bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of cerebral sinus venous thrombosis and its location on cerebral blood flow: a [15O]water PET study in acute stroke patients compared to healthy volunteers
Authors: Harloff Andreas , Blazhenets Ganna , Fostitsch Johannes , Strecker Christoph , Dersch Rick , Mayerhofer Ernst , Meyer Philipp T.
Published: October 2024

Background: Symptoms in acute cerebral sinus venous thrombosis (CSVT) are highly variable, ranging from headaches to fatal stroke, and the basis for this high inter-individual variability is poorly understood. We assessed whether acute CSVT significantly alters regional cerebral blood flow (CBF), if findings differ from CBF patterns know from large-artery occlusion in stroke, and whether the pattern of CBF alterations depends on clot location.
Results: Retrospective analysis of 12 patients with acute CSVT 10.6 ± 4.6 days after symptom onset and ten healthy volunteers who underwent [15O]water PET (two scans each, 300 ± 14 MBq [15O]water). Static image datasets (15-75 seconds after injection; normalized to cerebellum) reflecting relative CBF (rCBF) were analyzed using voxel- and region-of-interest-based analysis (AAL3-atlas). We mirrored datasets of patients with left-sided CSVT to harmonize the affected hemisphere.
Seven and five patients showed right- and left-sided CSVT, respectively. The superior sagittal sinus (SSS) was involved in 8/12 patients. CSVT patients had extensive rCBF deficits in the voxel-based analysis with accentuation in the right frontal cortex and caudate nucleus compared to controls, which were most pronounced in cortical areas in those with involvement of the SSS (8/12), and in subcortical areas in those without involvement of the SSS (4/12; p<0.05, false discovery rate corrected). ROI-analysis demonstrated significant frontal (p=0.014) and caudate nucleus (p=0.011) rCBF deficits driven by patients with and without SSS occlusion, respectively.
Conclusions: [15O]water PET was able to visualize characteristic patterns of impaired rCBF, which were different from intracranial large-artery occlusion in acute ischemic stroke, and exhibited substantial rCBF alterations depending on the involvement of the SSS. Our findings provide novel insights into the effects of disturbed venous drainage on CBF in acute CSVT, which may aid in understanding the pathophysiology, and guide future therapy of acute CSVT.
Multiple Machine Learning Methods Identified RRAGD as Novel Biomarkers for Hepatocellular Carcinoma and Liver Cirrhosis
Authors: Meng Hang , Li Ziqiang , Sun Yong , Song Bangyin , Song Tao , Zhai Jing , Li Bo , Zou Weilong
Published: October 2024

Background
Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide, usually developing from cirrhosis. Distinguishing biomarkers between HCC and liver cirrhosis is crucial and limited. Disulfidptosis is a recently discovered form of cell death, and it has important prognostic value for various tumors. The mechanism of disulfidptosis in HCC and liver cirrhosis is still unclear
Methods
RNA sequencing data and single-cell sequencing data related to HCC and liver cirrhosis were applied for high dimensional weighted gene co-expression network analysis (hdWGCNA) and Weighted co-expression network analysis (WGCNA) methods. These methods were used for analysis of disulfidptosis related to HCC and liver cirrhosis. A diagnostic model was constructed based on machine learning. Moreover, in vitro assays demonstrated the influence of RRAGD on disulfidptosis of HCC cells.
Results
Applying machine learning methods, we found 7 disulfidptosis-related genes in HCC and liver cirrhosis, including FXN, HSPA1A, AGPAT2, CCND1, RRAGD, SUSD4 and DKK4. These disulfidptosis-related genes in HCC and liver cirrhosis may be used for diagnosis of HCC and liver cirrhosis. RRAGD was significantly up-regulated in both HepG2 and Huh7 cells. RRAGD knockdown induced disulfidptosis of HCC cells under glucose starvation and SLC7A11 overexpression.
Conclusion
Multiplex analysis based on DRGs correlated strongly with HCC and liver cirrhosis, providing new insights for developing clinical diagnosis tools and designing immunotherapy regimens for HCC and liver cirrhosis patients.
The Association between Surgical Margins and Local Recurrence in Women with ductal carcinoma in situ treated with Breast Conserving Therapy: observational study
Authors: Naowaset Puttiporn
Published: October 2024

Introduction
The incidence of DCIS (DCIS) constitutes 25% of the newly identified breast cancers. Approximately 35% of DCIS cases are detected in asymptomatic women during routine mammography screening. The 20-year breast-cancer-specific mortality rate was 3.3%. Breast-conserving surgery(BCS), followed by radiotherapy, is the treatment of choice. However, an adequate margin for BCS remains unclear. Therefore, we need to investigate the relationship between the margin distance and cancer recurrence.
Methods
A total of 4,355 patients with DCIS were assessed between January 1, 2010, and January 31, 2020. Of these, 4,123 patients who had invasive ductal carcinomaco-existing DCIS and who were treated with mastectomy were excluded. Thus, 232 patients with pure DCIS treated with BCS were included. All distant radial margins were measured.
Results
A total of 232 patients with DCIS underwent breast-conserving surgery,169 patients received whole breast radiotherapy, and 63 did not. Most patients received hormone therapy, and as indicated, the median follow-up was 73 months.
Recurrence was observed in seven patients. Among them, four had margins less than 2 mm, while the others had margins > 2 mm. There were no significant differences in disease-free survival (DFS) among the margin statuses.
Conclusion
Margins wider than 2 mm did not demonstrate a reduction in local recurrence for women receiving adjuvant whole-breast radiation therapy, supporting the recommendation of a negative margin threshold for surgical management of DCIS.
30-Days Spirometry Holter - method design and prospective, observational study
Authors: Korczyński Piotr , Basza Mikołaj , Górska Katarzyna , Soliński Mateusz , Dąbrowiecki Piotr , Kowalczyk Weronika , Kołtowski Łukasz
Published: October 2024

Background
Asthma underdiagnosis and overdiagnosis remain significant problems for healthcare systems worldwide and indicate considerable pain points with current guidelines and diagnostic methods; therefore, new, targeted approaches seem crucial. This study introduces a novel spirometry-based approach using digital tools for objective asthma diagnosis.
Methods
This was a single-centre (Warsaw Medical University, Poland), prospective cohort study. It included adults with suspected asthma per GINA 2020, without confirmed obstruction in ambulatory spirometry. Patients were equipped and trained with a portable spirometer with built-in manoeuvre quality features AioCare® (HealthUp, Poland). The protocol included twice-daily spirometry examinations over four weeks and symptom reporting in the mobile app. The number of obstructions detected, probability of finding obstruction over time, spirometry values' variability, technical correctness, and reported symptoms were evaluated.
Results
26 patients enrolled (14 females, mean age 37.6 y.o., BMI 24.7 kg/m^2), with a primary outcome of observed obstruction in 42% of participants (3,08 per patient, 95%CI: 0.78–5.37). The detection probability of obstruction plateaued at 100% within the first 21 days of monitoring. Diurnal PEF and FEV1 variability were exceeded (≥ 10%) in 73% and 66% of patients, respectively. 88% of participants performed over half of their tests correctly. 85% of patients reported symptoms at least once.
Conclusions
The Spirometry Holter is a novel and feasible tool for monitoring airway limitation variability in line with GINA guidelines. It shows promise in objectively confirming asthma diagnoses in treatment-naive patients lacking documented prior obstruction.
Initial Experience of Single-port Robotic assisted Laparoscopic Ureteroureterostomy In Infant Duplex Systems with Upper Urinary Tract
Authors: Guo Yunkai , Gao Heyun , Zhang Wen , Li Geng , Hu Tao , Du Guowei , Liu Yifan , Yang Kun , Yu Shanzhen , Luo Mingshuang , Qin Zhenfang
Published: October 2024

Purpose Robotic assisted laparoscopic single port surgery (R-LSPS) has attracted more and more attention as its safety and stably function, and the patients demand for less scars after surgery. Due to the limitation of operating space in infant, there is no report about R-LSPS ureteroureterostomy before. We present the experience of R-LSPS ureteroureterostomy by Da Vinci Xi in 5 infant.
Methods The clinical data of 5 infants of duplex kidney with upper urinary tract treated by R-LSPS ureteroureterostomy were collected from December 2021 to December 2023. All cases were female, aged 0.8-3.2 months (mean age 1.6± 1.0 months). The body measurements, operation time, bleeding loss, complications, length of hospitalization and other indexes were recorded. Doppler ultrasound, urine routine and urine culture were regularly rechecked after operation. The follow-up time was 6-29 months.
Results The operation were done with the DaVinci Xi system. We made a 2.5-3cm incision at the lower edge of the umbilicus, inserted the a Gelport™ device without use of additional ports. Median operation time was 124.4±21.8min, median hospital stay time was 7.6±2.7 days (D), median bleeding volume was 9.0±4.2 ml. One infant had urine leak, with the sufficient drainage, the drainage tube was removed on the 8th day after surgery, on postoperative follow-up there was no ureteral stenosis. There were no complications observed on follow-up. Wounds recovered well at follow-up.
Conclusion R-LSPS ureteroureterostomy is safe and feasible in infant duplex systems with upper urinary tract.
Compartmentalised mucosal and blood immunity to SARS-CoV-2 associated with high seroprevalence before Delta wave in Africa
Authors: JAGNE YA JANKEY , Jobe Dawda , Darboe Alansana , Danso Madikoi , Barratt Natalie , Gomez Marie , Wenlock Rhys , Jarju Sheikh , Sylva Ellen , Touray Aji Fatou , Toure Fatoumata , Kumado Michelle , Saso Anja , Zafred Domen , Nicklin Martin , Sayers Jon , Hornsby Hailey , Lindsey Benjamin , Sesay Abdul , Temperton Nigel James , Kucharski Adam , Hodgson David , de Silva Thushan , Kampmann Beate
Published: October 2024

Background
The reported number of SARS-CoV-2 cases and deaths are lower in Africa compared to many high-income countries. However, in African cohorts, detailed characterisation of SARS-CoV-2 mucosal and T cell immunity are limited. We assessed SARS-CoV-2-specific immune landscape in The Gambia pre-Delta variant in July 2021.
Methods
A cross-sectional assessment of SARS-CoV-2 immunity in 349 unvaccinated individuals from 52 Gambian households was performed between March - June 2021. SARS-CoV-2 spike (S) and nucleocapsid (N) specific binding antibodies were measured by ELISA, variant-specific serum neutralizing-antibodies (NAb) by viral pseudotype assays and nasal fluid IgA by mesoscale discovery assay. SARS-CoV-2 T-cell responses were evaluated using ELISpot assay.
Results
We show that adjusted seroprevalence of anti-Spike antibodies was 56.7% (95% confidence interval (CI) 49.0–64.0), which was lower in children < 5 years (26.2%, 13.9–43.8) and 5–17 years (46.4%, 36.2–56.7) compared to adults 18–49 years (78.4%, 68.8–85.8). In spike-seropositive individuals, NAb titres were highest to Alpha variant (median IC50 110), with 27% showing pre-existing Delta variant titres > 1:50. Whilst T-cell responses were significantly higher in spike-seropositive individuals, 34% of spike-seronegative showed reactivity to one or more T-cell antigen pools. Strong correlations within SARS-CoV-2 T-cell, mucosal IgA, and serum NAb responses was observed.
Conclusion
High SARS-CoV-2 seroprevalence in The-Gambia induced mucosal and blood immunity, reducing Delta and Omicron impact. Children were relatively protected from infection. T-cell responses in seronegative individuals may indicate either pre-pandemic cross-reactivity or individuals with a T-cell dominated response to SARS-CoV-2 infection with absent or poor humoral responses.
Hasselt Corona Impact Study: Impact of COVID-19 on healthcare seeking in a small Dutch town
Authors: Veldman Carlijn , Gijssel Erik A. Van , Rooij Annelot H. Van , Buitenhuis Lonneke , Berg Jan Willem K. Van den , Blanker Marco H.
Published: October 2024

Introduction
We explored reasons for healthcare avoidance during the first COVID-19 wave in a region with high infection rates.
Methods
We conducted a mixed-method study using primary care electronic health records (n=5,980), questionnaires (n=2,361), semi-structured interviews (n=12), and an AI model to identify COVID-19 patients in a Dutch small town.
Results
Of 2,391 respondents (39% response rate), 535 (23%) reported COVID-19-related symptoms. Of these, 180 sought help, mostly from their GP. The care-seeking rate did not differ significantly between those with or without relatives who experienced severe illness or death before their own illness (p=0.270). Interviews revealed that the primary reason for not seeking help was the perception of not being ill enough and the overstressed healthcare system, especially GP services.
Conclusion
Only a third of participants with symptoms sought help, mostly from GPs. No significant difference in seeking healthcare was related to the serious illness or death of loved ones.
A Phase I Study of MLN4924 and Belinostat in Relapsed/Refractory Acute Myeloid Leukemia or Myelodysplastic Syndrome
Authors: Maher Keri , Shafer Danielle , Schaar Dale , Bandyopadhyay Dipankar , Deng Xiaoyan , Wright John , Piekarz Richard , Rudek Michelle A. , Harvey R. Donald , Grant Steven
Published: October 2024

Purpose:
Relapsed and/or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome continue to have a poor prognosis with limited treatment options despite advancements in rational combination and targeted therapies. Belinostat (an HDAC inhibitor) and Pevonedistat (a NEDD8 inhibitor) have each been independently studied in hematologic malignancies and have tolerable safety profiles with limited single-agent activity. Preclinical studies in AML cell lines and primary AML cells show the combination to be highly synergistic, particularly in high-risk phenotypes such as p53 mutant and FLT-3-ITD positive cells. Here, we present the safety, pharmacokinetics and pharmacodynamics of belinostat and pevonedistat in a dose escalation Phase I study in AML and High-Risk MDS.
Methods:
Eighteen patients (16 with AML, 2 with MDS) were treated at 5 dose levels (belinostat 800-1000mg/m2, pevonedistat 20-50mg/m2). Safety and tolerability were assessed according to protocol defined dose limiting toxicities (DLTs). Correlative pharmacokinetic and pharmacodynamic analyses were performed.
Results:
No dose limiting toxicities were noted. Most Grade 3 or 4 toxicities were hematologic in nature. The best response was stable disease in four patients, and complete remission in one patient who qualified as an exceptional responder. Pharmakokinetic studies revealed no association between drug exposure and best response. Pharmacodynamic RT-PCR studies demonstrated post-treatment increases in several proteins, including quantitative increases in the oxidative stress protein NQO1, ferroptosis protein SLC7A11, and GSR, linked to glutathione metabolism and oxidative stress, as did the anti-oxidants SRXN1 and TXNRD1.
Conclusions:
Patterns of post-treatment changes in correlative pharmacodynamic parameters may suggest possible mechanistic changes in the DNA damage response, oxidative damage, and ferroptosis pathways. The combination of pevonedistat plus belinosat is safe in an adult relapsed and/or refractory AML/High-Risk MDS population with modest but notable activity in this heavily treated, high risk population. Our findings also raise the possibility that certain extremely poor prognosis AML patients may respond to a regimen combining two targeted agents that have little or no activity when administered individually.
Trial Registration:
ClinicalTrials.gov ID NCT03772925, first posted 12/12/2018; CTEP Identifier 10246
Adjuvant chemotherapy in T1a/bN0 breast cancer with a high 21-Gene Recurrence Score (>25): A 10-year follow-up in a real-world cohort
Authors: Katz Daniela , Feldhamer Ilan , Goldvaser Hadar , Hammerman Ariel , Goldstein Daniel
Published: October 2024

Background
In ER+/HER2- early breast cancer (BC), a 21-Gene Recurrence Score (RS) > 25 indicates a high-risk of distant-recurrence and a predictes benefit from adjuvant chemotherapy (aCT), independent of tumor size. However, T1a/b (≤ 1cm) node negative (N0) tumors, that are usually regarded clinically as of very low risk of recurrence, are under-represented in trials validating the prediction role of RS testing. We therefore aimed to investigate the benefit of aCT in patients with T1a/bN0 BC and RS > 25, where clinical and genomic risk indicators are discordant.
Methods
The study cohort included all patients with T1a/bN0 ER+/HER2- BC with RS > 25, tested within Clalit Health Services (CHS), Israel’s largest healthcare provider, between February 2006 and December 2019. Demographic, clinicopathological and treatment data were extracted from the CHS centralized registry. Patients who received aCT were matched 1:1 by propensity-scoring to patients receiving no aCT. Invasive disease-free survival (iDFS) events and freedom from iDFS were primary endpoints. Distant-recurrences and freedom from distant-recurrence were the secondary endpoints. Kaplan-Meier analysis with log-rank test was used for comparing the study outcomes.
Results
Among 9858 CHS patients tested for RS during the study period 156 met the inclusion criteria. aCT was administered to 74 (47.4%) patients. Median follow-up was 121.0 months (95% CI, 108.4 -133.6). Within the 148 matched-cases, eighteen iDFS events occurred, nine (12.1%) in each treatment group (χ2 = 0.72, p = 0.39). Four (5.4%) of the aCT treated and three (4.0%) of the untreated patients were diagnosed with a distant recurrence (\(\:\chi\:2=0.22,\:\)p=0.64).
Conclusions
In our cohort, with a mean follow-up of 10-years, patients with T1a/bN0 BC and RS > 25, did not show improved iDFS with aCT compared to those who did not receive aCT. The 21 Gene Recurrence Score (RS) > 25 was not predictive of iDFS, possibly due to the low number of events observed.
Effects of Adjuvant Dexmedetomidine in Dorsal Penile Block for Penile Prosthesis Implantation
Authors: Sugiyama Kikuye , Swanton Amanda , Shah Tejash , Reissmann Molly , Canelli Robert , Munarriz Ricardo
Published: October 2024

Inflatable penile prosthesis (IPP) surgery is the gold standard treatment for medication-refractory erectile dysfunction. While satisfaction rates are high, post-operative pain and narcotic requirement remain a concern. Intraoperative dorsal penile nerve block (DPNB) with long-acting local anesthetic can improve analgesia. Recent studies on peripheral nerve blocks in other fields have demonstrated prolonged analgesia and minimal adverse effects with blocks containing local anesthetic and dexmedetomidine. This retrospective study aimed to evaluate the effect of DPNB for IPP surgery with and without dexmedetomidine on postoperative analgesia. This is a single institution retrospective IRB-approved study of patients undergoing IPP surgery with preoperative DPNB and without dexmedetomidine. The DPNB used in the 2019 control group utilized 0.25% bupivacaine, while the 2020–2021 intervention group also included 70 µg dexmedetomidine. The primary outcome was pain scores at post-operative hours 0, 2, 6, 12, 18, and 24, while secondary outcomes were intraoperative and postoperative narcotic use, intraoperative hypotension (IOH), (MAP < 60 for > 5 minutes or requiring intervention), and intraoperative bradycardia, (HR < 50 for > 1 minute). 98 patients met inclusion criteria, 32 in the control group and 66 in the intervention group. 24-hour pain scores were significantly lower in the intervention group (1.1 vs 3.8, 1.6 vs 3.9, 3.1 vs 4.9, 2.4 vs 4.3, 2.9 vs 5.3, 2.3 µg vs 4.4 µg; p < 0.05). Postoperative narcotic requirement was lower for the intervention group (46 vs 65, P < 0.05). Adverse effects (IOH and bradycardia) occurred in 16 intervention cases, each mild and brief. Intraoperative DPNB with local anesthetic and dexmedetomidine can safely improve immediate post-operative analgesia and decrease opioid consumption in the first 24 hours. This type of combination DPNB may be useful for other penile and scrotal surgeries, requiring prospective randomized study.
TYMS overexpression is frequent and linked to grade progression in urothelial bladder cancer
Authors: Plage Henning , Hofbauer Sebastian , Furlano Kira , Weinberger Sarah , Roßner Florian , Schallenberg Simon , Elezkurtaj Sefer , Frericks Adrian , Lennartz Maximilian , Marx Andreas Holger , Samtleben Henrik , Fisch Margit , Rink Michael , Slojewski Marcin , Kaczmarek Krystian , Ecke Thorsten , Klatte Tobias , Koch Stefan , Simon Ronald , Sauter Guido , Zecha Henrik , Weischenfeldt Joachim , Minner Sarah , Horst David , Schlomm Thorsten , Kluth Martina
Published: October 2024

Purpose:
While elevated Thymidylate synthase (TYMS) levels are observed in many cancers, its specific role in bladder cancer remains unclear. This study aims to clarify its activity in a large tumor cohort.
Methods:
A tissue microarray (TMA) containing over 2,700 bladder tumors was analyzed using immunohistochemistry and fluorescence in-situ hybridization (FISH) to assess TYMS expression and gene amplification.
Results:
TMYS immunostaining was detectable in 83.1% of 1,799 analyzable bladder cancers. The fraction of cancers with moderate to strong TMYS positivity increased markedly from pTaG2 low (6.5%) to pTaG2 high grade (20.7%), and pTaG3 cancers (29.0%; p < 0.0001). There was also a significant increase of moderate to strong staining from pTa to advanced stage pT2-4 cancers (pTa 13.2% vs. pT2-4 32.9% p < 0.0001). In muscle-invasive cancers, the frequency of TMYS immunostaining increased with tumor grade (p = 0.0007), but there was no association between TYMS expression and patient prognosis (p = 0.4365). TYMS amplification was found in 3.1% of 1,775 analyzable bladder cancers. TYMS amplification increased from pTa (0.6%) to pT2-4 (3.7%; p < 0.0001), but in muscle invasive-cancers TYMS copy number alterations were unrelated to tumor phenotype and patient prognosis. Strong TYMS positivity was significantly associated with TYMS amplification (p = 0.0096) but only a subset (28.6%) of amplified cancers showed a strong TMYS staining and only 7.2% of cancers with strong TYMS expression had a TYMS amplification.
Conclusion:
TYMS overexpression plays a role in early bladder cancer development and grade progression, but its expression is largely unrelated to the disease course in muscle-invasive cancers. Gene amplification is not the primary driver of TYMS protein overexpression.
Laser ablation for bronchial stone induced airway stenosis: a case report
Authors: Wang Huipeng , Zhang Xiangwu , Pu Wei , Tian Tinggeng , Chen Wanling
Published: October 2024

Broncholithiasis is the presence of calcified substances in the bronchus, usually accompanied by symptoms that cause severe airway irritation or obstruction[1]. Bronchopolithiasis is a rare disease that is most common in areas where tuberculosis and histoplasmosis are prevalent. There are currently no clear guidelines on the treatment options for patients with bronchopolithiasis[3]. We treated a patient with central airway obstruction due to bronchial calculus and tumour growth with remarkable results. The course of treatment is reported as follows.
Outcome and complication following single-staged posterior minimally invasive surgery in adult spinal deformity
Authors: Yeh Chun , Hsiao Pang-Hsuan , Chen Hsien-Te , Chen Michael Jian-Wen , Lo Yuan-Shun , Tseng Chun , Lin Chia-Yu , Li Ling-Yi , Lai Chien-Ying , Chang Chien-Chun
Published: October 2024

Background: The aging population is experiencing a rising incidence of musculoskeletal problems and degenerative spinal deformities. Adult spinal deformity (ASD) presents challenges, with associated risks in open surgery. Minimally invasive surgery (MIS) is becoming increasingly popular due to its positive outcomes and potential benefits. This study aimed to explore the clinical outcome and complications of posterior approach MIS in patients with ASD.
Methods: We conducted a retrospective analysis of patients with adult spinal deformity who underwent posterior minimally invasive surgery. 46 patients meeting the criteria were identified between June 2017 and September 2023. Comprehensive data, including demographic information, surgical details, full-length radiographic measurements, and visual analog pain score (VAS) were gathered both before and after the surgery, as well as at the final follow-up.
Results: Totally 46 patients were included. The mean age was 68.58 years, with a minimum follow-up period of 6 months. The mean operative time was 327 min and blood loss were 307 ml. Pre-operative radiographic outcomes were as follows: Coronal Cobb angle, 18.60±11.35°; Lumbar lordosis (LL), 22.79±21.87°; pelvic incidence (PI), 53.05±14.13°; PI-LL mismatch, 30.26±23.48°; pelvic tilt (PT), 32.53±10.38°; T1 pelvic angle (TPA), 31.91±12.39°; and sagittal vertical axis (SVA), 77.77±60.47mm. At the final follow-up, coronal Cobb angle was 10.08±6.47° (𝑃<0.0001), LL was 26.16±16.92° (𝑃 = 0.4293), PI was 54.17±12.13° (𝑃= 0.6965), PI-LL mismatch was 28.00±17.03° (𝑃 = 0.6144), PT was 27.74±10.24° (𝑃= 0.0345), TPA was 25.10±10.95 (𝑃 = 0.0090) and SVA was 47.91±46.94 mm (𝑃= 0.0129). The mean Oswestry Disability Index (ODI) and VAS scores for back pain at baseline and at last follow-up were 34.9 to 23.6 and 8.4 to 3.4, respectively. The occurrence of complications related to surgery is 39.1%, associated with 4.3% low reoperation rate.
Conclusion: Single-staged posterior MIS effectively corrects global alignment in adult spinal deformities, satisfying patient demand and yielding positive clinical outcome with low re-operation rate.
Obstetric Violence and its Associated Factors Among Women Attending Intrapartum Care at Public Health Facilities of Addis Ababa, 2023.
Authors: Ayele Ermias Getaneh , Jember Dessalegn Abebaw
Published: October 2024

BACKGROUND: -Intrapartum violence and abuse create psychological distance between women and care providers and then drive women away from formal health care systems in fear of being subjected to such violence; these violence and abuses are sometimes more prominent hindrances than geographical or financial barriers to maternal health service utilization.
OBJECTIVE: This study aimed to assess the prevalence of obstetric violence and its associated factors among women receiving intrapartum care at public hospitals in Addis Ababa, Ethiopia,2023.
METHODS: An institution-based cross-sectional study was conducted at six hospitals in Addis Ababa, Ethiopia. A total of 423 postpartum mothers were included in this study. Study participants selected using systematic random sampling. An interviewer-administered questionnaire was used to obtain necessary information on the sociodemographic characteristics of the participants, health system-related factors, obstetric-related factors and intrapartum obstetric violence-related questions. To maintain data quality, a pretest was administered at another site, and the data were checked for completeness, cleaned and entered into Epi-Data version 3.1 and exported into SPSS version 25 for analysis. The descriptive part was presented in tables and figures. A bivariable binary logistic regression was used to identify potential candidate variables (p<0.25) for multivariable binary logistic regression analysis. Basic assumptions for binary logistic regression were made, and model fitness was checked before running multiple binary logistic regression analyses. To control for potential confounding variables, multiple binary logistic regression analyses were performed, and the regression results are presented as the mean odds ratio (COR) and AOR with 95% CI, with a p value less than 0.05 indicating statistical significance.
RESULTS: The magnitude of intrapartum obstetric violence was 56.5%. The findings of the study showed that age (AOR: 6.4, 95% CI (2.76, 14.89), occupation (AOR: .15895% CI (.072, 346), number of ANC visits (AOR: 7.2095% CI (2.66, 19.52), duration of hospitalization at HFs (AOR: 6.57, 95% CI (2.95, 14.64), duration of assisted delivery (AOR: .424, .227, .791), and sex of health professionals who attended (AOR: 2.14, 95% CI (1.07, 1.28)) were factors associated with intrapartum obstetric violence.
CONCLUSION AND RECOMMENDATION: The magnitude of intrapartum violence was high. Any responsible body should intervene in these factors.
Epidemiologic sequential analysis of pure red blood cell aplasia and T-cell large granular lymphocyte leukemia in Korea
Authors: Park Sooyong , Kim Hyun Kyung
Published: October 2024

Pure red cell aplasia (PRCA) is a rare hematologic syndrome characterized by anemia with marked reticulocytopenia and, in Asia, is often accompanied by T-cell large granular lymphocyte leukemia (T-LGL). Minimal research has been done on the epidemiology and sequential events of PRCA combined with T-LGL. This study identified 2801 PRCA and 840 T-LGL patients by using big data of the National Health Insurance Service between 2003 and 2022. The average annual crude incidence of PRCA was 2.77 per million and remained largely unchanged over the 20 year period. The average annual crude incidence of T-LGL was 0.82 per million with an increasing trend over the same 20 year period. This attribute is a consideration for increasing accessibility of several T-LGL diagnostic tests. The average age for PRCA and T-LGL onset in increased over the study period. Associated PRCA conditions are rheumatic diseases (10.5%), thymoma (4.7%), parvovirus infection (1.0%), inflammatory bowel diseases (0.8%), T-LGL (0.6%) and no specific cause (82.4%). Interestingly, among patients with PRCA and T-LGL, the critical sequence of events was the previous PRCA diagnosis followed by T-LGL diagnosis. This suggests that PRCA is initially caused by autoreactive T cells which suppress erythropoiesis and sequentially evolve into clonal T cell proliferation and, eventually, T-LGL occurrence. The annual incidence and age of onset in PRCA and T-LGL are affected by an aging society and clinical availability of diagnostic tests. Further study should identify the causal relationship of PRCA diagnosis followed by T-LGL diagnosis.
A giant congenital epiglottic cyst in a neonate: a case report
Authors: Deng Xiao , Diao Min , Zhou Jieshu
Published: October 2024

Congenital epiglottic cyst is a rare disease, but a recognized cause of upper airway obstruction in neonates and infants. Airway management of large epiglottic cysts in newborns may be challenging, since the patients are at risk of severe airway obstruction and death. We reported a case of difficult intubation in a neonate with a giant congenital epiglottic cyst and shared a reliable approach for a better view of the glottis and successful intubation.
Ectopic Rathke's Cyst With Xanthogranuloma Change: Case Report
Authors: Chen Zi , Fan Ye , Zhang Wei , Lu Wen-biao
Published: October 2024

A 52-year-old woman presented with a rare case of ectopic Rathke's cleft cyst with xanthomatous change, presenting as diplopia, easy falls, and progressive aggravation. Head CT and MRI scans revealed a mass in the right cerebellopontine angle area, prepontine cistern, and right parasellar region. The patient underwent surgical intervention. The lesions were cystic with thick capsules and septations, containing a viscous mixture of yellowish-brown liquid and solid components. Histopathological examination confirmed a single layer of columnar to cuboidal epithelium lining the cyst wall in the xanthogranulomatous lesion, supporting the diagnosis of Rathke's cleft cyst with xanthogranulomatous changes. The association of xanthogranuloma with ectopic Rathke cleft cyst has not been previously documented, and the underlying mechanism remains unclear. It is hypothesized that inflammatory stimulation from the rupture of the ectopic Rathke cleft cyst may lead to the development of xanthogranuloma.
Elevated Neuron Spesific Enolase Levels in Post-traumatic Stress Disorder
Authors: UYSAL Melike , CEYLAN Mehmet Fatih , HESAPÇIOĞLU Selma TURAL
Published: October 2024

Neuron spesific enolase (NSE) is a biomarker indicative neuronal cell damage. The aim of this study is to assess the NSE levels in patients diagnosed with post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). Blood samples were collected from 43 individuals with PTSD (age range: 11–17), 43 individuals with MDD (age range: 10–17), and 40 age- and gender-matched healthy controls. The NSE levels were analyzed, and participants completed the Post-traumatic Stress Reaction Index, the Children's Depression Inventory, and the Screen for Child Anxiety Related Disorders. Additionally, the Clinical Global Impressions Scale was filled out by the researcher. Results indicated that the NSE levels in the PTSD group were significantly higher than those in both the MDD group and the healthy control group. No significant difference in NSE levels was observed between the MDD group and the healthy control group. The elevated NSE levels in the PTSD group suggest a potential association with neuronal pathology development following severe stress. The lack of significant difference in NSE levels between the MDD and control groups suggests that trauma may have a more pronounced impact on neuronal structures. These findings contribute to the existing literature on the biological effects of PTSD and MDD.
Near zero treatment gap for schizophrenia: Can it be reality in rural India?
Authors: Kalaivanan Rakesh Chander , Channaveerachari Naveen Kumar , Gowda Swetha , Kudumallige K Suresha , M Harisha D , Patley Rahul , Philip Sharad , Varshney Prateek , Basavaraju Vinay , Narayana Manjunatha , Math Suresh Bada , Thirthalli Jagadisha
Published: October 2024

Background: Treatment gap is a key indicator of adequacy of mental health services that drives policies and financial allocation for the sector. Impact of public health interventions on this gap is sparsely studied.
Methods: To demonstrate reduction in treatment gap for Schizophrenia in rural south Indian setting following a community intervention program running in two taluks of Karnataka, India (Thirthahalli and Turuvekere) between July 2018 and February 2019. Population based sampling of persons with Schizophrenia who consented were included and subjects who migrated, died, had changed/other diagnosis, did not consent were excluded Prevalence was measured by adding already existing cases with the ones identified by way of house-to-house survey, conducted by trained Accredited Social Health Activists (ASHAs). Screen-positives were further scrutinized by research social workers and psychiatrists to confirm the diagnosis. Gap was calculated by noting difference between target population and ones who had not contacted any service even once for psychiatric treatment.
Results: In Thirthahalli, out of 364 patients, 14 had not contacted any service even once, pegging the gap at 3.84%. In Turuvekere, out of 236 cases, 29 had not contacted, pegging the gap at 12.28%. Overall, 7.16% was the gap in both taluks. For the taluk of Thirthahalli, the previous treatment gap was measured as 58% for Schizophrenia in 2009 by the authors; thus, reducing it by almost 54% over one and a half decade of this intervention.
Conclusion: Meaningful reduction of gap for schizophrenia is a feasible target. Policies commensurate with this aim should be considered.
LAT4 drives Temozolomide induced radiotherapy resistance in glioblastoma by enhancing mTOR pathway activation
Authors: Zang Wenrui , Liu Yangwu , Zheng Jiajun , Chen Lei , Li Chiyang , Zhao Jiakun , Zhou Qiang , Wang Zhenyuan , Cao Yongfu , Zhang Wanling , Li Junjie , Lu Yuntao
Published: October 2024

Background
As the strong adaptive radio-chemoresistance, GBM represents the worst prognosis form of primary malignant tumor within the central nervous system. Previous researches indistinctly focused on the mechanisms of resistance to X-ray or chemo regimen in isolation, however, it is still unknown if there exists the synergistic or interact effect between the above two kinds of resistances.
Methods
We established TMZ-resistant GBM cell lines (TMZ-R) by chronically exposing U87MG cell lines to TMZ, and DMSO was used as placebo control. In vivo and in vitro experiments verified the synergistic resistance of TMZ-R cells to radiotherapy. Cell proliferation and clonogenesis assay were used to detect cell tolerance to chemo- or ratio-treatment, immunofluorescence and comet assay to detect cell damage, and in vivo imaging to measure tumor size. By transcriptomics and series validation tests, LAT4 was identified to be associated with such TMZ induced radiotherapy resistance. The relationship between LAT4 and mTOR pathway activity was also analyzed. Finally, the effect of BCH, LAT inhibitor, combined with radiotherapy on GBM prognosis was verified in vivo.
Results
We have first confirmed that TMZ not only induces resistance to chemotherapy in GBM cells but also enhances their resistance to radiotherapy,which is a surprising discovery during the establishment of TMZ-resistant U87MG GBM cell lines. Comprehensive transcriptomic analysis identified amino acid metabolism as a potential key factor in radiotherapy resistance. It has been validated that the upregulation of LAT4, a member of leucine metabolism, subsequent to chemotherapy modulates the mechanistic target of mTOR pathway and leads to radiotherapy resistance both in vitro and in vivo. Importantly, the application of inhibitors targeting leucine metabolism has been demonstrated to restore the sensitivity of these cells to radiotherapy, highlighting a potential therapeutic strategy for overcoming resistance in GBM.
Conclusions
Our study first discover the synergistic effect between tumor resistance to chemotherapy and radiotherapy. Our study highlights the critical role of LAT4 in activating the mTOR pathway and such resistance interaction. Targeting LAT4 and mTOR pathway will improve treatment sensitivity of GBM, especially in recurrent tumors.
The effect of virtual reality glasses and therapeutic touch on pain, anxiety and satisfaction during intrauterine insemination: a randomized controlled trial
Authors: BAL Sümeyye , KARAKAYA Neşe , KOÇ Emine , GÜVEN Davut
Published: October 2024

Background: Intrauterine insemination (IUI) also found that this experience was associated with anxiety. Therefore, measures must be taken to reduce or eliminate the pain and anxiety associated with it. Objectives: This study investigated the effect of virtual reality glasses (VRG) and therapeutic touch on pain, anxiety and satisfaction during intrauterine insemination. Methods: A randomized controlled trial design was used. Patients were randomized into three groups [32 virtual reality group(VRG), 32 therapeutic touch group (TT), 32 control group(CG)]. The study was conducted between January and June 2022 in the obstetric outpatient clinics of a public hospital in northern Türkiye. Anxiety was evaluated using the State Anxiety Inventory. Pain, and satisfaction were evaluated using the Visual Analogue Scale [VAS]. Results: There was a significant difference in the pain level of the VRG group during IUI was lower than those of CG and TT (p=0.01). Women were most satisfied with the TT application in the IUI procedure (p=0.000). Anxiety levels after IUI were lower in the TT and SG groups than in CG (p = 0.000). Conclusion: VRG application was effective in reducing pain associated with IUI procedure in women. Although the use of VRG with music reduced the pain associated with IUI more than the TT application, the women left the TT application satisfied Trial registration: The study was registered at the Clinical Trials.gov website under the code NCT05192330. The first trial registration date was (12/01/2022).
Colistin sulfate is effective and safe in the treatment of severe pneumonia patients with CRE resistance: a retrospective cohort study
Authors: Li Shiying , Zhang An , Tong Jin , Zong Kaican , Fu Xiao , Zhou Zhaogang , Zhang Lu , Zhang Yan , Hu Peng
Published: October 2024

Objective
Severe pneumonia is difficult to treat and with a high mortality. The increasing drug resistance problem increased the difficulties to treat, so we estimated whether colistin sulfate reduces the mortality of severe pneumonia patients with suspicious CRO infection.
Method
A retrospective cohort study was conducted on the patients consecutively admitted for pneumonia to the Second Affiliated Hospital of Chongqing Medical University from Jan 2022 to Feb 2023. Data were recorded.
Results
We found that the 28-day mortality after discharge of severe pneumonia patients with suspected MDR bacterial infections in our cohort study is also high (42/84, 50%). The 28-day mortality of discharge in tigecycline (TC) group is a bit lower than that of colistin combined with other antibiotics (OC) group (18/46, 39.1% vs. 24/38, 63.2%, P = 0.048). Further multivariate analysis revealed that positive sputum culture was significantly associated with the 28-day discharge mortality rate with different treatment regimens (OR 0.073, 95% CI 0.006–0.882, P = 0.040). And no significant differences were founded before and after the use of colistin sulfate for the white blood count (WBC), platelet count, level of CRP, PCT, ALT, and creatinine.
Conclusion
Colistin sulfate is effective and safe in the treatment of severe pneumonia patients with CRE resistance.
Evaluation of the implementation of the Kangaroo Mother Care after the DIB project in three health facilities in the central Cameroon region
Authors: Mandeng Marcelle Nina Ehouzou , Ndjabo Monique Amor , Bilo'o Lydienne Leslie , Kalla Ginette Claude Mireille , Omolomo Etienne Kimessoukié , Sap Suzanne Ngo Um
Published: October 2024

Background
Neonatal mortality remains high in Cameroon and stagnant since 2014 at 28‰ according to DHS 2018. In the strategy to reduce this mortality, the project named “Development Impact Bond” (DIB) was set up in ten health facilities in Cameroon. Our objective was to determine the level of implementation of KMC as well as its effect on neonatal mortality in three health facilities in the central region.
Methods
We carried out a cross-sectional study using a mixed (quantitative and qualitative) approach with simultaneous triangulation and retrospective data collection. To assess the level of KMC implementation, we chose the progress monitoring model proposed by Bergh et al in 2005. Qualitatively, we used an observation grid and a semi-structured interview guide to collect their verbatims according to the different phases of KMC implementation.
Results
After the DIB project, our evaluation showed a level of achievement in the institutionalization stage and progress towards sustainable KMC practice, with scores of 24.5, 25 and 27.5 out of 30 points respectively for YGOPH, YUTH and BDH. During the project, there was a 1.6-fold, 2-fold and 4-fold reduction in mortality for YGOPH, YUTH and BDH respectively, followed by a trend towards increased mortality in 2 first-rate facilities, notably YUTH and YGOPH. The causes of this post-project performance appear to be difficulties in involving administrators, in communicating with mothers and in reducing the motivation of caregiver’s staff.
Conclusion
The level of implementation of the KMC after the DIB project was high, notwithstanding a rebound in mortality that may be explained by continuing managerial, social and technical difficulties.
Microaggressions in Medicine: A Pilot Study on Differences and Determinants Among Doctors and Nurses
Authors: Lv TAO , Yan Wenjie , Li longlong , Jiang Shuai , Zhang Min , Du Yasong
Published: October 2024

Introduction
"Microaggression", encapsulates the notion that subtle and commonplace instances of discrimination and bias, can result in psychological and emotional distress, further entrenching inequality and cultivating a hostile social atmosphere for marginalized individuals or collectives. Studies endeavors to shed light on illuminating the impact of microaggressions on healthcare workers have found that they have consistently underscored their pervasive detrimental effects. This study aims to investigate the current status of microaggression encounters among healthcare workers, alongside an examination of the contributing risk factors associated with the occurrence of such microaggressions.
Methods
A total of 190 aged 18–60 years clinical healthcare practitioners were recruited from March to April 2023. Questionnaires including the Everyday Discrimination Scale-9 items (EDS).
Results
A total of 83 nurses [82(98.8%) female] and 107 doctors [54(50.5%) female] participated. Among the participants, 40(37.4%) doctors and 50(60.2%) nurses reported encountering microaggressions. Notably, the prevalence of microaggressions among nurses was significantly higher than that among doctors (P = 0.002). Binary logistic regression analysis provided insights into the independent factors influencing the experience of microaggressions. For doctors, the department emerged as a significant influencer (reference level = internal; ORauxiliary=6.138, Pauxiliary=0.016), for nurses, age (reference level = 18 ~ 35y; OR36 ~ 60=3.497, P36 ~ 60=0.037), department (reference level = internal; ORauxiliary=0.072, Pauxiliary=0.007), and family structure (reference level = nuclear family; ORbig family=0.242, Pbig family=0.012) demonstrated significant influence of experience of microaggressions.
Conclusions
Healthcare professionals have encountered a significant prevalence of microaggressions, with a distinct impact observed among nurses. The encounters with microaggressions within the healthcare workforce have exhibited a robust connection with symptoms of anxiety and depression. Specifically, doctors employed in auxiliary departments have been identified as being at a heightened risk of encountering microaggressions in comparison to their peers in internal medicine. Conversely, nurses stationed in auxiliary departments face an elevated risk in contrast to their counterparts in internal medicine. Moreover, among nurses, an advanced age and living in a nuclear family (as opposed to big family) have been identified as factors contributing to an increased vulnerability to microaggressions.
Effect of caloric restriction with protein supplementation on weight, adipose mass, and muscle mass in professional male soccer players: a controlled randomized trial
Authors: García Gloria , Díaz Gustavo , Niño Alexander , Belalcázar-Monsalve María Paula , Ballesteros-Arbeláez Felipe , Cruz Angélica , Del-Campo Juan , Tejero-González Carlos
Published: October 2024

Background
Achieving optimal body composition can be advantageous for athletes in terms of competitive performance. To date, there is no research examining the effects of caloric restriction (CR) on body composition in male professional soccer players.
Purpose
This study aims to investigate the impact of 6 weeks of CR with protein supplementation on body composition and the maintenance of changes after stopping CR for the next 6 weeks.
Methods
The study was a controlled, randomized, parallel-group, experiment involving 28 participants. The experimental group received a CR diet (2650 kcal/d) and the control group received a normal caloric (NC) diet (3500 kcal/d). The intervention lasted for 6 weeks, followed by 6 weeks without intervention and provision of ad libitum diet in both groups. Body composition was assessed using anthropometric measurements.
Results
The study participants were aged 27.6 ± 4.4 years on average. After 6 weeks, the CR group showed a significant reduction in body weight compared with the NC group (− 0.33 kg for CR vs. −0.08 kg for NC; p < 0.05). Both groups experienced a reduction in adipose mass after 6 weeks (p > 0.05), but only the CR group continued to decrease body fat after stopping CR (p < 0.05). Throughout the study, there was an increase in muscle mass, and no significant difference was observed between the two groups (p > 0.05).
Conclusions
CR with protein supplementation improves body composition in male professional soccer players by reducing weight, promoting fat loss, and enhancing muscle mass.