bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated TG/HDL-C Ratio as a Marker for NAFLD Risk and Severity: Insights from a Cross-Sectional Analysis
Authors: Xuan Yanyan , Zhang Qin , Chu Jinguo , Li Tongyu
Published: November 2024

Background
Non-alcoholic fatty liver disease (NAFLD) has emerged as a prominent global health concern, affecting approximately 25% of adults. This study aimed to investigate the association between the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) and NAFLD.
Methods
In this cross-sectional analysis, data from the 2017 to 2018 National Health and Nutrition Examination Survey were utilized to survey 4,763 individuals. Subgroup analyses, stratified by age and sex, were performed, along with adjusted multivariable logistic regression analyses to evaluate the relationship between TG/HDL-C levels and the likelihood of NAFLD, liver steatosis, and hepatic fibrosis stage. Additionally, a novel curve-fitting approach, employing an expanded generalized additive model, was applied to explore the non-linear connection between TG/HDL-C and NAFLD.
Results
Among the 4,763 participants, 1,874 individuals were diagnosed with NAFLD. All three models consistently demonstrated a positive association between TG/HDL-C levels and NAFLD. In the sex-stratified subgroup analysis, a 1.240-fold increased risk was observed among men. Furthermore, significant variations in the associations between TG/HDL-C and NAFLD were observed across different age groups, with the 20–40 age group exhibiting a stronger positive correlation. Interestingly, the relationship between TG/HDL-C and the risk of NAFLD exhibited an inverse U-shaped pattern.
Conclusion
Elevated TG/HDL-C levels were independently associated with a heightened risk of NAFLD and increased severity of hepatic steatosis in the American population.
Methodological Considerations and Effectiveness for Ecologically Valid Mental Fatigue Inducement in Sports: a Systematic Review
Authors: Bian Chao , Russell Suzanna , Mali Ana , Lathouwers Elke , De Pauw Kevin , Habay Jelle , Bogataj Špela , Roelands Bart
Published: November 2024

Background: Mental fatigue (MF) in sports has developed from well-controlled laboratory-based studies to applied studies with greater ecological validity. Ongoing developments in the representativeness of MF inducement approaches, including the broad range of sport-specific motor tasks to simulated real-life scenarios, have shown methodological variability and inconsistent outcomes of effectiveness. Evaluating and comparing these approaches is essential to provide recommendations for designinginducement tasks in future research and considerations for practitioners. Therefore, the systematic review aimed to summarize more ecologically valid MF-inducing tasks in representative sports contexts and to evaluate the MF inducement effectiveness via manipulation check outcomes and potential aftereffects on subsequent sport-specific performance.
Methods: The review was registered on the PROSPERO database (CRD42024577183). PubMed, Web of Science, PsycINFO, and SPORTDiscus were searched until 21 August 2024 for studies that applied acute, more ecologically valid MF-inducing tasks within sports-specific contexts. The MF inducement task design and effectiveness across representative sports and participants were investigated.
Results: Twelve papers were included. Only a quarter of studies presented an overall low risk of bias. The 20-minute sports-specific motor tasks with cognitive demands and most 30-minute simulated real-life scenarios (i.e., social media use on smartphones, watching tactical videos, sports-themed videogame play) successfully induced MF in differing athlete samples. Ineffective MF inducement was attributed to shorter task duration, passive engagement with sparse cognitive demands, or the involvement of less susceptible participants.
Conclusions: This systematic review evaluated MF inducement methodologies with greater ecological validity to sporting contexts. The inducement effectiveness varied within four task types. Athletes and sports practitioners should carefully manage the modality and content of pre-competition activities to minimize MF. Future research should refine and co-design the MF-inducing task with practitioners based on multifaceted MF evidence from laboratory and real-life settings, create immersive scenarios that can better replicate the inducement process in specific contexts, and improve measurement tools, which will provide comprehensive evaluation and verification of the MF inducement.
Identification and genetic diversity analysis of Paeonia lactiflora Pall. populations based on the chloroplast genes rpoB and psbK-psbI
Authors: An Kelu , Yin Guangyao , Wang Xin , Shi Yue , Zhang Xiaoqin , He Gaojie , Amu Laha , Chen Wenqin , Wang Baowei , Hu Xiuhua , Wang Xiaohui , Wei Shengli
Published: November 2024

Paeonia lactiflora Pall. is a species with significant medicinal and economic value. In this study, five complete chloroplast genome sequences of P. lactiflora samples originating from different regions in China were sequenced using the Illumina NovaSeq 4000 platform. All five P. lactiflora chloroplasts had a typical cyclic tetrameric structure with 130 genes annotated. Comparative genomic analysis indicated that rpoB and psbK-psbI function as potential specific DNA barcodes for intraspecific identification of P. lactiflora. PCR amplification of rpoB and psbK-psbI was performed on 246 samples from 7 production areas, achieving 100% amplification efficiency. Sequence analysis revealed that 5 and 10 haplotypes were identified based on rpoB and psbK-psbI, respectively. The joint analysis of two sequences identified 15 haplotypes named Hap1ཞHap15. Hap5 emerged as the most prevalent and geographically widespread haplotype across China. Haplotypic diversity (Hd) was 0.786, and nucleotide diversity was 0.00281, suggesting that P. lactiflora had high genetic diversity at the species level. The Neighbor-Joining tree showed that the 15 haplotypes were clustered into two branches, indicating extensive genetic exchange between clusters. The introduction of new individuals or rare genes into different clusters through gene flow increased genetic variation within clusters, enriching P. lactiflora genetic diversity. This study provides a foundation for identifying P. lactiflora, protecting and utilizing germplasm resources, and supporting molecular breeding efforts.
Characterization and Genomic Analysis of Cronobacter sakazakii phage JC03, a new member of genus Pseudotevenvirus
Authors: Jiang Jie , Sai Jingying , Huang Xin , Sun Lingling , Li Jinghua , Huang Honglan , Sun Yanbo , zhao chunyan
Published: November 2024

The Cronobacter sakasakii-infecting phage JC03 was isolated and characterized. The complete genome sequence analysis of phage JC03 revealed that its genome is composed of 177,089 bp of DNA, including 268 predicted open reading frames (ORFs) and 2 tRNAs, and it has a G + C content of 44.67%. The predicted ORFs were classified into functional groups, including DNA replication/modification, assembly /packaging, phage structure, host lysis, and hypothetical proteins; no gene was found to be related to antibiotic resistance and virulence. Based on the results of gene annotation, genome features and comparative genomics, we propose that JC03 is a new isolate of genus Pseudotevenvirus.
Prospective, randomized clinical trial evaluating the clinical performance of a new universal adhesive in Class I and Class II restorations
Authors: Perdigão Jorge , Chew Hooi Pin , Lee Ignatius K. , Woodis Kacie , Hatch Brain
Published: November 2024

Objective This randomized controlled trial compared the 1-year clinical efficacy of Scotchbond Universal Adhesive Plus (SBU+) with that of its predecessor Scotchbond Universal Adhesive (SBU) to restore Class I and Class II preparations using the self-etch strategy in adult patients.
Materials and methods - Fifty-one subjects participated in this study. Two posterior teeth in each subject were randomized to a restoration with SBU+ or to a restoration with SBU (control) using the self-etch strategy. Teeth were restored with Filtek Universal Restorative. Restorations were evaluated at baseline, 6 months and 1 year using the FDI criteria. The Wilcoxon signed-rank test was used to compare outcomes.
Results - No restorations were graded as “Insufficient/Unsatisfactory” or “Poor” for any of the FDI criteria at the baseline, 6-month, or 1-year visits. At 1 year the retention rate was 100% for both SBU+ and SBU. For fracture of the restorative material 42/44 SBU+ restorations (95%) and 44/44 SBU restorations (100%) were graded “Excellent/Very Good” (p>0.05). All restorations were clinically acceptable for marginal adaptation at 1 year with no statistical differences between the two adhesive materials. There were no recurrent caries lesions at the 1-year visit.
Conclusions -The clinical efficacy of the SBU+ at 1-year was not different to that of its predecessor SBU in Class I and Class II restorations of adult patients using the self-etch strategy.
Clinical relevance– The two dental adhesives used in this clinical trial showed excellent results in posterior restorations at 1 year without using a separate phosphoric etching step.
Anatomy of a famine: using fuzzy cognitive mapping to understand the crisis in Ayod County, South Sudan, 2017
Authors: Day Matthew
Published: November 2024

This paper explores the limitations of current famine analysis methodologies and introduces Fuzzy Cognitive Mapping (FCM) as a novel approach to understanding famine dynamics. Traditional methods, such as the Integrated Food Security Phase Classification (IPC), often fail to capture the complex, non-linear interactions among social, economic, political, and environmental factors that drive famine. These methods rely heavily on cross-sectional survey data and expert judgment, which are prone to errors and biases. This study demonstrates the utility of FCM in analyzing famine systems, using the 2017 Ayod County crisis in South Sudan as a case study. FCM integrates qualitative and quantitative data, enabling real-time analysis of dynamic systems with limited data availability. The results highlight how FCM can reveal critical linkages and feedback loops, offering a more nuanced understanding of famine trajectories and enhancing early warning systems. The paper argues for the adoption of FCM in humanitarian contexts to improve the timeliness and accuracy of famine response and prevention strategies.
Constructing food web of carnivorous fishes using multiple DNA barcoding markers of gut contents: A case from Bohai Bay, China
Authors: Pang Xiaoke , Guo Biao , Liu Kefeng , Han Chenglong , Zhao Yifan , Liu Yufei , Kinoshita Toshihisa , Yamashita Osamu , Wang Wenhui , Lu Xueqiang
Published: November 2024

Next-generation sequencing (NGS) technology through barcoding of DNA in highly-digested diet samples has become a powerful tool for diet reconstruction in food webs. However, traditional single markers can only detect very few prey species, and the constructed food web cannot reflect all effective feeding information. Here, we used multi-locus NGS with COI-M, COI-m, 18S and 16S markers to analyze the feeding habits of carnivorous fishes in Bohai Bay, China. We compared the prey identification results of single markers and multiple markers on the gut content analysis, and integrated examined the feeding characteristics of carnivorous fishes to reconstruct the food web. Our findings revealed that a four-marker combination could detect up to 56 orders and 156 species of preys in the diets of these fishes, which are 1.5 − 6.2 and 1.7 − 9.2 times that of detected by single markers, respectively. Calanoida was detected as one of the primary food sources of carnivorous fishes expect for Gobiiformes and Decapoda at order level, contrasting with the previous researches. Network structure analyses showed significant modularity in the food web of carnivorous fishes and their preys. Species Scomberomorus niphonius, Odontamblyopus rubicundus, Chaeturichthys stigmatias, Platycephalus indicus and Cynoglossus joyneri were found to be divided into three different modules in the food web, indicating that specific and directional proliferation strategies should be advocated to be adopt for their population recoveries. This study reported a detailed trophic network of the carnivorous fishes, providing valuable insights for effective conservation and restoration strategies to enhance fisheries structure and stabilize the marine ecosystem.
The Impact of two kinds of Liuzijue Qigong on Respiratory and Motor Function in Early Stroke Recovery Patients
Authors: Bi yuqing , wang shuoshuo , Li meng , Ni wei dong , fan hang , wang furong , chen haiyun , ding shanshan , zhang ying
Published: November 2024

Background
This study aims to assess the impact of two kinds of Liuzijue Qigong on respiratory and motor functions of hemiplegic stroke patients with impaired balance and respiratory function in early-phase recovery rehabilitation.
Methods
66 Stroke patients were randomly divided into three groups: Liuzijue Qigong group (LG), ancient Liuzijue Qigong group (AG), and the control group (CG). The primary outcomes Trunk Impairment Scale (TIS) and secondary outcomes Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), Fugl-Meyer Assessment Upper Extremity (FMA-UE) Scale and Berg Balance Scale (BBS) will be measured at baseline (T0), after 2 weeks of treatment (T1), and after 4 weeks follow-up (T2).
Results
The within-group comparison results showed that compared to T0, all three groups of stroke patients had significant increases (P < 0.05) in TIS, MIP, MEP, FEV1, FVC and BBS at T1 and T2. CG and LG had significant increases (P < 0.05) in FMA-UE at T1 and T2, but AG had no statistically significant differences at T1 (P > 0.05). The intergroup comparison results showed that at T1-T0 and T2-T0, LQG had significantly higher TIS, MIP, MEP, FEV1, FVC and FMA-UE scores than AG and CG (P < 0.017). There were no statistically significant differences in the intergroup comparison of BBS at T1-T0 and T2-T0 (P > 0.017).
Conclusions
Both forms of Liuzijue Qigong resulted in notable enhancements in the respiratory and motor functions of hemiplegic stroke patients with respiratory and balance dysfunction.
Trial registration:
ChiCTR2100051325, Registered on September 20, 2021
Investigating the Influence of Salt Concentration in Drying Lake Urmia on Saline Water Intrusion in an Adjacent Aquifer
Authors: Ahmadi Hojjat
Published: November 2024

Drying of Lake Urmia due to less water entry and evaporation leads to a rise in salt concentration as well as the saline water density. The declining saline water level and rising of its density have the opposite effect on the saltwater intrusion dynamic. In this study, based on the groundwater and lake water level fluctuations and density variation of Lake Urmia over two decades, the saltwater interaction in one of the coastal aquifers has been studied numerically using SEAWAT. The findings of the research have been approved by comparing the model results with the recorded data collected from the observation wells in the studied aquifer. The achieved results showed that in the case of constant lake water density saltwater wedge progresses slightly by the middle of the studied period and then recedes to the lakeside while considering the increasing density of the lake over 27 years showed that the length of the saltwater wedge in the field scale surprisingly has been expanded more than 250% during the shrinking period of the lake with more than 6 m dropping of water level. Overall, considering the behavior of the saltwater intrusion around the coastal area based on our findings would be conducive to the realistic management of the saline lakes and the implementation of any restoration program for drying lakes.
Non-damaging Retinal Laser Therapy in Patients with Retinitis Pigmentosa-Associated Cystoid Macular Edema
Authors: KAYA Seda CEVIK , CITIRIK Mehmet , YILMAZ Mevlut , SENSOY Eyupcan
Published: November 2024

Purpose
To evaluate the effects of non-damaging retinal laser therapy (NRT) on the visual and anatomic outcomes of retinitis pigmentosa-associated cystoid macular edema (RP-CME).
Methods
Forty eyes from 30 patients with RPE-CME were treated with NRT. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the subjects were analyzed 2 months after NRT treatment.
Results
The patients had a mean age of 35.82 years, and a 1:1 sex ratio. Before NRT, the mean BCVA was 0.43 LogMAR, and the mean CMT was 311.80 µm. After 2 months, CMT decreased by 79.7 µm (p < 0.001), and BCVA improved by 0.98 LogMAR (p < 0.001). Although 70% of eyes still had CME, complete resolution was observed in 30% of the eyes. Unilateral cases showed a greater reduction in CME thickness compared to bilateral cases (89.2 µm vs. 70.2 µm reduction, p < 0.05). However, recurrence of edema was observed in 21 eyes (52.5%) within six months.
Conclusion
Based on these results, NRT provided anatomical and functional improvements in patients with RP-associated CME. However, the high recurrence rate and the reproducibility of the treatment need to be further investigated.
Reduced cervical extensor muscle mass negatively influences the postoperative outcomes of single-door laminoplasty in elderly patients with cervical spondylotic myelopathy
Authors: sun Kai , zhang Bo , Wan Haiwu , yin Jinjian , Huang Bo , sun Guodong
Published: November 2024

Purpose
To investigate the relationship between the preoperative grading of paraspinal extensor muscle fat infiltration on cervical MR and the surgical outcomes of posterior single-door laminoplasty in elderly patients with cervical spondylotic myelopathy(CSM).
Methods
This study retrospectively reviewed 116 elderly patients who underwent posterior single-door laminoplasty for CSM between January 2015 and December 2020. The degree of fatty infiltration in the cervical extensor muscles was assessed via MR and classified into mild, moderate, and severe groups according to the Goutalier grading system. Baseline clinical data, surgical-related data, and clinical outcomes were collected and analyzed. Pre-and postoperative changes in the cervical sagittal alignment parameters were recorded for comparison.
Results
The baseline clinical data of the three patient groups showed no statistically significant differences.Significant statistical differences were found in the surgical parameters of postoperative drainage and hospital stay duration. At follow-up, the NDI scores, neck pain VAS scores, and JOA scores, along with their minimal clinically important difference (MCID), showed significant variations. Furthermore, the cervical sagittal alignment parameters during follow-up were significantly different across the three groups.
Conclusion
Elderly patients with CSM and severe fatty infiltration of the cervical extensor muscles experience poorer clinical outcomes following single-door laminoplasty, with a more pronounced loss of cervical sagittal balance observed during follow-up.
Systemic inflammatory markers are not optimal for the predicting of disease activity in Crohn's disease patients
Authors: Huang Jing-Wen , Zhan Min , Li Qian-kun , Zou Shu-fang , Cao Hui , WU Dong-sheng , Zhao Da , Yu Lian , Tian Gui-Xiang , Bin Bong-hua
Published: November 2024

Background and aims: Determining the disease activity is crucial for the management of Crohn's disease (CD). The value of serum systemic inflammatory markers for the evaluating the disease activity of CD.
Methods: The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), platelet to albumin ratio (PAR), neutrophil to platelet ratio (NPR), lymphocyte to monocyte ratio (LMR), and C-reactive protein/albumin ratio (CAR) were measured. The values of these markers to predict disease activity of CD based on Simple Endoscopic Score for Crohn's (SES-CD) and Crohn disease activity index (CDAI) were measured.
Results: In total, 121 CD patients were included, and 40 (33.1%) were at the remission stage according to CDAI. Except WBC and NPR, other markers were all significantly lower in the remission group. ESR (r = 0.291) and PAR (r = 0.216) were weakly linked with the SES-CD activity. Moreover, ESR (r = 0.372), CRP (r = 0.293), NP (r = 0.185), NLR (r = 0.204), PAR (r = 0.199), a CAR (r = 0.262), and LMR (r = -0.189) were weakly correlated with the CDAI activity. Additionally, young age and higher ESR were identified to be the independent risk factors associated with SES-CD active, and low BMI was the sole independent risk factor for CDAI active.
Conclusion:Systemic inflammatory markers are not optimal for the predicting of disease activity in CD patients.
Association of weight change after smoking cessation on the risk of cancer in patients with allergic diseases: a nationally representative cohort study
Authors: Cho Hahyeon , Ha Soonho , Jeong Seogsong , Lee Hwamin
Published: November 2024

Relationships between allergies and cancer are complex and depend on various factors. However, little is known regarding the effects of weight change after smoking cessation on the risk of cancer in patients with allergic diseases. This study investigated 26,614 patients with asthma, allergic rhinitis, and atopic dermatitis from the NHIS-HEALS cohort, who had biennial health screenings between 2005 and 2008. All patients were followed up from 2009 until the date of cancer diagnosis, death, or 2013, whichever earliest. Allergic diseases patients who quit smoking and gained weight have a significantly higher cancer risk than non-smokers with stable weight (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.11–2.27). This risk is particularly elevated in older adults (≥ 65 years, aHR, 2.06; 95% CI, 1.29–3.29), men (aHR, 1.53; 95% CI, 1.05–2.22), and those with multiple comorbidities (aHR, 1.77; 95% CI, 1.24–2.52). Moreover, varying effects of weight gain on lung cancer (aHR, 2.28; 95% CI, 1.21–4.28). These findings highlight the importance of personalized weight management strategies to maximize the benefits of smoking cessation in patients with allergic diseases. Comprehensive public health strategies that address both smoking cessation and weight control may be essential to reduce cancer risk among patients with allergic diseases.
Supply-side Readiness of Primary Health Care for COVID-19 Pandemic Response in Indonesia: A Survey in 34 Provinces
Authors: Fitrianingrum Nisaatul Maharanita , Kamilah Fariza Zahra , Larasanti Ayudina , Saputra Muhammad Anugrah , Espressivo Aufia , Herlinda Olivia
Published: November 2024

Background: During the COVID-19 pandemic, primary healthcare centres (Puskesmas) in Indonesia encountered multiple challenges due to the limited capacity of human resources, logistics, health facilities, and infrastructures. This situation compromised their ability to deliver essential health services. This study aims to portray the supply-side capacity of Puskesmas during the COVID-19 pandemic, focusing on health service delivery, pandemic response, and community engagement. It also identifies crucial components to enhance primary-level pandemic prevention, preparedness, and response (PPR).
Methods: An explanatory sequential mixed-method design was employed, gathering quantitative data through phone interviews and qualitative data from in-depth interviews and focus group discussions with Puskesmas’ staff and district health officials. A total of 385 Puskesmas across 34 provinces were selected using proportional multistage stratified random sampling.
Results: Findings indicate that during the pandemic’s early and peak phases in 2020 and 2021, Puskesmas struggled to deliver their tasks. Due to social restrictions, over 80% of Puskesmas adjusted their operations, including reduced working hours (35.97%), limited service types (33.94%), and restricted patient visits (18.55%). These adjustments adversely affected essential health services, like tuberculosis detection and treatment and childhood immunisation programs, with COVID-19 budget reallocations affecting essential service funding. Around 40% of Puskesmas failed to meet the personal protective equipment (PPE) standard, and over 80% experienced PCR test delays for over 24 hours. Furthermore, half of the Puskesmas in Indonesia had inadequate capacity to conduct COVID-19 vaccination programs. Despite these challenges, community health workers (CHWs) played a crucial role in contact tracing, monitoring self-isolated COVID-19 patients, and improving vaccine coverage.
Conclusion: The study highlights the importance for prioritising resource allocation and investment to strengthen primary healthcare in Indonesia for future pandemics, including enhancing the role of CHWs as critical partners of Puskesmas.
Hematocrit is an independent risk factor of recurrent Guillain-Barré syndrome
Authors: Wang Lijuan , Liu Yuelin , Ding Yaowei , Li Siwen , Jiang Wencan , Li Xiang , Chen Yuxin , Chen Kelin , Zhang Guojun
Published: November 2024

Guillain-Barré Syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, characterized by progressive weakness and diminished or absent myotatic reflexes. While GBS typically exhibits a monophasic course, recurrent episodes can occur in certain patients. This study aimed to explore potential risk factors associated with recurrent GBS. We conducted a retrospective analysis involving GBS patients admitted to Beijing Tiantan Hospital between January 2012 and January 2022. Patients were categorized into recurrent and non-recurrent groups based on follow-up outcomes, meanwhile, clinical and laboratory data were compared between the two cohorts. Then, we integrated statistically significant indicators to identify independent risk factors for recurrent GBS using multifactorial logistic regression. Univariate analysis revealed that hematocrit (HCT) and mean platelet volume (MPV) were significantly elevated, whereas free triiodothyronine (FT3) and the percentage of vaccination was lower in patients with recurrent GBS compared to non-recurrent groups. Multifactorial logistic regression analysis revealed HCT (OR:1.015;95%CI: 1.001–1.028༛P = 0.032) is an independent risk factor for recurrent GBS. Elevated serum HCT levels correlate with an increased risk of recurrent GBS. Crucially, the incidence of recurrent GBS patients rises in tandem with rising serum HCT levels.
Arthroscopically Assisted Internal Brace Augmentation of the Medial Patellofemoral Ligament for Treating Patellar Dislocation
Authors: He Yeteng , Li Xiang , Yin Weilong , Jiang Rendong , Peng Xianbo , Liu Ying , Wei Hanyu
Published: November 2024

Objective
To describe the early clinical outcomes of arthroscopically assisted Internal Brace augmentation of the medial patellofemoral ligament (MPFL) in treating patellar dislocation.
Methods
A retrospective analysis was conducted on 19 patients with patellar dislocation (Dejour A and B trochlear dysplasia, TT-TG <20 mm, Insall-Salvati index 0.8–1.2) treated with arthroscopically assisted Internal Brace MPFL augmentation, with at least 24 months of follow-up. The cohort included 12 females and 7 males (mean age: 18.32 years). Outcomes assessed included radiological evaluations (patellar congruence angle, tilt angle, and lateralization distance via CT) and clinical scores (Lysholm, Kujala, VAS, Tegner, and Crosby-Insall). Patient satisfaction and complications were also recorded.
Results
All 19 surgeries were completed successfully without complications. Six patients underwent concurrent cartilage debridement. No patients were lost to follow-up (mean: 28.95 months). At the final follow-up, Kujala, Lysholm, VAS, and Tegner scores improved significantly (p < 0.001). Patellar positioning was good, with no redislocation or subluxation. Radiological assessments showed significant improvements in congruence angle, tilt angle, and lateralization distance (p < 0.001). No postoperative complications were reported. Most patients (90%) were satisfied and returned to pre-injury activity levels.
Conclusion
Arthroscopically assisted Internal Brace MPFL augmentation effectively improves knee stability in patellar dislocation, with favorable early outcomes and low complication rates.
The exploration of the subclavian vessels in an emergency situation by orthopedic trauma surgeons
Authors: Grechenig Peter , Gänsslen Axel , Dauwe Jan , Wittig Ulrike , Sagmeister Maximilian , Koutp Amir , Puchwein Paul , Hohenberger Gloria
Published: November 2024

Purpose:
The aim of the present study was to evaluate the time and the safety of the procedure to perform an infraclavicular approach to the subclavian vessels for damage control of major vascular injuries of the upper extremity in the shoulder region using a cadaver model for non-thoracic surgeons.
Methods:
A sample of 100 orthopaedic trauma residents, specialists, and attendings was recruited from an AO cadaveric dissection course in Graz, Austria, on extremity access. Emergency infraclavicular access to the subclavian vessels was performed on 50 cadavers on 2 consecutive days. Attention was paid to time, successful clamping of the vessels, self-assessment and learning curve.
Results:
First day: Only 9 (27%) participants felt safe among the 33 participants who performed correct emergency access including clamping of the correct vessels on the first day.
Second day: 55 (71%) of the 77 participants who correctly clamped the subclavian vessels on the second day reported feeling safe.
Comparing day 1 to day 2 we found an improvement of 35% (subclavian artery) and 37% (subclavian vein) in the correct identification of subclavian vessels in our sample. The evaluations of this study show that there is no correlation between surgical experience and successful emergency access.
Conclusion:
The value of anatomic dissections is therefore of major importance to teach unusual techniques This study shows the importance and effectiveness of anatomical dissection courses and anatomical learning. To sum up, it can be said that correct self-assessment can be improved through practice.
Knowledge, Attitude, and Practice on Water, Sanitation and Hygiene among Internal Displaced Persons in Somalia
Authors: Tahlil Abdullahi Ahmed , Dahir Mohamed Abdisalan , Hassan Yahye Sheikh Abdulle , Osman Marian Muse , Dahir Gallad , Jimale Liban Hassan , Mohamed Mohamed Abdelrahman , Fiidow Osman Abubakar
Published: November 2024

Introduction
Access to clean water, adequate sanitation, and hygiene services is a basic human right. In spite of this, it remains one of the major challenges that internally displaced persons face in Somalia. This study assesses the knowledge, attitudes, and practices of IDPs regarding Water, sanitation and hygiene.
Methods
A cross-sectional study was conducted among IDPs in eight high-density IDP camps in Mogadishu and Baidoa. A sample size of 728 participants was recruited through multistage and systematic random sampling techniques. A structured questionnaire was used for data collection. Data analysis was done using SPSS version 26. The KAP scores were categorized based on predefined cut-off points. Associations of demographic variables with KAP levels was tested using chi-square and Fisher's exact tests; the level of significance was set as p < 0.05.
Result
The study revealed that the majority of participants had 71.2% poor knowledge, 70.3% negative attitudes, and 80.2% demonstrating poor practices towards WASH. The analysis showed that there are strong associations between the levels of knowledge and the following sociodemographic factors: age (p < 0.001), marital status (p = 0.001), level of education (p = 0.048), employment status (p < 0.001), family size (p < 0.001), duration of stay in IDP camp (p < 0.001), and utilization of healthcare services (p < 0.001). Negative attitude towards WASH was also significantly associated with younger age groups (p < 0.001), marital status (p = 0.004), educational attainment (p < 0.001), employment (p < 0.001), household size (p < 0.001), duration of camp residency (p < 0.001), and healthcare access (p < 0.001). Furthermore, the level of education, employment status, household size, and duration of stay in camp were significantly associated with WASH practices at p < 0.001.
Conclusion
The study found that there are gaps in the knowledge, negative attitude, and poor practices concerning WASH among IDPs in Somalia. It is, therefore, important that addressing these disparities will be a guarantee for better health and well-being among IDPs in Somalia.
The Effect of 𝛃-Human Chorionic Gonadotropin on Vasculogenic Mimicry in Bladder Cancer
Authors: Eid Hanya Elsayed , Sattar Anas , Gobena Edessa Negera , Weerasinghe Nirusha
Published: November 2024

Background – Bladder cancer is the 7th and 9th most prevalent cancer in the world and in the United Kingdom, respectively. The primary cause of death in affected patients is invasion and metastasis. Despite the presence of various anti-angiogenic drugs, their therapeutic effects are short-lived due to development of resistance, hence the need for research into novel biomarkers for therapeutic targeting. Vasculogenic mimicry (VM) is a neovascularization model in aggressive tumours whereby the malignant cells acquire the phenotype of endothelial cells to develop vessel-like networks to provide sufficient nutrients for tumour growth. It has been observed in several malignant tumours. β-human chorionic gonadotropin (β-hCG) is a hormone normally produced at detectable levels during pregnancy but can also be produced ectopically in several cancers, including of the bladder. Therefore, due to its angiogenic growth factor properties, β-hCG has been proposed to be central to cancer progression. This study thus aims to investigate the effect of various β-hCG concentrations on VM in vitro.
Methods – 3D cell cultures were prepared using T24 and SCaBER cell line suspensions, recombinant β-hCG solutions with varying concentrations of 500 mg/mL, 1000 mg/mL, and 2000 mg/mL, and rat tail I collagen. Upon incubation and fixation, immunocytochemical staining was performed targeting the endothelial cell markers CD31/34 and basement membrane laminin.
Results – Results demonstrated a two-fold increase in VM channel development when incubated with β-hCG compared to without. In SCaBER 3D cell cultures, VM channels’ development increased in a dose-dependent pattern, unlike in the T24 cultures, with the most VM channels developing in 2000mg/mL.
Conclusions – These findings suggest the possible association between β-hCG and VM in bladder cancer and the potential use of β-hCG as a less invasive screening biomarker for bladder cancer.
Learning Curve on Prostate Fusion Biopsies: Key Insights
Authors: Lepretre Mélanie , Chaoui Iyad , Bruyere Franck , Bourgi Ali
Published: November 2024

Purpose
MRI-guided prostate biopsies offering improved accuracy in detecting clinically significant cancer. Image fusion (IF) techniques have shown promise, but their adoption requires overcoming a learning curve. This study evaluates the impact of operator experience on prostate biopsy outcomes using the HITACHI ultrasound system.
Methods
This prospective study was conducted from September 2016 to March 2020, including 148 patients undergoing mpMRI and targeted biopsies. The patients were grouped into Early (first 50 cases), Intermediate (cases 51–100), and Late (cases 101–148) phases, based on operator experience. Biopsy outcomes, including cancer detection rates, procedure times, and false-negative rates, were analyzed across these phases.
Results
A significant learning curve was observed. In the Early phase, the detection rate for clinically significant cancers was 12%, increasing to 18% in the Intermediate phase and 25% in the Late phase. The overall positivity rate rose from 30–45%, while procedure times decreased from 45 to 30 minutes. Sensitivity for detecting clinically significant cancer improved from 60–85%, showing enhanced accuracy with operator experience.
Conclusion
Operator experience plays a crucial role in improving prostate biopsy outcomes using IF techniques. As proficiency increased, both cancer detection rates and procedural efficiency improved. These findings emphasize the need for adequate training and experience to optimize results and ensure the full benefits of fusion biopsy technologies in prostate cancer diagnosis.
The role of urinary Dickkopf-3/creatinine ratio in diagnosis of acute kidney injury before creatinine elevation in pediatric intensive care unit
Authors: Gökçeli Sefa Armağan , Günay Neslihan , Güntürk İnayet , Dündar Mehmet Akif , Akyıldız Başak Nur , Yazıcı Cevat , Yel Sibel , Poyrazoğlu Muammer Hakan , Dursun İsmail
Published: November 2024

Background
Early identification of AKI is crucial to lowering morbidity and mortality in pediatric intensive care units (PICU). Dickkopf-3(DKK3) is a glycoprotein produced by stressed tubular epithelium, plays role in Wnt/β-catenin pathway and demonstrates tubulointerstitial damage. The aim of this study to investigate the possible role of urinary DKK3 in detecting AKI before creatinine elevation in PICU and whether elevated urinary DKK3 is associated with worse outcomes.
Methods
117 patients were included in the study. Urine DKK3 levels were measured on PICU admission. Patients who developed AKI and those who did not during the 10-days follow-up were compared in terms of urine DKK3 levels, clinical and laboratory variables. Univariate and multiple binary logistic regression analyses were performed to examine risk factors for the development of AKI and mortality.
Results
Forty-two (35.8%) patients experienced AKI and 39(33%) patients died. Median urine DKK3 level was statistically significantly higher in patients developing AKI (p < 0.001). In multivariate logistic regression model, only LogDKK3/Cr (AOR:3.619; 95%CI:1.478–8.876) was independently associated with AKI. The predictors of mortality by logistic regression model, PELOD (AOR:1.115; 95% CI:1.026–1.212) and LogDKK3/Cr (AOR:3.914; 95%CI:1.397–10.961) were independently associated with mortality. Urine DKK3/Cr more than 63311 pg/ml increases the risk of AKI 5.547 times (95% CI:1.618–19.022, p = 0.006) and more than 86963 pg/ml increases the risk of mortality 5.569 times (95% CI:1.329–22.499, p = 0.019).
Conclusions
Urine DKK3 is a useful biomarker in predicting the development of AKI according to KDIGO SCr for patients in PICU and high levels are a risk factor for AKI and mortality.
Does intraoperative forced-air warming increase the risk of surgical site infections after spine surgery?: A propensity score-matched analysis
Authors: Handa Kyoichi , Kanno Haruo , Matsuya Shigetsune , Onoda Satsuki , Murotani Motoki , Ozawa Hiroshi
Published: November 2024

Purpose: To compare the incidence of surgical site infection (SSI) between spine surgeries with and without intraoperative use of forced-air warming (FAW).
Methods: This study analyzed 245 patients who underwent spine surgery. Baseline characteristics such as age, gender, body mass index, the American Society of Anesthesiologists Physical Status (ASA-PS), diagnosis of diabetes mellitus, and current smoking habits were investigated. Surgical data such as operative site, previous spine surgery at the same site, operative time, intraoperative blood loss, and use of spinal instrumentation were evaluated. Patients were divided into two groups based on the use of FAW. The baseline characteristics, surgical data, and incidence of SSI were compared between the two groups. To estimate the incidence of SSI without biases due to various confounding factors, a propensity score pairwise matching was performed.
Results: The FAW was used in 45 patients, while 200 patients underwent surgery without the use of the FAW. The incidence of SSI was not significantly higher in patients with FAW (8.9%) compared to those without FAW (3.0%) (P = 0.07). Patients with FAW exhibited significantly higher ASA-PS, longer operative times, greater intraoperative blood loss, and a higher rate of instrumentation use compared to those without FAW (P < 0.01). After propensity score matching, which yielded 39 pairs of patients, the incidence of SSI was no significant difference between patients with (10.3%) and without FAW (7.7%) (P = 0.69).
Conclusion: The present study using propensity score-matched analysis demonstrated FAW did not increase the incidence of SSI in spine surgery.
Association between body temperature and all-cause mortality in patients with sepsis: analysis of the MIMIC-IV database
Authors: Zhao Yunuo
Published: November 2024

Background:
Abnormal body temperature (fever or hypothermia) is a critical symptom in sepsis and is strongly associated with clinical prognosis and disease progression. Given the duality and variability of body temperature fluctuations throughout the disease course, further research is essential to refine clinical strategies for temperature management in sepsis patients.
Methods:
I extracted clinical data of sepsis patients from the MIMIC-IV database. A restricted cubic spline (RCS) curve was employed to describe the nonlinear relationship between body temperature and clinical outcomes. Based on peak temperature within the first 24 hours after admission, patients were categorized into three groups: <36°C, 36–38°C, and > 38°C. I subsequently matched patients one-to-one into three cohorts using a pairwise propensity score matching (PSM) approach. Alongside clinical data, I conducted log-rank and McNemar tests, and established multiple models, including multiple Cox regression, overlap-weighted (OW) adjusted Cox regression, multiple logistic regression, and OW-adjusted multiple logistic regression, to investigate the impact of temperature on clinical outcomes.
Results:
A total of 35,499 sepsis patients were included in my study: 311 with a temperature below 36°C, 27,538 with a temperature between 36–38°C, and 7,650 with a temperature above 38°C. The RCS analysis revealed a non-linear, U-shaped relationship between body temperature and 28-day, ICU, and in-hospital mortality. Patients with hypothermia had significantly higher 28-day mortality (54.34% vs. 19.28%), ICU mortality (44.37% vs. 12.89%), and in-hospital mortality (49.20% vs. 17.46%) compared to those with hyperthermia. Among patients younger than 65 years, hyperthermia was a protective factor against 28-day mortality relative to normal body temperature, while the opposite was observed in patients aged 65 and older. This trend was consistent in the analysis of ICU and in-hospital mortality.
Conclusions:
Among sepsis patients admitted to the ICU, a peak temperature below 36°C within the first 24 hours of admission was associated with higher 28-day mortality. However, no significant difference in clinical prognosis was observed between normothermic and hyperthermic patients.
The association between a body shape index and kidney stones: A cross-sectional study of NHANES 2007−2018
Authors: Wang Bo , Huang Shiwei , Dong Juefei , Yin Guangming , Wang Long , Wang Jinrong , Liu Jianye , Tan Jing
Published: November 2024

Background
Kidney stone disease (KSD) is a pervasive urological health problem, which affects the quality of life of older men. However, the relationship between the A Body Shape Index (ABSI) and KSD has rarely been studied in American populations.
Method
We used data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2018. A self-report questionnaire identified KSD. We investigated the correlation using multiple linear regression, subgroup analyses, and smooth curve fitting.
Result
The study included 31,235 participants, with 2,924 having kidney stones and 28,311 without. The results of the study showed a significant association between ABSI and kidney stones, that is, an increase in ABSI was associated with an increased risk of kidney stones (Q4 vs Q1, OR = 1.19, 95% CI= (1.03–1.37), p = 0.0040). After subgroup analyses, it was found that the association between ABSI and kidney stones was not significantly correlated between specific subgroups.
Conclusions
The present study shows that elevated ABSI is associated with an increased likelihood of developing kidney stones.
Modified Ablation Catheter Guided Transseptal Puncture under ICE Guidance
Authors: Hou Pan , Wang Rong , Hou Chenchen , Liu Li , Lin Feng , He Lewei , Ding Shifang , Lu Qing
Published: November 2024

Background
Zero-fluoroscopy procedures have become increasingly popular in electrophysiological interventional surgery. As the key technology to achieve zero-fluoroscopy, traditional transseptal puncture (TSP) under ICE guidance has some disadvantages, which limit its promotion and development. We aim to introduce, evaluate the efficiency and safety of a modified TSP technique distilled from practice with the potential to overcome the shortcomings of traditional TSP.
Methods
A total of 77 patients underwent atrial fibrillation radiofrequency ablation from March 1,2022 to February 28, 2023 were enrolled. 44 patients underwent traditional ICE guided transseptal puncture and 33 patients underwent advanced ICE guided transseptal puncture. Then success rate, attempts of puncture, puncture duration, proportion of ideal puncture location and incidence of puncture related complications were recorded subsequently.
Results
There were no significant differences in baseline data between the two groups. The number of puncture times (1.25 ± 0.44 vs.1.06 ± 0.24, p = 0.018) and puncture duration (2.52 ± 0.83 vs.3.94 ± 2.15, p = 0.001) of advanced method were significantly less than traditional method. There were no significant differences in the success rate of puncture, the proportion of ideal puncture location and the incidence of puncture related complications between the two groups.
Conclusions
This study presents a modified ablation catheter guided transseptal puncture under ICE guidance, which simplifies the operation of the puncture component and does not require ICE view tracking. This method has the advantages of high success rate, safety, simple steps, convenient use, and short learning curve, and is worthy of promotion and application.