bluuebunny/crossref_metadata_2025 huggingface dataset:
Bidirectional, longitudinal associations between depressive symptoms and IADL/ADL disability in older adults in China: a national cohort study
Authors: Zhu Xuequan , Wang Yanshang , Luo Yanan , Ding Ruoxi , Shi Zhenyu , Ping He
Published: April 2024

Introduction Based on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability.
Method Data were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves.
Results Data on 10092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10).
Discussion Study findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.
ADH4—a potential prognostic marker for hepatocellular carcinoma with possible immune-related implications
Authors: 李 玲 , Huang Yong-ta , Wang Li-ting , Wang Xiao-ling , Chen Zhen-yu , Jiang Shao-lan , Zeng Qiu-ling , Huang Hui-pin , Li Xiao-long
Published: April 2024

Objective
This study aims to explore ADH4 in hepatocellular carcinoma (HCC), its prognosis impact, and immune correlation for novel insights into HCC prognostication and treatment.
Methods
HCC prognostic marker genes were rigorously selected using GEO database, Lasso regression, GEPIA, Kaplan-Meier and pROC analyses. The interested markers (DNASE1L3, RDH16, ADH4, LCAT, HGFAC) in HCC and adjacent tissues were assessed by Immunohistochemistry (IHC). ADH4 expression were validated by symbol rank tests and unpaired Wilcoxon rank sum tests across pan-cancer and HCC datasets. Clinical significance and associations with clinicopathological variables were determined using Kaplan-Meier, logistic regression and Cox analyses on TCGA data. The ADH4 related immune responses were explored by Spearman correlation analysis using TIMER2 data. CD68, CD4, and CD19 protein levels were confirmed by IHC in HCC and non-cancerous tissues.
Results
ADH4 showed significant downregulation in various cancers, particularly in HCC. Immunohistochemistry analysis confirmed reduced ADH4 expression in HCC tissues compared to normal liver tissues. Moreover, ADH4 expression was associated with clinicopathological variables and served as an independent prognostic marker for HCC patients. Our nomograms based on ADH4 expression, tumor status, and T stage demonstrated its clinical prognostic significance. Additionally, ADH4 exhibited immunoregulatory functions in the HCC microenvironment, correlating with immune cell infiltration patterns. Furthermore, ADH4 expression inversely correlated with several immune checkpoint markers, suggesting its potential as a therapeutic target in HCC immunotherapy.
Conclusion
This study highlights the diagnostic, prognostic and immunomodulatory roles of ADH4 in HCC. ADH4 could serve as a valuable biomarker for HCC diagnosis and prognosis, as well as a potential target for immunotherapeutic interventions.
A Deep Learning Approach to Find Optimal Path in Underwater Networks Using ns3-ai
Authors: R Shruthi K , C Kavitha
Published: April 2024

Undersea communication has become increasingly common due to its varied applications including a collection of oceanographic information, environment monitoring, seismic and pollution monitoring, and many more [1]. The environment undersea is highly unstable due to its intermittent and noisy characteristics [1][2]. Therefore, the routing approach that comprehends the environment is the need of the hour. The reinforcement learning method is one such approach that performs action based on environmental conditions [3]. One of the machine learning methods called Reinforcement learning allows an agent to learn from the environment and behave accordingly. In this paper, the authors have used a deep learning approach, a class of reinforcement learning which uses neural networks to train agents. Ns3-ai framework provides the abstraction between the ns3 simulator and the ai framework [4]. Here, an underwater sensor network is simulated in ns3 and a deep-learning approach is used to train the agents. The connection between ns3 and the deep learning framework is established through ns3-ai. The deep learning framework trains the agents based on the data received from the ns3 simulator. The actions performed by the agents are transferred to ns3 simulator where the actual routing of the packets happens. The results are compared with Q learning algorithm. The deep learning approach outperforms Q learning in terms of delay and delivery time.
Characteristics of eye movements and correlation to cognitive functions in relation to the location of guide signs and driving speed
Authors: Maeyama Takaya , Okada Hiroki , Sawamura Daisuke
Published: April 2024

This study aimed to explore the relationship between eye movements and cognitive functions when recognizing destinations in guide signs using actual on-board videos and the effects of driving speed and location of guide signs on eye movements. Twenty-four participants were recruited. Attention and processing speed, verbal memory, visual memory, planning, and useful field of view (UFOV) were assessed as cognitive functions necessary for driving. Eye movements while recognizing the destination in guide signs (duration and number of fixations and amplitude and number of saccades) were measured using four conditions in on-board videos: slow/fast speed, front/left side. The results showed that cognitive functions correlated during in-front conditions at slow and fast speeds. At left-side guide signs, cognitive functions did not correlate, but correlated with age and driving experience. The results suggest that recognizing left-side guide signs required a higher skill, which depended more on the driver’s experience than on cognitive functions. In addition, of the four conditions, visual recognition of destinations in guide signs made more difficult with fast speeds and left-side locations. The increased load from left-side guide signs and faster speeds influenced eye movements. Thus, the location of the guide sign and the speed was shown to affect the difficulty in recognizing destinations within the guide signs.
A Novel Data Credibility-based Machine Learning Approach for UAV Capability Evaluation
Authors: Zhu Jun-Yi , Yu Chenhao , Chang Leilei , Cao You , Xu Xiaobin , Hao Zhiyong
Published: April 2024

The Unmanned Aerial Vehicle (UAV) has become more and more important in both civil use and military operations. The overall reconnaissance capability of the UAV swarm is often affected by multiple signals. A new approach is proposed by recognizing data credibility (DC) using multiple machine learning (ML) techniques, i.e., a novel DCML approach. There are two major components (and major theoretical contributions) of the proposed approach. The first component is the initial identification of less-credible data using a single ML technique. The second component is the cross-identification of less-credible data using multiple ML techniques based on the initial identification results. A practical case is studied for validating the proposed DRML approach. Case study results show that (1) The proposed approach in this paper demonstrates a proficient ability to identify less credible data, (2) The validation with various machine learning methods proves effective, but the efficacy of the method is not necessarily proportional to the quantity of methods employed, (3) The combination of BPNN and GPR yields the most favorable outcomes.
The seroprevalence of HBV infection and associated factors among pregnant women attending antenatal clinic (ANC) at Burao General Hospital (BGH).
Authors: Jama Ahmed Adan
Published: April 2024

Introduction:-
Hepatitis B virus disease is a potentially life-threatening liver infection and a major global health problem. Hepatitis B infection is associated with the risk of death arising from cirrhosis, liver and non-liver cancers, Transmission of Hepatitis B virus (HBV) results from exposure to contaminated blood or body fluids, unprotected sexual contact with an infected person, blood transfusion, use of contaminated needles, syringes, and sharps as well as vertical transmission from mother to child, there is risk of HBV transmission to the newborn delivered by a hepatitis B surface antigen (HBsAg)-positive woman. This risk is amplified with positivity of hepatitis B envelope antigen [1 ].
Methods
- The research was an institution based cross-sectional study, which involves the systemic collection and presentation of data to give a clear picture about the topic. This research used simple random sampling. This was probability sampling which involves choosing the nearest and the available person of research as a respondent, and systematic sampling for the lab results of the hepatitis B virus infection.
Findings
: In this study, the overall sero-prevalence of HBsAg was 3.9% (15/384), as documented from the reports of laboratory investigations, the socio-demographic characteristics of the participants, where majority of the age group participated in this study were between 26–35 years old, the educational level of the majority of participants were high school among other variables examined in this section
Conclusion
- In this study, the overall sero-prevalence of HBsAg was 3.9% (15/384), as documented from the reports of laboratory investigations, the socio-demographic characteristics of the participants, where majority of the age group participated in this study were between 26–35 years old, the educational level of the majority of participants were high school among other variables examined in this section According to the specific objective three the seroprevalence of HbsAg among pregnant women attending ANC at BGH, the total sero-prevalence of HBsAg in this research was 2.48 percent. Because many people may not have symptoms or are unaware they are sick, their disease is frequently undiagnosed and hence cannot be recorded or tallied, so this data only includes those who completed the test at Burao General Hospital.
Evaluating the quality of care for suspected placenta accreta spectrum referred to a regional PAS centre in Semarang, Indonesia
Authors: Cahyanti Ratnasari D , Wiyati Putri S , Dewantiningrum Julian , Pramono Besari A , Rinawati Rinawati , Nindrea Ricvan D , Ameh Charles
Published: April 2024

Background
In low middle income countries (LMICs), the increase in the rate of caesarean surgery, a main risk of placenta accreta spectrum (PAS), and limited resources to manage it. In Indonesia a PAS clinical guideline was developed, and disseminated, a regional PAS Centre was set up within a functional comprehensive emergency obstetric care (CEmOC) and the quality of care provided afterwards evaluated.
Study Design:
A retrospective cohort study design that included all suspected PAS cases referred in between January 2020 to December 2022, in Semarang, Indonesia. The study compared the quality of care provided for invasive and non-invasive cases. Differences in quality of care in each outcome group was explored at different shifts and periods of the day, public holidays or weekends and weekdays. The quality of 24/7 care based on maternal outcome, timeliness of emergency care, and adherence to national PAS management guidelines was evaluated.
Results
Ninety-nine of the 154 (64.28%) referral patients with suspected PAS were in the invasion group. Of these, 81 (81.8%) were diagnosed prenatally and confirmed at surgery or histopathology. The quality of care was similar between women with and without invasion regardless of time intervention. The multidisciplinary team and blood unit availability were found to be the key performance of adherence to the standard process.. The decision to delivery interval (DDI) of ≤ 30 minutes was the most important missing element in the timeliness of emergency care, with median (IQR) 57.50 (30–120) minutes on weekdays and 43.00 (20–66) minutes on public holidays and weekends in the invasion group. Nevertheless, in emergency cases, the access to ICU and time to transfusion in invasion group was adequate. A reduction in case fatality rate (CFR) of PAS was observed from 4.0% (2020) to 3.03% (2022).
Conclusions
The findings suggest that the regional PAS centre is functioning optimally according to national PAS guidelines, with no difference in the quality of care provided to all referred suspected PAS cases irrespective of the degree of placental invasion, the time of the day or period of the week.
Evaluation of Conventional Blades Versus Diode Laser Incisions on Postoperative Sequelae and Healing After Extraction of the Mandibular Third Molar.
Authors: SAINI DEEPIKA , GUPTA D.S. , DONEPURI NANDAKISHORE , CHAUDHARY NAKUL , BIJARNIYA POOJA , JAIN AASHITA
Published: April 2024

BACKGROUND
Postoperative morbidity heightens patients' apprehension towards the surgical extraction of the mandibular third molar. Various innovative strategies like lasers have been created to reduce these negative effects and there is limited research comparing the effectiveness and wound healing between laser and conventional methods of incision.
PURPOSE
To evaluate the conventional scalpel versus diode laser incisions on postoperative sequelae and healing after extraction of mandibular third molar surgery.
STUDY DESIGN
A prospective, randomized and comparative study was conducted in the outpatient clinic. A total no. of 36 patients, 18 in scalpel group (group A) and 18 in Laser group (group B) among individuals of a specific age range of 18 to 40 years requiring extraction of impacted mandibular third molar which were within the Pederson difficulty index range of 3 to 7 and free from any infection.
INDEPENDENT VARIABLE
Type of incision (conventional blade or diode laser); Patient demographics (gender);
MAIN OUTCOME VARIABLE
Post-operative swelling, pain, trismus and wound healing was evaluated on 1st , 3rd and 7th day.
COVARIATES
Preoperative pain level; Preoperative facial swelling, Surgical accessibility and Intraoperative precision.
ANALYSES
The intergroup comparison between the two groups was done using Independent t test with p < 0.05
RESULTS
36 outpatients (44.4% males and 55.6% females), 18 in each group, among individuals of a specific age range of 18 to 40 years were included in this study. Compared to scalpel incision, laser incision was associated with statistically lower pain scores on 3rd post operative day (p=0.001)and edema on postoperative days 3rd (p=0.023) and 7th (p=0.028). Mouth opening was statistically non - significant by postoperative. Scalpel incisions had shown better healing in 3rd and 7th postoperative days when compared with laser incisions (p = 0.001).
CONCLUSION
Our data indicate that utilizing laser incisions on impacted mandibular third molars has a beneficial impact on postoperative problems such as pain, edema, and trismus.The laser incision offered excellent accessibility and visibility to the operative site. The only disadvantage of the diode laser was delayed wound healing. The healing was faster and excellent after being incised with a conventional scalpel.
Genotypic and Phenotypic Analysis of Korean Patients with Tuberous Sclerosis
Authors: Shin Hui Jin , Lee Sangbo , Kim Se Hee , Lee Joon Soo , Oh Ji Young , Ko Ara , Kang Hoon-Chul
Published: April 2024

Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder caused by mutations in the TSC1 or TSC2 gene. The aim of this study was to analyze the genotypes and phenotypes of Korean patients diagnosed with TSC and expand our understanding of this disorder. This retrospective observational study included 331 patients clinically diagnosed with TSC between November 1990 and April 2023 at Severance Children’s Hospital, Seoul, South Korea. The demographic and clinical characteristics of the patients were investigated. Twenty-five novel variants were identified. Of the 331 patients, 188 underwent genetic testing, and genotype-phenotype variation was analyzed according to the type of gene mutation and functional domain. Fifty-one patients (51/188, 27%) were had TSC1 mutations, 109 (58%) had TSC2 mutations, and 28 (8.5%) had no mutation identified (NMI). Hotspots were identified in exons 15 and 18 of TSC1 and exons 34, 35, and 41 of TSC2. Patients with TSC2 mutations exhibited a significantly younger age at the time of seizure onset and had refractory epilepsy. Infantile epileptic spasms syndrome (IESS) was more common in the middle mutation domain of TSC2 than in the hamartin domain (p = 0.047). Additionally, retinal hamartoma, cardiac rhabdomyoma, and renal abnormalities were significantly associated with TSC2 compared with other gene types. This study contributes to our understanding of TSC by expanding the genotypic spectrum with novel variants and providing insights into the clinical spectrum of patients with TSC in Korea.
Evaluation of Tobacco heating system (THS) during closed lower limb fracture healing in trauma smokers’ patients
Authors: Herbst Moritz , Aspera-Werz Romina H. , Braun Benedikt , Schulz Kevin , Rollmann Mika F. , Histing Tina , Nüssler Andreas
Published: April 2024

Background
Since 1976, it's been recognized that increased cigarette consumption correlates with decreased bone density, hindering fracture healing and leading to prolonged hospitalization. Although prior research has shown the relatively less harmful effects of electronic nicotine delivery systems (ENDS) on bone cells in lab settings and animal models, clinical evidence regarding their impact on fracture healing remains scarce. This study aims to investigate whether switching to a tobacco heating system (THS) post-orthopedic surgery improves outcomes for smoking patients during tibia or femur fracture healing over a 6-month period.
Methods
The study is a prospective, open-label, non-parallel, single-center trial involving 150 patients from a Level 1 Trauma center, Germany, diagnosed and treated for closed tibia, closed femur shaft, or closed distal femur fractures (according to AO/OTA: 41A2-41C3, 42A-C, 43A-C, 32A-C, 33A2-3, 33B-C). Participants will be categorized into three groups based on smoking behavior: smokers (no intervention), THS (participants switching from cigarettes to THS), and ex-smokers (participants abstaining from cigarettes or ENDS during the study). Clinical, radiological, and laboratory data will be collected during preoperative and postoperative assessments at 6, 12, 18, and 24 weeks. The primary outcome will be the serum concentration of N-terminal propeptide procollagen type 1, a bone formation marker. Secondary outcomes include bone metabolism, healing, immunological, blood count, and clinical parameters. Approval for the study protocol and consent declarations was obtained from the ethics committee of the medical faculty of Eberhard Karls University (724/2022BO1).
Discussion
The study results will provide evidence that switching to THS previous orthopedic intervention improves clinical outcomes during closed tibia or femur fracture healing in smokers’ patients due to reduced bone resorption rate consequent to the diminished activity of cigarette smoke-activated osteoclast.
Trial registration:
The study is registered on ClinicalTrials.gov (NCT05859451).
Expression Level of Autoimmune Regulator In B Cells Correlates With Residual Islet β Cell Function In Type 1 Diabetes Mellitus
Authors: Li Weixia , Liu Yuting , Liu Shangming , Zhang Aixia , Jiang Pengjun , Fang Chen , Xie Dongmei , Wang Xin
Published: April 2024

Background
Autoimmune modulators (Aire) mediate immune tolerance by inducing expression of tissue-restricted antigen (TRA) in thymic medullary epithelial cells. However, the function of Aire in peripheral B cells remains unknown. We aimed to investigate whether Aire is expressed in human peripheral B cells and how its expression is regulated.
Methods
Human thymus tissues were collected and firstly, islet-specific autoantibodies and insulinogen c-peptide were determined by luciferase immunoprecipitation (LIPS). Secondly, Aire expression in peripheral blood lymphocytes was identified by flow cytometry, Western Blot and immunofluorescent staining. Then, immunofluorescent staining was performed on cells cultured in vitro and surgically resected tissues. Meanwhile, Aire promoter methylation. Finally, insulinogen expression was quantified by reverse transcription qPCR and IF staining. Data were compared by Mann-Whitney U test between groups.
Results
Aire was expressed in CD19+ B cells but not in CD3+ cells, and the expression of Aire in B cells was much lower than that in thymus. Induction of Aire expression under BCR activation in B cells. The level of Aire expression in peripheral B cells of patients with T1D and healthy subjects showed no difference in Aire expression level between the two groups.
Conclusions
Aire expression in peripheral B cells may play a role in peripheral immune tolerance and protection of islet β-cell function in T1D patients.
Angiotensin II type-1 receptor autoantibodies and effects in neonates of preeclamptic women.
Authors: PONTHIER Laure , HAMEL Chahrazed EL , MAZEAU Perrine COSTE , MARTINEZ Sophie , WEHBE Sarah , FROGET Rachel , YARDIN Catherine , GUIGONIS Vincent
Published: April 2024

Background
Maternal agonistic autoantibodies against the angiotensin II type 1 receptor (AT1-AAs) have been implicated in the pathophysiology of preeclampsia, but their presence in their offsprings and their possible neonatal effects have not been specifically explored. This prospective study aimed to evaluate the presence of AT1-AAs and their potential clinical effects in neonates of AT1-AAs positive mothers.
Methods
Preeclamptic women and their neonates were included. Blood samples were collected in order to search for AT1-AAs.
Results
AT1-AA determination was positive in 35 out of 64 of the studied women (54.7%). Thirty one newborns from the group of AT1-AA positive women were included and 22 (71%) were AT1-AA positive. The mothers’ and children’s AT1-AAs titers were significantly correlated. The 33 newborns from the group of AT1-AA negative women were all negative for AT1-AAs. Regarding the clinical data of newborns (birth weight, percentile of weight, gestational age, Apgar score at five minutes, mechanical or noninvasive ventilation), no significant difference was observed between the children with or without detected AT1-AAs.
Conclusion
Even though AT1-AAs are detected in newborns of positive mothers during the first days of life, no specific clinical signs seem to be associated with the presence of these antibodies.
Revolutionizing Bedridden Pain Management: Harnessing Audio Guidance for TENS Therapy via Robotic Arm Assistance
Authors: Kumar Y. Rakesh , Meka Tanusha , Kara Hema Sreyalahari , Nooka Pallavi
Published: April 2024

This project details the creation of the Audio-Guided Robotic Arm (AGRA) system, a novel solution that aims to revolutionize pain relief treatments using Transcutaneous Electrical Nerve Stimulation (TENS) therapy. AGRA is based on the novel concept of using audio input to autonomously localize specific body parts, precisely applying vibration pads, and autonomously operating the TENS machine without human intervention, thereby improving pain management in a variety of medical and therapeutic contexts. Its components include a sophisticated audio recognition module, a precise robotic arm, relays, and an easy-to-use interface. AGRA is a promising step toward personalized and efficient pain management across multiple healthcare domains, benefiting both patients and healthcare professionals. AGRA has potential in postsurgical recovery, physical therapy, sports injury rehabilitation, and pain management in palliative care settings. By offering non-invasive, automated precision, it enhances patient comfort while easing the healthcare provider's workload.
Association analysis between an epigenetic alcohol risk score and blood pressure
Authors: Bui Helena , Keshawarz Amena , Wang Mengyao , Lee Mikyeong , Ratliff Scott M. , Lin Lisha , Birditt Kira S. , Faul Jessica D. , Peters Annette , Gieger Christian , Delerue Thomas , Kardia Sharon L. R. , Zhao Wei , Guo Xiuqing , Yao Jie , Rotter Jerome I. , Li Yi , Liu Xue , Liu Dan , Tavares Juliana F. , Pehlivan Gökhan , Breteler Monique M.B. , Karabegovic Irma , Ochoa-Rosales Carolina , Voortman Trudy , Ghanbari Mohsen , Meurs Joyce B.J. van , Nasr Mohamed Kamal , Dörr Marcus , Grabe Hans J. , London Stephanie J. , Teumer Alexander , Waldenberger Melanie , Weir David R. , Smith Jennifer A. , Levy Daniel , Ma Jiantao , Liu Chunyu
Published: April 2024

Background
Epigenome-wide association studies have revealed multiple DNA methylation sites (CpGs) associated with alcohol consumption, an important lifestyle risk factor for cardiovascular diseases.
Results
We generated an alcohol consumption epigenetic risk score (ERS) based on previously reported 144 alcohol-associated CpGs and examined the association of the ERS with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension (HTN) in 3,898 Framingham Heart Study (FHS) participants. We found an association of alcohol intake with the ERS in the meta-analysis with 0.09 units higher ERS per drink consumed per day (p < 0.0001). Cross-sectional analyses in FHS revealed that a one-unit increment of the ERS was associated with 1.93 mm Hg higher SBP (p = 4.64E-07), 0.68 mm Hg higher DBP (p = 0.006), and an odds ratio of 1.78 for HTN (p < 2E-16). Meta-analysis of the cross-sectional association of the ERS with BP traits in eight independent external cohorts (n = 11,544) showed similar relationships with blood pressure levels, i.e., a one-unit increase in ERS was associated with 0.74 (p = 0.002) and 0.50 (p = 0.0006) mm Hg higher SBP and DBP, but could not confirm the association with hypertension. Longitudinal analyses in FHS (n = 3,260) and five independent external cohorts (n = 4,021) showed that the baseline ERS was not associated with a change in blood pressure over time or with incident HTN.
Conclusions
Our findings provide proof-of-concept that utilizing an ERS is a useful approach to capture the recent health consequences of lifestyle behaviors such as alcohol consumption.
Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis
Authors: Delgado-Ron Jorge Andres , Tiwana Muhammad Haaris , Murage Alice , Morgan Rosemary , Purewal Simran , Smith Julia
Published: April 2024

Background This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences.Methods Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees.Results Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities.Conclusion Targeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.
Violence Against Women Before and During the Covid-19 Pandemic: A Study of Reports From the Forensic Medical Institute of Curitiba/PR, Brazil
Authors: Joly Ádelin Olívia Lopes , Zvir Elisa Cristina , Moreira Emanuélle Branco , Silva Rhafaela Ribeiro , de Paula Isabela Cristina Santos Freire , Xavier Thaís Aparecida , Ignácio Sérgio Aparecido , Gabardo Marilisa Carneiro Leão , Alanis Luciana Reis Azevedo , Moysés Samuel Jorge , Werneck Renata Iani , Orsi Juliana Schaia Rocha
Published: April 2024

Objective
To analyze the epidemiological profile of women who suffered bodily violence before and during the COVID-19 pandemic, from reports of corpus delicti performed at the Forensic Medical Institute - Instituto Médico Legal (IML), Curitiba/PR, Brazil.
Materials and Methods
This study has a retrospective cross-sectional design, through secondary data analysis, of cases of injuries caused by bodily violence against women between 2019 and 2021 contained in IML reports. Only records of bodily injury examinations performed on women were eligible for the study. Reports that did not allow the identification of the victim's gender, as well as those referring to other bodily injuries that did not involve aggression, were excluded. The data were collected through an electronic form. The variables analyzed were age, ethnicity, marital status, gender, and relationship to the aggressor. To verify the association between the outcome (year when the report was issued) and independent variables, a bivariate analysis was performed using the Chi-square test. To verify the differences between proportions of significant variables, the z-test was used with values adjusted by the Bonferroni method. Variables with p values ≤ 0.05 were considered significant. Statistical analyses were performed using SPSS version 25.0 software.
Results
5033 reports of bodily injury against women were included in the study. In 2020, a greater proportion of personal injury examinations were observed in white women compared to 2019 and 2021 (p < 0.001). Single women were the most vulnerable to physical violence in 2020 and 2021 (p < 0.001). During those same years, assault by men, partners or former partners and by family members was more prevalent than in 2019 (p < 0.001). The Women's Police Station was the most sought-after place to report cases.
Conclusion
During the pandemic, single women, assaulted by men, who were a partner, ex-partner or family member, sought IML services more, when compared to the period before the pandemic.
A rare case of infiltrative optic neuropathy caused by vitreoretinal lymphoma with intraretinal and subretinal pigmented epithelial hyperreflective deposits prior to the disease onset
Authors: Kuji Takako , Komoto Shimpei , Maruyama Kazuichi , Fujimoto Satoko , Fujino Takahiro , Kitaguchi Yoshiyuki , Shimojo Hiroshi , Morimoto Takeshi , Nishida Kohji
Published: April 2024

Background
To describe a rare case of infiltrative optic neuropathy caused by vitreoretinal lymphoma (VRL) with intraretinal and subretinal pigmented epithelial (RPE) hyperreflective deposits before the disease onset.
Case presentation:
We presented an 87-year-old Japanese female. At 5 months before onset, she noticed a decline of her right visual acuity, and she visited ophthalmology clinic because her visual acuity was progressively deteriorated to counting finger. In clinic, uveitis complicated with vitreous opacification (VO) was revealed, and subcapsular triamcinolone acetonide was injected for treatment. Although her visual acuity and VO were improved after treatment, she was referred to Osaka University Hospital for detailed examination. Her right visual acuity was 20/50. Intraocular inflammation and VO were not detected. There were yellowish-white deposits likes hard drusen in her right macula, and optical coherence tomography (OCT) showed intraretinal and sub-RPE hyperreflective deposits in the same area. One month later, she visited to our hospital with acute visual exacerbation. Her right visual acuity was hand motion. Optic disc swelling with disc hemorrhage was shown in the right eye. There was neither VO nor intraocular inflammation at this time, and a magnetic resonance imaging (MRI) of the head without enhancement did not show hyperintensity and swelling of the optic nerve as well as intracranial lesions. One week later, VO occurred and we performed 25-gauge vitrectomy for vitreous collection. Finally, after consideration of all the clinical examinations, a diagnosis was made of infiltrative optic nerve neuropathy with vitreoretinal B-cell lymphoma. Intraocular injection of methotrexate was administered a total of 6 times. At the time of the last visit (6 months after surgery), VO and optic disc swelling had disappeared. Careful observation was continued, but no recurrent findings including MRI was observed, and visual acuity in the right eye improved to 20/50.
Conclusions
Although there were reports on VRL advanced from intraretinal or sub-RPE hyperreflective deposits, there have been no studies that these OCT findings has progressed to infiltrative optic nerve neuropathy with VRL. When differentiating optic neuropathy, OCT may assist in the diagnosis by evaluating intraretinal and sub-RPE findings.
Retrospective analysis of neonatal hydrocephalus over the past 12 years
Authors: Huang Chunling , Liu Yunfeng , Han Tongyan
Published: April 2024

Background
Neonatal hydrocephalus is a serious neurological disease, however, with the progress of medical technology, and the increasing survival rate of extremely premature infants, its incidence rate, etiology and diagnosis and treatment have also undergone great changes. In this study, we aimed to summarize the above clinical changes of neonatal hydrocephalus at our hospital over the past 12 years to provide a reference for clinical practice.
Methods
The medical records of infants with neonatal hydrocephalus admitted to the neonatal unit of Peking University Third Hospital from January 1, 2010, to December 31, 2021, were retrospectively examined. For comparative analysis, the infants were divided according to the time of admission into a group for the first 6 years and one for the latter 6 years. We compared the gestational age, birth weight, etiology, treatment, and prognosis of two groups.
Results
Sixty-two patients (28 in the first 6 years; 34 in the latter 6 years) were diagnosed with neonatal hydrocephalus. Their gestational ages ranged from 25 to 39+ 6 weeks (median, 30 weeks), and their birth weights ranged from 600 to 4046 g (median, 1255 g). The gestational age and birth weight were significantly lower in the latter 6-year group than in the first 6-year group. There was a significant increase in severe periventricular–intraventricular hemorrhage in infants and cerebral parenchymal hemorrhage in the latter 6-year group. In terms of surgical treatment, there are more applications of Venturar Access Device(VADs)in the latter 6-year group. Twenty-one infants (35%) died after treatment withdrawal. Of the surviving infants, 22 had normal development, and 19 had developmental delay.
Conclusion
Gestational age and birth weight were significantly lower in the latter 6-year group than in the first 6-year group, and there was a significant increase in severe intracranial hemorrhage and cerebral parenchymal hemorrhage in this group.
Metabolic landscape of clear cell renal cell carcinoma and search for metabolites predictive of drug response
Authors: Ozawa Michinobu , Naito Sei , Makinoshima Hideki , Ito Hiromi , Tsuya Atsushi , Narisawa Takafumi , Fukuhara Hiroki , Takai Yuki , Ushijima Masaki , Yagi Mayu , Nishida Hayato , Tsuchiya Norihiko
Published: April 2024

Background.
Clear cell renal cell carcinoma (ccRCC) commonly exhibits biallelic inactivation of VHL genes, profoundly impacting intracellular metabolic pathways and utilization of metabolic substrates. The aims of this study were to validate the metabolomic profile previously identified in ccRCC surgical specimens, to construct a metabolic classification in ccRCC, and to exploratorily investigate metabolic biomarkers of systemic therapy response.
Materials and Methods.
We first examined the metabolome in 52 paired tumor/normal surgical ccRCC samples, and then compared the metabolites using paired t-test. Unsupervised clustering analysis was done, and the patients were divided into four subgroups. Then tumor grade was compared among the four groups. Finally, to compare the metabolome according to the effect of systemic therapy, we analyzed 9, 11, 6 patients with vascular endothelial growth factor-tyrosine kinase inhibitor (VEGF-TKI), immune checkpoint blockade (ICB), and nivolumab plus ipilimumab (NI), respectively.
Results.
The upper stream of glycolysis and the pentose phosphate pathway were commonly activated, along with elevated glutamine levels and reduced proteinogenic amino acids (AAs) other than glutamine in ccRCC tissues, consistent with prior findings. Lactate levels, previously reported as elevated, varied across metabolic subgroup, with higher lactate levels associated with higher tumor grades. VEGF-TKI responders exhibited low levels of fatty acids. ICB responders showed reduced levels of AAs, including glutamine. NI responders displayed lower glutamine levels and elevated endoplasmic reticulum stress markers glucose-6-phosphate and mannose-6-phosphate.
Conclusions.
We validated the landscape of the ccRCC metabolome. Moreover, we identified low glutamine level in the primary cancer tissues is a candidate of biomarkers for ICB responders.
Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source
Authors: Bae Jae-Han , Ryu Jae-Chan , Ha Sang Hee , Cho Min Soo , Cha Myung-Jin , Chang Jun Young , Kang Dong-Wha , Kwon Sun U , Kim Jong S. , Kim Bum Joon
Published: April 2024

Background
Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up.
Methods
Patients with acute ischemic stroke classified as ESUS were included. All patients underwent transthoracic echocardiography and Holter to detect the source of embolism. Structural, electrophysiological markers of left atrial cardiopathy (i.e., left atrial enlargement [LAE], non-sustained tachycardia [NSAT]) as well as lesion patterns of ischemic stroke were examined. Implantable loop recorder (ILR) was implanted in selective patients. Sensitivity and positive predictive value analysis was used to assess the predictive value for AF detection.
Results
Among 312 patients with ESUS, AF was detected in 24 (7.7%) patients during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, and the imaging pattern of confluent plus additional lesions in a single vascular territory. Multivariable analysis showed that ILR implantation (hazards ratio 11.497 [95% confidence interval 3.795–34.818]), LAE (3.204 [1.096–9.370]), NSAT (4.070 [1.378–12.018]), and confluent plus additional lesions (4.977 [1.649–15.019]) were independent predictors of AF detection. The sensitivity of detecting AF in those with LAE, NSAT, or confluent plus additional lesions pattern was 91.7%. The positive predictive value of detecting AF in those with LAE, NSAT and confluent plus additional lesions pattern was 40.0%.
Conclusion
In conclusion, patients with LAE, NSAT, or confluent plus additional lesions may benefit from ILR monitoring detecting new AF.
Identification of Alcoholic Hepatitis-related and Mesenchymal Stem Cell Therapy Target Genes
Authors: Han Seul Ki , Lee Taesic , Lim Jisun , Kim Hyunsoo , Uh Young , Kim Moon Young
Published: April 2024

Background
Alcoholic hepatitis (AH) is a widespread and life-threatening chronic liver condition that poses a risk of short-term mortality if not properly managed. Clinicians often encounter challenges due to insufficient knowledge about the underlying mechanisms of AH. This study employs a meta-analysis to identify the molecular mechanisms and potential cell therapy targets for AH.
Methods
We collected four gene expression datasets, three from liver tissues and one from blood tissues, to identify genes associated with AH. Two liver datasets that had data on deaths after steroid treatment in patients with alcoholic hepatitis were also examined to uncover signatures associated with poor prognosis. Additionally, we curated three cohorts, including a mesenchymal stem cell (MSC) intervention group, to identify genes responsive to stem cell interventions. Candidate genes were selected using the inverse weighted variance-based method implemented in the METAL software. We utilized prior knowledge to narrow down potential upstream genes, including a transcription factor (TF) catalog, protein-protein interaction (PPI) networks, disease-gene association databases, and summary statistics for single nucleotide polymorphisms (SNP) linked to disease and expression.
Results
Through four stepwise meta-analyses of nine gene expression datasets, we identified genes targeted by MSC therapy. In detail, the first, second, third, and fourth steps of meta-analysis provided the liver-specific, liver-blood, severe-mortality, and MSC-Tx meta genes linked to AH condition, respectively. Multiple lines of evidence (TF, PPI, and SNP databases) were used to identify 47 AH-related upstream genes.
Conclusions
This study presented critical genes involved in the progression of AH and the therapeutic effects of MSC through meta-analysis. Utilizing these genes, we can confirm genetic changes induced by stem cell treatment, providing a foundation for targeted cell or function-enhanced genetic therapies.
Differential Biochemical Response of Wheat Genotypes Under Temperature Stress
Authors: Ravindra Satbhai , Swati Bharad , Mangesh Moharil , Ravindra Satbhai
Published: April 2024

Background
Changes under temperature induction response has been shown as a potential tool for empirical assessment for plant cell tolerance. By this technique, thermotolerant lines were identified from crop wheat, which showed better performance than the original population under high temperature. The present investigation ten days old seedlings of six wheat genotypes released by DR. PDKV, Akola ,Maharashtra, India viz., PDKV Sardar, AKAW-381, PDKV-Washim, AKAW-3722, WSM-109-4, AKAW-4627 compared with Raj-4083 (National check) by exposing to gradual increase of high temperature and duration (control 25°C to 30°C 1 hr, 34°C 1 hr, 38°C 2 hr and 42°C 3 hr) in order to investigate its effect on some physiological and biochemical parameters to provide the basic information to wheat breeder for improvement targeted to heat tolerant cultivar.
Results
Increase of temperature induced the proline accumulation in all genotypes till a temperature threshold 34°C 1 hr (it depended on genotype), while above the proline content declined. However, the level was dropped at 38°C 2 hr PDKV-washim, AKAW-3722 and PDKV Sardar and 42°C 3 hr in all seven wheat genotypes. The relative leaf water content (RLWC), chlorophyll ‘b’ content significantly declined with steady increase in hydrogen peroxide (H2O2) content. High temperature and duration of exposure induces the activity of Superoxide dismutase (SOD), Ascorbate peroxidase (APX) and peroxidase enzymes. However, it was observed that, at lethal temperature stress (42°C 3 hr) levels majority of biochemical parameters studied in this experiment found to be declined.
Conclusion
In our investigation, a positive association between rising temperatures, H2O2 levels and SOD, APX and peroxidase levels in all wheat genotypes was found. The fact that AKAW-4627 maintains greater RLWC and Chlorophyll a and b content as well as other biochemical parameters may be contributing to their minor rise in H2O2 content. A steady rise in high temperature with duration of their exposure an increase in the activity of superoxide dismutase, APX and peroxidase and carotenoids were observed. Among the seven-wheat genotype pre-released WSM-109-04 and AKAW4627 and PDKV Sardar genotypes followed by AKAW-381 showed better adaptability at higher temperature stress when compared with national check Raj-4083. The information generated on biochemical basis is useful for wheat breeder for further improvement in wheat for thermotolerance.
Novel genetic loci and functional properties of immune-related genes for colorectal cancer survival in Korea
Authors: Yun Dabin , Yang Jung-Ho , Yang Soyoun , Sim Jin-ah , Kim Minjung , Park Ji Won , Jeong Seung Yong , Shin Aesun , Kweon Sun-Seog , Song Nan
Published: April 2024

One major topic in colorectal cancer (CRC) research is the role of immune cells against cancer cells. The association of single-nucleotide polymorphisms (SNPs) and polygenic risk scores (PRS) with CRC was examined and their functional properties were identified using a gene-gene interaction network. 960 CRC patients at Seoul National University Hospital (SNUH, discovery) and 6,627 CRC patients at Chonnam National University Hospital (CNNUH, replication) were enrolled. SNPs were genotyped using the Korean Biobank Array. 2,729 immune-related genes were selected from the Ensembl, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes, and 37,398 SNPs were mapped. PRS were categorized into tertiles. Cox proportional hazard models were fitted for overall survival (OS) and progression-free survival (PFS). A gene-gene interaction network was analyzed.
Among CRC patients from SNUH, 154 (16.0%) died, while 245 (25.5%) had progression. In CNNUH, 3,537 (53.4%) died. For OS, the most significant association was observed for rs117322760 (8q23.1, PKHD1L1, hazard ratio (HR) = 4.58, p-value = 1.40 × 10-6). For PFS, it was observed in rs143531681 (7q36.1, NOS3, HR = 4.67, p-value = 9.72 × 10-8). For PRS, the highest tertile group showed an increased risk for OS (HR = 59.58, p-value = 9.20 × 10-48) and PFS (HR = 9.81, p-value = 1.69 × 10-23). Significant interactions were observed between PIK3R2 and PIK3CA for OS and ALOX5 and COTL1 for PFS. This study presented novel genetic variants associated with OS and PFS in CRC patients, and notable findings from the analysis of PRS and the gene-gene interaction.