bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Physical and Oral Frailty Among the Community Dwelling Geriatric Population -a Cross Sectional Study From South India
Authors: N Sandhya K , Varma Beena Varma , Janakiram Chandasekar , Vijayakumar Priya , Kartha Niveditha
Published: August 2024

Objective: Data on the prevalence of frailty in Kerala is sparse. The objective of this study was to estimate the prevalence of frailty among community-dwelling elderly people in Kerala and explore the sociodemographic factors associated with physical and oral frailty among this population. We further explored the associations between physical and oral frailty.
Design: Community based cross-sectional study.
Setting: Cluster sampled area of Thrissur District, Kerala.
Participants: Random sample0 of adults aged 60 years and above, from the cluster sampled
area of Thrissur district.
Methods: We sampled 1079 community-dwelling adults aged ≥60 years from the Thrissur district of Kerala, using stratified random cluster sampling. Physical frailty was defined and recorded based on Fried’s Frailty Phenotype, Reported Edmonton Frail Scale (REFS), and SARC-F sarcopenia scales. Oral frailty was recorded based on Tanaka measures and Oral and Maxillofacial Frailty Index (OMFI). Logistic regressions with robust standard errors were utilized to examine the associations between socio-demographic determinants and frailty, and between physical frailty and oral frailty.
Results: Overall, 35.2% were classified as physically frail and 62.2% as prefrail, while 22% of population had oral frailty. In the unadjusted model, individuals with oral frailty showed greater odds of being physically frail than those without oral frailty. (Crude OR= 1.584, 95% CI=1.157-2.169, p-value= 0.004). This association persisted after controlling for socio demographic variables and number of teeth. (Adjusted OR=1.423,95% CI=1.020-1.987, p value;0.038).
Conclusion: Integrating the multidisciplinary approaches like oral frailty assessment along with general frailty assessment can promote healthy aging.
Retrospective Analysis of Earthquake Related Crush Injurie Patients in ICU: 6-February Earthquake in Türkiye
Authors: Temel Sahin , Yuksel Recep Civan , Kaynar Ahmet Safa , Caliskan Mustafa , Demir Berna , Alkan Mustafa , Ülger Birkan , Deveci Kamil , Sipahioglu Hilal , Metin Hatice , Kayaaltı Selda , Kaya Elif , Unal Canan Baran , Esmaoğlu Aliye , Sungur Murat , Goksuluk Dincer , Gundogan Kursat
Published: August 2024

Background
On February 6, 2023 a devastating earthquake hit the south-eastern region of the Turkey. It is caused thousands of people injury and dead. The aim was to determine the characteristics, treatment and clinical outcomes of critically ill patients with crush injuries in ICU.
Subjects/methods:
This study was performed with a retrospective design in ICU. Patients were included as follows; effected 6 February earthquake, need ICU treatment and being crush syndrome.
Results
A total of 62 patients were included. The mean age was 41 ± 19 years and 47% were male. The median APACHE II score was 14. The most common ICU admission was multitrauma and crush injury. A total of %77 patients were needed surgical procedure (most of them extremities surgery (36%)and fasciotomy 36% due to compartment syndrome) and %24 patients had extremity amputation. AKI was developed in %65 of patients. A total of 25 (%40) patients were received RRT. The mNUTRIC score (p = 0.022), the BUN (p = 0.043) and the blood lactate level (p = 0.012) were identified as independent risk factors for 28-day mortality. An independent risk factor for limb amputation was identified in patients with high APACHE II and SOFA scores (p = 0.026, p = 0.034, respectively). The 28-day mortality was 13%.
Conclusions
As a result of the study, most of the patients need surgical operations and a quarter of patients required extremity amputation. AKI developed at a high rate and 40% of those patients needed RRT. The mNUTRIC score was found to be the most powerful predictor of mortality at 28 days.
Substitution of the Empirical Antibiotic Regimen Eliminated an Outbreak of Tobramycin Resistant Staphylococcus aureus of spa type t084 in a Swedish Neonatal Intensive Care Unit – We recommend an Early Warning System for Antibiotic Resistance
Authors: Jogenfors Anna , Mernelius Sara , Löfgren Sture , Bengnér Malin , Bengnér Johannes , Ingemansson Fredrik , Wetterbrandt Sofia , Matussek Andreas
Published: August 2024

During spring 2010, four cases of bacteraemia caused by a tobramycin resistant Staphylococcus aureus (TRSA) of spa type t084 were identified in the neonatal intensive care unit at Ryhov County Hospital, Jönköping, Sweden. Retrospective investigation and screening revealed an outbreak of TRSA t084 that may have started in late 2009. This study describes the outbreak and the measures taken to eradicate it. Screening of infants, staff members, environmental samplings, antibiotic susceptibility testing and spa typing was done. Moreover, pasteurization and bacteriology screening of donated human milk, multimodal hygiene interventions, antibiotic substitution (tobramycin for amikacin) were done. TRSA septicaemia was statistically significantly more common before compared to after the antibiotic substitution in infants with TRSA in clinical samples. This may indicate an insufficient empirical antibiotic regimen. The S. aureus prevalence among the infants was reduced (p = 0.002) after the multimodal hygiene interventions, but had no effect on the proportion of TRSA. No TRSA was found after July 2019 to the end of follow-up in December 2021. Only S. aureus spa type t084 resulted in secondary spread, indicating that this strain may have virulence traits that improve colonization and spread. Hygiene interventions reduced the prevalence of S. aureus. After the antibiotic substitution, no more cases of TRSA septicaemia were observed. The outbreak strain was eliminated after five years. Antibiotic resistance surveillance systems may reveal the presence of resistant strains and facilitate early identification of an outbreak. Furthermore, it provides guidance for an effective empiric antibiotic regimen.
Mind the Gap: Oncologist perceptions and knowledge of meditation as a complementary therapy
Authors: Godinho Alexandra , Seo Christina , Joshi Krutika , Phadke Siona , Rana Punam , Wegier Pete
Published: August 2024

Purpose
To understand the recommendation practices of mind-body complementary therapies by Canadian oncologists. In particular, to examine oncologist perceptions and knowledge of meditation, awareness for 2018 ASCO guidelines that recommend meditation to breast cancer patients for reducing anxiety/stress, and associated changes in oncologists’ recommendation of mind-body therapies to their patients.
Methods
Medical oncologists were invited to complete an online survey about prescribing meditation for improving quality of life. The survey assessed demographic and professional practice characteristics. Current complementary therapy recommendations, knowledge of meditation, and general awareness for the ASCO guidelines were assessed. Data was analyzed using a series of descriptive statistics.
Results
A large portion of oncologists (83%) reported recommending at least one form of complementary therapy; with 40% recommending meditation. Most oncologists were knowledgeable about the benefits of meditation, and had a general awareness of resources (i.e., digital meditation tools, 80%). Less than one third of oncologists were aware of the ASCO guidelines, however 56% of those unaware of the guidelines indicated that they plan on recommending these therapies in the future.
Conclusion
The results from this study are promising, as becoming aware of the guidelines had a positive impact on the willingness of oncologists to recommend complementary therapies to their patients. Future research should replicate the study in a larger sample of oncologists, and further explore potential reasons why some oncologists may be hesitant to recommend complementary therapies, such as meditation.
A Large-Scale Empirical Analysis of Electric Vehicle Us-age and Charging: Operational Demands and Infrastructure Implications
Authors: Yeh Sonia , Zhan Weipeng , Liao Yuan , Deng Junjun , Wang Zhenpo
Published: August 2024

As global electric vehicle (EV) adoption accelerates, granular analysis of empirical usage andcharging patterns remains scarce. This study presents a unique large-scale empirical exam-ination of 1.6 million EVs, including a broad array of vehicle types—private, taxi, rental,official, bus, and special purpose vehicle—across seven major Chinese cities with over 854million observations of driving and charging events. Our findings illuminate significant het-erogeneity in EV usage, battery energy, and charging behaviour across vehicle types withnotable city differences. Day-time high-power charging presents high loads on the electric-ity grid across all vehicle types, particularly from service-oriented vehicles, including taxis,rental cars, and buses. The maximum loads also are the highest in the center of the cities. Ourstudy of large-scale EV usage offers critical insights for developing charging infrastructure,managing energy grids, and providing flexibility services, which are pivotal to the evolutionof future transport ecosystems.
Development and Validation of a Nomogram Based on CT Imaging Features for Differentiating Pancreatic Head Cancer in Periampullary Carcinomas
Authors: Zhang Xiaohuan , Wang Junqing , Wu Wenjuan , Zhang Zhuiyang , Chen Fangming , Zhu Dongyang , Zhang Lei
Published: August 2024

Purpose To construct a predictive nomogram for differentiate pancreatic head cancer from other periampullary cancers based on CT imaging features.
Methods
This is a retrospective analysis, Patients diagnosed with periampullary carcinoma by pathological findings from April 2013 to April 2024 were consecutively collected. The variables evaluated included imaging characteristics (direct and indirect signs) and clinical data. Univariate and multivariate regression analyses were used to find statistically significant variables. A nomogram prediction models based on regression analysis and was internally validated.
Results
Multivariable analysis revealed that the distance from the end of the dilated pancreatic duct to the medial wall of the papilla (P＜0.05), the distance from the end of the dilated bile duct to the medial wall of the papilla (P＜0.01), papilla enlargement（P＜0.01）, and the presence of pancreatic and/or bile ducts between the tumor and the papilla (P＜0.05)were identified as independent risk factors for differentiating pancreatic head cancer from non-pancreatic head cancers, and were used to construct a nomogram. The nomogram demonstrated high accuracy, with an AUC of 0.826 in the development cohort and 0.801 in the validation cohort.
Conclusions
This study is based on CT imaging features to differentiate pancreatic head cancer from non-pancreatic head cancer in periampullary cancer. Multiple imaging signs with differential diagnostic significance were obtained, Development and validation of a nomogram that integrates these imaging features, providing a basis for treatment and comprehensive assessment in the clinic. Keywords Periampullary cancer·Pancreatic head cancer·Differential diagnosis·Computed tomography (CT)·Nomogram
Influence of hypothyroidism on radiomorphometric parameters of mandibular radiograph: A cross-sectional case control study
Authors: Nair Ananya , Bhardwaj Isha , Patil Vathsala , Singhal Deepak Kumar , Smriti Komal , Chhaparwal Yogesh , Chhaparwal Shubha
Published: August 2024

Thyroid hormones have a catabolic effect on bone mineral homeostasis. Hypothyroid patients have shown changes in bone mineral density with increased risk for osteoporosis and bone fractures. Radiomorphometric parameters on panoramic images are good indicators of bone mineral density. The aim of the study was to compare the radiomorphometric changes in dental panoramic images of patients diagnosed with hypothyroidism with age- and gender-matched control populations.
Materials and Methods
Panoramic radiographs of 47 patients diagnosed with hypothyroidism was measured for Radio morphometric indices like Mental index (MI), The inferior panoramic mandibular index (PMI), The antegonial index (AGI), Gonial Index (GI) and Mandibular cortical Index (MCI). The measurements were compared with age and gender matched healthy controls.
Results
The mean values of mental index, inferior panoramic mandibular index, and gonial index were observed in hypothyroidism than in healthy controls. However, only AGI showed statistically significant differences between cases and controls (p = 0.03).
Conclusion
Further studies with larger samples, comparing the dosage of hormone replacement therapy and hormone levels with bone changes, can provide substantial validated data
Health Policy Spotlight Effects on Critical Time-Sensitive Diseases: Evidence from Taiwan Categorization of Hospital Emergency Capability Policy
Authors: Lin Chih-Yuan , Liu Chih-Chin , Huang Yu-Tung , Lee Yue-Chune
Published: August 2024

Objective To investigate the effects of the Categorization of hospital emergency capability (CHEC) policy on critical time-sensitive diseases (CTSDs).
Setting CHEC is a policy implemented worldwide to regionalize and guide the dispatch of critical patients to the nearest appropriate hospital. In 2009, Taiwan's CHEC policy was designed to improve the quality of emergent care for CTSDs.
Research Design and Participants A nationwide observational quasi-experimental study was conducted to examine the quality of care for CTSD before (2006-2008) and after (2009-2012) the implementation of the CHEC policy. CHEC policy focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. A difference-in-differences estimation was used to assess the impact of the CHEC policy exposure (AIS and STEMI) on clinical practice and outcomes, compared with the unexposed counterfactual of septic shock. We selected diagnosis and treatment guideline adherence process quality measures as primary outcome and medical utilization, upward transfer rate, short-term and long-term mortality as secondary outcomes. Taiwan National Health Insurance 2005 Longitudinal Health Insurance Database contains one million random cases, including time-sensitive disease samples.
Results In our cohort of 9,923 cases, refined through 1:1 propensity score matching, 56% were male, mostly older adults. The CHEC policy significantly reduced medical orders and major diagnostic indicators, yet diagnostic fees notably increased. This led to a decrease in mortality rates, ultimately lowering overall medical expenses. Septic shock cases showed marked reductions in both primary diagnosis indicators and medical orders. In contrast, primary treatment indicators for AIS and STEMI rose, supporting the hypothesis of a health policy spotlight effect.
Conclusions This study highlights the CHEC policy's dual effects on reducing costs and enhancing patient outcomes. We observed a health policy spotlight effect, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs that have time-based surveillance indicators.
Automated Analysis of Heart Sound Signals in Screening for Structural Heart Disease in Children
Authors: Papunen Ida , Ylänen Kaisa , Lundqvist Oliver , Porkholm Martin , Rahkonen Otto , Mecklin Minna , Eerola Anneli , Kallio Merja , Arola Anita , Niemelä Jussi , Jaakkola Ilkka , Poutanen Tuija
Published: August 2024

Purpose
Our aim was to investigate the ability of an artificial intelligence (AI)-based algorithm to differentiate innocent murmurs from pathologic ones.
Methods
An AI-based algorithm was developed using heart sound recordings collected from 1413 patients at the five university hospitals in Finland. The corresponding heart condition was verified using echocardiography. In the second phase of the study, patients referred to Helsinki New Children’s Hospital due to a heart murmur were prospectively assessed with the algorithm, and then the results were compared with echocardiography findings.
Results
Ninety-eight children were included in this prospective study. The algorithm classified 72 (73%) of the heart sounds as normal and 26 (27%) as abnormal. Echocardiography was normal in 63 (64%) children and abnormal in 35 (36%). The algorithm recognised abnormal heart sounds in 24 of 35 children with abnormal echocardiography and normal heart sounds with normal echocardiography in 61 of 63 children. When the murmur was audible, the sensitivity and specificity of the algorithm were 83% (24/29) (confidence interval (CI) 64–94%) and 97% (59/61) (CI 89–100%), respectively.
Conclusions
The algorithm was able to distinguish murmurs associated with structural cardiac anomalies from innocent murmurs with good sensitivity and specificity. The algorithm was unable to identify heart defects that did not cause a murmur. Further research is needed on the use of the algorithm in screening for heart murmurs in primary health care.
Malaria Endgame: Can engagement of the for-profit private sector help the country reach the last mile of malaria elimination in Bangladesh?
Authors: Alam Mohammad Shafiul , Alam Md Jahangir , Hossain Mohammad Sharif , Matin Mohammad Abdul , Phru Ching Swe , Hasan Anamul , Rahman Md Mushfiqur , Rahaman Md Mosiqure , Islam Md Nazrul , Das Shyamol Kumer , Aktaruzzaman M. M. , Adnan Sheikh Daud , Islam Md Nazmul , Hazarika Anupama
Published: August 2024

Background
Among 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh's malaria burden. Despite the private sector's prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030.
Methods
This mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission.
Results
Among the 104 representative participants, majority were male (n=92, 88.5%), had a diploma in their respective fields (n=53, 51%) and were involved either in laboratory work (n=49, 47.1%) or as owners/managers of health centers (n=41, 39.4%). The selected health facilities were close to the corresponding UHC (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%). Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis.
Conclusions
This study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh's malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.
Enhancing parathyroid preservation in papillary thyroid carcinoma surgery using nano-carbon suspension
Authors: Lin De-Xin , Zhuo Xin-bin , Lin Yin , Lei Wen-Di , Chang Gui-Jian , Zhang Yong , Zhang Shi-Yan
Published: August 2024

This study evaluates the clinical significance of using nano-carbon suspension in total thyroidectomy with cervical lymph node dissection for papillary thyroid carcinoma (PTC). The objective is to assess the efficacy of nano-carbon in enhancing parathyroid gland preservation, reducing postoperative complications, and improving surgical precision. A retrospective analysis of 219 PTC patients who underwent total thyroidectomy and cervical lymph node dissection from March 2014 to March 2018 was conducted. Patients were divided into two groups: control (n = 112) without nano-carbon suspension and experimental (n = 107) with nano-carbon suspension. Comparative analyses included demographics, surgical parameters, postoperative calcium and parathyroid hormone (PTH) levels, number of lymph nodes dissected, and incidence of complications. Baseline characteristics, including age, sex, and BMI, were comparable between the experimental and control groups, with no statistically significant differences observed. Postoperative calcium levels were significantly more stable in the experimental group, with median levels of 2.22 mmol/L on day 1 compared to 2.06 mmol/L in the control group (p < 0.001), and 2.29 mmol/L at week 1 compared to 2.22 mmol/L in the control group (p < 0.001). PTH levels were also higher in the experimental group (35 pg/mL on day 1 vs. 28 pg/mL, p < 0.001; 37 pg/mL at week 1 vs. 30 pg/mL, p < 0.001). The experimental group had more lymph nodes dissected (median 135.83 vs. 84.12, p < 0.001) and a lower pathological parathyroid gland count (6.5% vs. 23.2%, p < 0.001). Postoperative numbness and twitching were reduced (4.7% vs. 16.1%, p = 0.006), and the recurrence rate at 12 months was lower (4.7% vs. 12.5%, p = 0.040). Nano-carbon suspension in thyroidectomy with cervical lymph node dissection for PTC enhances parathyroid gland preservation, improves surgical precision, and reduces specific postoperative complications, advocating its standard use in thyroid cancer surgeries to optimize patient outcomes.
Global, regional and national burden due to retinoblastoma in children aged younger than 10 years from 1990 to 2021
Authors: 李 聪 , Zhang Lijun , Zhang Jie , Jiao Jinghua , Hua Guangyao , Wang Yan , He Xue , Cheng Chingyu , Yu Honghua , Yang Xiaohong , Liu Lei
Published: August 2024

Background
Retinoblastoma (RB), an aggressive intraocular malignant neoplasm, is a significant contributor to the global disease burden in early childhood. To date, there has been no analysis of global burden and trends in RB among children. This study provides the incidence, mortality and disability-adjusted life years (DALYs) of RB among 0–9 years old children by age, sex, location, and sociodemographic index (SDI) level between 1990 and 2021, aiming to provide novel and robust information for health policy, allocation of medical resources and strategies for fighting RB.
Methods
Data were retrieved from newly released Global Burden of Disease (GBD) study. The measures were estimated both as numerical counts and age-standardised rates per 100,000 population. Joinpoint regression analysis was used to do a rigorous examination on the temporal trends, estimated as the average annual percentage change (AAPC). Spearman’s correlation test was used to examine the relationship between SDI and the burden of RB by location and year.
Results
Globally, the age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR), and age-standardised DALYs rate (ASDR) for RB among young children in 2021 were 0.09 [95% uncertainty interval (UI): 0.05 to 0.13], 0.04 (95%UI: 0.03 to 0.06), and 3.65 (95%UI: 2.21 to 4.96), respectively. Despite an overall increasing trend [AAPC: 0.62; 95% confidence interval (CI): 0.42 to 0.82], the incidence rate of RB demonstrated a significant decrease from 2019 to 2021, whereas overall downward trends were observed in terms of mortality and DALYs rate for RB. Trends in ASIR varied across regions, and the increased trends of ASIR of RB was highest in East Asia. Among all GBD regions, only Southern Sub-Saharan Africa exhibited increasing trends of mortality and DALYs rate. Gender comparisons showed negligible differences in ASIR, ASMR and ASDR in 2021. Moreover, the highest disease burden was noted in early neonatal (0–6 days), and 2–4 years old children at global and regional levels. The SDI-based analysis showed that the incidence rate of RB increased along with the increase in SDI level. In addition, the associations reflected a significantly negative correlation between the SDI level and ASMR as well as ASDR of RB among children aged 0–9 years.
Conclusions
RB related incidence, mortality, and DALYs varied across age and locations from 1990 to 2021. Evaluating spatiotemporal trends over time underscores the impact of health policies and substantial public health measures on the control of RB.
Birth outcomes of infants born to mothers with alopecia areata: A nationwide population-based study in Korea
Authors: Shin Jung-Won , Kang Taeuk , Swan Heather , Paik Kyungho , Huh Chang-Hun , Kim Hyun Jung
Published: August 2024

Data on pregnancy outcomes in patients with alopecia areata (AA) are limited. The aim of this study is to determine the association between maternal AA and risk of adverse birth outcomes in children, we conducted a retrospective cohort study on 45,328 children born to mothers with AA and 4,703,253 controls born to mothers without AA using the Korean National Health Insurance Claims database from 2002 to 2016. Multivariate logistic regression analyses were performed to evaluate the association between maternal AA and the birth outcomes of their children. Infants born to mothers with AA exhibited a significantly higher risk for preterm birth (odds ratio [OR], 1.39; adjusted OR [aOR], 1.14), low birth weight (OR, 1.36; aOR, 1.15), and cesarean section birth (OR, 1.24; aOR, 1.10)than controls. In addition, the risk of congenital malformations was also significantly higher in infants born to mothers with AA (OR, 1.19; aOR, 1.12), especially for malformations of the urinary (OR, 1.33; aOR, 1.18), circulatory (OR, 1.28; aOR, 1.11), nervous (OR, 1.26; aOR, 1.15), and musculoskeletal (OR, 1.19; aOR, 1.13) systems, than controls. Maternal AA is associated with an increased risk of adverse birth outcomes in infants.
Pragmatics performance, the relation to symptom severity, and early clinical predictors of pragmatics in 5~6-year-old children with autism spectrum disorder
Authors: Qian Lu , Ding Ning , Fang Hui , Xiao Ting , Sun Bei , Gao HuiYun , Ke XiaoYan
Published: August 2024

Background
Pragmatic language refers to the use of spoken language to effectively convey messages across diverse social communication contexts. However, minimal longitudinal research has focused on defining early predictors of pragmatic development in children with autism spectrum disorder (ASD).
Methods
In the current study, 71 ASD and 38 age- and gender- matched 24- to 30-month-old typically developing (TD) children were enrolled. Social-communication, language, and parent-child interaction measures were collected for the ASD group at baseline. Three years later, all subjects were assessed for pragmatic ability via the Chinese version of Language Use Inventory (LUI-Mandarin). First, the differences of pragmatic performance between the ASD group and the TD group at follow-up were analyzed. Second, pragmatic performance was correlated with autism symptomatology at follow-up, as well as the structural language difficulties and joint engagement (JE) levels at baseline for the ASD group. Furthermore, diverse multiple regression algorithms were performed to explore the effect of the early potential predictors of pragmatic development for the ASD group.
Results
First, our results revealed that performance was significantly lower in the ASD group than in the TD group with respect to LUI-Mandarin Total scores and subscale scores (t = -3.358 ~ -6.870, p < 0.05). Second, correlation analysis showed that more severe symptoms of ASD at follow-up were associated with lower LUI-Mandarin Total scores (r = -0.489 ~ -0.853, p < 0.05), and better language performance of Gesell (r = 0.555, p < 0.05). In addition, increased proportions of supported JE(SJE) state (r = 0.591, p < 0.05) were associated with higher LUI-Mandarin Total scores, while increased proportions of unengaged (UE) state were associated with lower LUI-Mandarin Total scores (r = -0.295, p < 0.05) for the ASD group. Third, diverse multiple regression algorithms consistently indicated that the proportions of SJE during parent-child interactions was a significant contributor to pragmatic development for the ASD group in the prediction models.
Conclusion
In summary, our findings suggest that pragmatic language difficulties are present in children with ASD as early as preschool age. Additionally, given the close correlation between the LUI-Mandarin and symptom severity on ADOS/ADI-R, the LUI-Mandarin might be a good way to triage children who need to wait a long time for a more extensive evaluation. Furthermore, more time occupied in SJE could be an important predictor for better pragmatic language outcomes for children with ASD.
Glioma Subtype Prediction Based on Radiomics of Tumor and Peritumoral Edema under Automatic Segmentation
Authors: Sun Xiangyu , Li Sirui , Ma chao , Fang wei , Jing Xin , Yang Chao , Li Huan , Zhang Xu , Ge chuanbin , Liu bo , Li Zhiqiang
Published: August 2024

Comprehensive and non-invasive preoperative molecular diagnosis is important for prognostic and therapy decision-making in adult-type diffuse gliomas. We developed a deep learning method for automatic segmentation of brain gliomas directly from conventional magnetic resonance imaging (MRI) scans of the tumor core and peritumoral edema regions. Three-dimensional volumes of interest were obtained using the segmentation method and radiomic features were extracted. We developed a subtype prediction model based on extracted radiomic features and analyzed significance and correlations between glioma morphological characteristics and pathological features using data from patients with adult-type diffuse glioma. The automated segmentation achieved mean Dice scores of 0.884 and 0.889 for the tumor core and whole tumor, respectively. The area under the receiver operating characteristic curve for the prediction of adult-type diffuse gliomas subtypes was 0.945. "Glioblastoma, IDH-wildtype", "Astrocytoma, IDH-mutant", and "Oligodendroglioma, IDH-mutant, 1p/19q-coded" showed AUCs of 0.96, 0.914, and 0.961, respectively, for subtype prediction. Glioma morphological characteristics, molecular and pathological levels, and clinical data showed significant differences and correlations. An automatic segmentation model for gliomas based on 3D U-Nets was developed, and the prediction model for gliomas built using the parameters obtained from the automatic segmentation model showed high overall performance.
Reversible splenial lesion syndrome induced by paracetamol and lithium: two case reports
Authors: Zhou Xin , Zhang Chunhua , Zhou Liming , Zhou Leliang , Zou Yongbiao
Published: August 2024

Background: Reversible splenial lesion syndrome (RESLES) is a rare neurological syndrome characterized by a reversible lesion in the splenium of the corpus
callosum (SCC). Various etiologies, such as infection, high-altitude cerebral edema, seizures, antiepileptic drug (AED) withdrawal, and metabolic abnormalities, are involved in the development of RESLES. However, few studies have reported the occurrence of this disorder associated with medications, particularly paracetamol, which has not yet been documented.
Case presentation: A 50-year-old man with neuropsychiatric symptoms who was receiving increased doses of paracetamol was referred to our hospital. The patient fully recovered 8 days after treatment. The second case involved a 35-year-old female who received 1500 mg/day lithium and 500 mg/day quetiapine for bipolar disorder (BD). She experienced generalized tremor, rigidity, dysarthria, high fever, hypertension, tachycardia, and tachypnea. Symptoms and brain lesions fully resolved two weeks after discontinuation of lithium. Brain magnetic resonance imaging (MRI) in both patients typically demonstrated a reversible lesion with transiently reduced diffusion in the SCC.
Conclusion: RESLES is a rare finding that is usually incidentally detected. Therefore, MRI should be performed to evaluate SCC in patients taking excessive medication who present with neuropsychiatric symptoms.
Exploring the Determinants of High-risk Fertility Behavior among Child bearing Women in Somaliland: Insights from Somaliland Demographic and Health Survey, 2020
Authors: Abdikarim Hodo , Muse Abdisalam Hassan , Chesneau Christophe
Published: August 2024

Purpose
The purpose of this study was to investigate the determinants of high-risk fertility behaviors in Somaliland using data from the nationally representative Somaliland Demographic and Health Survey (SLHDS). This was done in accordance with Sustainable Development Goal (SDG) 3, specifically Indicator 3:1 which aims to reduce the maternal mortality ratio to less than 70 per 100,000 live births.
Patients and Methods:
The study utilized the SLHDS data, which provided information on a wide range of health and demographic indicators. The data were collected through self-reported surveys conducted in both urban and rural areas. Descriptive statistics, including mean, frequency, and percentage, were computed, and bivariate and multivariable binary logistic regression analyses were performed to assess the associated factors of high-risk fertility behaviors.
Results
The analysis revealed significant associations between high-risk fertility behaviors and various individual-level and community-level variables. Individual-level factors included maternal age group, maternal and husband education levels, contraceptive use, and child-related variables. Community-level factors encompassed residence, region, household size, mass media exposure, household wealth status, toilet facility, water source, and access to healthcare services. However, the study acknowledged the presence of social desirability and recall biases due to the self-reported nature of the survey. Some important variables had to be removed from the analysis due to data incompleteness and inappropriateness.
Conclusion
This study sheds light on the determinants of high-risk fertility behaviors in Somaliland, providing valuable insights for policymakers and healthcare professionals. The findings underscore the need for targeted interventions and reproductive health programs that address individual-level and community-level factors. Future research should employ rigorous data collection methods to minimize biases and explore additional factors that may influence high-risk fertility behaviors in the context of Somaliland.
Oral Microbiota Associated with Clinical Efficacy of Ustekinumab in Crohn’s disease
Authors: Xu Feiyang , Xie Rui , He Le , Wang Honggang , Zhu Yifan , Yang Xiaozhong , Yu Huiming
Published: August 2024

Crohn’s disease (CD) is a chronic inflammatory gastrointestinal disease. Ustekinumab (UST) has been utilized as a therapeutic option for CD patients. However, approximately 40–60% of patients exhibit an inadequate response to UST. Accumulating evidence has confirmed the involvement of oral bacteria in the development of CD. Nevertheless, the relationship between oral microbiota and the efficacy of UST therapy in CD patients has remained unexplored. We recruited 28 healthy controls (HC) and 53 CD patients, 47 of whom completed the entire UST therapy. Oral samples and clinical data were collected. The clinical response and clinical remission were defined based on the CDAI score. Oral samples were analyzed by 16S rRNA gene sequencing. The analysis of sequence data was performed by QIIME and R. We revealed the oral microbial difference between the HC group and the CD group. The enrichment of Fusobacteria, Leptotrichia, Capnocytophaga, and Campylobacter, and the diminution of Haemophilus and Rothia, were observed in the CD group. Differences in oral microbiota were also identified among patients with different efficacy of UST. Compared to response group and remission group, a significantly higher abundance of Fusobacteria and Leptotrichia was identified both in nonresponse group and nonremission group. Predictive models for clinical response and clinical remission in UST were constructed based on oral microbiota, with the AUC value of 0.944 and 0.930, respectively. Oral microbiota was relevant to the UST efficacy in patients with CD based on the predictive model. It could be considered a non-invasive prognostic biomarker for UST therapy in CD patients.
Dynamic changes in hs-CRP and risk of all-cause mortality among middle-aged and elderly adults: Findings from A nationwide prospective cohort and mendelian randomization
Authors: Wang Zhonghai , Xiong Feng , Zhang Quanbo , Wang Han
Published: August 2024

Introduction
The general population experiences mortality rates that are related to high levels of high-sensitivity C-reactive protein (hs-CRP). We aim to assess the linkage of longitudinal trajectories in hs-CRP levels with all-cause mortality in Chinese participants.
Methods
We utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The exposures were dynamic changes in the hs-CRP and cumulative hs-CRP from 2012 to 2015, and the outcome was all-cause mortality. All participants were categorized into four trajectories according to hs-CRP levels. Multivariable logistic regression analysis, adjusted for potential confounders, was employed to evaluate the relationship of different trajectories of hs-CRP with mortality risk. A two-sample Mendelian randomization (TSMR) method and SHapley Additive exPlanations (SHAP) for identifying determinants of mortality risk were also employed.
Results
The study included 5,445 participants with 233 deaths observed, yielding a mortality rate of 4.28%. Compared to individuals maintaining low, stable levels of hs-CRP (Class 1), individuals with sustained elevated levels of hs-CRP (Class 4), those experiencing a progressive rise in hs-CRP levels (Class 2), or those transitioning from elevated to reduced hs-CRP levels (Class 3) all faced a significantly heighted death risk, with adjusted Odds Ratios (ORs) ranging from 2.34 to 2.47 across models. Moreover, a non-linear relationship was found between them. Further TSMR analysis also supported these findings. SHAP showed that hs-CRP was the fifth most important determinant of mortality risk.
Conclusions
In China, all-cause mortality increases with dynamic changes in hs-CRP levels. And cumulative hs-CRP shows an L-shaped relationship with all-cause mortality.
Prevalence and Clinical Characteristics of Myelinated Retinal Nerve Fibers in a Healthy Population: A Big-data Analysis
Authors: Pan Zhe , Gong Linyun , Chen Dongning , Xu Jie , Xue Cancan , Xian Haocheng , Dai Jinyue , Zhang Chun
Published: August 2024

Objective: To analyze the prevalence, clinical characteristics, and related factors of myelinated retinal nerve fibers (MRNFs) in a community-based cohort.
Methods: From March 2017 to June 2020, a total of 10,341 adults undergoing health examinations at Beijing Tongren Hospital received comprehensive systemic and basic eye examinations. Diagnosis of MRNFs was conducted using fundus photography.
Results: Excluding 97 blurred fundus photographs, the final population was 10,244 participants. The average age was 49.5±14.8 years, with 6,225 females (60.8%). 66 patients were diagnosed with MRNFs, showing a prevalence of 0.6±0.3%. In the 73 affected eyes of 66 patients, a total of 86 MRNFs lesions were found, with 64 eyes (87.7%) having a single lesion and 9 eyes (12.3%) having multiple lesions. A significant positive correlation was observed between the prevalence of MRNFs and elevated systolic blood pressure (P=0.025, OR: 1.014). Two eyes had extensive MRNFs connected to the optic disc, but not involving the macular fovea. The visual acuity of the affected eyes was 1.0.
Conclusions: In community-based study in healthy Chinese population, MRNFs were found in 0.6% of cases. They were linked to increased systolic blood pressure. Extensive MRNFs can work for normal visual function while they uncover the macular fovea.
Soil Profile Re-engineering Doubled the Yield and Water Use Efficiency of Crops over Six Years on Acidic and Compacted Sand in a Water-limited Environment
Authors: Azam Gaus , Rahman Md Shahinur , Scanlan Craig , Rahman Md Hasinur , Gazey Ross , Gazey Chris
Published: August 2024

Subsoil acidity and compaction commonly hinder the water use efficiency (WUE) of agricultural crops around the world. Over six years, a field experiment was conducted in south-western Western Australia (s-w WA) to examine the effects of soil re-engineering (loosening and lime incorporation) on the root architecture, yield, and WUE of wheat and barley. Treatments included an untreated control, soil loosening to a depth of 0.45 m and lime incorporation at three depths combined with loosening (0.45 m). Loosening reduced subsoil strength, while liming quickly decreased acidity, which was maintained for six years. In the control plots, roots were confined to the top 0.3 m of soil. Loosening alone significantly enhanced wheat root architecture but had no effect on barley. However, loosening with liming tripled the rooting depth and density for both crops, creating a more uniform root distribution. Loosening with lime incorporation to 0.45 m depth significantly boosted yield and WUE by up to 3.7-fold. Crop yields in re-engineered plots often met or exceeded two of the three yield frontiers (estimated yield potential from models applicable to s-w WA). These findings suggest that strategic deep tillage and liming can sustainably improve WUE in water-limited environments through better soil management.
Bile lakes in patients with biliary atresia who presented with jaundice-free native liver survival indicating the risk of subsequent liver transplantation due to various factors
Authors: Gohda Yousuke , Uchida Hiroo , Sumida Wataru , Shirota Chiyoe , Tainaka Takahisa , Makita Satoshi , Satomi Miwa , Yasui Akihiro , Kato Daiki , Maeda Takuya , ishii Hiroki , Ota Kazuki , Guo Yaohui , Liu Jiahui , Hinoki Akinari
Published: August 2024

Purpose
The prognostic factors of subsequent liver transplantation (LT) in patients with biliary atresia (BA) who presented with jaundice-free native liver survival were investigated.
Methods
This study retrospectively reviewed patients who underwent portoenterostomy (PE) for BA. Patients with jaundice-free native liver survival at 1 year postoperatively were divided into the autologous liver survivor and liver transplant recipient groups. Peri- and postoperative data were compared between the two groups.
Results
Among 97 patients with BA, 29 who received LT within 1 year after PE were excluded from the analysis. Further, 48 patients currently living with native liver and 20 who received LT after 1 year postoperatively were compared. Bile lake (BL) was the strongest risk factor of LT. The risk score was \(\:2.38*BLscore+0.00466*TBA\), and the area under the receiver operating characteristic curve was 0.83. Patients with BL and those without significantly differed in terms of the native liver survival rate. Patients with BL who presented with not only cholangitis but also gastrointestinal hemorrhage and hepatopulmonary syndrome received LT.
Conclusion
BL can cause different pathologies. Moreover, it is an evident risk factor of subsequent LT in patients with BA who are living with native liver at 1 year after PE.
Microglial process convergence onto injured axonal swellings, a human postmortem brain tissue study
Authors: Logan-Wesley Amanda L. , Gorse Karen M. , Lafrenaye Audrey D.
Published: August 2024

Traumatic brain injury (TBI) affects millions globally, with a majority of TBI cases being classified as mild, in which diffuse pathologies prevail. Two of the pathological hallmarks of TBI are diffuse axonal injury and microglial activation. While progress has been made investigating the breadth of TBI-induced axonal injury and microglial changes in rodents, the neuroinflammatory progression and interaction between microglia and injured axons following brain injury in humans is less well understood. Our group previously investigated microglial process convergence (MPC), in which processes of non-phagocytic microglia directly contact injured proximal axonal segments, in rats and micropigs acutely following TBI. These studies demonstrated that MPC occurred on injured axons in the micropig, but not in the rat, following diffuse TBI. While it has been shown that microglia co-exist and interact with injured axons in humans post-TBI, the occurrence of MPC has not been quantitatively measured in the human brain. Therefore, in the current study we sought to validate our pig findings in human postmortem tissue. We investigated MPC onto injured axonal swellings and intact myelinated fibers in cases from individuals that sustained a TBI and control human brain tissue using multiplex immunofluorescent histochemistry. We found an increase in MPC onto injured axonal swellings, consistent with our previous findings in micropigs, indicating that MPC is a clinically relevant phenomenon that warrants further investigation.
Inequities in food access during the COVID19 pandemic: a multilevel, mixed methods pilot study
Authors: Aepala Megha R. , Guan Alice , Cruz Tessa , Sowell Jamaica , Mattias Brenda , Lin Katherine , Hassberg Analena Hope , Shariff-Marco Salma , DeRouen Mindy C. , Akom Antwi
Published: August 2024

Background
Innovative data integration may serve to inform rapid, local responses to community needs. We conducted a mixed methods pilot study among communities of color or low-income in the San Francisco Bay Area amid the COVID-19 pandemic to assess a hypothesized data model to inform rapid response efforts.
Methods
Between 2020–2021, we collected (1) qualitative data through neighborhood reports submitted via Streetwyze, a mobile neighborhood mapping platform; (2) survey data on social and economic circumstances; and (3) geospatial data among residents of three counties. Qualitative data were coded and then integrated with survey and geospatial data. We used descriptive analyses to examine participants’ experiences with food in their neighborhoods.
Results
Seventy percent of participants reported food insecurity before and after the pandemic began in March 2020. Within neighborhood reports, food was the most frequently occurring sub-theme within the Goods and Resources parent themes (68% and 49% of reports, respectively). Security (88%), resource programs (88%), outdoor space (84%), and equity (83%) were more likely to be mentioned by participants who were food insecure compared to those who were not (12%, 12%, 16%, 17%, respectively). Mentions of food in neighborhood reports more often occurred in census tracts with lower socioeconomic status and more area-level food insecurity.
Conclusion
Individuals who were food insecure reported a constellation of needs beyond food, including needs related to safety and greater social equity. Our data model illustrates the potential for rapid assessment of community residents’ experiences to provide enhanced understanding of community-level needs and effective support in the face of changing circumstances.