bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishing an animal model for post-inflammatory hyperpigmentation following fractional CO2 laser application
Authors: Feng Jiangfeng , Song Xiuzu , Zhang Beilei , Xiang Wenzhong
Published: September 2024

Background
Post-inflammatory hyperpigmentation (PIH) is a common cosmetic concern, often leading to significant psychological distress for the patients. With the widespread application of lasers including ablative fractional resurfacing (AFR) with a 10,600 nm CO2 laser, PIH caused by lasers is becoming increasingly common. But due to the absence of an appropriate animal research model, our understanding of pathophysiological mechanisms and preventive strategies for PIH remains limited.
Methods
This study aimed to establish an animal model to investigate PIH following AFR CO2 laser application, focusing on the dynamic changes in melanin, inflammatory cytokines, growth factors, and skin structures as PIH developed. We employed pigmented guinea pigs as our experimental subjects and conducted our research in two phases. In the first phase, we utilized three modalities of AFR CO2 laser, namely Active FX, Deep FX, and Total FX, to identify which laser mode could induce PIH by monitoring dynamic melanin changes. In the second phase, we used the Total FX mode to re-establish the PIH model. Pathophysiological changes during PIH progression were investigated through histopathological observations, real-time quantitative polymerase chain reaction, and two-photon microscopy.
Results
We successfully established a replicable animal model for PIH following AFR CO2 laser intervention. Following intervention with Total FX, we observed a significant increase in inflammatory cytokines and growth factors within the skin tissue by the second week, with stable pigmentation becoming apparent by the third week.
Conclusions
Our research provides a promising animal model for understanding and further studying the mechanisms of PIH after laser procedures.
EBM Level:
V (animal study)
A Quantitative Study on Quality of Physical Infrastructure, WASH practices, Preschool Education and Safety in Anganwadi Centers, Government Preschools and Private Preschools in Delhi
Authors: Tabassum Zeba , Khalid Kainat , Neyazi Sumayya , Ahmed Ebtisham
Published: September 2024

As the foundation of all learning depends upon early childhood experiences, which consist of the pre-schooling age of a child’s life, i.e., 3 to 6 years, preschools have a significant role in all learning. Enhanced cognitive, social, language capabilities and even a higher level of school readiness can be achieved through the quality of preschool programs. So, this study is undertaken to understand the quality of various modes of preschools, i.e., Anganwadi centers, government preschools, and private preschools, regarding their physical infrastructure, WASH practices, preschool education, and safety, that run in Delhi. 45 preschoolers were taken, 15 from each mode, and a descriptive research design was used for comparing the quality of different modes. The findings show that government preschools and private preschools are working at good quality in terms of physical infrastructure, safety of the children, and classroom process, though government preschools are performing slightly better than private preschools. On the other hand, Anganwadi centers are working mostly at average quality in all variables. All three modes of preschool should extensively work on the WASH practices and preschool education, especially in curriculum transaction and a child-friendly environment, as they require attention.
Is there a comparable Mp-MRI for incidental prostate uptake on 18F-FDG PET/CT?
Authors: Özdemir Merve Şam , Kaya Nurullah , Savun Metin , Keskin Emin Taha , Yüzkan Sabahattin , Omak Özgür , Özdemir Harun
Published: September 2024

Purpose: Although 18F-FDG-PET/CT is helpful in defining many types of cancer, localized prostate cancer should not be treated with this technique. In this study, accidental 18F-FDG uptake in the prostate is described using multi-parametric MRI (mpMRI).
Methods and Materials: While 18F-FDG-PET/CT is useful for characterizing a variety of cancers, it is not advised for prostate cancer that is localized. This work investigates the use of mpMRI to describe incidental 18F-FDG uptake in the prostate.mpMRI included T2-weighted (T2W), dynamic contrast enhancement (DCE), and apparent diffusion coefficient (ADC) sequences. Patients were classified according to PI-RADS (Prostate Imaging Reporting and Data System) version 2.1 by an experienced uroradiologist, and 18F-FDG-PET was evaluated to determine whether the area of involvement on CT had a counterpart in mpMRI. A biopsy was performed on 30 of the 92 patients.These patients' maximum standardized uptake values (SUVmax) 6 < and ≥ 6, PS(PSA) density 0.15< and ≥ 0.15, PSA level, uptake pattern (focal involvement/diffuse involvement), and PI-RADS scores were compared. P < 0.05 was considered statistically significant.
Results: In the study, 92 patients with incidental 18F-FDG-PET/CT prostate uptake were examined. Median age was 66, PSA median was 3.6 ng/ml (range: 0-3198 ng/ml). Notably, in 70.6% of cases, PET/CT uptake didn't correlate with mp-MRI findings. Among PI-RADS 3-4-5 patients (29.3%), there was a correlation. Biopsies in 30 patients revealed 43.3% benign, 56.7% malignant. Significant differences between benign and malignant cases were observed in PSA density, PI-RADS scores, and PSA levels (p < 0.05), while SUVmax and uptake pattern were not significant.
Conclusions: Our study showed that incidental 18F-FDG-PET/CT prostate uptake was detected and that high PSA density values, PI-RADS scores, and PSA values, such as in routine patients, and not PET-CT findings such as SUVmax and uptake pattern, were more predictive of malignancy.
Pedal to the Metal: Accelerating Intracerebral Hemorrhage Treatment with Robotic-Assisted Surgery. A systematic review & meta-analysis of clinical effectiveness
Authors: Łajczak Paweł , Łajczak Anna
Published: September 2024

Introduction
Intracerebral hemorrhage (ICH) is a severe condition in vascular neurological surgery, often leading to high mortality and severe disability. Recent advancements in robotic-assisted (RA) systems, including ROSA, Remebot, and CAS-R-2, have shown promise in enhancing surgical precision and outcomes. This study aims to evaluate the effectiveness of RA systems in ICH drainage compared to conventional methods.
Materials and Methods
This systematic review followed PRISMA 2020 guidelines. The inclusion criteria were peer-reviewed English language articles reporting on the use of RA systems for ICH surgery in humans. Data extraction focused on surgical time, mortality rates, neurological outcomes, complication rates, and economic effectiveness. Meta-analyses were performed using R software, employing a random effects model to account for variations between studies.
Results
Fifteen studies were included in the systematic review, with eleven qualifying for the meta-analysis. The results demonstrated that RA systems significantly reduced surgery time (MD -94.94 minutes, 95% CI: -149.85 to -40.03, p <.01) and mortality at last follow-up (OR 0.37, 95% CI: 0.15 to 0.92, p = .032). RA systems also improved neurological outcomes, with lower mean modified Rankin Scale (mRS) scores (MD -0.81, 95% CI: -1.08 to -0.53, p <.01) and higher Glasgow Outcome Scale (GOS) scores (MD 0.68, 95% CI: 0.16 to 1.20, p <.01). Complications such as rebleeding, pulmonary infections, and intracranial infections were significantly reduced. Economic analysis showed lower overall treatment costs due to reduced hospital stays and fewer complications.
Conclusions
Robotic-assisted systems offer substantial benefits in the surgical management of ICH, including reduced surgery times, lower mortality rates, improved neurological outcomes, and fewer complications. Despite these promising results, further large-scale, multi-center randomized controlled trials are needed to validate these findings and standardize protocols for the use of RA systems in neurosurgery.
Prognostic value of NPR and CLR-based nomogram modeling in elderly patients with Acinetobacter baumannii sepsis
Authors: Lai Shaoqin , Li Xiaojun , Cai Donghao , Mei Chuangchuang
Published: September 2024

Background
Acinetobacter baumannii (A. baumannii) is one of the main pathogens that causes sepsis in elderly patients, with high morbidity and mortality rates once infected; new inflammatory indicators, such as the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR), have been proposed in recent years, and the prognostic effects of these new inflammatory indicators have not yet been adequately investigated in A. baumannii sepsis in elderly patients. Therefore, we verified the effects of these inflammatory indicators on A. baumannii sepsis prognosis in elderly patients by constructing a nomogram model.
Methods
The clinical data of 126 elderly patients with A. baumannii sepsis were retrospectively analyzed, and they were divided into a survival group (87 patients) and a death group (39 patients) according to survival status 28 days after infection. The prognostic risk factors were screened by univariate and multivariate Cox regression analyses and LASSO regression, and a predictive model was constructed and evaluated to analyze the predictive value of continuous variables for prognosis.
RESULTS
Out of 126 patients, 39 died, for a mortality rate of 31.0%. A high NLR (hazard ratio [HR] of 35.948, 95% confidence interval [CI], 6.890–187.548) and a high C-reactive protein (CRP)-to-lymphocyte ratio (CLR) (HR, 1.004; 95% CI, 1.002–1.006) are independent risk factors for death in elderly patients with Acinetobacter baumannii sepsis. The nomogram model predicted the highest discriminatory 7-day prognosis of A. baumannii sepsis in elderly patients, with an area under the working curve (AUC) of 0.821 for subjects, 0.778 and 0.784 for 14 and 28 days, respectively, and a standardized model with good agreement. The clinical decision curve revealed that the model provided good net benefit, ranging from 20%-100%.
Conclusion
The NPR and CLR are closely associated with the prognosis of A. baumannii sepsis in elderly patients, and in clinical practice, a focus should be placed on these new indicators of inflammation, especially the NPR and CLR, to help physicians better assess the prognosis of A. baumannii sepsis in elderly patients and to develop a more effective therapeutic regimen to improve the survival rate of patients.
Dosimetric Effects of Bladder Volume Changes in MR-Guided Radiotherapy for Cervical Cancer
Authors: Zhou Kaiwen , Zhao Junfeng , Chen Jinhu , An Xingwei , Yin Yong , Li Zhenjiang
Published: September 2024

Purpose
This study aims to assess the dosimetric impact of variable bladder volume on CTV and OAR in cervical cancer patients undergoing radiotherapy.
Method
A total of 27 cervical cancer patients were included in this study: 12 received radical radiotherapy, and 15 underwent postoperative radiotherapy. All patients were treated with the Elekta Unity MR-linac system. The dose requirement was 95–100% of the prescribed dose to the PTV(45 Gy/25 sessions/5 weeks). Daily images were acquired at the time of treatment using the MR-linac. For this study, MR images from the first three treatments of each patient were selected to contour the CTV and OAR (bladder, small bowel, rectum, right and left lateral femoral heads), and the treatment plan was recalculated using the Monaco TPS. The dosimetric effects of bladder volume changes on the CTV and OAR were analyzed by SPSS.
Result
Regarding the dosimetric effects on the CTV, in the postoperative radiotherapy group, D98 and D95 of the CTV decreased as the bladder filled, with D95 decreasing from 5175.5 cGy to 5000.7 cGy. In contrast, for patients undergoing radical radiotherapy, the mean dose of the CTV increased from 5143.4 cGy to 5368.1 cGy as the bladder filled (ρ = 0.306, P = 0.035). For the dosimetric effects on the bladder, in the postoperative radiotherapy group, V30 and V20 of the bladder decreased as the bladder filled. In the radical radiotherapy group, the minimum dose of the bladder decreased with increasing bladder volume, but the maximum dose increased from 5103.3 cGy to 5794.7 cGy (ρ = 0.451, P = 0.006). For the rectum and small bowel, in the postoperative radiotherapy group, changes in bladder volume did not significantly affect the dose of the small bowel and rectum (p > 0.05). However, in the radical radiotherapy group, the minimum and mean doses to the rectum and the D2 of the small bowel decreased with bladder filling.
Conclusion
This study assessed the dosimetric and volumetric effects of bladder filling on the CTV and OAR using daily MR images from the MR-linac. Bladder filling influences the dose distribution to CTV and OAR.
A Consortium of Fecal Microbes that Decolonizes Antibiotic-resistant Enteric Pathogens: A Potential Alternative to Fecal Microbiota Transplantation
Authors: Yoon Mi Young , Jeong Uk Jin , Cho Soo Yoon , Jung Hee Yong , Kim Erin , Rho Mina , Han Min , Lee Eun Hwa , Kim Jung Ho , Lee Seung Soon , Chung Youn Wook , Ryu Ji-Hwan , Choi Jun Yong , Yoon Sang Sun
Published: September 2024

Fecal microbiota transplantation (FMT) has proven effective in decolonizing carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE). However, its efficacy varies among patients, and frequent implementation poses challenges. Through microbiome analysis of fecal samples from both FMT responders and non-responders, we identified a consortium of four gut commensal species, termed BM111. In an antibiotic-pretreated mouse infection model, BM111 effectively decolonized a VRE strain, demonstrating its therapeutic potential. Additionally, in a humanized mouse model with feces from CPE-infected patients transplanted into germ-free mice, BM111 significantly cleared CPE strains. In animals treated with the BM111 consortium, their microbiome diversity increased post-treatment, correlating with BM111-induced positive outcomes. Further informatic analysis of cohorts from 11 countries confirmed the high prevalence and abundance of these four species in healthy individuals, supporting their potential to restore microbiome balance in patients with infection-induced dysbiosis. The BM111 consortium presents a promising, safe, and effective alternative to FMT for combating antibiotic-resistant enteric infections, warranting further clinical research and development.
Behavioral and Social Drivers of Routine Childhood Immunization in Selected Low Coverage Areas in the Philippines
Authors: Dalisay Soledad Natalia , Landicho Madilene , Lota Maria Margarita , Fujimori Yoshiki , Claro Paulyn Jean , Roxas Evalyn , Abeleda Alvin , Rosuello Jan Zarlyn , Dato Micaella , Vogt Florian , Danchin Margaret , Kaufman Jessica
Published: September 2024

Background
Routine childhood vaccination coverage under the National Immunization Program of the Philippines is well below the target of 95% with a high number of zero-dose children. Declining immunization rates led to outbreaks of vaccine preventable diseases such as measles, polio, and pertussis. This study aimed to identify the factors affecting childhood vaccine uptake by exploring the perspectives of community members, program managers, and coordinators.
Methodology:
Three regions with low vaccine coverage in the Philippines were selected as study sites. We conducted focus groups with adult caregivers of vaccinated and unvaccinated children aged 0–11 years recruited by barangay (community) health workers. Key informant interviews were also conducted with immunization program managers and coordinators from different administrative levels. Focus group and interview guides were informed by the World Health Organization’s Behavioural and Social Drivers (BeSD) of Vaccination framework, which include the following domains influencing vaccine uptake: “Thinking and feeling”, “Social processes'', “Motivation”, and “Practical issues''. Transcripts were analyzed by themes and deductive axial coding was used to categorize themes into BeSD domains and socioecological levels.
Results
Twelve focus groups (n = 143) and 57 key informant interviews were done. Under the ‘Thinking and feeling’ domain of the BeSD, at the intrapersonal level, the perception of benefits and negative side effects of routine vaccines were clear drivers of vaccination. In the ‘Social processes’ domain, factors at multiple socioecological levels such as influence of family, barangay health workers, and community leaders were identified. Incentives such as candies and hygiene kits were also a driver to vaccination. Practical issues such as the availability of vaccines and accessibility of vaccination sites remain a barrier to vaccination despite implementation of strategies such as outreach vaccination activities and house-to-house visits by health center personnel.
Conclusions
Availability of routine vaccines and accessibility to vaccination sites are major challenges in the Philippines. Acceptability of routine vaccines continue to be affected by previous controversies around the Dengue vaccine and the recent COVID-19 pandemic. Enhancing training for health care workers on health promotion education regarding vaccination may contribute to increased vaccine uptake. Integration of immunization with other population-based health programs could be explored.
A Comparative Analysis of Robotic versus Laparoscopic Total Pancreatectomy: Insights from the National Cancer Database
Authors: Baytar Doga Kahramangil , Charles Angel , Parrish Austin , Voskamp Sarah , Novikov Aleksey , McKean Jordan , Hughes Steven , Sahin Ilyas , George Thomas , Paniccia Alessandro , Nassour Ibrahim
Published: September 2024

Background
Total pancreatectomy is a complex procedure used in the management of pancreatic cancer. While minimally invasive techniques have been increasingly adopted, limited data exists comparing robotic total pancreatectomy (RTP) and laparoscopic total pancreatectomy (LTP). This study evaluates the utilization, short- and long-term outcomes of RTP and LTP using the National Cancer Database.
Methods
Patients with stages I-III pancreatic adenocarcinoma who underwent RTP or LTP between 2010 and 2019 were identified. Patient demographics, treatment characteristics, pathologic outcomes, postoperative outcomes, and overall survival were compared. Multivariable logistic regression and Cox proportional hazards models were used to assess the association of surgical approach with outcomes.
Results
Of the 995 patients included, 188 (19%) underwent RTP and 807 (81%) underwent LTP. The utilization of minimally invasive techniques increased over time, with RTP accounting for 24% of cases in 2019. RTP had lower conversion rates than LTP (16% vs. 24%, p = 0.031), but this difference was not significant after adjusting for confounders. Postoperative outcomes, including length of stay, 30-day readmission, and 30- and 90-day mortality, were similar between RTP and LTP. The median overall survival was 22.3 months for RTP and 23.6 months for LTP (p = 0.647).
Conclusion
RTP and LTP demonstrate comparable perioperative, pathological, and oncological outcomes for the management of pancreatic adenocarcinoma. Despite the increasing adoption of minimally invasive total pancreatectomy, it remains a rare operation and should be performed in experienced centers to optimize outcomes.
Comparison of intracerebrospinal fluid methotrexate by Ommaya reservoir versus lumbar puncture in leptomeningeal carcinomatosis with hydrocephalus: a retrospective cohort study
Authors: Hong Kun , Liu Chang , Zhang Yu , Li Yi , Li Qing , He Junying , Bu Hui
Published: September 2024

Objective
The aim of this study was to investigate the clinical efficacy and long-term outcome of different routes of intracerebrospinal fluid (intra-CSF) methotrexate administration in the treatment of leptomeningeal carcinomatosis (LC) with hydrocephalus.
Methods
A total of 36 patients were included in this retrospective study. 15 patients were enrolled in the Ommaya reservoir (OR) group and 21 in the lumbar punctures (LP) group. Overall survival (OS) was estimated using the Kaplane-Meier method. Prognostic models were constructed using Cox proportional hazards models.
Results
Of the 36 patients, most primary cancers were non-small cell lung cancer (69.4%) and breast cancer (13.9%). Compared with the LP group, the OR group had higher overall response rate (p = 0.016) and clinical response rate (p = 0.002). Further, the OR group provided better control of intracranial pressure (p = 0.042). All side effects, due to procedure-related complications and drug toxicities, were reported in 4 and 2 patients, respectively. Median OS was 54.7 weeks, in the OR versus 44.1 weeks in the LP group. No statistical difference was observed in the survival of the two groups (p = 0.53). Significant prognostic factors associated with poorer outcome on multivariate analysis were extraneural metastasis (p = 0.01), non-targeted therapy (p < 0.001), and ineffective response after intra-CSF chemotherapy (p = 0.041) .
Conclusions
Compared with intra-CSF methotrexate administration via LP, OR adminstration did not prolong the OS in LC patients with hydrocephalus. But it was more effective in relieving clinical symptoms and did not increase adverse events. Concomitant targeted therapy and effective response may improve the survival.
Impact of Long COVID on the Health-Related Quality of Life of Japanese Patients: A Prospective Nationwide Cohort Study
Authors: Yagi Kazuma , Kondo Masahiro , Terai Hideki , Asakura Takanori , Kimura Ryusei , Takemura Ryo , Tanaka Hiromu , Ohgino Keiko , Masaki Katsunori , Namkoong Ho , Chubachi Shotaro , Miyata Jun , Kawada Ichiro , Kaido Tatsuya , Mashimo Shuko , Kobayashi Keigo , Hirano Toshiyuki , Lee Ho , Sugihara Kai , Omori Nao , Watase Mayuko , Mochimaru Takao , Satomi Ryosuke , Makino Yasushi , Inoue Takashi , Sayama Koichi , Oyamada Yoshitaka , Ishii Makoto , Sato Yasunori , Fukunaga Koichi
Published: September 2024

Background:
Various prolonged systemic symptoms, forming the long coronavirus disease (COVID), have been observed in patients who have recovered from the acute phase of COVID-19. Although previous studies have reported that COVID-19 impacts health-related quality of life (HRQoL), the associations of long COVID symptoms and clinical characteristics with HRQoL remain unclear. This study aimed to clarify these associations in patients with long COVID using nationwide Japanese epidemiological data.
Methods:
A prospective nationwide cohort study was conducted on patients aged ≥ 18 years admitted and discharged with a confirmed diagnosis of COVID-19 from January 2020 to the end of February 2021 at 26 participating medical institutions in Japan. Various long COVID symptoms and HRQoL scores at 3, 6, and 12 months following diagnosis were collected, and 986 participants were included. Generalized estimating equations (GEE) were used to explore the association between HRQoL scores evaluated using the short form-8 (SF-8), long COVID symptoms, and baseline clinical characteristics.
Results:
Patients who had at least one long COVID symptom showed a significantly lower physical component summary score (PCS) and mental component summary score (MCS) compared with those without any symptoms at 3, 6, and 12 months after diagnosis. GEE revealed that long COVID-19 symptoms, including dyspnea, fatigue, headache, and muscle weakness, were significantly associated with worse PCS, whereas poor concentration, sleep disorders, fatigue, and headache were significantly associated with worse MCS. Comorbidities, including cardiovascular disease and asthma, and severity-related baseline parameters for patients with COVID-19, such as severe outcomes during hospitalization and oxygen requirement, were significantly associated with worse PCS scores, though these factors were not significantly associated with worse MCS scores.
Conclusions:
Patients with various long COVID symptoms have lower physical and mental HRQoL. Severe outcomes of COVID-19 during hospitalization and comorbidities had an impact on PCS, but these factors did not affect MCS.
Eating in the absence of hunger is not associated with weight, eating behaviors, or well-being in pregnant adults: prospective cohort study
Authors: Lipsky Leah , Burger Kyle , Faith Myles , Shearrer Grace , Nansel Tonja
Published: September 2024

Background/objectives : Eating in the absence of hunger (EAH) is considered a risk factor for weight gain. This study examined relations of EAH with pregnancy-related weight outcomes, eating behaviors, and indicators of well-being.Methods Early pregnancy BMI, gestational weight gain, and postpartum weight change were calculated from measured height and weight from < 12 weeks gestation to 1 year postpartum. Participants reported baseline eating behaviors (Dutch Eating Behavior Questionnaire), depressive symptoms (Edinburgh Postnatal Depression Scale), stress (Perceived Stress Scale), and sleep quality (Pittsburgh Sleep Quality Index). In 2nd trimester, n = 46 participants completed two EAH assessments: one of minimally-processed (raw fruit, unsalted roasted peanuts, raw vegetables) and one of highly-processed foods (cookies, brownies, candy, chips, cheese popcorn). EAH of all foods, and of sweet (fruit/desserts) and savory (vegetables/salty snacks) foods separately, were calculated for each assessment (6 variables).Results Primarily null estimates did not provide consistent evidence of associations of EAH with pregnancy-related weight outcomes, eating behaviors, or well-being.Conclusions EAH in pregnancy was not related to weight change, eating behaviors, depressive symptoms, sleep quality, or stress. Future studies in larger samples and diverse developmental periods are needed to determine the utility of laboratory-assessed EAH as a risk factor for weight gain.
Screening of serum biomarkers using antibody microarray in diagnosis of papillary thyroid carcinoma
Authors: Liu Caiyuan , Wang Yichan , Feng Wei , Feng Tiantian , Qin Haojie , Ma Liya , Zheng Zhe , Pan Xinmin
Published: September 2024

Objective
Papillary thyroid cancer (PTC) is one of the most common types of endocrine cancer. Given that a certain percentage of PTCs are very aggressive and prone to recurrence, early diagnosis of PTCs is of great clinical significance. However, it remains a diagnostic challenge because of lack of reliable serum biomarkers currently. This study aimed to find novel biomarkers with good diagnostic value for PTCs.
Methods
A total of 31PTC patients and 31healthy controls were included in this study. The Human Antibody Arrays were used to screen potential biomarkers and enzyme-linked immunosorbent assay analysis was performed to validate candidate proteins. The receiver operating characteristic curve was utilized to evaluate the diagnostic value of candidate.
Results
The mean levels of phosphatidylserine decarboxylase (PISD), prostaglandin E synthase 3 (PTGES3), prostaglandin D2 synthase (HPGDS), and proteasome 20S were 14.11±0.32 ng/mL, 14.09±7.01 ng/mL, 178.31±32.50 pg/mL, and 0.18±0.21 μg/mL in serum samples of PTC patients, and were 12.46±6.31 ng/mL, 11.27±4.23 ng/mL, 199.22±25.91 pg/mL, and 0.06±0.05 μg/mL in healthy control samples, respectively. Compared to the control group, the expression of PTGES3 and proteasome 20s were higher in the PTC group. Interestingly, the combination of HPGDS and proteasome 20S yields a better predictive value of PTC with a sensitivity and specificity of 80.56% and 75.00%, respectively.
Conclusion
The combination of HPGDS and proteasome 20S may serve as a potential predictive biomarker for PTC.
RETRACTED: ZW Cooling Bed for Treatment of Heatstroke Patients; A Randomized Trial for a New Therapeutic Approach Based on Computerized Simulation of Heat Dissipation
Authors: Alzeer Abdulaziz H. , Abdeldayem Amr H. , Smith Troy , Alarifi Mohammed I. , Almeshal Nawaf , Ahamed Shaik Shaffi
Published: September 2024

The authors have requested that this preprint be removed from Research Square.
Liberation and Discharge Status of Older Patients After Invasive Mechanical Ventilation: A Retrospective cohort study
Authors: Sakamoto Ayaka , Inokuchi Ryota , Iwagami Masao , Kuroda Naoaki , Inoue Yoshiaki , Tamiya Nanako
Published: September 2024

Background
Data on the proportion of patients liberated from invasive mechanical ventilation (IMV) and the prognosis of those who have undergone IMV are limited. Objective data on prognosis are important when discussing preference for IMV. Therefore, this study explored both the proportion of liberation and prognosis after IMV in older patients in Japan.
Methods
We conducted a retrospective cohort study using claim data from April 2014 to March 2019 from the National Health Insurance, Late Elders' Health Insurance, and Long-Term Care Insurance in Tsukuba City, Japan. Patients aged ≥ 65 years who underwent IMV were included and patients who died within 3 days after intubation were excluded. A descriptive analysis of the liberation and the discharge status on Day 180 was conducted including a stratification by age categories and care level (CL) < 3 or ≥ 3. The chi-square or Fisher’s exact tests were conducted to assess whether liberation and discharge status differed among age categories or CLs.
Results
In total, 272 patients were included in the study, and the median age was 78 years (interquartile range: 73–84). The median duration of mechanical ventilation was 9.0 days. Pneumonia was the most frequent main diagnosis (12.5%). In total, 73.5% achieved liberation and 42.6% were discharged alive until day 180, while 19.9% were hospitalized and 37.5% were deceased on day 180. The proportion of liberation did not differ among age categories and CLs. However, the IMV duration for those requiring CL ≥ 3 was longer, and the proportion of hospitalized patients on day 180 among patients who requiring CL ≥ 3 was significantly higher than that in patients requiring CL < 3 (35.1% vs 17.4%, p = 0.012).
Conclusions
This study shows that many older patients can be successfully liberated from IMV. However, one third of patients died in the hospital and one fifth of patients required prolonged hospitalization. IMV and hospitalization were likely to be longer among patients requiring CL ≥ 3. Therefore, it may be important to discuss not only the potential difficulty of liberation, but also to convey the risks of undesired outcomes and physical function decline when considering IMV.
Identifying critical genes of breast cancer and corresponding leading compounds of potential therapeutic targets
Authors: Fan Xiaokai , Yu Xuan , Chen Liang
Published: September 2024

Background:
In 2020, there were 2.26 million new breast cancer cases, accounting for 24.5% of the total 9.23 million new cancer cases in women, far exceeding other cancer types in women. And for the death of cancer patients, there were 4.43 million female cancer deaths, among them, about 15.5% cancer deaths were caused by breast cancer. Breast cancer is the number one morbidity and mortality among women in the world, and breast cancer has seriously endangered the health and life of women around the world. Therefore, to address the growing public health problem of breast cancer, we must identify the critical genes and additional treatment targets of breast cancer.
Methods:
The Weighted Gene Co-Expression Network Analysis (WGCNA) was used to explore the hub genes of breast cancer patients. The regulation network of these hub genes was constructed with reanalyzing Chromatin Immunoprecipitation sequencing (Chip-seq) of the breast cancer cells. With the single-cell RNA sequencing and spatial transcriptome dataset of breast cancer patients, the hub gene expression abundance of each cell cluster and associates of the hub genes and immune cell was estimated. To find the genes that could be a prognosis factor or a potential treatment target, we conducted survival analysis based on each gene’s mRNA level and protein level. Finally, we used virtual screening of natural product molecules to find the leading compounds of our predicted target.
Results:
128 hub genes were found in breast cancer patients. Among these, Squalene Epoxidase (SQLE) can be a potential drug target, 17 molecules were ranked the top and the ZINC263585481 small molecule was the most possible as a leading compound of SQLE.
Conclusion:
Our study provides a whole critical genes of the development of breast cancer and found amounts of leading compounds, which will facilitate the curing of breast cancer.
Clinical characteristics of high-altitude interstitial lung disease: a two-center, retrospective, observational study
Authors: Zhou Liang , Zhu Min , Wang Yujun , Chen Ling , Xu Linrui , Liu Jia , Chen Lei , Tuo Yajun , Meilang Qucuo , Luo Fengming
Published: September 2024

Introduction
: The impact of high altitude on patients with interstitial lung disease (ILD) remains unclear. This study aimed to describe the clinical characteristics of ILD patients in high-altitude regions.
Methods
This retrospective observational study included ILD patients (IPF and CTD-ILD) hospitalized at two hospitals in Qinghai and Tibet between April 2018 and September 2021. Patients were categorized into high-altitude (≥ 2500 meters) and low-altitude (< 2500 meters) groups. Demographic, clinical, hematological, and pulmonary function data were collected and analysed.
Results
A total of 119 patients were enrolled, with 56 in the high-altitude group and 63 in the low-altitude group. Compared with the low-altitude group, the high-altitude group had a significantly greater proportion of CTD-ILD patients (42.2% vs 82.1%, p < 0.001). Patients in the high-altitude group presented higher red blood cell counts and hemoglobin and hematocrit levels but lower PaO2/FiO2 ratio (P/F ratio), FVC, and DLCO. Multivariate analysis revealed that high altitude was an independent risk factor for prolonged hospital stay in both IPF and CTD-ILD patients.
Conclusions
This study revealed a higher prevalence of CTD-ILD, an increased proportion of Tibetan ethnicity, differences in the P/F ratio, MCV, FVC, MCHC, and HGB levels, and prolonged hospital stays in the high-altitude group.
The association between triglyceride glucose index and the risk of cardiovascular disease in obstructive sleep apnea
Authors: Wang Lixia , Dai Lu , Wang Xiaona , Guo Junwei , Huang Rong , Xiao Yi
Published: September 2024

Background
The triglyceride glucose (TyG) index is a dependable indicator of insulin resistance (IR), serves as a valuable biomarker for identifying obstructive sleep apnea (OSA) and predicting its comorbidities. Both OSA and the TyG index are significantly related to the incidence and development of cardiovascular disease (CVD). We focus on investigating the relationship between TyG index and the likelihood of developing CVD in OSA.
Methods
TyG index, homeostatic model assessment of IR (HOMA-IR) index and polysomnography were assessed in 191 participants with OSA and without pre-existing CVD. To estimate the lifetime CVD risk, we employed the ‘Prediction for Atherosclerotic CVD Risk in China’ equation. The TyG index’s association with CVD risk was scrutinized using multivariable logistic regression models, contrasting it with the HOMA-IR index. We compared the predictive power for high lifetime CVD risk of TyG index and HOMA-IR index using receiver-operating characteristic (ROC) curve analysis.
Results
There were 89 participants had high lifetime CVD risk. In fully adjusted models and additionally adjusted for HOMA-IR index, participants situated within the fifth quartile of TyG index exhibited increased lifetime CVD risk, with OR of 4.32 (95% CI, 1.19–15.67). The TyG index demonstrated significant threshold values across varying OSA severities and outperformed the HOMA-IR index in predicting high lifetime CVD risk, as evidenced by a larger area under the ROC curve.
Conclusions
The TyG index, independent of the HOMA-IR index and obesity, was linked to a heightened lifetime risk of CVD. In predicting cardiovascular outcomes, the TyG index could potentially surpass the HOMA-IR index among individuals with OSA.
Impacts of Infancy Responsive Caregiving Trajectory on Children’s Emotional and Behavioral Problems before 5 years old: a birth cohort study
Authors: Shang Bingzi , Liu Su , Wang Ke , Yuan Lingling , Zhang Yunhui , Shi Huijing
Published: September 2024

Background
Providing responsive caregiving might benefit children’s cognitive and emotional development, but the role of infancy responsive caregiving trajectory is unclear. This birth cohort study aimed to examine the effect of infancy responsive caregiving trajectory on children’s emotional and behavioral problems (EBPs) at 2 and 3–5 years old.
Methods
A total of 2321 mother-child dyads from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) were included in this study. Responsive caregiving was assessed using questionnaires at 2-, 6-, and 12-month old. The Strength and Difficulties Questionnaire (SDQ) was used to assess children’s EBPs. Group-based trajectory model (GBTM) was used to identify responsive caregiving trajectory. Ordered logistic regression was fitted to analyse the association of responsive caregiving trajectories and children’s EBPs.
Results
The study participants were categorized into four trajectory groups: Increasing group (n = 26, 1.12%), Fluctuating group (n = 366, 15.77%), Decline group (n = 125, 5.39%), And normal group (n = 1804, 77.73%). Compared to children in normal group, children in decline group had significantly increased risk of emotional symptoms, conduct problems, peer problems and prosocial behavior problems at 2 years old (aOR = 3.49, 2.70, 3.67 and 1.96), also conduct problems and hyperactivity at 3–5 years old (aOR = 1.96, 1.85). Children in fluctuating group had increased risk of hyperactivity and prosocial behavior problems at 2 years old (aOR = 1.81, 1.63), and prosocial behavior problems at 3–5 years old (aOR = 1.41). While, children increasing group did not show any increased risks of EBPs at 2 and 3–5 years old.
Conclusions
Consistently decreasing, low-level fluctuations in responsive caregiving during infancy could increase the risks of children’s EBPs. Maintaining consistent and stable level of responsive caregiving during infancy had beneficial effects on children’s emotional development.
Digital art learning for cognitive and psychological functioning among older adults: a randomized controlled trial protocol
Authors: Uno Akari , Browne Ryan , Shinada Takamitsu , Soga Keishi , Du Yegang , Takahashi Michio , Abiko Fumihira , Taki Yasuyuki
Published: September 2024

Background
Japan has one of the foremost aging populations in the world, and from a dementia prevention perspective, effective and easy-to-implement approaches to dementia prevention are becoming increasingly important. Artistic activities have been suggested to improve cognitive function and psychological well-being among older adults. Although visual art therapy has been shown to improve cognitive function in older adults with cognitive impairment, studies targeting healthy older individuals are limited. Furthermore, considering the spread of digital art, incorporating digital devices into art engagement for older adults may improve cognitive function. This study protocol aims to clarify the effects of digital art learning interventions on the cognitive and psychological functions of healthy older individuals, as well as the relationships between drawing movement data and related variables.
Methods
Eighty older adults will be randomly assigned to the digital art group or the control group (1:1). The digital art group will take part in a participatory digital art learning program, with lessons once a week for six months, while the control group will continue their usual daily lives. All participants will undergo cognitive and psychological function tests before and after the intervention. The effects of the program on cognitive and psychological functions, the primary outcome, will be determined by a two-way analysis of variance of the results of cognitive and psychological function tests before and after the intervention. To further clarify the mechanism of intervention effects in the digital art group, the relationship between the test results before and after the intervention and related indicators, such as drawing motion, will be clarified using the structural equation modeling.
Discussion
The study aims to clarify the effects of continuous digital art learning on the cognitive and psychological functions of healthy older individuals. The characteristics of this study are threefold: emphasis on preventive approaches, utilization of digital technology in art interventions for older adults, and utilization of drawing motion data obtained from digital pens in the analysis. The digital art learning developed through this study is expected to enrich the lives of older adults.
Trial registration
This study was registered with the UMINCTR (UMIN000051427) on June 23, 2023.
Interplay of Repetitive Negative Thinking, Defeat, and Entrapment in Patients with Suicidal Ideation versus Suicidal Behavior through the Integrated Motivational-Volitional Model
Authors: Dies Maria Aliño , Sánchez-Reolid Daniel , Monferrer Marta , Montes Maria Jesus , Fernández-Caballero Antonio , Fernández-Sotos Patricia , Ricarte Jorge Javier
Published: September 2024

Introduction: this study aims to elucidate the cognitive mechanisms underlying the transition from suicidal ideation (SI) to suicidal behavior (SB), exploring the interplay between repetitive negative thinking (RNT), feelings of defeat, and perceptions of entrapment (internal and external) within the framework of the Integrated Motivational-Volitional (IMV) Model.
Methods: an observational, analytical, cross-sectional, and prospective study was conducted with 64 patients from a suicide prevention program in Spanish hospital, they were stratified into SI and SB groups.
Results: a positive correlation was observed between RNT and both internal and external entrapment, as well as defeat, across both patient groups. These correlations were more robust for internal entrapment and were particularly prominent in the SB group.
Discussion: the findings suggest that RNT may serve as a transdiagnostic risk factor for suicide, with its influence being moderated by feelings of defeat and entrapment. This research underscores the critical role of RNT in the context of suicidal risk and supports the IMV model as a valuable framework for understanding the progression from SI to SB. Early identification and targeted therapeutic interventions for RNT, defeat, and entrapment could be pivotal in preventing the escalation to SB. Future studies should explore the causal pathways between these cognitive variables and evaluate the efficacy of interventions aimed at reducing RNT and its associated suicidal outcomes.
Oral Ursodeoxycholic Acid Therapy Failed to Mitigate SARS-CoV-2 Omicron Infection
Authors: Yu Dong-Shan , Song Zhi-Ying , Liu Yun , Zhu Guo-Jian , Sun Ke , Li Yan-Hua , Yu Rong-Yan , Xi Wen-Na
Published: September 2024

Background
Ursodeoxycholic acid (UDCA) was reported to reduce susceptibility to SARS-CoV-2 infection by downregulating farnesoid X receptor (FXR) -ACE2 signaling. However, we found a different story in real-world clinical studies.
Methods
We attempted to verify whether UDCA can effectively prevent SARS-CoV-2 transmission or have positive therapeutic effects in a real-world clinical study. We performed a retrospective study, collected, and assessed clinical presentation and laboratory data on patients with liver diseases infected with SARS-CoV-2 Omicron sub-variant BA.5.2 who had been treated with or without UDCA, patients treated with UDCA without SARS-CoV-2 infection were set as control group.
Results
The data showed treatment with UDCA did not prevent infection with the Omicron sub-variant BA.5.2, failed in reducing the duration of infection and hardly mitigated the severity of COVID-19. Meanwhile, the severity of liver diseases, especially TBil, ALP, γ-GT, liver cirrhosis and Child-Pugh classification, should be considered as risk factors for severe COVID-19 in chronic hepatic patients.
Conclusion
UDCA failed to show inhibitory effects against SARS-CoV-2 infection in complex clinical settings. The regulatory mechanism of the novel UDCA-FXR-ACE2 pathway needs to be further investigated in real-world clinical studies.
Triggers of Sudden Cardiac Arrest in Youth
Authors: Warneryd Amelie , Chand Simran , Lemma Abenezer , Lopez-Anderson Martha , Flanagan Lindsey J. , Vetter Victoria L.
Published: September 2024

Background
Exercise is considered a primary trigger for sudden cardiac arrest (SCA) in youth. We hypothesized that other factors have important associations.
Methods
During 2011–2012 and 2019–2020, we surveyed Parent Heart Watch members with children who had experienced sudden cardiac arrest or sudden cardiac death for 1) demographics; 2) pre-sudden cardiac arrest symptoms, evaluation, diagnoses; 3) family history; 4) medications, substances; 5) activity; 6) circumstances; and 7) post-sudden cardiac arrest diagnoses.
Results
82 responses (~ 60% of members), 23.2% with surviving children. Mean age sudden cardiac arrest, 17.2 (4.5) years, median, 16 years; range, 5–30 years; male, 75%. Race/ethnicity: white, 81.0%; Black, 3.8%; Hispanic, 5.1%; Native American, 2.5%; >1 race, 7.6%. Family history of sudden cardiac arrest < 50 years, 17.1%. Prior cardiovascular symptoms: exercise fatigue, 30.8%; chest pain, 60.3%; palpitations, 16.7%; ≥1fainting episode, 19.2%; shortness of breath, 19.2%; upset, 9.0%. Prior (10.5%) and post (63.2%) cardiac diagnoses; activity-related, 60.5%; recent flu-like illness, 25.0%. Medications/substances including caffeine, energy drinks, alcohol and tobacco consumed prior to arrest, 57.9%. Arrest witnessed, 72.4%; fifteen events in location with an automated external defibrillator (AED) - survival, 47% when AED present.
Conclusions
Symptoms of sudden cardiac arrest are common but often ignored and not medically evaluated or treated. While activity was frequently associated with SCA, other important triggers of SCA appear to be medications and substances, often in the presence of underlying and frequently undiagnosed heart conditions, present in over half of cases. Potential triggers of sudden cardiac arrest include activity, medications and substances, and intercurrent illnesses.
Individual and Combined Contamination of the Heavy Metals in Commercial Cat and Dog Food
Authors: Du Jiaying , Zhou Kerui , Jiang Han , Hu Shen , Zhang Wei , Zheng Qiang , Zhou Guangteng , Zhang Niya
Published: September 2024

As the long-term accumulation of heavy metals in food poses significant health risks to pets, there is a growing concern among people regarding heavy metal contamination in pet food. In order to investigate the heavy metals levels in pet food in China, we collected a total of 93 imported cat and dog food from the Chinese market produced in 2021–2022, comprising 45 cat food and 48 dog food, and determined the concentrations of lead (Pb), cadmium (Cd), chromium (Cr), mercury (Hg) and arsenic (As) in them. Cr and As were detected in all samples, followed by contamination rate of Hg. In cat food, Cr and As were the most prevalent heavy metals, and Cr and Hg were found in all dog food. Pb was not detected in canned foods, while Cr, As, Hg, and Cd had contamination rates of 100%, 100%, 85.71%, and 34.18% respectively. Dry food in cat and dog foods, with Cr, Hg, and As having the highest contamination rates at 100%. Some samples exceed the limits set by Hygienical Standard for Pet Feed of China (Announcement No. 20 of 2018) regarding Pb and Cr, while other heavy metals remained within acceptable limits. Canned food, however, met all regulatory limits for heavy metals. Across all types of pet food, Cr, Hg, and As were consistently the most prevalent combined contaminants. Analysis of the aHI values showed that Cr posed the highest risk, exceeding safety thresholds significantly. Pb and As also posed risks, with differing impacts between cats and dogs. This study underscores the extensive presence of heavy metal contamination in pet foods, posing a significant risk to pet health due to ongoing exposure to multiple heavy metals.