bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical recognition of a potentially full stomach and use of point-of-care gastric ultrasound (POCUS) by anesthesiologists: a Belgian survey
Authors: Maseri Adrien , Delhez Quentin , Dincq Anne-Sophie , Lacrosse Dominique
Published: January 2024

Background:
Pulmonary aspiration syndrome remains a noteworthy complication of general anesthesia, particularly in unfasted patients. Ensuring a high degree of certainty regarding gastric emptiness is strongly associated with a reduction in the likelihood of pulmonary aspiration. Gastric point-of-care ultrasound (POCUS) allows both qualitative and quantitative assessment of gastric contents.
Methods:
The survey, created and approved by two certified anesthesiologists trained to perform gastric POCUS, was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants were provided with a simulated clinical case of a patient at risk for gastric aspiration according to his medical history. The objective of this study was to assess the identification of clinical high-risk situations for gastric aspiration, the importance of the gastric POCUS criteria, the importance of understanding the technical and practical features of the procedure, and the potential impact of the procedure on the induction plan for general anesthesia. The survey utilized conditional branching to ensure unbiased responses to POCUS-related questions. The questionnaire included multiple-choice questions, quantitative variables, and 5-point Likert scales. Daniel's formula, corrected for a finite population, was used to calculate the margin of error.
Results:
The survey was completed by 323 anesthesiologists. Among them, only 20.8% (27) identified the risk of a full stomach based on the patient's history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Additionally, 80.17% (190) of the participants had access to adequate ultrasound equipment, and 78.90% (187) endorsed teaching gastric POCUS to anesthesiology trainees.
Conclusions:
This survey provides insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results highlight the importance of appropriate equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on enhancing training and encouraging the integration of gastric POCUS into daily clinical practice.
Multiple Rockfall Impacts on a Sand CushionComposed of Non-Spherical ParticlesUsing Three-Dimensional DEM
Authors: Zhou Yangli , Fu Haiying , Zhou Mingzhe , Zhao Yanyan , Wang Zhihao
Published: January 2024

Rockfall disasters are one of the primary geological hazards on Earth, and a rock shed with a sand cushion plays a crucial role in rockfall protection. Previous studies have mainly focused on the dynamic response of rockfall on the sand cushion for a single impact. However, in actual rockfall disasters, it is common for the sand cushions of rock sheds to suffer multiple rockfall impacts. This study utilized a three-dimensional discrete element method to investigate the dynamic response of rockfall on the sand cushion for multiple impacts from different heights. For the first time, non-spherical particles were used to simulate the sand particles composing the sand cushion, and comparative analysis confirmed that non-spherical particles better replicate the characteristics of the sand cushion compared to spherical particles. Subsequently, in-depth investigations were conducted on two scenarios: multiple rockfall impacts at the same position and multiple rockfall impacts at different positions, and specifically analyzed the impact force and penetration depth. The results indicated that when the rockfall impacts multiple times at the same position, both the maximum impact force and the maximum penetration depth increase with the number of impacts. When the rockfall impacts multiple times simultaneously at different positions, they have no mutual influence when the distance between the two rockfall impacts is greater than 6R. This study demonstrates the significance of studying multiple rockfall impacts, providing valuable insights for the rational design of rock sheds for rockfall protection and performance evaluations in the face of multiple rockfall disasters.
Assessing the Effect of Integrated Health Interventions on Maternal and Neonatal Health Outcomes in an aspirational district of Uttar Pradesh: A mixed method study
Authors: Yadav Surbhi , Ahmad Shamshad , Lohani Pallavi , Kumar Mahendra , Gahlot Anju
Published: January 2024

Introduction: India has made significant progress in maternal and neonatal health, yet challenges persist. This study examines Shrawasti, a Uttar Pradesh district, to understand strategies for enhancing maternal and neonatal health. It particularly focuses on birth asphyxia and postpartum haemorrhage due to oxytocin misuse.
Objective: To compare pre- and post-intervention maternal and newborn complications in Shrawasti and identify factors decreasing postpartum haemorrhage, newborn deaths, stillbirths, and birth asphyxia. The study aims to elucidate effective interventions for improving maternal and neonatal health.
Methodology: A retrospective observational study collected data from labour rooms and the Special Newborn Care Unit in Shrawasti. In-depth interviews with healthcare workers provided qualitative insights. Interventions were implemented based on initial findings and evaluated through systematic data organization and assessment. Results: Post-intervention, there was a significant reduction in stillbirths, asphyxia, and postpartum haemorrhage. Asphyxia decreased from 74.5% to 33.2%, stillbirths from 28.5% to 12.5%, and postpartum haemorrhage from 53.8% to 26%. Qualitative analysis highlighted improved healthcare practices, training effectiveness, staff behaviour shifts, and enhanced patient awareness. Documentation and monitoring practices also improved significantly.
Conclusion: Interventions significantly transformed maternal and neonatal healthcare in Shrawasti. Enhanced awareness, revised practices in oxytocin administration, effective training, and improved documentation were pivotal in reducing adverse outcomes. Addressing challenges through targeted interventions is crucial for better healthcare outcomes.
Ask and You Shall Receive: Taxonomy of AI Prompts for Medical Education
Authors: Olla Phillip , Elliot Lauren , Abumeeiz Mustapha , Pardalis Elaina
Published: January 2024

This manuscript meticulously explores the approach for interacting with Artificial Intelligence (AI) Large Language Models (LLMs) to elicit optimal outputs. The generation of high-caliber prompts serves as a pivotal element in achieving the sought-after outcomes from these computational models. The discourse herein delineates various categories of prompts, substantiated with exemplars within each domain of application under investigation. This manuscript highlights the categories of prompts related to the particular utility of each application domain, especially accentuating their relevance to educational stakeholders such as students and educators in medical education. The Application of Learning Domains (ALDs) proposed within this article, endeavor to demarcate areas that may find the most utility from AI LLMs, facilitating knowledge dissemination, practice and training, simulated personas, and augmented interactivity across a spectrum of users in the educational milieu and beyond.
Anti-inflammatory Effects of Nanoparticles Containing Alpha-Humulene in a Model of Alzheimer's Disease
Authors: Wendler Sabrina Aparecida , Nunes Jéssica Roberta , Dranski Lais Fernanda , Mainardes Rubiana Mara , Machado Christiane Schineider , Bini Ana Carolina Dorigoni , Schiewe João Alfredo , Miranda Livia Hoyer Garcia , Kerppers Ivo Ilvan
Published: January 2024

Alzheimer's disease (AD) is a neurodegenerative disorder that causes impairment in activities of daily living. Although there is no consensus on the pathophysiology, it is known that neuroinflammation is associated with the condition.
Objective:To evaluate the anti-inflammatory effects of nanoparticles containing alpha-humulene (HUM) in an experimental model of AD.
Methodology: 33 animals were part of the sample, 3 of which were in the negative control group. The other 30 received the amyloid-beta peptide in the CA1 hippocampal region for the neuroinflammation process. They rested for 30 days for the inflammatory process to occur. The HUM group was treated with α-humulene particles, the NHUM with α-humulene nanoparticles for 15 days, and the CP group wasn’t treated.
Results:There was a significant difference in IFNconcentration between CP and CN (p=0.0001), HUM and CN (p=0.0003), CP and NHUM (p=0.0006), and HUM and NHUM (p=0.0495) groups. TNF showed no difference between groups. IL-6 showed difference between CP and NHUM (p=0.0078) and CP and CN (p=0.0009). IL-12 showed difference between the CP and CN (p=0.0001) and NHUM and CN (p=0.0160). Among all, the highest concentration was in the CP group. Concerning IL-10, there was a difference between the CP and NHUM (p=0.0003) and NHUM and CN (p=0.0005), with NHUM having the highest concentration. Immunohistochemistry analysis showed in Anti-Tau and Anti-GAPF a strong positive in the CP, a positive in the HUM, and a weak positive in the NHUM group.
Conclusion: The Alzheimer's model used and the treatments with HUM and NHUM were effective.
The color systematics of volcanic ash fall samples in estimating eruption sequences: A case study of the 2017–2018 eruption at Shinmoe-dake, Kirishima volcano, Southwest Japan.
Authors: Shimano Taketo , Suzuki Yuki , Yasuda Atsushi , Maeno Fukashi , Miwa Takahiro , Nagai Masashi , Nakada Setsuya , Nakamura Michihiko
Published: January 2024

The color of pyroclasts is fundamental because it is affected by the processes and properties of the magma that derive the diversity in eruption style, as well as particle morphology, chemistry, and petrological characteristics. Currently, it is fundamental to derive the componentry of pyroclasts or the ratio of each component (CR) to monitor ongoing eruptions. However, the color description of pyroclasts and the derivation of the componentry have not yet been fully established to a robust quantitative standard. The derivation of the CR, as well as other petrological analyses, is too laborious and time-consuming to introduce as a sustainable monitoring method. In this study, we introduce spectroscopic colorimetry to rapidly and quantitatively describe the color of eruptive products as a proxy for petrological analyses and to derive the CR based on an objective clear standard for ash particle classification. We performed color spectroscopy of bulk and sieved ash samples and analyzed the componentry of the major size fraction for time series samples in the waxing stage of the 2017–2018 Shinmoe-dake eruption, Kirishima volcano, Southwest Japan. We found that the color of the bulk ash changed systematically with the evolution of componentry. This temporal color change was due to an increase in the amount of vesicular particles with clear glass against dark angular lava particles, as well as a grain size change, which we interpret as an indication of transition from phreatic/phreatomagmatic to magmatic eruption. Subsequently, the color of the ash changed when the amount of compositionally different lava particles increased gradually, coinciding with a shift toward a more dominant effusion of lava. As the lava effusion continued, a slight reddening of the ash, indiscernible to the naked eye, was clearly detected by the spectrometer before the onset of intermittent Vulcanian eruptions. We interpreted this to be due to oxidation caused by a decrease in ascent speed and formation of a stagnant caprock at a shallow depth of the conduit, which accumulated overpressure for the Vulcanian explosion. The rapid and objective derivation of the color values and componentry may help sustainable quasi-real-time monitoring of the eruptive materials of ongoing eruptions.
Resting-state Functional Connectivity in Anxiety Disorders:
A Multicenter fMRI Study
Authors: Langhammer Till , Hilbert Kevin , Adolph Dirk , Arolt Volker , Bischoff Sophie , Böhnlein Joscha , Cwik Jan , Dannlowski Udo , Deckert Jürgen , Domschke Katharina , Evens Ricarda , Fydrich Thomas , Hamm Alfons , Heinig Ingmar , Herrmann Martin J. , Hollandt Maike , Kircher Tilo , Kölkebeck Katja , Leehr Elisabeth , Lotze Martin , Margraf Jürgen , Mumm Jennifer , Pittig Andre , Plag Jens , Richter Jan , Ridderbusch Isabelle , Schneider Silvia , Straube Benjamin , Strohle Andreas , Szeska Christoph , Wittchen Hans-Ulrich , Wroblewski Adrian , Yang Yunbo , Lueken Ulrike
Published: January 2024

Anxiety disorders (AD) are associated with altered connectivity in large-scale intrinsic brain networks. The extent to which these signatures are shared across different phenotypes remains unclear, as well-powered transdiagnostic comparisons are still largely missing. We used resting-state functional magnetic resonance imaging (rsfMRI) to investigate differences in functional connectivity (FC) in a transdiagnostic sample of AD patients and healthy controls (HC). Before treatment, 439 patients from two German multicenter clinical trials at eight different sites fulfilling a primary diagnosis of panic disorder and/or agoraphobia (PD/AG, n=154), social anxiety disorder (SAD, n=95), or specific phobia (SP, n=190) and 105 HC underwent an 8-minute rsfMRI assessment. We performed categorical and dimensional regions of interest (ROI)-to-ROI analyses focusing on connectivity between regions of the defensive system and prefrontal regulation areas. AD patients showed increased connectivity between the insula and the thalamus compared to controls. This was mainly driven by PD/AG patients who showed increased (insula/hippocampus/amygdala - thalamus) and decreased (dorsomedial prefrontal cortex/periaqueductal gray - anterior cingulate cortex) positive connectivity between subcortical and cortical areas. In contrast, SAD patients showed decreased negative connectivity exclusively in cortical areas (insula - orbitofrontal cortex), whereas no differences were found in SP patients. State anxiety associated with the scanner environment did not explain the FC between these regions. Only PD/AG patients showed pronounced connectivity changes along a widespread subcortical-cortical network, including the midbrain. The relative specificity of findings contradicts a strong overarching factor and thus challenges the predominance of shared transdiagnostic dysfunctions in intrinsic connectivity.
Trial Registration: PROTECT-AD’s registration at NIMH Protocol Registration System: 01EE1402A and German Register of Clinical Studies: DRKS00008743. SpiderVR’s registration at ClinicalTrials.gov: NCT03208400.
Comparison of the digestive tolerance of an oligomeric versus a polymeric oral nutritional supplement in people with anorexia nervosa. A randomised crossover clinical trial.
Authors: Olveira Gabriel , García Ignacio Ruiz , Pérez Nuria Porras , Torres Francisca García , Delgado Lourdes Olivas , Torralvo Francisco José Sánchez , López Margarita Pascual , Marzalo Carmen Fernández
Published: January 2024

Background:
Most people with anorexia nervosa (pAN) have digestive symptoms, which affect tolerance to nutritional treatment. Oligomeric oral nutritional supplements could be better absorbed than polymeric ones and better tolerated. Objectives: to compare, in pAN, an oligomeric versus a polymeric nutritional supplement with respect to digestive tolerance (primary objective) and sensory perception (secondary objective).
Methods:
Randomised, crossover, double-blind, controlled clinical trial. Inclusion criteria: male or female aged 12–50 years with anorexia nervosa treated at the Unidad de Trastornos de la Conducta Alimentaria del Hospital Regional Universitario de Málaga, Spain. Participants were randomised to first receive a container of the oligomeric or polymeric supplement. A digestive symptom questionnaire was administered, which they completed again after taking the supplement, together with a questionnaire for sensory evaluation of the supplement. One week later, they received a container of the other type of supplement, and the process was repeated. Analysis was performed on a per protocol basis.
Results:
10 people were randomised to the oligomeric-polymeric sequence and 12 to the polymeric-oligomeric one, of whom 9 and 11 were tested, respectively. There were no statistically significant differences in digestive symptoms between the two supplements. The oligomeric one scored lower on taste and higher on acidity. Median (interquartile range) for oligomeric and polymeric respectively: taste 6.5 (4), 8(3), p 0.03; acidity 0 (1), 0 (0), p 0.01.
Conclusions:
In pAN, oligomeric nutritional supplements have a similar digestive tolerance to polymeric ones, and are perceived as having a worse taste and a higher degree of acidity.
Trial registration:
The trial is registered at ClinicalTrials.gov, number NCT05184738.
Advancing Liver Disease Sarcopenia Prediction: A Chest- Radiograph–Based Model for Older Adults
Authors: Sasaki Ryo , Nakao Yasuhiko , Mawatari Fumihiro , Nishihara Takahito , Haraguchi Masafumi , Fukushima Masanori , Sasaki Ryu , Miuma Satoshi , Miyaaki Hisamitsu , Nakao Kazuhiko
Published: January 2024

Background
Sarcopenia has been identified as a significant factor affecting the quality of life and prognosis of ageing population. We have been developing a deep learning model to predict height, weight for appropriate nutritional intervention in bedridden patients based on chest radiographs examinations. In this study, we developed and validated a model for predicting sarcopenia in patients with liver disease based on chest radiographs. The model was developed and validated in patients with liver disease based on chest radiographs.
Methods
A total of approximately 10842 male and chest Radiograph examinations, including physical examinations conducted in the past 15 years, were subjected to the study. BMI data were used as the teacher data and validation data, and a discriminant model S-CNN was developed using cut off BMI values (18.5, 19, 20). A convolutional neural network ResNet-152 was used to develop the model, and the model was trained on an Nvidia RTX A6000 using Python 3.8 and Pytorch 1.8.1. To validate sarcopenia, we used x-rays of 22 liver disease patients (13 sarcopenia cases) over the age of 65 years, in which grip strength and limb skeletal muscle mass were measured. Limb skeletal muscle mass was measured by bioelectrical impedance (BIA) and skeletal muscle mass index (SMI) was obtained. 2were determined as sarcopenia. Sensitivity, specificity, accuracy, and F1 score were used to evaluate the performance of the deep learning model; Receiver Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were used to evaluate the prediction accuracy of sarcopenia patients with liver disease.
Results
The S-CNN model showed a sensitivity, specificity, accuracy, and F 1 scores were 98.0%, 98.0%, 97.0%, and 98%, respectively. Next, the results were validated with chest radiographs including liver disease sarcopenia, AUC = 0.62 (BMI cut off = 18.5), AUC = 0.62 (BMI cut off = 19), and AUC = 0.77 (BMI cut off = 20).
Conclusion
The highest AUC for prediction of sarcopenia in patients with liver disease by chest radiography was found at BMI (cut off = 20). Development of a more accurate model and its validation on a large scale are expected to realize a simplified pickup of sarcopenia in elderly patients with liver disease.
Host and geography impact virus diversity in New Zealand’s longfin and shortfin eels
Authors: Waller Stephanie J , Egan Eimear , Crow Shannan , Charsley Anthony , Lokman Mark , Williams Erica , Holmes Edward , Geoghegan Jemma L
Published: January 2024

The fishing and aquaculture industry is vital for global food security, yet viral diseases can result in mass fish die off events. Determining the viromes of traditionally understudied species, such as fish, enhances our understanding of the global virosphere and factors that influence virome composition and disease emergence. Very little is known about the viruses present in New Zealand’s native fish species including the shortfin eel (Anguilla australis) and the longfin eel (Anguilla dieffenbachii), both of which are fished culturally by Māori (the indigenous population of New Zealand) and commercially. Through a metatranscriptomic analysis of longfin and shortfin eels across three different geographic locations in the South Island of New Zealand, we aimed to determine whether viruses had jumped between the two eel species, and identify whether eel virome composition was impacted by life stage, species and geographic location. We identified nine novel viral species spanning eight different families, enhancing our understanding of eel virus diversity in New Zealand and the host range of these viral families. Viruses from the Flaviviridae (genus Hepacivirus) were widespread and found in both longfin and shortfin eels, indicative of host jumping or virus-host co-divergence. Notably, both host specificity and geographic location appeared to influence eel virome composition, highlighting the complex interaction between viruses, hosts and their ecosystems. This study broadens our understanding of viromes in aquatic hosts and highlights the importance of gaining a baseline knowledge of fish viral abundance and diversity, particularly in aquatic species that are facing population declines.
Impact of the Financial Inclusion Improves Sanitation and Health (FINISH) 2022- 2024 intervention. Protocol for a cluster - randomized controlled trial in Kenya’s Homa Bay County and Uganda’s Kamwenge District
Authors: Josphat Martin Muchangi , Muhula Samuel , Kuijpers Maarten , Jerop Mabel , Wanjiku Judy , Nankanja Maureen , Arulraj Joana , Ojakaa David , Munai Dennis , Mukasa Hajra
Published: January 2024

Background: Open defecation (OD) remains a rampant practice in Uganda and Kenya. Amref Health Africa, in collaboration with other partners, is implementing the Financial Inclusion for Sanitation and Health Initiative (FINISH) program in Kenya's Homabay and Uganda's Kamwenge regions. The initiative aims to enhance safely managed sanitation through the involvement of communities, governments, entrepreneurs, and financiers to improve government engagement, demand creation, market-based service delivery and products, and inclusive financing to businesses and households for sanitation. This evaluation will specifically determine the impact and cost-effectiveness of the FINISH intervention, as well as explore stakeholder views.
Methods:This evaluation comprises a mixed methods approach. The quantitative design is a cluster-randomized controlled trial (cRCT). The intervention areas are Homa Bay County in Kenya and Kamwenge District in Uganda while the control areas are Siaya and Bushenyi in Kenya and Uganda respectively. With the village in both countries as the randomization unit, intervention and control households will be selected using multi-stage cluster random sampling. Change in diarrhea prevalence among children aged under five years is the main impact estimand. The sample sizes have been estimated at 1,090 households in Kenya (623 for Homa Bay and 467 for Siaya) and 649 households in Uganda (284 for Kamwenge and 365 for Bushenyi Districts). Ethics approvals and licenses were obtained from relevant institutions in Kenya and Uganda. Random assignment, instrumental variable (IV) techniques, and difference-in-difference will comprise the major impact assessment methods.
Conclusion: This protocol is expected to lay ground for interrogation of the impacts of the FINISH model in relation to health and social outcomes in Kenya and Uganda. The study will propose strategy-level recommendations on how governments, communities, financial institutions, and entrepreneurs would work together to enhance safely managed sanitation in Kenya and Uganda.
Factors related to cerebral venous sinus thrombosis: A cross-sectional study
Authors: Hasimu Aihemaiti , Maimaiti Anaerguli , Chen Boni , Zheng Gang , Ma Zhiming , Zou Zhihao , Luo Kun
Published: January 2024

Objective: To study the factors related to cerebral venous sinus thrombosis (CVST) and to provide experience in single-center diagnosis and treatment of severe CVST, the relationship between high altitude and CVST and its possible mechanism was analyzed.
Methods: The clinical data of 33 CVST patients treated in the General Hospital of Xinjiang Military Command from March 2018 to January 2022 were collected. During the same period, 882 non-CVST patients who were admitted to the hospital for treatment were selected as the control group, and the clinical data of both groups were collected. A cross-sectional study was used to analyze the factors related to CVST.
Results: Multivariate logistic regression analysis showed that age, high altitude, systemic disease and surgical status were statistically significant (P < 0.05).
Conclusion: Age, high altitude, systemic disease and surgical status may be influencing factors of the occurrence of CVST. The pathogenesis of CVST caused by high altitude is complex; the specific mechanism is unknown but may be mainly related to hypoxia, dehydration, polycythemia, vascular endothelial cell injury, blood flow status and coagulation function changes. In the future, these results may be further verified by establishing an animal model of CVST under altitude hypoxia conditions.
Prevalence and Knowledge about Cross-Generational Sexual Relationships among Undergraduates in a Nigerian Tertiary Institution
Authors: Ayamolowo Love Bukola , Okunade Praise Toluwani , Ayowole Damilola Jeremiah , Adesoji Bukola Abimbola
Published: January 2024

Background
Cross-generational sexual relationships keep exposing more young persons to sexually transmitted infections, psychosocial and emotional trauma and various forms of abuses and has been linked with more cases of human immunodeficiency virus infection within the sub-Saharan Africa region; hence, the need to assess the knowledge and prevalence of cross-generational sexual relationships among undergraduates of a Nigerian institution.
Methodology:
The study was a descriptive cross-sectional survey which involved the use of a four-stage sampling technique to select 390 undergraduates across the 13 faculties of the institution. Data were collected using tested, semi-structured and self-administered questionnaires. Data collected were analysed using Statistical Product of Service Solution version 23.
Results
The mean age of the participants was 21.44 ± 2.62 years. The study showed that the prevalence of cross-generational sexual relationships was 13%, 51.80% of respondents had fair knowledge while.68.1% of respondents practising cross-generational sexual relationships were unwilling to quit. Poor family structure and monthly pocket money adversely affects the prevalence of cross-generational sexual relationships among the study population. There was no statistical significance between socio-demographic characteristics and prevalence about cross-generational sexual relationships among the respondents.
Conclusion
This study identified a significant prevalence and fair knowledge about cross-generational sexual relationships among undergraduate students, a trend mostly influenced by poor family structure, poor monthly pocket money and peer pressure. An extensive orientation and continuous education against the practice of cross-generational sexual relationships is recommended so as to prevent further worsening cross-generational sexual relationships prevalence among young persons, especially in tertiary institutions.
Is a history of obstructive pyelonephritis treated without drainage a risk factor for febrile urinary tract infection after ureteroscopic lithotripsy? – a retrospective study from two institutions
Authors: Yanagi Masato , Ueda Takayuki , Nagasawa Masato , Akatsuka Jun , Katsu Akifumi , Kono Hiroyoshi , Kimata Ryoji , Hamasaki Tsutomu , Nishimura Taiji , Kondo Yukihiro
Published: January 2024

Background
A history of preoperative obstructive pyelonephritis (OP) is a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). However, the impact of a history of OP treatment without drainage on post-URSL fUTI has not yet been studied. Therefore, this study aimed to investigate the impact of a history of OP treatment without drainage on post-URSL fUTI.
Methods
We retrospectively reviewed the medical records of 229 consecutive patients who underwent URSL at two institutions between September 2019 and August 2023. Risk factors for post-URSL fUTI were analyzed by comparing patient demographics. Additionally, we compared the frequency of post-URSL fUTI among patients with a history of OP treated without drainage, those with a history of OP treated with ureteral stent (US) placement, and those without a history of OP.
Results
Of the 229 patients, 19 (8.3%) developed post-URSL fUTI. A history of OP was a significant risk factor for post-URSL fUTI. No significant difference in the incidence of post-URSL fUTI was identified between the patients with a history of OP treated without drainage and those treated with US placement (p = 0.6326). The incidence of post-URSL fUTI was significantly higher in patients with OP treated without drainage than in those without a history of OP (p = 0.0493).
Conclusions
A history of OP was a risk factor for post-URSL fUTI. Additionally, a history of OP treatment without drainage was also a risk factor for post-URSL fUTI.
Synthetic data reliably reproduces brain tumor primary research data
Authors: Khalaf Roy , Davalan William , Mohammad Amro H. , Diaz Roberto Jose
Published: January 2024

Purpose
Synthetic data has garnered heightened attention in contemporary research due to confidentiality barriers and its capacity to simulate variables challenging to obtain, notably in cases where premature death prevents adequate follow-up. Indeed, a significant challenge in clinical neuro-oncology research is the limited availability of data pertinent to rapid-onset conditions with relatively poor prognoses. This study aimed to evaluate the reliability and validity of synthetic data in the context of neuro-oncology research, comparing findings from two published studies with results from synthetic datasets.
Materials and Methods
Two published neuro-oncology studies focusing on prognostic factors were selected, and their methodologies were replicated using MDClone Platform to generate five synthetic datasets for each. These datasets were assessed for inter-variability and compared against the original study results.
Results
Findings from synthetic data consistently matched outcomes from both original articles. Reported findings, demographic trends and survival outcomes showed significant similarity (P < 0.05) with synthetic datasets. Moreover, synthetic data produced consistent results across multiple datasets.
Conclusion
Integrating synthetic data into clinical research offers excellent potential for providing accurate predictive insights without compromising patient privacy. In neuro-oncology, where data fragmentation and patient follow-up pose significant challenges, the adoption of synthetic datasets can be transformative.
Herpes Simplex Virus Necrotising Stromal Keratitis post-Descmets stripping automated endothelial keratoplasty - A Rare Case
Authors: Rajarajan Mugundhan , Das Nikita
Published: January 2024

PURPOSE:
This study aims to report a case of HSV keratitis post-Descemet’s stripping automated endothelial keratoplasty (DSAEK)
METHODS:
A 69-year-old male presented with right eye defective vision in the last 1 year. He had poor visual recovery after he underwent cataract surgery 1 year ago. On examination, he had an old Descemet membrane detachment with a taut membrane.
He underwent RE DSAEK, on postoperative day 15 he came with complaints of foreign body sensation, and he was diagnosed with HSV Epithelial keratitis. Topical steroids were stopped and topical antiviral and cycloplegics were given. He reviewed back to us after 2 days with a large central geographic ulcer, therapeutic dose of oral acyclovir was added to his treatment regimen. He reviewed back on post-operative day 25 even though the geographic ulcer had reduced in size but, he had developed a central anterior to mid stromal whitish infiltrate- a diagnosis of HSV necrotising stromal keratitis was made and he was continued on topical and oral antivirals. On postoperative day 36, the geographic ulcer had reduced to 60% of its original size- topical steroids, oral antivirals, and topical cycloplegics were given. On his follow-up visit after 3 days (postoperative day 39)- the epithelial defect had heaped up margins with a resolving anterior stroma infiltrate, here a diagnosis of meta herpetic ulcer was made. He underwent an amniotic membrane transplant and tarsorrhaphy on the same day. On postoperative day 1 month 14 days Amniotic membrane graft (AMG) was well integrated, anterior to mid stromal corneal scar was noted lenticule was well attached, here slow steroid taper was advised, with a prophylactic dose of oral acyclovir.
CONCLUSION:
We successfully managed a case of HSV keratitis post-DSAEK, HSV keratitis can develop following keratoplasty even in the absence of a previous history of infection, hence early clinical suspicion and medical management can allow complete resolution of infection with scarring.
There are very few case reports of HSV keratitis after endothelial keratoplasty in literature and according to our knowledge, there are no previous case reports of HSV NSK after DSAEK.
Presentation, treatment, and outcomes in patients with spontaneous isolated celiac artery dissection
Authors: Zhang Xinyang , Zhu Feng , Zhang Liqiang , Guo Chao , Li Chunting , Shang Dan
Published: January 2024

Objective: Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, and its natural history and outcomes have not been thoroughly studied. The aim of this study was to review our institution’s experience in the evaluation, treatment, and outcomes of patients with SICAD.
Methods: A retrospective review was conducted on 76 patients who presented with SICAD between January 2010 and July 2022. The clinical manifestations, initial radiological findings, methods of treatment and follow-up computed tomography were reviewed, and patients were contacted for assessment of current symptoms.
Results: in this study, a total of 76 patients with SICAD were collected. The mean age of the patients was 52.8±8.7 years. The mean angle between celiac trunk and aorta in symptomatic patients was 57.78 ± 14.94°, and 59.65 ± 20.11° in asymptomatic patients. Of the 76 patients, 27underwent endovascular treatment due to refractory pain or aneurysmal dilatation. Among these 27 patients, 2 experienced failure in the endovascular intervention due to issues with the guide wire reaching the true cavity and challenges in inserting the long sheath behind the celiac artery. The remaining 49 patients were managed conservatively. Within the conservative group, one patient (1.3%) without aneurysmal dilation experienced a recurrence of abdominal pain one year after the initial hospitalization. Subsequent CT revealed slight dilation of the celiac trunk dissection compared to the initial presentation. After rehospitalization and conservative treatment, symptoms improved, and no recurrence have been observed since discharge. It is noteworthy that all patients, whether treated with endovascular or conservative methods, experienced improvement in symptoms.
Conclusions:The symptoms of SICAD may not be influenced by the angle between celiac trunk and aorta. Conservative treatment is effective in more than half of the patients. Even if abdominal pain recurs, as long as the patient’s condition is stable, conservative treatment remains effective. Endovascular treatment had more favorable outcomes in achieving complete remodeling compared to conservative treatment.
Role and Expression of Annexin IV (ANXA4) and Matrix-remodeling Associated 5 protein (MXRA5) in connective tissue remodeling of placenta in preeclampsia.
Authors: Hafeez Shimaa , Baz Mona El , Sobh Ahmed , Atta Sara
Published: January 2024

Objective: To evaluate the expression of Annexin IV (ANXA4), Matrix-remodelling associated 5 (MXRA5), and Tissue inhibitor metalloproteinase 2 (TIMP2) level in connective tissue remodelling of placenta in women with preeclampsia.Methods: Forty-eight pregnant women complicated by preeclampsia, their age range from 20 to 40 years, in addition to 48 age and sex matched normotensive pregnant women served as control group were enrolled in the study. The placental samples in this study were obtained by cesarean section, frozen immediately in liquid nitrogen, and stored at − 80°C till time of assay for subsequent RNA and protein biochemical measurements.Results: There was statistically significant decrease in mean ANXA4 among cases compared to controls. Additionally, there was statistically significant decrease in mean MXRA5 among cases compared to controls (p < 0.001 for both). There was statistically significant decrease in mean MXRA5 among patients with severe PE compared to mild PE (p < 0.001). A statistically significant moderate positive correlation between ANXA4 and MXRA5 (r = 0.571, p < 0.001) in total sample, and the degree of correlation increased to 0.732 among cases when stratified the groups to cases and controls. There was a statistically significant lower mean difference of pAKT-ELIZA among PE patients (0.29 ± 0.04) compared to controls (0.56 ± 0.14, p < 0.001).Conclusions: In pre-eclampsia patients, there was a statistically significant positive correlation between the pAKT protein level and ANXA4 and MXRA5 compared to controls. Reduced MXRA5 expression is a more sensitive biomarker for predicting the severity of PE compared to ANXA4.
Inhibition of the P38 MAPK/NLRP3 Pathway Mitigates Cognitive Dysfunction and Mood Alterations in Aged Mice after Abdominal Surgery Plus Sevoflurane
Authors: Lv Jin-Meng , Wang Lu-Ying , Li Bao-Dong , Shan Yong-Lin , Wu Zi-Qiang , Lu Qing-Meng , Peng Heng-Yue , Zhou Ting-Ting , Li Xiao-Ming , Zhang Li-Min
Published: January 2024

Background
Cognitive dysfunction, encompassing perioperative psychological distress and cognitive impairment, is a prevalent postoperative complication within the elderly population, and in severe cases, it may lead to dementia. Building upon our prior research that unveiled a connection between postoperative mood fluctuations and cognitive dysfunction with the phosphorylation of P38, this present investigation aims to delve deeper into the involvement of the P38 MAPK/NLRP3 pathway in perioperative neurocognitive disorders (PND) in an abdominal exploratory laparotomy (AEL) aged mice model.
Methods
C57BL/6 mice (male, 18-month-old) underwent AEL with 3% anesthesia. Then, inhibitors targeting P38 MAPK (SB202190, 1 mg/kg) and GSK3β (TWS119, 10 mg/kg) were administered multiple times daily for 7 days post-surgery. The NLRP3-cKO AEL and WT AEL groups only underwent the AEL procedure. Behavioral assessments, including the open field test (OFT), novel object recognition (NOR), force swimming test (FST) and fear conditioning (FC), were initiated on postoperative day 14. Additionally, mice designated for neuroelectrophysiological monitoring had electrodes implanted on day 14 before surgery and underwent novel object recognition while their local field potential (LFP) was concurrently recorded on postoperative day 14. Lastly, after they were euthanasized, pathological analysis and western blot were performed.
Results
SB202190, TWS119, and astrocyte-conditional knockout NLRP3 all ameliorated the cognitive impairment behaviors induced by AEL in mice and increased mean theta power during novel location exploration. However, it is worth noting that SB202190 may exacerbate postoperative depressive and anxiety-like behaviors in mice, while TWS119 may induce impulsive behaviors.
Conclusions
Our study suggests that anesthesia and surgical procedures induce alterations in mood and cognition, which may be intricately linked to the P38 MAPK/NLRP3 pathway.
Antithrombotic therapy at discharge and prognosis in patients with chronic coronary syndrome and atrial fibrillation who underwent PCI: a real-world study
Authors: Wang Yimeng , Wang Lulu , Yang Yanmin , Zhang Han , Tan Jiang-shan , Shu Yuyuan
Published: January 2024

Background: This study aimed to describe the status of antithrombotic therapy at discharge and prognosis in patients with atrial fibrillation (AF) and chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI).
Methods: This was an observational, prospective study. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, systemic embolism or ischemia-driven revascularization. Bleeding events were collected according to the Thrombolysis in Myocardial Infarction (TIMI) criteria.
Results:Between 2017 and 2019, a cohort of 546 patients (mean age 65.78, [SD 8.73], of whom 18.3% were female) with AF and CCS who underwent PCI were evaluated, with a median followed-up time of 36 months (Interquartile range: 22-45). MACE events occurred in 13.0% of the patients, while the TIMI bleeding events were observed in 17.4%. Utilization of oral anticoagulation (OAC) therapy increased from 23.2% in 2017 to 51.0% in 2019 (p<0.001).
History of heart failure (HF) (Hazard ratio [HR], 1.744; 95% confidence interval [CI], 1.011-3.038) and TAT (HR, 2.708; 95%CI, 1.653-4.436) had independent associations with MACE events. OAC (HR, 10.378; 95%CI, 6.136-17.555) was identified as a risk factor for bleeding events. A higher creatine clearance (HR, 0.986; 95%CI, 0.974-0.997) was associated with a lower incidence of bleeding events.
Conclusions: Antithrombotic therapy has been improved among patients with AF and CCS who underwent PCI these years. History of HF and TAT were independently associated with MACE events. Higher creatine clearance was protective factors of bleeding events, while OAC was a risk factor for TIMI bleeding events.
The Relationship between Cathepsins and Sepsis: A Mendelian Randomization Study
Authors: Zhou Li , Liu Hai , Wen Shu , Wang Xiaolan , Liu Hongmei , Dong Wei , Liu Yiwen
Published: January 2024

Background An increasing body of evidence suggests a connection between cathepsins and sepsis. However, more research is needed to better understand the causal relationship between the two. To gain a deeper insight into the association between cathepsins and sepsis, we conducted multiple Mendelian randomization (MR) analyses. Methods In this study, MR analysis was employed to investigate the causal associations between nine cathepsins and various severities of sepsis (sepsis, 28-day death, under 75). The research design consisted of forward MR analysis, reverse MR analysis and multivariable MR analysis. Under the premise of meeting the three fundamental assumptions of MR studies, genetic instrumental variables (IVs) were selected for specific analyses. The MR studies utilized the inverse variance-weighted (IVW) method as the primary analytical approach. Results In the forward MR analysis, the IVW method indicated that Cathepsin E and Cathepsin O are identified as potential risk factors for the occurrence of sepsis and sepsis (under 75). Additionally, a negative correlation was observed between Cathepsin F and 28-day mortality. Conversely, results from the reverse MR analysis suggested that the occurrence of sepsis might contribute to a reduction in the levels of Cathepsin Z. Within the multivariable MR analysis, incorporating nine cathepsins as covariates, Cathepsin O emerged as a risk factor for 28-day mortality. Interestingly, the multivariable MR analysis also affirmed that with an elevation in the levels of Cathepsin E, the risk of sepsis (under 75) increases. Conclusion Our MR study, for the first time from a genetic perspective, provides evidence of a causal relationship between cathepsins and the susceptibility to sepsis. This discovery holds significant implications for guiding clinical practices in the treatment of sepsis.
Overcoming barriers in the introduction of early warning scores for in-hospital emergencies in Austrian medical centers - a mixed methods approach
Authors: Treml Benedikt , Dahlmann Philipp , Rajsic Sasa , Bauernfeind Lydia
Published: January 2024

Background: In-hospital cardiac arrest is associated with high mortality and data regarding an effect of early warning scores upon mortality remains inconsistent. Moreover, an aging population and a shortage of skilled health care workers strain Austrian acute care hospitals. The question arises if this constitutes barriers in the implementation of early warning scores in Austria. Therefore, this work sought to identify barriers by assessing local and national data. The first retrospective part investigated i) the local situation regarding in-hospital cardiac arrests at Medical University Innsbruck. The second prospective part focused on ii) the identification of barriers during implementation of early warning scores at Austrian medical centers.
Methods: The interviews were part of a master thesis (BT). Ten experts with profound expertise in in-hospital emergency medicine were interviewed using guided interviews. The main results were identified using a structured content analysis according to Mayring. The retrospective analysis included all patients experiencing an in-hospital cardiac emergency between 2017 and 2022. Using the Consolidated Framework for Implementation Research, we stratified our data into five domains described. Finally, we applied the eight steps of leading change to develop and consider best practice guidelines.
Results: In six years, 1317 patients were treated by one of the emergency medical teams, with 365 of them being resuscitated. The incidence rate of in-hospital cardiac arrests was demonstrated to be 0.86 cases/1000 admissions per year.
The guided interviews demonstrated a nearly complete absence of the usage of early warning scores in Austria. Strained human resources after the pandemic, the fear of an increased workload and the lack of robust data regarding the benefit of survival were mentioned as main reasons. The best practice tutorial considers the challenges identified and provides guidance for structured implementation in hospitals.
Conclusion: Implementing one of the most established early warning scores, the NEWS, correctly as a „fire alarm“, may facilitate ongoing clinical education. Moreover, this could mitigate a further increasing workload. Identifying common barriers and facilitators in five domains described and applying this to the eight steps of leading change enabled us to provide a tutorial for overcoming these barriers.