bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of a U-shaped Toothbrush in Removing Plaque in Pre-school Children: A Randomized Controlled Trial
Authors: Abdulrahman Kamar , Tolibah Yasser Alsayed , Bshara Nada 
Published: September 2024

Abstract

This randomized controlled trial aimed to evaluate the U-shaped toothbrush in dental plaque removal in preschool children in comparison with traditional toothbrushes. Thirty children aged between 4–5 years old were randomly divided into two groups; Group 1 (n = 15): children used a traditional toothbrush for 21 days and then used the U-shaped toothbrush for 21 days, while Group 2 (n = 15): children used U-shaped toothbrush for 21 days and then used the traditional toothbrush for 21 days. Plaque accumulation was evaluated by two blinded examiners using Turesky modification of the Quigley–Hein plaque index (TMQHPI) at seven-time points (pre-brushing (T0), immediately after using the first toothbrush (T1), 7 days after using the first toothbrush (T2), 21 days after using the first toothbrush (T3), immediately after using the second toothbrush (T4), 7 days after using the second toothbrush (T5), and 21 days after using the second toothbrush (T6) to determine which toothbrush achieved better plaque removal. At T1, T2, T5, and T6, the plaque accumulation reduction was significantly lower when using the U-shaped toothbrush. In conclusion, U-shaped toothbrushes improved preschool children's ability for plaque control.
Empowering Geriatric care: Safe Beta-Lactam Allergy De-labeling Strategies
Authors: Goldhaber Gal , Confino-Cohen Ronit , Lachover-Roth Idit , Engler Anat Cohen- , Harel Saray Sity- , Rosman Yossi 
Published: September 2024

Abstract

Purpose: Drug allergies represent a significant health concern among the elderly, with beta-lactam (BL) antibiotics being one of the most implicated agents. There remains a paucity of data on the safety and efficacy of BL allergy de-labelling in this population.
We aimed to investigate the safety and efficacy of BL allergy evaluation in a cohort of geriatric patients bearing BL allergy labels.
Methods: A retrospective study, including patients aged > 65 years referred for allergy evaluation at the Allergy Unit of the Meir Hospital. Patients suspected to have BL allergy underwent a comprehensive anamnesis, skin testing, and oral challenge. Patients successfully de-labelled were subject to long-term follow-up to monitor BL use and outcomes.
Results: Over the course of 2009 to 2019, 166 elders with suspected BL allergies were evaluated. Ultimately, 145 (87.3%) patients had their BL allergies ruled out. Sixteen (9.6%) were diagnosed with IgE-mediated allergies, 4 (2.4%) with severe delayed-type hypersensitivity, and 1 (0.6%) with a benign rash. The evaluation process was safe, with no occurrences of severe reactions during oral challenges, and none of the patients required hospital admission or adrenaline treatment.
106 patients were available for long-term follow-up. Of these, 38 patients (35.8%) were subsequently treated with the previously suspected culprit drug. None reported immediate reactions or severe delayed hypersensitivity following exposure.
Conclusion: De-labelling of BL allergies is safe and effective in elders, underscoring the importance of this procedure. There is need to heighten awareness regarding allergic workups in geriatric populations bearing BL allergy labels.
Validation of the Distress Thermometer for detecting psychological distress in patients with stable chronic obstructive pulmonary disease: optimal cut-off score and influencing factors
Authors: Tian Xu , Liu Xiaoling , Gan Xiuni , Jimenez-Herrera Maria F. , Shang Hongcai , Ren Yi 
Published: September 2024

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) are at high risk for psychological distress, yet validated screening tools are not routinely used in clinical practice. The Distress Thermometer (DT), originally developed for cancer patients, is a brief screening tool for detecting psychological distress. However, the optimal cut-off in COPD patients remains unclear. Aim This study aims to validate the DT for use in stable COPD patients and to explore factors influencing psychological distress. Methods A cross-sectional study was conducted involving 386 stable COPD patients. Data were collected using sociodemographic questionnaires, the DT, and the Hospital Anxiety and Depression scale (HADS). Receiver Operating Characteristics (ROC) analysis was employed to determine the predictive metrics of various DT cut-off scores compared to the HADS. Bivariate binary logistic regression was used to identify factors influencing psychological distress. Results The mean DT reported by patients was 3.77, while the mean total HADS score was 29.68. The DT score showed a high correlation with the total HADS score (r = 0.640). An optimal DT cut-off score of ≥ 5 was identified, yielding a Youden index of 0.815, with sensitivity and specificity of 97.40% and 84.14%, respectively. Using this cut-off score, the incidence of significant psychological distress was found to be 32.1%. Risk factors for psychological distress included gender, number of children, educational level, frequency of exercise, GOLD degree, and number of acute exacerbations. Conclusions The DT is a valid screening tool for identifying psychological distress among COPD patients. With an optimal cut-off score of ≥ 5, the DT offers high sensitivity and specificity, making it a reliable measure for clinical use. This study also highlights significant factors contributing to psychological distress, emphasizing the importance of integrating routine psychological assessments and care into the routine management of COPD to improve patient outcomes.
Caloric Requirement Targets for Nutritional Support in Adult Autoimmune Encephalitis
Authors: li jinmei , wang jiaqi , li yinping , yan bo 
Published: September 2024

Abstract

Background
Autoimmune encephalitis (AE) is a severe neurological disease often accompanied by consciousness disturbances, severe swallowing difficulties, and gastrointestinal dysfunction, increasing the risk of malnutrition. Early nutritional support is believed to improve the recovery of neurological patients. However, the optimal caloric intake target during the acute phase of AE remains unclear.
Objective
This study aims to evaluate the impact of caloric intake on short-term clinical outcomes in acute AE patients, specifically focusing on the improvement in Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores, to provide recommendations for nutritional support during the acute phase.
Methods
A retrospective study analyzed clinical data from 128 adult AE patients requiring nutritional support, admitted to West China Hospital, Sichuan University, from January 2020 to January 2024. Patients were categorized into low-calorie intake (below 70% of requirements), standard-calorie intake (70%-100% of requirements), and high-calorie intake (above 100% of requirements) groups.
Results
Higher caloric intake was significantly associated with improved CASE scores (β = 8.58, SE = 3.75, 95% CI = 1.14 to 16.03, p = 0.02). Low caloric intake negatively impacted the improvement of CASE scores (p = 0.049), particularly in seizures and speech problems. The low-calorie intake group had significantly longer hospital stays and nutrition therapy durations (45.79 ± 30.98 days, p < 0.01; 40.39 ± 31.92 days, p = 0.02).
Conclusions
Adequate caloric intake has a significant positive impact on the short-term clinical outcomes of AE patients, suggesting that meeting or exceeding caloric requirements may promote neurological recovery in AE patients. Future prospective studies are needed to validate these findings and further optimize nutritional support strategies.
Association between Perioperative Potentially Inappropriate Medication Exposure Levels and Postoperative Hospital Length of Stay among Chinese Older Hospitalized Patients: A Retrospective Cohort Study
Authors: Gu Kai , Yang Yi , Li Jiajie , Chen Yuheng , Tang Yulin 
Published: September 2024

Abstract

Background
​Potentially inappropriate medication (PIM) administration in geriatric surgical patients is increasingly prevalent in the perioperative period. The relation between the variation in PIM exposure and other key postoperative geriatric outcomes, such as postoperative hospital length of stay (POLOS), however, has seldom been reported, and current researches mentioning perioperative PIM concentrate on preoperative long-term home medications or postoperative prescriptions that may not be actually taken. We aimed to investigate whether the level and the change of short-term PIM exposure in the immediate perioperative period was associated with prolonged POLOS (pPOLOS).
Methods
We performed a retrospective cohort study of patients ≥ 65 years of age who underwent elective inpatient surgery at a tertiary academic hospital from July 2022 and March 2023. PIMs were defined using the Beers Criteria as suggested by the American Geriatrics Society. Stage-varying exposure variables were used to quantify cumulative PIM exposure levels during the preoperative (Pre-PIMs), intraoperative (Intra-PIMs), and even the entire perioperative stage period (Total-PIMs, represented by summing Pre-PIMs and Intra-PIMs) for each participant. A multivariable logistic model and restricted cubic spline model were applied to explore the association and dose-response relationship of PIM exposure with the risk of pPOLOS in the total population and subgroups.
Results
196 (44.6%) of 439 participants had a prolonged postoperative length of stay. There was PIM exposure in 378 (86.1%) of the current cohort, analgesics were administered most frequently both preoperatively and intraoperatively albeit via quite different mechanisms of action. Compared to participants without PIM exposure, only those with continuous exposure to Pre-PIM and Intra-PIM (high exposure group) significantly increased risk of pPOLOS with an adjusted OR of 3.13 (95% CI: 1.24-8.80, P = 0.021). The effect of Total-PIMs on pPOLOS risk (OR: 1.21, 95%CI: 1.06-1.40, P = 0.006) was more significant than that of Pre-PIMs or Intra-PIMs, and also showed a more obvious linear dose-response trend visually in the restricted cubic spline analysis. In subgroup analysis, significant modification effects of Charlson Comorbidity Index on the association of Total-PIMs with pPOLOS risk were observed.
Conclusion
Combined exposure to Pre-PIMs and Intra-PIMs more independently indicates the risk of pPOLOS in older patients than its individual exposure. These findings could help clinicians to be aware of the possible vulnerability of elderly patients under continued preoperative to intraoperative exposure to PIMs, and highlight the potential value of medication optimization and deprescribing PIMs in the immediate perioperative setting.
The impact of learner autonomy on the performance in voluntary online cardiac auscultation courses
Authors: Fang Yudong , Fang Ligang , Zhu Wenling , Lin Xue 
Published: September 2024

Abstract

This study explores the impact of learner autonomy on academic performance in a free, non-mandatory online heart sound auscultation course, emphasizing the enhancement of online learning outcomes through learner autonomy. Medical students and doctors were recruited via WeChat groups and participated in four 2-hour live sessions over four weeks, delivered through Plaso teaching software. Participants engaged with real heart sounds using in-ear headphones and were evaluated through random questions during lectures and a comparison of scores on ten heart sound auscultation questions before and after training. Results from 122 doctors and 77 medical students showed that 146 (73%) attended and 46 (23%) completed all sessions, with heart auscultation scores improving significantly from 40 to 70 (p = 0.000). Full participation and active engagement were key predictors of successful exam performance, while intrinsic motivation correlated with complete course attendance (P = 0.045). Moreover, ROC curve analysis revealed that outstanding learners spent more time reviewing post-class materials. The study concludes that while learner autonomy is crucial for success in voluntary online courses, sole reliance on autonomy may not suffice. Effective learning requires identifying intrinsic needs, full participation, active interaction, and additional review. Course designers are advised to recruit learners precisely, incorporate interactive elements, and promote post-class review to enhance learner autonomy.
Prevalence and risk factors for persistent opioid use after thoracic surgery: a retrospective cohort study using claims data in a prefecture of Japan
Authors: Yokoyama Ryota , Iwagami Masao , Shimada Kensuke , Kawamura Chitose , Komiyama Jun , Taniguchi Yuta , Suzuki Ai , Sugiyama Takehiro , Inomata Shinichi , Tamiya Nanako 
Published: September 2024

Abstract

Background:
Thoracic surgery is known to lead to postoperative opioid dependence in countries with high opioid consumption; however, there are limited reports from countries with moderate to low opioid consumption, such as Japan. This study aimed to investigate the prevalence and risk factors for persistent opioid use after thoracic surgery in Japan.
Methods:
We conducted a retrospective cohort study using linked medical claims data of individuals covered by the National Health Insurance in Ibaraki Prefecture, Japan. The participants were patients aged ≥ 18 years who underwent thoracic (mediastinal or lung) surgery between October 2012 and September 2021. Based on previous studies, persistent opioid use was defined as opioid prescription from both (i) 0 to 14 days after surgery and (ii) 91 to 180 days after surgery. Multivariable logistic regression analyses were conducted to assess the factors associated with persistent opioid use.
Results:
Among the 6041 patients who underwent thoracic surgery during the study period, 3924 were included in the final analysis. The median age was 68 years (range, 64–71 years) and 2316 (61.0%) were male patients. Among the patients included in the final analysis, 130 (3.3%) developed persistent opioid use. Multivariable analysis showed that neoadjuvant therapy (chemotherapy or radiotherapy) (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.09–3.77; P = 0.027) and thoracotomy (vs video-assisted thoracoscopic surgery) (OR, 1.50; 95% CI, 1.01–2.24; P = 0.046) were independent risk factors for persistent opioid use.
Conclusions:
In a prefecture of Japan, 3.3% of patients who underwent thoracic surgery developed persistent opioid use. Neoadjuvant therapy (chemotherapy or radiotherapy) and thoracotomy were independent factors associated with persistent opioid use after thoracic surgery. Individualized perioperative pain management strategies should be considered for high-risk patients.
Unexpected High Frequency of Novel and Known Pathogenic Germline Variant of the Lgr4 Gene in the Ethnic Group of West Siberia
Authors: Gervas Polina , Molokov Aleksey , Babyshkina Nataliya , Zherebnova Anna , Choynzonov Evgeny , Cherdyntseva Nadezda 
Published: September 2024

Abstract

Background: Hereditary breast cancer (BC) is an autosomal dominant disease caused by mutations in genes such as BRCA1/2, BRAD1, RAD54L, RAD51, ATM, BRIP1, and others. The prevalence and range of mutations can differ among various regions and ethnic groups. In a previous study using whole exome sequencing, we identified a germline pathogenic variant of the LGR4 gene (rs34804482, NM_018490.3: c.2531A>G) in a young Tuvan BC patient (belonging to the Turkic-speaking tribes of Central Asia). The aim of this study was to determine the frequency of the germinal pathogenic variant rs34804482 of the LGR4 gene (NM_018490.3: c.2531A>G) in ethnic groups of West Siberia (comparing BC patients and healthy subjects) using the PCR-RT method.
Methods: The study involved 735 BC patients from various ethnic groups in Siberia, including Russians, Buryats, Tuvans, Yakuts, Altaians, and Khakassians, with a median age at diagnosis of 43±15.6 years. The control group consisted of 727 healthy women from the same ethnic groups in Siberia, with a median age of 43.05±13.5 years.
Results: In a general group of BC patients, the frequency of the pathogenic variant of the LGR4 gene (rs34804482) was 0.027. Specifically, the frequency of this variant was 0.015 in Russian BC patients, 0.022 in Buryat BC patients, and 0.069 in Tuvan BC patients. This variant was not detected in Khakassian and Yakut BC patients. In Tuvan women with BC, the frequency of the pathogenic variant of the LGR4 gene was significantly higher than in Russian BC patients (X2 = 8.153, p = 0.005). The frequency of the pathogenic variant of the LGR4 gene (rs34804482) in healthy Tuvan women was significantly higher than in healthy Russian women (0.066 versus 0.016, X2=6.368, p=0.012). The mutation frequency in healthy Russians was close to that in Europeans (0.016 versus 0.0219). The highest frequency of this pathogenic variant was found among healthy Tuvans (0.066), significantly higher compared to Americans (0.0000) and other ethnic groups (according to ExAc).
Conclusions: Our study was the first to investigate the frequency of the pathogenic variant of the LGR4 gene (rs34804482) in different ethnic groups of Siberia, comparing BC patients with healthy individuals. We found no statistically significant differences in the mutation frequency between BC patients and healthy individuals in the ethnic groups studied. The highest frequency of this pathogenic variant was observed among healthy Tuvans (0.066), which was significantly higher compared to other ethnic groups.
Joint zonated quantification of multiple parameters in hepatic lobules
Authors: Laue Hendrik Oliver Arp , Budelmann Daniel , Albadry Mohamed , Engel Christiane , Weiss Nick , Dahmen Uta , Schwen Lars Ole 
Published: September 2024

Abstract

Metabolic processes in the hepatic lobule are spatially organized. Consequently, many liver diseases have a distinct zonation pattern. Understanding the interplay between a zonated disease pattern and its impact on liver function requires the joint quantification of both phenomena. Our study presents an image analysis workflow for the joint zonated quantification of multiple parameters from whole-slide images of conventionally stained serial sections. Portal fields and central veins are annotated and transferred to adjacent slide images via image registration. This allows identifying the same lobules and zones in multiple slides, where zones are obtained by dividing the distance between portal fields and central veins in twelve intralobular zonal distributions of various parameter combinations quantified from multiple slides can then be plotted as scatter diagrams or visualized in the lobule/zone geometry. As a proof-of-concept, we quantify the distribution of periportal steatosis and pericentral cytochrome P-450 (CYP) expression using HE and immunohistochemically stained WSI. The data can be used to parameterize computational simulations of physiological processes in the lobules and zones more accurately.
Social Determinants of Alcohol Use Disorder in Patients Attending Private Primary Care Clinics in Nairobi Kenya
Authors: Elazia Verah Kabwayi , Mohamoud Gulnaz , Orwa James , Merali Mohamoud , Shabani Jacob 
Published: September 2024

Abstract

Introduction:
Socio-demographic factors are predictors of Alcohol Use Disorder (AUD). The Kenyan WHO STEPWISE survey indicated that 13% of adult Kenyans are heavy episodic drinkers. However, the relationship between social determinants of AUD among patients attending primary health care clinics has not been well investigated in Kenya. We aimed to determine the association between sociodemographic determinants and AUD in patients attending private primary care clinics in Nairobi, Kenya.
Methods
A cross-sectional survey design was used to purposively sample 389 patients. Data were collected using self-administered questionnaires adapted from the Alcohol Use Disorder Identification Test (AUDIT) Tool. The prevalence of AUD was calculated as a percentage of all the enrolled patients. Independent associations between explanatory variables and AUD were determined using the chi-square test. Variables with a p-value < 0.2 were considered for Multivariable Logistic Regression to identify factors associated with AUD.
Results
The prevalence of AUD in this cohort of participants was 18.5%. Significant social determinants for AUD were: tobacco and marijuana smoking (AOR 2.89 95%CI: 1.09–7.46), insomnia (AOR 3.40 95%CI: 1.52–7.70), and first-degree relatives who consumed alcohol (AOR 4.00 95% CI:1.86–8.63). The study showed that social determinants influenced the occurrence of AUD.
Conclusion
Alcohol users with insomnia, marijuana users and those with a family history of alcohol use should be prioritized for AUD screening. Further studies could explore the influence of these findings on AUD qualitatively.
Melatonin-Related Genes as Key Players in Alzheimer's Disease: Discovery of Promising Biomarkers for Treatment Targets for Alzheimer's Disease
Authors: Zhang Huaxiong , Hamit Dilmurat , LI Qing , Hu Xiao , LI San-feng , XU Fu , WANG Ming-yuan , BAO Guo-qing , LI Hong-yan 
Published: September 2024

Abstract

Background
Melatonin can improve mitophagy, thereby ameliorating cognitive deficits in Alzheimer’s disease (AD) patients. Hence, our research focused on the potential value of melatonin-related genes (MRGs) in AD through bioinformatic analysis.
Methods
First, the key cells in the single-cell dataset GSE138852 were screened out based on the proportion of annotated cells and Fisher’s test between the AD and control groups. The differentially expressed genes (DEGs) in the key cell and GSE5281 datasets were identified, and the MRGs in GSE5281 were selected via weighted gene coexpression network analysis. After intersecting two sets of DEGs and MRGs, we performed Mendelian randomization analysis to identify the MRGs causally related to AD. The biomarkers GSE5281 and GSE48350 were identified through receiver operating characteristic (ROC) curve and expression analyses. Furthermore, gene set enrichment analysis, immune infiltration analysis and correlation analysis with metabolic pathways were conducted, as well as construction of a regulator network and molecular docking.
Results
According to the Fisher test, oligodendrocytes were regarded as key cells due to their excellent abundance in the GSE138852 dataset, in which there were 281 DEGs between the AD and control groups. After overlapping with 3,490 DEGs and 550 MRGs in GSE5281, four genes were found to be causally related to AD, namely, GPRC5B, METTL7A, NFKBIA and RASSF4. Moreover, GPRC5B, NFKBIA and RASSF4 were deemed biomarkers, except for METTL7A, because of their indistinctive expression between the AD and control groups. Biomarkers might be involved in oxidative phosphorylation, adipogenesis and heme metabolism. Moreover, T helper type 17 cells, natural killer cells and CD56dim natural killer cells were significantly correlated with biomarkers. Transcription factors (GATA2, POU2F2, NFKB1, etc.) can regulate the expression of biomarkers. Finally, we discovered that all biomarkers could bind to melatonin with a strong binding energy.
Conclusion
Our study identified three novel biomarkers related to melatonin for AD, namely, GPRC5B, NFKBIA and RASSF4, providing a novel approach for the investigation and treatment of AD patients.