bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of intraoperative hypoxemia and hypoproteinemia as prognostic indicators in anastomotic leakage post-radical gastrectomy: an 8-year multicenter study utilizing machine learning techniques
Authors: Liu Yuan , Zhao Songyun , Shang Xingchen , Shen Wei , Du Wenyi , Zhou Ning 
Published: November 2024

BackgroundComplications and mortality rates following gastrectomy for gastric cancer have improved over recent years; however, complications such as anastomotic leakage (AL) continue to significantly impact both immediate and long-term prognoses. This study aimed to develop a machine learning model to identify preoperative and intraoperative high-risk factors and predict mortality in patients with AL after radical gastrectomy.MethodsFor this investigation, 906 patients diagnosed with gastric cancer were enrolled and evaluated, with a comprehensive set of 36 feature variables collected. We employed three distinct machine learning algorithms—extreme gradient boosting (XGBoost), random forest (RF), and k-nearest neighbor (KNN)—to develop our models. To ensure model robustness, we applied k-fold cross-validation for internal validation of the four models and subsequently validated them using independent datasets.ResultsIn contrast to the other machine learning models employed in this study, the XGBoost algorithm exhibited superior predictive performance in identifying mortality risk factors for patients with AL across one, three, and five-year intervals. The analysis identified several common risk factors affecting mortality rates at these intervals, including advanced age, hypoproteinemia, a history of anemia and hypertension, prolonged operative time, increased intraoperative bleeding, low intraoperative percutaneous arterial oxygen saturation (SPO2) levels, T3 and T4 tumors, tumor lymph node invasion, and tumor peripheral nerve invasion (PNI).ConclusionAmong the three machine learning models examined in this study, the XGBoost algorithm exhibited superior predictive capabilities concerning the prognosis of patients with AL following gastrectomy. Additionally, the use of machine learning models offers valuable assistance to clinicians in identifying crucial prognostic factors, thereby enhancing personalized patient monitoring and management.
The combined assessment of p16INK4a and Mib/Ki-67 in oral squamous cell carcinoma
Authors: Richter Maximilian , Doll Christian , Mrosk Friedrich , Hofmann Elena , Koerdt Steffen , Heiland Max , Neumann Konrad , Beck Marcus , Dommerich Steffen , Jöhrens Korinna , Raguse Jan-Dirk 
Published: November 2024

ObjectiveDespite numerous studies addressing the impact of p16INK4a in oral squamous cell carcinoma (OSCC), consistent data regarding survival and tumor proliferation behavior are lacking. Although some authors investigate both p16INK4a and Mib/Ki-67 in their cohorts, direct correlations are consistently missing. The aim of this study was to investigate the combined influence of p16INK4a and Mib/Ki-67 status on prognosis in OSCC.Materials and methodsClinical data of all patients diagnosed with OSCC and treated curatively between 2005 and 2011 were collected retrospectively. Tissue microarrays of formalin-fixed paraffin-embedded specimens were stained for p16INK4a and Mib/Ki-67 using the CINtec Histology V-Kit or MIB-1 antibody and correlated with the clinical outcome.ResultsA total of 316 patients, with a mean age of 61.7 years were included. Tumor tissues that were tested p16INK4a positive with low Mib/Ki-67 expression demonstrated a remarkable 5-year survival rate of 83% with an improved RFS compared to all other subgroups (p=0.034; p=0.017; p=0.026) and an improved OS compared to those with high Mib/Ki-67 expression (p=0.026; p=0.020). Cox regression identified the combined p16INK4a and Mib/Ki-67 status as a risk factor on OS (HR 6.25; CI1.26-31.0; p=0.025) and RFS (HR 5.88; CI1.19-29.20; p=0.030).ConclusionThese results underscore the importance of a combined assessment of p16INK4a and Mib/Ki-67 in evaluating the prognosis of OSCC, leading to the identification of distinct subgroups that may serve as risk factors for treatment stratification.
Transforming a hospital's organizational culture to promote parent-child relationships and child development
Authors: Benjamin Mariel , Quinn Carrie , Pressman Aliza , Fattah Layla , Parlakian Rebecca , Galinsky Ellen , Hammond Blair 
Published: November 2024

IntroductionEarly caregiving interactions and experiences profoundly shape a child's brain development. The American Academy of Pediatrics (AAP) recently advocated for a public-health approach to promoting safe, stable, nurturing relationships that is “founded on universal primary preventions”, including consistent messaging on fostering family resilience, nurturing connections, and positive childhood experiences. Hospitals have unique access to families with children ages 0–5 and therefore play a key role in supporting these early experiences. This project sought to shift the organizational culture of maternity and pediatric units at a hospital towards promoting early relationships and child development through a physical messaging campaign paired with staff training. This study examined whether the messaging campaign and staff training shifted staff's self-reported knowledge, attitudes, and behavior.MethodsNon-physician staff across six pediatric and maternity units in a large urban hospital participated in the intervention. Staff completed surveys before and after message installation and training.ResultsAnalysis of 356 pre-intervention surveys and 320 post-intervention surveys showed significant changes in staff's knowledge, attitudes, and behaviors that promote early learning and parent-child relationships. Most staff also reported feeling more empowered in their work (88%) and that the hospital environment had become a friendlier place for parents and families (89%).DiscussionA messaging and training intervention can create a culture whereby staff support early caregiving and child development in the hospital setting. Further research is needed to understand whether the intervention impacts caregivers and their children.
Case Report: Early-onset or recalcitrant cytopenias as presenting manifestations of activated PI3Kδ syndrome
Authors: Remiker Allison S. , Lopes Joao Pedro Matias , Jesudas Rohith , Superdock Alexandra , Park Nami , Pateva Irina 
Published: November 2024

BackgroundPatients with recurrent, chronic, or refractory cytopenias represent a challenging subgroup that may harbor an underlying diagnosis, such as an inborn error of immunity (IEI). Patients with IEIs such as activated phosphoinositide 3-kinase delta syndrome (APDS), frequently have hematologic manifestations, but these are not often reported as presenting symptoms. As a result, IEIs may be overlooked in patients presenting with early and/or recalcitrant cytopenias. Here, we describe the diagnostic journey and management of three patients who presented to a pediatric hematologist/oncologist with early-onset or recalcitrant cytopenias and were ultimately diagnosed with APDS.Case presentationsPatients presented with early-onset and/or refractory cytopenias, with two of the three developing multilineage cytopenias. Prior to an APDS diagnosis, two patients underwent a total of approximately 20 procedures, including biopsies, invasive endoscopies, and imaging, with one undergoing eight differential diagnoses that were ruled out through additional testing. Recalcitrant cytopenias, a history of infection, and a family history of lymphoproliferation, infection, or autoimmunity raised suspicion of an underlying IEI, leading to genetic testing. Genetic testing identified a pathogenic variant of PIK3CD in each patient, resulting in the diagnosis of APDS. Following these diagnoses, two patients underwent modifications in the management of care with the administration of intravenous immunoglobulin therapy (IVIG), the mTOR inhibitor sirolimus, or surgical procedures. These treatment modifications either improved or resolved the cytopenias. The third patient showed improvement in immune thrombocytopenia with IVIG 1 month prior to receiving a definitive diagnosis. Following diagnosis, follow-up genetic testing of family members led to the identification of additional cases of APDS.ConclusionsThese cases highlight the importance of early genetic evaluation in patients with early-onset or recalcitrant cytopenias and demonstrate the challenges of differential diagnosis. In addition, these cases demonstrate beneficial changes in management and outcomes that can follow a definitive diagnosis, including the identification of targeted treatment options. Collectively, this case series supports the notion that underlying IEIs should be considered in the workup of early-onset or recalcitrant cytopenias, particularly in patients who present with a combination of hematologic and immunologic manifestations that are refractory to treatment, manifest at an unusually young age, or can be tied to family history.
Successful tocilizumab treatment for rapidly progressive interstitial lung disease with anti-MDA5-positive juvenile dermatomyositis: a case report and literature review
Authors: Qiu Lingzhi , Shao Xiaoyan , Ma Le , Fan Zhidan , Yu Haiguo 
Published: November 2024

BackgroundCurrently, no established integrated treatment regimen exists for anti-melanoma differentiation-associated gene 5 (anti-MDA5)-positive juvenile dermatomyositis (JDM) complicated by rapidly progressive interstitial lung disease (RP-ILD). We present a case of refractory anti-MDA5-positive JDM with RP-ILD that was successfully treated using a combination of tocilizumab and plasma exchange, along with a review of the relevant literature.MethodsA literature review was conducted to gain insights into the clinical features and treatment strategies for managing refractory anti-MDA5-positive JDM complicated by RP-ILD.ResultsWe report a case of successful management of anti-MDA5-positive JDM complicated by RP-ILD using a combination of immunosuppressive agents, plasma exchange, and tocilizumab.ConclusionTocilizumab may serve as an effective adjunctive treatment option for patients with refractory anti-MDA5-positive JDM complicated by RP-ILD who do not respond to conventional intensive immunosuppressive therapies.
Population pharmacokinetics and dose optimization of ceftazidime in critically ill children
Authors: Li Mengting , Gao Liuliu , Wang Zuo , Zeng Lingkong , Chen Chen , Wang Jun , Li Sichan , Liu Maochang , Wang Yang 
Published: November 2024

ObjectiveThe aim of this study was to develop a population pharmacokinetic model for ceftazidime in critically ill children in the pediatric intensive care unit (PICU) and optimize an appropriate dosing regimen for this population.MethodsWe performed a prospective pharmacokinetic study on critically ill children aged 0.03–15 years. A population pharmacokinetic model was developed using the NLME program. Statistical and graphical methods were used to assess the stability and predictive performance of the model. Monte Carlo simulations were conducted to determine the optimal ceftazidime dosing regimen to achieve 70% fT &gt; minimum inhibitory concentration (MIC).ResultsThis study included 88 critically ill children and 100 ceftazidime serum concentrations. The pharmacokinetic characteristics of ceftazidime were best described by a one-compartment linear elimination model. The weight and estimated glomerular filtration rate (eGFR) were determinant covariates for the clearance (CL) of ceftazidime. The recommended ceftazidime dosage regimens achieved a probability of target attainment (PTA) &gt;90% for critically ill children at MIC values of 2, 4, and 8 mg/L. For bacterial infection at an MIC of 16 mg/L, it is difficult to achieve effective pharmacodynamic (PD) targets in vivo with the commonly used dose of ceftazidime.ConclusionThe population pharmacokinetic model of ceftazidime was established in critically ill children. Based on this model, we recommend evidence-based, individualized dosing regimens for subgroups with different weights and renal functions. The current daily dosage for children adequately meets the treatment requirements for MICs of 2, 4, and 8 mg/L, while for bacterial infection at an MIC of 16 mg/L, an elevated dosage regimen may be required.Clinical Trial Registrationhttps://www.medicalresearch.org.cn/login, Identifier MR-42-22-000220.
Empagliflozin improves pressure-overload-induced cardiac hypertrophy by inhibiting the canonical Wnt/β-catenin signaling pathway
Authors: Yuan Xun , Pan Li , Zhang Chi , Zhu Qiulian , Huang Zexin , Qin Yuan , Zhang Guiping , Feng Zhimei , Yang Caixian , Hou Ning 
Published: November 2024

BackgroundEmpagliflozin (EMPA) is an SGLT-2 inhibitor that can control hyperglycemia. Clinical trials have indicated its cardio-protective effects against cardiac remodeling in diabetes or non-diabetes patients. However, the underlying molecular mechanisms of EMPA’s cardio-protective effects remain elusive.MethodsWe evaluated whether the EMPA attenuated the pressure-overload-induced cardiac hypertrophy by inhibiting the Wnt/β-catenin pathway. Furthermore, the effects of the EMPA on a mouse model of transverse aortic constriction (TAC) induced cardiac hypertrophy was also evaluated. Mice were administrated with 0.5% CMC-Na as a vehicle or EMPA (10 mg/kg/day, daily, throughout the study) by intragastric gavage.ResultsThe in vivo echocardiography and histologic morphological analyses revealed that EMPA attenuated TAC-induced cardiac hypertrophy. Moreover, it also ameliorated TAC-induced cardiac fibrosis and decreased the cell size of the cardiomyocytes in isolated adult cardiomyocytes. Molecular mechanism analysis revealed that the EMPA reduced the TAC-induced enhanced expression of the Wnt/β-catenin pathway in vivo. For in vitro assessments, isolated neonatal rat cardiomyocytes (NRCMs) were treated with Angiotensin II (AngII) and EMPA; the results showed that in the absence of EMPA, the expression of the Wnt/β-catenin pathway was enhanced. In the trans-genetic heterozygous β-catenin deletion mice, EMPA attenuated TAC-induced cardiac remodeling by reducing the Wnt/β-catenin pathway. In addition, molecular docking analysis indicated that EMPA interacts with FZD4 to inhibit the TAC and AngII induced Wnt/β-catenin pathway in cardiomyocytes.ConclusionOur study illustrated that EMPA might directly interact with FZD4 to inhibit the TAC and AngII-induced activation of the Wnt/β-catenin pathway to attenuate the adverse cardiac remodeling.
Left atrial spatial entropy: a novel tool for electrophysiological substrate characterization in atrial fibrillation
Authors: Gigli Lorenzo , Preda Alberto , Coluzzi Davide , Sartore Marta , Vila Muhamed , Carbonaro Marco , Baroni Matteo , Varrenti Marisa , Vargiu Sara , Guarracini Fabrizio , Frontera Antonio , Pannone Luigi , Chierchia Gian Battista , De Asmundis Carlo , Mazzone Patrizio , Sassi Roberto 
Published: November 2024

BackgroundElectrical remodeling has been linked to the progression and recurrence of atrial fibrillation (AF) after catheter ablation (CA). Substrate mapping based solely on a voltage amplitude electrogram (EGM) does not provide a comprehensive understanding of the left atrial (LA) disease. The aim of this study is to assess left atrial spatial entropy (LASE) from voltage maps routinely obtained during AF ablation to further characterize the LA substrate.Materials and MethodsHigh-density electroanatomic maps (EAMs) of 27 patients with paroxysmal or persistent AF undergoing routine CA were prospectively collected. Computational post-processing was performed on the voltage maps. Using the Shannon entropy model, the probability distribution of the amplitude range values associated with each point of the map was used to measure LASE. Finally, correlations between LASE and clinical and electrophysiological characteristics of AF were explored.ResultsLASE differentiated between patients with paroxysmal and persistent AF (6.45 ± 0.41 vs. 5.87 ± 0.53; p = 0.028) and patients with normal and abnormal LA substrate (6.42 ± 0.42 vs. 5.87 ± 0.56; p = 0.043), independent of the basal rhythm during EM acquisition (6.33 ± 0.41 vs. 6.11 ± 0.63; p = 0.619). Accordance between LASE and EAMs was assessed by ROC analysis (AUC: 0.81; C.I.: 0.62–0.99; Youden index: 6.06; sensitivity: 80%; and specificity: 80%). Patients with the lowest LASE reported AF recurrence at the follow-up.ConclusionLASE may play a role in the further characterization of the LA substrate and the type of AF, independent of basal rhythm.
Validation of the Italian version of the Eating-Related Eco-Concern Questionnaire: insights into its relationship with orthorexia nervosa
Authors: Tecuta Lucia , Casu Giulia , Tomba Elena 
Published: November 2024

IntroductionUrgent calls for research on the relationship between climate change concerns and eating disorder risk have been made. This study aimed to validate an Italian version of the Eating-Related Eco-Concern Questionnaire (EREC), a brief unidimensional measure of eating behaviors related to eco-concern.MethodsSix hundred and sixty-three adults (85% females, mean age 37 ± 12 years) completed the EREC, Climate Change Worry Scale (CCWS), Eating Disorder Examination-Questionnaire (EDE-Q), Eating Habits Questionnaire for orthorexia nervosa symptoms (EHQ-21), and questions on dietary habits and motivations, and past experiences of extreme climate events.ResultsConfirmatory factor analysis results indicated that the original one-factor model showed acceptable fit to the data after including the error covariation between two pairs of items. Internal consistency was adequate, and EREC scores correlated positively and strongly with CCWS scores. Participants scored significantly lower in EREC than in CCWS, indicating greater climate-related concerns in general terms than relating specifically to eating. While EREC was unrelated to EDE-Q scores, weak-to-moderate correlations were observed with EHQ-21 subscale and total scores. Pro-environmental and/or ethical reasons for current diet and personal experience of extreme climate events were associated with significantly higher EREC scores.DiscussionThe Italian EREC appears to be a valid and reliable tool for the screening of eating-related concerns and behaviors related to climate change. Ecological concerns may represent a healthy adaptive response, but the EREC can serve as a valuable tool to identify individuals whose eating behaviors related to eco-concern might warrant further clinical attention due to potential risks of developing rigid or unhealthy patterns.
The relationship between impostor phenomenon and career decision-making difficulties among nursing interns: the mediating role of psychological resilience
Authors: He Meina , Li Yao , Hu Hui , Yu Zuqiang , Cai Cong , Cheng Yao , Ma Lu , Liu Shanshan 
Published: November 2024

BackgroundIn the face of a global nursing shortage, nursing interns are crucial to sustaining the healthcare workforce. However, these interns encounter significant challenges in career decision-making, often exacerbated by the impostor phenomenon, which impedes their capacity to make informed choices. Despite its importance, little research has been reported on the specific conditions and contributing factors that affect nursing interns’ career decision-making processes.ObjectiveTo understand the current status of nursing interns’ impostor phenomenon, psychological resilience, and career decision-making difficulties, and to validate the mediating role of psychological resilience between impostor phenomenon and career decision-making difficulties using structural equation modeling.MethodsFive hundred eighty-two nursing interns from four tertiary hospitals in Wuhan City, Hubei Province of China were selected by stratified random sampling. Data were collected with the Clance Impostor Phenomenon Scale, Career Decision-Making Difficulties Questionnaire, and the 10-item Connor–Davidson Resilience Scale through an online survey. Mediation effect tests were conducted using SPSS 26.0 and PROCESS software.Results(1) The score for career decision-making difficulties was 99.34 (SD = 21.78), the score for impostor phenomenon was 57.58 (SD = 12.13), and the score of psychological resilience was 32.11 (SD = 8.50); (2) Psychological resilience had a significant negative correlation with career decision-making difficulties (r = −0.724, p &lt; 0.01), and impostor phenomenon had a significant negative correlation with psychological resilience (r = −0.608, p &lt; 0.01), and had a significant positive correlation with career decision-making difficulties (r = 0.700, p &lt; 0.01). Psychological resilience played a partial mediating role between impostor phenomenon and career decision-making difficulties (p &lt; 0.01), with the mediating effect (Effect Value = 0.518, Bootstrap 95% CI: 0.430, 0.610) accounting for 41.27% of the total effect.ConclusionCareer decision-making difficulties are common among nursing interns. Effective strategies should address the impostor phenomenon and promote psychological resilience to enhance self-awareness and create a supportive environment.
Risk factors for psychiatric disorders following traumatic brain injury: a multivariate logistic regression analysis
Authors: Liu Hanyu , Yi Tongjun 
Published: November 2024

ObjectiveThis study aimed to investigate the incidence and risk factors of psychiatric disorders following traumatic brain injury (TBI).MethodsA total of 232 patients with closed TBI admitted to our hospital from January 2021 to January 2023 were included. Basic demographic data, injury circumstances, and psychiatric conditions during hospitalization were collected. Patients were followed up at 9 months post-injury, and based on clinical interviews, symptoms, and questionnaires, they were categorized into those with post-TBI psychiatric disorders and those without. The study aimed to explore the predictive factors for psychiatric disorders after TBI.ResultsAmong the 232 patients, 104 developed psychiatric disorders by the end of the 9-month follow-up, resulting in an incidence rate of 44.83%. The employment rate was significantly lower in the psychiatric disorder group compared to the non-psychiatric disorder group. Additionally, the GCS scores upon admission were significantly higher in the psychiatric disorder group, along with a greater proportion of limb injuries, post-traumatic coma, intracranial hematomas, and frontal lobe injuries. The results of the multivariate logistic regression analysis indicated that unemployment (caused by poor recovery from TBI), lower GCS scores at admission, limb injuries, post-traumatic coma, frontal lobe injuries, and the presence of psychiatric symptoms during hospitalization were independent predictors of psychiatric disorders following TBI.ConclusionUnemployment, lower GCS score on admission, limb injury, post-traumatic coma, frontal lobe injury, onset of psychiatric symptoms during hospitalization was identified as independent predictors of post-traumatic psychiatric disorders. Routine mental health screenings for conditions such as depression and anxiety should be integrated into the care of TBI patients.