bluuebunny/crossref_metadata_2025 huggingface dataset:
Echocardiographic Determinants of Oxygen Uptake During Exercise in Patients with repaired Tetralogy of Fallot and Severe Pulmonary Regurgitation
Authors: Alborikan Sahar , Althunayyan aeshah , Pandya Bejal , Vonklemperer katherine , Walker Fiona , Cullen Seamus , Bhan Amit , Badian Sveeta , Encarnacion Delfin , Monteiro Ricardo , Petersen Steffen , Bhattacharyya Sanjeev , Lloyd Guy
Published: December 2024

Background: Reduced exercise capacity in patients with repaired Tetralogy of Fallot cannot be explained wholly by severe pulmonary regurgitation alone. We investigated the effect of pulmonary regurgitation and other measures of left and right ventricular function to identify the principal determinants of exercise performance.
Methods: 100 patients with TOF were evaluated, 60 with severe PR and 40 with no or minimal PR. Patients underwent cardiopulmonary exercise testing with concurrent echocardiography. Echocardiography was performed at rest and during exercise (both at low and high intensity for the appropriate parameters). Contractile reserve was expressed as the percentage increase at the relevant time point. Univariate and multivariate linear regression was used to generate a predictive model for exercise function.
Results: There was no difference in exercise performance between those with and without pulmonary regurgitation when judged by peak absolute oxygen consumption VO2 (1695±627vs1744±521, ml/min, p>0.05), or a range of other submaximal cardiopulmonary parameters. Right ventricular volumes were higher in those with pulmonary regurgitation while left ventricular long axis function was reduced. There were no associations between exercise measures with the degree of pulmonary regurgitation and right ventricular volume at rest or during exercise. There was lower contractile reserve of the right ventricle in those with pulmonary regurgitation (fractional area change 20±15 % vs 23±16 %, p<0.05) balanced by improved reserve of the left ventricle. Augmentation of the left ventricular global longitudinal strain and right ventricular fractional area curve together showed the strongest association with peak VO2.
Conclusions: There was an overall marked reduction in exercise capacity in patients with repaired tetralogy of Fallot, but no difference between those with and without PR. The degree of exercise limitation is more dependent upon the ability of right and left ventricles.
An Evaluation of Speech Therapy Care in the Surrounding Area of an Interdisciplinary Cleft Lip and Palate Tertiary Care Center
Authors: Schaffrath Katharina , Ooms Mark , Seidel Simone , Hölzle Frank , Modabber Ali
Published: December 2024

The anatomical deformation in cleft patients requires speech therapy to support cleft patients as best as possible. The aim of this study was to evaluate the standard of knowledge of therapists concerning clefts. Furthermore, the study aimed to determine whether there was a difference between therapists with and without treatment experience in cleft patients as well as among therapists with more or less years of general professional experience. We developed a questionnaire about different areas of speech therapy: “General,” “Speech therapy,” “Development opportunities and influences,” and “Interdisciplinary collaboration.” For a total of 50 questions, we used single-, multiple-choice questions and the visual analog scale (VAS). Speech therapists with experience in treating cleft patients (n = 42) felt more confident regarding their knowledge and abilities than therapists without experience (n = 62), especially concerning nonspecialist disciplines and cleft specifications. No difference was found in therapy duration, indications, influences, and potential for development. Professional experience (years) and cleft experience correlate; with more knowledge in the group with more than eight years of experience. Cleft centers remain first choice for patients’ care thanks to the higher number of patients, daily treatment routine, the direct contact among examiners, and a common treatment concept.
Physicochemical characteristics of lignins from corncob and agave tequila bagasse warrant their use for sustainable materials
Authors: Maldonado-Pérez Azalea , Cetina Abraham , Vázquez-Torres Humberto , Mercado Mónica Vázquez-Del , Escalante Alfredo , Toriz Guillermo
Published: December 2024

Corncob and agave tequila bagasse are agricultural residues composed of lignin, cellulose and hemicelluloses. Despite being the second most abundant biopolymer, commercial applications of lignin are restricted owed to its heterogeneous and complex chemical structure. However, lignin properties (UV-absorption, biodegradation, biocompatibility, antioxidant, etc.) forecast production of sustainable high-added value materials. The aim of this contribution was to characterize the material properties of organosolv lignins from corncobs (CC) and agave tequila bagasse (T), to aid in the development of sustainable materials. The physicochemical characteristics of both polymers were determined. The degree of polymerization was 16, determined by GPC for both residues, resulting in similar thermal properties (TGA and DSC). Infrared and nuclear magnetic resonance spectroscopies showed that T was composed mainly of syringyl (S) units, while CC contains p-hydroxyphenyl (H), syringyl (S), and guaiacyl (G) units. The surface composition as investigated by XPS, showed that T has more hydroxyl groups available on the surface and a higher surface area (12.2 m2/g) as compared to CC. Hydrodynamic size, determined by light scattering, ranged from 255–712 nm for T, while CC particles had a wider distribution (from 70-1000 nm), with an 8-fold polydispersity index as compared with T; the z potential was in the vicinity of -30 mV for T and − 20 mV for CC. Spherical nanoparticles with diameters of 42 nm for T and 49 nm for CC were observed. Based upon the specific material properties of each lignin, sustainable, high value-added products can be obtained.
HIF-1α-regulated Galectin-3 affords the vasculogenic mimicry and poor prognosis of hepatocellular carcinoma
Authors: Kong Fei , Jin Meishan , Fu Yu , Liang Zhuoshuai , Shi Jikang , Jiang Jing , Liu Yawen , Cheng Yi
Published: December 2024

In present study, we explore the role of HIF-1α-regulated Galectin-3 in VM and poor prognosis of HCC as well as the potential regulatory mechanism. Immunohistochemistry method was used to evaluate HIF-1α and CD31/PAS expression in HCC patients. Vitro experiments were conducted to reveal the molecular mechanisms that regulate Galectin-3 expression under hypoxia. Moreover, the effects of Galectin-3 on the biological function of HCC cells were investigated using MTS kit, wound-healing assay, cell transwell assay, flow cytometry assay and three-dimensional culture under hypoxia. HIF-1α expressions were significantly higher in HCC tissues than those in adjacent hepatic tissues in cirrhosis-free patients with HCC (P = 0.023). The patients with positive-HIF-1α expression had worse overall survival (P = 0.002). HIF-1α was positively correlated with Galectin-3 in HCC tumor tissues (P < 0.05). Higher expression of Galectin-3 linked to poor overall survival (P = 0.002). HIF-1α and Galectin-3 were correlated with VM of HCC (P < 0.05). Hypoxia promotes proliferation, migration, invasion and VM formation of HCC cells, and suppresses to apoptosis (P < 0.05). Galectin-3 is the target genes of HIF-1α transcription factor. Silencing Galectin-3 abolished effect of hypoxia microenvironment on the function of HCC cells. In conclusion, HIF-1α-regulated Galectin-3 contributes to the vasculogenic mimicry and poor prognosis of HCC.
A Hemodynamically Stable Patient With Traumatic Diaphragmatic Rupture and Herniated Shattered Spleen in the Left Thorax: A Case Report
Authors: Bahsan Kassim , Mwesige Sylvery , Lusasi Shedrack , kitua Daniel , Swallow Andrew , Mwanga Ally
Published: December 2024

Background
Blunt abdominal injuries often result in damage to the parenchymal organs, particularly the liver and spleen. In rare cases, these injuries can also lead to diaphragmatic rupture, causing the intraperitoneal organs to herniate.
Presentation of the case:
This report presents the case of a 55-year-old man who experienced a traumatic abdominal injury resulting in a diaphragmatic injury with herniation of the bowels and a ruptured spleen.
Discussion
The occurrence of isolated diaphragmatic hernia, resulting from blunt abdominal injury, together with herniation of intraperitoneal organs and a ruptured spleen, is infrequently reported in the literature. The diagnosis of the ruptured herniated spleen in the left hemithorax was delayed for 7 days, and no appropriate treatment was provided, despite the patient being in a stable condition.
Conclusion
Although diaphragmatic hernias are uncommon and create diagnostic challenges, a heightened level of suspicion is necessary because not all cases exhibit conventional symptoms, as demonstrated in the case discussed here.
Design and on-site test verification of blasting excavation in the machinery room of a pumped-storage power station building
Authors: Chen Xiaocui , Mi Yuan , Shuai Xinru , Zhao Wenhu , Zheng Yuan , Li Xiji
Published: December 2024

Blasting is widely used in modern engineering construction owing to its speed, efficiency, and low cost. However, the vibration effects caused by blasting resulted severe cracking of the rock-anchored beam. Using a pumped-storage power station building in East China as the engineering background, on-site blasting tests at the busbar tunnel section were conducted to measure the vibration speed of a rock-anchored beam during multihole overall blasting. Using the LS-DYNA dynamic analysis platform, we established a 3D numerical model of an underground power plant and validated the model with test data obtained from sensors. A blasting plan for the excavation layer in the machinery room section was proposed to explore the rock fragmentation rate at the midsection groove and the protective layer on both sides for various detonation methods, as well as the vibration velocity at remote measuring points. The results show that a reasonable detonation sequence can increase the rock fragmentation rate by approximately 9% without increasing economic costs. By adopting a row-by-row detonation scheme, the peak blasting vibration velocity in all directions was reduced, thereby reducing the effects of blasting vibration by approximately 77%. These make the on-site rock-anchored beam meet the control standards well, thus providing technical support for the designing drilling and blasting schemes for similar projects.
Continuous PPI Treatment after Gastric Bypass Increases the Risk of Pathological PTH Levels at Ten Years Postoperatively
Authors: Stevens Katharina , Hultin Hella , Sundbom Magnus
Published: December 2024

Introduction: Apart from massive weight loss, metabolic and bariatric surgery, especially gastric bypass (RYGBP), can cause nutritional deficiencies. Proton pump inhibitors (PPI), relatively often used after RYGBP, are associated with reduced calcium absorption. We have studied the long-term impact of PPI upon calcium homeostasis among RYGBP patients.
Methods: In the Scandinavian Obesity Surgery Registry (SOReg), 550 primary RYGBP patients, with eGFR > 60 ml/min/1.73m2, had PTH and 25-OH D levels registered at 10 years. To avoid the impact of hypovitaminosis D, those with 25-OH D >75 nmol/L were selected.
Results: At 10 years, 10.3% of patients reported continuous PPI treatment, i.e., daily use during the last month. In an age adjusted logistic regression model, continuous PPI treatment was associated with a quadruple risk (OR: 4.65 [1.54-14.04]) of having a pathological PTH level (>7 pmol/L).
Conclusion: This unique study has shown a correlation between continuous PPI use and pathological PTH levels, thereby inferring that the medication may have detrimental effects upon calcium homeostasis among gastric bypass patients. The risk of having pathological PTH levels was more than tripled among those with PPI treatment, highlighting the importance of specialized follow-up while also suggesting that a limited duration of PPI treatment is preferable.
Inverse U-shaped association between weight-adjusted waist index and femur bone mineral density in the older adults:NHANES 2005-2018
Authors: Wang Jun , Lv Xin , Huang Jianjun , Liu Xiaogang , Liu Yaobo , Hao Gang , Lu Bocheng
Published: December 2024

The weight-adjusted waist Index (WWI) emerges as a novel metric for assessing obesity. The aim of this research was to explore the association between WWI and total femoral Bone Mineral Density (BMD) in the older adults of the United States. This study involving individuals aged 60 years and older utilized data from the National Health and Nutrition Examination Survey (NHANES) across five survey cycles (from 2005–2010, 2013–2014, and 2017–2018) to examine the association between WWI and total femur BMD. In this research, we employed a suite of statistical methods to explore both linear and nonlinear associations. Additionally, a threshold effect analysis was conducted to ascertain the saturation threshold for WWI. Analysis via multivariate linear regression uncovered a notably positive correlation between WWI and total femur BMD among 7292 US seniors aged 60 years and older [β: 0.0138, 95% CI: (0.0069, 0.0206), P: 0.0003]. Consistent positive correlations were observed across various demographic subgroups. Furthermore, in the smooth curve fitting analysis ,an inverse U-shaped association was identified between the WWI and total femur BMD.And in the threshold effect analysis, the critical inflection point was established at 11.93 cm/√kg. So, this research established an inverse U-shaped association between WWI and total femur BMD in the older adults,and maintaining a certain level of WWI may have a positive protective effect on total femur BMD of the older adults in the United States.
Does Pre-Checkpoint Inhibitor Sarcopenia, Visceral, or Subcutaneous Fat Predict Survival in Non-Small Cell Lung Cancer Patients?
Authors: Kooser Julia , Davis Mellar , Guo Tian , Vanenkevort Erin , Young Amanda , Koppenhaver Nicole , Lagerman Braxton , Gupta Mudit , Patel Aalpen , Wojtowicz Mark
Published: December 2024

Background
The role of skeletal muscle area (SMA), subcutaneous, and visceral fat area (SFA and VFA) in cancer survivorship is inconsistent. We investigated the prognostic significance of the skeletal muscle index, subcutaneous and visceral fat area specifically via CT scans around the time of checkpoint inhibitor therapy in patients with non-small cell lung cancer (NSCLC).
Methods
CT scans of patients within 60 days of checkpoint inhibitor medication use were utilized to assess skeletal muscle area visceral fat index (VFA), subcutaneous fat area (SFA), and visceral and subcutaneous fat ratio corrected by patients’ height in meters squared. Skeletal muscle and fat areas at L3 were read by a single trained reader using TeraRecon software. Survival (in days) was calculated from the first CT scan to the death date. Survival analysis was performed using a Cox proportional hazards model to evaluate the association between body composition metrics and patient survival outcomes at one and two years. Multiple regression models were utilized with all CT parameters in a single model
Results
With 46 patients included in the analysis, our results did not show a significant relationship between any parameters assessed (SMA, SFA, VFA, visceral and subcutaneous fat ratio, and days from checkpoint inhibitor therapy to initial scan) and cancer survivorship in either female or male patients.
Discussion
Our results demonstrate no significant relationship between the parameters assessed and NSCLC survivorship in either male or female patients, which is consistent with small studies. However, meta-analyses of multiple studies support the association of pre-immunotherapy with reduced survival.
Conclusion
Pre-treatment Sarcopenia, SFA, and VFA do not appear to predict cancer survival on checkpoint inhibitors in small studies. Larger studies are needed to explore the utility of CT scan-derived SMI and fat area in predicting checkpoint inhibitor benefits in patients with lung cancer.
A Prospective, Longitudinal, Comparative Analysis of the World Health Organization / International Committee of the Red Cross Basic Emergency Care Course on Emergency Medicine Knowledge and Confidence Among Recent Medical School Graduates
Authors: Michaeli Nichole , Beck Andrew , De Luca Giovanna , Gitau Mary , Lubetkin Derek , Ochieng Derick , Wanjiku Grace W. , Myers Justin G.
Published: December 2024

Background
The Basic Emergency Care (BEC) course was created by the World Health Organization (WHO) in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM) to train frontline providers in low-resource settings. This study evaluates the effectiveness of the course for graduating medical students at the University of Nairobi one year after BEC course completion.
Methods
This longitudinal, prospective, comparative study was conducted with recent graduates of the University of Nairobi School of Medicine from October 2021 to May 2023. Participants’ retention of emergency medicine knowledge was assessed with a multiple-choice examination 12 to 18 months after completing the BEC course. A survey assessed participants’ confidence in managing patients with emergencies 12–18 months after completing the BEC course using a 4-point Likert scale. These results were compared to a control group of recent University of Nairobi School of Medicine graduates who did not take the BEC course
Results
The follow-up test scores were lower than the immediate post-course test scores, which suggests some knowledge loss over time. Compared to the control group, the BEC participants had higher test scores during the follow-up period although the difference was not significant. There was no difference between most of the immediate post-course and follow-up survey responses. On follow-up evaluation, BEC participants reported a significant decrease in confidence in understanding emergency drugs and managing an obstructed airway and a patient requiring immobilization. However, compared to the control group, BEC participants had significantly higher self-reported confidence in most areas assessed by the survey.
Conclusion
This study shows that the WHO BEC course is an effective tool for emergency medicine training for recent graduates from the University of Nairobi. There was an overall increase in confidence among newly practicing physicians who took the BEC. The participants’ decrease in knowledge and confidence 12 to 18 months after the BEC course suggests the need for regular refresher courses.
A Green Three-Ratio Manipulating Spectrophotometric ApproachesFor the determination of a binary mixture of pantoprazole and domperidone
Authors: Abuseada Hamed Hamed Mohamed , Sattar Osama Ibrahim Abdel- , Madkour Ahmed , Taha Ahmed Sobhy
Published: December 2024

Pantoprazole (PAN), a proton pump inhibitor, is widely prescribed to treat gastrointestinal disorders such as gastroesophageal reflux disorder (GERD), and hyperacidity. Suppressing gastric acid secretion effectively alleviates symptoms like heartburn, acid regurgitation, and indigestion. Domperidone (DOM), a prokinetic agent, that enhances gastrointestinal motility is often prescribed with PAN in patients with additional motility disorders. This combination is useful for patients who suffer from nausea, vomiting, or bloating due to motility dysfunction. (Pantosec-D) tablets contain both PAN and DOM This combination provides rapid relief from gastrointestinal symptoms by addressing both acid-related and motility-related issues. This combination ensures better management of gastrointestinal problems by enhancing the patient's comfort and quality of life. The establishment and validation of three spectrophotometric techniques—the ratio difference (RD), the first derivatives (1DD), and the mean centering (MC) methods of the ratio spectra—for determining PAN and DOM in combined pharmaceutical formulations are presented in this study. These methods are based on manipulating the ratio spectra of the cited medications to resolve their spectral overlapping, including the RD, 1DD, and MC methods. DOM was measured using the RD method, which calculated the amplitude difference between 209 and 233 nm. Conversely, PAN was evaluated by determining the 254 and 223 nm amplitude differences. DOM and PAN were shown to be selectively determined at 215 nm and 249 nm, respectively, using the first derivatives of the ratio spectra approach. PAN was evaluated at 254 nm in the mean centering method, whereas DOM was specifically quantified at 209 nm. The suggested procedures were verified in compliance with ICH regulations. Pharmaceutical formulations comprising PAN and DOM were effectively analyzed using the linear correlations obtained for both drugs over concentration ranges of zero–52 µg/mL and 1–18 µg/mL, respectively. Compared with reported chromatographic methods, these techniques provide easy-to-use, reasonably priced, and dependable substitutes for the standard quality control of these medications in mixed dosage forms.
Strength profile of the superior and inferior rotator cuff: A comparison between painful and non-painful participants aged between 18 and 75 years.
Authors: Briel Sonia , Brandt Corlia , Olivier Benita
Published: December 2024

Background:
The ideal force couple ratio of the superior cuff, supraspinatus versus anterior deltoid is yet to be determined in both an athletic and non-athletic population.
Objective:
To determine the muscle force and muscle force couple ratios of the superior cuff, between the supraspinatus and the anterior deltoid and of the inferior cuff, between the external rotators and the internal rotators in painful and non- painful shoulders in an adult non-athletic population.
Methods:
This was an analytical cross-sectional study. The shoulders of both painful and non-painful shoulders of adults, females and males aged between 18 years and 75 years of age were tested. The ratios of the superior cuff (supraspinatus versus anterior deltoid) and of the inferior cuff (external versus the internal rotators) were determined.
Results:
Specific force couple ratio of supraspinatus versus anterior deltoid was determined. Higher values for the force couple’s ratios were concluded in the non-painful group of supraspinatus: anterior deltoid of 1.25 (0.20) versus the lower value of the painful group of supraspinatus: anterior deltoid of 1.20 (0.23). Statistically significant difference was determined between supraspinatus: anterior deltoid in males (1.25) versus females of (1.16) (p > 0.12) with a small effect size of (0.27). Statistically significant difference (p < 0.001) of the external rotators force values between the non-painful and the painful participants were determined. No significant difference of the internal rotator force values between the non-painful and the painful participants were determined.
Conclusions:
All force couple ratios should be considered in the evaluation and rehabilitation of all population groups.
Pediatric Odontogenic Infection Treatment Approaches: Retrospective Analysis
Authors: Emodi Omri , Frid Hanna , Rachmiel Adi , Bilder Amir , Elzami Ron , Rashish Sharon , Klein Adi
Published: December 2024

Severe pediatric odontogenic infections may result from caries, periodontal issues, or direct trauma. Untreated, they can cause serious complications. Treatment protocols vary between hospitals. This study compared patient characteristics, treatment outcomes, and hospitalization parameters in two Israeli hospitals. A retrospective (2018–2021) cohort study included patients under 18 suffering from dental infections treated at the Maxillofacial Surgery Department of Rambam Health Care Campus (RHCC) in Haifa, Israel, or the Pediatrics Department of Hillel Yaffe Medical Center (HYMC) in Hadera, Israel. Data included patient demographics, clinical evaluations, treatments, and hospitalization details. The treatment protocol of each hospital was the predictor variable (HYMC: hospitalization with IV antibiotics; RHCC: tooth extraction with subperiosteal drainage). The primary and secondary outcomes were hospitalization duration and days to clinical improvement, respectively. A total of 156 patients (78 per hospital) were enrolled. The total hospitalization period was twice as long at HYMC compared to RHCC (3.6 ± 1.2 vs 1.9 ± 0.7; p < 0.001), and the time to clinical improvement was nearly three times higher (3.5 ± 1.3 vs 1.1 ± 0.3; p < 0.001). The study demonstrates that surgical treatment results in faster clinical improvement and shorter hospitalization, indicating the need for personalized treatment protocols to optimize patient outcomes.
Navigating the Cityscape: Role of Urban Elements in Imageability of Residential neighbourhoods, Case of Ahmedabad
Authors: Shaju Ar. Anushree , Raval Prof. Pooja
Published: December 2024

Cities have been primarily identified with the identical character and memory that the built landscape offers. The research aims to identify the spatial dimensions and structural elements that qualitatively evaluate urban forms contributing to imageability by examining how residents perceive their neighborhoods, including physical elements and social interactions. In Ahmedabad’s case, the residential neighborhoods in the east and west have remarkably contrasting built and social environments. The research contributes to the evolved ideas of legibility and way-finding in the contemporary discourses of Indian cities through qualitative research with identified cases.
Multi-omics analysis reveals the alleviating effects of Bifidobacterium infantis M-16V on food allergy through modulation of gut microbiota, metabolome, and gene expression in mice and infants
Authors: Li Na , Zhang Yufei , Gao Shenshen , Zhang Qingqing , Wang Xinqiong , Cui Weiwei , Xu Chundi
Published: December 2024

Background
Food allergy (FA) has become a growing public health issue globally, with a steady increase in prevalence over recent decades. Despite this, effective treatment strategies remain elusive. Modulating the composition and function of gut microbiota through probiotic intervention has gained attention as a promising strategy for the prevention and management of FA.
Results
M-16V alleviated infants’ clinical symptoms such as crying, reflux, and abnormal stool patterns, which were accompanied by improvements in biochemical parameters. M-16V significantly attenuated mice OVA-induced allergic responses, suppressed the production of OVA-sIgE and OVA-sIgG1, elevated OVA-sIgA levels, and downregulated the expression of allergy-related mRNA. In both mice and infants, microbial metabolic pathways were pivotal in modulating immune cell function. Notably, M-16V enhanced the abundance and diversity of the gut microbiota.
Conclusion
Our results highlight the therapeutic efficacy of M-16V in mitigating FA and provide valuable insights for developing of novel microbiota-targeted interventions aimed at the prevention and treatment of FA.
Optimal screening method for targetable gene rearrangements in papillary thyroid carcinoma with wild-type BRAF
Authors: Jin Meihua , Kim Chae A , Jeon Min Ji , Lee Yu-Mi , Sung Tae-Yon , Kim Tae Yong , Kim Won Bae , Kim Won Gu , Song Dong Eun
Published: December 2024

The continued advancement of targeted therapies for actionable gene rearrangements has increased the demand for cost-effective screening methods for detecting these gene rearrangements in papillary thyroid carcinoma (PTC). Herein, ribonucleic acid (RNA) sequencing was performed on 106 patients with PTC having wild-type BRAF. The patients were divided into two groups: Group 1 (n = 58) included patients selected by an endocrine pathologist based on characteristic pathological features, including multinodular invasive growth, prominent intratumoral stromal fibrosis, mixed-growth patterns with varying degrees of nuclear atypia, pale eosinophilic to clear cytoplasm, and/or multiple lymph node (LN) metastasis. These patients were prescreened and then subjected to pan-tyrosine receptor kinase (TRK) immunohistochemistry (IHC) staining and RNA sequencing. In Group 2, RNA sequencing was conducted on samples from 48 randomly selected patients. Gene rearrangements were identified in 66 patients (62.3%), with a significantly higher proportion in Group 1 (77.6%) than in Group 2 (43.8%) (p < 0.001). NTRK was the most common gene rearrangement, which was detected in 31 patients (29.2%). The second most common gene rearrangement was RET (18.9%), followed by ALK (9.4%), and then BRAF (2.8%). Patients with gene rearrangements were significantly younger and had smaller primary tumors, although they demonstrated greater extrathyroidal extension and LN metastasis than those without rearrangements. Pan-TRK IHC revealed a sensitivity of 52% and a specificity of 94% for the prediction of NTRK gene rearrangements. This study demonstrates that pathological screening combined with pan-TRK IHC is a cost-effective method for examining targetable gene rearrangements in patients with PTC having wild-type BRAF.
N7-methylguanosine-based signature for tumor subtyping and prognosis and immunotherapy prediction of stomach cancer
Authors: Luo Jin , Mai Yunxiao , Wang Xiaowu , Chen Shengxiang , Ye Chengmeng , Yuan Ziwei , Hu Xiao , Zhou Ruiyao
Published: December 2024

Background
Gastric cancer is an aggressive disease with complex tumor heterogeneity, influenced by genomic, transcriptomic, and translational processes. N7-methylguanylate (m7G) modification is a potential factor in tumor heterogeneity, but its role in gastric cancer remains unclear.
Methods
We conducted cluster analysis on m7G-related genes in the TCGA-STAD dataset to identify gene patterns. Using LASSO regression, we identified genes that were differentially expressed in relation to m7G. A nomogram was developed to predict patient prognosis based on these genes. To further explore the molecular mechanisms, we performed survival analysis, functional enrichment analysis, and gene silencing experiments. Additionally, we examined tumor mutations, immune cell infiltration, and immune-related genes to evaluate immune responses and drug sensitivity.
Results
Clustering analysis identified two main gene groups linked to m7G modification. Survival analysis showed that high-risk patients, based on the selected genes, had poorer outcomes. Functional enrichment revealed that m7G modification influences tumor heterogeneity and the tumor microenvironment (TME), impacting prognosis. Silencing RASGRF2, the most significantly impacted gene, inhibited survival, proliferation, invasion, and migration of gastric cancer cells (AGS and HGC-27). Correlation analysis of immune responses and mutation patterns suggested that m7G modification affects the effectiveness of immunotherapy and drug sensitivity.
Conclusions
m7G modification plays a critical role in gastric cancer, influencing tumor heterogeneity and prognosis. The predictive nomogram provides a robust tool for forecasting patient survival, and targeting m7G modification could offer new therapeutic opportunities.
TDF and its analogs have not survival advantage over entecavir for patients with Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure
Authors: Xu Xinyi , Tu Huilan , Xu Xianbin , Yu Xia , Weng Haoda , Yu Yue , Zhang Xiuding , Zhou Ruoqi , Zhu Wenfeng , Yu Shi , Sheng Jifang
Published: December 2024

Background: Both entecavir and tenofovir are frequently prescribed for HBV-ACLF, however, their comparative efficacy were not fully clarified. The study aimed to compare the survival, virological and liver function response between patients with entecavir and tenofovir and its analogs.
Methods: We retrospectively analyzed 534 patients with HBV-ACLF who were given either entecavir (n= 115) or tenofovir and its analogs (n= 102) in a single medical center in China. The primary endpoints were 28-day and 90-day liver-transplantation-free mortality. Secondary outcomes were changes of serum HBV-DNA and MELD scores.
Results: Over 90-day follow-up, 20.9% died in patients with entecavir, and 11.8% in those with tenofovir and its analogs. The cumulative liver-transplantation-free survival rates were similar between the two groups ( 18.2% and 22.2% for 28-day and 90-day mortality in entecavir group; 5.1% and 12.2% for 28-day and 90-day mortality in tenofovir group, respectively, P= 0.003, and 0.060, respectively). In the multivariate Cox proportional hazard analysis adjusting age, cirrhosis, hepatic encephalopathy, ascites, MELD scores, serum HBV-DNA levels and sex, the types of antivirals was not associated to the 90-day mortality (HR: 0.691, 95% CI: 0.337 to 1.42, P=0.314)(entecavir as the reference). The main findings were consistent with that after PSM or by competing risk model. Beside, the decline of serum HBV-DNA levels and improvement of MELD scores were also comparable between the two groups.
Conclusion: There was no significant difference in the efficacy of entecavir and tenofovir and analogs in treating patients with HBV-ACLF. There findings suggest both entecavir and tenofovir and its analogs can serve as first-line antivirals for HBV-ACLF.
Human Immunodeficiency Virus - Assocciated Hyperthropic Cardiomyopathy Presenting with Chest Pain Suspected with Acute Myocarditis: An Unusual Case Report
Authors: Pramana Ketut Angga Aditya Putra , Suyasa I Putu Gede Eka Ariawan
Published: December 2024

Background: Human Immunodeficiency Virus-associated cardiomyopathy (HIVAC) is a stage 4 disease that is linked to HIV and is still a major cause of illness and death in people who have HIV. The cause of HIVAC and how it shows up in the body depend on how weak the host's immune system is. Myocarditis caused by direct HIV toxicity, opportunistic diseases, and food deficiencies may be a cause of HIVAC. We describe a woman with a low CD4 count who had severe dilated cardiomyopathy caused by HIV.
Case Presentation: A 40-year-old female with HIV receiving antiretroviral therapy presented with severe chest pain that began two hours before hospital admission. Complaints were linked to perspiration and shortness of breath. The vital signs revealed a blood pressure of 80/50 mmHg, a heart rate of 85 bpm, and a respiratory rate of 25 brpm. The electrocardiogram revealed normal sinus rhythm with anteroseptal old myocardial infarction, while echocardiography showed left ventricular hypertrophy, a 77% ejection fraction, septal thickening with asynergic ventricular regions in the inferolateral area, and a suspicion of myocarditis. The CD4 count at admission was reduced to 144 cells/mm3, and the high sensitivity troponin level was increased. She initiated inotropic and vasopressor therapy, a maintenance protocol of dual antiplatelet medicines, anticoagulants, heart failure care, and steroid treatment. After five days of therapy, the patient's symptoms improved, and a referral for magnetic resonance imaging (MRI) was arranged to validate the diagnosis of acute myocarditis.
Conclusion: This instance underscores the significance of antiretroviral therapy (ART) in sustaining adequate CD4 counts and suppressing elevated viral loads to avert opportunistic infections, perhaps serving as a crucial factor in HIVAC.
Menstrual inequity: the ‘stain’ on participation and democracy in South Africa
Authors: Nomsenge Sinazo
Published: December 2024

Healthy experiences of menstruation require access to material and nonmaterial resources including sanitation facilities, privacy and comfort infrastructure, hygiene and pain management products as well as accurate and empowering menstrual education. These resources remain inaccessible for many women and adolescents thereby compromising their participation in various aspects of their socioeconomic advancement including schooling, work, and personal development. For adolescents, inadequate access to essential menstrual resources compromises schooling experiences with research suggesting that in addition to many adolescents missing school during menstruation, the quality of their social and educational participation is significantly impeded by the lack of access to essential resources. Beyond this, limited access to critical resources and infrastructure interferes with women’s work and socioeconomic engagements in ways that compel many to employ menstrual concealment practices that compromise their health, comfort, safety, and ultimately, their equitable participation in social and economic activity. Moreover, stigma and secrecy surrounding menstruation limit open engagements about menstrual needs and challenges thereby making various aspects of society inherently inequitable and incapable of fostering democratic participation. This paper draws on qualitative phenomenological research conducted with 15 women living in uMlazi and Inanda in KwaZulu-Natal, South Africa. In-depth interviews were used to explore participants’ experiences and perceptions on how menstrual inequity influences patterns of socio-economic, educational, and developmental participation among adolescents and women. From data collected, the paper suggests that inadequate access to essential menstrual resources shapes inequitable patterns of participation in schooling, work, social and developmental activity.
Histological Anaplasia and Chromosome 6 Chromothripsis as Predictive Factors of Aggressivity in Low-grade Glioma, MYB/MYBL1-Altered
Authors: Aboubakr Oumaima , Wefers Annika K. , Dangouloff-Ros Volodia , Métais Alice , Sievers Philipp , Roux Alexandre , Hasty Lauren , Saffroy Raphaël , Pierron Gaelle , Guillemot Delphine , Daoud Lina , Adle-Biassette Homa , Samoyeau Thomas , Boddaert Nathalie , Grill Jacques , Pallud Johan , Beccaria Kevin , Blauwblomme Thomas , Varlet Pascale , Tauziède-Espariat Arnault
Published: December 2024

In the Central Nervous System (CNS), MYB/MYBL1 alterations are found in two tumor types: angiocentric glioma (AG), and diffuse astrocytoma (DA). These tumors share clinical features (mainly epileptic pediatric tumors located in the supratentorial area), a histopathological pattern (AG can look like DA) and seem to be associated with comparably favorable prognoses. However, aggressive cases of AG have been reported in the literature, one of them harboring a MYB::QKI fusion. This study aims to compare and contrast aggressive cases of low-grade gliomas (LGGs), MYB/MYBL1-altered to typically indolent cases in order to identify factors (clinical, radiological or histomolecular) associated with aggressive forms of AG and DA. We retrospectively reviewed and fully characterized 28 LGGs (14 AGs and 14 DAs) with MYB/MYBL1 alterations in terms of clinical course, radiology, histopathology and molecular biology (including DNA-methylation profiling). While most AGs and DAs in our cohort had a favorable oncological outcome, we describe three cases of AG and one case of DA with tumor progression and one terminal case of AG. Initial signs of histopathological anaplasia were exclusively found in aggressive AGs (2/3) but their significance in DA is unclear as they were encountered in the aggressive case but also in two indolent cases, and because DA seem to respond well to chemotherapy. Two aggressive AGs also were found to have a chromosome 6 chromothripsis and harbored additional molecular alterations in their initial tumor sample (KRAS, hTERT, and TP53 mutations). No radiological pattern, fusion partner or methylation cluster was associated with progression in LGG, MYB/MYBL1-altered. These cases with an aggressive clinical course raise the question of potential higher grades of LGG, MYB/MYBL1-altered, which need to be confirmed by additional reports.
Developing a Comprehensive Model of Home-Based Long-Term Care for Older People in Iran: A Multi-Method Study
Authors: Mobasseri Khorshid , Ghasemyani Shabnam , Khodayari-Zarnaq Rahim , kousha ahmad
Published: December 2024

Introduction
: With the increasing aging population, the demand for care that fosters independence in older adults is rising. Complications from hospitalization and the preference for aging in place highlight the need for geriatric home care systems. This study aims to develop a comprehensive home-based care model specifically for Iranian seniors and evaluate its feasibility.
Methods
This study employed a multi-phase approach in Iran. It began with a mixed-methods analysis, including a survey on caregiver reliance followed by qualitative interviews to identify challenges in home care services. Phase 2 involved a scoping review of home care frameworks from various countries. In Phase 3, an initial model was created based on previous findings and relevant documents in Iran. In the fourth phase, feedback was gathered from an expert panel selected through purposive sampling, with discussions recorded and concluding at saturation. The feedback was then integrated into the final model. Additionally, in a Delphi study, experts evaluated the model components using a four-point Likert scale, calculating the content validity index (CVI) for each item, where a CVI of 79% or higher indicated validity, and continuous feedback led to iterative refinements.
Results
Following the design of the initial model, an expert panel convened with 15 participants to review the framework. The final model comprises seven key components: leadership & governance, legislative framework, financial framework, human resource management system, information management system, and control & monitoring system. Results from the Delphi study indicated that with a CVI exceeding 80%, this model is deemed a valid framework for delivering home-based care.
Conclusion
This study presents a comprehensive model that serves as a valuable guide for policymakers seeking to implement integrated home care with professional oversight. By doing so, it aims to enhance the quality of care and improve stakeholder satisfaction.
Comparison of the Lethal Triad and the Lethal Diamond in a multicenter cohort from the TraumaBase® registry of severe trauma patients
Authors: Dupuy Charles , Martinez Thibault , Duranteau Olivier , Gauss Tobias , Kapandji Natacha , Pasqueron Jean , Holleville Mathilde , Abdallah Georges Abi , Harrois Anatole , Ramonda Véronique , Huet-Garrigue Delphine , Doublet Téophane , Leone Marc , Legros Vincent , Pottecher Julien , Audibert Gérard , Millot Ingrid , Popoff Benjamin , Cohen Benjamin , Vardon-Bounes Fanny , Willig Mathieu , Gosset Pierre , Angles Emilie , Mellati Nouchan , Higel Nicolas , Boutonnet Mathieu , Pasquier Pierre
Published: December 2024

Background
To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-hour mortality in transfused severe trauma patients.
Methods
We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of packed red blood cells (RBCs) within the first 6 hours of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L.
Results
A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score [ISS]: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7%), and a 24-hour mortality rate of 16.1% was observed. Receiver operating characteristic (ROC) curve analysis revealed no significant difference in the association with 24-hour mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-hour mortality was similar between the lethal triad and the lethal diamond, with Cramer’s V values of 0.29 and 0.28, respectively.
Conclusions
This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-hour mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.
Challenges in the Diagnosis of Pelvic Fracture-Related Lower Urinary Tract Injury: A 13-Year Retrospective Analysis
Authors: Yang Yu-Kuan , Wang Ta-Ming , Cheng Chi-Tung , Tee Yu-San , Liao Chien-Hung , Hsieh Chi-Hsun , Fu Chih-Yuan
Published: December 2024

Introduction: Pelvic fractures from high-energy trauma are associated with lower urinary tract injuries (LUTI) in 10-15% of cases, leading to significant morbidity if not promptly diagnosed. Bladder and urethral injuries can result in infection, urinary obstruction, and long-term complications. However, diagnosing LUTI in hemodynamically unstable patients remains challenging, often requiring a combination of retrograde cystography, computed tomography (CT) cystography, and retrograde urethrography (RUG). This study reviews 13 years of clinical experience with pelvic fracture-related LUTI, focusing on the diagnostic role of CT imaging.
Materials and Methods: We retrospectively analyzed pelvic fracture cases with hematuria at a tertiary center from 2009 to 2021. All patients received abdominal and pelvic CT scans on admission. We recorded demographic data, injury characteristics, Injury Severity Score (ISS), diagnostic methods, and infection rates. Comparisons were made between patients with bladder and urethral injuries, and between patients with initial positive and negative CT findings of LUTI. Additionally, the clinical characteristics of delayed LUTI diagnosis in patients with severe trauma were summarized
Results: Of 2,865 patients with pelvic fractures, 127 (4.4%) were diagnosed with LUTI. The median age was 36 years, and 76% were male, with a median ISS of 26. Bladder injuries were present in 54% of LUTI cases, urethral injuries in 40%, and combined injuries in 6%. Diagnosis via CT was significantly higher for bladder injuries (58%) than urethral injuries (20%). Among those diagnosed with CT in the emergency department, infection rates and need for further urological imaging were lower. Thirteen patients (10%) had delayed diagnoses, primarily due to initial focus on life-saving interventions. No significant difference in outcomes was noted between early and delayed diagnoses.
Conclusion: CT imaging is valuable for the initial evaluation of pelvic fractures with suspected LUTI, reducing the need for invasive diagnostic studies and aiding early diagnosis. Delays in LUTI diagnosis did not significantly impact outcomes, especially when diagnosis was made within two weeks. Future studies should focus on refining guidelines for early diagnosis in emergency settings where comprehensive urological assessments may be limited.