bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Local Cannabis Policy and Retail Availability With Cannabis Use and Problematic Cannabis Use Among Adolescents in Northern California
Authors: Young-Wolff Kelly C. , Asera Alex , Padon Alisa A. , Slama Natalie E. , Alexeeff Stacey E. , Pacula Rosalie L. , Campbell Cynthia I. , Sterling Stacy A. , Satre Derek D. , Lu Yun , Dyer Wendy T. , Does Monique B. , Silver Lynn D.
Published: October 2024

Objectives. To examine whether local cannabis policies and retail availability are associated with cannabis use and problematic cannabis use (PCU) among adolescents in Northern California.

Methods. The sample comprised adolescents aged 13 to 17 years screened for past-year cannabis use during well-child visits in 2021. Exposures included local bans on cannabis storefront retailers, policy protectiveness, and retail proximity and density. Outcomes included self-reported past-year cannabis use and PCU diagnoses. Modified Poisson regression models adjusted for sociodemographics.

Results. The sample (n = 103 134) was 51.1% male with a median age of 15 years (interquartile range [IQR] = 14–16 years); 5.5% self-reported cannabis use, and 0.3% had diagnosed PCU. Adolescents had a lower prevalence of cannabis use in jurisdictions that banned storefront retailers (adjusted prevalence rate [APR] = 0.857; 95% confidence interval [CI] = 0.814, 0.903 vs allowed), banned delivery (APR = 0.751; 95% CI = 0.710, 0.795 vs allowed), or had more policy protections (APR range = 0.705–0.800). Lower PCU prevalence was also found among those in jurisdictions that banned (vs allowed) storefront retailers (APR = 0.786; 95% CI = 0.629, 0.983) or delivery (APR = 0.783; 95% CI = 0.616, 0.996). Longer drive time and lower density of storefront retailers were associated with a lower cannabis use prevalence.

Conclusions. More protective cannabis policies and less retail availability were associated with a lower prevalence of adolescent cannabis use and PCU. ( Am J Public Health. 2024;114(S8):S654–S663. https://doi.org/10.2105/AJPH.2024.307787 )
Corticosteroid Effects on Upper Esophageal Sphincter Function in Anterior Cervical Discectomy and Fusion
Authors: Lai Chih-Jun , Chen Jo-Yu , Jhuang Jing-Rong , Hsiao Ming-Yen , Wang Tyng-Guey , Yeh Yu-Chang , Lai Dar-Ming , Tsuang Fon-Yih
Published: October 2024

Background:

The aim of our study was to explore the effect of local corticosteroids on dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). To address a gap in the limited research on this topic, we utilized high-resolution impedance manometry (HRIM) and the Eating Assessment Tool-10 (EAT-10) questionnaire to assess the effects on key swallowing muscles, including the upper esophageal sphincter (UES).

Methods:

We randomly assigned patients undergoing ACDF to either the corticosteroid group or the saline solution group. Patients received 10 mg of local triamcinolone or saline solution prevertebrally at the cervical spine level before wound closure. Swallowing function preoperatively and at 1 month postoperatively were compared between the groups with use of HRIM parameters (e.g., UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contraction) and EAT-10 scores. Patients were also followed for postoperative complications and mortality within 12 months after surgery.

Results:

Thirty patients completed the study. The median age was 55 years in the corticosteroid group and 57 years in the saline group, and each group had 8 female patients. All participants were Taiwanese. We found no significant difference in median preoperative UES relaxation pressure between the corticosteroid and saline solution groups (33.8 and 31.3 mm Hg, respectively; p = 0.54). Postoperatively, the corticosteroid group had significantly lower median UES relaxation pressure than the saline solution group (24.5 versus 33.6 mm Hg; p = 0.01). Before and after surgery, all other HRIM parameters and EAT-10 scores were similar between the groups, with the corticosteroid group demonstrating median pre- and postoperative EAT-10 scores of 0 and 4, respectively, and the saline solution group demonstrating scores of 2 and 3, respectively. There were no adverse events.

Conclusions:

The findings suggest that local corticosteroids may reduce UES relaxation pressure at 1 month after ACDF, potentially enhancing UES opening. Further research is required to verify our findings.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Interrelation of Spiritualism and Materialism of Madrasah Teachers
Authors: Susmiyati Sri , Zurqoni Zurqoni , Saugi Wildan , Dewi Lharasati , Abdillah Muhamad Hasan
Published: October 2024

While materialism is strongly spreading in society, one of which is in the educational environment, madrasah teachers are supposed to have high spiritualism to be able to control it. This research aims to analyze the interrelation of spiritualism and materialism of madrasah teachers in East Kalimantan. The research used a quantitative-correlative approach with 1604 madrasah teachers in East Kalimantan as the research population. The selected sample, 241 State Madrasah Aliyah teachers, was taken using a purposive sampling technique. Data was collected using a questionnaire instrument, which was then analyzed using linear regression correlation analysis techniques. The research results show that there is a very significant relationship between spiritualism and materialism of madrasah teachers. The higher the teacher's spiritualism, the lower the materialism, conversely the lower the spiritualism, the higher the teacher's materialism. This research has implications for the importance of building the spiritualism of madrasah teachers so that they are not easily influenced by the strong materialism in the current era.
Suitability assessment of planned landfill site selection using GIS and the Analytic Hierarchy Process (AHP) approach in Boditi city, southern Ethiopia
Authors: Balta Mathewos Muke , Gamo Kataro Galasso
Published: October 2024

Deciding the location of facility sites in an area with partial planning and a highly growing city is challenging for decision-making. It is even more difficult when assessing suitable site choice for solid waste. This study used geospatial data to assess suitable landfill site locations hoping to create a neat city using geospatial data for Boditi city, southern Ethiopia. Geographic information systems (GIS) and a multicriteria approach were used with other criteria to help select suitable locations. Biased comparisons and weighted scoring methods were used to evaluate the ten criteria used by the city to decide which site was suitable. The locations are sorted into four groups, stretching from highly suitable to unsuitable, using suitability mapping. Overall, of the 3,040 ha, 138.7 ha (4.56%) was considered highly suitable, while 2414 ha (79.41%) was considered moderately suitable for landfill sites. In addition, 476.21 ha (15.66%) was identified as less suitable, leaving the remaining 11.09 ha (0.37%) considered unsuitable. The study selected the best landfill site in terms of accessibility, topography, and compensation cost, in addition to ten criteria that will help minimize the risk of adverse impacts on life, land, water, and air environments associated with waste disposal.
Embracing Innovation in Education: Investigating the Use and Impact of Artificial Intelligent Assistants Among Preservice Teachers
Authors: Zaugg Tiffanie
Published: October 2024

The study investigates the potential of Artificial Intelligence (AI) assistants in reducing administrative burdens on public school teachers in the United States, where approximately $1.04 billion annually is allocated for teachers to perform non-teaching tasks. As AI technologies advance, their integration into educational settings presents an opportunity to automate 20-40% of administrative activities, reallocating up to 13 hours per week toward more impactful educational engagements. The shift could significantly mitigate teacher burnout, a significant factor in the profession’s high turnover rates. The introduction of the AI chatbot, “EL” (Education and Learning in Inclusive Environments), is posited as a transformative tool designed to assist with routine administrative tasks, potentially enhancing educational efficiency and allowing teachers to focus more on direct student interaction and pedagogical innovation. The quasi-experimental research design employed a t-test and Cohen’s d to analyze the effects of AI assistant usage among pre-service teachers at the University of Central Florida. Through a pretest and post-test approach, the study assessed the effectiveness of AI assistants in creating lesson plans, including accommodations and modifications. Additionally, the research examined the correlation between the frequency of AI assistant usage and the likelihood of pre-service teachers allowing their future students to use AI tools. Preliminary results indicate a significant change in the practices of pre-service teachers regarding AI, as the paired t-test reveals a statistically significant difference between pre- and post-test scores (t = -5.26, p = 3.85×10⁻⁶), with notable improvements in their use of AI in educational settings. A t-test was completed to determine the difference between control student (without AI) and treatments students lesson plan (with AI) creation which was to include accommodations and modifications. Using SPSS, the analysis yielded a statistic of approximately -3.53 with a p-value of approximately 0.0009, suggesting that integrating AI assistants like "EL" can effectively support teachers and enhance students' learning experiences. These findings highlight the necessity of including AI literacy in teacher education programs. Correlational statistics were run to determine the relationship between the participants' use of AI and their attitudes toward their future students using AI assistants. The data yielded a t-statistic of -5.26 and a p-value of 3.85×10−6. which indicates a strong and statistically significant relationship between the frequency of pre-service teachers using AI assistants/chatbots for academic purposes and their propensity to allow future students to use such technology.
Association between preoperative diaphragm thickening fraction and postoperative pulmonary complications in patients undergoing thoracoscopic esophagectomy for esophageal cancer
Authors: Okura PT Kazuki , Hasegawa MSc PT Kakeru , Sakamoto PT Ririko , Takahashi PT Yusuke , Nagaki  , Wakita  , Sato  , Kasukawa  , Miyakoshi
Published: October 2024

Objective:
This study aimed to investigate the association between preoperative diaphragm thickening assessed using ultrasound imaging and postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic esophagectomy for esophageal cancer.
Methods:
This single-center, prospective, cohort study enrolled patients with esophageal cancer who were scheduled to undergo thoracoscopic esophagectomy between June 2021 and May 2024. The diaphragm thickening fraction (DTF) was measured using ultrasound imaging at preoperatively and 1 week and 2 weeks postoperatively. Our primary outcome comprised overall PPCs. We investigated the longitudinal change in the DTF and the relationship between the DTF and PPCs. We also examined the optimal cutoff value for the ability of the DTF to predict PPCs.
Results:
This study enrolled 73 patients. PPCs occurred in 21 (29%) patients, 10 (14%) of whom had pneumonia. The estimated difference between the preoperative and 1-week postoperative least squares means of the DTF was −56.3% (95% credible interval [CrI]: −65.4, −47.2) and −36.5% (95%CrI: −43.7, −29.2) between the preoperative and 2-week postoperative values. The mean relative risk (RR) of preoperative DTF to PPCs was 0.89 per 10% increase(95%CrI: 0.80, 0.99), after adjusting for potential confounders. In the posterior distribution, the probability that the RR of the DTF per 10% increase would be <1 was 98.0%. According to the receiver operating characteristic curve, the optimal cutoff value of preoperative DTF predicting PPCs was 123.6%.
Conclusion:
DTF is decreased 1 and 2 weeks after thoracoscopic esophagectomy in patients with esophageal cancer. The higher the preoperative DTF, the lower the risk of occurrence of PPCs.
A high-throughput Cyclin D-CDK4 NanoBiT assay facilitates identification and characterisation of antisense oligonucleotide-based CDK4 inhibitors
Authors: Poulter James , Saleban Mostafa , Mistry Ruju , Ash Malachi , Rose Ailsa
Published: October 2024

Disrupting the interaction between cyclin D and CDK4 is a potential approach to treating cyclin D-CDK4 related cancers, however this is hampered by a lack of high-throughput methodologies to measure their interaction. Here we report the development of NanoBiT luciferase assays for measuring each cyclin D-CDK4 interaction and use them to evaluate antisense oligonucleotides (AONs) targeting CDK4 as a potential cancer therapy. We demonstrate high specificity of the assays to measure each cyclin D-CDK4 interaction with cyclin D mutants with abolished CDK4 binding showing significantly decreased bioluminescence. Using the NanoBiT assays we identified two AONs targeting CDK4 that reduced cyclin D-CDK4 interactions by up to 72%. Viability assays revealed the best performing CDK4 AON caused a significant reduction in cell viability in MDA-MB-231 and MCF-7 cells, as well as a significant decrease in colony formation. Flow cytometry revealed an increase in late apoptotic cells, indicating cells entering apoptosis being the underlying cause of reduced cell number. This AON-based approach offers a potential alternative to current CDK4/6 inhibitors, particularly for resistant cancers. Furthermore, the NanoBiT assay provides a valuable tool for high-throughput screening of cyclin D-CDK4 interaction inhibitors.
Electrochemical Heteroarylation and Amidation of Alkanes using Activated Glassy Carbon Electrodes without Mediators
Authors: Bosque Irene , Gómez José Carlos González , Laze Loris
Published: October 2024

The functionalization of challenging unactivated C(sp3)-H bonds was achieved electrocatalytically via hydrogen atom transfer and without mediators. This was possible through the sole activation of the surface of the Glassy Carbon Electrode in an electrochemical fashion using a phosphate buffer. This activation produced oxygenated functional groups on the surface, capable of abstracting these hydrogen atoms from C(sp3)-H of alkanes. Minisci and Ritter-type reactions were achieved using this procedure. Extensive characterization of the AGCE and preliminary mechanistic studies allow us to propose plausible reaction mechanisms. Furthermore, a regular battery can be used within this protocol to achieve the desired substituted alkanes under inexpensive and user-friendly conditions.
Panax notoginseng saponins in the treatment of ischemic stroke：Meta-analysis and systematic review
Authors: Fan Danjie , Song Shuyue , Ji Xiangyu , Li Dachuan , Zhao Yuyang , Xie Kunming
Published: October 2024

Background
Panax notoginseng saponins(PNS)preparation is one of the most commonly used Chinese medicines for treating acute ischemic stroke༈AIS༉in China. However, compared with the traditional routine western medicine༈WM༉treatment, the effectiveness and safety of PNS as an auxiliary treatment need to be systematically reviewed.
Methods
The deadline for inclusion is before June 30, 2024. Comparing the randomized controlled trials(RCT)of PNS༈Include Xuesaitong and Xueshuantong༉combined with WM and WM alone in the treatment of AIS, the two researchers independently extracted the data, used Cochrane Bias Risk Scale to evaluate the quality of the included studies, and used RevMan5.3 for meta-analysis.
Results
In this study, 15 RCT involving 1499 participants were included, and the treatment of patients was evaluated by the National Institutes of Health Stroke Scale(NIHSS). Meta-analysis shows that adding PNS as an auxiliary treatment is more effective in clinical total efficiency [RR = 1.22,95%CI༈1.17–1.29༉, P < 0.00001] compared with simple WM treatment. The included studies reported 49 cases of adverse reactions༈ADR༉, of which 27 cases occurred in the experimental group.
Conclusion
PNS combined with WM is effective in treating AIS, which suggests that it may be a safe and effective alternative and can better improve neurological symptoms. However, due to the limitations of low methodological quality and small sample size, it is suggested that more high-quality RCT are still needed to verify the safety of PNS preparation.
Exosome-Derived lncRNA LIPE-AS1 for Enhancing Oocytes Maturation and Ameliorating Diminished Ovarian Reserve through Targeting miR-330-5p/HDAC3 Axis
Authors: Hu Rong , Li Jialing , Tian Miaomiao , Guo Hua , Wang Feimiao , Gao Jinmei , Wang Lu , Ma Jie
Published: October 2024

Diminished ovarian reserve (DOR) is a multi-factor gynecological disease that has become a major global health problem. Currently, there is no effective prevention and therapy for DOR. Exosome-drived long non-coding RNAs (lncRNA) in follicular fluid (FF) plays a vital role in development of follicles. Exosome-drived lncRNA LIPE-AS1, which we screened from FF of patients with DOR, regulates histone deacetylase 3 (HDAC3) expression by competitively inhibiting miR-330-5p. Exosomes as nanosized membrane vesicles, could targeted deliver therapeutic agents by modification with target ligands. In this study, we utilize the engineering tochnology to conbime exosome and lncRNA for ovary-targeting therapy of DOR. Firstly, we elucidated the mechanism of lncRNA LIPE-AS1 in occurrence and development of DOR. Secondly, we biologically prepared the exosomes with LIPE-AS1 high expression using 293T cells (Exo-LIPE-AS1). Co-culture of Exo-LIPE-AS1 with oocytes of DOR models promotes oocyte development and improve oocyte quality in vitro. Last, we constructed the FSHβ-modified and LIPE-AS1 loaded exosomes (ExoFSHβ-LIPE-AS1). The engineered exosomes ExoFSHβ-LIPE-AS1 could deliver more efficiently to ovary in vitro. In this way, ExoFSHβ-LIPE-AS1 facilitate the fertility of DOR models. Our research elucidates that exosomes as targeted lncRNA LIPE-AS1 delivery vehicles have potentially preventive and therapeutic effects for DOR.
Molecular epidemiology of human papillomavirus genotypes among HIV-positive and HIV-negative women with cervical cancer in Nigeria
Authors: Nyam Chuwang J. , Musa Jonah , Joyce Brian T. , Kim Kyeezu , Wang Jun , Green Stefan J. , Gursel Demirkan B. , Abdulkareem Fatimah , Akanmu Alani S. , Silas Olugbenga A. , Imade Godwin E. , Anorlu Rose , Ogunsola Folasade , Sagay Atiene S. , Murphy Robert L. , Hou Lifang , Mehta Supriya D.
Published: October 2024

Background
The prevalence of invasive cervical cancer (ICC) is high in Nigeria, with over 12,000 new cases and 8,000 deaths annually. Differences in diagnostic methods for human papillomavirus (HPV) genotypes have generated varied prevalence rates across populations.
Methods
We examined the prevalence and distribution of HPV genotypes among HIV-negative women with ICC, HIV-positive women with ICC, and HIV-positive women without ICC. We utilized baseline data and DNA samples from cervical tissue obtained from a prospective cohort study between March 2018 and September 2022. High-throughput next-generation amplicon sequencing of the HPV L-1 gene was used to identify and classify the HPV genotypes. Modified Poisson regression models estimated associations between HIV and HPV status, adjusting for other variables of interest.
Results
Among 286 women tested for HPV, 48.9% were HIV-negative with ICC, 17.2% were HIV-positive with ICC, and 33.9% were HIV-positive without ICC. The prevalence of high-risk HPV (HR-HPV) was 77.6% among HIV-positive women with ICC, whereas it was 60.0% among HIV-negative women with ICC (p < 0.001). HIV-positive women more frequently had multiple HPV genotypes (8.2% versus 1.4% among HIV-negative women with ICC and 2.1% among HIV-negative women without ICC) (p < 0.001). HPV16 or HPV18 accounted for 29.4% of all HPV cases. The most frequently detected HR-HPV genotypes included HPV16 (20.6%), HPV18 (8.7%), HPV45 (4.2%), and HPV35 (2.8%). In multivariable models adjusted for age, BMI, parity, and study site, HIV-positive women had an increased risk of HR-HPV (aPRR = 1.46, 95% CI: 1.17, 1.82) and any HPV infection (aPRR = 2.29, 95% CI: 1.83, 2.74) compared to HIV-negative women.
Conclusion
Our NGS approach to HPV typing in Nigerian women, including those with cervical cancer and HIV, revealed the presence of HPV types not covered by the Gardasil-4 vaccine. This highlights the need for broader coverage of vaccines to protect against most HR-HPV types, irrespective of HIV status.
The impact of initiation timing of continuous renal replacement therapy on outcomes in critically ill patients with acute kidney injury: a retrospective study from the MIMIC-IV database
Authors: Nuermaimaiti Mangsuer , Wang Meiping , Lou Ran , Wang Nan , Si Quan , Wang Tingting , Jiang Li
Published: October 2024

Background
Acute kidney injury (AKI) is common in critically ill patients, optimal timing for initiation of renal replacement therapy (RRT) for AKI but without life-threatening indications is unclear.
Methods
A retrospective study was performed using the Medical Information Mart for Intensive Care (MIMIC-IV), including AKI patients identified based on Kidney Disease Improving Global Outcomes (KDIGO) definition, The time to initiate CRRT was defined as the interval from first diagnosis of AKI to the initiation of CRRT, analyzed as a continuous variable. The primary outcome was 28-day mortality, restricted cubic splines (RCS) to assess the relationship between CRRT initiation timing intervals and clinical outcomes.
Results
The study included 673 patients, with a 28-day mortality rate of 38.78%. RCS analysis revealed no significant association between variations in CRRT timing intervals and 28-day mortality (P > 0.05). In the subgroup of patients with non-renal SOFA scores < 8, observed an increase in 28-day mortality (OR, 1.011 [95% CI, 1.001-1.021], P < 0.05), along with a greater likelihood of reduced 28-day CRRT, mechanical ventilation (MV), and ICU-free days for each 1-hour delay in CRRT initiation (OR, -0.037 [95% CI, -0.064 to -0.010], P < 0.05; OR, -0.051 [95% CI, -0.078 to -0.024], P < 0.05; OR, -0.056 [95% CI, -0.082 to -0.003], P < 0.05).
Conclusion
The findings indicate that while no significant relationship exists between mortality and the timing of CRRT initiation, patients with lower non-renal SOFA scores who initiate RRT promptly may experience improved clinical outcomes. Further exploration and validation require the adoption of novel research methodologies and more pertinent clinical studies.
Is operative revision associated with favorable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? An initial retrospective, single-center data analysis of 42 cases
Authors: Lausmann Christian , Memarnia Navid , Salber Jochen , Citak Mustafa , Gehrke Thorsten , Linke Philip
Published: October 2024

Purpose:
Clinical outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA) have not been published to date. Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical outcome following surgical intervention for histologically verified endoprosthesis-associated arthrofibrosis of the hip after THA.
Methods:
This study enrolled 7983 THA revision procedures during the study period, in 51 cases arthrofibrosis has been histologically confirmed based on the synovial-like interface membrane (SLIM) criteria. For the final statistical analysis 42 cases (59.5 % women) with an average age of 63.6 years were included, achieving a follow-up rate of 82.6 % with a mean follow up of 70 months. Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). In addition to the complication and revision rates, the Harris Hip Score (HHS) and the EQ-5D-3L questionnaire were analysed for all cases at the time of follow-up.
For the risk analysis of a poor clinical outcome (HHS <55), the study cohort was divided into two different groups.
Results:
Open arthrolysis was performed in all cases (100 %), with a mobile component being replaced in 73.8 % of cases (n = 31) and only two cases requiring additional replacement of the femoral and acetabular components due to aseptic loosening.
The Harris Hip Score (HHS) had a mean value of 53.2 before revision surgery and increased significantly postoperatively to a mean value of 65.7 (p < 0.001). It is noteworthy that only 34.1 % of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37).
Complications occurred in seven cases (16.7 %,), with dislocation in 2 cases and persistent AF symptoms in 3 cases being the most common, accompanied by a revision rate of 14.3 % (n = 6). In three cases, a new open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4kg vs. 78.7kg, p = 0.086) and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.
Conclusion:
The initial clinical results following surgical intervention for endoprosthesis-associated arthrofibrosis show a moderate to poor postoperative outcome with an acceptable complication rate. The type of surgical intervention does not appear to have any influence on a poor clinical outcome.
Electrocardiographic Sex Index: A Continuous Representation of Sex
Authors: Karabayir Ibrahim , Celik Turgay , Patterson Luke , Butler Liam , Herrington David , Akbilgic Oguz
Published: October 2024

Clinical risk calculators consider sex as a binary variable. However, sex is a complex trait with a variety of anatomic, physiologic and metabolic attributes that are not easily summarized with a binary variable [1]. We propose a continuous representation of sex, the ECG Sex Index (ESI), derived via electrocardiographic artificial intelligence (ECG-AI).
We used an ECG repository at Wake Forest Baptist Health (WF) to develop a convolutional neural network-based ECG-AI model to detect sex from standard 12-lead ECGs. We utilized a rank-ordered transformation of the outcome of ECG-AI to create the ESI. We also created a sex discordance index (SDI) from the ESI and assessed its utility in 1-year risk prediction for all-cause mortality (ACM), heart failure (HF), and kidney failure (KF).
The WF cohort included 3,573,844 ECGs and EHR data from 754,761 patients; 75% were White, 17% were Black, and 51% were female, with a mean age (SD) of 61 (17) years. The PhysioNet external validation cohort included 45,152 ECGs from 10,646 patients from two hospitals in China. The PhysioNet cohort was 100% Asian, 43.6% female, and had a mean age (SD) of 59 (20) years. ECG-AI provided a holdout AUC of 0.95 and an external validation AUC of 0.92. Lower ESI levels in males and higher ESI levels in females were associated with a greater risk for clinical outcomes. The ESI and SDI were found to be noninferior to binary sex in logistic regression and better than binary sex in machine learning in predicting the risk for clinical outcomes.
The ESI and SDI present a more informative representation of sex and should be considered predictors in clinical risk calculators.
Surgical Fixation of Hip Fractures – A Novel Technique for Pre-Operative Planning
Authors: Liau Glen Zi Qiang , Thirukumaran Kamaraj , Sim Seth Ian , Pang Alexander Shao-Rong
Published: October 2024

Purpose: Use of the dynamic hip screw (DHS) is considered the gold standard for hip fracture stabilisation, but conventional DHS (CHDS) fixations may be limited by longer surgical duration and delayed recovery compared to minimally invasive DHS (MIDHS) fixations. We describe a novel low-cost surgical method grounded in trigonometry that reduces intra-operative time, peri-operative complications, and improves overall patient outcomes.
Methods: A prospective double-blinded study included 15 patients who underwent surgical fixation of IT hip fractures using a 4-hole DHS system. All surgeries were performed at a tertiary referral hospital between January 2019 and April 2023 by surgeons with similar levels of experience. Main outcome measurements included tip-apex distance (TAD), surgery duration, haemoglobin loss, and hospital stay duration. Two independent assessors measured TAD using the post-operative anteroposterior and lateral radiographs. Kyle's classification was used to categorize the IT fractures. IBM SPSS Statistics 26.0 for Mac (SPSS, Chicago, IL, USA) was used for the statistical analysis. Statistically significant difference was defined as p-value < 0.05.
Results: Both groups had similar baseline characteristics (p > 0.05), except for Kyle's classification (p = 0.04). The MIDHS group had more complex fractures (40% MIDHS Kyle 3/4 vs 10% CDHS Kyle 3/4) but the mean surgical duration was significantly shorter (p = 0.019) (43.8 ± 12.3 minutes) compared to the CDHS group (73.4 ± 18.2 minutes). Postoperatively, there was no significant difference (p>0.05) in hospital stay duration, haemoglobin (Hb) loss, or TAD.
Conclusions: Despite having more complex fractures, MIDHS group had even shorter surgical duration compared to CDHS group, with no significant difference in TAD, haemoglobin loss and hospital stay duration.
Venetoclax and azacitidine compared with intensive chemotherapy for adverse-risk acute myeloid leukemia patients receiving allogeneic hematopoietic stem cell transplantation in first complete remission: a multicenter study of TROPHY group.
Authors: Mo Xiaodong , Wen Qi , Jiang Chuanhe , Liu Xiaodan , Xia Yi , Ma Yilei , Yang Yang , Wang Yu , Chang Yingjun , Wang Luxiang , Zhang Zilu , Huang Xiaojun , Cao Yang , Zhao Yanmin , Hu Xiaoxia
Published: October 2024

It was commonly accepted that adverse-risk acute myeloid leukemia patients should receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1). In this multicenter study, we aimed to compare the post-transplant outcomes between patients receiving venetoclax with azacitidine (VEN-AZA, n = 47) and intensive chemotherapy (IC, n = 264) before allo-HSCT. In total cohort, the 3-year probabilities of overall survival, leukemia-free survival, and event-free survival of IC group were all better than VEN-AZA group, particularly for the patients with ASXL1 mutation or with SF3B1 mutation. Even in the patients ≥ 55 years or those with HCT-CI ≥ 1 scores before allo-HSCT, the survival of VEN-AZA group was not superior to the IC group. After propensity score matching, the overall survival at 1 year after allo-HSCT for IC group was better than that of VEN-AZA group (93.6 vs. 78.0%, P = 0.034), and the other clinical outcomes were comparable between VEN-AZA and IC groups. TP53 mutation was the most important adverse prognostic factor for post-transplant relapse and survival. Thus, our results did not support the preferential use of VEN-AZA over IC regimens in young and medical fit adverse-risk AML patients who would receive allo-HSCT in CR1.
Antenatal Stress, marital satisfaction and antenatal depression of Chinese couples: An actor - partner interdependence model extended to mediation
Authors: Dong Yuting , Liu Xiaoqing , Xu Xingyan , Luo Jinying , Liu Shiqiong , Zeng Hang , Song Yang , Zhou Xiaowan , Li Huangyuan , Wu Siying , Lin Shaowei
Published: October 2024

Background
Pregnant women exhibit heightened vulnerability to stress and an elevated risk of depression during gestation. Antenatal depression increases the likelihood of adverse outcomes, including postpartum depression. Current research often overlooks the spouse's role, focusing solely on the pregnant woman.
Aims
To explore couple-based antenatal stress interactions on depression and the mediating role of marital satisfaction.
Methods
Convenience sampling method was used to select 244 couples attending Maternal and Child Health Hospital of Fujian province as the study subiects. The path relationships between antenatal stress, marital quality and antenatal depression of couples were analysed by APIMeM.
Results
Individual antenatal stress exerts a direct effect on antenatal depression, both within the individual and in their spouse. Furthermore, marital satisfaction mediated the actor effect of antenatal stress and depression in wives, as well as the partner effect of antenatal stress in husbands on their wives’ antenatal depression.
Conclusion
Antenatal emotions exhibit cross-partner effects, and the marital satisfaction may serve as a potential mediating factor in the relationship between antenatal stress and antenatal depression. Couples are encouraged to prioritize stress management during pregnancy, enhancing marital satisfaction can mitigate the harmful effects of antenatal stress on depression, potentially improving pregnancy outcomes and postnatal health.
LncRNA LFQR promotes cytoactivity and resistance to quizartinib via FLT3 transcriptional activation in FLT3-ITD acute myeloid leukemia
Authors: Tang Yan-Lai , Liu Ying-Li , Zhang Xiao-li , Luo Xue-Qun , Sun Yu-Meng , Lian Jun-Yi , Song Shi-Yao , Ke Zhi-Yong , Wang Li-Na , Liang Cong , Fan Zhong , Huang Li-bin , Wang Wen-Tao
Published: October 2024

FMS-like tyrosine kinase-3 internal tandem duplication (FLT3-ITD) acute myeloid leukemia (AML) is an adverse subtype of leukemia associated with a poor patient prognosis. FLT3 inhibitors exhibit promising clinical activity, however, their effectiveness is limited by drug resistance. Therefore, overcoming resistance to FLT3 inhibitors remains an important clinical problem, necessitating the development of new strategies. In this study, we identified a lncRNA, AL713998.1, which was upregulated in both FLT3-ITD AML and quizartinib-resistant cells (LFQR). In vitro experiments showed that LFQR silencing significantly inhibited cell proliferation, impaired self-renewal capacity, caused cell cycle arrest and induced cell differentiation, specifically in FLT3-ITD AML. In addition, the interaction of LFQR with SFPQ was verified using RNA pull-down assays, mass spectrometry and RNA immunoprecipitation. Mechanistically, LFQR promotes SFPQ binding to the promoter region of FLT3 and facilitates transcriptional regulation, thereby increasing the expression of kinase and oncoproteins in FLT3-ITD AML cells. Notably, LFQR inhibition also impaired the cytoactivity of quizartinib cells and reversed their resistance to quizartinib. Overall, our study highlights that LFQR may serve as a potential therapeutic target in FLT3-ITD AML, and its knockdown can significantly improve the efficacy of quizartinib, thus providing a promising strategy for overcoming resistance to FLT3 inhibitors.
Longitudinal Impact of Metabolic Syndrome Evolution on Incident Chronic Disease Multimorbidity: A Cohort Study
Authors: Wang Yuxian , Chen Zekai , Qin Hailun , Fu Peng , Huo Zhenyu , Wu Kuangyi , Zheng Huancong , Cai Zefeng , Wu Weiqiang , Lan Yulong , He Zhen , Wu Shouling , Chen Youren
Published: October 2024

Background
Metabolic syndrome (MetS) has been associated with the development of chronic diseases, including cardiovascular disease (CVD), type 2 diabetes (T2D), and chronic kidney disease (CKD). However, the association of a longitudinal MetS evolution with the multimorbidity of these disease remains unclear. We aimed to investigate the impact of MetS evolution on incident chronic disease multimorbidity.
Methods
This prospective cohort study included 36,201 participants in the Kailuan cohort who were free of CVD, CKD, T2D before 2006–2010. MetS patterns was categorized according to the status of MetS obtained during the 2006 and 2010 surveys. The primary endpoint was chronic disease multimorbidity (suffering from at least 2 of CKD, CVD and DM), and secondary endpoints included CVD-T2D multimorbidity, CVD-CKD multimorbidity and T2D-CKD multimorbidity. Cox regression models were used to assess the association of MetS evolution with chronic disease multimorbidity and its components.
Results
During a median follow-up of 12.02 years, 930 participants developed chronic disease multimorbidity. After considering potential confounders, the persistent metabolic disorder group (hazard ratio [HR], 2.95 [95% CI, 2.41–3.60]), the MetS recovery group (HR, 1.87 [95% CI, 1.48–2.36]), and the MetS progression group (HR, 1.70 [95% CI, 1.39–2.06]) were all associated with an elevated risk of chronic disease multimorbidity compare with the sustained metabolic health group. Generally similar results were observed in CVD-T2D multimorbidity, CVD-CKD multimorbidity and T2D-CKD multimorbidity, and the analysis of single diseases complements our conclusions.
Conclusions
Not only the current presence of MetS, but also a history of metabolic disorders, even in the absence of current MetS, may increase the risk of chronic disease multimorbidity. The findings emphasize the need for primary prevention of MetS and intervention in individuals with a history of MetS in order to halt further progression to chronic disease and the multimorbidity.
Efficacy and safety of anlotinib combined with chemotherapy plus anlotinib maintenance in Radioiodine-refractory differentiated thyroid cancer: a case report and literature review
Authors: Zhou Chun-yan , Li Huan-huan , Lan Xin , Pan Xiao-mei , Song Feng-ping , Duan Dong
Published: October 2024

Background: Radioiodine-refractory differentiated thyroid cancer is one of the leading causes of mortality among patients with thyroid cancer, presenting significant clinical challenges in both diagnosis and management. In addition to sorafenib and levatinib, China's self-developed tyrosine kinase inhibitor, anlotinib, has been approved by the national medical products administration for the treatment of progressive, locally advanced or metastatic radioiodine-refractory differentiated thyroid cancer. Despite the potential of single-agent therapy to improve treatment efficacy, the management of patients with advanced radioiodine-refractory differentiated thyroid cancer who have exhausted first- and second-line treatments remains a considerable challenge, with limited chances of achieving satisfactory outcomes. Recent research has shown that anlotinib combined with chemotherapy has an enhanced antitumor efficacy and a tolerable safety profile in patients with triple-negative breast cancer and advanced ovarian cancer. However, the efficacy and safety of anlotinib with chemotherapy for radioiodine-refractory differentiated thyroid cancer have not been reported in the literature.
Case presentation: Here, we present a case of metastatic radioiodine-refractory differentiated thyroid cancer that was treated with a combination of anlotinib and chemotherapy, along with anlotinib maintenance therapy after the failure of sorafenib treatment, resulting in favorable outcomes.
Conclusions: The combination of anlotinib and chemotherapy, followed by anlotinib maintenance, showed promising efficacy and manageable toxicity in the treatment of advanced radioiodine-refractory differentiated thyroid cancer.
Challenges Management of Patients with Oral Cancer and Its Impact on Oral health‑related quality of life in Resource-limited Settings
Authors: bushabu Fidele Nyimi , kapamona Panumvita , Lubamba Grace Paka , David Kayembe Mwimbi , Kazadi Em Kalala , Milolo Augustin Mantshumba , Ingenya Edize Ekofo , Mwinaminayi Pierre Muyembi
Published: October 2024

Purpose
the purpose of the present study was to identify the challenges in the management of patients with OC in resource-limited settings, and to evaluate their quality of life in this area.
Material and methods
A cohort random study of Congolese participants was conducted using a clinical questionnaire and an Oral Health Impact Profile (OHIP)‑14 questionnaire between the OC patient and control groups. Predictor variable was the treatment method, clinical characteristics and the main outcome variable(s) were the challenges or quality of life. The Chi‑square test was used to compare the percentage of qualitatively dependent variables, independent sample t‑test and ANOVA to compare OHIP score. Statistical significance was set at 5%.
Results
Out of 457 patients, 66% were male, and 34% female.More than fifty percent of patients were unemployed. Observation therapy and traditional medicine were done in 29.8% and 25.4%. More than sixty percent of patients reported delays in initiating cancer treatment and 78% of participants could not inform other persons because of the conception of oral cancer diseases. The patients with OC were affected by the quality of life even with or without the treatment done.
Conclusion:
Challenges management of oral cancer in resource-limited settings result in several factors. This mostly are the result of the poor socioeconomic status of the patients and the conception of oral cancer diseases in the region. With or without treatment, the patients were affected in their quality of life.
Estimation of Central Venous Pressure Using Cardiac Ultrasound of Inferior Vena Cava in Ventilated Children: A Prospective Multicenter Observational Study
Authors: Sée Perrine , Hayotte Aurélie , Roux Enora Le , Guilbert Anne-Sophie , Collignon Charlotte , Denante Solene , Klifa Roman , Rambaud Jérome , Brissaud Olivier , Dauger Stéphane
Published: October 2024

Background:
Although ultrasound (US) parameters of the inferior vena cava (IVC) cannot be used to estimate central venous pressure (CVP) in adults under mechanical ventilation (MV), the limited pediatric literature reports highly contradictory results. Pediatric evidence was awaited.
Methods:
This prospective, multicenter, observational study, conducted in six pediatric intensive care units, included children aged 2 days to 12 years who were under MV and had a central venous catheter in the superior vena cava to monitor CVP. US measurements were performed by experienced intensivists in order to calculate the following parameters: i) IVC-Collapsibility: [(IVCdmax - IVCdmin)/IVCdmax] x 100, ii) IVC-Distensibility: [(IVCdmax - IVCdmin)/IVCdmin] x 100, iii) IVC/Aortic: (IVCdmax/Ao) x 100. The search for correlation was studied using scatter plot and Pearson and Spearman's correlation tests for linear and monotonic relationships, respectively.
Results:
We included 120 children with a median age of 11.5 [2.0; 46.3] months and a median weight of 9.0 [5.0 ;15.0] kg. A third of the patients were admitted for post-operative care, including cardiac surgery, and a fourth for respiratory failure, with a median CVP of 7.5 [5.0; 10.3] mmHg at inclusion. No significant relationship was found between CVP and IVC-Collapsibility (Pearson r = -0.05, p = 0.55; Spearman r = -0.09, p = 0.32), IVC/Ao (Pearson r = 0.16, p = 0.08; Spearman r = 0.17, p = 0.06), or IVC-Distensibility (Pearson r = -0.003, p = 0.97; Spearman r = -0.09, p = 0.29).
Conclusion:
There is no correlation between CVP and IVC-US parameters in children under MV.
Adjunctive diagnostic tool for histopathological classification in congenital mesoblastic nephroma
Authors: Hamada Hiroshi , Kohashi Kenichi , Iwasaki Takeshi , Hashisako Mikiko , Hino Yuko , Fukuhara Masahiro , Kamouchi Amane , Kawakubo Naonori , Tajiri Tatsuro , Oda Yoshinao
Published: October 2024

Purpose: Congenital mesoblastic nephromas (CMN) are histologically classified into classical, cellular, and mixed subtypes. Most cellular CMNs harbor ETV6-NTRK3 gene fusions, and classic and mixed CMNs harbor EGFR internal tandem duplications (EGFR-ITDs). Classic CMNs are considered benign, whereas recurrent or metastatic diseases occur in the cellular subtypes. Direct identification of mutations is desirable for an accurate diagnosis. However, molecular genetic analyses cannot be performed in a number of histopathology laboratories. This study aimed to investigate a surrogate marker for the accurate histological classification of CMN.
Methods: Overall, 11 CMN cases diagnosed at our institute were included in this study. Reverse transcription-polymerase chain reaction was performed for the NTRKgene fusion and EGFR-ITDs in all cases. Comprehensive mRNA analysis was performed using the nCounter® Gene Expression Assay. Principal component analysis (PCA) was performed based on the gene expression levels. Immunohistochemical evaluation was conducted for the expression of p-Mek1/2, p-Erk1/2, and EGFR.
Results: PCA revealed differences in mutation patterns between the EGFR-ITDs and NTRKfusion tumor groups. Gene ontology analysis of the highly expressed genes in the EGFR-ITDstumor group revealed enrichment related to the mitogen-activated protein kinase (MAPK) signaling pathway. p-Mek1/2 and p-Erk1/2 immunoreactivity was significantly increased in the EGFR-ITDs tumor group (p = 0.018 and p = 0.017, respectively). EGFR immunoreactivity is not a useful marker for CMN with EGFR-ITD.
Conclusion: p-Mek1/2 and p-Erk1/2 immunoreactivity may be useful markers for EGFR-ITDs. Thus, MEK1/2 inhibitors possess the potential to be used as a targeted therapy for CMN with EGFR-ITDs.
Can Robots Keep You Upright?: An Ergonomic Analysis of Surgeon Posture in Robotic versus Conventional Total Knee Arthroplasty
Authors: Gapinski Zachary , Mason Eric , Kothari Ezan , Desai Pratik , Haidukewych George , Green Cody
Published: October 2024

Background
Robotic-assisted technology has become an increasingly utilized adjunct within the realm of primary total knee arthroplasty (TKA). Previous studies have shown that robotic-assisted total knee arthroplasty (raTKA) offers potential advantages of enhanced bony preparation and optimal implant alignment with equivalent long-term patient outcomes and component longevity in comparison to conventional TKA (cTKA). Furthermore, recent studies have identified the additional benefit of decreased surgeon physiologic stress with the use of raTKA. The purpose of this study was to compare differences in surgeon posture between primary raTKA and cTKA.
Materials and Methods
We prospectively evaluated 103 consecutive primary TKA cases (48 raTKAs, 55 cTKAs) performed by three high-volume, fellowship-trained arthroplasty surgeons. Throughout each case, surgeons wore a posture-tracking device to evaluate time spent slouching. The threshold for slouching was set to 30 degrees of flexion from a neutral spinal axis. Demographic and operative factors were collected. Two tailed tests and multivariate analysis were used to assess for differences between groups.
Results
After controlling for individual surgeon differences in posture, we found a decrease in percentage and duration of time spent slouching in raTKA cases compared to cTKA cases (42.4 vs 72.5%, P < 0.001, 35.4 vs 54.7 min, P = 0.037). On average, use of the robot decreased surgeon slouching time by 19.3 min (26.6%, p < 0.001). Patient factors such as increased age and ASA 2 were also associated with favorable effects on posture (p < 0.001).
Conclusions
Surgeons performing primary raTKA cases spend significantly less case time and case percentage in a slouched posture compared to conventional primary TKA cases. This suggests potential for ergonomic benefit of robotic-assisted technology in primary TKA. Further research is needed to determine the long-term effects of posture on surgeon pain and career longevity.