bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Social Values, Work Values, and Self-Efficacy on Career Development of Veterinary Medicine Students
Authors: Hsu Pei-Chuan , Lin Zheng-Wei , Chou Chung-Hsi , Lai Jyh-Mirn
Published: July 2024

The study explores how social support, work value, and self-efficacy contribute to veterinary students’ career development. Veterinary students at National Taiwan University were recruited as participants in this study. The social value, work value, self-efficacy, and career development scale reliabilities were 0.914, 0.780, 0.915, and 0.892, respectively. The data was analyzed by using the multiple regression method. After controlling students’ gender and grades, whether veterinary medicine was the first choice or had clinical or internship experience, students’ social values, work values, and self-efficacy positively affected students’ career development, and students’ self-efficacy was the most significantly predicted factor in their career development. We suggest that the veterinary medicine faculty should be attentive to this trend when designing the curriculum, as the study confirms the positive impact of social values, work values, and self-efficacy on students’ career development. In the future, we will recruit students from the five veterinary schools in Taiwan to conduct this study again to understand better how their social values, work values, and self-efficacy affect Taiwanese veterinary students’ career development.
Wandering Pacemaker: A Case Report
Authors: Perez-Kersey Plicy , Gallotti Roberto G. , Permut Lester C. , Greene Christina L.
Published: July 2024

Background
Pacemaker implantation in children is nuanced. While indications for permanent pacing are similar to those in adults, the logistics of implanting large generators in small infants and children introduces many potential complications, perhaps most insidious migration. In small children, pacemaker leads are placed on the epicardium via sternotomy and the generator is placed anterior or posterior to the rectus abdominis sheath. This precarious position is prone to erosion.
Case Presentation
Our patient is an 8-year-old female with an underlying glycosylation disorder with multi-organ involvement and global developmental delay. She underwent permanent pacemaker placement at 2 years of age due to prolonged sinus pauses of unclear etiology. She presented to care several times for non-specific illness symptoms, with the pacemaker ultimately being found to have migrated into the gastrointestinal tract. The device was safely extracted via the rectum by general surgery.
Conclusions
We present a case of pacemaker migration into the gastrointestinal tract, review the literature on this infrequent but significant complication, and provide recommendations to aid in the prompt recognition of this predicament. This case highlights that routine assessment of a pacemaker’s position and function is critical to ensuring patient safety.
Influence of Thoracolumbar Mobility on Running Performance: a Comparative Study
Authors: SARIOGLU Kubra , TUNAY Volga BAYRAKCI
Published: July 2024

Background
Thoracic mobility is important to the lumbopelvic-hip complex during running.
Objective
To compare the Thoracolumbar (TL) mobility for runners and sedentary individuals. Design: Cross-sectional. Participants: The first group consisted of 35 runners (RTY, running for the last two years), the second group had 35 runners (RSM, running for the last 6 months) and 35 sedentary individuals. Outcomes Measures: Using the Myoton device, muscle tone (Hz), elasticity, and stiffness (N/m) measurements were made over the Latissimus Dorsi (LD) muscle. Trunk flexibility and flexibility of lumbar extensor muscles (cm), the trunk range of motion (ROM, ˚), TL Fascia Length Test and Modified Schober Test were used for thoracic mobility.
Results
The differences were significant on the nondominant side for tone values (p = .001); Modified Schober test (p = .001); lumbar extensor shortening test (p = .003) (cm); goniometric platform measurements both sides of trunk (p = .037, p = .005) (˚); the right side in lateral flexion (p = .010), flexion (p = .001) and extension (p = .001) (ROM ˚); the right (p = .018) and left sides (p = .001) in trunk lateral flexion (flexibility measurements).
Conclusion
We observed that trunk range of motion, lumbar mobility, and TLF flexibility could be influenced by contralateral movements during running.
Impact of Coronary Artery Calcium on Progression of Diastolic Dysfunction: A Cohort Study
Authors: Choi Ki Hong , Kang Danbee , Lee Seung Hun , Kim Darae , Cho Sung Won , Choi Soo-Hee , Park Taek Kyu , Lee Joo Myung , Song Young Bin , Hahn Joo-Yong , Choi Seung-Hyuk , Gwon Hyeon-Cheol , Cho Soo Jin , Yang Jeong Hoon
Published: July 2024

Background
The relationship between coronary artery calcium (CAC) and progression of diastolic dysfunction (DD) during longitudinal follow-up is uncertain. This study aimed to investigate the prevalence and progression of DD according to severity of CAC and understand their synergistic effect on mortality.
Methods
This was a population-based cohort study. All 15,193 adults who underwent a health screening exam with simultaneous echocardiography and CAC scan were enrolled. Definite DD (≥ 3/4 abnormal parameters for DD [e’, E/e’, tricuspid regurgitation-velocity, and left atrial volume index) and definite or probable DD (≥ 2/4) were defined. All-cause mortality was assessed based on the CAC and DD.
Results
Among the population, 7,995 participants (52.6%) had CAC = 0; 4,661 (30.7%) had 0 < CAC < 100; and 2,537 (16.7%) had CAC ≥ 100. The prevalence ratios for definite (adjusted-ratio:1.72, 95% CI:1.23–2.22) and definite or probable DD (adjusted-ratio:1.83, 95% CI:1.31–2.36) were significantly higher in individuals with CAC ≥ 100 than in those with CAC = 0. There was significant linear association of CAC with E/e’ (adjusted p-for linearity = 0.001). Compared with CAC < 100 without definite DD, the adjusted HRs with 95% CI for mortality of CAC ≥ 100 without definite DD, CAC < 100 with definite DD, and CAC ≥ 100 with definite DD were 2.56 (95% CI:1.67–3.94), 3.08 (95% CI:1.28–7.39), and 3.91 (95% CI:1.68–9.10). Among participants without DD at CAC measurement who had at least two echocardiographic measurements, the presence of significant CAC (≥ 100) was significantly associated with accelerated progression in definite DD over time (adjusted-HR:1.46, 95% CI:1.13–1.88), with more rapid elevation of E/e’ during follow-up (difference:0.06, 95% CI:0.02–0.10, p = 0.003).
Conclusions
In the general population, there was a significant relationship between CAC and prevalence of DD, and both subclinical parameters were associated with increased mortality. Moreover, CAC ≥ 100 significantly affects the progression of DD independently of other clinical factors.
Etiology, treatment and complications of childhood hypertension : A retrospective study
Authors: Riyami Mohamed Salam Al
Published: July 2024

Background
Hypertension is common in children, with an estimated prevalence of about 2–5%, and is increasing worldwide. This study reports a single-center experience of hypertension in children
Methods
A retrospective chart review of children aged from one month to 13 years old who were diagnosed with hypertension.
Results
A total of 129 children were included. Secondary hypertension was seen in 103 (79.8%) patients compared to only 26 (20.2%) who had primary hypertension. Primary hypertension was more common among pre-teen children (50.0%), whereas a higher proportion of the cases with secondary hypertension were aged between 1–5 years. Renal parenchymal diseases were the most common etiology for secondary hypertension, followed by endocrine and then vascular causes. In this study, no significant association was noted between hypertension and obesity. The most common complications of hypertension in these children were cardiovascular complications, followed by neurological complications. Hypertension was only managed by lifestyle modification in 14.7% of children, while the rest were also started on antihypertensive medications. During the last follow-up, 50% of children had improvement in blood pressure readings."
Conclusion
Secondary hypertension is more common compared to primary hypertension in our patients. The results of this study will increase awareness among pediatricians about the importance of early recognition and management of hypertension. Larger population-based studies are needed to better assess the prevalence, causes, and outcomes of hypertension in our region.
Association between Statin Intensity and Femoropopliteal Stent Primary Patency in Peripheral Arterial Disease
Authors: Seyferth Elisabeth R , Song Helen , Vance Ansar Z. , Clark Timothy W.I.
Published: July 2024

Background. Statins are widely used in coronary and peripheral arterial disease, but their impact on patency of stents placed for peripheral arterial disease is not well-studied. The purpose of this study was to evaluate femoropopliteal stent primary patency according to statin intensity at the time of stent placement and compare this effect to other covariates that may influence stent patency. Materials and Methods. A retrospective review identified 278 discrete femoropopliteal stent constructs placed in 216 patients over a 10-year period; Rutherford categories were 2 (3.6%), 3 (12.9%), 4 (21.2%), 5 (49.6%), and 6 (12.6%). Stent locations were common femoral (1.8%), common femoral/superficial femoral (0.7%), superficial femoral (50.7%), superficial femoral/popliteal (32.7%) and popliteal (14.0%) arteries; 63.3% of stents were paclitaxel-eluting. Primary patency of each stent construct was determined with duplex ultrasound, angiography, or computed tomographic angiography. Greater than 50% restenosis or stent occlusion was considered loss of patency. Cox proportional hazard and Kaplan-Meier modeling were used to assess the effect of statin use and additional covariates on stent patency. Results. Patients on any statin at the time of stent placement were half as likely to undergo loss of primary unassisted patency as patients on no statin therapy (hazard ratio, 0.53; 95% confidence interval, 0.19–0.87; P = .004). Moderate/high intensity statin therapy conferred 17 additional months of median stent patency compared to the no statin group. Antiplatelet therapy, anticoagulant therapy, drug-eluting stents (versus bare metal or covered stents), and Rutherford class were not predictive of stent patency (P = 0.52, 0.85, 0.58, and 0.82, respectively). Conclusion. Use of statin therapy at the time of femoropopliteal stent placement was the most predictive examined variable influencing primary unassisted patency.
Can the HEMPA method predict musculoskeletal disorders in nurses and caregivers?
Authors: Esmaeili Sayed Vahid , Alboghobeish Ali , Izadi Neda , Azizi Fatemeh , Dorfeshan Fatemeh , Sahlabadi Ali Salehi
Published: July 2024

Introduction
Caregivers and nurses perform occupational activities that can lead to work-related musculoskeletal disorders (WMSDs) associated with patient handling. It is also important to predict and assess the WMSDs risk using reliable and trustworthy tools. This study conducted to investigating the ability of the HEMPA technique to predict WMSDs.
Methods
This descriptive and analytical study was conducted on 90 caregivers and nurses working in different wards of a medical teaching hospital in 2023. Data collection was conducted based on a three-part questionnaire that included demographic information, the body map questionnaire, and the HEMPA tool. The ability of the HEMPA tool to predict the prevalence of the WMSDs and to examine the multivariate relationship between the outcome and different variables was determined using logistic regression. The predictive power of the HEMPA technique for different body parts was indicated by the area under the ROC curve values. The study data were analyzed using Stata version 14 software, with a significance level of less than 5% for all tests (P < 0.05).
Result
In this study, 90 caregivers and nurses participated with an age range of 24–60 years and BMI of 27.15 ± 4.02. Most of the participants (52.2%) were male, married (83.3%), and had a high school diploma (81.1%). The risk assessment of 16 different departments of the hospital were at the medium level. The highest prevalence of musculoskeletal disorders in the back (93.3%), neck (87.7%) and the highest intensity of pain in the lower back (34.4%) and back (24.4%) were reported. The highest chance of suffering from musculoskeletal disorders was identified in the Left-Thigh (AOR = 0.47; 95% CI: 0.29–0.76) and Right-Thigh (AOR = 0.47; 95% CI: 0.29–0.76) areas. Based on the ROC Curve values, the highest AUC corresponds to Left-Thigh (AUC = 0.79, 95% CI = 0.69–0.89) and Right-Knee (AUC = 0.76, 95% CI = 0.62–0.90) respectively. The lowest AUC was determined for Left-Ankle (AUC = 0.68, 95% CI = 0.57–0.79) and Right-Hand (AUC = 0.66, 95% CI = 0.55–0.78), respectively.
Conclusion
The results indicated that the HEMPA technique can predict and detect different levels of risk of WMSDs in different areas of the body well and with high accuracy. Therefore, emphasis on the ergonomics of patient handling and application of comprehensive and reliable techniques and methods such as HEMPA that follow the workplace ergonomics workplace can be effective in preventing and managing musculoskeletal disorders in these people.
Association of prior to intensive care unit statin use with sepsis-associated delirium: a retrospective propensity score analysis
Authors: Hong Liang , Li Jing , Shen Xiao , Tao Hong , Chen Wenxiu , Zhang Cui , Yang Min
Published: July 2024

Background
The association between statin use and sepsis-associated delirium (SAD) remains controversial. This study aimed to determine whether statin use decrease the risk of SAD.
Methods
This retrospective cohort study analyzed data of 6649 adult Intensive Care Unit (ICU) patients from the MIMIC-IV database who met inclusion criteria. We examined the association between prior to ICU admission (pre-ICU) statin use and the incidence of SAD by univariate and multivariable logistic regression analysis, propensity score matching (PSM), inverse probability weighting (IPW), and subgroup analysis employing propensity score matching and inverse probability weighting to adjust for potential confounders. The adjusted odds ratio (OR) with 95% CI were calculated in corresponding cohorts.
Results
Of the study population, 35.1% patients developed SAD. Patients with pre-ICU statin use showed a lower incidence of SAD compared to those without (27.6% vs. 38.0% in origin cohort, 27.2% vs. 33.9% in the matched cohort). Pre-ICU statin use showed a stable protective effect against SAD across different analyses: in original cohort (OR 0.562, 95% CI 0.491 ~ 0.642, P < 0.001), propensity score matched cohort (OR 0.707, 95% CI 0.630 ~ 0.794, P < 0.001) and inverse probability weighted cohort (OR 0.627, 95% CI 0.573 ~ 0.686, P < 0.001). E-value analysis suggested the robustness to unmeasured confounding.
Conclusion
Pre-ICU statin use is associated with a reduced incidence of SAD, particularly among elderly patients and those receiving lipophilic statins. These findings support the potential role of statins administration in the management of delirium in septic patients and underscore the importance of maintaining statin therapy during critical illness. Future prospective studies are needed to confirm these results and guide clinical practice.
Prevalence of distress and changes over time among patients with progressive fibrosing interstitial lung disease
Authors: Yamada Tomoko , Sugano Koji , Matsuno Kei , Hotta Saori , Fujii Mitsuhiro , Ihara Hiroaki , Takahashi Kazuhisa
Published: July 2024

Background
Patients with progressive fibrosing interstitial lung disease (PF-ILD) frequently experience respiratory symptoms and decline in activities of daily living (ADL) and quality of life (QOL) with disease progression. However, no effective treatment or palliative care strategy has been established for patients with PF-ILD. This study aimed to clarify the degree of physical and psychological distress in patients with PF-ILD and to evaluate symptom changes over a one-year period in patients with idiopathic pulmonary fibrosis (IPF) and those with other PF-ILDs (non-IPF).
Methods
Consecutive patients diagnosed with PF-ILD were recruited. The participants were divided into two groups and evaluated at registration (T0), 26 weeks (T1), and 52 weeks (T2) after registration. They were also followed-up for symptoms, ADL, QOL, depressive condition, laboratory findings, and other factors from study registration to 52 weeks (T2).
Results
Of the 70 patients with PF-ILD, 32 had IPF and 38 did not. The IPF and non-IPF groups showed no noticeable differences in clinical symptoms or laboratory findings on multivariate analysis at T0. The repeated-measures analysis of variance used to observe the changes over the course of the year in both groups showed that dyspnea in patients with IPF worsened from T1 to T2. In contrast, cough, which is one of the major symptoms in non-IPF patients, worsened, especially from T0 to T1 and T0 to T2. The QOL of non-IPF patients also declined from T0 to T1.
Conclusions
Patients with PF-ILD demonstrated several clinical signs and symptoms. In this one-year follow-up study, dyspnea tended to be worse in patients with IPF and cough in non-IPF patients, and QOL was temporarily worse in non-IPF patients. Respiratory symptoms are directly related to the patient's daily life and led to reduced QOL. Therefore, further long-term studies in this population are required.
Fat mass index predicts the effect of weight loss and quality of life early after laparoscopic sleeve gastrectomy
Authors: Jiang Yi-Ming , Zhong Qing , Shang-Guan Zhi-Xin , Lin Guang-Tan , Guo Xiao-Jing , Huang Ze-Ning , Lu Jun , Huang Chang-Ming , Lin Jian-Xian , Zheng Chao-Hui
Published: July 2024

Background Fat mass index (FMI) is a body composition indicator that reflects body fat content. Laparoscopic sleeve gastrectomy (LSG) is widely performed in patients with obesity.
Objective This study aimed to evaluated the value of the FMI in predicting weight loss effect and quality of life early after LSG.
Material and Methods From January 2014 to July 2022, the clinical data and computed tomography (CT) images of patients underwent LSG at a tertiary referral teaching hospital were analyzed. Body composition indicators were calculated using the SliceOmatic software. Achieving initial body mass index within 6 months postoperatively was defined as early eligible weight loss (EEWL). The relationship between body composition and EEWL was analyzed.
Results A total of 243 patients were included. Receiver operating characteristic (ROC) curve analysis showed that the predictive value of the FMI for EEWL in patients after LSG was higher than that of other indicators (all P<0.05; area under the curve = 0.813). The best FMI cut-off point was 13.662. Accordingly, the patients were divided into the high-FMI group and low-FMI group. The %EWL and BMI of patients in the low-FMI group at 1, 3, 6, 9, 12 and 24 months after surgery were better than those in the high-FMI group (all P<0.001). Patients in the low-FMI group had higher BAROS (Bariatric Analysis and Reporting Outcome System) scores than those in the high-FMI group (P<0.001).
Conclusion Compared with other body composition indicators, FMI can effectively predict the early effect of weight loss and quality of life after LSG.
Early predictors of induction of remission with exclusive enteral nutrition in pediatric Crohn's disease
Authors: Hu Yudie , Lv Yao , Lou Jingan , Luo Youyou , Yang Gan , Liu Yang , Zhou Jiaying , Zhen Changjun , Yu Jindan , Fang Youhong , Zhao Hong , Peng Kerong , Ni Yan , Chen Jie
Published: July 2024

Background Exclusive enteral nutrition (EEN) is recommended as the first line therapy for mild to moderate pediatric Crohn's disease (CD) with inducing clinical remission and promoting mucosal healing. However, early factors that could predict the efficacy of EEN in inducing remission of CD is lack.
Methods A total of 56 patients in the derivation cohort and 19 patients in the validation cohort were included in this study. Baseline clinical covariates were compared between the clinical remission group and the no clinical remission group and between the mucosal healing group and the no mucosal healing group. More than 100 laboratory covariates before EEN were analyzed with the Pediatric Crohn’s Disease Activity Index(PCDAI) and the Crohn’s Disease Endoscopic Index of Severity (CDEIS)at the end of the 8-week EEN. Predictive models were developed by forward stepwise (binary likelihood) logistic regression, and the probabilities of clinical remission and mucosal healing were calculated for selected baseline levels of covariates.
Results The clinical remission diagnostic model performed well inboth the training cohort (AUC 0.93; p<0.05) and the validation cohort (AUC 0.72; p=0.19). Indirect bilirubin (IBIL)>4.95 μmol/L, CD3>76.78% and iron>9.025 mmol/L at baseline were associated with a reduced clinical remission rate. The mucosal healing diagnostic model also presented the optimal discrimination in both the derivation cohort (AUC 0.87; p<0.05) and the validation cohort (AUC 0.83; p=0.07). Factors determining a lower mucosal healing rate were human IL-10>4.35 μmol/L and RDW>14.55%.
Conclusion IBIL, CD3 and iron are reliable predictors of the induction of clinical remission with EEN. Human IL-10 and RDW are early predictors of the induction of mucosal healing with EEN.
Trajectory of perceived barriers to healthy eating and exercise and weight change among obese adults in a six-month weight management program
Authors: Ranjan Piyush , Chopra Sakshi , Malhotra Anita , Kaloiya Gauri , Upadhyay Ashish , Siddhu Anupa , VIKRAM NAVAL
Published: July 2024

Background Barriers to healthy eating and exercise mediate the odds of weight loss success. To identify the trajectory of barriers to healthy eating and exercise and its association with weight change during obesity management program.Methods Indexed is a mixed-method study. Purposive sampling was used to enroll 250 participants in a six-month obesity management program. The perceived barriers to healthy eating and exercise were quantitatively measured using standardized questionnaires,i.e., Barriers to Healthy Eating and Exercise and qualitatively through in-depth interviews throughout the obesity management program (baseline, 3- and 6-months).Results The sample was middle-aged (41.8 ± 8.5 years) presenting with obesity (31 ± 3.7 kg/m2) and slight female preponderance (70%). At baseline, the scores for barriers to healthy eating (2.7 ± 0.8, out of 5) and exercise (2.7 ± 0.7, out of 5) were low and comparable; and they improved after 6-month participation in the obesity management program. Improvement in knowledge- (amount of exercise, portion size estimation), attitude- (amotivation for diet and physical activity, tiredness for exercise) and practice-related (lack of time for diet and physical activity, and exercise skills) barriers to exercise and healthy eating were positively associated with weight change (P < 0.01). Qualitative analysis identified social (eating out, festivities) and environmental (low neighborhood walkability and safety, food accessibility, culture-centric foods) barriers.Conclusions The trajectory of perceived barriers to healthy eating and exercise indicates improvement throughout the obesity management and is positively associated with weight loss.
Preliminary Application of 3D-Printed Interbody Fusion Devices in the Treatment of Lumbar Degenerative Diseases
Authors: Ji Jingtao , Chen Guangdong , Miao Jun
Published: July 2024

Objectives: To investigate the effectiveness, safety, and usability of 3D-printed interbody fusion cages in posterior lumbar fusion surgery.
Methods: This randomized controlled trial included 36 patients with single-stage lumbar degenerative disease undergoing PLIF surgery. The patients were divided into two groups: the control group (17 patients) used PEEK (polyetheretherketone) cages for interbody fusion, while the experimental group (19 patients) used 3D-printed cages. The study aimed to assess the postoperative effectiveness and safety of the surgeries using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores, and to evaluate the stability and fusion effect of the cages through postoperative imaging.
Results: All patients were followed up for 3 to 26 months. There were statistically significant differences (P<0.01) in VAS and ODI scores before and three months after surgery within both the control and experimental groups. No statistically significant differences (P>0.01) were found between the preoperative VAS and ODI scores of the two groups. However, there were statistically significant differences (P<0.01) in the postoperative VAS and ODI scores between the two groups.
Postoperative X-rays and CT scans showed satisfactory placement of the anterior cages and pedicle screws in all patients. During the follow-up period, 3 out of 17 patients (17.6%) in the PEEK cage group experienced cage migration, and 1 patient (5.9%) showed signs of pedicle screw loosening, while the remaining pedicle screws were stable. In contrast, none of the 19 patients with 3D-printed cages experienced cage migration, and no signs of pedicle screw loosening were observed.
Zuckerkandl’s tubercle and its relation with recurrent laryngeal nerve during thyroid surgery in a tertiary care hospital in Nepal: A cross-sectional study
Authors: Baidhya Rachana , Regmi Deepak , Bhusal Suzit , Bista Apeksha , Shrestha Reshika
Published: July 2024

Background:Thyroid surgery occurs frequently in our part of the world, with Recurrent Laryngeal Nerve (RLN) injury being a serious intraoperative complication that affects airway and voice quality. Zuckerkandl’s Tubercle (ZT), present in over 70% of patients, is a reliable landmark for locating the RLN to follow careful dissection and identification. The purpose of this study is to assess Zuckerkandl’s Tubercle (ZT) and its relation with Recurrent Laryngeal Nerve during Thyroid Surgeries.
Methods: A cross-sectional study was conducted prospectively at the Department of Otorhinolaryngology, Head and neck surgery, Kathmandu Medical College and Teaching hospital, Sinamangal from December 2019 to November 2020. Forty-four RLNs were evaluated in 34 patients undergoing thyroid surgery. Per-operative documentation on the prevalence of ZT and its relation with RLN was recorded, its size and distance from the RLN measured.
Results: Zuckerkandl’s tubercle was present in 73.7% in the right side and in 76% in the left side. On the right side, 92.9% were unilobed in nature and 7.1% were bilobed, while on the left side, 100% were unilobed in nature. The size of the ZT was graded according to Pelizzo's grading system for ZT into grade 0-3. On the right side, 26.31% was grade 0, 31.57% were grade 1, 36.8% were grade 2 and 5.2% was grade 3. On the left side, 24% were grade 0, 20.0% were grade 1, 44.0% were grade 2 and 12.0% were grade 3. On the right side, RLN was present medial to the ZT in all cases (100%), while on the left side, RLN was present medial to ZT in 84.2% and lateral to ZT in 15.8% cases.
Conclusion:Identification and preservation of RLN is of utmost importance during thyroid surgeries. Zuckerkandl’s tubercle has a consistent relationship with RLN and can be used as an important landmark for identifying RLN during thyroid surgery.
Agreement between manual and automatic ultrasound measurement of the velocity-time integral in the left ventricular outflow tract in intensive care patients: evaluation of the AUTO-VTI® tool
Authors: LOUART Benjamin , MULLER Laurent , EMOND Baptiste , BOULET Nicolas , ROGER Claire
Published: July 2024

Background: Transthoracic echocardiography (TTE) is widely used in intensive care unit (ICU) to manage patients with acute circulatory failure. Recently, automated ultrasound (US) measurement applications have been developed but their clinical performance has not been evaluated yet. The aim of this study was to assess the agreement between automated and manual measurements of the velocity-time integral in the left ventricular outflow tract (VTI-LVOT) using the auto-VTI® tool.
Methods: This prospective, single-center, interventional study included ICU patients with acute circulatory failure. The examination involved two successive manual measurements of VTI-LVOT (mean of 3 consecutive heartbeats in regular sinus rhythm, and 5 heartbeats in irregular rhythm), followed by a measurement using auto-VTI® software. In patients receiving a fluid challenge, trending ability in detecting fluid responsiveness was also evaluated.
Results: Seventy patients were included between January 19, 2020, and September 24, 2020, at the Nîmes University Hospital. The feasibility of the auto-VTI® was 94%. The mean difference between the two methods was 11% with limits of agreement from -19% to 42%. The proportion of agreement at the 15% difference threshold was 68% [58%; 80%]. The precision and least significant change (LSC) measured for the manual measurement of VTI were 7.4 and 10.5%, respectively, and by inference for the automated method 28% and 40%.
Conclusions: The new auto-VTI® tool, despite interesting feasibility, demonstrated an insufficient agreement with a systematic bias and an insufficient precision limiting its implementation in critically ill patients.
Stratified Analysis of the Correlation between Wedged Hepatic Venous Pressure and Portal Venous Pressure in Patients with Portal Hypertension: A Multicenter Study
Authors: Lv Yifan , Zhu Bing , Li Dongze , Tian Hua , You Shaoli , Lv Sa , Wang Fuchuan , Yang Yongping , Ding Huiguo , Wu Yifan , Dong Chengbin , Zhang Yu , Liu Fuquan
Published: July 2024

Aim: To evaluate the differences in the agreement between wedged hepatic venous pressure (WHVP) and portal venous pressure (PVP) at different hepatic venous pressure gradient (HVPG) levels to provide new guidance for the clinical diagnosis and management of portal hypertension (PHT).
Methods: A multicenter study of 785 patients with PHT from three centers was stratified into five groups by their HVPG: <12 (group A), 12 ≤ HVPG < 16 mmHg (group B), 16 ≤ HVPG < 20 mmHg (group C), 20 ≤ HVPG < 24 mmHg (group D), ≥24 mmHg (group E). Concordance was analyzed using Pearson’s correlation coefficient (R), the intraclass correlation coefficient (ICC), and Bland‒Altman analysis in each HVPG stratum.
Results: Correlation and agreement between WHVP and PVP varied by HVPG group. Highest agreement was observed in the range of 20 ≤ HVPG < 24 mmHg. (R=0.52, ICC=0.66). The proportion of patients with a discrepancy between WHVP and PVP that was greater than 10% of the PVP value was highest in group A (95.3%) and lowest in group D (51.3%). Overestimation of PVP was more common in group E (48.5%), and underestimation of PVP was more common in group A (93.8%).
Conclusions: The correlation between WHVP and PVP varies significantly across HVPG levels, the highest agreement being in the range of 20 ≤ HVPG < 24 mmHg. WHVP frequently underestimates PVP when HVPG is < 12 mmHg and tends to overestimate PVP when HVPG is ≥ 24 mmHg.
First evidence on occurrence, and risk assessment of EU-regulated mycotoxins along the cassava value chain in Uganda
Authors: Oyesigye Elias , Cervini Carla , Oluwakayode Abimbola , Mahuku George , Medina Angel
Published: July 2024

This study investigated the occurrence and distribution of EU-regulated mycotoxins (aflatoxin B1, B2, G1, G2, fumonisins B1, B2, ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN), and citrinin (CIT) in cassava products, as well as assess the potential risk of Aflatoxin B1 (AFB1) exposure among cassava consumers. A total of 192 samples of cassava products (flour and chips) were analysed using LC/MS-MS. All positive samples irrespective of their origin(flour or chips), exhibited AFB1 levels exceeding the EU regulatory threshold of 5 µg/kg. The sum of fumonisins-FB1 + FB2, ZEN and DON were significantly (P < 0.05) higher in cassava flour (14.3 µg/kg; 3.71 µg/kg; 25.1 µg/kg) compared to chips (6.54 µg/kg; 1.25 µg/kg; 0.25 µg/kg), respectively. Aflatoxins G2 was not detected in all the 192 samples analysed. Cassava flour samples from farmers exhibited significantly (P < 0.05) higher mean concentrations of AFB1 (27.1 µg/kg), total aflatoxins (78.2 µg/kg) and ochratoxin A (79.6 µg/kg) in contrast to wholesalers, whose mean levels were notably lower at 8.91, 5.79 µg/kg and 2.44 µg/kg, respectively, pointing the likely critical source of mycotoxin contamination. Cassava consumers in Northern Uganda are at a higher risk of 2.06 cancer cases per 100,000 individuals per year compared to those in Eastern Uganda at 0.25. This study underscores the urgent need for improving storage practices of cassava flour at the household level, especially in Northern Uganda, recognises a shift from the conventional practice of sampling in market areas to household-level samples, and emphasises the need for analytical methods that target more than one mycotoxin.
Loneliness Predicts Suffering in Advanced Cancer Patients
Authors: Rendon Ana Maria Higuita , Medina Angela Medina , Gonzalez Carolina Palacio , Gomez John Jairo Vargas , Limonero Joaquin , Daveloza Alicia Krikorian
Published: July 2024

Objective: To determine the relationship between suffering, loneliness, social interaction, and symptom distress in patients with advanced cancer.
Methodology: Quantitative, observational, analytical cross-sectional study. Patients with advanced cancer attending a Pain and Palliative Care unit of an oncology institution participated. Assessment instruments included PRISM (suffering), the UCLA Loneliness Scale, the Edmonton Symptom Assessment Questionnaire, and Cohen´s Social Network Index (SNI). Univariate, bivariate, and multiple regression analyses were performed.
Results: One-hundred forty-four patients participated, mostly women (68.1 %), with a median age of 62 years, and 48.6% lived with a partner. About 75% reported moderate to severe suffering, 33% had clinically significant loneliness, and half reported a network width of at least eight people. ESAS showed fatigue as the most common problem and well-being had a median score of 5; In general, a low symptomatic burden was found. Suffering was significantly correlated with loneliness, pain, fatigue, depression, and anxiety, but not with levels of social interaction. According to the multiple regression analysis, loneliness has a positive and significant influence on the increase in suffering.
Conclusions: A high percentage of patients show significant suffering and almost a third show clinical levels of loneliness, which contrasts with a relatively large social network with frequent interactions, and a generally low symptomatic burden. The most single important predictor of suffering was loneliness. Our study points to the need to regularly assess these feelings and address them in treatment to lessen suffering. Future studies should delve deeper into the relationship between suffering and loneliness.
SLC34 mutation: Personal experience with six families and literature review
Authors: Bennani Hamza Naciri , Chtioui Imane , Allirot Camille , Somrani Rim , Jouve Thomas , Bourdat-Michel Guylhene , ROSTAING Lionel
Published: July 2024

Background
Mutations in SLC34A1 and SLC34A2 genes, which encode co-transporters NaPi2a and NaPi2c, respectively, can lead hypophosphatemia due to renal phosphate loss. This condition results in hypercalcitriolemia and hypercalciuria, leading formation of kidney stones and nephrocalcinosis. Phenotype is highly variable. Management include hyperhydration, dietary modifications, and/or phosphate supplementation. Thiazides and azoles may be used, but randomized studies are needed to confirm their clinical efficacy.
Methods
We conducted a retrospective study in pediatric nephrology unit at Grenoble University Hospital from January 2010 to December 2023. Study aimed to describe clinical and biological symptoms of patients with confirmed SLC34A1 and SLC34A3 gene mutations and their outcomes.
Results
A total of 11 patients (9 females) from 6 different families had mutations in the SLC34A1 (5 patients) and SLC34A3 (6 patients) genes. Median age at diagnosis was 72 [1-108] months. Average follow-up duration was 8.1 ± 4.5 years. Presenting symptom was nephrocalcinosis (4 cases), followed by renal colic (3 cases). At diagnosis, 90% of patients had hypercalciuria and 45% had hypercalcitriolemia. Management included hyperhydration and dietary advice. All patients showed favorable outcomes with normal growth and school attendance. One patient with an SLC34A3 mutation showed regression of nephrocalcinosis. Renal function remained normal.
Conclusion
Clinical and biological manifestations of SLC34 gene mutations are highly variable, even among siblings; therefore, management must be personalized. Hygienic-dietary measures (such as hyperhydration, a low sodium diet, and age-appropriate calcium intake) result in favorable outcomes in most cases. Use of azoles (e.g., fluconazole) appears to be a promising therapeutic option.
Radiotherapy for Refractory, Corticosteroid-Resistant Orbital Inflammatory Diseases: Plan Design, Clinical Efficacy, and Prognosis/Outcomes
Authors: Ma Yan , Chen Haiyang , Huang Fujing , Pang Xiaolin , Zheng Jian , He Fang
Published: July 2024

Purpose
Orbital inflammatory diseases (OID), including Graves’ ophthalmopathy (GO), orbital pseudotumor (OP), and IgG4-related ophthalmic disease (IgG4-ROD), often require prolonged corticosteroid therapy, which may lead to severe hormonal side effects. These diseases are notably refractory and resistant to corticosteroids. While opposing lateral-field radiotherapy has shown positive results, the potential of volumetric-modulated arc therapy (VMAT) to enhance efficacy and reduce side effects remains uncertain. This study evaluates the radiation dose, clinical efficacy, side effects, and outcomes of orbital VMAT in patients with refractory, corticosteroid-resistant OID.
Methods and materials:
A retrospective analysis was conducted on 58 patients with refractory, corticosteroid-resistant OID treated with orbital VMAT from November 2019 to July 2022. The primary endpoint was the reduction or cessation of corticosteroid use following radiotherapy, with secondary endpoints including improvements in ocular clinical symptoms (diplopia, proptosis, visual acuity, and extraocular movement) and long-term side effects.
Results
The median target dose was 20 Gy, with an average lens irradiation dose of 5.4 Gy. Initially, all 58 patients received corticosteroids. After a median follow-up of 27.5 months, 89.7% (52/58) of patients responded positively to radiotherapy: specifically, 55.2% (32/58) completely tapered off corticosteroids, while 34.5% (20/58) reduced their dosage. Symptomatic improvements were observed in diplopia (66.0%), proptosis (63.5%), visual acuity (55.2%), and extraocular movements (66.7%). Regarding the long-term side effects of radiotherapy, incidences of dry eye syndrome and lens opacities were reported at 3.4% and 1.7%, respectively.
Conclusions
Orbital VMAT is an effective treatment for refractory, corticosteroid-resistant OID, reducing corticosteroid use and improving ocular symptoms with minimal side effects. Further prospective clinical trials are warranted to validate more appropriate VMAT doses and planning models, enhancing treatment outcomes without increasing radiotherapy side effects.
Tilt and self-potential observations of Kibedani Geyser, Japan: Relationship between fluid flow and CO2-driven geyser activity
Authors: Tanabe Harutou , Aizawa Koki , Matsushima Takeshi
Published: July 2024

Multi-parameter, multi-site observations were undertaken at the Kibedani Geyser, Japan, where the eruption of cold spring-water (20℃) is driven by underground CO2 pressure. Video, temperature, self-potential (SP), ground tilt, and acoustic observations were undertaken. Tilt and SP data display temporal changes related to the geyser cycle of 38 min (32 min between eruptions, with 6 min of eruption). Tilt data indicate that an inclined crack-shaped cavity pressure source expands between eruptions and contracts during eruption, with post-eruption re-expansion beginning ~2.5 min after eruption, when ground tremor has ceased. SP changes suggest groundwater inflow to the pressure source. We conclude that CO2 accumulates in the cavity, uplifting water for eruption. Tilt and SP multi-site observations were effective in estimating fluid flows associated with geyser activity.
Nuclear magnetic resonance spectroscopy based investigation of placenta and serum metabolic signatures in an L-NAME-induced preeclampsia rat model
Authors: Xu Xiaomin , Gao Lidan , Sun Congcong , Li Xiaoqing , Li Yanjun , Wang Wenhuan , Yang Xiaokai , Zheng Yanyan
Published: July 2024

Introduction
Despite numerous studies investigating potential metabolic biomarkers of preeclampsia (PE), there remains a dearth of comprehensive animal model validation to ascertain the utility of these metabolic markers as predictors for PE risk.
Objective
To characterize the serum and placental metabolome profiles in a N-nitro-L-arginine methyl ester (L-NAME) induced PE rat model, and identify potential differential metabolites to improve disease classification based on existing diagnostic markers.
Methods
The serological indicators and uterine artery blood flow indexes were measured in L-NAME-induced early-onset PE (EOPE) and late-onset PE (LOPE) rat models. Untargeted proton nuclear magnetic resonance metabolomics analysis was employed to compare serum and placenta tissue extracts, aiming to identify distinguishing metabolites. The random forest decision tree algorithm was utilized for validating biomarker metabolites and establishing classification models.
Results
Several characteristic metabolites associated with the development of preeclampsia in humans can be validated using L-name-induced PE as a model. EOPE and lope exhibit distinct and overlapping metabolic signatures, indicating unique and shared pathways. A combination of two serum metabolites (aspartate/ tryptophan/ 3-hydroxybutyrate) could effectively discriminate between different groups. Moreover, the classification accuracy of placental metabolites (creatine/acetate) combined with serum tryptophan surpasses that of existing serum markers and uterine artery blood flow indexes.
Conclusion
The identification of serum and placental metabolites holds potential to augment the classification accuracy of existing biomarkers. Nevertheless, comprehensive validation of metabolic markers necessitates further support from additional PE animal models.
The short-term clinical outcomes of endoscopic rubber band ligation for grade I~III internal hemorrhoids
Authors: Xu Shanshan , Li Zhenjuan , Ding Hui , Zhang Hao , Li Xiuling
Published: July 2024

Background To investigate the short-term safety and efficacy of endoscopic rubber band ligation (ERBL) for grade I~III internal hemorrhoids, and to analyze the related factors of adverse events after ERBL.
Methods The clinical data of 266 patients with grade I~III internal hemorrhoids treated by ERBL in Henan Provincial People's Hospital from January 2021 to June 2023 were retrospectively analyzed. According to the Goligher’s grading of internal hemorrhoids, the patients were divided into three groups: grade I (98 patients), grade II (56 patients) and grade III internal hemorrhoids (112 patients). The clinical efficacy and adverse events (AEs) 24h after ERBL of the three groups were compared and analyzed.
Results The effectiveness rate of grade I, II and III internal hemorrhoids were 88.8%, 87.5% and 86.6%, respectively, with no statistical difference (p>0.05). A total of 107 (40.2%) patients had AEs 24h after ERBL, of which 11 (4.1%) had postoperative bleeding, 48 (18.0%) had anal pain, 80 (30.1%) had sense of anal sagging, and 15 (5.6%) had urinary retention. The postoperative adverse events of grade I, II and III internal hemorrhoids were 42.9% (42/98), 51.8% (29/ 56) and 32.1% (36/112), respectively, and the difference was statistically significant (p<0.05). Univariate and multivariate analysis showed that the suspension ligation was the protective factor for postoperative AEs [OR (95%CI): 9.64 (2.124,43.79), p=0.04].
Conclusions ERBL is effective for grade I~III internal hemorrhoids, but it is safer for grade III internal hemorrhoids. Suspension ligation can reduce postoperative adverse reactions. Multicenter, prospective studies are needed to verify our conclusion.
Investigation of psychological distress and sleep quality in hematopoietic stem cell transplantation patients: a cross-sectional study
Authors: Wu Qian , Xu Jing , Huang Jing , Chen Lin , Zhang Yongjia , Zhang Yuan , Wang Tiehao
Published: July 2024

Objective
The aim of this study was to investigate the current status and correlation between psychological distress and sleep quality in hematopoietic stem cell transplantation, and to identify risk factors affecting psychological distress and sleep quality in patients.
Methods
This study investigated 275 patients who underwent hematopoietic stem cell transplantation in the laminar flow research unit of West China Hospital of Sichuan University. Surveys were conducted after they underwent transplantation, including demographic characteristics, the West China Heart Clearance Index score, and the Pittsburgh Sleep Quality Index.
Results
Anxiety and depression were present in 106 of the 275 patients. 198 patients had sleep disturbances. Sleep quality was significantly associated with anxiety and depression. Length of hospitalization, transplant complications and sleep disorders were risk factors for anxiety and depression. Transplant complications and anxiety and depression were risk factors for sleep disorders.
Conclusion
Hematopoietic stem cell transplant patients commonly experience anxiety, depression, and sleep disturbances during hospitalization. Early assessment and intervention can improve patient prognosis and quality of life in the mid- and long-term.
Single specimen genome assembly of Culicoides stellifer shows evidence of a non-retroviral endogenous viral element
Authors: Castellanos-Labarcena Jessica , Milián-García Yoamel , Elliott Tyler A. , Steinke Dirk , Hanner Robert , Adamowicz Sarah J.
Published: July 2024

Background Advancing our knowledge of vector species genomes is a key step in our battle against the spread of diseases. Biting midges of the genus Culicoides are vectors of arboviruses that significantly affect livestock worldwide. Culicoides stellifer is a suspected vector with a wide range distribution in North America, for which cryptic diversity has been described.Results With just one specimen of C. stellifer, we assembled and annotated both a high-quality nuclear and a mitochondrial genome using the ultra-low input DNA PacBio protocol. The genome assembly is 119 Mb in length with a contig N50 value of 479.3 kb, contains 11% repeat sequences and 18,895 annotated protein-coding genes. To further elucidate the role of this species as a vector, we provide genomic evidence of a non-retroviral endogenous viral element integrated into the genome that corresponds to rhabdovirus nucleocapsid proteins, the same family as the Vesicular Stomatitis Virus.Conclusions This genomic information will pave the way for future investigations into this species's putative vector role. We also demonstrate the practicability of completing genomic studies in small dipterans using single specimens preserved in ethanol as well as introduce a workflow for data analysis that considers the challenges of insect genome assembly.