bluuebunny/crossref_metadata_2025 huggingface dataset:
Early vs. Late Anticoagulation in Acute Ischemic Stroke for Non-Atrial Fibrillation Indications
Authors: Zhang Ming May , Mousa-Ibrahim Fady , Leshko Nicole A.
Published: July 2024

Background/Objective: In persons whose sole indication for anticoagulation is atrial fibrillation (AF), early therapeutic anticoagulation after acute ischemic stroke (AIS) may decrease ischemic risk without increasing hemorrhagic risk. However, literature to guide anticoagulation timing in patients with a non-AF indication remains extremely limited.
Methods: This retrospective cohort study compared outcomes of early (within ≤4 days of AIS) versus late anticoagulation (5-14 days) for persons with AIS and non-AF indications for anticoagulation. The primary outcome was a composite of intracranial hemorrhage or major extracranial bleeding while on therapeutic anticoagulation, within 30 days of the index event. The main secondary outcome was a composite of major bleeding events while on therapeutic anticoagulation, recurrent AIS, systemic embolism, and all-cause mortality, within 30 days of the index event.
Results: Eighty-one patients were included for analysis, with 65 patients in the early cohort and 16 patients in the late cohort; median time to anticoagulation was 1 day and 7 days, respectively. The most common indication for anticoagulation was deep vein thrombosis. The primary composite outcome occurred in 3 patients (4.6%) in the early cohort and 2 patients (12.5%) in the late cohort (p = 0.255). The secondary composite outcome occurred in 10 patients (15.4%) in the early cohort and 7 patients (43.8%) in the late cohort (p = 0.034). There were no statistical differences in any individual components of the composite outcomes, although recurrent AIS and mortality had numerically higher incidence in the late cohort.
Conclusions: In this retrospective study, early anticoagulation was not associated with increased major bleeding risk, but late anticoagulation was associated with an increased composite risk of major bleeding, thrombotic events, and all-cause mortality, driven by increases in recurrent AIS and mortality. Further studies are warranted to expound on the optimal timing of anticoagulation in this patient population.
The Mystery of the Missing P Waves
Authors: chen yuanguo , Zhang Haibo
Published: July 2024

This case report discusses a 60-year-old female with a history of rheumatic heart disease, mitral stenosis, and atrial fibrillation, who presented with fatigue and was discovered to have significant bradycardia without visible P waves on ECG. The diagnosis and management involving electrophysiological studies highlight the complexities of treating atrial arrhythmias in the presence of mechanical valve replacements and extensive atrial fibrosis.
Monitoring Racial Disparities in the Era of Artificial Intelligence
Authors: Mbalaka Blessing
Published: July 2024

This paper utilized primary findings from an AI image generator of faces to analyse how racially inclusive the program is. This paper rendered 100 results and found that, from the findings, 77% of the faces generated were white faces, while the program failed to render a single black face. This paper calls for algorithmic auditing at the state level to ensure algorithmic inclusivity. Not rectifying this dilemma may yield AI algorithms that are not sufficiently catered to the South African context and application. Another consideration pertains to evaluating whether these algorithms are safe for public dissemination. This paper rests on the position that strong policy and state instruments are required to help circumvent the encroachment of technology that has not been sufficiently vetted for public use. This paper critically engages with the already prevalent discourse on bias mitigation and looks at ways people could bypass these regulatory mechanisms, such as the European Union’s Artificial Intelligence Act. This critical perspective looks to help assess if the proposed conjectures are sufficient.
Association between insulin and sarcopenia in elderly Chinese individuals: a cross-sectional and longitudinal study
Authors: Sun Guofang , Liang Jianjun , Chen Dechao , Zhao Kongjun , Liu Wangmi
Published: July 2024

Background:The link between insulin and sarcopenia among older adults in China is not yet fully understood. This study seeks to investigate this association using data from a nationally representative large-scale survey.
Methods: The study utilized data from two waves of the China Health and Nutrition Survey (CHNS) conducted in 2009 and 2015. Subjects meeting the inclusion criteria were classified according to the Asia Working Group for Sarcopenia2019 criteria. The study employed ordinary least squares (OLS) regression models to analyze the cross-sectional association between muscle mass and insulin. Additionally, logistic regression models were utilized to examine the longitudinal association between sarcopenia and insulin.
Results: In 2009, a cross-sectional association study enrolled a total of 2329 participants aged over 60 years, with 53.1% women and a median age of 68.00 years. The prevalence of sarcopenia in the study population was 30.83%, with a higher prevalence in females (60.03%). In the adjusted OLS regression model based on blood biomarker, insulin was positively associated with muscle mass (β=0.075, 95% confidence interval (CI): 0.034 - 0.117, P <0.01). In 2009, individuals without sarcopenia were divided into two groups based on the median value of insulin in the total population. When 944 individuals were followed up in 2015 to assess the incidence of sarcopenia, a significant difference was found between the two groups (12.44% vs 7.45%, P=0.01). The adjusted logistic regression models indicated that higher insulin levels were associated with a reduced incidence of sarcopenia (Hazard ratio =0.958, 95% CI: 0.925 - 0.989, P=0.01).
Conclusions: Adequate insulin could potentially serve as a protective factor in preserving healthy muscle mass among Chinese adults aged 60 and above.
Persistent symptoms after 1 year in hospitalized children with acute COVID-19 compared to other conditions
Authors: Tagarro Alfredo , Conde Marta , Gastesi Irati , de Pablo Lucía , Villanueva Sara , Aguilera-Alonso David , Esteban Ana , Epalza Cristina , López María , Domínguez-Rodríguez Sara , Gómez Pablo , Ballesteros Álvaro , Pinto Carlota , Navarro Marisa , Giaquinto Carlo , Moraleda Cinta
Published: July 2024

Purpose
We evaluated the prevalence and characteristics of persistent signs and/or symptoms in children and young people (CYP) one year after hospitalization for acute COVID-19 compared with a control group of CYP hospitalized for other conditions.
Methods
We conducted an observational study in three hospitals in Madrid. We included a group of children who aged 1 month to 18 years of age who were hospitalized for acute COVID-19 from March 2020 to December 2021. We selected a group of patients for comparison among hospitalized patients the same month as the participants with COVID-19, for different reasons, with no history of COVID-19 at recruitment or during follow-up. Data were collected from clinical records and a standardized questionnaire answered by families. The primary outcome was the presence of persistent symptoms one year after hospitalization.
Results
Ninety-six patients were enrolled and analyzed (50 acute COVID-19 patients and 46 non-COVID-19 participants). The definition of persistent symptoms was met in 34/96 (35%) CYP: 17/50 (34%) COVID-19 participants and 17/46 (37%) non-COVID-19 participants (p=0.767). Symptoms persisted ³12 months in 14/50 (28%) COVID-19 participants and in 7/46 (15%) non-COVID-19 participants (p=0.140).
Both groups rated similarly before and after admission on all the specific items related to emotional welfare, social relationships, and current activities. Readmissions occurred in 11/50 (22%) COVID-19 participants and in 6/46 (13%) non-COVID-19 participants (p=0.267).
Conclusion: This study found a non-significant difference in the prevalence of persistent symptoms 1 year after hospitalization between children and young people (CYP) with acute COVID-19 and those hospitalized for other reasons.
AO classification system and 3D reconstruction view method for radial distal fractures with isolated joint surface collapse bone fragments: An independent inter-observer and intra-observer consistency study
Authors: Aozhengzheng Dong , Xing Gao , Yongsheng Li , Zhe Zhao , Wencui Li , Jianquan Liu , Jianwen Yin , Jiabei Li , Xiangyu Cheng , Xiaoqiang Chen , Guanghui Wang
Published: July 2024

Purpose
This study aimed to compare the consistency among surgeons of varying experience levels in classifying distal radius articular collapse fractures using conventional CT scans and 3D images reconstructed with software MIMICS 26.0 (MIMICS, Boston, MA)according to the AO classification. Additionally, the study compared the consistency in identifying the position of isolated bone fragments on the articular surface using both imaging methods. The aim was to determine a more practical approach for the AO classification of distal radius articular collapse fractures and identifying isolated bone fragment positions, thereby assisting clinicians in preoperative decision-making.
Methods
The study included 80 patients with distal radius articular collapse fractures. Four independent assessors (two senior and two junior orthopedic clinicians) evaluated the fractures' AO classification and the relative positions of isolated articular bone fragments using conventional CT images and 3D reconstructed images. After six weeks, the 80 cases were randomly reassigned, and all assessors re-evaluated the abovementioned parameters. The intraclass correlation coefficient (ICC) was used to calculate inter-observer and intra-observer reliability, presented with a 95% confidence interval.
Results
The results showed that AO classification of distal radius articular collapse fractures using 3D reconstructed images had lower overall inter-observer consistency (0.577 (0.369–0.729)) compared to direct AO classification from conventional CT scans (0.642 (0.486–0.761)). However, determining the relative positions of bone fragments in the coronal plane using 3D reconstructed images showed higher overall inter-observer consistency (coronal plane 0.806 (0.700–0.882); sagittal plane 0.809 (0.712–0.879)) compared to conventional CT scans (coronal plane 0.762 (0.635–0.852); sagittal plane 0.698 (0.558–0.802)).
Conclusion
In conclusion, for distal radius articular collapse fractures, the consistency in AO classification assessments among observers was generally moderate, influenced by the experience level of the doctors. Junior doctors showed higher consistency in classification assessments using 3D reconstruction, while senior doctors had higher consistency using conventional CT scans. The method of observation for bone fragment positions, whether by conventional CT scan or 3D reconstruction of the distal radius, showed differences in consistency, with 3D reconstruction reaching almost perfect consistency levels in identifying bone fragment positions on the articular surface.
Shared and distinct prefrontal cortex activation between genders in depression individuals during verbal fluency task: evidence from one large sample of fNIRS studies
Authors: Zhang Yan , Zheng Minxiao , Xiang Nian , Qiu Min , Da Hui , Xiao Qiang , Wei Qiang , Ke Shanzhi , Zhu Dongmei , Shi Hui
Published: July 2024

Background Cognitive impairment is a key characteristic of depression. While sex differences in various aspects of depression have been well-documented, fewer studies investigated gender differences in abnormal brain region activation during specific cognitive tasks. This study aimed to explore sex differences in cognitive deficits using fNIRS technology, providing neurobiological evidence for gender-specific therapy approaches.
Methods 853 young adults participated in the study, 422 healthy individuals (224 male, 198 female) and 431 individuals with depression (233 male, 198 female). The average oxyhemoglobin levels in the prefrontal cortex were measured using a 53-channel fNIRS imaging device.
Results Compared to male healthy controls, lower oxyhemoglobin activation was observed in the male depression group in the frontopolar cortex, Broca's area, and left and right dorsolateral prefrontal cortex. Similarly, lower oxyhemoglobin activation was found in the female depression group in the right BA, FPC, and left dlPFC compared to female healthy controls. Additionally, a significant difference in oxyhemoglobin activation was noted between male and female depression groups in the left and right dlPFC.
Conclusion Females and males had similar but unique prefrontal brain activations. FPC and BA may be the shared neural basis, whereas dlPFC may be distinct underlying physiological mechanisms for depression between genders.
Unexpected HBsAg decrease after nucleoside analogues re-treatment among HBeAg positive postpartum women: a pilot study.
Authors: Tang Qiao , Wang Chunrui , Li Hu , Chen Zhiwei , Zhang Li , Zhang Jing , Liu Xiaoqing , Xue Yunling , Qiu Yue , Peng Mingli , Zeng Yi , Hu Peng
Published: July 2024

Background/Purpose:
Mother-to-child transmission (MTCT) is one of the main routes of transmission of HBV, and previous studies focused on the efficacy and safety of nucleoside analogues (NAs) in the prevention MTCT. There are limited data on virologic changes of chronic hepatitis B (CHB) patients after discontinuing treatment postpartum and the efficacy of re-treatment.
Methods
A retrospective-prospective real-word pilot cohort study on HBeAg-positive pregnant women with chronic HBV infection was conducted. Biochemical and virological characteristics (HBsAg, HBeAg and HBV DNA) in patients received NAs treatment pre-pregnancy (n = 10), patients discontinued treatment after delivery (n = 88) and re-treatment patients (n = 22) were collected during follow-up.
Results
The incidence of ALT flare was numerically higher in patients discontinued NAs treatment postpartum compared to patients received NAs treatment pre-pregnancy (28.9% versus 0%, P = 0.058). More significantly decreases of HBsAg, HBeAg and HBV DNA were observed in re-treatment patients compared to patients received NAs treatment pre-pregnancy. Significantly higher incidences of half decrease of HBsAg and 0.5 lg decrease of HBsAg were achieved in 95.5% (21/22) and 76.2% (16/21), and numerically higher incidence of HBsAg < 1000 IU/mL was achieved in 36.4% (8/22) in re-treatment patients compared to patients received NAs treatment pre-pregnancy and patients discontinued treatment. Long-term follow-up results indicated that it is safe for HBeAg positive pregnant patients to discontinue treatment after delivery.
Conclusion
HBeAg positive patients received NAs treatment during pregnancy and discontinued it postpartum can benefit from NAs re-treatment because of unexpected decrease of HBsAg, which may be helpful for achieve the goal of functional cure.
Comparative Efficacy and Safety of Nalbuphine and Hydromorphone in Painless Colonoscopy Techniques: A Randomized Controlled Trial
Authors: Hou Chunliu , Zhang Siming , Chen Huiyi , Wang Di , Han Qingqing , Wen Guochun , Su Xuesen , Zhang Wenjie , Tian Shouyuan , Li Yan
Published: July 2024

Background: Colonoscopy is essential for diagnosing colon lesions but is often associated with discomfort. Painless colonoscopy techniques are being increasingly used to improve the patient experience." However, in the case of painless colonoscopy, anesthesia is performed outside the operating room, which requires more significant peri-examination of hemodynamic changes and adverse postoperative reactions. This requires a more careful selection of narcotic analgesics, and there needs to be optimal analgesic drug guidance in clinical practice. This study compared the efficacy and safety of nalbuphine and hydromorphone in improving patient comfort and maintaining hemodynamic stability during elective colonoscopy.
Methods: This prospective, randomized, double-blinded controlled trial included 72 adult patients (aged 18-65) who underwent sedation colonoscopy. The 72 patients were randomly divided into two groups using a computer-generated random sequence. Body mass index 18.5-28.0 kg/m2; American Society of Anesthesiologists (ASA) grade I to II. Then, the nalbuphine group was given 0.13 mg/kg nalbuphine, the hydromorphone group was given 0.016 mg/kg hydromorphone, and during the operation, 10-20 mg/time propofol could be appropriately injected according to the patient's examination and cooperation. All patients were continuously monitored for oxygen saturation, heart rate, and noninvasive mean arterial blood pressure. The colonoscopy time and anesthesia time were recorded. Adverse reactions such as hypotension, decreased oxygen saturation, nausea, and vomiting were recorded. Anesthesiologist satisfaction, gastroenterologist (operator), and patient satisfaction were recorded.
Results: Both nalbuphine and hydromorphone effectively maintained hemodynamic stability, with no significant differences in vital signs observed between the groups (P > 0.05). However, nalbuphine significantly reduced the incidence of postoperative nausea, vomiting, dizziness, and headache compared to hydromorphone (P < 0.05). The reduced side effects of nalbuphine were marked, suggesting a better postoperative comfort profile.
Conclusions: While nalbuphine and hydromorphone effectively maintain intraoperative vital signs, nalbuphine offers superior postoperative comfort. This makes nalbuphine a preferable analgesic choice in outpatient colonoscopy settings. Further research is warranted to determine the optimal dosages for both drugs and to explore their mechanisms of action in procedural pain management.
Register Number: ChiCTR2300077446
Contrast-associated acute kidney injury in second-generation cryoballoon-based pulmonary vein isolation
Authors: Harms Phillip , Rottner Laura , Heeger Christian , Reissmann Bruno , Ouyang Feifan , Mathew Shibu , Wohlmuth Peter , Schlüter Michael , Metzner Andreas , Kuck Karl-Heinz , Maurer Tilman , Lemes Christine
Published: July 2024

Background - An effective treatment of symptomatic Atrial fibrillation (AF) is the second-generation cryoballoon (CB2) based pulmonary vein isolation (PVI). However, this technique is associated with an increased exposure to contrast media and little is known about postprocedural acute kidney injury (AKI).
Objective - We evaluated the incidence, characteristics and risk factors of contrast-associated AKI after CB2-based catheter ablation in a large patient cohort.
Methods - 444 patients with symptomatic drug-refractory paroxysmal AF (PAF, n=236 [53%]) or persistent AF (n=208) who underwent CB2-based PVI were included. The study group was divided into four groups based on the estimated glomerular filtration rate (eGFR) documented the day before the procedure. Serum creatinine levels were measured before and 48 hours after the procedure. AKI was assessed using the KDIGO guidelines.
Results - The overall incidence of AKI was 2.9% (13/444). Among the AKI group, the majority were in CKD stage 4 (2/7, 28.6%), followed by CKD stage 3 (7/111; 6.3%), CKD stage 1(1/70; 1.4%) and CKD stage 2 (3/256; 1.2%). Baseline CKD stage (HR 1.3659, 95% CI 0.05107 - 36.53, p = 0.033) was identified as independent predictor of AKI. Arterial hypertension was prevalent in the AKI group.
Conclusions - The overall incidence of postcontrast AKI in CB2-based ablation of AF was low. Cryoablation PVI is a safe therapeutic option for individuals with CKD stages 1 and 2. However, in patients with CKD stages 3 and 4, it is associated with an increased incidence of AKI.
Effects of Depressive Symptoms on Cognitive Impairment among older adults in China: A mediation analysis of Proactive Health
Authors: Li Yilin , Cheng Ziyi , Liu Yifang , Wang Zhikang , Wang Qi , Liu Junan
Published: July 2024

Background
Cognitive impairment has become a major public health issue. Depressive symptoms and cognitive impairment are closely related disorders in the aging population. However, the effect of proactive health on the association between depressive symptoms and cognitive impairment was not clear. This study aimed to examine the mediating role of proactive health in the effect of depressive symptoms on cognitive impairment.
Methods
This population-based cross-sectional study recruited 3607 participants aged 60 and above from the China Health and Retirement Longitudinal Study. Direct relationships between depressive symptoms, proactive health, and cognitive impairment were analyzed using multiple logistic regression. The bootstrap method was used to test the mediating role of proactive health in the effect of depressive symptoms on cognitive impairment.
Results
After adjusting the confounders, participants in the depressive symptoms group (OR 1.223, 95% CI, 1.047-1.429) and depression group (OR 1.892, 95% CI, 1.401-2.554) had an increased risk of cognitive impairment, while those who had fair proactive health literacy (OR 0.668, 95% CI, 0.499-0.895) and good proactive health literacy (OR 0.498, 95% CI, 0.358-0.694) had a decreased risk of cognitive impairment.
The mediation effect of proactive health accounted for 6.47 % of the total effect regarding depressive symptoms with cognitive impairment.
Conclusions
This study revealed that depressive symptoms not only directly influenced cognitive impairment among older adults but also indirectly via proactive health. Exercise should be encouraged among the elderly to promote their participation in social activities, thereby improving their proactive health literacy and ultimately preventing cognitive impairment.
Video Analysis Based Effective Multi-Facial Emotion Recognition and Classification Framework Using Gcrcnn
Authors: Bedre Jyoti S. , Prasanna P. Lakshmi
Published: July 2024

Facial emotions are the varying expressions of a person's face that communicate one's feelings and moods. Facial emotion in videos can be detected using techniques that analyze keyframes for facial muscle movements and patterns. However, these detections can be challenging due to potential simultaneous expressions and camera angle complexities. To overcome these pitfalls, this paper provides a practical framework for detecting facial emotions in videos. Firstly, the input key frames are pre-processed by MF and IN algorithms to acquire an enhanced image. Secondly, human detection and tracking occur using YOLOV7 and BYTE tracking algorithms. Then, the T-SNEVJ algorithm is used for face detection. Thirdly, facial landmark extraction using the HC technique, mesh generation, and feature extraction are done. Here, ED-SVR is utilized for mesh generation. In the meantime, feature point tracking followed by motion analysis is done using CC_OF. Finally, the GCRCNN algorithm classifies multi-facial emotions. The proposed system achieves a better accuracy and recall of 99.34% and 99.20%. Thus, the proposed methodology outperforms the existing FER techniques.
Symptomatic Management of phlebitis on peripheral venous catheters: A national survey of nursing practice.
Authors: BROUILLET Guillaume , VITTORIO Axel DI , PINSON Elisabeth , ROUSSEAU Geoffroy , LEMAIGNEN Adrien
Published: July 2024

Background: There are no international guidelines for the symptomatic management of phlebitis on peripheral venous catheters. Nurses therefore propose heterogeneous and low evidence-based management strategies to treat this complication. To explore the various management approaches for phlebitis on peripheral venous catheters proposed by registered nurses in France.
Methods: Registered nurses and nurse executive practicing in both public and private sectors in France were invited to respond to a survey on the management of phlebitis on peripheral catheters. This survey was developed by nurses, nurse executive, and a physician. The survey was distributed via email through the National Order of Nurses from March 31, 2023, to April 30, 2023. No follow-up was conducted. A descriptive analysis of the survey results was then performed.
Results: 3,038 healthcare providers practicing in 4 French regions responded to the survey. Phlebitis on peripheral venous catheters is most frequently encountered in medical wards. Respondents to the survey used heterogeneous strategies for the symptomatic treatment of phlebitis on peripheral venous catheters. 70° Alcohol dressings was the most common strategy reported (85.75% of respondents), applied for 92.40% of respondents without a medical prescription. The duration of treatment and its daily frequency of use were also highly variable.
Conclusion: Nursing practices for the symptomatic treatment of this complication are highly heterogeneous in France, often conducted without medical prescription, although the use of 70° alcohol dressing is considered as a medication in France, which could be debated.
Calcium Silicate and Epoxy Sealer in Endodontic Treatment: A Randomized Controlled Trial Short title: Calcium Silicate and Epoxy Resin Sealers
Authors: Minh Duyen Tran Ngoc , Quynh Anh Nguyen Ho , Anh Vu Dien Hoa , Duc Minh Nguyen , Van Khoa Pham , Quynh Lan Ngo Thi
Published: July 2024

Background
The selection of an appropriate sealer is critical for the success of endodontic treatments. Although calcium silicate-based sealers (CSS) and epoxy resin-based sealers (ERS) have exhibited promise in short-term studies, a comprehensive understanding of their long-term clinical effectiveness in single-visit root canal treatment remains essential.
Objectives
This study aimed to compare and evaluate the long-term clinical effectiveness of a calcium silicate-based sealer and an epoxy resin-based sealer in the context of single-visit root canal treatment.
Materials and methods
A prospective, longitudinal clinical trial was conducted involving 42 teeth diagnosed with irreversible pulpitis conditions. The teeth were randomly assigned to two groups based on the obturation sealer used: calcium silicate-based sealer (CSS) and epoxy resin-based sealer (ERS). Postoperative parameters, including pain, swelling, fistula, and sensitivity under biting pressure, were assessed at regular intervals for up to 36 months following the single-visit endodontic treatment. Treatment outcomes were determined based on established criteria, categorizing cases as success, failure, or uncertain. Statistical analysis employed the Chi-squared test, t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test (p < 0.05).
Results
Preliminary results indicate comparable incidences of postoperative complications between the two groups over the long-term follow-up period.
Conclusion
This study suggests that both calcium silicate-based and epoxy resin-based sealers demonstrate similar long-term clinical effectiveness in single-visit root canal treatments. These findings offer valuable insights for practitioners aiming to achieve sustained treatment success through sealer selection.
Clinical relevance: We can use two types of cement Calcium silicate-based and epoxy resin-based sealersinterchangeably in root canal treatment.
ClinicalTrials registration number: NCT05904184
The Profile of Patients Attending the Eye Emergency Clinic Within the Last Year: Is it a True Ocular Emergency?
Authors: dağ yaşar , Aydın Seyfi , Kumantas Ebrar
Published: July 2024

Purpose
Ocular emergencies require immediate intervention to prevent rapid vision loss or functional impairment. The aim of this study was to evaluate patients presenting to the general emergency department with ocular complaints and referred to the Eye Clinic and to determine the proportion of true ocular emergencies.
Methods
In a retrospective cross-sectional study in a tertiary hospital in Istanbul, patients aged 0-100 years who presented to the emergency department with ocular complaints between January and December 2022 were included. Inconclusive diagnoses and incomplete records were excluded. Patients were divided into three groups: Top Eye Emergencies (TEE), Relative Eye Emergencies (REE) and Non-Emergency Eye (NEE).
Results
Among 652,224 individuals seeking care, 9,982 (1.5%) were referred to the Eye Emergency Clinic. Of these, 2,788 (27.9%) were female, and 7,194 (72.1%) were male, with ages ranging from 0 to 98 years. Top Eye Emergencies (TEE), Relative Eye Emergencies (REE, and Non-emergency Eye (NEE) comprised 13%, 60%, and 27% of cases, respectively. Common Top Eye Emergencies (TEE) conditions included chemical injuries, orbital-preseptal cellulitis, and orbital fractures. Relative Eye Emergencies (REE)commonly featured corneal foreign bodies, corneal erosion, and conjunctivitis. Non-emergency Eye (NEE) mostly involved simple eye redness, trauma without eye involvement, and subconjunctival hemorrhage.
Conclusions
Consistent with the literature, 1.5% of patients presenting to the general emergency department had eye complaints. However, 27% of those referred to the ophthalmological clinic did not have an urgent eye condition. This is partly due to the high proportion of patients presenting to the emergency department with ocular complaints and the lack of knowledge of emergency physicians about ophthalmological diseases, leading to unnecessary referrals to the Ophthalmology Clinic, resulting in loss of workforce and reduced time allocated to patients with true ocular emergencies.
Association Between Weight-Adjusted Waist Index and Chronic Diarrhea in US Adults: Insights from NHANES 2005-2010
Authors: Liang^ Xueming , Lan^ Zhenyu , Cui^ Yuan , Wen^ Haibin , Qin^ Yuqi , Huang^ Zuli
Published: July 2024

OBJECTIVE
We aimed to assess the association between the weight-adjusted waist circumference index (WWI) and chronic diarrhea in US adults.
METHODS
We selected individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2010 and used logistic regression analyses, subgroup analyses, and dose-response curves to assess the association between WWI and chronic diarrhea.
RESULTS
Of 11,322 participants included in this study (mean age, 47.22 ± 0.36 years; 5,731 [52.00%] female), 1,366 (12.07%) reported previous episodes of chronic diarrhea, whereas 9,956 (87.93%) did not. After adjusting for potential confounders, the WWI score was associated with chronic diarrhea (OR, 1.23; 95% CI, 1.05–1.44; P < 0.001). Compared to individuals in tertile 1 (Q1) of WWI scores (8.109 ≤ WWI score ≤ 10.45), those in tertile 4 (Q4; 11.572 < WWI score ≤ 15.704) had an adjusted OR for chronic diarrhea of 1.53 (95% CI, 1.14–2.05; P = 0.01; Table 2). The multivariable restricted cubic spline showed a nonlinear association between WWI and chronic diarrhea (P = 0.83). When the WWI score was ≥ 11.01, there was a correlation; however, no association was found in participants with a WWI score < 11.01 (P < 0.001). Subgroup analyses showed that WWI was associated with chronic diarrhea in men (OR, 1.548; 95% CI, 1.205–1.988) and individuals aged 40–60 years (OR, 1.370; 95% CI, 1.101–1.704), with a high educational level (OR, 1.297; 95% CI, 1.023–1.644), medium family income (OR, 1.385; 95% CI, 1.116–1.719), BMI > 30 kg/m² (OR, 1.266; 95% CI, 1.072–1.496), no chronic kidney disease (OR, 1.235; 95% CI, 1.030–1.480), hypertension (OR, 1.318; 95% CI, 1.069–1.626), diabetes mellitus (OR, 1.410; 95% CI, 1.090–1.823), hyperlipidemia (OR, 1.218; 95% CI, 1.027–1.444), no PHQ-9 (OR, 1.202; 95% CI, 1.022–1.415), and no coronary heart disease (OR, 1.239; 95% CI, 1.061–1.447). There was no significant interaction (P > 0.05).
CONCLUSIONS
The weight-adjusted waist circumference index is associated with chronic diarrhea in US adults.
Pre-hospital care for children - a descriptive study from Central Norway
Authors: Myhre Martine , Næss Lars Eide , Skogvoll Eirik , Haugland Helge
Published: July 2024

Background
Pre-hospital incidents involving pediatric and neonatal patients are infrequent, and clinical characteristics and care for these patients differ from the adult population. Lack of knowledge, guidelines, and experience can make pre-hospital pediatric care challenging, and there is limited research on the epidemiology and best practice of care for this population. We examined the pre-hospital pediatric population in the county of Sør-Trøndelag, Norway, to improve our understanding of this population in our region.
Methods
We conducted a retrospective observational cohort study of emergency incidents involving children under twelve years of age with dispatch of Emergency Medical Services (EMS) in Sør-Trøndelag between 2018 and 2022. Incidents and patient characteristics were extracted from the Emergency Medical Communication Center (EMCC) database. In addition, data on patient characteristics and interventions for more serious incidents seen by the Helicopter Emergency Medical Service (HEMS) were included from the database LABAS.We provided descriptive statistics and estimated population incidences using Poisson regression.
Results
The catchment area of EMCC Sør-Trøndelag has a population of approximately 43,000 children under the age of twelve years. During the five-year study period, there were 7,005 emergency calls concerning this patient population, representing 6% of all emergency calls (total no. 108,717). Of these, 3,500 (50%) resulted in the dispatch of an ambulance and/or HEMS, yielding an annual incidence of EMS dispatches of 17 per 1,000 children. The three most common primary medical problems were respiratory distress, altered consciousness, and trauma. Among the 309 HEMS patients, 131 (42%) received advanced interventions from the HEMS physician. Assisted ventilation was the most frequent intervention.
Conclusion
Pediatric and neonatal patients make up a small proportion of pre-hospital patient dispatches in Sør-Trøndelag. Consequently, each EMS provider infrequently encounters children in the pre-hospital environment, resulting in less experience with pediatric advanced medical interventions. This study identifies some clinical characteristics and interventions regarding pediatric and neonatal patients that have been pointed out as focus areas for pediatric pre-hospital research.
A population-based case-control analysis of the association between enema and nervous system injury caused by diquat poisoning
Authors: Xue Xiang , Meng Jiankang , Huang Changbao , Sun Zhaorui , Nie Shinan
Published: July 2024

Objective：The objective of this study was to investigated whether enema is associated with nervous system injury caused by diquat poisoning using a population-based case-control analysis.
Methods: The medical records of patients with acute diquat(DQ) poisoning admitted to the hospital from January 2018 to January 2024 were retrospectively collected. A series of symptoms of central nervous system injury occurred after DQ poisoning were defined as DQ nervous system injury, which identified as the case group in our study. The controls group were matched 1:2 on population-based without nervous system injury in DQ poisoning patients. Conditional logistic regression models were performed.
Results: We identified 101 DQ poisoning patients with nervous system injury and selected 202 DQ patients without nervous system injury. DQ poisoning patients performed 2 and ≧3 enemas had ORs of nervous system injury of 3.084(95%CI 1.230, 7.734) and 4.693(95%CI 1.408, 15.645) compared with DQ poisoning patients with no enema, respectively. Further analyses were performed in various age subgroups. The ORs of conducting 2 and ≧3 enemas were dramatically higher among cases group than controls group in subgroup aged ≧60 years old (OR=10.184, 14.982 respectively).
Conclusions: We concluded that enemas increased the risk of with nervous system injury caused by DQ, particularly among the elderly.
The Role of Direct Oral Anticoagulants in Managing Myeloproliferative Neoplasms Patients
Authors: Bang Soo-Mee , Lee Ji Yun , Lee Ju-Hyun , Park Woochan , Seo Jeongmin , Kang Minsu , Jung Eun Hee , Kim Sang-A , Suh Koung Jin , Kim Ji-Won , Kim Se Hyun , Lee Jeong-Ok , Kim Jin Won , Kim Yu Jung , Lee Keun-Wook , Kim Jee Hyun
Published: July 2024

Thrombosis and bleeding significantly affect morbidity and mortality in myeloproliferative neoplasms (MPNs). The efficacy and safety of direct oral anticoagulants (DOACs) in MPN patients remain uncertain. In a large, retrospective, nationwide cohort study conducted from 2010 to 2021, 368 MPN patients were analyzed after being newly treated with DOACs for AF or VTE. Of these, 62.8% received DOACs for AF and 37.2% for VTE. The AF group was statistically older with higher CHA2DS2-VASc scores compared to the VTE group. Antiplatelet agents were used in 51.1% of cases, and cytoreductive drugs in 79.3%, with hydroxyurea being the most common (64.9%). The median follow-up was 22.3 months, with one-year cumulative incidence rates of thrombosis and bleeding at 11.1% and 3.7%, respectively. Multivariate analysis identified CHA2DS2-VASc scores ≥ 3 (HR = 3.48), concomitant antiplatelet use (HR = 2.57), and cytoreduction (HR = 2.20) as significant thrombosis risk factors but found no significant predictors for major bleeding. Despite the limitations of retrospective data, DOAC treatment in MPN patients seems effective and has an acceptable bleeding risk.
Effects of Different Intensive Lipid-Lowering Therapies on Stabilization and Regression of Carotid Plaque: A Randomized Open-Label Trial
Authors: Luo Sihua , Lin Lili , Qiu Pengda , Cai Kuan , Liang Hao , Lin Yuhui , Xu Yunhong
Published: July 2024

Background
Atherosclerotic plaques in carotid arteries are significant predictors of cardiovascular events such as stroke and myocardial infarction. Lipid-lowering therapies, particularly statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have shown promising in plaque regression and stabilization, which are crucial for cardiovascular disease (CVD).
Methods
This randomized open-label trial was conducted at the Third Affiliated Hospital of Guangzhou Medical University from March 2022 to December 2023. The study included patients at high CVD risk with non-calcified carotid plaque. Participants were randomized into four groups: statin alone (Statin), statin plus ezetimibe (Statin_E), statin plus alirocumab (Statin_P), and statin plus ezetimibe and alirocumab (Statin_EP). The primary outcomes were morphological stabilization of carotid plaque at 6 months and regression at 12 months, assessed by contrast-enhanced carotid ultrasonography. Secondary outcomes were changes in blood lipid levels.
Results
A total of 312 high CVD risk patients were enrolled, among whom 299 completed the study. After six months, patients in the Statin_P and Statin_EP groups showed significantly lower levels of total cholesterol and low-density lipoprotein cholesterol compared to the other groups. These patients also demonstrated a significantly greater proportion of plaques transforming from types I or II to types III or IV and a significant decrease in intraplaque neovascularization (P < 0.05), indicating the plaques in these groups had stabilized. After 12 months, the regression in plaque size was more pronounced in the Statin_P and Statin_EP groups (left: χ2 = 26.37, p = 1.90e − 04, CI 95% [0.06, 1.00]; right: χ2 = 19.00, p = 4.16e − 03, CI 95% [0.00, 1.00]).
Conclusion
Intensive lipid-lowering therapies that combine statins with PCSK9 inhibitors, such as alirocumab, are more effective in regressing carotid plaques and stabilizing plaque morphology compared to other treatments. These findings support the use of PCSK9 inhibitors in combination with statin therapy for managing atherosclerotic disease and reducing cardiovascular events.
Trial registration:
The trial was registered in the Chinese Clinical Trial Registry (Registration No. ChiCTR2200058389).
The influence of cancer on the reprogramming of lipid metabolism in healthy thyroid tissues of patients with papillary thyroid carcinoma
Authors: Hellmann Andrzej Rafał , Zwara Agata , Czapiewska Monika , Korczynska Justyna , Sztendel Alicja , Mika Adriana
Published: July 2024

Background and objectives Over the years we observed changes in the metabolism of glucose, amino acids, fatty acids (FA) and nucleotides in cancer cells in order to maintain their viability and proliferate. Moreover, as the latest data show, cancer also forces a complete change in the behavior of other tissues. For instance, fat-filled adipocytes are often found in the vicinity of invasive solid human tumors. We investigated the effects of papillary thyroid carcinoma (PTC) on the lipid metabolism of healthy tissue distant from the tumor.
Method Thyroid tissue was collected from female patients immediately after surgical removal of the entire thyroid gland. Blood samples were collected from PTC patients and healthy volunteers. Real-time PCR assays were performed to analyze the expression of lipogenic genes and a broad panel of FA was determined using the gas chromatography-mass spectrometry method.
Results The concentration of lipids was higher in paratumor tissue than in healthy thyroid tissue (p=0.005). The lipogenic genes tested were significantly increased in paratumor tissue compared to healthy tissue, especially enzymes related to the synthesis of very long-chain saturated and polyunsaturated FAs (VLCSFAs and PUFAs, respectively) (p ˂0.001). The FA profile also showed increased levels of C22-C26, VLCSFAs and almost all PUFAs in paratumor tissue (p ˂0.05).
Conclusion Our study suggests that a restructuring of lipid metabolism occurs in the adjacent healthy thyroid gland and that the metabolism of VLCSFAs and PUFAs is higher in the paratumor tissue than in the distant tissue of the healthy thyroid gland.
Time Series Analysis for forecasting neonatal intensive care unit census and neonatal mortality
Authors: Dalili Hosein , Shariat Mamak , Sahebi Leyla
Published: July 2024

Background: Neonatal intensive care units(NICUs) play a crucial role in caring for premature or critically ill newborns, but challenges persist in managing patient volumes and addressing mortality. This study aims to analyze the time series of the NICU admission numbers, hospitalization days, and mortality proportion.
Methods: We used seven years of retrospective daily NICU census data for model development (March 2016 - December 2022, N=7,216 infants). Best-fitting models of ARIMA and SARIMA were applied for forecasting admission number, long stay and mortality proportion in STATA.14 and SPSS.20. The accuracy of forecasting approved by root mean squared error (RMSE), mean absolute percentage error (MAPE).
Results: We observed a decreasing trend in mortality proportion in the NICU, with more pronounced seasonal patterns in admission numbers (which increased during the winter season) and length of stay (which decreased during the winter season). Our regression time series analysis showed that as the length of stay in the hospital increases, the mortality proportion also increases.
Conclusion: More extensive and well-designed studies are required to investigate the risk factors for prolonged stays in the NICU and how to manage them. Research should also concentrate on interventions that can effectively reduce long NICU stays and improve short- and long-term outcomes for newborns.
Sonographic Characteristics of Thyroid Nodules with a Halo
Authors: Cao Danming , Zou Rong , Zhang Ming , Tang Kui
Published: July 2024

Objective
To investigate the sonographic characteristics of thyroid nodules with a halo, explore the value of contrast-enhanced ultrasound (CEUS) combined with fine needle aspiration (FNA) in identifying nodules with a halo, and predict the risk of metastasis by analyzing the pathological features of the halo.
Methods
A retrospective analysis was conducted on 185 cases of thyroid nodules accompanied by halos between January 2019 and December 2022. After describing the ultrasound characteristics of the thyroid nodules and their halos, all patients were divided into three groups, the first group (group I = CEUS only) of patients underwent CEUS, the second group(group II = CEUS + FNA) underwent FNA based on the first group, and the third group(group III = FNA only) underwent FNA directly. The CEUS and FNA results were graded using the Chinese Thyroid Imaging Report and Data System(C-TIRADS) and Bethesda Reporting System for Thyroid Cytopathology, respectively. Those graded below C-TIRADS 4b or Bethesda IV were defined as benign, and the results of FNA were referenced when the two methods were combined. The surgical pathology results were used as the gold standard. We plotted working curves to compare the diagnostic efficacy of CEUS and FNA alone and in combination in the diagnosis of thyroid nodules with halos. The pathological features of the halo were analyzed and the number of patients with cervical lymph node metastases was recorded.
Results
One hundred and sixty patients met the requirements. Benign nodules were mainly characterized by a thin (0.75 ± 0.31 mm) and uniform halo with good integrity, while malignant nodules had a thicker (1.48 ± 0.51 mm) halo with uneven and irregular margins (P < 0.05). The sensitivity and specificity were highest when the cutoff value was 1.09 mm, with 76.08% and 84.29%, respectively. The halos of benign nodules were mostly hyper- or iso-enhanced, whereas the halos of malignant nodules were predominantly hypo-enhanced (P < 0.05). The areas under the curve (AUCs) for CEUS, FNA, and CEUS + FNA were 0.751(95% CI = 0.642–0.841), 0.863(95% CI = 0.767–0.929), and 0.918(95% CI = 0.834–0.967), respectively. Cervical lymph node metastasis occurred in only 13 (11.5%) malignant nodes with halos. The primary pathological components of the halo around malignant nodules were almost reactive hyperplastic fibrous tissue.
Conclusion
The halo surrounding malignant thyroid nodules is thicker, with uneven and irregular margins, and shows hypo-enhancement on CEUS. Combining CEUS with FNA improves the diagnostic efficacy of thyroid nodules with halos. The reactive hyperplastic fibrous halo may be one of the reasons why malignant nodules are less likely to metastasize.
Hypoflexid function in the “trenchant heel” of carnassial teeth, with comments on talonid evolution
Authors: Lang Andreas , Martin Thomas
Published: July 2024

The carnassial teeth of Carnivora and Dasyuromorphia are characterized by the enlargement of the carnassial blades and reduction of crushing structures. In some species, the highly carnassialized teeth exhibit a unicuspid talonid with only the hypoconid present (“trenchant heel”). This condition is similar to that seen in the molars of pretribosphenic cladotherians such as Dryolestida, with a single talonid cusp and hypoflexid groove. Tooth wear and reconstruction of the power stroke show that the hypoflexid of the trenchant heel occludes with the paracone of the distal upper antagonist, providing a cutting and guiding function during the power stroke, and maintaining a uniform inclination of the tooth movement up to the point of centric occlusion. In case of the Dasyuromorphia, this occlusal relationship is most pronounced between the distal molars (M4/m4), whereas in the Carnivora it occurs between the upper and lower mesial molars (M1/m1). The occurrence of distal hypoflexid-like grooves is a recurring trend in mammal evolution, before and after the evolution of tribosphenic molars with multicuspid talonid.