bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Auto-clave Sterilization Affect Nickle Ion Release of Stainless Steel Crowns and Space Maintainer Bands?
Authors: Alessa Noura , Alhamdan Habah , Alrobaish Shahad , AlQahtani Nisrin , Alarifi Norah , Almutairi Manal , Alhowaish Latifa , Al-Homaidhi Majedah
Published: October 2024

Aim
This study aimed to investigate the effect of autoclave sterilization on the leaching of nickel ions from stainless steel crowns and space-maintainer bands used in pediatric dentistry.
Materials and Methods
Sixty space maintainer bands and 60 stainless steel crowns were divided into sterilized and non-sterilized groups. These samples were immersed in artificial saliva, placed in individual petri dishes, and then incubated at 37°C. The samples were analyzed for 42 d using a gas chromatography-mass spectrometry (GC-MS) machine to quantify the release of nickel ions.
Results
Nickel release was higher in the sterilized samples than in the non-sterilized samples for both space maintainer bands and stainless steel crowns. This trend persisted throughout most days of the experiment, with a peak release observed on day 7. The sterilized group showed significantly higher levels of ion release than the non-sterilized group (p < 0.05).
Conclusion
This study suggests that nickel allergy testing may be advisable before placing stainless steel crowns or space maintainers, particularly for patients at risk of allergies. Dentists should be mindful of the increased nickel release observed from sterilized crowns and bands, as this information could influence treatment decisions, especially in children who are predisposed to allergies.
The Relationship Between Circulating Tumor Cells in Peripheral Blood and Clinical Characteristics of Pediatric Neuroblastoma and Prognostic Evaluation
Authors: Tuo Junhua , Zhao Zhi , Ma Xiaoning , Liu Zhengsheng , Yang Baogang , Zhang Meng , He Xuan
Published: October 2024

Objective
This study aims to evaluate the relationship between the detection of circulating tumor cells (CTCs) in peripheral blood and the clinical characteristics and prognostic value of advanced (III-IV) pediatric neuroblastoma (NB).
Methods
This retrospective analysis included 144 children with advanced NB who received comprehensive treatment at our hospital from September 2020 to October 2022. Detailed clinical data of the patients were collected, and CTCs in samples were detected using a negative enrichment method based on immunomagnetic beads adsorption combined with immunofluorescence technology. The prognostic evaluation criteria and cut-off values for CTCs were determined using the receiver operating characteristic (ROC) curve method. Furthermore, univariate and Cox multivariate regression analyses were used to identify independent risk factors affecting the prognosis of children with NB.
Results
According to the optimal cut-off values obtained from the X-tile software, the patients were divided into high and low expression groups. The number of children with Progress (P < 0.001), Maximum tumor diameter ≥ 10cm (P = 0.004), low differentiation (P = 0.034), and stage IV (P = 0.007) in the high expression group was significantly higher than in the low expression group. The CTCs in children with Progress were higher than those in children with Mitigation (P < 0.001); children with Maximum tumor diameter < 10cm had lower CTCs than those with ≥ 10cm (P < 0.001); stage IV children had higher CTCs than stage III children (P = 0.036). The AUC for Maximum tumor diameter, Degree of differentiation, and Tumor stage were 0.703, 0.669, 0.574, and 0.598, respectively. Multivariate Cox regression analysis showed that CTCs (P < 0.001, OR = 2.958), Efficacy (P = 0.005, OR = 1.814), and Maximum tumor diameter (P < 0.001, OR = 2.586) were independent prognostic factors affecting OS in children with NB. Time-dependent ROC curve analysis showed that the model's AUC for predicting 1-year and 2-year survival was 0.747 and 0.802, respectively.
Conclusion
CTCs detection can significantly assess the clinical characteristics and prognosis of advanced pediatric NB, and CTCs, Efficacy, and Maximum tumor diameter are independent prognostic factors.
Investigating student-teachers' continuous intention to use mobile learning management system: The technology acceptance model and expectation confirmatory model
Authors: Buabeng-Andoh Charles
Published: October 2024

This study investigated student-teachers’ continuous intention to use mobile learning management system. The sample size of the participants was two hundred and sixty-one. The participants responded to online survey questionnaires consisting of items from the combination of both Technology Acceptance and the Expectation Confirmatory Models. To perform the data analysis, the structural equation modeling was adopted as the key method. The inquiry revealed that the combined model had a robust predictive power to elucidate student-teachers’ continuous intention to operate technology. In addition, the Expectation Confirmatory Model constructs were important in elucidation student-teachers' intention to continue to use technology as compared to the Technology Acceptance Model constructs. On the whole, satisfaction had the greatest impact on the continuous intention to use technology. This research adds to the current body of knowledge by creating an integrated model using Technology Acceptance Model and Expectation Confirmatory Model to predict the continuous intention to use mobile learning management system among student-teachers in school. In addition, this study adds to research on determinants influencing student-teachers' continuous use of technology in schools in the emerging economies context.
DST-Net: Dual Self-Integrated Transformer Network for Semi-Supervised Segmentation of Optic Disc and Optic Cup in Fundus Image
Authors: Wang Jing , Wang Jinke , Yang Zhipeng , Xu Min , Tamura Shinichi
Published: October 2024

Current neural network-based optic disc (OD) and optic cup (OC) segmentation tend to prioritize the image's local edge features, thus limiting their capacity to model long-term relationships, with errors in delineating the boundaries. To address this issue, we proposed a semi-supervised Dual Self-Integrated Transformer Network (DST-Net) for joint segmentation of the OD and OC. Firstly, we construct the encoder and decoder of the self-integrated network from the mutually enhanced feature learning modules of Vision Transformer (ViT) and Convolutional Neural Networks (CNN), which are co-trained with dual views to learn the global and local features of the image adaptively. Secondly, we employed a dual self-integrated teacher-student network with a substantial amount of unlabeled data, which is utilized through semi-supervised learning to facilitate the acquisition of more refined segmentation outcomes. Finally, the Boundary Difference over Union Loss (BDoU-loss) enhances the network's focus on the boundaries. We implemented the comparative experiments on the publicly available dataset RIGA+. The Dice value of OD and OC of the proposed DST-Net reached 95.12(±)0.14 and 85.69(±)0.27, respectively, outperforming other State-Of-The-Art (SOTA) methods and proving its promising prospect in OD and OC segmentation.
Association of exposure to phenols and parabens mixtures with grip strength among adults in the United States: A cross-sectional study
Authors: Xu Yueyang , Gui Siyu , Qin Shaokun , Jin Neng , Cheng Yuanyue , Ye Shuming
Published: October 2024

Previous research has indicated potential health hazards of phenols and parabens from environmental exposure to humans. However, studies examining their relationship with grip strength remain limited. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), this study included 1,858 adults aged 20 years and older to explore the independent and combined associations of phenols and parabens with grip strength. In single exposure analyses, bisphenol A (BPA) exhibited a negative association with grip strength, while benzophenone-3 (BP3) and butyl paraben (BuP) showed positive associations. Restricted cubic splines (RCS) regression indicated a U-shaped nonlinear relationship between BPA and grip strength across all participants. Weighted quantile sum (WQS) regression models revealed a negative association between combined exposure to various metals in urine and grip strength. Quantile based g-computation (qgcomp) analysis suggested positive weights for urinary mixture of BuP, BPA, and methyl paraben (MeP), whereas 2,5-dichlorophenol (25-DCB), propyl paraben (PrP), and 2,4-dichlorophenol (24-DCB) had negative weights. Subgroup analyses indicated significant differences in results across age and gender subgroups. Given the limitations of cross-sectional studies, prospective and mechanistic investigations are warranted in future research.
Medial Temporal Lobe Subfields Correlate with Alzheimer's Cognitive Domains; Insights from High-Resolution T2 MRI of ADNI Database
Authors: Saberian Parsa , Mozafar Mehrdad , Sadeghi Mohammad , Dizjani Alma , Rajaeitabar Ali , Akherati Ali , Eghdami-Chafi Fatemeh , Sadeghi-Ronizi Mehdi , Shakeri Shayan , Rostami Rezvaneh , Torabi Pouya , Khavandegar Armin , Amiri Fatemeh , Mayeli Mahsa
Published: October 2024

Background
Alzheimer's Disease (AD) causes multi-domain cognitive decline. Brain imaging biomarkers and neuropsychiatric testing detect difficulties, although it is unclear how cognitive processes and medial temporal lobe subregions relate. High-resolution T2 MRIs of AD patients' medial temporal lobes were compared to composite scores for memory, language, executive function, and visuospatial ability.
Methods
156 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants provided data. Composite cognitive scores and high-resolution T2 MRI volumetric assessments of medial temporal lobe subregions were obtained. Multiple linear regression was used to account for factors and analyze composite scores and regional volumes.
Results
In AD patients, left cornu ammonis (CA), subiculum (SUB), perirhinal cortices (BA35), and bilateral parahippocampal cortex (PHC) size positively linked with memory performance. Language was strongly connected with hippocampi and cortical volumes in moderate cognitive impairment, and right entorhinal cortex (ERC) volume in AD patients. The bilateral SUB in normal cognitive function and the right SUB in AD positively linked with executive ability. Cognitively normal people with bilateral SUB had better visual-spatial skills.
Conclusion
Across AD stages, medial temporal subregions and cognitive composites had unique structure-function patterns, with left hemisphere effects preceding bilateral participation, underlining their combined value for early disease identification and monitoring.
A retrospective Cohort Research of the Impact of Intraocular Lens (IOL) Loading Methods on the Adhesion Phenomenon during Cataract Surgery
Authors: Yanan Li , Li Zhang , Yiren Wang , Jinhong Miao , Liu Jing , Zheng Liu
Published: October 2024

Purpose
This study aims to observe the optic and haptic adhesion phenomenon of different intraocular lens (IOL) and the impact of different methods of IOL loading on the occurrence of adhesion phenomena.
Methods
253 patients (253 eyes) undergoing routine cataract surgery combined with IOL implantation at Peking University Third Hospital from July 2021 to July 2022 were enrolled. As an observative retrospective study, the Trial Registration Number (TRN) is not applicable for our research. Five types of IOLs including Tecnis ZCB00, Tecnis ZXR00, Tecnis ZMT, A1UV, and A1UL22 were selected and loaded using 7 different methods to compare the incidence of different IOL adhesion types and additional device assistance.
Results
The incidence of adhesion and additional device assistance in A1UV and A1UL22 groups were significantly higher than that in other three groups (P < 0.05). Routine loading method group exhibited the highest incidence of haptic adhesions (55%), while balanced salt solution (BSS) group presented the lowest incidence of haptic adhesions (5.9%, P < 0.05). BSS and viscoelastic group showed the highest incidence of double haptic loop adhesions (33%) among all the loading ways groups.
Conclusions
A1UV and its preloaded A1UL22 IOL presented the highest incidence of adhesion, compared with the other three IOLs (Tecnis ZCB00、Tecnis ZXR00、Tecnis ZMT). The application of BSS during IOL loading was effective in reducing the adhesion incidence.
Circulating HIF-1α and VEGF as Potential Biomarkers in Connective Tissue Disease-associated Pulmonary Arterial Hypertension
Authors: Shi Xiaofei , Ma Xin , Wang Huanhuan , He Xuegai , Fan Hua , Mao Yimin
Published: October 2024

Objective:Pulmonary arterial hypertension (PAH) is an independent risk factor for increased mortality in patients with connective tissue disease (CTD); however, early diagnosis remains challenging. We aimed to assess the serum levels of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) and explore their clinical significance in patients with CTD-associated PAH.
Methods:Demographic characteristics, laboratory parameters, and hemodynamic measurements were obtained for the patients with CTD-associated PAH (CTD-PAH). Serum levels of HIF-1α and VEGF were measured by enzyme-linked immunosorbent assay (ELISA). Pearson correlation was utilized to determine the correlation between these biomarkers and clinical parameters. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic accuracy of HIF-1α and VEGF in identifying CTD-PAH.
Results:Both VEGF and HIF-1α levels were significantly elevated in patients with CTD-PAH and CTD without PAH (CTD-non-PAH) compared with those in the healthy control (HCs) group (P<0.01). Furthermore, HIF-1α levels were higher in patients with CTD-PAH than in individuals with CTD-non-PAH, as were the VEGF levels. In patients with CTD-PAH, HIF-1α and VEGF levels were positively correlated with mean pulmonary arterial pressure (mPAP), brain natriuretic peptide (BNP) levels, and negatively correlated with the 6-Minute Walk Distance (6MWD). The combined HIF-1α and VEGF analysis were used for diagnosing CTD-PAH and yielded an area under the curve (AUC) of 0.933.
Conclusion:Elevated serum levels of HIF-1α and VEGF were observed in patients with the CTD-PAH. Our findings suggest that HIF-1α and VEGF may serve as potential biomarkers for the diagnosis of CTD-PAH.
The Unique Fabrics Combination Method for Making Affordable Washable Fabric Mask with Good Filtration Efficiency
Authors: Su Anselm Ting , Kuan Jew Win , Shanat Musdi Hj , Osman Baderin , Mahmud Haalah
Published: October 2024

The aim of this paper is to report a unique method to make reusable washable fabric face mask that has good filtration efficiency and yet affordable using common fabric materials including the polypropylene filter available in the market to support the needs of universal masking. Part 1 study involved multiple combinations of common commercially available fabric materials to find the most filtration efficient combination for the purpose of making the reusable and washable fabric face mask. The filtration efficiency and breathing resistance of all prototypes were tested according to ASTM F2299/F2299M-03 standard using TSI 8130 High Flow Automated Filter Tester, and AFNOR SPEC S76-001:2020 using INSPEC Breathing Resistant Rig respectively in the National Institute of Occupational Safety and Health, Dust Mask Laboratory. The study found a unique combination of non-woven fusible interlinings fabric with melt blown polypropylene filter fabric to produce washable and reusable fabric mask that can sustain up to 50 normal household washing machine washes maintaining the filtration efficiency between 60–95% and breathing resistance below 4 milibar, which are acceptable to function as non-medical mask. Part 2 study involved field testing of the prototype face masks made from Part 1 study among randomly selected 764 school children in comparison arms. The experiment showed no increase in incidences of all-cause and sickness absenteeism using the prototype masks produced as compared to usual face masks at end of two months.
Cost-Reduction Strategy to Culture Patient Derived Bladder Tumor Organoids
Authors: Sisakht Mahsa Mollapour , Gholizadeh Fatemeh , Hekmatirad Shirin , Mahmoudi Tokameh , Montazeri Saeed , Sharifi Laleh , Daemi Hamed , Romal Shahla , Yazdi Mohammad Hosein , Faramarzi Mohammad Ali , Shahverdi Ahmad Reza , Hamidieh Amir Ali
Published: October 2024

Organoids as an aggregation of stem cells can recapitulate the function of organs in miniature form and have developed great potential for clinical translation, drug screening and personalized medicine over the last decade. Most organoids are currently cultured in basement membrane matrices (BMMs), which is hampered by xenogeneic origin, batch-to-batch variability, cost and complexity. In addition, organoid culture relies on biochemical signals provided by various growth factors in the composition of the medium. We have developed a method for culturing organoids from bladder tumors in a sodium alginate hydrogel scaffold in addition to fibroblast conditioned medium (FCM)-enriched culture medium that is inexpensive and easily amenable to clinical applications. Tumor organoids in Alginate and FCM based medium grow in comparable to those cultured in BMMs and standard medium. The organoids express specific bladder organoid markers containing CK14, CK20, LGR5, Uroplakin III, FOX1A, GATA3, CK5 and CK44 and the proliferation potential showed by confocal microscopy. The results indicate that alginate is very promising for early passage human bladder organoid culture with increase the scalability potential. Furthermore, using FCM based medium as an alternative solution can be consider, especially for low-resource situation and to develop cost effective tumor organoids.
Exploration and application of the entropy weight method coupled with grey correlation analysis in the evaluation of river water ecological health - a case study of the Pujiang River
Authors: Luo BenFu , Yan YuJing , Xiang Yu , Wang ShiJie , He HaiXing , Liu YuHang , Deng Shuai , Zhou Xiang
Published: October 2024

Healthy riverwater ecosystems have gradually become the target and direction of riverwater ecological protection. However, commonly used methods for assessing river ecosystem health may not fully or accurately reveal the true state of river health, leading to some level of challenge in restoring river ecosystems. Taking the Chengdu City, Sichuan Province, China Pujiang River as a case study, this research evaluates and compares the aquatic ecological health of the river section based on investigations of plankton, attached algae, benthic animals, fish, water quality, and environmental environment. By coupling the biological index method, comprehensive health assessment method, entropy weight method, and grey correlation analysis method, the study assesses the aquatic ecological health of this river section. The biological index method is significantly influenced by the evaluation objects and methods, providing an intuitive reflection of the environmental health status of specific biological populations; however, it may encounter contradictions with significantly different results between parallel indices, making it challenging to reflect the complexity and dynamics of the entire ecosystem comprehensively. The comprehensive health assessment method offers a more thorough evaluation. Still, it may be influenced by a single indicator's weight, resulting in varying outcomes due to the selection of different aquatic biotic indicators and lacking key assessment indicators like plankton. Given the chaotic and vague issues arising from the biological index method and comprehensive health index method, this study combines the entropy weight method with the grey relational analysis approach to assess the health status of river ecosystems. The entropy weight method quantitatively determines the weight of evaluation indicators. At the same time, the grey correlation analysis measures the degree of correlation between different factors, providing more accurate and instructive evaluation results. Applying the entropy weight method coupled with the grey correlation analysis in the Pujiang River case accurately evaluated the aquatic ecological health, indicating a state of good to excellent health and highlighting the key focus areas in water quality and environmental environment. This approach demonstrated good effectiveness and significant cost-efficiency. Determining indicator weights using the entropy weight method coupled with grey correlation analysis is more objective and informative, presenting a promising innovative method for evaluating river ecosystem health.
Effects of SGLT2 inhibitors on acute myocardial infarction: A systematic review and meta-analysis
Authors: Hu Chunmei , Ou Shulin , Zheng Xi , Tan Xianhua
Published: October 2024

Background: Current treatment guidelines and expert consensus are controversial regarding the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) during acute progression of acute myocardial infarction (AMI) .Therefore, we conducted a systematic review and meta-analysis to evaluate the impact of SGLT2i on AMI , and safety outcomes in patients.
Methods: PubMed, Web of Science, Embase, China Science and Technology Journal Database, Wan fang Database and China National Knowledge Infrastructure Database were searched for clinical trials from database establishment to December 31，2023 with no language restrictions. The risk of bias was evaluated by Collaboration Handbook. Review Manager (version 5.3) were used for meta-analysis.
Results: A total of nine articles including 16083 patients were included. In patients with AMI, SGLT2i reduced the risk of the cardiovascular-death (RR 0.64, 95% CI 0.53–0.78, P<0.0001, I2=32% for the heterogeneity), hospitalization rate for heart failure (RR 0.69, 95% CI 0.53–0.90, P=0.006), arrhythmia (RR 0.53, 95% CI 0.33–0.86, P=0.009).
No significant differences were observed between the two groups with regard to all-cause deaths(RR 0.72, 95% CI 0.51–1.01, P=0.06), recurrence rate of myocardial infarction(RR 0.94, 95% CI 0.80–1.10, P=0.43), unplanned revascularization rate(RR 1.10, 95% CI 0.74–1.65, P=0.63)，and with similar risks of adverse events(RR 0.61, 95% CI 0.32–1.16, P=0.13)( such as acute kidney injury was lower than that of control group, genital infection was higher than that of control group).
Conclusions: This meta-analysis of patients with AMI showed that SGLT2i significantly reduce the risk of cardiovascular death , hospitalization and arrhythmia for AMI, but not recurrence rate of myocardial infarction, unplanned revascularization rate and all-cause death. Therefore, given that SGLT2i may reduce the risk of hospitalization and cardiovascular death for AMI, they should be considered the fundamental treatment for all patients with AMI.
Comorbidity Patterns and Healthcare Resource Utilization in COPD Patients: A Retrospective Analysis Using Association Rules
Authors: Cheng Zhuozhuo , Zhang Rui , Xu Haofeng , Huang Junting , Liang Zijing , Yan Ping
Published: October 2024

Background
Patients with chronic obstructive pulmonary disease (COPD) frequently present with multiple concurrent chronic diseases, which has a profound impact on their quality of life. At present, there is a paucity of research investigating the interrelationships between COPD and comorbidities. Furthermore, there is a dearth of systematic and comprehensive studies in this area.
Methods
The data were extracted from the discharge summaries of patients whose primary diagnosis was COPD (ICD-10: J44). The 15 most frequent comorbidities in patients’ other diagnoses were identified, and the association rule mining (ARM) method with the apriori algorithm was then employed to derive comorbidity combinations associated with length of stay (LOS) and antimicrobial drug costs.
Results
The study encompassed data from 2,159 patients. The five most prevalent comorbidities were other respiratory diseases (41.69%), hypertension (31.91%), liver diseases (25.34%), heart diseases (20.84%), and arrhythmia (15.05%). Some comorbidity combinations identified by ARM were found to be significantly associated with longer LOS of at least seven days. Conversely, some were associated with higher antimicrobial drug costs. The combination of diabetes, heart disease, other respiratory disease, and hypertension demonstrated the strongest association with longer LOS (adjusted OR (aOR): The odds ratio was 3.03 (95% CI: 1.03–8.88). The combination of diabetes, other respiratory diseases and hypertension was associated with higher antimicrobial drug costs, amounting to a minimum of 400 RMB (aOR: 2.63, 95% CI: 1.31–5.31).
Conclusion
Other respiratory diseases and hypertension were among the most frequently reported comorbidities in patients with COPD in Guangzhou, China. It is possible that specific groups of comorbidities may contribute to a greater burden of healthcare resource utilization. Further investigation is required to elucidate the mechanisms underlying these associations and to identify potential measures to optimize the healthcare resource utilization.
The interplay between lying, sitting, standing, moving, and walking on obesity risk in older adults: A compositional and isotemporal substitution analysis
Authors: Pelclová Jana , Vindiš Jan , Jašková Paulína , Hron Karel
Published: October 2024

Introduction: Obesity in older adults is linked to various chronic conditions and decreased quality of life. Traditional physical activity guidelines often overlook the specific postures and movements that older adults engage in daily. This study aims to explore the compositional associations between posture-specific behaviours and obesity risk in younger (M = 67.35 ± 2.03 years) and older (M = 75.73 ± 4.17 years) seniors and investigate the differences in BMI associated with replacing time spent in lying, sitting and standing with moving or walking.
Methods: The study involved 309 older adults aged 65 and above from Czech Republic. Participants' movement behaviours, including lying, sitting, standing, moving, and walking, were measured using accelerometers. The data were analysed using compositional data analysis (CoDA) and isotemporal substitution models to assess the impact of reallocating time between different activities on body mass index (BMI).
Results: The younger group engaged in more overall movement (193.84 min/day vs. 172.41 min/day) and walking (92.15 min/day vs. 76.62 min/day) than the older group. Significant BMI increases were observed when 30 minutes were reallocated from movement to lying, sitting, or standing (up to +3.306 kg/m²), while reallocating the same amount of time from lying, sitting, or standing to movement led to BMI reductions (up to -2.537 kg/m²). In the older group, reallocating time from slow walking to lying or sitting led to BMI increases (up to +1.855 kg/m²), while increasing time spent slow walking at the expense of lying or sitting reduced BMI (up to -0.949 kg/m²).
Conclusions: Promoting movement and walking, particularly slow walking, is crucial in managing obesity risk in older adults. The findings emphasize the importance of reducing sedentary time and encouraging low-intensity physical activity tailored to the capabilities of seniors, especially those aged 70+, to effectively mitigate obesity risk.
Effect of a playful parenting programme on early childhood development and care outcomes of young children in vulnerable communities: Findings from a quasi-experimental study
Authors: Sargsyan Viktoria , Walea Harriet , Mahat Bal , Tamale Robert , Chaudhari Ramdhani , Birungi Janet , Marasini Sabina , Thapa Nisha , Kuikel Bihari , Karmacharya Biraj , Rasheed Muneera
Published: October 2024

Background: World Vision launched the Inclusive Playful Parenting for a Brighter Childhood (IPP4BC) project in identified vulnerable communities in Nepal and Uganda to mitigate risk for children at risk of poor development due to COVD 19. The intervention, based on the nurturing care framework, offered a customized parenting curriculum for young children, emphasizing holistic development through behavior change approaches tailored to local contexts.
Objective: To evaluate the effect of the IPP4BC project, on early childhood development (ECD) and care outcomes of children under 6 years in vulnerable communities in Nepal and Uganda, particularly those affected by the COVID-19 pandemic.
Methods: The intervention was delivered by trained facilitators over a 7-month period in different arms defined by the dosage: high (10 group sessions, 4 home visits) medium (5 group sessions, 2 home visits) or low (delivery of key messages through media) dose. An endline evaluation designed as quasi-experimental non-equivalent control groups post-test only study, assessed the effect of the project utilizing the Malawi Development Assessment Tool (MDAT) for child outcomes and the Multiple Indicator Cluster Survey (MICS) for caregiver outcomes. Additionally, an implementation survey was conducted to assess program fidelity and participant engagement.
Findings: In Nepal, higher intervention doses were associated with significantly better child development outcomes (High dose M = 1.20, SD = 2.22, Medium dose M = 1.01, SD = 1.99; Low dose M = 0.43, SD = 2.32, p < 0.001) whereas in Uganda, only medium dose (M = -0.03, SD = 1.28) showed significant improvement (High dose M = -0.30, SD = 1.30; Low dose M = -0.28, SD = 1.51, p = 0.015). A higher proportion of caregivers in both high and medium dose reported engagement with early learning practices compared to low dose. With respect to uptake, in Nepal, a higher number of families received home visits compared to group sessions, while in Uganda, more families reported attending group sessions than receiving home visits.
Conclusion: The study demonstrated that higher intervention doses were associated with better child development outcomes in Nepal and only with medium dose in Uganda, emphasizing the importance of implementation factors like dosage, quality and delivery modality in community-based interventions for improving ECD outcomes in vulnerable populations.
Using Deep Learning Neural Networks to Improve Dementia Detection: Automating Coding of the Clock-Drawing Test
Authors: Hu Mengyao , Qin Tian , Gonzalez Richard , Freedman Vicki , Zahodne Laura , Melipillan Edmundo , Murphey Yi
Published: October 2024

Alzheimer’s disease and related dementias (ADRD) is a growing public health concern. The clock-drawing test (CDT), where subjects draw a clock, typically with hands showing 11:10, has been widely used for ADRD-screening. A limitation of including CDT in large-scale studies is that the CDT requires manual coding, which could result in biases if coders interpret and implement coding rules differently. This study created and evaluated an intelligent CDT Clock Scoring system built with Deep Learning Neural Networks (DLNN) to automatically code CDT images. We used a large, publicly available repository of CDT images from the 2011–2019 National Health and Aging Trends Study (NHATS) and compared three advanced DLNN methods – ResNet101, EfficientNet and Vision Transformers (ViT) in coding CDT into binary and ordinal (0 to 5) scores. We extended beyond the traditional nominal classification approach (which does not recognize order) by introducing structured ordering into the coding system and compared DLNN-coded CDT images with manual coding. Results suggest that ViT outperforms ResNet101 and EfficientNet, as well as manual coding. The ordinal coding system has the ability to allow researchers to minimize either under- or over-estimation errors. Starting in 2022, our developed ViT-coding system has been used in NHATS’ annual CDT-coding.
Personalized Decision Making for Coronary Artery Disease Treatment using Offline Reinforcement Learning
Authors: Ghasemi Peyman , White James A. , Lee Joon
Published: October 2024

Choosing optimal revascularization strategies for patients with obstructive coronary artery disease (CAD) remains a clinical challenge. While randomized controlled trials offer population-level insights, gaps remain regarding personalized decision-making for individual patients. We applied off-policy reinforcement learning (RL) to a composite data model from 41,328 unique patients with angiography confirmed obstructive CAD. In an offline setting we estimated optimal treatment policies and evaluated these policies using weighted importance sampling. Our findings indicate that RL guided therapy decisions generally outperformed physician-based decision making, with the best RL policy achieving about a 38% improvement in expected rewards based on a composite major cardiovascular events outcome. Additionally, we introduced methods to ensure that RL CAD treatment policies remain compatible with locally achievable clinical practice models, presenting an interpretable RL policy with a limited number of states. Overall, this novel RL-based clinical decision support tool, called RL4CAD, demonstrates potential to provide clinical decision support for the optimization of care in patients with obstructive CAD referred for invasive coronary angiography.
Air in the left atrium? Right-to-left-shunts in patients scheduled for neurosurgical intervention in semi-sitting position – a literature review based on two case scenarios
Authors: Nikolic Marina , Eisner Christoph , Neumann Jan Oliver , Haux Daniel , Krieg Sandro M , Wielpütz Mark Oliver , Weigand Markus Alexander , Tochtermann Ursula , Fischer Dania
Published: October 2024

Background: Neurosurgery performed in the semi-sitting position provides advantages for certain procedures. However, this approach is associated with potential complications, particularly venous air embolism. Due to typically negative venous pressure at the wound site, air can be drawn into the veins. This risk is especially high in patients presenting with an intra- or extracardiac right-to-left-shunt. Trans-oesophageal echocardiography can be used to detect a patent foramen ovale or other possible pulmonary-systemic shunt before placing the patient in the sitting position.
Case presentation: In this report, we present two young patients undergoing scheduled microsurgical vestibular schwannoma removal in a semi-sitting position who were diagnosed with congenital heart defects due to routine preoperative assessment of possible intracardiac right-to-left shunts, using pre- and intraoperative transesophageal echocardiography (TEE) and additionally conducting an agitated saline bubble study under Valsalva manoeuvre – Patient A was diagnosed with a persistent left superior vena cava and Patient B with an unroofed coronary sinus (UCS). These findings left the anesthesiological and surgical teams confronted with rather difficult individual decisions of the further perioperative management proceeding.
Conclusions: Perioperative transesophageal echocardiography is a diagnostic tool to both detect intraoperative position-related air embolisms and to rule out intracardiac right-to-left shunts, e.g. a patent foramen ovale, in order to decide for or against a (semi-)sitting position. Depending on the surgical circumstances a semi-sitting positioning of patients presenting with an intracardiac right-to-left-shunt, e.g. a PFO, can be feasible in individual cases if there is an implemented therapeutic algorithm to immediately terminate significant venous air entry. However, since certain other intra- or extracardiac right-to-left-shunts, such as here presented PLSVC or UCS, are utterly rare, there is no definitive way of estimating the amount of entered air or even flow through detected anomalous more or less obliterated vessels. Therefore, it is recommended to avoid a (semi-)sitting positioning in favour of a lateral or prone positioning of the patient undergoing intracranial surgery once the preoperative TEE shows air bubbles in the left atrium or ventricle whose origins cannot be defined solely through TEE for certain in order to ensure patient safety by minimizing the risk of intraoperative paradoxical air embolisms.
Clinical trial number: not applicable.
Geriatric contribution to heart failure care: a retrospective review of patient records
Authors: Reimers-Wessberg Marianne , Fastbom Johan , Ugarph-Morawski Anna , Seiger Åke , Eriksdotter Maria
Published: October 2024

Background: Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment changes among patients during inpatient geriatric care for worsening of HF as well as information given to next caregiver.
Methods: Data were retrospectively collected from 134 individuals treated for heart failure (HF) as main diagnosis in wards specialized in geriatric medicine. Data on referral content, Natriuretic peptide type B(NT-pro-BNP), echocardiography (ECHO) and drug treatment as well as length of care episode and information to the next caregiver, were collected.
Results: During the investigated geriatric care episode, 20 % of the patients were analyzed for NT-pro-BNP and 2 % were investigated with ECHO. No significant changes in drug treatment with angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) or beta blockers (BB) were made, but significant increase in treatment with furosemide (55 to 83 %, p<0.001) and spironolactone (19 to 28 %, p=0.033) was observed. Five patients were at discharge treated with target doses of both ACEI/ARB and BB.
A subgroup of patients was prescribed more spironolactone during the care episode (higher dose or new prescription). These patients had more weight loss (p<0.001), longer care episodes (p=0.002) and more NT-pro-BNP assessments (p=0.008) where the longer care episode seemed to influence the increase of spironolactone most.
There was a significant wash out of information in the referrals at discharge to primary care, compared to the referrals at admission to geriatric care. Information on etiology dropped from 31.4 % to 5.8 % (p<0.001) and information on ejection fraction (EF) dropped from 19.8% to 3.5% (p<0.001).
Conclusions: The contribution by geriatric care to investigations was modest or low. During the geriatric care episode, no net changes in pharmacological treatments for heart failure were made, except for spironolactone and furosemide.
The wash out of information about the patients in referrals from geriatricians to primary care physicians is worrying. More collaboration between cardiologists, geriatricians and primary care physicians may improve the health situation among geriatric HF patients.
A novel external-fixation technique for delayed, nonreducible Gartland type III supracondylar humerus fractures in children
Authors: Gao Chao , Zhu Huan Ye , Sun Jing Hua , Zheng Hua Jiang , Wu Yong Yao , Cao Jin
Published: October 2024

Background
Percutaneous pinning is widely recognized as the gold-standard approach for managing supracondylar humerus fractures (SHFs) in pediatric patients. However, manual reduction of delayed SHFs can present significant challenges, and repeated attempts may result in iatrogenic injuries. Additionally, immobilizing the edematous elbow joint with a cast carries the risk for Compartment Syndrome. To address these concerns, we implemented a medial mini-open approach combined with external fixation.
Materials and Methods
The treatment outcomes of 32 patients treated with external fixation frames between 2015 and 2023 were analyzed. These outcomes encompassed limb alignment, elbow movement, appearance, and patient satisfaction.
Results
The resetting process was more direct in the open reduction than in the closed reduction and resulted in satisfactory reductions in all the patients, who achieved a normal or good range of motion. According to Flynn’s criteria, 30 patients showed a favorable prognosis, and 20 of them were classified as excellent. Both the patients and their parents expressed that they would choose this treatment approach again.
Conclusion
To treat delayed SHFs, utilization of medial mini-open reduction alongside external fixation appears to be a safe and efficacious approach.
Hybrid Constructed Wetlands for Tertiary Treatment of Poultry Slaughter Wastewater to Meet Quality Standards of Discharge and Reuse: A Full-Scale Case Study in Vietnam
Authors: Dang Hung Viet , Lam Huy Quoc , Nguyen Linh My
Published: October 2024

The construction and operation of a small-scale hybrid constructed wetland (HCW) system for tertiary wastewater treatment was presented. The HCW system includes a vertical sub-surface flow CW (VFCW), a horizontal sub-surface flow CW (HFCW) and a free water surface flow CW (FWSCW) operated in series had a total area of 150 m2. It received 7.5 m3/day of secondary effluent wastewater from the existing treatment system of a poultry slaughter enterprise at the production capacity of 500 ducks per day in an on-site experiment of 12 months. The results showed that the removal efficiencies of biological oxygen demand (BOD5), chemical oxygen demand (COD), total suspended solids (TSS), ammonia nitrogen (NH4+-N), nitrate nitrogen (NO3--N), total nitrogen (TN), orthophosphate (PO43--P), total phosphorus (TP), Escherichia coli (E. coli) and total coliforms (T. coli) reached average values of 76.2, 78.7, 77.1, 83.9, 86.3, 84.9, 72.3, 73.9, 98.9 and 96.4%, respectively, while the effluent concentrations of the study system complied with the most difficult limits not only for discharge into the receiving water source but also for reusing wastewater to water plants. The function made by various configurations such as a VFCW, a HFCW and a FWSCW placed sequentially in the HCW system proved crucial to treat wastewater and make it reusable.
WITHDRAWN: Analysis of the efficacy of a new device-assisted mini-incision in the treatment of carpal tunnel syndrome：a retrospective study
Authors: Guo Tianhao , Li Chenfei , Tian Dehu , Gao Ruijiao , Yu Kunlun , Sun Naichao , Yang Jing , Bai Jiangbo
Published: October 2024

This study aimed to compare the efficacy and safety of a new device-assisted mini-incision approach for carpal tunnel release (CTR) with the conventional approach. Patients with primary carpal tunnel syndrome (CTS) who underwent surgical treatment at our hospital between January 2022 and July 2023 were included. A total of 109 patients were included in our study. Of these, 54 cases in the group A underwent treatment using a new device-assisted mini-incision approach, while 55 cases in the group B underwent treatment using the conventional approach. Objective testing and subjective evaluation were performed to assess the efficacy of both groups. And postoperative complications were compared between the two approaches. At the 6-month follow-up, all patients in both groups had recovered. There were no significant differences between the two groups in postoperative pinch strength, grip strength, 2-point discrimination (2-PD), visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Boston Carpal Tunnel Questionnaire (BCTQ) (P > 0.05). Statistically significant differences were observed between the two groups in operation time, incision length and return to work time (P < 0.01). The incidence of wound pain and pillar pain was lower in Group A compared to Group B. These results suggest that patients who underwent the new device-assisted mini-incision surgery experienced satisfactory results and few postoperative complications.
Body Mass Index Changes and Predictors among Adults Living with HIV/AIDS Who Are on Anti-Retroviral Therapy at Chiro General Hospital, Eastern Ethiopia: A facility-based retrospective cohort study
Authors: Amsalu Sintayehu , Gebremichael Berhe , Wilfong Tara , Amsalu Sewmehon , Oumer Abdu
Published: October 2024

Background: Human immunodeficiency virus continues to be a major global public health issue. Body mass index is a general indicator of nutritional status and has emerged as a powerful predictor of morbidity and mortality among adult PLHIV initiating antiretroviral therapy in resource-limited settings. However, there is a dearth of information regarding longitudinal changes in body mass index and its predictors among adult PLHIV in Ethiopia, particularly in the study area. This study aimed to assess body mass index changes and their predictors among adults living with HIV/AIDS who were receiving on antiretroviral therapy at Chiro General Hospital, Eastern Ethiopia from August 15, 2023 to September 30, 2023.
Methods: A Facility-based retrospective cohort study was implemented among 1049 randomly selected charts of adults living with HIV/AIDS. The data were collected by reviewing charts of clients and antiretroviral therapy registers. The data were entered into Epi data statistical software version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics were used to describe the characteristics of the patients. A linear mixed effect model was used to identify the predictors of body mass index change. A P value of less than 0.05 was considered statistically significant.
Results: Generally, in this study patients presented a linear increase in the mean BMI from 19 kg/m2 baseline to 21.2 kg/m2 at the 5th year of follow up. Moreover, the following variables were identified as independent predictors of BMI change: age (β = 0.58, 95% CI; 0.043, 0.072), marital status (β = -0.275, 95% CI: -0.457,-0.093 ), advanced WHO stage (β = -0.496, 95% CI: -0.548, -0.443 ), CD4 count (β = 0.001, 95% CI: 0.001, 0.001), duration of antiretroviral therapy (β = 0.005, 95% CI: 0.001,0.009), time of follow up (β = 0.205, 95% CI: 0.198,0.212), no ART shift (β = -0.844, 95% CI: -1.135, -0.552), no CPT (β =0.591, 95% CI: 0.365,0.817), urban residence (β=0.767, 95% CI:0.401,1.132) and good adherence to ART (β= 0.975, CI:0.302, 1.649).
Conclusion: There was a significant improvement in the mean BMI over time and a reduction in the rate of undernutrition during the follow-up period.
Comparison of the preoperative transpapillary unilateral biliary drainage methods for the future remnant liver in patients with hilar cholangiocarcinoma
Authors: Okuno Mitsuru , Iwata Keisuke , Iwashita Takuji , Mukai Tsuyoshi , Shimojo Kota , Ohashi Yosuke , Iwasa Yuhei , Senju Akihiko , Iwata Shota , Tezuka Ryuichi , Ichikawa Hironao , Mita Naoki , Uemura Shinya , Yoshida Kensaku , Maruta Akinori , Tomita Eiichi , Yasuda Ichiro , Shimizu Masahito
Published: October 2024

Object:
Transpapillary preoperative biliary drainage (PBD) only for the future remnant liver (FRL) in hilar cholangiocarcinoma (HCCA) can be performed minimally invasively, with the expectation of swelling of the FRL. However, verification of the appropriate transpapillary unilateral PBD method for FRL is limited.
Methods:
Twelve unilateral across-the-papilla plastic stent placement cases (PS group), 14 unilateral intraductal plastic stent placement cases (IS group), and 11 unilateral endoscopic nasobiliary drainage cases (ENBD group) met the inclusion criteria. Each group was compared regarding thehospital stay duration, recurrent biliary obstruction (RBO), time to RBO (TRBO), and surgical outcomes.
Results:
No significant differences were observed in the patient characteristics between the groups. Hospital stay for the endoscopic procedure was significantly longer in the ENBD group (50[33-163]days) than in the PS group (14[2-36]days; P<0.01) or IS group (21[6-118]days; P<0.01). There were no significant differences in the RBO, TRBO, surgical time, amount of intraoperative blood loss, or post-surgical adverse events (AEs) between the groups.
Conclusions:
PS, IS, and ENBD groups showed similar clinical outcomes in liver resection cases for HCCA, excluding the hospital stay duration for the endoscopic procedure. Considering the hospital stay duration, unilateral PS and IS placement can be considered acceptable for transpapillary PBD.
Clinical Trial Registration: UMIN000052598