bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of sarcopenia status on higher-level functional capacity in daily living among older orthopedic outpatients in Japan
Authors: Tomita Yoshihito , Nakashima Hiroki , Mizukami Satoshi , Arima Kazuhiko , Kusano Yosuke , Abe Yasuyo , Kanagae Mitsuo , Aoyagi Kiyoshi
Published: July 2024

Background
A higher risk of disability has been reported in sarcopenia and severe sarcopenia patient groups than in the non-sarcopenia group. Here, we showed an independent association between sarcopenia and disability among older orthopedic outpatients in Japan.
Methods
The sample included 103 older outpatients aged ≥65 years with orthopedic diseases. Body mass index (BMI) was calculated as weight divided by height squared (kg/m2). Sarcopenia was defined as low grip strength and low muscle mass. The classification of sarcopenia was based on the recommendations of the Asian Working Group for Sarcopenia. Muscle mass was evaluated using bioelectrical impedance analysis using InBody 430. Higher-level functional capacity was determined using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a multidimensional 13-item scale that consists of three subscales: instrumental activities of daily living, intellectual activity, and social role. The association between sarcopenia and disability was assessed using logistic regression analysis.
Results
The prevalence rates of sarcopenia and severe sarcopenia were 14.7% and 11.8%, respectively. Older age was associated with severe sarcopenia. The percentage of individuals with disabilities in social roles was significantly higher in the severe sarcopenia group than that in the non-sarcopenia group. After adjusting for age, sex, BMI, and comorbidity, severe sarcopenia was significantly associated with disability in social roles among orthopedic outpatients. The sarcopenia group showed no significant social role disabilities.
Conclusions
Sarcopenia is a serious problem facing older orthopedic outpatients. Severe sarcopenia was found to be associated with disability in social roles among older orthopedic outpatients.
Should No.253 lymph nodes be dissected routinely in laparoscopic radical resection of colorectal cancer?
Authors: Yao Qi-jun , Liu Zhi-min , Pei Fengyun , He Fang , Zhao Yandong , Huang Jun
Published: July 2024

Background
Laparoscopic radical resection of colorectal cancer (CRC) has become the most important treatment for resectable CRC. However, it is still controversial whether No.253 lymph nodes should be routinely dissected during radical resection of sigmoid colon cancer and rectal cancer.
Patients and methods:
From June 2016 to January 2019, 508 patients with sigmoid or rectal cancer received surgical treatment in the Sixth Affiliated Hospital of Sun Yat-sen University were enrolled in this retrospective cohort study. Patients were divided into No.253 LN dissection group (n = 220) and No.253 LN preservation group (n = 288) according to whether No.253 LN were removed during operation. Propensity score matching (PSM) was used to adjust the differences in baseline characteristics. The incidence of postoperative complications and survival rate related results were analyzed after PSM.
Results
294 patients were equally divided into No.253 LN dissection group (n = 147) and No.253 LN preservation group (n = 147) after PSM. There were no statistically significant differences in overall survival (OS), progression-free survival (PFS), recurrence free survival (RFS) and distant metastasis-free survival (DMFS) between the two groups (P value was 0.054, 0.159, 0.837 and 0.143 respectively). Though, No.253 LN-positive group had a shorter OS (P = 0.003) and PFS (P = 0.004), a low positive rate (4/220) of No.253 LN metastases was observed. CT or MRI in assessment of LN involvement reveal that LN diameter ≥ 5mm in diameter indicated a higher discrimination accuracy, which should be paid attention in clinical practice.
Conclusion
Routine dissection of No.253 LN is not necessary for all patients with sigmoid colon cancer or rectal cancer but is performed in specific cases. For certain cases, such as in patients with regional LN ≥ 5mm, especially ≥ 10mm, evaluated by preoperative CT/MRI, dissection of No.253 LN should be considered into clinical practice.
Changes in the spectrum of ocular disease during the COVID-19 pandemic in late 2022 in the Hubei Province
Authors: Bao Qing , Chen Xiaomin , Zheng Zhiwei , Zheng Yan , Li Yuting , Ren Yaoyao , Shen Yanru , Zhang Nan , Ke Min
Published: July 2024

Purpose
We aimed to investigate changes in the ocular disease spectrum during the coronavirus disease-2019 (COVID-19) pandemic in late 2022 in the Hubei Province.
Methods
This retrospective observational study was conducted in two parts. The first part involved collecting COVID-19-related information from residents of Hubei Province during the COVID-19 pandemic through an online questionnaire survey. The second part involved extracting electronic medical records from ophthalmology outpatient departments at two hospitals in Hubei Province during the pandemic and epidemic prevention and control periods, analyzing changes in the spectrum of ocular diseases.
Results
In the first part，31.65% of patients with systemic symptoms of COVID-19 experienced ocular discomforts. The most common ocular symptoms were eye fatigue, ocular pain and dry eye. In the second part, 76.5% of patients who visited the ophthalmic clinic had COVID-19-related systemic symptoms during pandemic period. The proportion of ornea/keratitis, glaucoma/acute angle-closure glaucoma (AACG) and vitreoretinal disease/retinal vein obstruction (RVO)/acute macular neuroretinalpathy (AMN) increased markedly during pandemic period. Additionally, the number of patients under 18 years and over 60 years in pandemic perioddecreased significantly.
Conclusion
The COVID-19 pandemic has led to certain changes in the spectrum of ocular disease, which warrants the attention of ophthalmologists.
Childhood sexual abuse, internet addiction, problematic pornography use, and depression among medical students in Bangladesh
Authors: Siddik Md Abu Bakkar , Shakil Md. Rajwanullha , Hasan Mahedi , Hakim Md. Azizul
Published: July 2024

Background
Due to several factors (eg. sexual abuse, academic pressure), medical students go through significant mental health issues such as internet addiction (IA), problematic use of pornography (PPU), and depression. This study aimed to assess the prevalence of childhood sexual abuse (CSA) history, IA, PPU, and depression among medical students and associated factors. Methodology: Childhood sexual abuse history, Young’s Internet Addiction Test (IAT-20), Brief Pornography Screener (BPS), Patient Health Questionnaire (PHQ-9), and other sociodemographic information were collected through an online Google form across Bangladesh in this cross-sectional study. Descriptive analysis, Pearson chi-square test, and ordinal logistic regression were employed to assess the prevalence, significant factors, and gender-based assessment. Later, to assess the correlation between the dependent variables, a bivariate co-relation matrix was employed.
Results
A total of 3264 students participated with a mean age of 21.5 years old. we found that 28.3% of students had a history of CSA, among them 7.35% were male, and 20.96% were female. 70.2% of students had PPU, 62.1% of them were addicted to the internet and 50.4% of them were depressed. Gender, medical college type, marital status, CSA, IA, and PPU had a significant effect on increasing depression among the participants and positively related with each other.
Conclusion
The study found many medical students with IA, PPU, and depression. Students must discuss their CSA-related experiences. To protect children from CSA, lawmakers should pass legislation. Eliminating IA and PPU requires psychological therapy for students. Marriage may reduce depression, encouraging stakeholders to explore its effects. Finally, public awareness is essential.
Epidemiology of non-cystic fibrosis bronchiectasis at a single center in Japan: a retrospective cohort study
Authors: Hashimoto Kazuki , Abe Yuko , Fukushima Kiyoharu , Niitsu Takayuki , Komukai Sho , Miyamoto Satoshi , Nii Takuro , Matsuki Takanori , Takeuchi Noriyuki , Morimoto Kozo , Kida Hiroshi
Published: July 2024

Background: The characteristics of non-cystic fibrosis bronchiectasis (NCBE) in Asia, including Japan, remain largely unknown. We aimed to provide insights into the clinical characteristics and treatment outcomes of NCBE, especially regarding nontuberculous mycobacteria (NTM) infection, and establish a basis for comparison with global datasets. In addition, long-term macrolide antibiotic use in patients with NCBE and a history of exacerbations is established, but the effects in patients without exacerbations remain unclear.
Methods: In this single-center, retrospective study, the medical records of patients who satisfied the NCBE criteria between 1 January 2012 and 31 August 2023 were reviewed. Severe exacerbations and mortality during the observation period were recorded. Baseline characteristics, prognostic factors, and overall survival of patients with and without non-NTM infection were evaluated; effects of long-term macrolide antibiotic use in patients without severe exacerbations were estimated using inverse probability weighting (IPW).
Results: In 1044 patients with bronchiectasis, severe exacerbation rates were 22·32%, with mortality rates of 3·16% at 3 years. Notably, the high prevalence of NTM infection (n=458, 43·87%) in this cohort was distinctive. Compared with the NTM group, the non-NTM group had a higher proportion of elevated inflammatory markers, with significant differences in C-reactive protein levels (p=0·0023) and blood neutrophil counts (p<0·001). Pseudomonas aeruginosa was more frequently identified as having colonization and was associated with severe exacerbations (p<0·001) in the non-NTM group. NTM infection was not associated with mortality (p=0·4621, hazard ratio=0·79). Among patients with non-NTM infection and without a history of exacerbation in the past 2 years, 34·3% received long-term macrolide antibiotics that did not invariably reduce severe exacerbations (P=0·3801, IPW P=0·7222).
Conclusions: This study highlights NCBE epidemiology in Japan, advising caution in the casual use of macrolides for mild cases.
Clinical Trial Registration: UMIN Clinical Trials Registry Number: UMIN000054726 (Registered on 21 June 2024)
Repair defects after endoscopic debridement of head and neck cancer carcinoma with prior irradiation of submental flaps
Authors: Zhang Xinrui , Zhao Yaoxin , Wang Yingqi , Huang Haiqiong , Ma Huimin , Hu Huayong , Zhang Jianzhong
Published: July 2024

Background: To explore the feasibility and effect of submental flaps to repair the head and neck carcinoma with prior irradiation after endoscopic surgery.
Methods: This study retrospectively analysed five cases with necrotic or recurrent of head and neck malignant tumours of post radiation after endoscopic surgery in our department from January 2023 to December 2023, including five males and aged 43–60 years. After endoscopic resection, the submental flap was prefabricated to repair the nasopharynx or oropharynx postoperative defects.
Results: All cases in which flaps were used survived, and the average size of the SF used to repair the defects was 12–15 cm by 6–7 cm. All the patients had nasal feeding and the tracheal cannula was removed hospital discharge. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. Upon intraoperative evaluation, all five patients had SF venous drainage, as well as nasal blockage and inadequate nasal ventilation. During the follow-up period 6–12 months, no visible ulcer surface or dry scab formation was seen.
Conclusions：This study features the use of a submental flap to repair the head and neck defects with prior irradiation after endoscopic surgery, and it is a simple and fast procedure with adequate tissue and good arteriovenous blood supply to adjacent sites. This method is reliable and effective for postoperative defect repair of head and neck carcinoma, and it is worthy of widespread promotion.
Busulfan-Fludarabine Versus Busulfan-Cyclophosphamide for Allogeneic Transplant in Acute Myeloid Leukemia: Long Term Analysis of GITMO AML-R2 Trial
Authors: Rambaldi Alessandro , Cavallaro Gianluca , Grassi Anna , Pavoni Chiara , Micò Maria Caterina , Busca Alessandro , Cavattoni Irene , Santarone Stella , Borghero Carlo , Olivieri Attilio , Milone Giuseppe , Chiusolo Patrizia , Musto Pellegrino , Saccardi Riccardo , Patriarca Francesca , Pane Fabrizio , Saporiti Giorgia , Rivela Paolo , Terruzzi Elisabetta , Cerretti Raffaella , Marotta Giuseppe , Carella Angelo Michele , Arnon Nagler , Russo Domenico , Corradini Paolo , Bernasconi Paolo , Iori Anna Paola , Castagna Luca , Mordini Nicola , Oldani Elena , Grazia Carmen DI , Bacigalupo Andrea
Published: July 2024

We report the long-term results of a randomized trial (GITMO, AML-R2), comparing 1:1 the combination of busulfan and cyclophosphamide (BuCy2, n= 125) and the combination of busulfan and fludarabine (BuFlu, n= 127) as conditioning regimen in acute myeloid leukemia patients (median age 51 years, range 40-65) undergoing allogeneic hematopoietic stem cell transplantation. With a median follow-up of 6 years, significantly better non-relapse mortality (NRM) was confirmed in BuFlu recipients, which is sustained up to 4 years after transplant (10% vs 20%, p= 0.0388). This difference was higher in patients older than 51 years (11 % in BuFlu vs 27% in BuCy2, p= 0.0262). The cumulative incidence of relapse, which was the first cause of death in the entire study population, did not differ between the two randomized arms. Similarly, the leukemia-free survival (LFS) and overall survival (OS) were not different in the two cohorts, even when stratifying patients per median age. Graft-and relapse free-survival (GRFS) in BuFlu arm vs the BuCy2 arm was 25% vs 20% at 4 years and 20% vs 17% at 10 years. Hence, the benefit gained by NRM reduction is not offsets by an increased relapse. Leukemia relapse remains a major concern, urging the development of new therapeutic approaches.
Patient-reported outcome measures for acute rhinosinusitis in adults and children: A systematic review of the quality of existing instruments
Authors: Baalmann Ann-Kristin , Nestler Sophie , Donhauser Theresa , Apfelbacher Christian , Piontek Katharina
Published: July 2024

Background
Acute rhinosinusitis (ARS) is a self-limiting inflammation of the nose and sinuses caused by viral or bacterial infections that requires primarily symptomatic treatment. Patient-reported outcome measures (PROMs) are suitable tools for the assessment of the effectiveness of remedies for ARS from the patient’s perspective in clinical trials and real-world studies. Data regarding the quality of existing PROMs for ARS is limited.
Purpose
To conduct a systematic review of the quality of existing disease-specific PROMs for use in adults and children with ARS according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the identified instruments in future clinical studies.
Methods
We systematically searched PubMed, Web of Science and Embase for studies reporting on the development and/or validation of PROMs for ARS. We assessed the methodological quality of each included study, evaluated the quality of measurement properties per PROM and study, and graded the evidence. Based on the overall evidence, we derived recommendations for use of the instruments.
Results
We identified four studies on three PROMs measuring symptoms of ARS and quality of life in adults (Sinonasal Outcome Test-16, SNOT-16; Measurement of Acute Rhinosinusitis, MARS; Rhinosinusitis Quality-of-Life Assessment, RhinoQoL). For ARS in children, we identified two studies on two PROMs measuring symptoms of ARS (Pediatric Rhinosinusitis Symptom Scale, PRSS; Sinus Symptom Questionnaire, S5). Our assessment of measurement properties indicates that all instruments require further validation before they can be unrestrictedly recommended for use in future research (COSMIN category B). In particular there were no content validity studies for any of the identified instruments, but also data on other important measurement properties, e.g., structural validity, are lacking.
Conclusion
Currently, no PROM for ARS in adults and children can be unrestrictedly recommended based on the evaluation of their quality. Further validation is required for all identified PROMs. Content validation involving patients and experts should be given priority.
Systematic review registration:
OSF (https://doi.org/10.17605/OSF.IO/VAP8U)
Satellite telemetry reveals complex mixed movement strategies in ibis and spoonbills of Australia: implications for water and wetland management
Authors: McGinness Heather M. , Lloyd-Jones Luke R. , Robinson Freya , Langston Art , O’Neill Louis G. , Rapley Shoshana , Jackson Micha V. , Hodgson Jessica , Piper Melissa , Davies Micah , Martin John M. , Kingsford Richard , Brandis Kate , Doerr Veronica , Nally Ralph Mac
Published: July 2024

Waterbird population and species diversity maintenance are important outcomes of wetland conservation management, but knowledge gaps regarding waterbird movements affect our ability to understand and predict waterbird responses to management at appropriate scales. Movement tracking using satellite telemetry is now allowing us to fill these knowledge gaps for nomadic waterbirds at continental scales, including in remote areas for which data have been historically difficult to acquire. We used GPS satellite telemetry to track the movements of 122 individuals of three species of ibis and spoonbills (Threskiornithidae) in Australia from 2016 to 2023. We analysed movement distances, residency, home range (when resident) and foraging-site fidelity. From this we derived implications for water and wetland management for waterbird conservation. This is the first multi-year movement tracking data for ibis and spoonbills in Australia, with some individuals tracked continuously for more than five years including from natal site to first breeding attempt. Tracking revealed both inter- and intra-specific variability in movement strategies, including residency, nomadism, and migration, with individuals switching between these behaviours. During periods of residency, home ranges and distances travelled to forage were highly variable and differed significantly between species. Sixty-five percent of identified residency areas were not associated with wetlands formally listed nationally or internationally as important. Tracking the movements of waterbirds provides context for coordinated allocation of management resources, such as provision of environmental water at appropriate places and times for maximum conservation benefit. This study highlights the geographic scales over which these birds function and shows how variable waterbird movements are. This illustrates the need to consider the full life cycle of these birds when making management decisions and evaluating management impacts. Increased knowledge of the spatio-temporal interactions of waterbirds with their resource needs over complete life cycles will continue to be essential for informing management aimed at increasing waterbird numbers and maintaining long-term diversity.
Inability of Quadriceps Muscular Stiffness to Explain Variances in Torque during Isometric Knee Extension Tests Across Different Degrees of Knee Position in Healthy Individuals
Authors: LI Yuanchao , He YaNan , Pan Zhiming , Chen YM , Shen PF , Ling JX , Liu Chunlong
Published: July 2024

Objective
This study aims to assess how internal (IR) and external (LR) knee joint rotation affect stiffness and strength in quadriceps femoris (RF, VL, and VM) during isometric knee extensor tests at various knee flexion angles (30°, 60°, 90°), and to explore their relationship.
Methods
A descriptive observational cohort study recruited 46 healthy young adults. Participants performed maximum voluntary quadriceps contractions at three knee flexion angles (30°, 60°, 90°), with three tibial rotation conditions (internal 10°, neutral, external 10°) set for each angle. Muscle hardness of dominant lower limb RF, VL, and VM was recorded using MyotonPro during isometric knee extensor tests. Isokinetic training instrument measured quadriceps femoris strength under neutral, 10° external, or 10° internal tibial rotation. Statistical analysis employed repeated measures general linear models.
Results
Knee joint rotation and flexion did not interact. Muscle hardness of RF, VL, and VM significantly increased during isometric knee extension compared to resting, but rotation angle and tibial position showed no significant differences. Quadriceps femoris strength was unaffected by 10° tibial rotation but varied with knee flexion angle, notably greater at 60° flexion (P < 0.01). Moderate correlations were observed between quadriceps muscle hardness and strength in each group.
Conclusion
Isometric knee extension force remains unaffected by tibial position but correlates with knee flexion angle. However, quadriceps femoris muscle hardness does not vary significantly with knee rotation or flexion. MyotonPro-measured muscle hardness under different conditions may not fully explain corresponding muscle strength variations.
Merozoite surface protein 2 polymorphism of Plasmodium falciparum isolates in a selected malarious area of Northwest Ethiopia
Authors: Ashagre Agenagnew , Dinsa Jimma , Mekonnen Daniel Abebe , Abdu Melat , Eshetu Tegegne , Keffale Migbaru , Abere Aberham , Aemero Mulugeta
Published: July 2024

Background
The genetic diversity of Plasmodium falciparum provides the parasite with many effective immune evasion and drug resistance mechanisms. This phenomenon is a major problem in eradicating malaria globally. This study aimed to assess merozoite surface protein 2 polymorphisms in P. falciparum isolates from Northwest Ethiopia.
Method
A cross-sectional study was conducted to assess merozoite surface protein 2 polymorphisms in P. falciparum isolates from selected malarious areas in Northwest Ethiopia from April to June 2021. A convenience sampling technique was used to select a total of 150 study participants. A finger prick blood sample was collected for the preparation of blood films and dried blood spots for molecular genotyping. The Merozoite surface protein 2 allele frequency and multiplicity of infection were computed. Spearman's rank coefficients were used to assess the associations between the multiplicity of infection and parasite density and age. A P value < 0.05 was considered to indicate statistical significance.
Result
Polymorphism analysis was performed on 126 P. falciparum isolates. There were 38 different merozoite surface protein 2 alleles, 20 of which corresponded to the IC/3D7 allelic family and 18 to the FC27 allelic family. The majority of the isolates contained multiple infections, and the mean multiplicity of infection was 3.46. There was no statistically significant difference in the multiplicity of infection in relation to the age of patients (P = 0.646). However, a statistically significant correlation was found between parasite density and the multiplicity of infection (P = 0.046). The heterozygosity index for merozoite surface protein 2 was 0.948.
Conclusion
This study showed that P. falciparum isolates contain multiple genotypes with a high multiplicity of infections, suggesting the presence of extensive genetic diversity and mixed-strain infections. This could reflect a high level of malaria transmission intensity, which requires more effort to control malaria transmission in the study area.
A Smart Pipe Length Splitting Method for Cost Minimization of a Pressurized Irrigation Network. A Case Study in Greece
Authors: Samarinas Nikiforos , Gravani Asimenia , Evangelides Christos , Loukas Athanasios
Published: July 2024

The increasing global demand for high-quality agricultural products poses significant challenges for water resource management while the traditional irrigation methods, reliant on open canal systems, are inefficient and environmentally detrimental, necessitating a shift to more efficient pressurized irrigation networks. However, designing these systems is complex and costly, primarily due to the high expenses associated with pipe materials. This research introduces a novel pipe length splitting (PLS) method which optimizes the pipe diameters and lengths by allowing a strategic splitting of the pipes under certain constraints (e.g. flow velocity, head losses etc.) aiming to reduce costs without sacrificing the network efficiency. In this work the proposed PLS method combined with the existing computationally efficient Simplified optimization method offers a robust solution for cost minimization while it is very flexible and compatible also with various existing optimization methods (e.g. linear and dynamic programming). In this work the network under study was the existing open canal irrigation network of Limnochori in North Greece which was studied as a pressurized irrigation network. Applying the Simplified method in conjunction with the PLS, the comparative study shows a total cost reduction of 21,930€ while PLS affected 45% of the total number of pipes. These numbers can be considered remarkable considering that the network can be characterized as a small-medium sized network (107 hydrants). Ultimately, the PLS method is a valuable tool for engineers and decision-makers, which could be used also to other hydraulic works, providing economic benefits through cost savings while also supporting broader goals of environmental sustainability and water resource conservation.
Rainfall analysis using FUCOM weighted logarithmic distance measure based on probabilistic dual hesitant preference values
Authors: . Rohit , Kumar Kamal , Bhardwaj Reeta , Kaur Gagandeep
Published: July 2024

Rainfall analysis is an area of primary concern because of the involved uncertainties. These uncertainties may be pertaining to the unambiguous nature of data, intrinsic errors involved due to rainfall randomness etc. To tackle such situations of uncertainties, probabilistic dual hesitant sets (PDHFSs) are the best fit. The information gathered in the form of PDHFSs not only contains the aspect of surety/unsurety, but also considers the associated probable information. Thus, utilizing the advantages of PDHFSs, this article focusses on developing TOPSIS and CODAS based on weight determination using FUCOM technique. Further, the proposed methodology is applied on a problem based on rainfall analysis and a detailed comparison analysis is done with the existing methodologies.
Revisiting contemporary laboratory characteristics of patients with syphilis: insights from a multicenter study
Authors: Yao Hang-Ping , Chen Rui , Mao Han-Xin , Zhang Jia-Le , Zhu Lin-Wei , Wu Kai
Published: July 2024

Despite the persistent susceptibility of Treponema pallidum to penicillin, the global incidence of syphilis remains high. Syphilis is a complex disease with physical consequences extending beyond manifestations. In this multicenter case–control study, we analyzed data from 536 patients with syphilis who underwent complete blood cell analysis, biochemical examination, and coagulation function tests at the First Affiliated Hospital Zhejiang University School of Medicine and People’s Hospital of Hangzhou Medical College in China. Moreover, we included 84 bone marrow-derived stem cell donors in the control group. Our findings indicated that patients with syphilis exhibited macrocytic anemia, coagulation abnormalities, multiple organ dysfunction, reduced anabolism and glucose metabolism, and electrolyte imbalance. Notably, HIV infection was noted to exacerbate coagulation disorders and liver injury in patients with syphilis. Furthermore, patients with neurosyphilis demonstrated decreases in the levels of hemostasis and anabolism. The aforementioned laboratory-based pathogenic features represent a contemporary understanding of syphilis progression. As such, when administering anti-T. pallidum treatment to patients with syphilis, particularly those exhibiting penicillin allergy and latent syphilis, medical professionals should address the associated physical damage.
Inclusion of people with disabilities in Chilean health policy: a policy analysis
Authors: Gatta Danae Rodríguez , Monclus Pamela Gutiérrez , Wilbur Jane , Hanefeld Johanna , Banks Lena Morgon , Kuper Hannah
Published: July 2024

Background
Around 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key national stakeholders regarding the policy context, policy processes, and actors involved.
Methods
A policy content analysis was conducted of 12 health policy documents using the EquiFrame framework, adapted to assess disability inclusion. Documents were reviewed and rated on their quality of commitment against 21 core concepts of human rights in the framework. Key national stakeholders (n = 15) were interviewed, and data were thematically analysed under the Walt and Gilson Policy Analysis Triangle, using NVivo R1.
Results
Core human rights concepts of disability were mentioned at least once in nearly all health policy documents (92%). However, 50% had poor policy commitments for disability. Across policies, Prevention of health conditions was the main human rights concept reflected, while Privacy of information was the least referenced concept. Participants described a fragmented disability movement and health policy, related to a dominant biomedical model of disability. It appeared that disability was not prioritized in the health policy agenda, due to ineffective mainstreaming of disability by the Government and the limited influence and engagement of civil society in policy processes. Moreover, the limited existing policy framework on disability inclusion is not being implemented effectively. This implementation gap was attributed to lack of financing, leadership, and human resources, coupled with low monitoring of disability inclusion.
Conclusions
Improvements are needed in both the development and implementation of disability-inclusive health policies in Chile, to support the achievement of the right to healthcare for people with disabilities and ensuring that the health system truly “leaves no one behind”.
Automatic External Defibrillator (AED) Location – seconds that save lifes
Authors: Timler Wojciech , Jaskiewicz Filip , Kempa Joanna , Timler Dariusz
Published: July 2024

1. Introduction and objective
Sudden cardiac arrest (SCA) is a significant cause of adult mortality, categorized into in-hospital (IHCA) and out-of-hospital (OHCA). Survival in OHCA depends on early diagnosis, alerting Emergency Medical Service (EMS), high-quality bystander resuscitation, and prompt Automatic External Defibrillator (AED) use. Accelerating technological progress supports faster AED retrieval and use, but there are barriers in real-life OHCA situations. The study assesses 6th-year medical students' ability to locate AEDs using smartphones, revealing challenges and proposing solutions.
2. Material & Methods
The study was conducted in 2022-2023 at the Medical University of Lodz, Poland. Respondents completed a survey on AED knowledge and characteristics, followed by a task to find the nearest AED using their own smartphones. As common sources did not list the University AEDs, respondents were instructed to locate the nearest AED outside the research site.
3. Results
A total of 300 6th-year medical students took part in the study. Only 3.3% had an AED locating app. Only 32% of students claimed to know where the AED nearest to their home is. All 300 had received AED training, and almost half had been witness to a resuscitation.
Out of the 291 medical students who completed the AED location task, the median time to locate the nearest AED was 58 seconds. Most participants (86.6%) found the AED within 100 seconds, and over half (53%) did so in under 1 minute.
4. Conclusions
National registration of AEDs should be mandatory. A unified source of all AEDs mapped should be created or added to existing ones. With a median of under one minute, searching for AED by a bystander should be considered as a point in the chain of survival.
Comparisons between Criteria for Successful Radioiodine Remnant Ablation in a cohort of Patients with Papillary Thyroid Carcinoma
Authors: Wang Junyao , Chai Hong , Yang Jiahuan , Zhu Yunyun , Zhong Peng , Chen Zequan , He Ziyan , Zhang Ke , Chen Libo
Published: July 2024

Objective
Multiple criteria for successful radioiodine remnant ablation (RRA) under thyroid-stimulating hormone (TSH)-stimulation have been inconsistently employed, resulting in difficulties in efficacy comparison and iatrogenic hypothyroidism. Establishing an optimal standard for successful RRA is a priority.
Methods
Five existing criteria for successful RRA under endogenous TSH-stimulation were retrieved and then compared in a cohort of 51 patients with papillary thyroid cancer post RRA. Criterion A, a negative diagnostic 131I whole-body scan (DxWBS); Criterion B, a negative DxWBS and serum thyroglobulin (Tg) < 2 ng/mL, irrespective of anti-thyroglobulin antibody (TgAb) level; Criterion C, Tg < 2 ng/mL with TgAb ≤ 46 IU/mL; Criterion D, a negative DxWBS and Tg < 1ng/mL with TgAb ≤ 100 IU/mL or a negative DxWBS with TgAb > 100 IU/mL; Criterion E, a negative DxWBS and Tg ≤ 1 ng/mL with TgAb ≤ 46 IU/mL. Non-TSH-stimulated DxWBS was compared to TSH-stimulated DxWBS.
Results
Success rates of 98.0% (50/51), 78.4% (40/51), 78.0% (32/41), 64.7% (33/51) and 56.1% (23/41) were achieved regarding the criteria A, B, C, D, and E, respectively. The success rate of RRA by criterion A was significantly higher than those by other criteria. The similar success rates of RRA by criteria B and C were higher than that by criterion E. The success rate of RRA regarding non-TSH stimulated DxWBS was comparable to that of TSH-stimulated DxWBS, with a negative predictive value of 98.0%.
Conclusions
Compared with negative TSH-stimulated DxWBS criterion, the success rate of RRA decreases when the cut-off value of serum Tg is introduced. A negative non-TSH-stimulated DxWBS seems promising in predicting a successful RRA.
Absolute blood lymphocytes/monocytes and lymphocytes/neutrophils in patients with neurosyphilis may affect the response to therapy and diagnostic efficacy
Authors: Guan Hongjing , Di Xiaoyun , Li Mengqing , Yu Nawei , Cai Rentian , Chen Chen , Peng Jingli , Xia Zihao , Wei Hongxia
Published: July 2024

Background:To investigate the effects of absolute blood lymphocytes/absolute monocyte (LMR), absolute lymphocytes/absolute neutrophils (LNR) and sero-TRUST titers on treatment response after initial treatment in HIV-negative neurosyphilis (NS) patients, whether they can be used as auxiliary indicators for response after treatment.
Methods: NS patients who were hospitalized in Nanjing Second Hospital from January 1, 2018 to December 31, 2022 for initial treatment ,complete treatment response will be taken as the study endpoint. COX regression was used to analyze the influencing factors of treatment response in NS patients. Evaluate the ability to respond by assessing baseline LMR and LNR, changes in LMR and LNR at different time points compared to baseline, and the multiple decrease in the toluidine red unheated serum test titer from baseline(sero-TRUST) using time-dependent ROC curves.The forest plot analyzed the influencing factors of the LNR difference between baseline and 3 months after treatment (LNR3), baseline sero-TRUST titer (sero-TRUST0), sero-TRUST decrease from baseline at 3 months or 6 months after treatment (sero-TRUST3 or sero-TRUST6).
Results: A total of 249 patients were included in this study, including 200 in the response group and 49 in the non-response group.Univariate and multivariate COX regression analysis showed that baseline blood LMR> 1.93 (HR : 2.907, P=0.013), LNR > 0.3 (HR: 0.559, P= 0.013), and sero-TRUST titer >1:16 (HR: 1.760, P=0.002) affects the outcome of response after treatment. The AUC of LNR3 > 0.12 at 3M was 81.52 , the AUC of the baseline sero-TRUST titer was > 1:16 was 71.64, and the AUC of sero-TRUST3 titer decreased by more than 2 times at 3M was 72.85.The forest plot showed that if the blood was positive for syphilis ≥for 240 days before screening, the more likely the baseline sero-TRUST titer was less than 1:16.
Conclusion: The complete response rate of patients with NS to initial treatment was low, and peripheral blood LMR ,LNR ,and sero-TRUST may affect treatment response.The increase in LNR3 > 0.12 ,the baseline sero-TRUST titer > 1:16 , and the sero-TRUST 3 >2 titer could be used as auxiliary indicators to evaluate the treatment response of patients.
Accessing the Efficacy and Peri-Operative Adverse Effects of Three Different Hyperbaric Bupivacaine 0.5% Dosages for Spinal Anesthesia Induction in Lower Limb Orthopedic Surgeries: A Randomized Clinical Trial
Authors: Soufiani Alireza Rezayi , Joulani Mohammadamin , Jolani Mohammad Sajad , parish masoud
Published: July 2024

Background
Spinal anesthesia (SA) is a conventional method for proper nerve block in abdominopelvic and lower extremity surgeries. It is approximately used in over 5% of surgical interventions worldwide. Compared to general anesthesia, SA has reduced perioperative complications significantly. Bupivacaine hydrochloride is a relatively safe and widely used anesthetic drug for SA induction. The hyperbaric type of bupivacaine (HB) induces anesthesia more efficiently with a lower incidence of life-threatening adverse reactions like Perioperative hemodynamic changes and respiratory depression. More investigations are needed to define the best dosage that provides adequate anesthesia while reducing adverse effects for each surgical procedure.
Methods
this double-blinded randomized clinical trial compared the consequences of the (12.5mg,15mg,20mg) dosages of HB-bupivacaine in elective lower limb orthopedic surgery. Using block randomization, we allocated 60 participants to three (n = 20) study groups. The same protocol of anesthesia induction was used for patients. Outcome variables assumed as the incidence of the adverse effects (Hypotension, Anxiety, Bradycardia, Nausea and Vomiting(N/V), Hypoventilation, and Decreased o2 saturation), and the requirement for intervention to control the unwanted reaction. Addressing that, blood pressure (BP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (O2 sat), and respiratory rate (RR) were measured 10 times perioperatively. One-way ANOVA test, the chi2 test, or repeated measures ANOVA test with the Bonferroni adjustment were utilized as appropriate.
Results
We found that the incidence of hypotension and the N/V are associated with the HB-bupivacaine dosage. Contrary, our findings indicate that the incidence of apnea, bradycardia, and hypoventilation did not exhibit a significant dose-dependent pattern between the groups. Repeated measures analysis revealed significant intergroup differences for Herat rate, systolic, diastolic, and mean arterial pressure. The observed differences were more prominent 10–30 minutes after injection of HB-bupivacaine. The regression model claimed that gender and drug dosage significantly predict the incidence of adverse effects.
Conclusion
Our results, suggest that the administration of the 12.5mg HB-bupivacaine provides adequate anesthesia while minimizing the risk of adverse events for lower limb orthopedic surgeries lasting up to 180 minutes.
Trial registration:
The study was registered at the Clinical Trial Registry Center (IRCT20160202026328N7).
Association between antithrombotic agents use and hepatocellular carcinoma risk: a two-sample Mendelian randomization analysis
Authors: Yang Fengyi , Li Ouyang , Gao Benjian , Chen Zhuo , Li Bo , He Jiaqi , Yang Xiaoli
Published: July 2024

Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer worldwide. Multiple observational studies demonstrated a negative correlation between the use of antithrombotic agents and the risk of HCC. However, the precise causal relationship between these factors remains uncertain. Therefore, our study used a two-sample Mendelian randomization (MR) analysis to assess the causal link between these two factors.
Method: The summary statistics of single nucleotide polymorphisms (SNPs) associated with the use of antithrombotic agents were acquired from a genome-wide association study (GWAS) performed on individuals of European descent, as well as from the GWAS on the UK Biobank. A two-sample MR analysis was performed using the inverse variance weighting (IVW), the weighted median estimate, the MR-Egger regression, and the weighted-mode estimate. The robustness of the primary findings was assessed by sensitivity analysis.
Results: Ten SNPs associated with the use of antithrombotic agents were selected as instrumental variables. The MR analysis performed using the four methods mentioned above revealed a negative correlation between the use of antithrombotic agents and HCC. The other methods also produced similar results. No heterogeneity and horizontal pleiotropy were found.
Conclusion: Our findings suggested an inverse association of antithrombotic agents with the risk of HCC.
The Effect of Internet Addiction on Well-Being among University Students in Hong Kong
Authors: Lai Cyrus
Published: July 2024

This paper investigates the effect of Internet Addiction on university students’ well-being, focusing on parental strain, study strain, and self-identity. The research model is based on the conservation of resource theory, which suggests stress interaction and resource loss spiral. A sample of 74 Hong Kong university students revealed parental strain and study strain positively related to Internet Addiction, parental strain is significantly negatively correlated with well-being, and resources can significantly predict well-being.
Elevated cytokine levels in the central nervous system of cluster headache patients in bout and in remission
Authors: Ran Caroline , Olofsgård Felicia Jennysdotter , Wellfelt Katrin , Steinberg Anna , Belin Andrea Carmine
Published: July 2024

Background: Cluster headache is characterized by activation of the trigeminovascular pathway with subsequent pain signalling in the meningeal vessels, and inflammation has been suggested to play a role in the pathophysiology. To further investigate inflammation in cluster headache, inflammatory markers were analysed in patients with cluster headache and controls.
Methods: We performed a case-control study, collecting cerebrospinal fluid and serum samples from healthy controls, cluster headache patients in remission, active bout, and during an attack to cover the dynamic range of the cluster headache phenotype. Inflammatory markers were quantified using Target 48 OLINK cytokine panels.
Results: Altered levels of several cytokines were found in patients with cluster headache compared to controls. CCL8, CCL13, CCL11, CXCL10, CXCL11, HGF, MMP1, TNFSF10 and TNFSF12 levels in cerebrospinal fluid were comparable in active bout and remission, though significantly higher than in controls. In serum samples, CCL11 and CXCL11 displayed decreased levels in patients. Only one cytokine, IL-13 was differentially expressed in serum during attacks.
Conclusion and Interpretation: Our data shows signs of possible neuroinflammation occurring in biological samples from cluster headache patients. Increased cerebrospinal fluid cytokine levels are detectable in active bout and during remission, indicating neuroinflammation could be considered a marker for cluster headache and is unrelated to the different phases of the disorder.
Prognostic significance and treatment strategies for IKZF1 deletion in pediatric B-cell precursor acute lymphoblastic leukemia
Authors: Pan Lili , Chen Yiqiao , Weng Kaizhi , Guo Biyun , Zhuang Shuquan , Huang Shuxian , Lian Zhulan , Wang Xiaofang , Li Nainong , Zheng Yongzhi
Published: July 2024

Background
The predictive importance of IKZF1del in pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has shown variability across different studies. Thus, the optimal treatment approach for children with IKZF1del BCP-ALL remains contentious, with ongoing debate surrounding the use of IKZF1del-based high-risk stratification versus a minimal residual disease (MRD)-guided protocol.
Methods
IKZF1 status was reliably determined in 804 patients using multiplex ligation-dependent probe amplification (MLPA) data obtained from four hospitals in Fujian, a province of China. In the Chinese Children Leukemia Group (CCLG)-ALL 2008 cohort, IKZF1 status was included in the risk assignment, with all IKZF1del patients receiving a high-risk regimen. Conversely, in the Chinese Children’s Cancer Group (CCCG)-ALL 2015 cohort, IKZF1del was not incorporated into the risk assignment, and patients were treated based on an MRD-guided risk stratification protocol.
Results
IKZF1 del was found in 86 patients (86/804, 10.7%) overall and in 30 (30/46, 65.2%) BCR-ABL1-positive patients. For patients overall, IKZF1del was a poor prognostic predictor, though the significance diminished upon age adjustment, white blood cell (WBC) count at diagnosis, treatment group, and MRD status. In the CCLG-ALL 2008 cohort, IKZF1del conferred a notably lower 5-year overall survival (OS) and event-free survival (EFS) and a significantly higher 5-year cumulative incidence of relapse (CIR) than IKZF1wt. In the CCLG-ALL 2015 cohort, IKZF1del conferred a lower 5-year OS and EFS and a higher 5-year CIR than IKZF1wt, but the differences were not significant. The IKZF1del patients treated with higher intensity chemotherapy (CCLG-ALL 2008 high-risk regimen) had a markedly lower 5-year OS and EFS compared with those treated with the MRD-guided protocol (CCCG-ALL 2015 protocol). Furthermore, patients treated with the CCLG-ALL 2008 high-risk regimen experienced a higher frequency of serious adverse events (SAEs), especially infection-related SAEs, compared with those treated with the CCCG-ALL 2015 MRD-guided protocol.
Conclusions
The prognostic effect of IKZF1del may vary in different protocols. Compared with higher intensity chemotherapy, the MRD-guided protocol may be a more effective approach to treating BCP-ALL with IKZF1del in children.
Androgens as potential prognostic biomarkers are correlated with E-cadherin/β-catenin pathway in endometrial carcinoma
Authors: Wu Xirong , Zhang Kaiwen , Wang Tianqi , Yan Ye , Zhang Jingying , Zhao Shuangshuang , Yang Xiaoqing , Tian Wenyan , Wang Yingmei
Published: July 2024

Background
Androgens are associated with the risk of endometrial carcinoma (EC). However, their roles as prognostic factors are less clear. This study aimed to investigate the prognostic impact of different androgenic hormones and further uncovered the involved mechanism.
Methods
We examined associations between endogenous testosterone levels (total, bioavailable and free testosterone) and the clinical outcomes in patients with EC. The biological function of androgen was examined by in vitro and in vivo experiments.
Results
Compared with healthy controls, patients with EC showed significantly higher levels of testosterone. However, higher levels of bioavailable and free testosterone in EC patients correlated with favourable clinicopathological features. Kaplan-Meier survival analysis indicated that higher bioavailable and free testosterone levels were associated with better overall survival (P = 0.048, P = 0.036, respectively), which was not observed in subgroup analysis of total testosterone (P = 0.097). Furthermore, in vitro and in vivo experiments confirmed that androgen-dihydrotestosterone (DHT) could inhibit the migration and invasion of EC cells. Mechanistically, DHT could recruit β-catenin to E-cadherin to stabilize the adhesion junctions and inhibit β-catenin translocation into the nucleus in EC cells.
Conclusions
Androgens may potentially predict the prognosis of patients with EC.