bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavioral and Biomedical Factors Associated with Lifestyle Modification Practices among Diagnosed Hypertensive Patients in South region Ethiopia
Authors: Barata Tagese Yakob , Yakob Begidu , Menza Mesfin , Dawit Desalegn , Elias Chernet , Isreal Eskider , Abraham Awoke
Published: July 2024

Background
More than 23 million deaths and 36.5% of disability-adjusted life-years are the result of the direct effects of unhealthy behavior alone. Daily behaviors have strong implications for health outcomes and quality of life.
Objective
To determine the behavioral and biomedical factors associated with lifestyle modification practices among diagnosed hypertensive patients attending selected public hospitals in south region Ethiopia.
Methods
A hospital-based cross-sectional study was conducted among diagnosed adult hypertensive patients aged ≥ 18 years in public hospitals South region of Ethiopia from June 1/2023 to July 30/2023. The study population was randomly selected from among patients diagnosed with hypertension that was followed up during the study period using a systematic random sampling technique. The data were entered into EpiData-4.6.0.2 and exported to SATAT version 14 for analysis. A binary logistic regression model was fitted to determine independent predictors of lifestyle modification practices among hypertensive patients. An adjusted odds ratio with a 95% confidence interval was used to declare a state of significance.
Results
Out of 443 potential participants approached, 433 agreed to successfully participate in the study, for a response rate of 97.7%. Of the total (433) participants, 56.1% (95% CI, 51.38–60.74) of the patients practiced the recommended lifestyle modifications. Alcohol consumption (AOR = 0.64, 95% CI: 0.42–0.96), ever-practiced reducing salt intake (AOR = 2.48, 95% CI: 1.57–3.93), and low-density lipoprotein cholesterol levels in the blood (> 160 mmg/dL) (AOR = 3.3, 95% CI: 1.72–6.34) were independently associated with lifestyle modifications in patients with hypertension.
Conclusion
This study revealed that the prevalence of lifestyle modification practices was low among hypertensive patients. Factors significantly associated with lifestyle modification practices were a history of alcohol consumption, reduced salt intake, and low-density lipoprotein. Lifestyle modification is not one-stop practical, but continuous counseling and health promotion are needed to scale up healthy behavior in patients with hypertension to create a good lifestyle.
Pancreatic cancer organoids derived from EUS-guided fine needle aspiration specimens can be used to predict chemotherapy resistance.
Authors: Oyama Soshi , Matsuda Akiko , Murakami Yuko , Kakizaki Yasuharu , Ishizawa Tetsuya , Kobayashi Kazutoshi , Nakamura Hitomi , Nawa Yoshihito , Otaki Yu , Nagata Yamato , Honma Soichiro , Makino Naohiko , Sato Hidenori , Ueno Yoshiyuki
Published: July 2024

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis. Although chemotherapy has become increasingly important in recent years, there are no practical markers to predict therapeutic efficacy. Here, we have aimed to identify novel markers that predict resistance to chemotherapy drugs using patient-derived organoids (PDOs) of PDAC. PDOs were established using endoscopic ultrasound - guided fine needle aspiration (EUS-FNA) specimens. Drug sensitivity tests were performed on 15 PDOs and the correlation between drug sensitivity and transcriptome analysis were evaluated. BARD1 and RAD50 have been identified as genes associated with gemcitabine resistance. Additionally, SLC25A10 and MAP3K9 were identified as genes associated with gemcitabine + paclitaxel resistance.PDOs derived from EUS-FNA specimens can be used to assess individual drug resistance and to identify predictive factors for chemotherapy resistance.
The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and obstructive sleep apnea : a cross-sectional study
Authors: Chen Kehan , Zou Zhijiang , Lou Yuhang , Mei Ruoyu , Liu Zhongzheng , Xu Bing , He Wei , Song Jukun
Published: July 2024

Background
Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by repeated instances of either partial or total blockage of the upper airway while sleeping. This leads to disrupted sleep and several related health issues. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel indicator that has the potential to provide more accurate assessment of the risk for cardiovascular and cerebrovascular illnesses. This study sought to explore the relationship between NHHR and OSA.
Methods
This research included cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008, as well as between 2015 and 2018. The study included a total of 19,234 individuals. The NHHR was determined by dividing the non-high-density lipoprotein cholesterol by the high-density lipoprotein cholesterol. The participants were divided into quartiles according to their NHHR levels. OSA was characterized by symptoms described by the individuals themselves, such as extreme tiredness throughout the day, gasping or snorting during asleep, and frequent snoring. The link between NHHR and OSA was evaluated using multivariate logistic regression and segmented linear regression models.
Results
In this research, 19,234 individuals with a mean age of 41.88 ± 20.58 years were included. Among them, 50.46% were diagnosed with OSA. The mean and standard deviation for NHHR were measured as 3.08 ± 1.51.An elevated NHHR was shown to be substantially correlated with a higher risk of OSA, with an odds ratio (OR) of 1.113 and a 95% confidence interval (CI) ranging from 1.807 to 1.140 (p < 0.001). The observed correlation remained significant even after controlling for possible confounding variables such as age, gender, race, and other characteristics associated to health.An inverted U-shaped association was identified, which was nonlinear. The turning point of this relationship occurred at an NHHR value of 5.198.When the NHHR was below a certain level, each additional unit rise in NHHR resulted in a 17% increase in the risk of OSA. However, when the NHHR was beyond this level, the risk of OSA remained constant.
Conclusions
The presence of NHHR is a strong indicator of the probability of developing OSA. This highlights the crucial need to closely monitor and control lipid profiles in patients who have or are at risk of developing OSA. These findings provide fresh perspectives on the connection between lipid metabolism and OSA, indicating that NHHR might serve as a helpful indicator in clinical evaluations.
Quantum inspired approach for denoising with application to medical imaging
Authors: Hashemi Amirreza , Dutta Sayantan , Georgeot Bertrand , Kouamé Denis , Sabet Hamid
Published: July 2024

Background noise in many fields such as medical imaging poses significant challenges for accurate diagnosis, prompting the development of denoising algorithms. Traditional methodologies, however, often struggle to address the complexities of noisy environments in high dimensional imaging systems. This paper introduces a novel quantum-inspired approach for image denoising, drawing upon principles of quantum and condensed matter physics. Our approach views medical images as amorphous structures akin to those found in condensed matter physics and we propose an algorithm that incorporates the concept of mode resolved localization directly into the denoising process. Notably, our approach eliminates the need for hyperparameter tuning. The proposed method is a standalone algorithm with minimal manual intervention, demonstrating its potential to use quantum-based techniques in classical signal denoising. Through numerical validation, we showcase the effectiveness of our approach in addressing noise-related challenges in imaging and especially medical imaging, underscoring its relevance for possible quantum computing applications.
Whole exome sequencing-based homologous recombination deficiency test for epithelial ovarian cancer
Authors: Chiang Ying-Cheng , Huang Hsien-Neng , Kuo Kuan-Ting , Hwu Wuh-Liang , Cheng Wen-Fang , Lin Po-Han
Published: July 2024

Background
The homologous recombination deficiency (HRD) test is an important tool for identifying patients with epithelial ovarian cancer (EOC) benefit from the treatment with poly(adenosine diphosphate-ribose) polymerase inhibitor (PARPi). Using whole exome sequencing (WES)-based platform can provide information of gene mutations and HRD score; however, the clinical value of WES-based HRD test was less validated in EOC.
Methods
We enrolled 40 patients with EOC in the training cohort and 23 in the validation cohort. The WES-based HRD score was calculated using the scarHRD software. We first evaluated the concordance of the HRD status defined by the Myriad MyChoice CDx and then assessed the value of HRD on clinical prognosis in patients with EOC.
Results
The HRD score defined by the WES-based test was positively correlated with that of the Myriad MyChoice® CDx test (r = 0.82, p < 0.01) in the training cohort. In compared to HRD status of Myriad test, the sensitivity, specificity, positive predictive value, and negative predictive value of the WES-based HRD test were 93.5% (29/31), 77.8% (7/9), 93.5% (29/31), and 77.8% (7/9), respectively. Patients with positive HRD status defined by WES-based scarHRD test and Myriad MyChoice® CDx test were both highly associated with platinum sensitive response (both Fisher's exact test, p = 0.002) as well as the superior progression-free survival (both log-rank p = 0.002). The multi-variate Cox regression model incorporated with optimal debulking surgery showed that the recurrence risk was decreased in the patients with positive HRD status, either defined by Myriad MyChoice® CDx test (Hazard ratio (HR) 0.33, 95% confidence interval (CI) 0.14–0.79, p = 0.013) or WES-based test Myriad MyChoice® CDx test (HR 0.34, 95% CI 0.14–0.80, p = 0.014). Nine patients had mutations in the genes involved in HR DNA repair, and all of them were positive for HRD. In the validation group, 23 patients were defined as positive HRD by WES-based testing. Six positive HRD patients and 5 negative HRD patients received maintenance PARPi. The median responsive interval of PARPi was 17 months in positive HRD patients and 3 months in negative HRD patients.
Conclusions
The WES-based test is a feasible option for determining the HRD status in EOC patients.
Risk Factors for Adverse Reactions to Nurse-Administered Propofol During Outpatient Endoscopy: A Cross-Sectional Study
Authors: Inca Renzo , Montero Cynthia Bazán , Montachez Estela Bulnes , Alva Lary Salazar , Carrillo José Salvador , Zevallos Alejandra , Salazar Fernando
Published: July 2024

Background
Endoscopic procedures are essential for diagnosing and managing gastrointestinal conditions, often requiring sedation for patient comfort. Propofol is a common choice for outpatient sedation due to its rapid onset and predictable recovery time. Although propofol has an established safety profile, adverse drug reactions (ADRs) can still occur. This study investigated the prevalence and risk factors associated with ADRs related to nurse-administered propofol sedation during outpatient endoscopic procedures at a private hospital in Peru.
Method
We conducted a retrospective study. The clinical records of 919 Peruvian patients who underwent endoscopic interventions under propofol sedation were reviewed. This study included patients between the ages of 18 and 69 years who had American Society of Anesthesiologists (ASA) physical status classification scores of I–III and who were hemodynamically stable with an oxygen saturation (SO2) > 90% before the procedure. Sedation was nurse-administered using standardized protocols. ADR data, including severity and causality assessment data, were collected. Data were collected and analyzed by SPSS, Inc., and the statistical significance was calculated at the p < 0.05 level.
Results
A total of 693 patients were included in the study, 30.9% of whom experienced at least one ADR, predominantly cardiovascular or respiratory events such as hypotension and hypoxia, with causality scores classified as probable or definitive. Among the ADRs, 35.8% (n = 87) were moderately severe, and 64.2% (n = 143) were mildly severe. There were no reports of any serious adverse events. An ASA class III status (p = 0.048, PR adjusted (PRa) = 1.73, 95% CI: 1.01–2.99) and a procedure time of more than 20 minutes (p < 0.0001, PRa = 2.05, and 95% CI: 1.53–2.73) were significant risk factors for ADR occurrence. Patients with ADRs had longer recovery times than did those without ADRs (22 min ± 22.5 vs 14 min ± 8, respectively; p < 0.001).
Conclusion
In our work, moderate propofol sedation administered by trained nursing staff to outpatients undergoing interventional endoscopic procedures was generally safe but not free from risks. Vital parameters should be monitored regularly during long-term interventions and when patients are classified as ASA III.
Carotid atherosclerosis associated with tau pathology and cognitive function in cognitively intact adults: the CABLE study
Authors: Zhang Ming-Zhan , Sun Cheng-Kun , Chen Yan-Ming , Hao Quan , Zhang Zi-Qi , Guo Fan , Tan Lan , Tan Meng-Shan
Published: July 2024

Background
Carotid atherosclerosis has been implicated in cognitive decline, but the evidence from current studies is insufficient and the detailed mechanism remains unclear.
Objective
This study aimed to explore the association of carotid atherosclerosis with cognitive function and cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers, as well as attempted to investigate the underlying mechanisms.
Methods
This study included 365 participants with objective normal cognition from the Chinese Alzheimer’s Biomarker and LifestylE (CABLE) database. Multiple linear regression models were utilized to assess the associations of carotid atherosclerosis (carotid intima-media roughness [CIMR], carotid intima-media thickness [CIMT], carotid plaque, and CIMT level) with CSF AD biomarkers and cognitive function. The mediation analyses were used to explore whether CSF AD biomarkers mediated the carotid atherosclerosis and cognitive function.
Result
We found that CIMR, carotid plaque, and CIMT level were significantly associated with tau pathology (T-tau and P-tau, P < 0.05); All markers of carotid atherosclerosis were associated with cognitive function (CM-MMSE and MoCA, P < 0.05). Furthermore, mediation analyses revealed that the effect of carotid plaque on cognitive decline was partially mediated by tau pathology (proportion of mediation = 19.7%, P = 0.012).
Conclusion
This study indicated that carotid atherosclerosis was associated with tau pathology and cognitive function, and tau pathology partially mediated the association between carotid atherosclerosis and cognitive function.
Artificial Intelligence contouring in radiotherapy for organs-at-risk and lymph node areas
Authors: Meyer Céline , Huger Sandrine , Bruand Marie , Leroy Thomas , Palisson Jérémy , Rétif Paul , Sarrade Thomas , Barateau Anais , Renard Sophie , Jolnerovski Maria , Demogeot Nicolas , Marcel Johann , Martz Nicolas , Stefani Anaïs , Sellami Selima , Jacques Juliette , Agnoux Emma , Gehin William , Trampetti Ida , Margulies Agathe , Golfier Constance , Khattabi Yassir , Olivier Cravereau , Alizée Renan , Py Jean-François , FAIVRE Jean-Christophe
Published: July 2024

Introduction: The delineation of organs-at-risk and lymph node areas is a crucial step in radiotherapy, but it is time-consuming and associated with substantial user-dependent variability in contouring. Artificial intelligence (AI) appears to be the solution to facilitate and standardize this work. The objective of this study is to compare eight available AI software programs in terms of technical aspects and accuracy for contouring organs-at-risk and lymph node areas with current international contouring recommendations.
Material and methods: From January–July 2023, we performed a blinded study of the contour scoring of the organs-at-risk and lymph node areas by eight self-contouring AI programs by 20 radiation oncologists. It was a single-center study conducted in radiation department at the Lorraine Cancer Institute. A qualitative analysis of technical characteristics of the different AI programs was also performed.
Three adults (two women and one man) and three children (one girl and two boys) provided six whole-body anonymized CT scans, along with two other adult brain MRI scans. Using a scoring scale from 1 to 3 (best score), radiation oncologists blindly assessed the quality of contouring of organs-at-risk and lymph node areas of all scans and MRI data by the eight AI programs.
Results: For adults CT scanns: There were two AI programs for which the overall average quality score (that is, all areas tested for OARs and lymph nodes) was higher than 2.0: Limbus (overall average score = 2.03 (0.16)) and MVision (overall average score = 2.13 (0.19)). For children CT scann, MVision was the only program to have a average score higher than 2 with overall average score = 2.07 (0.19). For brain MRIs: TheraPanacea was the only program with an average score over 2, for both brain delineation (2.75 (0.35)) and OARs (2.09 (0.19)). The comparative analysis of the technical aspects highlights the similarities and differences between the software.
Conclusion: For adult CT-scann, two AI programs on the market, MVision and Limbus, delineate most OARs and lymph nodes areas that are useful in clinical routine. For children CT-scan, only one IA, MVision, program is efficient. For adult brain MRI, Therapancea,only one AI program is efficient.
Trial registration: CNIL-MR0004 Number HDH434
The moderating role of COMT gene rs4680 polymorphism between maladaptive metacognitive beliefs and negative symptoms in patients with schizophrenia
Authors: Fekih-Romdhane Feten , Kerbage Georges , Hachem Nagham , Murr Michelle El , Haddad Georges , Loch Alexandre Andrade , Hayek Elissar El , Hallit Souheil
Published: July 2024

Background: Although the positive association between impairments in metacognitive capacity and negative symptoms in people with schizophrenia spectrum disorders is widely evidenced in the literature, the explaining mechanisms of this association are still less known and poorly understood. This study aims to bridge this knowledge gap by testing the hypothesis that COMT rs4680 variants will act as moderators in the relationship between certain metacognitive domains and negative symptoms’ severity.
Method: A cross-sectional study was carried-out during the period between February and March 2024. A total of 115 biologically unrelated Arab (Lebanese) patients with schizophrenia (mean age of 57.52 ± 10.35 years, 63.5% males) were included.
Results: After controlling for sex and duration of illness as a potential confounder, moderation analyses showed that the AG genotype of the COMT rs4680 served as a significant moderator between maladaptive metacognitions about cognitive confidence and negative symptoms. In non-carriers of the COMT rs4680 AG genotype, greater endorsement of lack of cognitive confidence is significantly associated with greater negative symptoms.
Conclusion: Findings suggest that metacognition may be a relevant treatment target in the management of negative symptoms particularly in non-carriers of the COMT rs4680 AG genotype. Therefore, genetic testing could potentially be used to match patients with metacognitive interventions that are more likely to be effective in supporting recovery from negative symptoms.
Spastic pelvic floor syndrome and puborectalis syndrome: The different stages of the same disease
Authors: Xiong Yu , Li Wenzhe , Jiang Dazhen , Wang Tiankun , Tu Mengqi , Wang Jie , Qian Qun , Jiang Congqing , Liu Weicheng
Published: July 2024

The diagnosis and treatment of puborectalis syndrome (PRS) and spastic pelvic floor syndrome (SPFS) are still up for debate. This study aims to investigate examine the similarities and differences between PRS and SPFS. This study recruited 13 PRS cases, 10 SPFS cases, and 16 controls. Pelvic magnetic resonance imaging (MRI), histology, and ultrastructural pathology were explored. Additionally, anorectal manometry was performed prior to surgery, Wexner constipation scores and patient assessment of constipation quality of life (PAC-QOL) scores monitored before surgery, 6 and 12 m post-surgery. The puborectalis thickness in the pelvic MRIs of the SPFS and control groups did not appear to differ (4.62 ± 0.38 vs 4.56 ± 0.47, p = 0.378); however, the puborectalis in the PRS group was substantially thicker than that of the SPFS (8.65 ± 1.17 vs 4.62 ± 0.38, p < 0.001). The SPFS group showing atrophy and degeneration of muscle fibers and the PRS group exhibiting necrosis of muscle fibers, both groups had distorted texture myofibrils, disorganized arrangement, rough Z lines, however, in severe cases of PRS group, localized myofibrils fracture and myofilament dissolution presenting as vacuolation. Patients with normal preoperative rectal propulsion force had improvements in postoperative Wexner constipation scores and PAC-QOL scores. Histological and ultrastructural pathological evidence suggests that SPFS and PRS are distinct phases of paradoxical puborectalis syndrome (PPS). Furthermore, one indication for PPS surgical treatment is normal rectal evacuation pressure.
Prevalence Of Ambulatory Hypertension in Pediatric Kidney Transplant Recipients Using the New 2022 Ambulatory Blood Pressure Monitoring Guidelines
Authors: Mahajan Ruchi Gupta , Zangla Emily , Kizibash Sarah
Published: July 2024

Background: Childhood hypertension is a significant risk factor for early cardiovascular disease. Ambulatory blood pressure monitoring (ABPM) is an important tool for hypertension surveillance in pediatric kidney transplant recipients. The prevalence of post-transplant hypertension in pediatric kidney transplant recipients using the 2022 ABPM guidelines in not known.
Objective: To determine the prevalence, characteristics, and predictors of ambulatory hypertension in pediatric kidney transplant recipients
Method: We retrospectively identified all pediatric (age <; 22 years) kidney transplant recipients who successfully completed 24-hour ABPM for hypertension surveillance per the institutional protocol at the University of Minnesota between 1/2020 and 9/2022. We defined ambulatory hypertension using the 2022 ABPM guidelines. We compared continuous and categorical variables using the Wilcoxon rank sum and Fisher’s exact tests and used logistic regression to identify the predictors of ambulatory hypertension.
Results: Our cohort included 71 patients with median post-transplant follow-up time of 5.5 years (IQR: 7.5). Table 1 presents the baseline characteristics of the study cohort. We observed abnormal ABPM (excluding isolated nocturnal blunting) in 23/42 (54.8%) patients already on antihypertensive medications (indicating poor control) and 8/29 (27.6%) patients without an existing diagnosis of hypertension. Among those already on antihypertensive medications, nocturnal hypertension in 29.6% (n=21) and blunted nocturnal dip in 39.4% (n=28) of all patients. Masked hypertension was seen in 13.8% (n=4) and white coat hypertension in 10.3% (n=3) of patients with no prior diagnosis of hypertension (table 2). After adjusting for age at transplant, race, donor type, preemptive transplantation, and BMI, the female sex was significantly protective against post-transplant ambulatory/masked hypertension (Adjusted OR: 0.19; 95% CI: 0.05, 0.72; p = 0.01). Left ventricular hypertrophy was more prevalent in children with blunted nocturnal dipping, but the difference did not achieve statistical significance (54.1% vs. 36.8; p=0.36).
Conclusion: Using the 2022 ABPM guidelines, ambulatory/masked hypertension is highly prevalent in pediatric kidney transplant recipients. Isolated nocturnal hypertension, blunted nocturnal dipping, and the male sex characterize ambulatory hypertension in this population. Clinic blood pressures may miss poorly controlled hypertension among those on antihypertensive medications. Transplant centers should consider adding 24-hour ABPM to transplant protocols to optimize the diagnosis and treatment of hypertension.
Clinical utility of novel anthropometric indices in identifying type 2 diabetes mellitus among South African adult females
Authors: Sekgala Machoene Derrick , Sewpaul Ronel , Kengne Andre , Mchiza Zandile , Peer Nasheeta
Published: July 2024

Aim
To assess the clinical utility of novel anthropometric indices and other traditional anthropometric indices in identifying the risk of type 2 diabetes mellitus (T2D) among South African adult females.
Methods
In the first South African National Health and Nutrition Examination Survey (SANHANES-1), traditional [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)] and novel [a-body shape index (ABSI), abdominal volume index (AVI), body adiposity index (BAI), body roundness index (BRI), conicity index (CI), and Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE)] anthropometric indices were assessed. T2D was diagnosed using glycated haemoglobin (HbA1c) ≥ 6.5% among participants without known T2D. Basic statistics and multiple regression analyses were explored the association between anthropometric indices and newly diagnosed T2D. Receiver operating characteristic (ROC) curve analysis was measured the predictive ability of both traditional and novel indices.
Results
Among 2 623 participants, 384 (14.6%) had newly diagnosed T2D. All anthropometric indices mean values were significantly higher among participants with T2D (most p < 0.001). Higher mean values increased T2D odds e.g., in the model adjusted for age, employment, residence, and population group, odds ratio (OR) and 95% confidence interval (CI) for T2D with some of anthropometric indices were: 1.86 (1.60–2.15) for WC, 1.84 (1.59–2.13) for WHtR, 1.73 (1.51–1.99) for AVI, 1.71 (1.49–1.96) for BRI and 1.86 (1.57–2.20) for CUN-BAE. The top quartile for all indices had the highest T2D odds (p < 0.05). These outcomes were the highest for WC, AVI, and CUN-BAE and remained so even after removing the confounding effects of age, employment, population group, and residence. Based on the ROC analysis, none of the anthropometrical indices performed excellently (i.e., had an area under the curve [AUC] > 0.80). The WC, WHtR, AVI, BRI, and CUN-BAE, however, performed acceptably (AUCs 0.70–0.79), while also exhibiting corresponding cutoff values of 86.65 cm, 0.57, 15.52, 3.83, and 38.35, respectively.
Conclusions
The data shows that traditional and novel anthropometric indices similarly identifying newly diagnosed T2D among adult South African females. We recommend the continuing the use of traditional indices, as they are affordable and easy to use in our setting.
A nomogram based on hematological parameters for prediction of spontaneous abortion risk in pregnancies
Authors: Xiang Junmiao , Liu Lin , Bao Ruru , Cai Zhuhua
Published: July 2024

Background
Pregnancy loss significantly affects physical and mental health. A nomogram for predicting spontaneous abortion risk was developed to improve pregnancy outcomes.
Methods
A total of 1346 pregnant women were enrolled from The Third Affiliated Hospital of Wenzhou Medical University (May 2020 - May 2022). The training set included 941 participants, and the validation set had 405. Feature selection was optimized using a random forest model, and a predictive model was constructed via multivariable logistic regression. The nomogram’s performance was assessed with receiver operator characteristic (ROC), Hosmer-Lemeshow test, calibration curve, and clinical impact curve (CIC). Discrimination and clinical utility were compared between the nomogram and its individual variables.
Results
Antithrombin III (AT-III), homocysteine (Hcy), complement component 3 (C3), protein C (PC), and anti-β2 glycoprotein I antibody (anti-β2GP1) were identified as risk factors. The nomogram demonstrated satisfactory discrimination (Training AUC: 0.813, 95% CI: 0.790–0.842; Validation AUC: 0.792, 95% CI: 0.741–0.838). The Hosmer-Lemeshow test (P = .331) indicated a good fit, and the CIC showed clinical net benefit. The nomogram outperformed individual variables in discrimination (AUC: 0.804, 95% CI: 0.779–0.829).
Conclusion
The developed nomogram, incorporating AT-III, Hcy, C3, PC, and anti-β2GP1, aids clinicians in identifying pregnant women at high risk for spontaneous abortion.
Continuous Electroencephalography in Acute Liver Failure: Findings and Prognostic Value
Authors: Chen Denise Fay , Farrque Mirza , Karakis Ioannis , Gupta Navnika , Rodriguez Andres , Kandiah Prem A.
Published: July 2024

Background and Objectives:
Neurologic complications contribute significantly to morbidity and mortality in acute liver failure (ALF) and present a major obstacle to transplant-free survival and liver transplantation. Preservation of cerebral function is key to achieving good outcomes in this population, but neurologic assessment in these patients is challenging. Continuous electroencephalography (cEEG) is a low-risk, noninvasive diagnostic tool which monitors real-time cerebral function. We aimed to investigate cEEG findings and prognostic significance of specific EEG features in a cohort of strictly defined ALF patients.
Methods:
This was a retrospective, single-center study of adult patients with ALF who underwent cEEG monitoring for at least 6 hours between 2013 and 2022. Clinical, laboratory, imaging, and treatment characteristics were evaluated. cEEG variables included background continuity and frequency, the presence of sporadic epileptiform discharges, rhythmic or periodic patterns, and electrographic or electroclinical seizures. The primary outcome was mortality or transition to end-of-life care during the index admission.
Results:
A total of 32 patients with ALF were included. 56.3% of patients had rhythmic or periodic patterns, of which the majority were generalized periodic discharges (GPDs, 37.5%). 12.5% of patients had sporadic epileptiform discharges and 6.3% of patients demonstrated seizures. Nineteen (59.4%) patients died or were transitioned to end-of-life care during the index admission. Worsening background continuity or frequency was significantly associated with poor outcome (p=0.003, p = 0.018, respectively), with a 100% mortality rate in patients demonstrating these EEG trends. An EEG background of suppression, attenuation, burst-suppression, or burst-attenuation occurring at any time during the record was also associated with poor outcome (p = 0.002). The presence of rhythmic or periodic patterns, sporadic epileptiform discharges, or seizures was not predictive of outcome.
Conclusions:
CEEG background features provide useful prognostic information in ALF patients, in conjunction with other laboratory and clinical markers of disease severity.
Gastrointestinal Bleeding Following Left Ventricular Assist Device (LVAD) Implantation: A Case Report and Literature Review
Authors: Zhao Dan , Yang Shan , Deng Lijing
Published: July 2024

Introduction: Left ventricular assist devices (LVADs) have become increasingly prevalent as a life-prolonging treatment for patients with advanced heart failure. Despite continuous advancements in the field of continuous-flow left ventricular assist devices (CF-LVADs), recipients still face a relatively high incidence of LVAD-related adverse events, with gastrointestinal bleeding (GIB) being one of the most frequent complications. GIB is closely associated with severely impaired quality of life, frequent hospitalizations, need for blood transfusions, and potential mortality in these patients. Furthermore, many patients experience recurrent GIB events, which further exacerbates their discomfort and medical resource utilization. Although various medical and endoscopic treatment strategies exist, evidence regarding their benefits remains largely ambiguous, with all relevant studies based on data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) rather than clinical trials. While current research provides significant insights into the management of adverse events in LVAD recipients, there is a scarcity of effective and validated indicators and methods for predicting post-implantation GIB events. 1. Case Presentation: We report the case of a 36-year-old male patient with a history of chronic heart failure, diagnosed with dilated cardiomyopathy. While awaiting heart transplantation, the patient experienced worsening heart failure and underwent an emergency LVAD implantation. During the postoperative treatment period, the patient experienced recurrent episodes of GIB that could not be controlled by endoscopic interventions. Ultimately, the patient underwent surgical resection of the bleeding intestinal segment by the gastrointestinal surgery team. Following the surgery, the bleeding ceased, and the patient's bowel function recovered successfully. This case report aims to enrich the literature on GIB following LVAD implantation and its management. 2. Conclusion: Gastrointestinal bleeding is a common complication following LVAD implantation, often requiring endoscopic hemostatic treatment. In refractory cases, surgical resection of the affected intestinal segment may be necessary. Moreover, with frequent bleeding episodes, antiplatelet and anticoagulation therapies often need to be discontinued, which in turn increases the risk of life-threatening events. This case highlights the importance of a multidisciplinary approach in managing GIB in LVAD recipients, as well as the need for further research to develop effective strategies for predicting and preventing this complication.
Telomere Maintenance Patterns Exhibit Distinct Prognostic and Immune Landscapes in Cutaneous Malignant Melanoma
Authors: Kan Daohong , Hu Taotao , Li Yi , Jia Yuming , Lei Kaijian , Li Li , Yang Chaokun , Xie Fang
Published: July 2024

Background
Cutaneous malignant melanoma (CMM) is notorious for its ability to metastasize or spread to other parts of the body, rendering it one of the most perilous forms of skin cancer. This study aims to investigate the prognostic significance of telomere maintenance in CMM.
Materials & Methods
A total of 593 CMM samples were collected from TCGA and GEO datasets. CMM samples were clustered into two telomere maintenance clusters using nonnegative matrix factorization (NMF). Gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA) were employed to investigate the biological difference between distinct TM modification patterns. The immune landscape of CMM was visualized through single-sample gene-set enrichment analysis (ssGSEA) and CIBERSORT. Additionally, a risk score was identified using least absolute shrinkage and selection operator (LASSO), and hub-genes were determined via multi-variate COX analysis. Survival analyses were performed using the Kaplan-Meier method, and differences in survival were assessed using the log-rank test. Single-cell sequencing validation was conducted using the Tumor Immune Single Cell Hub on GSE123139 dataset(TISCH).
Results
Two telomere maintenance patterns were identified based on CMM samples. There were 6 hub-genes were screened by LASSO and multi-variate COX analyses and risk score was calculated based on the expression and coefficient of each hub-gene. CMM samples were classified into low- and high-risk groups. The overall survival (OS) of low-risk group was significantly higher than the high-risk group. A prognostic signature was identified based on risk score and patients’ clinical characteristics and visualized by nomogram.
Conclusions
Our study explored the potential prognostic value of telomere maintenance in CMM. We have developed a prognostic signature for CMM based on telomere maintenance related genes. telomere maintenance may aid in risk stratification and treatment strategy for patients with CMM.
Resurgence of common respiratory viruses and mycoplasma pneumoniae in children after ending the zero-COVID policy, Shanghai, China, 2023
Authors: Liu Pengcheng , Xu Menghua , Lu Lijuan , Zhu Xunhua , Jia Ran , Dong Niuniu , Su Liyun , Xu Jin
Published: July 2024

Background
China has adhered to policies of zero-COVID for almost three years since the outbreak of COVID-19, which have remarkably affected the circulation of respiratory pathogens. However, China has begun to end the zero-COVID policies in late 2022. Here, we reported a resurgence of common respiratory viruses and mycoplasma pneumoniae with unique epidemiological characteristics among children after ending the zero-COVID policy in Shanghai, China, 2023.
Methods
Children hospitalized with acute respiratory tract infections were enrolled from January 2022 to December 2023. Nine common respiratory viruses and 2 atypical bacteria were detected in respiratory specimens from the enrolled patients using a multiplex PCR-based assay. The data were analyzed and compared between the periods before (2022) and after (2023) ending the zero-COVID policies.
Results
A total of 8550 patients were enrolled, including 6170 patients in 2023 and 2380 patients in 2022. Rhinovirus (14.2%) was the dominant pathogen in 2022, however, Mycoplasma pneumoniae (38.8%) was the dominant pathogen in 2023. Compared with 2022, the detection rates of pathogens were significantly increased in 2023 (72.9% vs. 41.8%, p < 0.001). An out-of-season epidemic of respiratory syncytial virus was observed during the spring and summer of 2023. The median age of children infected with respiratory viruses in 2023 was significantly greater than that in 2022. Besides, mixed infections were more frequent in 2023 (23.8% vs. 28.9%, p < 0.001).
Conclusions
China is now facing multiple respiratory pathogen epidemics with changing seasonality, altered age distribution, and increasing mixed infection rates among children in 2023. Our finding highlights the need for public health interventions to prepare for the respiratory pathogen outbreaks in the post-COVID-19 era.
Maximum standardised uptake value of positron emission tomography as a predictor of oesophageal cancer outcomes
Authors: Lai Hsing-Hua , Ho Wei , Lo Chien-Ming , Chuang Kai-Hao , Chen Yu , Chen Li-Chun , Lu Hung-I
Published: July 2024

Objectives
This study aimed to analyse the value of pre-operative 18F-fluorodeoxyglucose positron emission tomography (PET)-computed tomography that can predict tumour pathological complete response, tumour histology grade, overall survival, and recurrence-free survival in patients with locally advanced oesophageal squamous cell carcinoma who underwent concurrent chemoradiotherapy (CCRT) followed by surgery.
Methods
We retrospectively reviewed the cases of patients with locally advanced oesophageal squamous cell carcinoma undergoing CCRT followed by surgery. Patients who did not undergo PET within 3 months of surgery were excluded. We set a pre-operative PET maximum standardised uptake value (SUVmax) of > 5 as the threshold and classified the patients into two groups. We analysed the tumour response and histology grade, and compared the overall survival and recurrence-free survival between the two groups.
Results
This cohort included 92 patients with oesophageal squamous cell carcinoma who underwent CCRT followed by surgery; 49 patients had a pre-operative PET SUVmax < 5, and 43 patients had a pre-operative PET SUVmax > 5. The patients’ pre-operative PET SUVmax correlated with tumour histology, ypT stage, and tumour response. Patients with a pre-operative SUVmax < 5 had better 2-year-overall survival (78% vs. 62%, P < 0.05) and 2-year recurrence-free survival (62% vs. 34%, P < 0.05) than those with a pre-operative SUV > 5.
Conclusions
Pre-operative SUVmax may be useful to predict tumour response, survival, and recurrence in patients with locally advanced oesophageal squamous cell carcinoma who undergo CCRT followed by surgery.
Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a Meta-analysis
Authors: Peng Xiangting , Ling Qiying , Duan Xuanchu
Published: July 2024

Objective
Trabeculectomy and non-penetrating trabecular surgery are common operations for glaucoma. This meta-analysis aims to compare the effect of trabeculectomy and non-penetrating trabecular surgery in postoperative astigmatism of patients with glaucoma.
Methods
We searched the PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure to identify studies that, compared between trabeculectomy and non-penetrating trabecular surgery in patients with glaucoma. The time frame for the search was from the time of construction to April 2024. There were no restrictions regarding study type or type of glaucoma. The primary endpoint was the surgically induced astigmatism assessed 6 months after operation.
Results Five
eligible studies were included in this meta-analysis and presented data for 359 eyes with various types of glaucoma at different stages. The results revealed an increase in astigmatism in patients with glaucoma after trabeculectomy and non-penetrating trabecular surgery. Trabeculectomy had a higher incidence of astigmatism than in the non-penetrating trabecular surgery group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.51, 95% CI = 0.19 to 0.83, P = 0.002).
Conclusion
Our results demonstrated that both trabeculectomy and non-penetrating trabecular surgery could increase astigmatism until 6 months after operation. Moreover, non-penetrating trabecular surgery group seems to have less influence on astigmatism. Studies with longer follow-up durations and larger sample sizes are necessary in the future.
Trial registration number
CRD42024517708
Clinical and radiological characteristics of odontogenic orbital cellulitis
Authors: Tumuluri Vinay , Tong Jessica Y. , Tumuluri Krishna , Selva Dinesh
Published: July 2024

Purpose: To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis
Method: Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes.
Results: Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25-56 years).
All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n=1, 25%), hand movements (n=1, 25%) and no perception of light (n=2, 50%). The organisms implicated were Streptococcus milleri (n=3, 75%) and Streptococcus constellatus (n=1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration.
Conclusions: Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.
The tumor-maintaining function of UTX/KDM6A in DNA replication and the PARP1-dependent repair pathway
Authors: Wang Shu-Ping , Yeh Lin-Wen , Chen Je-Wei , Yeh Jia-Yun , Kao Mei-Han , Hong Hsiao-Chin , Wu Sean , Cheung Wai-Mui , Liu Ta-Yu , Aberin Marvin , Paas-Oliveros Ernesto , Escajeda Arian , Shih Edward , Tarn Woan-Yuh , Chang Yao-Ming , Wang Lan-Hsin
Published: July 2024

Histone H3K27 demethylase UTX (aka KDM6A) is mutated in many human cancers, suggesting its tumor suppressive role during cancer development. However, most tumors still express wild-type UTX/KDM6A and its function is not always linked to tumor suppression. This suggests that UTX could be a pleiotropic factor in tumorigenesis; its deficiency promotes tumor initiation, while its presence is required for tumor maintenance. Here, we present evidence of UTX/KDM6A's role in sustaining tumor growth, revealing its function in tumor maintenance. We find that UTX/KDM6A sustains tumor cell cycling and survival via regulating DNA replication-associated transcriptional programs in a demethylase-independent manner. UTX/KDM6A can also interact with PARP1 and facilitate its recruitment to DNA lesions. Therefore, UTX/KDM6A depletion disrupts DNA replication and repair pathways, activating ATM–CHK2 and ATR–CHK1 signaling pathways and triggering S and G2/M checkpoints, leading to a pronounced defect in tumor growth. Analysis of human cancer xenograft models further demonstrates that knockdown of UTX/KDM6A by RNA-interference, rather than inhibition of its enzymatic activity via GSK-J4, shows potent anticancer effects. Dual inhibition of UTX/KDM6A and ATR further demonstrates synergistic anticancer activities. Our work highlights UTX/KDM6A as a potential therapeutic target for cancer treatment, especially when combined with ATR inhibition.
The impact of intraoperative use of opioids on the survival of individuals undergoing surgery for Glioblastoma
Authors: Naufal Rodrigo Ferrari Fernandes , Izadora Lorenna , Reyes Capovilla Martins Gonzalez , junior Mario wolak , Pokorny Gabriel , Carvalho Georgea Carneiro , Romero Flávio Ramalho
Published: July 2024

Introduction: Glioblastoma (GBM) is a primary tumor of the central nervous system (CNS). It is one of the most aggressive tumors affectinghumans, hasno cure, and has an extremely inverse prognosis, with an average survival ranging from 7 to 15 months. The role of opioids, either in stopping or stimulating tumor progression, has been demonstrated. The main objective of this study was to investigate the effect of intraoperative opioid use on patient survival.
Methods: This retrospective study included 133 patients who underwent 167 surgical procedures for glioblastoma resection. The inclusion and exclusion criteria were as follows: patients older than 18 years, of both sexes, and those with confirmed GBM. Patients who died in the postoperative period due to causes unrelated to the underlying disease were excluded, as were those who did not have specific data on the medications used in the perioperative period in their records. The following outcomes were analyzed: age, preoperative and postoperative Karnofsky scale (KPS) scores, duration of the surgical procedure, opioid dose, overall survival, disease-free survival, sex, and race. Correlation tests were performed using the Spearman test, a T1-robust ANOVA test was used to assess variance between the opioid dosage groups, and Cox proportional hazard models were used to evaluate the association between opioid dosage and patient survival.
Results: Analysis of the correlation between total opioid dosage and the investigated variables showed that surgical duration and age at surgery were significantly correlated with the total opioid dosage. There was no association between the total opioid dosage and the survival times of patients.
Conclusion: This study suggests that there is no relationship between intraoperative opioid dosage and overall ordisease-free survival in patients receiving glioblastoma treatment.