bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Integrating High-fidelity Simulation and Team-Based Learning in Pediatric postgraduates CPR Training: A Mixed Method Running Head：High-fidelity Simulation and TBL
Authors: Zhang Li-dan , Wang Li , Li Ya-ting , Guo Yao-yu , Lin Hong-xin , Ye Xiao-ting , Chen Hua-bao , Tang Yan-lai , Chen Chun , Xu Ling-ling
Published: August 2024

Background Given the overall lack of cardiopulmonary
resuscitation (CPR) training in society, Standardized CPR training
is very imperative to bolster widespread CPR adoption. At present,
the traditional teaching method is not conducive to improving
students' comprehensive ability, however, there is limited
literature on the combined use of high-fidelity simulation and
team-based learning (TBL) in pediatric graduate student education. The study aimed to evaluate the effectiveness of using high-fidelity simulation combined with TBL teaching method in standardized training of cardiopulmonary resuscitation for pediatric postgraduates.
Methods
This mixed-methods study involved twenty-four postgraduate students as experimental subjects. The teaching intervention comprised high-fidelity simulation combined with the team-based learning (TBL) method. Notably, all participants were new to this combined approach, having previously been exposed to traditional teaching methods. We measured total learning performance with a pre-post design. Subsequently, semi-structured interviews were employed, and data analysis followed Colaizzi's methodology. NVivo 12.0 was used to code and analyze interview records.
Results
The high-fidelity simulation + TBL teaching method led to significant improvements in clinical operation scores, including hands-on CPR (80.95 ± 5.81 vs 88.46 ± 7.35), endotracheal intubation (76.03 ± 6.51 vs 81.89 ± 9.72), defibrillation (79.96 ± 4.37 vs 89.84 ± 3.98), and team collaboration (28.33 ± 2.46 vs 32.99 ± 2.85) (P < 0.05). Additionally, a comprehensive qualitative analysis identified 10 core themes, which could be grouped into four thematic clusters: "Reflection and feedback," "Highly simulated clinical scenario," "Improving clinical thinking," and "Teamwork and communication."
Conclusion
The integration of high-fidelity simulation and TBL enhances teaching efficiency and overall clinical emergency response capabilities for postgraduate students, offering structured small group learning applicable to standardized pediatric CPR training.
Telerehabilitation using a 2-D planar arm rehabilitation robot for hemiparetic stroke: A feasibility study of clinic-to-home exergaming therapy
Authors: Ollinger Gabriel Aguirre , Chua Karen Sui Geok , Ong Poo Lee , Kuah Christopher Wee Keong , Plunkett Tegan Kate , Ng Chwee Yin , Khin Lay Wai , Goh Kim Huat , Chong Wei Binh , Low Jaclyn Ai Mei , Mushtaq Malaika , Samkharadze Tengiz , Kager Simone , Cheng Hsiao-Ju , Hussain Asif
Published: August 2024

Aims: We evaluated the feasibility, safety and efficacy of a 2D-planar robot for minimally-supervised home-based upper-limb therapy for post-stroke hemiparesis.
Materials and Methods: The H-Man, end effector robot, combined with web-based software application for remote tele-monitoring were evaluated at homes of participants. Inclusion criteria were: strokes > 28 days, Fugl-Meyer Motor Assessment (FMA) >10-60/66, presence of a carer and absence of medical contraindications. Participants performed self-directed, minimally-supervised H-Man training for 30 consecutive days at their homes, after 2 therapist-supervised clinic on-boarding sessions. Web-based compliance measures were accessed sessions (>20mins/day), training minutes/day and active training hours/30days. Clinical outcomes obtained at weeks 0, 5 (post-training), 12 and 24 (follow-up) consisted of FMA, Action Research Arm Test (ARAT) and WHO-Stroke Specific Quality Of Life (SSQOL). To estimate immediate economic benefits of the home-based robotic therapy, we performed cost-effectiveness analysis (CEA), followed by budget impact analysis (BIA).
Results: Altogether, all 12 participants completed H-Man at home without adverse events; 9 (75.0%) were males, mean (SD) age, 59.4 years (9.5), median (IQR) stroke duration 38.6 weeks (25.4, 79.6) baseline FMA (0-66) 42.1 ±13.2, ARAT (0-57) 25.4 ±19.5, SSQOL (0-245) 185.3 ±32.8. At week 5 follow-up, mean (SD) accessed days were 26.3 days ±6.4, active training hours of 35.3 hours ±14.7/30days, or ~6 days/week and 77 training minutes ± 20.9/day were observed. Significant gains were observed from baseline across time; ΔFMA 2.4 at week 5 (FMA 44.5, CI 95% 39.7 – 49.3, p < 0.05) and ΔFMA 3.7 at week 24 (FMA 45.8, CI 95% 40.5 – 51, p < 0.05); ΔARAT 2.6 at week 5 (ARAT 28.0, CI 95% 19.3 – 36.7, p < 0.05), and ΔARAT 4.8 at week 24 (ARAT 30.2, CI 95% 21.2 – 39.1, p < 0.05). At week 5 follow-up, 91% of participants rated their overall experience as satisfied or very satisfied. Incremental CEA observed savings of -S$144/per cure over 24 weeks, BIA – potentially 12% impact reduction over five years.
Conclusions: This study demonstrates the feasibility, acceptability, safety, clinical efficacy and cost-effectiveness of a home-based, web-enabled telemonitored carer-supervised robotics-aided therapy.
Parenting style in the NICU is stable, measurable, and predictive of 2-year parenting style
Authors: Neel Mary Lauren , Kjeldsen Caitlin , Srini Rachelle , McGovern Kevin , He Zhulin , Maitre Nathalie
Published: August 2024

Objective: To establish psychometric properties of Baby Care Questionnaire (BCQ) in preterm infants, individual level stability of BCQ scores from NICU to 2 years corrected gestational age (CGA), and to determine whether early BCQ scores predict 2-year parenting styles.
Study design: In this prospective study, the BCQ assessed early parental structure and attunement at 4 time points between NICU and 2-years CGA. The Parenting Styles and Dimensions Questionnaire (PSDQ) at 2-years evaluated authoritative, authoritarian, and permissive parenting styles. Intraclass correlations analyzed reliability and Reliable Change Index (RCI) studied individual-level stability. Multivariate regression examined predictive properties.
Results: n=162 parent/preterm infant dyads were followed sequentially. Cronbach’s α BCQ structure and attunement were 0.9 and 0.8. RCI showed high individual level stability of both constructs. Higher early structure scores were associated higher 2-year authoritative scores.
Conclusions: Early parenting characteristics beginning in the NICU are stable in infancy, measurable, reliable, and predictive of 2-year parenting styles. Early parental structure correlates with 2-year authoritative parenting style.
Dynamicity of Ecosystem Service Value Driven by Land Use/Land Cover Alteration in Vadodara City, India
Authors: Pal Anindita , Tiwari Atul K , Dutta Shyamal , Rawal Ami , Kanchan Rolee
Published: August 2024

The ecosystem is considered the fundamental unit of ecology which plays a crucial role in providing a range of essential services to individuals. These services include the provision of food and shelter, as well as the regulation of climate and environment, either directly or indirectly. However, the emergence of urban industrial cities has witnessed the uncontrolled exploitation of resources, the decline of biodiversity, unprecedented population growth and climate change. Consequently, these factors have led to ecological crises as the ecosystem services experience a gradual increase in the built-up areas. Considering this, the current study examines the relationship between land use change and the status of ecosystem services in Vadodara City, India. The ecosystem service value was calculated using the methodology proposed by Costanza in 1997 and 2014, while the contribution of Land Use/Land Cover (LULC) was determined using the Maximum Likelihood Classification. The findings highlighted that LULCs are critical drivers for the loss of ecosystem services. During 2001–2021, it was found that built-up and water bodies increased by 24.48% and 0.21%, respectively, while vegetation, agricultural and barren land decreased by 1.11%, 25.61% and 0.19% respectively. The valuation of ecosystem services in 2001 observed $3,517,118 and $125,607,186 using the corresponding coefficients of Costanza, 1997 and 2014, while in 2021, their cumulative value slightly increased to $3,629,024 based on the 1997 coefficient and $131,537,398 based on the 2014 coefficient. Furthermore, the study analyses the response of ecosystem service values to land use alterations and the elasticity value at the zonal level to gain insight into spatial variation.
Chondroblastoma: A Sharing of Therapeutic Experiences
Authors: yang Di , Ouyang Haiping , zhou Ziyu , Wang Zhongliang
Published: August 2024

Background
Chondroblastoma (CBL) is a rare benign bone tumor with potentially local recurrence and metastases. At present, the local recurrence risk factors are controversial. The purpose of this study is to analysis local recurrence factors in our medical centre. Sharing Our Therapeutic Experience.
Methods
In a retrospective study, we identified 28 patients who were diagnosed pathologically and an analysis that included age at diagnosis, gender, side, tumor location, tumor volume, epiphyseal plate status, affected epiphyseal plate, aneurysmal bone cyst, surgical therapy was performed. Kaplan-Meier estimators were used to analyze the local recurrence-free survival (LRFS). Intraclass Correlation Coefficient (ICC) and Kappa coefficient were utilized for the analysis of inter-rater variability in medical evaluations.
Results
All relapsed patients were over the 11 years old. There was a statistically significant difference in tumor volume between patients with recurrence and those without recurrence, as determined by the unpaired t-test. Furthermore, the Kaplan-Meier curve revealed a statistically significant association between local recurrence-free survival and tumor volume, with a distinct separation observed between patients with tumor volumes greater than 25 cm³ and those with volumes less than 25 cm³.
Conclusion
Curettage, combined with alcohol as an adjuvant and bone grafting, has demonstrated promising outcomes. However, it is noteworthy that a larger tumor size correlates with an increased likelihood of recurrence.
A risk signature constructed by Tregs-related genes predict the clinical outcomes and immune therapeutic response in kidney cancer
Authors: Li Gang , Cui Jingmin , Li Tao , Li Wenhan , Chen Peilin
Published: August 2024

Regulatory T cells (Tregs) have been found to be related to immune therapeutic resistance in kidney cancer. However, the potential Tregs-related genes still need to be explored. Our study found that patients with high Tregs activity show poor prognosis. Through co-expression and differential expression analysis, we screened several Tregs-related genes (KTRGs) in kidney renal clear cell carcinoma. We further conducted the univariate Cox regression analysis and determined the prognosis-related KTRGs. Through the machine learning algorithm - Boruta, the potentially important KTRGs were screened further and submitted to construct a risk model. The risk model could predict the prognosis of RCC patients well, high risk patients show a poorer outcomes than low risk patients. Multivariate Cox regression analysis reveals that risk score is an independent prognostic factor. Then, the nomogram model based on KTRG risk score and other clinical variables was further established, which shows a high predicted accuracy and clinical benefit based on model validation methods. In addition, we found EMT, JAK/STAT3, and immune-related pathways highly enriched in high risk groups, while metabolism-related pathways show a low enrichment. Through analyzing two other external immune therapeutic datasets, we found that the risk score could predict the patient's immune therapeutic response. High-risk groups represent a worse therapeutic response than low-risk groups. In summary, we identified several Tregs-related genes and constructed a risk model to predict prognosis and immune therapeutic response. We hope these organized data can provide a theoretical basis for exploring potential Tregs' targets to synergize the immune therapy for RCC patients.
Investigating Factors Influencing Subjective Taste and Smell Alterations in Colorectal Cancer Patients
Authors: Wang Wenhui , Li Zhao , Zhang Xiaomeng , Li Yize , Kong Shengnan , Sun Juanhua , Zhang Hongmei
Published: August 2024

Purpose
This study aimed to assess the factors influencing self-reported taste and smell disturbances in patients with colorectal cancer.
Methods
A total of 152 participants were enrolled in the study. All subjects completed surveys that assessed taste and smell alterations using the Taste and Smell Survey (TSS), linear analog self-assessment (LASA), Patient-Generated Subjective Global Assessment (PG-SGA), and Pittsburgh Sleep Quality Index (PSQI). The TSS gathered data on the nature of taste and smell changes and their impact on quality of life. LASA was employed to evaluate the quality of life in cancer patients, while PG-SGA was used to indicate the nutritional status of the participants. PSQI was used to evaluate sleep quality.
Results
Among the 152 colorectal cancer patients, the total TSS score was 5.68 ± 2.84. No changes were observed in 5 cases (3.3%), mild changes in 58 cases (38.2%), and moderate to severe changes in 89 cases (58.6%). The severity of taste and smell disturbances increased with tumor stage, the cycle of chemotherapy, deteriorating sleep quality, and poor nutritional status, displaying significant correlations. Additionally, 83 patients (54.6%) complained of taste abnormalities, while 81 (53.3%) reported smell abnormalities.
Conclusion
Taste and smell disturbances are prominent in colorectal cancer patients. Taste abnormalities are significantly correlated with tumor stage, the cycle of chemotherapy, sleep quality, and nutritional status. Recognizing the high prevalence of taste and smell abnormalities and the influencing factors among patients with colorectal cancer may aid in predicting and understanding the severity of these symptoms more effectively.
Exploring the Molecular Mechanisms and Shared Genetic Characteristics of Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma
Authors: Fu Yuanjing , Gu Weiying , Lin Yan , Cao Yang , Luo Jiaru , Zheng Zhuojun , Liu Yan
Published: August 2024

Monoclonal gammopathy of undetermined significance (MGUS) serves as a precursor to multiple myeloma (MM), with a subset of MGUS cases advancing to MM each year. Despite extensive research, the mechanisms driving this progression are not yet fully understood. Leveraging transcriptomic data from the Gene Expression Omnibus (GEO) database, this study conducted an analysis of differentially expressed genes (DEGs) between MGUS and MM. Weighted gene co-expression network analysis (WGCNA) was utilized to pinpoint significant gene modules linked to disease progression. Univariate Cox analysis and LASSO regression were employed to identify genes associated with MM prognosis. Immune scores and immune cell proportions were calculated using ESTIMATE and CIBERSORT tools. A total of 961 DEGs related to MM and 355 DEGs associated with MGUS were identified. Cross-analysis revealed 12 intersecting genes, with four (DAP3, HIST1H1C, MRPL4, and UBE2S) as core genes. The MGUSscore effectively stratified MM patients into high-risk and low-risk groups, with the high-risk group showing significantly shorter overall survival (P < 0.05). Core genes were closely linked to immune cell infiltration. A ceRNA network identified 68 miRNAs and 10 lncRNAs related to core genes. DAP3, HIST1H1C, MRPL4, and UBE2S are potential therapeutic targets for MM.
Bio-printing method as a novel approach to obtain a fibrin scaffold settled by limbal epithelial cells for corneal regeneration
Authors: Pietryga Krzysztof , Jesse Katarzyna , Drzyzga Rafał , Konka Adam , Zembala-John Joanna , Kowalik Aleksandra , Kiełbowicz Zdzisław , Ćwirko Marek , Bułdak Rafał J. , Dobrowolski Dariusz , Wylęgała Edward
Published: August 2024

Treatment of Limbal Stem Cell Deficiency (LSCD), based on autologous transplantation of the patient's stem cells, is one of the few medical stem cell therapies approved by the European Medicines Agency (EMA). It relies on isolating and culturing in vivo Limbal Epithelial Stem Cells (LESC) and then populating them on the fibrin substrate, creating a scaffold for corneal epithelial regeneration. Such a solution is then implanted into the patient's eye. The epithelial cell culture process is specific, and its results strongly depend on the initial cell seeding density. Achieving control of the density and repeatability of the process is a desirable aim and can contribute to the success of the therapy. The study aimed to test 3D printing as a potential technique to increase the control over LESCs seeding on a scaffold and improve process reproducibility. Cells were applied to 0.5 mm thick, flat, transparent fibrin substrates using extrusion bioprinting; the control was the traditional manual application of cells using a pipette. The 3D printing enabled uniform coverage of the scaffold surface, and LESCs density in printed lines was close to the targeted value. Moreover, printed cells had higher cell viability than those seeded traditionally (91.1 ± 8.2% vs 82.6 ± 12.8%). The growth rate of the epithelium was higher in 3D-printed samples. In both methods, the epithelium had favorable phenotypic features (p63 + and CK14+). 3D printing constitutes a promising approach in LSCD therapy. It provides favorable conditions for LESCs growth and process reproducibility. Its application may lead to reduced cell requirements, thereby to using fewer cells on lower passages, which will contribute to preserving LESCs proliferative potential.
Effect of Instructional Guidelines on the Parent's Care of Neonates with Neural Tube Defects
Authors: Khamis Asmaa
Published: August 2024

Background Neural Tube Defects account for the most congenital anomalies of the central nervous system for paediatric patients. The presence or diagnosis of any congenital anomalies, especially neural tube defects can have a significant impact on parents holistically. This study aimed to evaluate the effect of instructional guidelines on parents’ care for neonates with neural tube defects.
Methods: A quasi-experimental design was used to conduct this study. This study was conducted in the neonatal intensive care unit and the Neurological Department at the Children's Hospital affiliated to Ain Shams University Hospital and Helwan General Hospital. A convenience sample consisting of 40 parents and their neonates who suffered from neural tube defects was used.
Results: There was a marked improvement in parents’ knowledge and reported practices as well as the stress level after implementation of the instructional guidelines. There were strong positive correlations between studied parents’ total knowledge and their total reported practices related to their care for their children with neural tube defects. There was a statistically significant relationship between the gender of the studied parents and their knowledge, practices and PSI regarding the care of neonates with Neural Tube defects post-implementation of instructional guidelines (P = 0.000, P ≤ 0.001).
Conclusion: The implementation of the instructional guidelines has a positive effect on parents’ care for neonates with neural tube defects, so the research findings support the research hypothesis.
Characterization and Application of the Fluorescent APTA-nano Biosensors Based on CdTe-TGA QDs for Determination of 25-hydroxyvitamin D3
Authors: Bardajee Ghasem Rezanejade , Tahriri Farhad , Vancaeyzeele Cedric
Published: August 2024

Medical studies have shown that vitamin D deficiency is strongly associated with several metabolic disorders, including diabetes, cardiovascular diseases, and cancer. So, it is crucial to regularly check its concentration in the blood serum. Traditional methods for detecting 25-hydroxyvitamin D3 [25(OH)D3] as a marker of vitamin D status are expensive, time-consuming, and require a skilled workforce and specialized laboratory. This study developed a simple and cost-effective fluorescence system for 25-hydroxyvitamin D3 determination. The fluorescent APTA-nano biosensors were fabricated using cadmium telluride quantum dots modified with thioglycolic acid (CdTe-TGA QDs) and functionalized with thiol-25(OH)D3-aptamer through ligand exchange. The thiol-25(OH)D3-aptamer interacted directly with CdTe-TGA QDs, increasing fluorescence intensity. However, it decreased when the target molecules of 25-hydroxyvitamin D3 were introduced. The structural and morphological characteristics of APTA-nano biosensors were confirmed by various analytical methods such as UV-visible spectroscopy, Fourier-transform infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FESEM), energy dispersive x-ray spectroscopy (EDX), transmission electron microscopy (TEM), and dynamic light scattering (DLS). According to the typical Stern-Volmer equation, the relationship between fluorescent quenching and target concentration was linear with a detection limit of 1.35 × 10-8 M, a quantification limit of 4.50 × 10-8 M, and a relative standard deviation of 1.75%. The optimized APTA-nano biosensor demonstrated high specificity towards the target and stability over 28 days. Furthermore, it detected 25-hydroxyvitamin D3 in human serum with a recovery rate of up to 99.77%. The results indicate that the fluorescent APTA-nano biosensors could be valuable in developing robust sensing technology for low-concentrated analytes.
Methionyl-tRNA synthetase 1 expression, the possibility as a diagnostic and prognostic factor in papillary thyroid cancer
Authors: Park Seulkee , Lee Jun Sung , Jeong Ho Jung , Yun Hyeok Jun , Kim Seok-Mo , Nahm Ji Hae , Chang Hojin , Lee Yong Sang , Chang Hang-Seok
Published: August 2024

Background
Methionyl-tRNA synthetase 1 (MARS1) is a critical enzyme in translation initiation, responsible for catalyzing the transfer of Met to the initiator tRNA. In this study, we aimed to examine whether MARS1 expression is different between normal follicular cells and papillary thyroid carcinoma (PTC) cells in thyroid tissue and whether it can supplement the limitations of general cell staining methods currently performed for diagnosis of PTC.
Methods
Initially, 103 patients were included to compare MARS1 expression in PTC and normal follicular cells. Next, 100 patients were selected to compare MARS1 expression using immunohistochemical analysis in patients with (n = 50) and without (n = 50) lateral neck metastasis.
Results
The average MARS1 expression grade of PTC cells was 2.59 and that of normal follicular cells was 1.28. MARS1 expression in the two groups showed significant differences (p < 0.001). There was a significant difference in the average MARS1 expression grade of PTC cells between the metastasis and non-metastasis groups (p < 0.05). Additionally, a significant difference was observed in the average MARS1 expression grade between the lymph node of the metastasis group and PTC cells of the non-metastasis group (p < 0.05).
Conclusions
Our analyses suggest that MARS1 could be used as a complementary method to the current fine needle aspiration biopsy tissue staining method. Additionally, MARS1 could be a predictor of the prognosis of PTC.
The efficacy of mifepristone-misoprostol regimen versus misoprostol only for medication abortion at 22+0/7 – 30+0/7 weeks gestational duration
Authors: Touval Or , Ellert Avital , Daykan Yair , Schonman Ron , Klein Zvi , Yagur Yael
Published: August 2024

Objective
To compare duration of medication abortion after pretreatment with mifepristone versus misoprostol-only regimens at 22 + 0/7 to 30 + 0/7 weeks gestational duration.
Methods
This retrospective cohort study included patients admitted for medication abortion from 2014 to 2022. Included patients underwent feticide due to genetic or anatomical abnormalities at gestational duration of 22 + 0/7 to 30 + 0/7 weeks. Excluded from the study were patients admitted at gestational duration of < 22 + 0/7 or > 30 + 0/7 weeks, multiple gestation, diagnosis of intrauterine fetal demise before feticide, with contraindication for vaginal delivery and who were administered a medical regimen other than the mifepristone-misoprostol or misoprostol-only protocol. Information collected included patients’ demographics, clinical outcome, additional procedural interventions, and complications. Data of patients treated with mifepristone-misoprostol versus misoprostol-only were compared.
Results
The study group included 46 patients in the mifepristone-misoprostol group and 35 in the misoprostol-only group. Median interval from first dose of misoprostol to fetal expulsion was shorter in the mifepristone-misoprostol group (10.6 vs. 15.3 h; p = 0.007) with shorter duration of hospitalization (3.5 ± 1.1 vs. 4.1 ± 1.2 days; p = 0.013). Study groups were no different in terms of complications. Patients in the mifepristone group had an earlier gestational duration (23.8 ± 1.69 vs. 25.37 ± 2.4 weeks; p = 0.002). However, multivariable Cox regression found that mifepristone-misoprostol was independently associated with shorter induction (OR 1.7, 95% CI 1.03–2.9, p = 0.03,).
Conclusion
medication abortion with mifepristone-misoprostol was associated with shorter time to fetal expulsion at 22 + 0/7 to 30 + 0/7 weeks gestational duration, compared with misoprostol-only regimen.
Impact of HPV Status on Oropharyngeal Cancer Detection via Gastrointestinal Endoscopy: A retrospective study
Authors: Tayama Sayoko , Miyamoto Hideaki , Waki Kotaro , Honda Munenori , Matsuno Kenshi , Yamasaki Akira , Gushima Ryosuke , Nagaoka Katsuya , Naoe Hideaki , Imuta Masanori , Kawakami Fumi , Komohara Yoshihiro , Miyamaru Satoru , Murakami Daizo , Orita Yorihisa , Tanaka Yasuhito
Published: August 2024

Gastrointestinal endoscopy (GIE) performed by gastroenterologists is an important modality for early pharyngeal cancer detection. Human papillomavirus (HPV) is one of the causes of oropharyngeal squamous cell carcinoma (OPSCC). However, the prevalence of HPV-related OPSCC detected by GIE is currently unknown. We retrospectively analyzed 207 OPSCC from 2018 to 2022, where HPV infection was diagnosed by p16 immunohistochemistry. We compared detection modalities and evaluated the proportion of lesions detected by GIE in both p16-positive and p16-negative cases. Out of the 207 patients, 92 (44.4%) were p16-positive. p16-positive cases had significantly lower rates of alcohol use, smoking, and history of esophageal or head/neck squamous cell carcinoma (all p < 0.001). Only 4.3% of p16-positive cases were detected by GIE, compared to 44.3% of p16-negative cases (p < 0.001). p16-positive patients were often diagnosed at advanced stages and underwent transoral resection less frequently (2.2% vs. 31.3%, p < 0.001). In cT1 cases, GIE or laryngoscopy revealed that p16-positive lesions were typically protruding and white to normal-colored, while p16-negative lesions were predominantly flat and erythematous.
In conclusion, HPV-related OPSCC cases are rarely detected by GIE, and few cases are treated with minimally invasive transoral resection, indicating a need for improvement in early detection.
Clinical Outcomes of Plate-Haptic Diffractive Multifocal Toric IOL in Cataract Eyes with Long Axial Length and Corneal Astigmatism
Authors: XU Zhe , WANG Jingwen , SHI Ce , NI Shuang , XU Jingwei , ZHU Sha , FANG Jianxia , XU Wen
Published: August 2024

The prospective study is aimed to determine the clinical outcomes of plate-haptic diffractive multifocal toric intraocular lens (IOL) implantation in cataract patients with long axial length and corneal astigmatism. Visual outcomes, defocus curves, contrast sensitivity, rotational stability, vector changes of refractive astigmatism and patient satisfaction were assessed over 3 months. Vector analysis was performed by the Alpins method. A total of 36 eyes (18 patients) underwent cataract surgery with implantation of AT LISA toric 909M multifocal toric IOL. Postoperatively, mean refractive sphere and cylinder were reduced to 0.13 ± 0.23 and − 0.29 ± 0.32 diopter (D), respectively. Mean uncorrected distance and near visual acuities (logMAR) were 0.40 ± 0.10 and 0.19 ± 0.16, respectively. At 3 months, 91.7% of patients showed IOL rotation of less than 5 degrees. The difference vector was 0.34 ± 0.26 D, for a correction index of 0.93 ± 0.40 at 3 months. In summary, plate-haptic diffractive multifocal toric IOL improves distance and near visual functions and reduces refractive astigmatism in cataract patients with long axial length and corneal astigmatism.
Near Infrared Fluorescent Manipulator During Minimally Invasive Sacrocolpopexy: A Pilot Study
Authors: Hernandez-Aranda Diego , Eigg Marc , Panza Joseph , Hernandez Diego
Published: August 2024

Objective: The objective of this paper is to evaluate fluorescent guided surgery using a near infrared (NIR) fluorescent vaginal/rectal manipulator during minimally invasive sacrocolpopexy.
Methods: This was a pilot study of fluorescent pelvic manipulators in women undergoing previously scheduled reconstructive pelvic surgery. Subjects were eligible if a traditional 30mm end-to-end anastomosis (EEA) sizer was planned for use during the participant’s surgery. The prototype devices under study were developed with a patent protected polymer that fluoresces under NIR imaging. Measurement outcomes include subjective feedback from the surgical team, the frequency in which the surgeon reverted back to a traditional steel manipulator, adverse intraoperative complications and video documentation of findings.
Results: Twenty subjects were enrolled. The fluorescent manipulator could be visualized through vaginal/rectal tissue in all surgeries and no intraoperative complications were noted. The surgeons continued with the fluorescent manipulator, over the traditional manipulator, in 100% of the cases. Subjectively, the operating staff noted improved communication, increased confidence in the surgical learner and enhanced visualization of the anatomy. On review of the videos, fluorescent NIR transillumination of the tissue highlighted anatomic distortion in 60% of the available videos.
Conclusion: Fluorescent vaginal/rectal manipulators transilluminated the tissue allowing for real time visual information and better surgical decision making; in addition, it increased communication between surgical teacher and learner as anatomic borders and surgical planes were highlighted with fluorescence. With improved visualization, there is a potential to decrease unintentional perforations, reduce operating room time and improve communication with surgical learners and surgical team members.
Vaginal Spheres Versus Pelvic Floor Muscle Training in the Treatment of Urinary Incontinence and Sexual Dysfunction: A Randomized, Single-Blind, Controlled Trial
Authors: BLANCO-RATTO Laia , RAMIREZ-GARCIA Inés , KAUFFMANN Stephanie , ORTIZ Cristina NARANJO , FARRES Montserrat GIRABENT
Published: August 2024

Background
Female sexual dysfunction is closely linked to pelvic floor muscle dysfunction, especially in the context of urinary incontinence. While pelvic floor muscle training can be performed through exercises alone or with intravaginal medical spheres, the benefits of incorporating these devices into therapy remain unclear. This study aimed to compare the efficacy of pelvic floor exercises combined with vaginal spheres versus exercises alone in improving stress and stress-predominant mixed urinary incontinence and sexual function.
Methods
This randomized, single-blind trial was conducted at the RAPBarcelona Center and included 71 adult women with stress or stress-predominant mixed urinary incontinence and sexual dysfunction. Participants were randomly assigned to either pelvic floor muscle exercises alone (control group) or exercises combined with vaginal Enna Balls (intervention group), and the intervention period lasted four months, with assessments at baseline and follow-ups at 8 and 16 weeks. The primary outcome measure was the impact on incontinence, which was assessed using the ICIQ-UI-SF questionnaire. Secondary outcomes included sexual function, measured by the Female Sexual Function Index, and monitoring of adverse events and treatment adherence at weeks 4, 8, 12, and 16.
Results
The mean age of participants was 46.85 ± 1.58 years. Post-treatment, the ICIQ-UI-SF score significantly decreased from 9.01 ± 0.52 to 3.92 ± 0.59 (p < 0.05). No significant changes were observed in the overall Female Sexual Function Index score (p > 0.05), except for an increase in desire, which showed statistical differences between groups at the end of treatment (p = 0.041). Tolerance and adherence to the interventions did not significantly differ between groups.
Conclusions
Home-based pelvic floor muscle training, both with and without vaginal spheres, is effective and safe for women with stress urinary incontinence or stress-predominant mixed urinary incontinence and sexual dysfunction. Vaginal spheres are particularly recommended for their safety, popularity, and ability to enhance female desire. However, they do not significantly improve overall female sexual function in the short term. Further research is needed to explore their long-term benefits and broader impacts on sexual health.
Trial Registration:
The study was registered on clinicaltrials.gov with the identifier NCT05732844 on January 29, 2023. More details can be found at (https://www.clinicaltrials.gov/study/NCT05732844?term=NCT05732844&rank=1&tab=history&a=1#version-content-panel)
Novel biallelic GNE variants identified in a patient with chronic thrombocytopenia without any symptoms of myopathy
Authors: Tsuda Shota , Sakamoto Atsushi , Kawaguchi Hiroyuki , Uchiyama Toru , Kaname Tadashi , Yanagi Kumiko , Kunishima Shinji , Ishiguro Akira
Published: August 2024

[Background] GNE encodes a rate-limiting enzyme that regulates the biosynthesis of a sialic acid precursor. As sialic acids are critical for the platelet membrane and muscle fibers, GNE variants cause GNE-related thrombocytopenia and GNE-related myopathy. Here, we report a neonate with thrombocytopenia that initially met the criteria for neonatal allo-immune thrombocytopenia (NAIT) but was resistant to treatments and then revealed novel biallelic heterozygous GNE variants without any symptoms of myopathy when diagnosed.
[Case] NAIT was initially diagnosed due to alloantibodies against HPA5 and its mismatch between the patient and his mother. However, intravenous immunoglobulin therapy and platelet transfusions showed minimal improvement in the platelet count. Platelet counts remained around 60 × 109/L, suggesting congenital thrombocytopenia. Gene panel sequencing at the age of 13 identified biallelic pathogenic variants of GNE. The patient did not exhibit any symptoms of muscular weakness suggesting GNE-related myopathy.
[Discussion] We demonstrated a GNE-related thrombocytopenia patient with novel biallelic heterozygous GNE variants. Clinical trials have involved the use of sialic acids or their precursors, as well as gene therapy, to treat GNE-related myopathy, which may slow or halt the progression of the disease. Therefore, early diagnosis of this disease may significantly impact its clinical course.
Exploring a three-dimensional analysis method to occlusion plane determination: A retrospective study
Authors: Xiong Jiabi , Yao Xiu , Xu Xiaoming , Dong Zhengjie
Published: August 2024

Background
The available literature lacks comprehensive guidance on constructing the occlusal plane within the broader facial and skeletal context. This study aims to accurately determine the occlusal plane (OP) within the normal population through three-dimensional data analysis using cone-beam computed tomography (CBCT) and specific feature points alignment.
Material and methods
One hundred patients underwent both clinical evaluation and CBCT imaging examination. A digital model was constructed based on the imaging data, delineating a virtual occlusal plane (V-OP), a virtual Frankfort plane (V-FP), and a virtual plane formed by two camper lines (V-CL) using specific feature points. Two angles, formed by V-OP and V-FP, as well as V-OP and V-CL, were computed using the angle measurement function in Geomagic Control X. The angular relationship between V-OP and the angular bisector plane (ABP) of V-FP and V-CL was determined through calculations using the aforementioned data. Ordinary two-way ANOVA with post hoc Sidak’s multiple comparisons was performed (p < 0.05).
Results
The mean ± standard deviation of the angle between V-FP and V-OP is 8.94° ± 4.22°, and it is 4.82° ± 3.07° between V-CL and V-OP. In comparison, the mean ± standard deviation of the angle between ABP and the occlusal plane was 3.12° ± 1.78°, lower than that of the former two groups.
Conclusions
The ABP and OP are nearly parallel, suggesting stability across different patients, making it a reliable reference for digital dental alignment.
Trial registration
This study was registered in the Chinese Clinical Trial Registry as “Exploring the Method of Determining the Occlusion Plane in 3D Data Analysis: A Retrospective Study” (No. ChiCTR2300077289) on November 3rd, 2023 (https://www.chictr.org.cn/searchproj.html?regno=ChiCTR2300077289).
Physician Burnout and Patient Care Practices in Sierra Leone
Authors: Naveed Asad , Jalloh Mohamed B. , Johnson Sylnata A.A. , Bah Abdul K. , Barrie Fatmata B. , Jegede Adesola G. , Sengeh Joseph V. , Sillah Arthur
Published: August 2024

Background
Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can negatively impact patient care. While burnout is well-studied in developed nations, research in resource-constrained settings like Sierra Leone remains limited. This study aimed to quantify burnout prevalence among Sierra Leone's public sector physicians and its impact on self-reported patient care practices.
Methods
The study involved a random sample of physicians from major government hospitals across Sierra Leone's administrative regions. Burnout was assessed using the Maslach Burnout Inventory (MBI), and self-reported patient care practices were evaluated using an adapted version of Shanafelt et al.'s 2002 questionnaire. Statistical analyses included chi-square tests, Fisher exact tests, and logistic regression to explore associations between burnout, demographic variables, and patient care practices.
Results
A total of 140 physicians (31% female, 69% male, p = 0.8), 51.4% met burnout criteria. Burnout was similar across genders (p = 0.8) and age groups (p = 0.5). Most respondents were aged 26–35. Marital status did not differ significantly (p = 0.8), with 54% single overall. Regional distribution showed no significant difference (p = 0.5), with 78% from Western Urban. Duration of practice was also similar (p = 0.5), with 35% house officers, 39% medical officers, and 26% senior medical officers. Physicians experiencing burnout were more likely to report high emotional exhaustion (62%), high depersonalization (44%), and low personal accomplishment (46%). Burnout was also associated with suboptimal patient care practices, including avoiding diagnostic tests due to cost concerns, expediting patient discharge, and prescribing medication without proper evaluation.
Conclusion
This study revealed a high prevalence of physician burnout in Sierra Leone, which significantly impacts patient care and physician well-being. A multipronged, collaborative approach is necessary to address burnout, involving individual, organizational, and systemic interventions. Further longitudinal research is needed to develop contextually relevant strategies to support healthcare workers in resource-constrained settings.
Prevalence and Outcome of Community-Acquired Clostridium Difficile Infection Among Children Admitted with Diarrhoea at Mulago Hospital
Authors: Khainza Rebecca Esther , Mugalu Jamiir , Bwanga Freddie , Oburu Geoffrey Ofumbi , Ndeezi Grace
Published: August 2024

Background: Clostridium difficile infection (CDI) is a potentially serious emerging infectious disease. CDI is usually considered to be hospital-acquired, causing diarrhoea in as high as 15% of children in healthcare settings during non-outbreak and 64% during outbreak periods in the US. However, recent studies show that the infection is increasingly being acquired from the community even without prior antibiotic use. Globally, few studies have been done to show the contribution of C. difficile in community-onset diarrhoea, and in sub–Saharan Africa, we have not come across any published data on C. difficile in community-onset childhood diarrhoea.
Study objective: This study was to determine the prevalence of CDI and to describe the outcome and factors associated with this infection among children aged 2-36 months with diarrhoea at Mulago National Referral Hospital (MNRH).
Methods: This was a descriptive cross-sectional/prospective cohort study among children aged 2-36 months admitted with diarrhoea at MNRH. The stool was examined for clostridium difficile toxin A and B using an enzyme-linked immune fluorescent assay.
Findings: Out of the 322 children admitted with diarrhoea during the study period, 168 were enrolled. Of the 168 children, there were 107(63.7%) males. The male-to-female ratio was 1.8:1. Their median age was 9.0 months with an Interquartile range of 7-14.
The prevalence of CDI in this study was 4/168(2.4%).
Three of the children with CDI were male. All the four children with CDI were below 12 months of age. On admission, the mean frequency of diarrhoea was 8.8 (SD 5.6) in children with CDI compared to 6.4 (SD 3.8) in children without. Children with CDI were hospitalised for a longer duration; 7.5 (SD6.5) vs. 4.5 (SD4.5) days in children without. The known risk factors such as HIV, antibiotic use, malnutrition, and age were not significantly associated with CDI.
Conclusion:The prevalence of CDI in children with community-acquired diarrhoea at MNRH is low, so routine testing is not necessary. The outcomes of children with CDI did not differ from those without, and the study lacked statistical power to make recommendations on factors associated with CDI.
Crocin Induces Apoptosis in Primary Cancer Epithelial Cells Isolated from Human Breast Tumors via Different Mechanisms in HER2- Negative or Positive Cells: A Preliminary Study
Authors: Bathaie S. Zahra , Faridi Nassim , Hydrazideh Hamid , Hashemi S. Ali , Abroun Saeid , Tamanoi Fuyuhiko , Mohagheghi Mohammad-Ali
Published: August 2024

Purpose
The anticancer effect of Crocin, a natural C20 carotenoid, has been previously demonstrated in different cancer cell lines and animal cancer models. Herein, we investigated its effect on primary breast cancer cells isolated from women’s breast tumor samples.
Methods
We previously isolated and characterized epithelial breast cancer and normal cells from female patients. In this study, we treated five cancer cells and five normal cells from the same sample with Crocin. Then, the type and mechanisms of Crocin-induced cell death were studied using different techniques.
Results
All of these tumors were estrogen and progesterone receptor-positive. Two samples were in grade II and HER2-negative, while three others were grade III and HER2-positive. The IC50 of Crocin were obtained using MTT assay for all cells. It induced procaspase-9 expression and cleavage, sub-G1 accumulation, XBP1 mRNA splicing and expression of the spliced XBP1, LC3-II accumulation, and accumulation of unprenylated Rap1α in all cancer cells. The p27 mRNA expression was only induced in cells isolated from HER2-negative samples. However, an increase in the p27 protein level was observed in all cells. Crocin also down-regulated the CXCR-4 and suppressed EpCAM in these cancer cells. The unfarnesylated Lamin B was observed only in one sample.
Conclusion
Crocin suppressed the proliferation of human primary epithelial breast cancer cells, enhanced stress responses, and decreased metastatic markers. There was a difference between p27 expression in HER2-negative and positive tumors.
Alterations in fecal bacteriome virome interplay and microbiota-derived dysfunction in patients with schizophrenia
Authors: Wang Qiang , Tao Shiwan , Wu Yulu , Xiao Liling , Huang Yunqi , Wang Han , Tang Yiguo , Liu Siyi , Liu Yunjia , Ma Qianshu , Yin Yubing , Dai Minhan , Xie Min , Cai Jia , Zhao Zhengyang , Lv Qiuyue , Zhang jiashuo , Zhang Mengting , Wei Menghan , Chen Yang , Li Mingli
Published: August 2024

Rising studies have consistently reported gut bacteriome alterations in schizophrenia (SCZ). However, little is known about the role of the gut virome on shaping the gut bacteriome in SCZ. Here in, we sequenced the fecal virome, bacteriome, and host peripheral metabolome in 49 SCZ patients and 49 health controls (HCs). We compared gut bacterial community composition and specific abundant bacteria in SCZ patients and HCs. Specific gut viruses and host peripheral metabolites co-occurring with differential bacteria were identified using Multiple co-inertia analysis (MCIA). Additionally, we construct a latent serial mediation model (SMM) to investigate the effect of the gut virome on SCZ through the bacteriome and host metabolic profile. SCZ patients exhibited decreased gut bacterial β-diversity compared to HCs, with eight differentially abundant bacteria, including coprobacillaceae, enterococcaceae etc. Gut viruses including Suoliviridae, Rountreeviridae, Intestiviridae etc. co-occur with these SCZ-related bacteria. We found that the viral-bacterial transkingdom correlations observed in HCs were dramatically lost in SCZ. The altered correlations profile observed in SCZ may impact microbiota-derived peripheral metabolites enriched in the bile acids pathway, eicosanoids pathway, and others, contributing to host immunity dysfunction and inflammation. The SMM model suggested potential causal chains between gut viruses and SCZ, indicating that the gut virome's effect on SCZ is significantly mediated by the bacteriome and metabolites. In conclusion, these findings provide a comprehensive prospective on the role of gut microbiota in the pathogenesis of SCZ. They reveal that SCZ patients harbor an abnormal bacteriome-virome ecology, shedding light on the potential development of microbial therapeutics.
GNSS-Acoustic positioning error in the vertical component considering the uncertainty of a reference sound speed profile
Authors: Tomita Fumiaki , Kido Motoyuki , Iinuma Takeshi , Ohta Yusaku
Published: August 2024

method
~2 and ~ 6 cm in the former and latter cases, respectively. Moreover, we optimized the vertical GNSS-A positioning errors by considering the uncertainty of a reference SSP and other error sources, and the optimization of the vertical GNSS-A positioning errors was more reasonable than the conventional error evaluation. Although this study focused on the uncertainty of a reference SSP, it is important to carefully evaluate various other systematic error sources to precisely detect vertical seafloor motion.