bluuebunny/crossref_metadata_2025 huggingface dataset:
Removal of retained bullets from the hip joint in civilian gunshot injuries.
Authors: Maqungo Sithombo , Nicol Andrew , Kauta Ntambue , Graham Simon , Swanepoel Stefan , Laubscher Maritz , Antoni Anna
Published: August 2024

PurposeRemoval of bullets retained within joints is indicated to prevent mechanical blockade, 3rdbody wear and resultant arthritis, plus lead arthropathy and rarely, systemic lead poisoning. We aimed to report on the largest series of removal of bullets from the hip joint using open surgical techniques.MethodsThis is a retrospective cohort study of all patients who presented to a single Level 1 Trauma Unit with civilian gunshot injuries that had breached the hip joint between 01 January 2009 and 31 December 2022.Results:We identified one hundred and seventeen (117) adult patients who met our inclusion criteria. Of these patients 72 had bullets retained within the hip joint area. Forty-six patients underwent bullet removal using the following techniques: hip arthrotomy (n=19), surgical hip dislocation (n=18), direct removal without capsulotomy (tractotomy) (n=5), removal at site of fracture fixation/replacement (n=3), posterior wall osteotomy (n=1). No patients underwent hip arthroscopy. In 26 patients we did not remove bullets for the following reasons: final location was extra-capsular embedded in the soft tissues (n=17), clinical decision to not remove though bullet due to the patients’ clinical condition not allowing for further surgery (n=8) and patient refusal (n=1).Conclusion:With adequate pre-operative imaging and surgical planning, removal of retained bullets from the hip joint can be achieved using open surgical techniques without the need for hip arthroscopy.
The relationship between non-communicable disease risks and mental wellbeing in adolescence: a cross-sectional study utilising objective measures in Indonesia
Authors: Cini Karly I , Dumuid Dorothea , Francis Kate L , Wulan Nisaa R , Sawyer Susan M , Agung Fransisca Handy , Pham Minh D , Kennedy Elissa C , Fisher Jane , Tran Thach , Medise Bernie , Devera Yoga , Riyanti Aida , Wiweko Budi , Luchters Stanley , Kaligis Fransiska , Wiguna Tjhin , Ansariadi Ansariadi , Azzopardi Peter S
Published: August 2024

Background
Risk factors for non-communicable diseases (NCDs, cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental disorders) arise in adolescence but are mostly framed as relevant to health in adulthood; little is known about the relationship between co-occurring NCD risks and mental wellbeing in young people. This study aims to describe the prevalence and co-occurrence of distinct NCD risk factors, and how they relate to current mental wellbeing amongst adolescents in Indonesia, a young and populous country where NCD burden is increasing rapidly.
Methods
We assessed NCD risk and mental wellbeing amongst 1,331 school-based 16-18-year-olds in Jakarta (N = 609) and South Sulawesi. Five domains of NCD risk (adiposity, substance use, physical inactivity, excess sedentary time, and diet) were either measured or self-reported. In Jakarta, we also measured blood glucose, triglycerides, cholesterol, and blood pressure. Wellbeing was assessed using three indicators: general quality of life (QoL), physical function QoL, and psychological distress. We used linear regression to estimate the associations between co-occurring risks and wellbeing, adjusted for covariates of wellbeing: province, gender, socioeconomic status, and religion.
Results
NCD risk clustering was common, and more than half of adolescents had co-occurring risks in 3 or more of the 5 domains (58.9% (95%CI 53.7–63.9)). Adolescents with any NCD risk were more likely to report psychological distress, with this relationship most pronounced in those with excess sedentary time spent on video gaming and computer use. A higher number of NCD risk factors was associated with poorer psychological wellbeing and decreased general and physical function QoL. In the Jakarta subsample, reduced HDL and raised blood glucose was associated with psychological distress; and a higher number of risk biomarkers was associated with lower physical function QoL.
Conclusions
Our analysis also shows that these NCD risks (both individual risks and co-occurring risk count) are related to poorer profiles of mental wellbeing in adolescents, after adjusting for likely confounders.
Efficacy and safety of Intensive Blood Pressure Control in Ischemic Stroke Patients Following Endovascular Thrombectomy: A Update Meta-Analysis
Authors: Zhou Yitao , Zhou Yangbin , Yang Huijie , Wang Menglu , Huang Ganying
Published: August 2024

Objective
This meta-analysis aimed to determine the potential benefits or effectiveness of intensive blood pressure management in ischemic stroke patients who have undergone endovascular thrombectomy (EVT) and make an effective update for the evidence.
Methods
We comprehensively searched all relevant studies published before May 23, 2024, using multiple databases, including Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wangfang. The primary outcome was 90 days functional independence (Modified Rankin Scale, mRS score = 0–2), while the secondary outcomes comprised 90-day mortality, 7-day mortality, symptomatic intracranial hemorrhage (sICH), complications and hemicraniectomy.
Results
17 studies with a total of 5825 patients were included. The primary outcome: 90 days functional independence, a significant difference between different blood pressure management (OR = 1.58, 95% CI [1.17, 2.13]) was observed, with obvious heterogeneity (I2 = 83.20%, p < 0.01). The secondary outcomes: The significant difference were found in 90-day mortality (OR = 0.75, 95% CI [0.58, 0.99]), sICH (OR = 0.74, 95% CI [0.58, 0.95]), hemicraniectomy (OR = 0.42, 95% CI [0.22, 0.81]). No significant difference were found in 7-day mortality (OR = 0.88, 95% CI [0.49, 1.58]), complications (OR = 1.32, 95% CI [0.50, 3.50]). Subgroup analysis for the heterogeneity.
Conclusion
Our results suggested that more intensive blood pressure management may yield greater benefits in terms of patients' clinic outcomes. However, the results should be interpreted cautiously. Additionally, blood pressure target of SBP < 140 mmHg may provide fundamental insights for future randomized controlled trials.
Genomic profiling and expanded use of targeted anticancer drugs in solid cancers with exhausted evidence-based treatment options: the PRECODE study protocol
Authors: Hansen Karin Holmskov , Lyng Maria Bibi , Kodahl Annette Raskov , Asmussen Jon Thor , Arshad Arman , Petersen Henrik , Krogh Lotte , Ehmsen Sidse , Kristensen Thomas Kielsgaard , Ditzel Henrik J.
Published: August 2024

Background:
Genomic profiling of advanced solid cancer in patients with no further evidence based standard treatment options is a novel approach to identify potential experimental treatment options based on specific genomic alterations. Due to the expected short survival of these patients timely assessment of potential druggable targets is critical to minimize the risk of deterioration during the analysis.
The primary objective of this prospective study is to evaluate the turnaround time for genomic profiling and the feasibility of clinical investigational procedures. The secondary objectives are to investigate how often genomic alterations in tumor tissue gives rise to a matched treatment offer and evaluate the clinical outcome.
Methods:
The PRECODE study is a prospective, non-randomized, single-center cohort study conducted at Departments of Oncology and Pathology, Odense University Hospital, Denmark. Enrollment between March 1, 2019 and December 31, 2024. Eligibility criteria are age > 18 years, written informed consent, advanced solid tumors, exhausted treatment options, ECOG performance status 0-2, adequate organ function and life expectancy >3 months. A core needle biopsy is analyzed by next generation sequencing using a pan-cancer comprehensive panel. Results are discussed weekly at institutional/local and national multidisciplinary tumor boards.
Discussion:
Strategies and methods for genomic profiling of advanced solid cancers differ. Rapid analysis and interpretation of sequencing data are key to avoiding delays in initiation potential experimental treatments, as these late-stage patients may quickly deteriorate.
A highly optimized setup with fast-track clinical evaluation and genomic profiling has been established. Local and national multidisciplinary teams have been established to optimize individualized treatment decisions
Trial registration: ClinicalTrials.gov Identifier: NCT05385081 (retrospectively registered)
Iodine Deficiency Disorders in Khorasan Razavi Province, Iran: Assessing Salt Iodization and Iodine Intake Patterns
Authors: Esmaeilzadeh Nayereh , Bajestani Majid Jafari Nejad , Hoseini Seyed Javad , Abasalti Zahra , Emami Omid , Nasrollahzadeh Zohreh , Mood Zahra Izadi , Ghorbani Ahmadali , Oraee Melika
Published: August 2024

Considering iodine deficiency, researchers examine salt consumption by healthcare providers, health ambassadors and the general population in Khorasan Razavi province, Iran. This cross-sectional study used validated questionnaires and tested salt samples with standardized test kits and iodometry. Analyses were descriptive and kappa-based.
This study included 3115 participants, including 812 health workers and 912 health ambassadors, as well as 1,391 households. Higher levels of iodine deficiency may be detected due to new and stricter WHO standards that was least likely to be met all participants. (Kappa=0.0793) shows poor concordance. More than 90% of participants buy bagged salt but 31-63% store salt away from light, heat, and humidity. 42-66% store their salt in dark containers. Up to 38% of health workers add salt after cooking. Only 30-63% of groups knew about iodine deficiency diseases. About 37-66 % of participants consider iodization when purchasing salt.
Our findings provide rural and urban areas face disparities, as do households and health workers. Using updated WHO/UNICEF/ICCIDD standards to assess iodine deficiency led to lower compliance rates. The region can address iodine deficiency disorders with targeted interventions, awareness campaigns, monitoring, and quality control to enhance public health.
Exploring Determinants of Vaccination Rates among Pediatric Populations in East Gojam, Amhara Region, Ethiopia
Authors: Woudneh Awoke Fetahi , Shiferaw Nigatu Tiruneh
Published: August 2024

Introduction: Vaccination is a critical public health intervention that significantly reduces morbidity and mortality among children. Despite its importance, vaccination coverage remains suboptimal in many regions, including East Gojam, Amhara Region, Ethiopia. This study investigates the socio-demographic, economic, and cultural determinants of vaccination status among pediatric populations in East Gojam.
Methods: Using a cross-sectional design, data were collected from 1,900 respondents, categorizing vaccination status as not vaccinated, partially vaccinated, or fully vaccinated. Multinomial logistic regression analyzed the impact of predictors such as child age, gender, parental education level, household income, geographic location, and access to healthcare, and trust in healthcare providers, sources of vaccination information, cultural beliefs, and perceived government support for vaccination.
Results: The results revealed that higher parental education levels and urban residence positively influence vaccination rates. Older children were less likely to be fully vaccinated, indicating a need for targeted outreach. Access to healthcare services and trust in healthcare providers significantly promoted vaccination, while negative cultural beliefs and misinformation adversely affected vaccination rates. Perceived government support for vaccination was also a significant predictor.
Conclusion: The study concludes that addressing these multifaceted determinants through educational programs, improved healthcare access, trust-building initiatives, accurate information dissemination, and stronger governmental support, targeted outreach for older children, community engagement, and multi-sectoral collaboration can enhance vaccination coverage and improve public health outcomes in East Gojam and similar settings.
Anticoagulant therapy in neonatal acute infectious peritonitis based on the TAT, PIC, tPAIC, and sTM: a new case series
Authors: Wang Wenya , Gao Yue , Qiao Yan , Wu Yang , Zhang Ge , Li Jiao , Zhang Li
Published: August 2024

Background: Neonatal acute peritonitis is a leading cause of morbidity and mortality and poses challenges that demand prompt diagnosis and treatment, particularly in infants with disseminated intravascular coagulation.
Case presentation：Here, we report a case series of four infants with acute perionitis caused by necrotising enterocolitis, gastrointestinal perforation, and meconium peritonitis. Laboratory tests for thrombin-antithrombin complex(TAT), α2-plasmin inhibitor-plasmin complex(PIC), soluble thrombomodulin (sTM), and tissue plasminogen activator-inhibitor complex (tPAIC) suggested the activation of the coagulation system followed by treatment with anticoagulant therapy in these infants.
Conclusions: Overall, thrombin-antithrombin complex, α2-plasmin inhibitor-plasmin complex, soluble thrombomodulin, and tissue plasminogen activator-inhibitor complex may guide anticoagulant therapy, offering prospects for improving the outcomes in neonates with acute peritonitis.
Myocarditis and pericarditis are temporally associated with BNT162b2 COVID-19 vaccine in adolescents: a systematic review and meta-analysis
Authors: Choi Yongyeon , Lee Jue Seong , Lee Hyeran , Yoon Yoonsun , Shin Seung Hwan , Hwang Myung-Jae , Choi HyoSug , Na Sara , Kim Jong Hee , Kang Hyun Mi , Ahn Bin , Seo Kyoungsan , Choe Young June , Park Sangshin
Published: August 2024

The incidence of myocarditis and pericarditis has been documented in adolescents after COVID-19 vaccinations. This study aims to assess the risk of myopericarditis in adolescents following COVID-19 vaccination, using a meta-analysis of the published cases. We performed a comprehensive literature search of the following databases on July 5, 2023: MEDLINE, EMBASE, PubMed, and the Cochrane Library. We performed a meta-analysis using a random-effects model to estimate the incidence of myopericarditis per million of administered COVID-19 vaccine doses or COVID-19 infections. A total of 33 studies were included in the meta-analysis. Twenty-nine studies reported the incidence of myopericarditis after COVID-19 vaccination, whereas four studies reported the incidence following COVID-19 infection. The incidence of myopericarditis per million COVID-19 infections (1583.9 cases, 95% CI 751.8–2713.8) was approximately 42 times higher than that for COVID-19 vaccine administrations (37.6 cases, 95% CI 24.2–53.8). The risk of myopericarditis after COVID-19 vaccination was particularly high among the 16–19 age group (39.5 cases, 95% CI 25.8–56.0), males (43.1 cases, 95% CI 21.6–71.9), and those who received the second dose (47.7 cases, 95% CI: 22.2–82.2). Regionally, the highest incidence rate of myopericarditis following COVID-19 vaccination was observed in Europe (49.0 cases, 95% CI: 16.4–98.4), followed by the Western Pacific (39.7 cases, 95% CI: 18.1–69.5) and the Americas (27.7 cases, 95% CI: 14.0-45.7), although no statistically significant differences were noted (p = 0.51). Adolescents faced a potential risk of myopericarditis after COVID-19 vaccination, but this risk is less harmful than that of myopericarditis following COVID-19 infection.
Cost-effectiveness analysis of S-ademetionine compared with ursodeoxycholic acid for the treatment of Intrahepatic Cholestasis in China
Authors: Kim Hansoo , Lyu Juntao , Royle Ruth , Kim Kyoo , Morales-Castillo Mauricio , Byrnes Joshua
Published: August 2024

Chronic liver disease is a costly health problem that is increasing in prevalence in China. Intrahepatic cholestasis (IHC), such as alcoholic liver disease and non-alcoholic fatty liver disease, are the leading causes of chronic liver disease. In China, the recommended treatments for IHC are S-Adenosylmethionine (SAMe) and ursodeoxycholic acid (UDCA). Despite its use as a supplement in liver disease in China and worldwide, no studies assessing the cost-effectiveness or cost-utility of SAMe compared with UDCA in IHC have been identified in the literature. The aim of this study is to assess the cost-effectiveness of SAMe compared with UDCA in a Chinese clinical setting. The modelled economic evaluation was undertaken using two paralleled decision-analytic Markov models: SAMe compared with placebo and UDCA compared with placebo. The results show that SAMe yielded an additional 3.49 QALYs at CNY263,417 per 100 patients, resulting in an ICER of CNY75,423 compared to placebo. UDCA resulted in a gain of 0.87 QALYs at an additional cost of CNY358,197 per 100 patients and an ICER=CNY410,361 compared to placebo. SAMe is dominating UDCA with an ICER of -CNY36,175, and it is estimated to be a cost-effective option for improving health outcomes and saving costs in China.
Proteomic Evaluation of the Thrombosis-inflammation Interplay in STEMI with MVO
Authors: Qi Yu , Li Yufang , Wei Xuan , Wu Han , Li Guannan , Chen Jianzhou , Kang Lina , Wang Kun
Published: August 2024

Background
Coronary microvascular obstruction (MVO) occurs in up to half of acute myocardial infarction patients receiving successful primary percutaneous coronary intervention (pPCI) and is associated with a much worse outcome. Whereas the fluid phase cross-talk between thrombosis and inflammation is well appreciated, the pathophysiological implication is still scant.
Objectives
This study sought to investigate the differentially expressed proteins and possible biological processes involved in MVO after pPCI in ST-segment elevation myocardial infarction (STEMI) patients based on thrombus proteomics.
Methods
Aspirated thrombi and pPCI from 16 STEMI patients within 12 h of symptom onset were collected, including 8 MI with MVO (MVO+) and 8 MI without MVO (MVO-). 4D label-free proteomics was used to explore the differentially expressed proteins. Gene ontology enrichment analysis was performed using Metascape software and protein‒protein interaction analysis was performed using Cystoscope software. Afterward, the Connectivity Map database was used to select drug candidates for MVO treatment.
Results
We identified a total of 471 proteins with expression changes greater than 1.5-fold at P < 0.05, of which 50 were significantly upregulated and 421 were downregulated in the MVO + group compared with the MVO- group. Gene ontology enrichment analysis of significant differentially expressed proteins revealed the central role of platelet activation and neutrophil degranulation processes in patients with MVO. The protein‒protein interaction network also confirmed the significant interaction of inflammation and platelet activation, which may mediate the role of thrombus-inflammation in the pathogenesis of MVO. Drug screening revealed 4 drug candidates for MVO treatment: D-64131, TC-1, SB-431542 and alvespimycin.
Conclusions
Using the thrombus proteomic approach, we revealed the central role of the thrombus-inflammation interaction and potential drug candidates in STEMI with MVO. The findings from our study will contribute to the treatment of MVO in the future.
The influence of coronal alignment changes according to the degree of articular congruency in lateral tibial plateau fracture reduction
Authors: Sim Jae Ang , Kim Han Soul , Lim Ji-Sup , Lee Byung Hoon
Published: August 2024

Purpose
Surgical treatment of tibial plateau fractures involves anatomic reduction and rigid fixation. A residual articular depression may alter the joint contact pressure and lower limb alignment and precipitate posttraumatic osteoarthritis. The degree of acceptable articular incongruency remains controversial, and the correlation between malreduction and malalignment has not been thoroughly investigated. We investigated the correlation between postoperative articular congruency in different fracture zones in the sagittal plane and whole lower limb alignment after surgery for lateral tibial plateau fractures.
Materials and Methods
Among the 254 patients surgically treated for plateau tibia fractures between January 2010 and December 2022 at a single center, 67 patients of all ages with lateral tibial plateau fractures (Schatzker types I–III) were selected and retrospectively reviewed. All patients underwent open reduction and internal fixation (ORIF) via plate and screw construct, with or without an augmentation procedure. We used simple radiographs and preoperative three-dimensional computed tomography to measure lower extremity alignment variables, intra-articular step-offs, and fracture zones in the sagittal plane. We stratified the fracture site into three zones in the sagittal plane at the joint center of the lateral tibial plateau. Malreduction was defined as an articular step-off ≥ 2 mm. Malalignment was defined as a difference > 5° in hip-knee-ankle angle (HKA).
Results
HKA strongly correlated with postoperative articular step-off (Spearman's ρ = -0.69; p < 0.001). Postoperative valgization of HKA was significantly associated with increased articular incongruency (β= -0.96, p < 0.001), particularly with step-offs ≥ 2 mm (β= -3.77, p < 0.001). Linear regression of articular step-offs and fracture locations did not demonstrate any significance. However, 13 of 24 malreduced fractures (54%) were in zone 2. Only zone 2 significantly affected postoperative valgization when assessing the association between fracture location and HKA (β = -2.68, p < 0.001). Articular incongruency located in zone 2 showed a significant association with HKA valgization after controlling for fractures in zones 1 and 3 (β = -0.775, p < 0.001).
Conclusion
This study highlighted that the articular step-off should be minimized to < 2 mm during surgery for lateral tibial plateau fractures to prevent valgus malalignment of the whole lower limb.
Minimum Dietary Diversity and Its Associated Factors Among Children of 6–23 Months in Rural, Ethiopia, 2023
Authors: Darebo Teshale , Dereje Rahel , Fufa Dinaol Abdissa
Published: August 2024

Background: Dietary diversity is a useful indicator of diet quality and nutrient adequacy, which plays an important role in children's growth and development. Meeting this standard of dietary diversity remains a challenge in developing countries. However, in Ethiopia, including the study area, there is limited evidence on dietary diversity and associated factors in children aged 6 to 23 months.
Objectives: To assess the prevalence of dietary diversity and associated factors among children aged 6-23 Months in rural, Ethiopia, 2023.
Methods: A Community -based cross-sectional study design was conducted from April 11, 2023 to May 20, 2023 among 597 study participants. Face-to-face interviews were conducted by structured questioners, and the data was entered into Epi-data version 3.1 software. Later, IBM SPSS version 27 was used to perform bivariate and multivariate logistic regression analyses. To check for multicollinearity, the tolerance test and variance inflation factors (VIF) were used. The Hosmer-Lemeshow goodness of fit test was used to assess model fitness. Adjusted odds ratios and their 95% confidence intervals were used to identify statistically significant factors at P values 0.05.
Result: The results showed that the prevalence of optimal dietary diversity was 35.5% [95% CI: 31.5, 39.7]. The study also found that factors such as Decision-making power (AOR: 2.46, 95% CI: (1, 24, 4.9)), participation in cooking demonstrations (AOR = 1.61, 95% CI (1.10, 2.363), attendance at ANC follow-ups (AOR = 5.027, 95% CI (2.02, 12.46)), have nutrition counseling (AOR=2.450, 95% CI, (1.32), 4.54), good food security (AOR=2.7, 95% CI, (1.8, 4.06), child growth and development-monitoring behavior (AOR=1.8, 95% CI: 1.24, 2.6) were significantly associated with unacceptable dietary diversity.
Neonatal Cardiac POCUS - A Survey of Academic Neonatal Centers in the United States
Authors: McNamara Patrick , Aleem Numra , Wren John , Ruoss Lauren , Stanford Amy , Hyland Rachael , Thomas Brady , Giesinger Regan
Published: August 2024

Objective
To investigate the current state of clinical practice and training regarding the use of cardiac point of care ultrasound (cPOCUS) in neonatal intensive care units.
Study Design:
An online survey was disseminated through the Association of Academic Directors of Neonatology to appraise clinical usage, infrastructure, and training for cPOCUS. A single response per center was obtained.
Results
Overall survey response rate was 51% (48/94). Of respondents [40/48 (83%)] who reported having a POCUS program, 19/40 (47%) reported performing cPOCUS. In 74% of centers, < 10 cPOCUS studies are performed monthly. Only 16% (3/19) of centers had standardized imaging protocols. The most common indication for cPOCUS was central line evaluation. Only 9 (19%) programs reported cPOCUS training, of whom 4 had a formalized process of ongoing competency assessment.
Conclusion
Although use of cPOCUS is increasing, program infrastructure and governance, training, and evaluation vary markedly between institutions and are missing in many. There is an urgent need to develop consensus standards regarding clinical practice and training.
Alterations in sleep-activity cycles and clock gene expression across the synucleinopathy spectrum
Authors: Comas Maria , Vidal Xavier , Rawashdeh Oliver , Grunstein Ronald R. , Lewis Simon J.G. , Matar Elie
Published: August 2024

Background
Neurodegenerative synucleinopathies including Parkinson's disease (PD) and Dementia with Lewy bodies (DLB) are strongly associated with sleep disturbances. Furthermore, isolated Rapid Eye Movement Sleep Behaviour Disorder (iRBD) is now established as the strongest risk factor for developing PD or DLB, often preceding the clinical diagnosis by several years.
Objectives
We aimed to investigate sleep/wake cycles and circadian rhythms in patients with early PD and DLB, along with ‘at risk’ prodromal subjects diagnosed with iRBD.
Methods
Fifteen healthy controls, 20 iRBD, 16 PD and 17 DLB patients within 5 years of diagnosis, underwent assessment. Sleep/wake cycles were evaluated using questionnaires and actigraphy. Salivary and oral mucosa samples were collected every 3 hours to measure melatonin levels and Bmal1 clock gene expression over 24-hours.
Results
Both subjective and objective measures of sleep/wake cycles demonstrated that the DLB group exhibited the most significant sleep/wake cycle disruption. In the DLB group, no fundamental sine wave could be fitted to the level of melatonin secretion, indicating a severe disruption in the daily rhythm of this hormone. There was a statistically significant pattern of decreasing median Bmal1 amplitude from HC, to iRBD, to PD and then to DLB (p = 0.037).
Conclusions
This work highlights a differential gradient of objective disruption in the daily circadian rhythms from iRBD to established PD and DLB and is the first to directly demonstrate disruption of clock gene expression and melatonin in DLB. The findings support sleep/wake disruption as a marker of neuropathological severity and potentially a novel therapeutic target across the synucleinopathy spectrum.
Development and Validation a Machine Learning Nomogram Model to Differentiation Mycoplasma Pneumoniae Coinfection with Other Pathogen in Children Patients
Authors: Xu Wenbei , Liu Xiaohan , Meng Lingjian , Sun Xiaonan , Dong Lina , Li Qiang , Kang Haiquan , Mao Yiping , Lin Huashan , Hu Chunfeng , Xu Kai , Meng Yankai
Published: August 2024

Objectives
The aim of this study was to develop and validate a machine learning model for distinguishing mycoplasma pneumoniae coinfection with other pathogens (Co-MPP) in children from mycoplasma pneumoniae pneumonia (MPP) in children.
Methods
Between June 2023 and March 2024, 191 consecutive pediatric patients were enrolled in this study. The latest laboratory test results before bronchoalveolar lavage (BAL) were included in the statistical analysis. After the least absolute shrinkage and selection operator (LASSO) feature screening, we input the final features into seven different machine learning classifiers (LR, SVM, KNN, Random Forest, Extra Trees, XGBoost, and LightGBM) and selected the optimal classifier for model construction. The nomogram model combined the radiomics (rad) signature and the clinical signature. The ROC curves were drawn to evaluate the diagnostic efficacy of different models. The calibration efficiency of the nomogram was evaluated by drawing calibration curves, and the Hosmer-Lemeshow test was used to evaluate the calibration ability of the models. Decision curve analysis (DCA) was utilized to evaluate the clinical utility of the models. Statistical significance was considered when the p-value was < 0.05. The statistical analysis in this study was conducted using R and SPSS 27.0 software.
Results
A total of 1834 handcrafted radiomics features were extracted, including 360 first-order features, 14 shape features, and texture features. The LR classifier achieved the best value of AUC, reaching 0.922 and 0.867 for distinguishing Co-MPP from MPP in the training and test cohorts, respectively. For building the clinical signature, LR was selected as the base model. The univariate analysis results of all clinical laboratory and CT imaging features showed that only reticulation and bronchial lumen occlusion were significantly different between MP and Co-MPP patients (p = 0.011, < 0.001, respectively). The performance showed that the clinical signature achieved AUC values of 0.729 and 0.706 in the training and test cohorts, respectively. The nomogram using the LR algorithm was performed to combine the clinical signature and rad signature. Delong test results showed the performance of the nomogram and rad signature were both higher than the clinical signature (p < 0.05), while the nomogram and rad signature showed no significant difference. Both rad signature and nomogram showed significant clinical benefit.
Conclusion
Our study demonstrated that machine learning can assist clinicians in distinguishing Co-MPP from MPP in children. Furthermore, the rad signature and nomogram model showed higher clinical benefit compared to the clinical signature.
Concept mapping to promote clinical reasoning in multimorbidity: a mixed methods study in undergraduate Family Medicine
Authors: Fonseca Marta , Broeiro-Gonçalves Paula , Barosa Mariana , Marvão Pedro , Carreira Marta , Azeredo Sofia , Pires Joana , Rendas António , Rosado-Pinto Patrícia , Heleno Bruno
Published: August 2024

Introduction
: Clinical reasoning significantly impacts physicians' performance and patient care quality. Research into learning transfer within clinical reasoning education, especially in managing multimorbidity in Family Medicine, is crucial. This study evaluates the impact of concept maps (CMs) on promoting clinical reasoning skills among undergraduate students, compared to traditional teaching methods (TM).
Methods
A mixed methods approach was used in a controlled, non-randomized study with fifth-year Family Medicine undergraduates allocated to sessions using either CMs or TM. Quantitative data included a feedback questionnaire and evaluation of an individual task. Qualitative data comprised responses to an open-ended question and analysis of problem representation in the individual task.
Results
Among 313 eligible students, 112 participated (CM: 60, TM: 52). Both groups reported high satisfaction with their teaching methods. The CM group valued the holistic view and organization for managing multimorbidity cases, showing higher odds of positive scores on individual tasks (differences not statistically significant). Additionally, the CM group had a more homogeneous code matrix for problem representation in two clinical vignettes.
Conclusions
While no definitive evidence supports the superiority of CMs over traditional methods, promising trends were noted. The CM group showed improved performance in individual tasks and better organization in managing multimorbidity cases. Further investigation is recommended to explore varying levels of CM usage and modifications to pre-class workloads.
Overuse of antibiotics in the management of acute diarrhea in children under five years in four provinces of Mozambique (2014-2019)
Authors: Salência-Ferrão Judite , Chissaque Assucênio , Manhique-Coutinho Lena , Kenga Andréa , Cassocera Marta , Deus Nilsa
Published: August 2024

Background
Even with great reduction in the last years, diarrhea continues as one of leading causes of hospital admission and mortality in children less than five years of age globally. The success of diarrheal disease management relies on the rapid recognition of the symptoms and adequate treatment, to which WHO guidelines, do not recommend antibiotic use for all cases of acute diarrhea in children under five years old, being reserved to specific conditions such as bloody diarrhea, co-infection, malnutrition and chronic associated conditions. Therefore, we aimed to evaluate the frequency of antibiotics use in diarrhea management in children aged 0–59 months admitted with acute diarrhea in four provinces of Mozambique, from 2014 to 2019.
Methods
A cross-sectional hospital-based surveillance was conducted from January 2015 to December 2019 in six sentinel sites located in four provinces. Socio-demographic, epidemiological and clinical data were obtained by interviewing the child’s caregivers and by accessing the child’s medical records and children’s vaccination card. Data collected through ViNaDia was double-entered in Epi InfoTM3.5.1. (Centers for Disease Control and Prevention, Atlanta 2008), followed by data comparison. IBM SPSS software was used to conduct the data analysis.
Results
During the study period 2382 children who presented at one of the study health facilities with diarrhea was enrolled through ViNaDia surveillance between 2015–2019 and a total of 85.1% (2028/2382) provided information about the use of ATB and were included in the present analysis. The majority was male. The most frequent age group was 0–11 months with 49.4%. Underweight was observed in 28.8% and wasting in 15.2%. The comorbidities observed was HIV (7.8%), malaria (7.0%), and pneumonia (2.1%). Bloody diarrhea and “rice-water” was reported in 1.5% (10/1664) and 2% (29/1664) respectively. Antibiotics use was 93.2% [95% CI: 92.0–94.2; 1890/2028]. Administration of multiple antibiotics was 49.1% [95% CI: 47.0–51.5; 930/1890]. The most prescribed antibiotics were Ampicillin (46.2%), Gentamicin (38.4%) and Cotrimoxazole (30.5%).
Conclusions
The results of our study indicate an overuse of antibiotics in the management of acute diarrhea in children attended in four provinces of Mozambique. The study suggests the drawing of a local guideline for the efficient management of acute diarrhea.
Development of Complete Atrioventricular Block Following the Administration of the COVID-19 vaccine in a Young Patient: a Case Report
Authors: AlHabil Yazan , Abuzahra Saad , Azamtta Murad , Daralamouri Yunis
Published: August 2024

Background
COVID-19 vaccines have been a crucial element in combating the COVID-19 pandemic. With a substantial portion of the world’s population receiving the vaccine, uncommon side effects, such as abnormalities in the cardiac conduction system, have become apparent.
Case Presentation
This case report details a 16-year-old female patient who presented with persistent generalized fatigue, excessive sleepiness, and dizziness after receiving her second dose of the Pfizer-BioNTech vaccine. Initially, the patient sought medical attention at an outpatient clinic, where she was diagnosed with pericarditis. The treatment plan included prednisolone, colchicine, and esomeprazole, but the patient did not experience any improvement. One month later, the patient sought medical attention at our hospital and underwent an extensive medical evaluation. Electrocardiogram (ECG) findings were significant for complete atrioventricular (AV) dissociation, confirming the diagnosis of a third-degree heart block. After a thorough discussion regarding all possible interventions with the patient took place, an informed decision was made to implant a permanent pacemaker. Complete resolution of symptoms was reported by the patient at the 3-month follow-up visit.
Conclusions
The association between COVID-19 vaccines and heart conduction issues has led to various theories, considering factors like hypoxia, electrolyte imbalance, and cytokine responses. While congenital heart block parallels have been explored, transient AV blocks challenge this notion. Cytokine-mediated immune responses are linked to vaccine-induced myocarditis. Recent literature reports myocardial injury following Pfizer-BioNTech and Sino-pharm vaccinations, notably in elderly patients. Management protocols for device implantation during COVID-19 infection remain unclear. In conclusion, despite the novel and vague nature of this case, medical professionals need to be cautious of this possible complication in young and healthy patients after receiving their COVID-19 vaccine shots.
Assessing the response lag and vulnerability of terrestrial vegetation to various compound climate events in mainland China under different vegetation types
Authors: Yao Tian , Wu Chuanhao , Yeh Pat J.-F. , HU Bill X. , Jiao Yufei
Published: August 2024

In the context of climate warming, the compound dry-hot (CDH), dry-cold (CDC), wet-hot (CWH), and wet-cold (CWC) events have become more frequent and widespread in recent decades, causing severe but disproportionate impacts on terrestrial vegetation. However, the understanding of how vegetation vulnerability responds to these compound climate events (CCEs) is still limited. Here, we developed a multivariate copula conditional probabilistic model integrating the Standardized Precipitation Index (SPI), Standardized Temperature Index (STI), and Normalized Difference Vegetation Index (NDVI) together to quantify the vegetation response to each of CDH, CDC, CWH and CWC events under diverse climates in mainland China. Results show that CDC events result in the largest probability of vegetation loss relative to other three CCEs, with the probability of NDVI below the 40% percentile being 4.8%-13.0% (0.5%-2.6%) larger than individual dry (cold) events. In contrast, CWH leads to the lowest vegetation loss probability among all CCEs, with the probability of NDVI below the 40% percentile being 5.6% ~ 6.9% (4.2% ~ 5%) less than individual wet (hot) events. The response of vegetation vulnerability to CCEs varies considerably with ecosystems and climate types. Vegetation in Loess Plateau and northwestern Xinjiang (Inner Mongolia) is highly susceptible to CDC (CDH) events, while that in northeastern and southern China (eastern coastal and southwestern regions) is more vulnerable to CWC (CWH) events. Shrubland, grassland and cropland exhibit higher vulnerability to CDC and CDH events, while deciduous (evergreen) forests are more vulnerable to CWC(CWH) events, which may be related to vegetation physiological characteristics, survival strategies, and climatic adaptations. This study enhances our understanding on the response of various vegetation types to CCEs, and provides theoretical support for the development of measures to mitigate climate hazards.
Medical image encryption algorithm based on DNA and spiral transformation
Authors: Zhang Zhao , Zhao Bing
Published: August 2024

Medical image encryption plays a key role in healthcare and privacy protection as an important application in the field of image encryption. In this paper, a new medical image encryption method is proposed based on spiral transform and DNA operations. The algorithm makes use of Chaotic sequences generated by a 5-dimensional hyperchaotic system to perform double helical transform, DNA encoding, arithmetic and decoding operations on medical images respectively. The emulation experiments show that the algorithm has good encryption performance and can resist various attacks, especially in the anti-clip attack with good results.
Impact of Multi-Parameter Images Obtained from Dual-Energy CT on Radiomicis to Predict Pathological Grading of Bladder Urothelial Carcinoma
Authors: Wei Wei , Wang Shigeng , Hu Mengting , Tong Xiaoyu , Fan Yong , Zhang Jingyi , Cheng Qiye , Dong Deshuo , Liu Lei
Published: August 2024

Objective: To investigate the effect of radiomics models obtained from dual-energy CT (DECT) material decomposition images and virtual monoenergetic images (VMIs) in predicting the pathological grading of bladder urothelial carcinoma (BUC).
Materials and Methods: Preoperative Energy-Spectrum CT images were retrospectively collected from 112 pathologically confirmed cases of BUC patients, including 76 cases of high-grade urothelial carcinoma and 36 cases of low-grade urothelial carcinoma. Enhanced CT venous phase images of all patients were reconstructed at 40 to 140 keV VMIs (interval 10 keV), Iodine maps, and Water maps, and a total of 13 sets of images were obtained, and imaging features were extracted in each of the 13 sets of images. The best features related to BUC were identified by recursive feature elimination (RFE), the Minimum Redundancy Maximum Relevance (mRMR), and the Least Absolute Shrinkage and Selection Operator (LASSO) in order. A five-fold cross-validation method was used to divide the samples into training and testing sets, and models for pathological prediction of BUC grading were constructed by a random forest (RF) classifier. ROC curves were plotted to evaluate the performance of 13 models obtained from reconstructed images.
Results: There were no statistically significant differences in the area under the curve (AUC) between the training set and the testing set for all 13 models, with the AUC ranging from 0.91 to 0.96 in the training set and 0.84 to 0.90 in the testing set for each group of reconstructed images. Although the features selected for the reconstructed images were very different among the groups, all the features selected from 40 to 100 keV VMIs had dependencevariance of the GLDM feature set.
Conclusion: The variation of spectral CT parameters did no effect on the radiomics-based prediction of the pathological grading of BUC and did not affect the accuracy of the model even if the relevant features differed between reconstructed images.
Euglycemic diabetic ketoacidosis associated metabolic encephalopathy caused by dapagliflozin：a rare case report
Authors: Chu Lulu , Xi Zhenhua , Ma Runzhi , Shi Weiliang , Yu Guoshen
Published: August 2024

Background
Sodium–glucose cotransporter-2(SGLT-2) inhibitors are a newer class of anti-diabetic drugs with the incresed risk of euglycemic diabetic ketoacidosis(EuDKA). Encephalopathy is a rare but life-threatening event of EuDKA. Due to paradoxically normal or slightly elevated serum glucose levels, it's easy to be mimicked by cerebral infarction, structural brain damage, thus leading to delayed diagnosis and causing seriously irreversible brain injury.
Case presentation: We report a severe EuDKA with metabolic encephalopathy secondary to dapagliflozin in a type 2 diabetes mellitus(T2DM) patient. A 72-year-old female presented with complaining of 70 minutes of coma. Laboratory evaluation revealed a severe metabolic acidosis with an elevated anion gap, and ketones were elevated in blood and positive in urine. The patient eventually was diagnosed with metabolic encephalopathy associated with EuDKA and managed accordingly. Unfortunately, owing to the irreversible brain damage, the patient's state of consciousness is not fully recovered.
Conclusions
Metabolic encephalopathy is a rare but life-threatening complication of EuDKA caused by SGLT-2 inhibitors, the imaging features are similar to those of other metabolic encephalopathy such as poisoning and hypoxia. The precise pathogenesis of encephalopathy in EuDKA remains poorly understood, potentially resulting from the toxic consequences of electrolyte disturbances, ketosis, and acidosis. For unconscious patients with taking SGLT-2 inhibitors, commonly testing the level of ketones and magnetic resonance imaging of the brain are essential.
Multigenerational exposure of Daphnia carinata to NSAIDs in individual concentrations and binary mixtures
Authors: de Souza Helena da Silva Viana , Kumar Anupama , Nugegoda Dayanthi
Published: August 2024

Pharmaceuticals, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, are widely used for medical purposes but have also become prevalent environmental contaminants. However, there is limited understanding of their effects on aquatic organisms, especially regarding multigenerational and mixture exposures. This study aimed to evaluate the toxicological impacts of ibuprofen and naproxen, individually and in combination, on three generations of Daphnia carinata, a freshwater organism. Daphnids were exposed to environmentally relevant concentrations of ibuprofen and naproxen (0.1, 0.5, 2.5 µg/L and 0.1 + 0.1, 0.1 + 0.5, 2.5 + 2.5 µg/L) throughout multiple generations. Various endpoints were assessed, including reproduction, body size, reproduction recovery, and behaviour. The results revealed that both ibuprofen and naproxen had negative impacts on reproduction, leading to reduced reproductive output across generations.Additionally, daphnids exhibited changes in body size, with significant alterations observed in the F2 and F3 generations. Male individuals and ephippium were also present at all concentrations throughout all generations. Although reproduction recovery could not be observed in daphnids after one generation in clean water, the average number of neonates was higher in a few treatments in generation F4 compared to generation F3. In addition, binary mixtures of the drugs showed synergistic effects on daphnids' reproduction. The multigenerational approach provided valuable insights into the long-term effects of these NSAIDs on reproductive success and population dynamics. This study contributes to understanding the ecotoxicity of ibuprofen and naproxen in aquatic organisms, particularly in a multigenerational context and in the presence of mixture exposures.
Machine learning to improve the understanding of rabies epidemiology in low surveillance settings
Authors: Keshavamurthy Ravikiran , Boutelle Cassandra , Nakazawa Yoshinori , Joseph Haim , Joseph Dady W. , Dilius Pierre , Gibson Andrew D. , Wallace Ryan M.
Published: August 2024

In low and middle-income countries, a large proportion of animal rabies investigations end without a conclusive diagnosis leading to epidemiologic interpretations informed by clinical, rather than laboratory data. We compared Extreme Gradient Boosting (XGB) with Logistic Regression (LR) for their ability to estimate the probability of rabies in animals investigated as part of an Integrated Bite Case Management program (IBCM). To balance our training data, we used Random Oversampling (ROS) and Synthetic Minority Oversampling Technique. We developed a risk stratification framework based on predicted rabies probabilities. XGB performed better at predicting rabies cases than LR. Oversampling strategies enhanced the model sensitivity making them highly desirable to predict rare events like rabies in a biting animal. XGB-ROS classified most of the confirmed rabies cases and only a small proportion of non-cases as either high (confirmed cases = 85.2%, non-cases = 0.01%) or moderate (confirmed cases = 8.4%, non-cases = 4.0%) risk. Model-based risk stratification led to a 3.2-fold increase in epidemiologically useful data compared to a routine surveillance strategy using IBCM case definitions. Our study demonstrates the application of machine learning to strengthen zoonotic disease surveillance under resource-limited settings.
RETRACTED: Validating the Theory of Planned Behavior in Translation Education: A Higher-Order Construct Model Approach
Authors: Alhamami Munassir
Published: August 2024

The authors have requested that this preprint be removed from Research Square.