bluuebunny/crossref_metadata_2025 huggingface dataset:
The clinical value of the SII for predicting the development of urosepsis after percutaneous nephrolithotripsy
Authors: Wu Huang , Lian Fuyan
Published: October 2024

Purpose
Based on accumulating evidence, biomarkers related to the inflammatory response are closely associated with tumors. However, there are fewer studies related to urosepsis. The aim of this research was to investigate the importance of the SII as a predictor of the development of urosepsis after percutaneous nephrolithotripsy, utilizing a retrospective research design.
Materials and Methods
This study encompassed a cohort of 639 individuals diagnosed with kidney stones between January 2019 and August 2022. The patients were categorized into a modeling group consisting of 439 individuals and a validation group comprising 200 individuals, following a ratio of 7:3. R software was used to perform multivariate logistic regression analysis after screening with LASSO regression. The risk line graph model, ROC curve, calibration curve, and decision curve of the modeling group were drawn and visualized using R statistical software. These findings were also drawn and verified in the validation cohort.
Results
In a cohort of 439 patients, the prevalence of urosepsis was found to be 9.11% (40/439). Subsequently, a multivariate logistic regression analysis was conducted following a screening process utilizing LASSO regression. Our results suggested four risk factors for PCNL-US, namely, positive urinary nitrite (OR = 3.176, 95%CI: 1.390–7.097, P < 0.001), preoperative fever (OR = 2.762, 95%CI: 1.021–7.104, P = 0.039), positive urine culture (OR = 2.447, 95%CI: 1.077–5.476, P = 0.030), and high preoperative SII (OR = 4.943, 95%CI: 2.323–10.776, P < 0.001). According to above four factors, we constructed a column-line graph prediction model of risk factors for PCNL-US. The area under the ROC curve (AUC) of the modeling group was 0.818 (95% CI: 0.739–0.898). The area under the ROC curve (AUC) of the validation group was 0.794 (95% CI: 0.679–0.909). The Hosmer-Lemeshow test was greater than 0.05 in both groups, indicating a good calibration curve and good clinical decision-making performance.
Conclusions
This study suggested that positive urinary nitrite levels, preoperative fever, and positive urine culture are risk factors for PCNL-US. Additionally, a high preoperative SII level is recognized as a separate risk factor for the occurrence of urosepsis. The clinical prediction model constructed based on these four risk factors may serve as a reference for preventing the occurrence of PCNL-US.
MRI imaging characteristics of brainstem and midbrain aqueduct in patients with iNPH
Authors: Xiao Kui , Zhou Liangxue , Tang Xielin , Liu Shenghua , Deng Ziang , Yang Feilong
Published: October 2024

This study explores the specific magnetic resonance imaging (MRI) indicators of the brainstem and mesencephalic aqueduct in patients with idiopathic normal pressure hydrocephalus (iNPH). We analyzed the head MRI data of 50 iNPH patients and 30 healthy middle-aged and elderly individuals. The study included an analysis of the length, diameter, and angle of the cerebral aqueduct, as well as the longitudinal cross-sectional areas of the midbrain and brainstem. Additionally, we evaluated the midbrain proportion, brainstem volume ratio, the angle between the brainstem and spinal cord, and the area and morphology of the pontine cistern. The findings revealed that, compared to healthy individuals, iNPH patients exhibited significant dilation of the midbrain aqueduct diameter, a reduced aqueduct angle, and a decreased longitudinal cross-sectional area of the brainstem, with the most pronounced reduction in the midbrain area. Notably, the cerebral pools surrounding the brainstem in iNPH patients were dilated, with the pontine cistern presenting a "hammer" shape, and the prevalence of this "hammer" shape was significantly positively correlated with the area of the pontine cistern. These unique imaging characteristics not only enhance the clinical recognition of iNPH, but also provide new imaging evidence for the early diagnosis and treatment of iNPH.
Predicts Value of a Combined Nomogram Model Integrating ultrasound and cytology for ATA risk stratification of lymph node negative papillary thyroid carcinoma
Authors: Qin Xiachuan , LIU Xiaoling , He Fanding , Xiao Weihan , Ye Xianjun
Published: October 2024

Objectives
This study aimed to predict the American Thyroid Association (ATA) risk stratification of lymph node negative (N0) papillary thyroid carcinoma (PTC) patients using preoperative ultrasonic and cytological features to provide guidance for clinical treatment strategies.
Methods
In this multicenter, retrospective study, 500 N0 PTC patients who underwent total thyroidectomy with lymph node dissection were included across 2 institutions from September 2018 to February 2024. Patients were categorized into low, intermediate-high recurrence risk groups based on the 2009 ATA risk stratification system. Univariate logistic regression analysis was performed to assess the relationship between ultrasonic and cytological features and ATA risk stratification. Significant features (P < 0.05) were then incorporated into a multivariate logistic regression model to identify independent predictors of risk stratification. A Nomogram was constructed using predictors from the final multivariate logistic regression.
Results
Papillary like arrangement,Escape like arrangement, Nucleolus, Size, echo, Margin, and ECE were identified as independent predictors of ATA risk stratification. A Nomogram model was developed based on these predictors, demonstrating good discrimination with a C-index of 0.799. The calibration curve further demonstrated excellent predicted consistency between the predicted metastasis probabilities. Additionally, the Nomogram displayed a C-index of 0.778 in the testing cohort.
Conclusions
Risk stratification in N0 PTC patients correlates with factors such as Papillary arrangement, Escape like arrangement, Nucleolus, Size, Echo, Margin, and ECE, emphasizing the necessity of closely monitoring patients presenting with these risk factors. Additionally, the Nomogram model integrating seven preoperative risk factors specifically tailored for solitary N0 PTC patients was devised, showcasing notable predictive accuracy for preoperative ATA risk stratification.
Long-term Shoreline Dynamics of South Kerala Coast using Satellite images
Authors: S Shanmuga Priyaa , J Rajkumar , JENA BASANTA KUMAR
Published: October 2024

The shoreline experiences significant changes due to human activities and natural processes, resulting in erosion and accretion. Studying the morphology of shorelines is crucial for identifying the causes and impacts of coastal processes along the coast, which helps protect the ecosystem and facilitate future development. This study comprehensively analyses shoreline changes along the Kerala coast from 1973 to 2024, revealing substantial shifts due to frequent cyclones and other natural events. Key findings include significant erosion at Shangumugam, Valliyathura, Punthura, and Edapadu beaches and notable accretion at Thumba, Kochuveli, Vizhinjam, Adimalathura, Pullavila, Karumkulam, and Poovar. Trend analysis from 2000 to 2024, using high-resolution satellite images, identified consistent erosion patterns, particularly after Cyclone Ockhi in 2017, which caused significant, unrecovered erosion along the Vizhinjam coastline. It is observed that the frequency of cyclonic activity has increased in recent times. Validation of shoreline data derived from satellite images of varying resolutions (PAN (2.5m), LISS 4 (5m), MSI (10m)) against field data collected using DGPS demonstrated that higher spatial resolution results in more accurate shoreline extraction, with errors decreasing from 3.3m (10m vs. 1m) to 0.3m (2.5m vs. 1m). This highlights the importance of high-resolution satellite imagery in monitoring and managing shoreline changes. The study accentuates Kerala's increasing vulnerability to natural disasters and the necessity of advanced monitoring techniques for effective coastal management.
Impact of Lactobacillus johnsonii on Metabolic Control in Type 2 Diabetes with Circadian Disruption
Authors: Yang Yan , Wang zhen , Shen Hongxia , Shi Zhenhong , Mei Xianghui , Wu Na , Sun Li , Wang Defeng
Published: October 2024

Objective: In clinical practice, we have observed that most patients with type 2 diabetes mellitus (T2DM) and circadian rhythm disruption have poor blood glucose control. However, there is a subset of patients with T2DM and circadian rhythm disruption who still have good blood glucose control. Previous studies have shown that individuals with circadian rhythm disruption are more prone to developing T2DM, and the occurrence of T2DM is associated with the gut microbiota. However, the role of gut microbiota in patients with T2DM and circadian rhythm disruption remains unclear.
Methods: Stool samples were collected from 6 patients with poorly controlled type 2 diabetes mellitus (T2DM) and circadian rhythm disruption, as well as from 6 patients with well-controlled T2DM and circadian rhythm disruption. Metagenomic sequencing was performed on the stool samples. Compared to the well-controlled group, the abundance of Lactobacillus johnsonii(L. johnsonii ) was significantly decreased in the poorly controlled group. To investigate the effects of L. johnsonii supplementation on glucose and lipid metabolism, diabetic mice with circadian rhythm disruption were administered L. johnsonii and their metabolic indicators were measured.
Results: A metagenomic analysis is conducted in 6 patients with poorly controlled type 2 diabetes combined with disrupted circadian rhythm group (P-T2D-RD), as well as in 6 patients with well-controlled type 2 diabetes combined with disrupted circadian rhythm group (W-T2D-RD). Metagenomic sequencing of the gut microbiota revealed a higher microbial diversity in the W-T2D-RD group. Additionally, a significant decrease in the abundance of L. johnsonii was observed in patients with P-T2D-RD when compared to those with W-T2D-RD. Following supplementation of L. johnsonii to the mice in the type 2 diabetes mellitus rhythm disruption Lactobacillus johnsonii group (T2DM-RD-L), the fasting blood glucose levels and postprandial blood glucose levels were significantly reduced. Additionally, total cholesterol and low-density lipoprotein levels decreased, high-density lipoprotein levels increased in the T2DM-RD-L group.
Conclusion: Lactobacillus johnsonii has a positive impact on both glucose and lipid metabolism in patients with type 2 diabetes mellitus and circadian rhythm disruption.
N6-methyladenosine modification of circular RNA circASH2L suppresses growth and metastasis in hepatocellular carcinoma through regulating hsa-miR-525-3p/MTUS2 axis
Authors: Xu Dafeng , Liu Yachong , Liu Qiumeng , Li Ganxun , Zhang Lu , Yu Chengpeng , Liang Huifang , Chen Xiaoping , Zheng Jinfang , Song Jia
Published: October 2024

Background
CircRNAs have been demonstrated to play a crucial role in regulating the growth and progression of various cancers, including hepatocellular carcinoma (HCC). Nevertheless, the circRNA's expression pattern and function in HCC need more investigation.
Methods
Bioinformatics techniques were used to identify differentially expressed circRNAs in HCC. CircASH2L expression in HCC tissues was assessed through qRT-PCR and ISH analysis. To assess circASH2L's impact on HCC progression, a variety of experiments were carried out both in vitro and in vivo, such as CCK8, colony formation, EdU assay, flow cytometry, transwell assay, and xenograft mouse model. Various experimental techniques including qRT-PCR, dual luciferase reporter assay, FISH, RNA pull-down, and RIP experiments were utilized to evaluate the relationship between circASH2L, miR-525-3p, and MTUS2. Additionally, experiments were conducted to explore the impact of m6A modification on circASH2L expression, including RNA stability assay, m6A RNA immunoprecipitation assay (MeRIP), and Co-IP experiments.
Results
We found that circASH2L was downregulated in HCC tissues and the downregulation of circASH2L was significantly correlated with malignant characteristics as well as poor overall survival of patients with HCC. CircASH2L was found to inhibit cells growth, migration and invasion as well as tumorigenesis and metastasis in vivo. Mechanistically, we established that circASH2L directly interacted with miR-525-3p to enhance MTUS2 expression, subsequently leading to tumor suppression. Moreover, the influence of circASH2L on tumor suppression was attenuated by increasing miR-525-3p levels, and MTUS2 was recognized as an essential intermediary in circASH2L-induced tumor suppression. Additionally, N6−methyladenosine (m6A) modification was identified in circASH2L. Our data suggested that METTL3 was responsible for mediating m6A methylation of circASH2L, ultimately regulating circASH2L expression through the promotion of its degradation. These findings collectively highlight the role of circASH2L as a tumor suppressor through a unique circASH2L/miR-525-3p/MTUS2 axis, shedding light on the significance of m6A modification in regulating circASH2L function.
Conclusion
The work emphasizes circASH2L as a promising therapeutic target for treating HCC, offering new insights into the role of circRNAs in HCC development.
Utility of Tissue Biopsy in Amoxicillin-Clavulanate induced Concomitant Hepatic Failure and Renal Failure: A Case Report
Authors: Das John A. , Azad Saima , Kapp Meghan E. , Liu Wendy , Nguyen Vinh
Published: October 2024

Several reports indicate that amoxicillin-clavulanate can cause both liver injury as well as acute kidney injury. However, the majority of the existing literature has described liver-related injury, with fewer reports noting kidney injury. In this report, we describe a case of concomitant drug induced liver injury (DILI) and acute interstitial nephritis (AIN) as a result of amoxicillin-clavulanate exposure. A 62-year-old African American male presented with one week of generalized weakness, painless jaundice, nausea, vomiting, and diarrhea. Prior to admission, the patient had completed a 10-day course of amoxicillin-clavulanate for bacterial sinusitis. Upon admission, laboratory data revealed transaminitis and elevated creatinine levels suggestive of liver injury and renal failure. Through tissue biopsy of both organs, the diagnosis of amoxicillin-clavulanate induced acute liver injury and acute tubulointerstitial nephritis with bile cast nephropathy was made. This case highlights the critical role of tissue biopsy in reaching a unifying diagnosis for this rare adverse effect of amoxicillin-clavulanate.
Narcotic Drugs and Psychotropic Substances Control System in Ethiopia: A National Survey
Authors: Beyene Kidanemariam G/Michael , Borta Heran Gerba , Alemu Asnakech , Shute Teshita , Zewdie Baharu , Fantaw Debalke , Shimelis Bitsat , Dagnachew Betelhem , Alemu Wondie , Mekie Yonas , Endale Sisay , Tamiru Melaku Tileku
Published: October 2024

Introduction
Narcotic drugs and Psychotropic substances (NPS) play an indispensable role in health care despite their misuse could jeopardize the health of the people and the health system. The study presents a comprehensive assessment of NPS control system in Ethiopia, aiming to elucidate its regulatory landscape, challenges, and opportunities. By integrating both quantitative and qualitative data, the study offers a nuanced understanding of the multifaceted factors influencing NPS control system in the country.
Methods
An institution-based cross-sectional mixed study design was employed among 1199 study participants and 26 key informants in Ethiopia from April 14 to May 30, 2022. Multi-stage sampling technique was used to select study participants, and purposive sampling technique was used to select the key informants. The quantitative data were collected using a structured interview questionnaire whereas semi-structured questionnaire was used for in-depth interviews. Descriptive analysis was used for quantitative data analysis, and thematic analysis method was used for qualitative data.
Results
Findings from the qualitative analysis reveal significant gaps in the implementation of NPS laws and regulations, particularly in terms of enforcement and coordination. Structural deficiencies, stakeholder collaboration challenges, and communication gaps were identified as key barriers to effective NPS control. The quantitative survey provided detailed insights into the operational aspects of NPS management, highlighting areas for improvement such as reporting practices, storage methods, and dispensing protocols.
Conclusions
There are considerable gaps in the NPS control system in Ethiopia. The study underscores the importance of addressing the identified challenges to optimize NPS control efforts and safeguard public health in Ethiopia. Hence, necessary measures at all levels must be taken to strengthen the NPS control system in Ethiopia.
The microsurgical anatomy of the paracentral lobule artery: a cadaveric series
Authors: Georgountzos Georgios , Triantafyllou George , Mavrovounis Georgios , Piagkou Maria , Stranjalis George , Kalamatianos Theodosis
Published: October 2024

Purpose
The paracentral lobule artery (PLA) is a typically present branch of the distal anterior cerebral artery (ACA), irrigating the homonymous lobule. The PLA origin is either a pericallosal portion of the ACA or a prominent branch of the ACA termed callosomarginal (CMA). In addition to the paracentral lobule, the PLA irrigates the cingulate gyrus in the medial hemispheric surface, and the superior portion of the precentral and postcentral gyri in the lateral hemispheric surface. The present cadaveric case series aimed at establishing previously unreported morphometric estimates of the PLA, including its length according to its site of origin, its supplying branches according to its distribution area, as well as its anastomoses.
Methods
Seventeen colored latex-injected cadaveric heads were studied with a surgical microscope and microsurgical instruments.
Results
The PLA was invariably present and most commonly originated from the A4 (n = 15 hemispheres, 50%) segment of the ACA. Other PLA origins were the CMA (n = 10, 30%), the A3 (n = 5, 16.7%) and the A5 (n = 1, 3.3%) segments. When the PLA originated from the A4, its mean (SD) overall length was 7.6 (17.9) mm and its mean (SD) diameter was 0.88 (0.26) mm. The PLA supplied the paracentral lobule, cingulate gyrus and post central gyrus with a mean (SD) of 28.07 (13.4), 8.53 (4.27), 5.92 (4.4) branches respectively and the precentral gyrus with a median [IQR] of 2 [0–6] branches. The most common anastomoses of the PLA in the medial and the lateral hemispheric surface involved the ipsilateral posterior internal frontal artery and the branches of the middle cerebral artery, respectively. There were no significant differences between genders or hemispheric sides for the anatomical features of the artery analyzed.
Conclusion
The present study established previously unreported morphometric estimates for the PLA by considering all possible PLA variant origins and morphological variants. Given that variable pathologies have been previously detected in the areas supplied by the PLA, a better understanding of its anatomy can aid surgical planning and approaches.
Machine Learning Algorithms to Detect Patient-Ventilator Asynchrony. A Feasibility Study.
Authors: Williams Jeffrey , Ahari Jalil , Wong Kendrew , Jose Arun , Gutierrez Guillermo
Published: October 2024

Background: Adequate ventilatory support requires frequent assessment of patient-ventilator interactions. It is desirable, therefore, to develop a reliable, automated method for this task. This study evaluates the feasibility of developing machine-learning algorithms to emulate how experienced clinicians evaluate normal and abnormal breathing patterns, including patient-ventilator asynchrony.
Methods: We enrolled 44 adult patients within 24 hours of initiating invasive mechanical ventilation. Airway flow and pressure signals were acquired directly from the ventilator and stored as sequential 2.2-minute epochs for waveform classification. Experienced clinicians visually classified 50,712 epochs, encompassing approximately 2.6 million breathing cycles. Nineteen clinical variables were used to train four Random Forest algorithms to: 1) detect asynchronous breathing, 2) identify asynchrony type, 3) grade signal disruption, and 4) identify dynamic hyperinflation. Algorithm accuracy was assessed by the percentage of correctly identified epochs, while clinical reliability was evaluated by comparing the algorithms’ predictions to those of clinicians with varying experience in asynchrony classification.
Results: The algorithm detected asynchronous breathing with 91% accuracy. Accuracies for asynchrony classification, severity grading, and dynamic hyperinflation were 82%, 87%, and 93%, respectively. Algorithm classifications aligned more closely with expert clinicians (kappa = 0.46, and 0.59) than non-experts (kappa = 0.25, and 0.38; p < 0.05). Greater time asynchronous was associated with increased 28-day mortality (p = 0.015).
Conclusions: Machine-learning algorithms may be trained to emulate experienced clinicians in evaluating breathing during mechanical ventilation. Larger databases and advancements in artificial intelligence may lead to powerful algorithms capable of establishing associations between airway signals and successful ventilatory support.
Gadoxetic acid-enhanced magnetic resonance imaging to predict pathologic complete response of colorectal liver metastases in preoperative chemotherapy
Authors: Noguchi Yuka , Einama Takahiro , Ohara Mayuko , Ichio Kouki , Kobayashi Kazuki , Yonamine Naoto , Tsunenari Takazumi , Takihata Yasuhiro , Takao Mikiya , Edo Hiromi , Okamoto Koichi , Kajiwara Yoshiki , Shinto Eiji , Ogata Sho , Ueno Hideki , Shinmoto Hiroshi , Kishi Yoji
Published: October 2024

Background
Recent advances in chemotherapy have expanded the opportunity for curative resection of colorectal liver metastases (CRLMs). Disappearing liver metastases (DLMs) are often encountered following chemotherapy. This study aimed to determine whether the DLMs observed by contrast-enhanced computed tomography (CECT) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) following preoperative chemotherapy were associated with a pathologic complete response(pCR).
Methods
Patients who underwent hepatectomy between April 2020 and December 2022, following preoperative chemotherapy at our institution, were selected. Before chemotherapy, all patients underwent CECT, some patients also underwent EOB-MRI, and both imaging studies were performed on all patients after chemotherapy. Pathologic responses of all resected tumors were evaluated. For the unresected DLMs, they were defined as DLMs if they did not reappear in the imaging studies conducted over the following year.
Results
A total of 29 patients were selected. After chemotherapy, 138 DLMs were found by CECT and 106 were found by EOB-MRI. Of the resected DLMs confirmed only by CECT, tumor cells remained in 90% of them. All of resected DLMs confirmed by EOB-MRI showed a pCR. Of the remaining 39 unresected DLMs, one reappeared within a year.
Conclusions
EOB-MRI is superior to CECT for the diagnosis of DLMs.
Incremental prognostic value of combined information of arterial stiffness and the result of treadmill exercise test in patients with suspected coronary artery disease
Authors: Chung Jaehoon , Kim Hack-Lyoung , Joh Hyun Sung , Lim Woo-Hyun , Seo Jae-Bin , Kim Sang-Hyun , Zo Joo-Hee , Kim Myung-A
Published: October 2024

The effectiveness of diagnostic tools can be enhanced by their combination. This study aimed to investigate whether arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events. A total of 1,788 consecutive subjects (mean age 55.8 ± 10.7 years, 59.1% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and coronary revascularization. During a mean follow-up period of 875 days (interquartile range, 116–2,212 days), there were 88 cases of MACE (4.9%). The elevated baPWV (≥ 1,440 cm/s) (hazard ratio [HR] 5.18, 95% confidence interval [CI] 2.68–10.0, P < 0.001) and positive ETT result (HR 2.81, 95% CI 1.77–4.47, P < 0.001) were associated with MACE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects’ risk (low baPWV and negative ETT result vs high baPVW and positive ETT result; HR 16.44, 95% CI 6.17–43.78, P < 0.001). Arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. Combined information of baPWV and ETT result can serve as a useful clinical tool for risk stratification in this high-risk patient population.
Correlation between METS-IR index and obstructive sleep apnea in non- diabetic adults: evidence from NHANES 2001–2018
Authors: Yin Huangyi , Huang Wei , Yang Bijun
Published: October 2024

Background: Insulin resistance (IR) is strongly associated with obstructive sleep apnea (OSA). Whereas, few studies have focused on the potential correlation between the Metabolic Score for Insulin Resistance (METS-IR), a novel non-insulin-dependent IR index, and OSA.
Methods: Subjects from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2008 and 2015-2018 were recruited. The potential relationship between METS-IR and other IR indices with OSA was explored through three logistic regression analysis models and restricted cubic spline (RCS) curves. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of these indicators for OSA. On the basis of age, sex, race, body mass index (BMI), hypertension, and cardiovascular disease (CVD), subgroup analyses were conducted to test the robustness of the METS-IR and OSA relationship.
Results: In all of 6,633 non-diabetic participants were enrolled, with an OSA prevalence of 28.40%. After adjusting for potential confounders, METS-IR, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride glucose Index (TyG), and homeostatic model assessment of insulin resistance (HOMA-IR) indices showed positive associations with OSA prevalence. In the highest tertile of METS-IR, TG/HDL-C, TyG index, and HOMA-IR indices, OSA prevalence was 3.22-fold, 1.42-fold, 1.45-fold, and 1.51-fold higher, respectively, compared to the lowest tertile (METS-IR: OR = 3.22, 95% CI: 2.67, 3.89, P < 0.0001; TG/HDL-C: OR = 1.42, 95% CI: 1.15, 1.76, P =0.002; TyG index: OR = 1.45, 95% CI: 1.18, 1.78, P<0.001; HOMA-IR: OR = 1.51, 95% CI: 1.24, 1.85, P <0.001). ROC analysis revealed that METS-IR had the highest diagnostic accuracy for OSA (AUC = 0.65). The relationship between METS-IR and OSA did not show significant interaction across all subgroups (P for interaction > 0.05).
Conclusion: Compared with HOMA-IR, TG/HDL-C and TyG, METS-IR index was positively correlated with OSA prevalence and had superior diagnostic accuracy.
Compare the molecular differences of pleural effusion and metastatic lymph node biopsy of lung adenocarcinoma based on NGS and evaluate the Clinical efficacy
Authors: Liang Shuo , Wang Yuan , Wei Jiacong , Sun Zihan , Xiao Xiaoyue , Li Weihua , Wang Cong , Sun Yue , Chang Xinxiang , Zhao Linlin , Zhao Huan , Guo Huiqin , Zhang Zhihui
Published: October 2024

Objective
The present study is to investigate the next-generation sequencing (NGS) molecular typing results of liquid-based cytology specimens (LBCSs) of pleural effusion in lung adenocarcinoma evaluate the clinical efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) treatment and compare the consistency of the molecular typing results with those of metastatic lymph node biopsy specimens (MLNBSs).
Methods
A total of 222 cases of lung adenocarcinoma pleural effusion LBCSs and 201 cases of MLNBSs were collected to compare the consistency of NGS molecular typing results. The impacts of different tumor cell contents in LBCSs on mutation detection limitation was evaluated. The clinical efficacy evaluation was performed on 91 patients treated with EGFR-TKI was evaluated and the survival curve analysis was conducted using Kaplan-Meier method.
Results
The mutation rates of cancer-related genes detected by NGS were comparable LBCSs and MLNBSs of lung adenocarcinoma(82.0% vs 79.1%, P = 0.455). However, the mutation rate of EGFR T790M was significantly higher in pleural effusion LBCSs than in MLNBSs(12.2%>3.5%, P = 0.001). After EGFR-TKI treatment, the mean progression-free survival time (PFS) was 11.4 months in 91 patients with molecular typing based on LBCSs.
Conclusions
The results of NGS molecular typing of pleural effusion LBCSs from lung adenocarcinoma patients can yield comparable PFS to that of histological specimens following the clinical application of EGFR-TKI treatment.
Structural modifications of certain pyrrolizidine alkaloids during sample extraction and its impact on analytical results
Authors: Kaltner Florian , Klein Lisa Monika
Published: October 2024

Pyrrolizidine alkaloids (PAs), a group of plant toxins often contaminating food or feed, are typically extracted from samples using liquid extraction. The crude extracts are then often purified using solid-phase extraction (SPE) cartridges before being analysed by LC-MS/MS. During the development of analytical methods based on strong cation exchange SPE, certain structurally related PAs showed unexpectedly low or significantly increased recoveries, suggesting transformation reactions may be at play. To investigate this hypothesis, sample preparations were conducted using PA-free milk as food matrix, water or organic solvents, into which PA reference standards were spiked before or after critical steps of the protocol. The results revealed a significant decrease in acetylated PA N-oxides to their corresponding deacetylated compounds, as well as the formation of epoxydic PAs from PA compounds containing chlorine and hydroxyl groups in the α position. Evaporation of the alkaline SPE eluates, combined with the use of the protic solvent methanol in cases of deacetylation, was responsible for these phenomena. An alkaline ester hydrolysis mechanism was hypothesised for the deacetylation, while an internal SN2 reaction, similar to the chlorohydrin reaction, was suggested for the formation of epoxy PA compounds. Consequently, using different sample preparation methods may inadvertently bias the determined PA patterns.
A prospective split-mouth clinical study: Comparison of the effect of lornoxicam and etodolac on postoperative sequels following lower third molar surgery
Authors: Karabıyık Zulfikar , BASIRY Mohammad NABI
Published: October 2024

Purpose
This study aims to compare the efficacy of two non-steroidal anti-inflammatory agents (NSAIDs), namely lornoxicam and etodolac for controlling pain, edema and trismus after removal of lower impacted third molars.
Materials and Methods
A total of 20 patients comprised of both genders with bilateral impacted lower impacted third molars (in similar positions) was included in the present study. Patients were randomly assigned either to the lornoxicam group (8 mg of lornoxicam) or to the etodolac group (400 mg of etodolac). The drugs prescribed were handed out immediately after tooth extraction. Postoperative pain was assessed using visual analog scale (VAS). Swelling was evaluated using reference lines on the face. Trismus was assessed using a caliper at maximum mouth opening (mm).
Results
There was no significant difference in postoperative pain, trismus, and swelling between lornoxicam and etodolac group (p > 0.05).
Conclusions
Based on the results obtained in the present study, ıt has been verified that both lornoxicam and etodolac were adequately effective in the management of pain following third molar surgery. Lornoxicam and etodolac had similar impacts on pain, swelling and trismus after lower third molar surgical extractions.
NanoString nCounter-based assay for detection of fusion-associated salivary gland tumors
Authors: Goytain Angela , Ng Tony L.
Published: October 2024

Purpose
Salivary gland tumors include numerous subtypes that vary from benign to highly aggressive, with many showing overlapping histopathological features that can make diagnosis challenging. Most subtypes express driver fusion genes that are tumor specific, and detection of such fusions is useful for differentiating amongst specific diagnoses, determining appropriate tumor grading, and guiding effective treatment. Currently, fusions can be detected by FISH, RT-PCR or through next-generation sequencing approaches, all of which are highly effective methodologies but can be costly or time consuming, limiting their use on a routine basis.
Methods
We developed a rapid NanoString nCounter platform-based assay to detect salivary gland tumor fusions using a combination of fusion junction-specific probes and an approach through differential exon expression analysis. The assay includes 68 junction-specific probes and analysis of exon expression across 9 fusion-associated genes in a single multiplex assay.
Results
Out of 55 retrospective and 171 prospective cases assayed, we accurately detected the majority of cases of pleomorphic adenoma, adenoid cystic carcinoma, cribriform adenocarcinoma, clear cell carcinoma, mammary analogue secretory carcinoma and NUT-rearranged carcinoms, including cases of these tumor types arising in non-salivary gland sites, with the major drawback being an inability to detect MAML2-containing mucoepidermoid samples. With mucoepidermoid carcinoma excluded, the assay shows an overall sensitivity of 96.1% and specificity of 100%.
Conclusion
We show that the majority of salivary gland tumor fusions can be effectively detected with a single rapid NanoString based assay, which can serve as a useful adjunctive tool for routine diagnostic head and neck pathology. The assay is low cost with a rapid turnaround time (30 hour total assay time per sample batch, with minimal technician input required) compared to alternate detection methods.
Study of hemodialysis catheter infections in Menofia University Hospital
Authors: Gomaa Azza A.E. , Zeid Amany M.A. , Nagy Ibrahim M.
Published: October 2024

Introduction
Central line-associated bloodstream infection (CLABSI) is a bloodstream infection proven by a laboratory within 48 hours after central line installation and unrelated to another location infection. We aimed to decrease the incidence of catheter-related blood stream infection (CRBSI) at the Menofia University Hospital hemodialysis unit by improving the safety of patients with central venous catheters (CVC).
Methods
We conducted a prospective interventional study conducted at Hemodialysis Unit Menofia University Hospital on 100 patients with CVC and followed up for CRBSI during the period from the beginning of January 2024 till the end of March 2024, followed by an educational program during April 2024 about general infection control procedures, and then reassessment was done during the period from the start of May 2024 till the end of July 2024. 100 patients, 53 males and 47 females, were enrolled before and after the intervention educational program.
Results
The infection prevalence in the pre-intervention was 42%, which was significantly reduced after intervention to 14%. This illustrates the role of intervention to decrease the incidence of the participants fever, chills, discharge, and tenderness (P < 0.05). Comparison of pre-intervention versus post-intervention infection control procedures showed that the intervention is a significantly improving factor against catheter-related infection (CRI).
Conclusions
The predictive factors of CRI included prolonged duration of CVC usage, difficult insertion, patient role (keeping the catheter dressing clean and dry), and catheter type. These factors can be considered as risk factors for the presence of infection.
Quality of Life and Appraisal Factors of Patients with Advanced Cancer and Their Family Caregivers
Authors: Liu Jia , Zhang Yuexia , Guan Ting , Wang Xiaomeng , Ma Chunxuan , Northouse Laurel , Song Lixin
Published: October 2024

Purpose
Few existing interventions have effectively improved the quality of life (QOL) for patients with advanced cancer and their caregivers, partly due to limited research on the factors associated with QOL. Guided by an adapted stress-coping model, this study aimed to examine the associations between the QOL of cancer patients and their caregivers and their primary and secondary appraisals. Primary appraisals involve perceptions and evaluations of advanced cancer and related caregiving, while secondary appraisals relate to their available resources and coping capabilities.
Methods
Using multi-level modeling, we conducted a secondary analysis of the baseline data collected from a randomized clinical trial that examined the effects of a family-based, psychoeducational support program for patients with advanced cancer and their caregivers (N = 362 dyads).
Results
The appraisal variables hypothesized in the adapted stress-coping model explained 74.14% of the variance in the QOL of patients with advanced cancer and their caregivers when controlling for demographics and other disease-related variables. Better QOL in patients and caregivers was associated with less negative appraisals of illness/caregiving, less uncertainty and hopelessness, less avoidant coping strategies, more family support, more health behaviors, higher self-efficacy, and more active coping strategies.
Conclusion
Our study highlights the significant impact that advanced cancer has on patients and their caregivers’ perceptions, responses to the illness, and QOL. It also highlights that effective interventions may need to target illness/caregiving appraisals, uncertainty, hopelessness, family support, health behaviors, self-efficacy, and coping strategies tailored to patient and caregiver needs.
Associations of Naples Prognostic Score with Stroke and all-cause mortality in adults : evidence from NHANES (2005-2018)
Authors: Xu Zhiqiang , Pei Minyue , Yang Xiaoqing , Xu Lixia , Zhang Dongya , Li Xiaochang , He Caihong , Guan Ruilei , Zhang Jijun , Xiao Weizhong , Yang Gaiqing
Published: October 2024

Objective
This study seeks to assess the associations of Naples Prognostic Score with stroke and all-cause mortality in adults.
Methods
We analyzed data from 44,601 participants in the 2005–2018 National Health and Nutrition Examination Survey (NHANES). The Naples Prognostic Score (NPS) was derived from total cholesterol, serum albumin, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Participants were classified into three groups based on their NPS. Stroke incidence was determined through self-reported questionnaires, and mortality data were diligently tracked using the National Death Index. We investigated the relationship between NPS and stroke prevalence using multiple logistic regression analysis. To explore the association between NPS and all-cause mortality in stroke survivors, we applied Kaplan-Meier survival analysis and Cox proportional hazards models. Furthermore, we conducted a detailed subgroup analysis to assess interaction effects on all-cause mortality risk within this population.
Results
The median age of the participants was 50.00 years [interquartile range: 35.00–64.00], with males comprising 49.36% of the study. The overall stroke prevalence was 3.93%. Participants were categorized into three groups based on their NPS: 6,328 (18.1%) in Group 0 (NPS 0), 24,015 (68.8%) in Group 1 (NPS 1 or 2), and 4,580 (13.1%) in Group 2 (NPS 3 or 4). After adjusting for covariates, individuals in Group 2 exhibited a significantly higher stroke prevalence compared to Group 0, with an odds ratio (OR) of 1.83 [95% confidence interval: 1.49–2.26]. Among the 1,372 patients with a history of stroke, with a median follow-up duration of 5.94 years, we utilized Cox proportional hazards models to assess the relationship between NPS and all-cause mortality risk. The analysis revealed that, after adjusting for covariates, stroke patients in Group 2 faced a significantly elevated risk of all-cause mortality (hazard ratio [HR] = 2.08 [95% confidence interval: 1.40–3.09]) compared to those in Group 0. Subsequent subgroup analyses to explore interaction effects on all-cause mortality risk among stroke patients shown no significant interactions (p for interaction > 0.05).
Conclusions
This study establishes the associations of Naples Prognostic Score with stroke and all-cause mortality in adults.
The impact of prophylactic cranial irradiation on the prognosis of patients with limited-stage small cell lung cancer in the MRI era
Authors: Chen Mengyuan , Sun Zehua , Pan Jingcong , Xu Yujin , Wang Yuezhen , Chen Ming , Hu Xiao
Published: October 2024

Purposes: To evaluate the impact of Prophylactic cranial irradiation (PCI) on the prognosis of patients with limited-stage small cell lung cancer (SCLC) in the era of MRI surveillance.
Methods: Limited-stage SCLC patients recruited in a prospective study with complete remission (CR) or partial remission (PR) of tumor after definitive chemo-radiotherapy (CRT) were retrospectively analyzed. Survival data were calculated by Kaplan-Meier methods, Cox proportional hazards model was applied for multivariate prognostic analysis.
Results: Between June 2002 and January 2017, 620 patients with limited-stage SCLC were accrued in a prospective study. After CRT, 228 (36.8%) patients achieved CR, of whom, 29 patients did not receive PCI, among the rest 199 patients, 172 (86.4%) received brain MRI to exclude brain metastasis (BM) before PCI. With a median follow-up time of 25.6 months, the cumulative BM rate was 17.1% and 37.9% in patients who received or did not receive PCI (P = 0.011). The median survival time was 30.2 months and 30.5 months, respectively and the 1 -, 3 -, 5-year survival rates were 93.7%, 42.9%, 35.8% and 83.4%, 46.5%, 41.9%, respectively (P = 0.98). Multivariate analysis indicated that baseline KPS ≥ 90 was a favorable independent prognostic factor for OS in CR patients (HR: 0.33, 95% CI: 0.23-0.46, P=0.000). After CRT, 392 (63.2%) patients achieved PR, 53 cases did not receive PCI and 310 (91.4%) of the remaining 339 patients received brain MRI before PCI. With a median follow-up time of 15.5 months, the cumulative brain metastasis rate was 12.7% and 46.2% respectively (P = 0.000). The median survival time was 25.7 months and 18.6 months, respectively. The 1 -, 3 -, and 5-year survival rates were 87.6%, 40.2%, 29.2% and 75.7%, 16.7%, 10.3% (P=0.000). Baseline KPS ≥ 90 (HR: 0.32, 95% CI: 0.25-0.41, P=0.000) and PCI (HR: 0.57, 95% CI: 0.41-0.79, P=0.001) were favorable prognostic factors for OS in PR patients.
Conclusions: In this study, PCI significantly reduced the incidence of BM in patients with limited-stage SCLC who were evaluated as CR and PR after CRT, but it has no significantly positive impact on overall survival in CR patients. Further prospective randomized studies were warranted.
Trauma and ICD-11 PTSD in treatment for substance use disorders: A Danish multi-site study
Authors: Karsberg Sidsel , Najavits Lisa , Pedersen Mads Uffe , Elklit Ask , Vang Maria Louison
Published: October 2024

Background
Previous research has indicated high levels of PTSD among people with substance use disorders (SUD), necessitating an exploration of trauma profiles in this population. This study aims to assess the prevalence of ICD-11 PTSD and study demographic, trauma-related, and substance-use related factors among individuals in SUD treatment in Denmark, focusing on differences between alcohol use disorder (AUD) and drug use disorder (DUD).
Methods
The study utilized a multi-site approach, collecting data from five Danish SUD treatment settings. A total of 1347 adult individuals were interviewed as part of an initial structured screening process for SUD treatment. Participants were assessed using the ICD-11 PTSD criteria.
Results
The findings indicate that approximately 25% of individuals in treatment met the criteria for probable PTSD, with an additional 15% showing subclinical PTSD symptoms. The prevalence of PTSD was higher in DUD treatment compared to AUD treatment. The study also highlighted significant differences in social functioning and clinical profiles between the two groups.
Conclusion
The high prevalence of PTSD symptoms among individuals in SUD treatment underscores the need for targeted interventions. The study suggests that PTSD should be a particular focus in DUD treatment due to the higher vulnerability and impact of trauma-related symptoms in this group.
Utilizing Retinal Arteriole/Venule Ratio to Estimate Intracranial Pressure
Authors: Nortvig Mathias Just , Andersen Mikkel C Schou , Eriksen Niclas Lynge , Aunan-Diop Jan Saip , Pedersen Christian Bonde , Poulsen Frantz Rom
Published: October 2024

Purpose
Intracranial pressure (ICP) control is important to avoid secondary brain injury in patients with intracranial pathologies. Current methods for measuring ICP are invasive and carry risks of infection and hemorrhage. Previously we found correlation between ICP and the arteriole-venous ratio (A/V ratio) of retinal vessels in an outpatient setting. This study investigated the usability of fundoscopy for non-invasive ICP estimation with the addition of intraocular pressure (IOP) in patients in a neuro-intensive care unit (NICU)
Methods
This single-center prospective cohort study was conducted at the NICU of Odense University Hospital from September 2020 to May 2021. Adult patients with a Glasgow Coma Score of 8 or less, who underwent invasive pressure neuromonitoring were included. Fundoscopy videos were captured daily and analyzed using deep learning algorithms. The A/V ratio was calculated and correlated with ICP. The data was analyzed using mixed-effect linear regression models.
Results
Forty patients were enrolled, whereof 15 were included in the final analysis. ICP ranged from − 1 to 111 mmHg (mean: 10.4, SD: 6.1), and IOP ranged from 4 to 13 mmHg (mean: 7.4, SD: 2.1). The A/V ratio showed a significant negative correlation with ICP > 15 mmHg (regression slope: -0.0659, 95%-CI: [-0.0665;-0.0653], p < 0.001). No significant change in A/V ratio was observed for ICP ≤ 15 mmHg. A similar significant correlation was found for ICP > IOP (regression slope: -0.0055, 95%-CI: [-0.0062;-0.0048], p < 0.001). Taking the IOP into account did not improve the model. The sensitivity analysis showed a sensitivity of 80.08% and a specificity of 22.51%, with an AUC of 0.6389.
Conclusion
In line with our previous work, non-invasive fundoscopy is a potential tool for detecting elevated ICP. However, challenges such as image quality and diagnostic specificity remains. Further research with larger, multi-center studies are needed to validate the utility. Standardization may enhance the technique's clinical applicability.