bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation Between Low Platelet‐to‐Lymphocyte Ratio and High Mortality Rates in Adult Trauma Patients With Moderate‐to‐Severe Brain Injuries
Authors: To Kang-Wei , Hsu Shiun-Yuan , Yu Chia-Ying , Tsai Yu-Chin , Lin You-Cheng , Hsieh Ching-Hua 
Published: December 2024

Background: White blood cell (WBC) subtypes reflect immune and inflammatory conditions in patients. This study aimed to examine the association between the ratio of platelets to WBC subtypes and mortality outcomes in patients with moderate‐to‐severe traumatic brain injury (TBI).Method: The Trauma Registry System of the hospital was retrospectively reviewed to gather medical records of 2397 adult patients who were hospitalized from 2009 to 2020 and had moderate‐to‐severe TBI with a head abbreviated injury scale (AIS) score of 3 or higher. The monocyte‐to‐lymphocyte ratio (MLR), neutrophil‐to‐lymphocyte ratio (NLR), and platelet‐to‐lymphocyte ratio (PLR) were compared between the survivors (n = 2, 138) and nonsurvivors (n = 259). A multivariate logistic regression analysis was performed to investigate the independent effects of the univariate prognostic factors on mortality outcomes. The survival variations among the PLR subgroups were evaluated by the Kaplan–Meier survival analysis including a log‐rank test.Results: The PLR of the deceased patients was considerably lower than that of the survivors (129.5 ± 130.1 vs. 153.2 ± 102.1, p < 0.001). However, no significant differences were observed in monocyte and neutrophil counts, MLR, or NLR between the deceased and survivor groups. A lower PLR was recognized as an independent risk factor for mortality (odds ratio: 1.26, 95% confidence interval: 1.06–1.51, p = 0.010). The receiver operating characteristic (ROC) established PLR as the most strong predictor among the three ratios (area under the ROC curve = 0.627, sensitivity = 0.846, and specificity = 0.382, according to the cut‐off value = 68.57). When the patient groups were divided by PLR quartile, the Kaplan–Meier analysis showed significantly worse survival in the lowest PLR quartile group (< 83.1) compared with the highest quartile group (≥ 189.1) (p < 0.001).Conclusion: Lower PLR is associated with greater mortality in adult patients with moderate‐to‐severe TBI. PLR may be a valuable measure for classifying mortality risk in this population.
Age Characteristics of Patients With Type 2 Diabetic Foot Ulcers and Predictive Risk Factors for Lower Limb Amputation: A Population‐Based Retrospective Study
Authors: Yao Yuanying , Chen Lei , Qian Yu 
Published: December 2024

Background: Limited data are available about the epidemiological characteristics and the risk factors for amputation, particularly in developing countries from Asia, especially in China.Objective: We aim to investigate the age features of patients with Type 2 diabetic foot ulcers (DFUs) and analyze the critical influencing factors predicting lower extremity amputation and major amputation.Methods: Data were retrieved from the electric medical record system to identify patients aged > 18 years with Type 2 DFU from January 1, 2017, to December 31, 2023. A logistic regression model was adopted to analyze the risk factors for amputation and major amputation.Results: Nine hundred eighteen patients with Type 2 DFU were eligible for our study, 68.2% of whom were male. In patients with Type 2 diabetes in the hospitals we studied, the prevalence of Type 2 DFU was 1.07%. A majority of patients with DFU were in the 70–79 age group in the winter season, and deaths also peaked in this age group. A total of 38.8% of patients aged 50–59 years underwent amputation. Vascular CTA, complications, history of amputation, and infection sites were the important contributing factors in patients with DFU lower extremity amputation. History of amputation and hemoglobin were the main influencing factors of patients with major amputation resulting from DFU.Conclusion: Most patients with DFU were in the age group of 50–59 years, but the majority of deaths occurred in the 70–79‐year age group. Several factors influence the amputation, and those findings provide new insights into the relationship between the severity of narrowed blood vessels and the likelihood of amputation.
The Effect of a Non-Surgical Adhesive Bone Conduction Device on Temporal Processing Performance in Adults with Single Sided Deafness: A Pilot Study
Authors: Qi Li , Hui Elizabeth , Nunez Desmond A. 
Published: December 2024

Background There is a dearth of information on the effects of bone conductive devices on temporal processing in individuals with single-sided deafness (SSD). This study investigates the effect of an adhesive bone conductive device on temporal processing in adults with SSD. Methods A prospective cohort study of temporal processing in adults with SSD was undertaken. Outcome measures were the pitch pattern test (PPT) and the duration pattern test (DPT) scores, sound field pure tone audiometric (PTA) averaged hearing thresholds, and word recognition scores (WRS). These were measured under 3 conditions: unaided in quiet, unaided in noise, and aided in noise. Eight SSD novice hearing amplification users were recruited. Results The adhesive bone conduction device (BCD) resulted in a statistically-significant improvement (Wilcoxon signed ranks test, P = .018) in median [interquartile range (IQR)] PPT score, 65% (IQR = 35.5), and DPT score, 38% (IQR = 42.5) in noise. Conclusions Adults with SSD demonstrated improved temporal processing scores with masking of the normal-hearing ear when using an adhesive BCD placed behind the deafened ear.
Susceptibility of various Gram-negative bacteria to antibacterial agents: SMART in China 2019–2020
Authors: Fu Ying , Chen Yueliang , Wang Yanfei , Yao Bingyan , Li Pengcheng , Yu Yunsong 
Published: December 2024

Abstract
Background
The Study for Monitoring Antimicrobial Resistance Trends (SMART) is an international surveillance program longitudinally monitoring aerobic and facultative Gram-negative bacteria (GNB) involvement in infections and their antimicrobial resistance profiles. Here the incidence and resistance patterns of Chinese GNB isolates from bloodstream infections (BSI), intraabdominal infections (IAI), respiratory tract infections (RTI) and urinary tract infections (UTI) to commonly used antibacterial agents has been updated. 4,975 GNB isolates collected from 22 hospitals across 7 regions of China from 2019 to 2020 were analyzed. Antimicrobial minimum inhibitory concentrations were assessed using broth microdilution, and susceptibility interpretations followed the breakpoints of European Committee on Antimicrobial Susceptibility Testing 2022 or Clinical and Laboratory Standards Institute.

Results
This study affirmed that Escherichia coli (Ec) was the most commonly identified GNB (32.1%) and then Klebsiella pneumoniae (Kp) (25.3%), Pseudomonas aeruginosa (Pa) (13.9%) and Acinetobacter baumannii (10.5%). The detection rates of carbapenem-resistant (CR) Enterobacterales varied across major infection sites, ranging from 10.3% in UTI to 18.9% in RTI. Specifically, the detection rates of CR-Kp and CR-Pa ranged from 16.2% in IAI to 35.8% in UTI and from 16.1% in UTI to 38.0% in RTI, respectively. Extended-spectrum β-lactamases (ESBL)-producing Ec and Kp bacteria exhibited over 91.7% susceptibility to carbapenems and at least 87.8% susceptibility to amikacin and colistin, but showed lower susceptibility to piperacillin/tazobactam (57.5–86.2%), levofloxacin (10.8–39.7%) and aztreonam (15.3–27.6%) across different infection sources. Amikacin showed higher efficacy against CR strains compared to other commonly used antibacterial drugs, with 80.0% susceptibility against CR-Ec and 82.3% susceptibility against CR-Pa, while only 36.3% susceptibility was observed against CR-Kp.

Conclusions
The study found varying incidences of CR isolates in Chinese hospitals. Treatment options remained limited due to resistance to multiple antibacterial agents. Carbapenems demonstrated effective antimicrobial in vitro activity against ESBL-producing Enterobacterales found in BSI, IAI, UTI and RTI, outperforming broad-spectrum cephalosporins and other β-lactamase inhibitors.
Pericardial effusion in an Indian context: clinical insights and dynamics from a tertiary care centre
Authors: Shaik Nafeez Javed , Hegde Sindhu Sujeeth , Seshadri Shubha , Cherukuri Mounika 
Published: December 2024

Abstract
Background
Pericardial effusion (PE) indicates the build-up of fluid within the pericardial sac, which encases the heart. The present study was undertaken to assess the clinical profile, etiology of pericardial effusion and to determine the correlation of cardiac tamponade and constrictive pericarditis with etiology.

Methods
A prospective observational hospital based longitudinal study was undertaken among the 88 newly diagnosed and known patients of pericardial effusion who are above 18 years. The clinical profile of pericardial effusion including history, examination, standard lab parameters routinely done including thyroid function tests, HIV Serology, ECG, Echocardiography and imaging if done (HRCT thorax), pericardial fluid analysis (if performed) were elicited.

Results
Majority of the patients were males (55.7%), with a mean age of 51.3 years. Among the 88 patients of pericardial effusion, 20 had cardiac tamponade, 13 individuals were diagnosed with constrictive pericarditis. Dyspnea was the most common presenting complaint (65.9%). Chronic kidney disease / uremia is the most common cause of pericardial effusion accounting for 25%, followed by neoplastic (20.5%) and tuberculosis (17%). While in cardiac tamponade patients neoplasm followed by tuberculosis were the most common etiology, patients with constrictive pericarditis had tuberculosis followed by chronic kidney disease as the most common etiology. Echocardiography features were not significantly different according to the etiology of the pericardial effusion (p > 0.05). Thickened pericardium found in the echocardiography showed maximum specificity (76.9%), while thickened fluid/exudates showed maximum sensitivity (65.2%) and negative predictive value (77.1%) for tuberculous pericardial effusion.

Conclusion
Chronic kidney disease, closely followed by infections (mostly tuberculosis), are the frequent causes of PE in the present settings. Breathlessness is the most frequent clinical feature in the patients of PE. Fibrin strands, thickened pericardium, thickened fluid in Echocardiography assists in diagnosing tubercular pericardial effusion. Cardiomegaly in chest X-ray or CT scans should further prompt towards diagnosing pericardial effusion. It is essential to incorporate these findings into the clinical practice, by evaluating the patients presenting with breathlessness for PE. CKD needs to be placed on par with tuberculosis while suspecting the etiology of the PE in the present settings. ADA levels in pericardial fluid (> 40) can be considered as a specific marker for tubercular PE.
Comparison of INTERGROWTH- 21st and Fenton growth standards to assess size at birth and at discharge in preterm infants in the United Arab Emirates
Authors: Cheikh Ismail Leila , Mohamad Maysm N. , Ohuma Eric O. , ElHalik Mahmoud S. , Dash Swarup K. , Osaili Tareq M. , Hasan Hayder , Hashim Mona , Saleh Sheima T. , Daour Rameez Al , Parker Simon R. , Ali Habiba I. , Stojanovska Lily , Al Dhaheri Ayesha S. 
Published: December 2024

Abstract
Background
Accurate growth assessment of preterm infants is essential in guiding medical care and suitable nutritional interventions. Currently, different growth references are used across hospitals in the United Arab Emirates (UAE). This study aims to compare the INTERGROWTH-21st standards with Fenton growth references regarding birth size classification and at the time of discharge in a sample of preterm infants in the UAE.

Methods
A retrospective single-center evaluation of medical records of infants born < 37 weeks of gestation was conducted using data from 2018 to 2020. Anthropometric measurements (weight, length, and head circumference) were obtained at birth and at the time of discharge, and then converted to percentiles according to the two reference standards.

Results
A total of 1537 infants with a median birth gestation of 35.3 weeks, and a median birthweight of 2320 g were included. The rates of SGA, AGA, and LGA at birth were 11.5%, 80.42%, and 9.08% using INTERGROWTH-21st growth charts compared to 9.5%, 83.2%, and 7.3% respectively according to Fenton charts. The findings indicated statistically significant differences between the two growth charts classifying of preterm infants based on weight, length, and head circumference (p < 0.05). For every 5 cases assessed as SGA at discharge according to Fenton charts, only 3 were classified as SGA by INTERGROWTH-21st curves.

Conclusions
Differences exist between the two growth charts with only moderate agreement. Thus, there is a need for harmonizing growth assessment standards. Misclassification of these vulnerable infants would affect their in-hospital and post-discharge nutrition and medical care plan.
Exploring mHealth app utilization for diabetes self-management: survey insights from a northern district in Malaysia
Authors: Supramaniam Premaa , Beh Ying-Shan , Junus Suria , Devesahayam Philip Rajan 
Published: December 2024

Abstract
Background
Mobile health applications (mHealth apps) offer potential benefits for improving diabetes management, such as better glucose monitoring and patient engagement, but their widespread adoption faces challenges, including privacy concerns and user adherence. This research investigates mHealth app usage among patients living with diabetes in Kinta District, Perak, exploring experiences, challenges and patient perceptions regarding diabetes management using mHealth apps.

Methodology
A cross-sectional community survey was conducted in September till November 2020 across nine government health clinics focusing on diabetes mellitus (Type 1 or Type 2) patients, aged 18 years and older, receiving Diabetes Medication Adherence Counseling (DMTAC) services and able to use smart devices. A self-developed questionnaire with four sections was used to gather demographic information, explore mHealth apps usage and understand both users and non-users’ experiences and perceptions. The questionnaire was tested through cognitive debriefing, translated into Malay, pre-tested and finalized by the expert committee. The questionnaire was digitally implemented using Google® Form and QR code. After obtaining informed consent, data collection was performed by the trained DMTAC pharmacists. Statistical analyses involved descriptive and inferential analyses.

Results
The study analyzed the engagement of 295 patients living with diabetes with mHealth apps. Females (54.9%), of Malay ethnicity (58.3%) and with a mean age of 53.8 years (SD: 12.38) constituted the majority. Diabetes duration had a median of 6 years (IQR: 3.0, 10.0) with prevalent comorbidities like hypertension (58.0%) and dyslipidemia (42.7%). Most patients were employed (44.7%) and their primary source of diabetes management information was through healthcare providers (92.5%). Despite the high app use for social interaction, only 13.6% used mHealth apps for disease management. Users were influenced by social media (65.0%) and favored for wellness apps and disease monitoring. Users perceived the mHealth app as useful (97.5%), yet faced challenges over the app initiation, charges and data security. Non-users cited lack of awareness (70.2%), struggled with app startup (22.4%) and preference for conventional healthcare visits (22.0%). In multivariable analysis, longer diabetes duration reduced mHealth app usage (p = 0.046), while multimorbidity increased the likelihood (p = 0.001). Awareness of the availability of health apps significantly influenced the usage of mHealth apps (p < 0.001).

Conclusion
The findings highlight the underutilization of mHealth apps for diabetes management despite their perceived usefulness. Challenges faced by users and non-users underscore the need for more awareness, thus encourage widespread acceptance and usage of mHealth apps in diabetes care.
Simoultaneous bilateral medial opening wedge high tibial osteotomy can be performed safely and effectively without bone grafting: analysis of a monocentric retrospective series
Authors: Screpis Daniele , Baldini Marco , Piovan Gianluca , Santamaria Fabio , Iacono Venanzio , Gigante Antonio , Zorzi Claudio 
Published: December 2024

Abstract
Background
Simultaneous bilateral high tibial osteotomy (SBHTO) is a potential solution to treat bilateral medial osteoarthritis (OA) associated with tibial varus deformity. Concerns on the potential problems related to bone healing exists, and most of the surgeon performing SBHTO use bone void filler as associated procedure.
This paper aim to evaluate safety and efficacy of SBHTO using locking plate, autologous cancellous bone mobilization and no bone void filler with immediate weight bearing at tolerance protocol.

Methods
Consecutive patients performing primary SBHTO between January 2019 and December 2022 were retrospectively evaluated. Functional and pain score, subjective satisfaction and complications were noted at 2, 3, 6 months and final follow up, with a minimum of 12 months.

Results
A total of 40 patients (80 knees) were included. Mean correction for each limb was 8.67° ± 2.24°. No patients presented with major complications. Pain was reduced but activity level worsened 2 months after surgery. All pain and functional scores improved significantly from months 3 up to final follow up. 95% of patients reported to be subjectively satisfied with surgery.

Conclusions
This paper showed that SBHTO can be performed safely and with good results without bone grafting the osteotomy gap, even for correction up to 12°. Pain improved already 2 months after surgery, while activity level and function start to improve at 3 months after surgery.

Level of evidence
IV.
The therapeutic effects of probiotics on core and associated behavioral symptoms of autism spectrum disorders: a systematic review and meta-analysis
Authors: Lee Jen-Chin , Chen Chia-Min , Sun Cheuk-Kwan , Tsai I-Ting , Cheng Yu-Shian , Chiu Hsien-Jane , Wang Ming Yu , Tang Yen-Hsiang , Hung Kuo-Chuan 
Published: December 2024

Abstract
Background
We aimed at investigating the efficacies of probiotics in alleviating the core and associated symptoms of autism spectrum disorder (ASD).

Methods
Randomized placebo-controlled trials were identified from major electronic databases from inception to Nov 2023. The outcomes of interests including improvements in the total and associated symptoms of ASD were quantitatively expressed as effect size (ES) based on standardized mean difference (SMD) with 95% confidence interval (CI).

Results
Ten studies with 522 participants (mean age = 8.11) were included in this meta-analysis. The primary results revealed significant improvement in total symptoms in the probiotics group compared with the controls (SMD = − 0.19, p = 0.03, ten studies, n = 522) but not the core symptoms (i.e., repetitive restricted behaviors, As affiliations 3 and 5 are same, we have deleted the duplicate affiliations and renumbered accordingly. Please check and confirm.problems with social behaviors/communication). Subgroup analyses demonstrated improvement in total symptoms in probiotics users relative to their controls only in studies using multiple-strain probiotics (SMD = − 0.26, p = 0.03, five studies, n = 288) but not studies using single-strain regimens. Secondary results showed improvement in adaptation (SMD = 0.37, p = 0.03, three studies, n = 139) and an improvement trend in anxiety symptoms in the probiotics group compared with controls (SMD = − 0.29, 95% CI − 0.60 to 0.02, p = 0.07, three studies, n = 163) but failed to demonstrate greater improvement in the former regarding symptoms of irritability/aggression, hyperactivity/impulsivity, inattention, and parental stress.

Conclusions
Our study supported probiotics use against the overall behavioral symptoms of ASD, mainly in individuals receiving multiple-strain probiotics as supplements. However, our results showed that probiotics use was only associated with improvement in adaptation and perhaps anxiety, but not core symptoms, highlighting the impact of adaptation on quality of life rather than just the core symptoms. Nevertheless, the limited number of included trials warrants further large-scale clinical investigations.
Utilising artificial intelligence for cultivating decorative plants
Authors: Salybekova Nurdana , Issayev Gani , Serzhanova Aikerim , Mikhailov Valery 
Published: December 2024

Abstract
Background
The research aims to assess the effectiveness of artificial intelligence models in predicting the risk level in tulip greenhouses using different varieties. The study was conducted in 2022 in the Almaty region, Panfilov village.

Results
Two groups of 10 greenhouses each (area 200 m2) were compared: the control group used standard monitoring methods, while the experimental group employed AI-based monitoring. We applied ANOVA, regression analysis, Bootstrap, and correlation analysis to evaluate the impact of factors on the risk level. The results demonstrate a statistically significant reduction in the risk level in the experimental group, where artificial intelligence models were employed, especially the recurrent neural network “Expert-Pro.” A comparison of different tulip varieties revealed differences in their susceptibility to risks. The results provide an opportunity for more effective risk management in greenhouse cultivation.

Conclusions
The high accuracy and sensitivity exhibited by the “Expert-Pro” model underscore its potential to enhance the productivity and resilience of crops. The research findings justify the theoretical significance of applying artificial intelligence in agriculture and its practical applicability for improving risk management efficiency in greenhouse cultivation conditions.