinical data of ccRCC patients, including genome and transcriptome data, were downloaded from The Cancer Gene Atlas (TCGA) and International Cancer Genome Consortium (ICGC) database. The differentially expressed genes (DEGs) of patient clusters determined by mitophagy gene expression and univariate Cox regression analysis were identified and used to classify patient clusters for constructing mitophagy scores via PCA analysis. Immune cell infiltration and immune cell function were analyzed by ssGSEA algorithm and TIDE algorithm.
Results
Based on the expression of mitophagy marker genes, ccRCC patients were divided into three mitophagy clusters with different gene expression patterns, prognosis and immune niches. 1,356 DEGs of mitophagy clusters related with prognosis were screened out for building mitophagy score. ccRCC patients with high mitophagy scores have better prognosis. Meanwhile, lower mitophagy patients with high expressed several immune-checkpoint proteins and had high immunophenoscore after immune-checkpoint blockers treatment, indicating better responsiveness to immune therapy.
Conclusions
mitophagy features are tightly correlated with ccRCC prognosis and immune responsiveness. mitophagy score built here is able to predict the prognosis and immune features of ccRCC patients and be indicative for immunotherapy.