bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fishing in Murky Waters: The Challenging Route to Diagnosing Twin-Twin Transfusion Syndrome in a Resource-Limited Humanitarian Setting, A Case Study
Authors: Okot Jerom , Ochola Henry , Aeku Michael Job , Okema James Nelson , Ouma Simple , Pebolo Francis Pebalo 
Published: June 2024

Abstract

Background
Twin-to-twin transfusion syndrome (TTTS), though rare, poses risks for fetal demise if undetected. This late-diagnosed TTTS case from South Sudan demonstrates persistent challenges in identifying high-risk pregnancies in humanitarian settings.
Case presentation:
A 38-year-old multigravida at unknown weeks gestation presented with fever, labour pains, drainage of liquor, and fetal hand prolapse. Her antenatal care only reported non-specific symptoms without most diagnostics. Evaluation revealed malaria, suspected twin pregnancy, and malpresentation. Ultrasound confirmed polyhydramnios and a suspicious intrauterine mass concerning for TTTS. Undiagnosed TTTS became apparent only during emergent cesarean delivery, finding a demised anomalous donor twin. The acute intrapartum decompensation pointed to late-stage V TTTS preventing intervention. While the viable preterm neonate survived, risks from demise were avoidable through earlier detection.
Conclusion
This case reinforces literature on missed screening opportunities to recognize TTTS before Quintero staging with poorer prognoses. Subtle signs like sudden abdominal enlargement during third trimester were likely overlooked due to limited access to comprehensive ultrasound and Doppler surveillance. Strengthening displacement-sensitive antenatal protocols, building frontline imaging capacity, improving provider awareness, and prompt referrals could help mitigate TTTS-related morbidity and mortality in marginalized populations. Global health efforts must address these persisting care gaps in pregnancy surveillance and access to specialty care, especially in humanitarian settings.
Acceptance of an immediate post-partum intrauterine contraceptive device and associated factors among women who gave birth in public hospitals of Addis Ababa, Ethiopia: A cross-sectional study.
Authors: Geberemariam Wondossen Teklesilassie , Mekonnen Baize , Asfaw Hussen Mekonnen 
Published: June 2024

Abstract

Background
Despite the post-partum intrauterine device being highly effective, inexpensive, non-hormonal, and reversible its acceptance is very low in developing countries including Ethiopia. Considering the importance of the use of immediate postpartum intrauterine contraceptives is a valuable means to keep women and children healthy. This study aimed to assess the acceptance of an immediate post-partum contraceptive device and associated factors among women who gave birth in selected public hospitals in Addis Ababa.
Method
A health institution-based cross-sectional survey was conducted among 336 women who gave birth in selected public health facilities in Addis Ababa from the beginning of February to March 2021. Information was gathered by using interviewers administered questionnaires. Data were double entered in Epidata version 4.6 statistical package, cleaned, and exported to IBM SPSS statistics version 25 for analysis. Logistic regression models were used to predict the association of outcome variables and adjusted for possible confounders
Result
Overall, a total of 42 (12.5%) of women accepted to use the immediate use of post-partum intrauterine devices. Woman's employment status such as (Private employees (AOR = 4.269, 95% CI: (1.280-14.234) (P < 0.018), daily laborer (AOR = 7.373, 95% CI: (1.534–35.433) (P < 0.013), student (AOR = 11.004, 95% CI: (1.602–75.572) (P < 0.015)), and monthly income of the mother Birr greater than 7,901.00 (AOR = 6.589, 95%CI: (1.736–25.009) (P < 0.006) were found to accept the immediate post-partum contraceptive device than women with monthly income of less than Birr 3,200 and less.
Conclusion
The acceptance of an immediate intrauterine contraceptive device among women giving birth in the study areas was low. Public Awareness by using different communication menses and tarnishing of health care workers were recommended.
Impact of frequent whole-body CT scans during immune checkpoint inhibitor (ICI) therapy on antitumor immune efficacy
Authors: Dong Jigang , sha Sha , Qi Ying , Fu Chengrui , Li Baosheng 
Published: June 2024

Abstract

Objective:The effect of frequent whole-body CT scanning during immune checkpoint inhibitor (ICI) therapy on the anti-tumor immune effect of ICI.
Methods:We conducted a retrospective clinical study and a basic study in a mouse tumor model, respectively. Retrospective clinical study: We retrospectively analyzed the correlation between the frequency of CT scans during immune checkpoint inhibitor (ICI) treatment and the duration of remission (DOR) of ICI treatment in patients with stage IV non-small cell lung cancer (NSCLC). BASIC RESEARCH: We established a mouse lung adenocarcinoma tumor model and administered ICI to mice, which were irradiated with five whole-body CT scans during ICI treatment in order to observe the effect of frequent whole-body CT scans on the anti-tumor effect of ICI treatment in mice. The effects of frequent whole-body CT scans on the tumor microenvironment of mice were also analyzed by single-cell sequencing and multi-assay flow cytometry.
Results:The more frequent CT scans during ICI treatment in NSCLC patients the longer the DOR of ICI treatment. In the mouse model we observed that the addition of whole-body CT scan radiation had a tendency to inhibit tumor growth in mice compared with the anti-PD-1 group alone.Frequent CT scan radiation during the application of the immune checkpoint inhibitor PD-1 increased the proportion of infiltrating CD8+ T cells in tumor tissues and significantly increased the proportion of IFNγ-secreting CD8+ T cells, and single-cell sequencing of the results also revealed that IFNγ and killing-related genes were significantly upregulated in tumor-infiltrating CD8T cells.
Conclusions:To our knowledge this is the first study worldwide on the effect of multiple CT scan radiation on the anti-tumor immune effect of ICI. Our findings suggest that frequent CT scans during ICI treatment did not promote tumor progression; instead, a trend toward delayed tumor progression was observed.
Treatment of AO/OTA Type 43-C3 Pilon Fractures with a Combination of Miniplate and Main Plate: A Retrospective Analysis
Authors: Zhan Junfeng , Yang Hu , Huai Chaoyue , Yao Yunfeng , Xie Yang , Zhong Qigang 
Published: June 2024

Abstract

Background
Type-C3 pilon fracture is a distal tibial fracture with a high disability rate that is difficult to treat and has many postoperative complications. Effective treatment of type-C3 pilon fracture remains an important research focus. This study proposed to treat type-C3 pilon fractures with a miniplate combined with a main plate and compared it with the traditional treatment.
Methods
This study retrospectively analyzed 64 cases of type-C3 pilon fractures treated at our hospital between June 2018 and June 2022, including a miniature steel plate group (MP group, n = 31) and a traditional treatment group (TT group, n = 33). Hospitalization duration, duration of hand surgery, reduction quality, fracture healing, complications, imaging data, and functional scores of the two groups were analyzed.
Results
The surgery was completed successfully in both groups, and the average follow-up duration was 16.78 ± 3.27 months. There were no significant differences in the duration of preoperative waiting, hospital stay, and weight-bearing between the two groups (P > 0.05). The duration of surgery was significantly shorter in the MP group than in the TT group (P < 0.05). The quality of fracture reduction and healing at 6 weeks after surgery in the MP group was significantly better than that in the TT group (P < 0.05). There was no significant difference in the visual analog scale scores between the two groups. However, at 6 months postoperatively and at the last follow-up, the American Orthopedic Foot and Ankle Society score and ankle fire activity range of motion were significantly better for those in the TT group. There were two cases of ischemic osteonecrosis, two of poor incision healing, and one of severely poor wound healing in the TT group; however, only one patient in the MP group had poor incision healing.
Conclusion
The use of miniplates combined with main plates in the treatment of type-C3 pilon fracture has obvious advantages, which simplifies the difficulty of the surgery, reduces the volume of the ankle joint, reduces postoperative complications, and is beneficial to postoperative exercise and ankle function recovery.
Sclerotherapy for the ranula with Bleomycin: technical considerations and preliminary experience
Authors: Zhang Hong-Yu , Su Li-Wen , Sun Huan , Rui Chao-Chen , Wu Yang 
Published: June 2024

Abstract

Ranula is a mucous cyst that occurs in the floor of the mouth. It can be classified into three types based on origins: accessory (minor) salivary gland cysts, Rivini duct cysts, and sublingual gland cysts. Because of the anatomical characteristics, surgical resection of the cysts not only carries the risk of damaging adjacent tissues but also has a high recurrence rate. Intralesional injection of sclerotherapy may be a better alternative treatment. We summarized 65 cases of ranula treated with intralesional injections of bleomycin(BML). According to the origin of the ranula, 60 cases were from the accessory (minor) salivary glands or the ducts of Rivini, and 5 cases were from the body of the sublingual gland. The results showed that 60 cases of ranula from the accessory (minor) salivary glands and Rivini ducts were 100% cured during the follow-up period. The median number of injections for all patients was 1.16. All 5 cases of ranula from the sublingual gland did not wholly recover. This study confirmed that BLM intralesional injection is a safe and effective treatment modality for cysts from oral floor accessory (minor) salivary glands or the ducts of Rivini rather than sublingual gland cysts. Therefore, before treatment, it is necessary to determine the type and origin of the cyst by characterizing its morphology to ensure the effectiveness of the treatment.
Human Papillomavirus Prevalence and Genotyping in Paraffin-Embedded Cervical Tumor Samples from Women in Kordofan State, Western Sudan
Authors: Hamid Hussien , Eldour Ahmed A. A. , Elamin Elwaleed M. 
Published: June 2024

Abstract

Background
This study aimed to assess HPV prevalence and genotypic distribution in Sudanese cervical tumors, filling a global data gap and aiding screening and prevention efforts.
Methods
121 FFPE blocks of cervical tumors with a mean age of 53 ± 14 years were collected. Despite 41 samples having degraded DNA, all underwent amplification with HPV-specific primers and human HLA-DQA1 gene as an internal control. DNA microarray chips was used to detected 41 HPV genotypes.
Results
A 121 cervical tumor specimens were analyzed using DNA microarray chip techniques to identify 41 HPV genotypes. The majority of age group (46.3%) falling into the ≥ 60 years age group. we found that the most predominant tumor is SCC (69.3%), with a significant age-tumor progression correlation (P = 0.001).
The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, unsupervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.
Authors: Fluet Gerard , Qiu Qinyin , Gross Amanda , Gorin Holly , Patel Jigna , Merians Alma , Adamovich Sergei 
Published: June 2024

Abstract

Background: This parallel, randomized controlled trial examines intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a twelve-week, home-based upper extremity rehabilitation program. Seventeen subjects played games presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally.
Methods: 33 persons 20 to 80 years of age, at least six months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the system. Subjects had the Home Virtual Rehabilitation System [1]systems placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for twelve weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. Classification and Regression Tree (CART) models were generated to predict responders using demographics and baseline measures.
Results: There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ between groups. 21 subjects from both groups, demonstrated clinically important improvements in UEFMA score of at least 4.25 points. Subjects with pre training UEFMA scores below 53.5 averaged a seven-point UEFMA increase. IMI scores were stable pre to post training.
Conclusions: Scaffolding did not have a meaningful impact on adherence or motor function improvement. A sparsely supervised program of game-based treatment in the home was sufficient to elicit meaningful improvements in motor function and activities of daily living. Common factors considered barriers to the utilization of telerehabilitation did not impact adherence or motor outcome.
Trial registration: Clinical Trials.gov - NCT03985761, Registered June 14, 2019.
A Network Analysis of the Associations Between Posttraumatic Stress Symptoms and Posttraumatic Growth Among Lung Cancer Patient
Authors: Gao Jinmiao , Zhang Lan 
Published: June 2024

Abstract

Background: Lung cancer patients who experience a traumatic event may experience two types of psychological changes, positive posttraumatic growth (PTG) or negative posttraumatic stress disorder (PTSD), but the two types of psychological changes can also coexist.
Methods: This study used network analysis to examine the interaction between PTSD and PTG in 350 patients.
Results: The nodes with strong connections were from "Strong Negative Beliefs" to" Feeling Cut of from Others", " Strong Physical Reactions” to” Trouble with Positive Feelings", " More willing to express emotions" to " Ability to handle difficulties" and " Nightmares" to " Strong Physical Reactions". Network centrality showed the highest EI scores for " Nightmares", " Intrusive Memories", " Excessive Blame of Selfor Others", and " Concentration Dificulities". The bridging analysis showed that " lrritability", " Taking Risks", " Trouble with Positive Feelings" and " Accepting the workaround", "Interpersonal closeness", " Greater feeling of self-reliance", " Appreciating each day", and " Changed priorities" were the bridging points connecting the coexistence network, indicating the network coexistence of PTSD and PTG.
Limitations: The data used in this study were cross-sectional, and the temporal nature and causal inferences of associations with symptoms cannot be drawn.
Conclusions: PTSD and PTG are co-existing and non-independent post-traumatic psychological responses in patients with lung cancer.
Body Fat Ratio as a Novel Predictor of Complications and Survival After Rectal Cancer Surgery
Authors: Zhao Haiyuan , Liu Gang , Li Yang , Liu Ben , Lu Feixiang , Yang Nianzhao , Zhao Jun 
Published: June 2024

Abstract

Aim
To investigate the relationship between body fat ratio (BFR), visceral fat area (VFA), body mass index (BMI), and visceral fat density (VFD) and to assess their reliability in predicting the risk of postoperative complications and survival status in patients with rectal cancer (RC).
Methods
The study prospectively included 460 patients who underwent surgical treatment for RC at the First Affiliated Hospital of Wannan Medical College between September 2018 and July 2021. BFR, VFA, BMI, and VFD were measured, and patients' basic information, clinical data, complications, and survival were recorded. Statistical analysis was performed to determine the optimal BFR cutoff and elucidate group differences.
Results
BFR exhibited significant correlations with VFA (R = 0.739), BMI (R = 0.783), and VFD (R = -0.773; all P < 0.05). The area under the receiver operating characteristic curve of BFR, VFA, BMI, and VFD in predicting postoperative complications were all > 0.7, with an optimal BFR cutoff value of 24.3. Patients in the BFR-low group had fewer postoperative complications and lower intraoperative indices, hospitalization times, and costs (P < 0.05) compared to the BFR-high group. BFR predicted complications with high diagnostic significance and was validated by multiple models. Patients in the BFR-high group had better survival than those in the BFR-low group (P < 0.05).
Conclusion
BFR is closely related to BMI, VFA, and VFD. Reasonable control of BFR or a modest increase may help prevent and treat postoperative complications of RC and improve patients’ long-term survival.
Repeated scoring with Adult Appendicitis Score improves the sensitivity and the specificity of appendicitis diagnosis in patients with early equivocal signs of appendicitis: A secondary analysis
Authors: Lastunen Kirsi S. , Leppäniemi Ari K. , Mentula Panu J. 
Published: June 2024

Abstract

Background
The use of computed tomography at the early stage of acute appendicitis can lead to overdiagnosis and predispose patients unnecessarily to ionising radiation. Adult Appendicitis Score (AAS) can be used to select patients for imaging. Observation and re-scoring in the DIAMOND trial reduced the need for imaging. In this study, we wanted to determine if the AAS change (ΔAAS) can be used as a diagnostic tool to select patients for imaging even more precisely.
Methods
Eighty-eight patients with early equivocal appendicitis entered the observation arm in the DIAMOND trial. The data of these patients were reanalysed, and ΔAAS during the observation was calculated. The baseline AAS, final AAS, and the CRP change (ΔCRP) were selected as reference standards.
Results
Eighty-three patients with complete data were analysed. The AUROC values: ΔAAS 0.932 (95%CI 0.868–0.996), baseline AAS 0.629 (95%CI 0.498–0.760), final AAS 0.936 (95%CI 0.886–0.987), and ΔCRP 0.796 (95%CI 0.696–0.897). From receiver operating characteristic curves, we identified the limits for low (ΔAAS ≤ -2), intermediate (ΔAAS − 1 − 0), and high (ΔAAS ≥ 1) probability of appendicitis. The negative predictive value of the low probability group and the positive predictive value of the high probability group for acute appendicitis were 97% and 94%, respectively.
Conclusions
Patients with equivocal signs of appendicitis could benefit from short observation and calculation of ΔAAS to reduce overdiagnosis and exposure to excessive imaging.
Trial registration
The DIAMOND trial was originally registered in ClinicalTrials.gov (NCT02742402) on April 7th, 2016 and approved by the institutional review board and the ethical committee of Helsinki University Hospital (reference number 27/13/03/02/2016).
A high fraction of inspired oxygen does not mitigate atelectasis-induced lung tissue hypoxia or injury in experimental acute respiratory distress syndrome
Authors: Tojo Kentaro , Yazawa Takuya 
Published: June 2024

Abstract

Background
Although alveolar hyperoxia exacerbates lung injury, clinical studies have failed to demonstrate the beneficial effects of lowering the fraction of inspired oxygen (FIO2) in patients with acute respiratory distress syndrome (ARDS). Atelectasis, which is commonly observed in ARDS, not only leads to hypoxemia but also contributes to lung injury through hypoxia-induced alveolar tissue inflammation. Therefore, it is possible that excessively low FIO2 may enhance hypoxia-induced inflammation in atelectasis, and raising FIO2 to an appropriate level may be a reasonable strategy for its mitigation. In this study, we investigated the effects of different FIO2 levels on alveolar tissue hypoxia and injury in a mechanically ventilated rat model of experimental ARDS with atelectasis.
Methods
Rats were intratracheally injected with lipopolysaccharide (LPS) to establish an ARDS model. They were allocated to the low, moderate, and high FIO2 groups with FIO2 of 21, 60, and 100%, respectively, a day after LPS injection. All groups were mechanically ventilated with an 8 mL/kg tidal volume and zero end-expiratory pressure to induce dorsal atelectatic regions. Arterial blood gas analysis was performed every 2 h. After six hours of mechanical ventilation, the rats were euthanized, and blood, bronchoalveolar lavage fluid, and lung tissues were collected and analyzed. Another set of animals was used for pimonidazole staining of the lung tissues to detect the hypoxic region.
Results
Lung mechanics, ratios of partial pressure of arterial oxygen (PaO2) to FIO2, and partial pressure of arterial carbon dioxide were not significantly different among the three groups, although PaO2 changed with FIO2. The dorsal lung tissues were positively stained with pimonidazole regardless of FIO2, and the HIF-1α concentrations were not significantly different among the three groups, indicating that raising FIO2 could not rescue alveolar tissue hypoxia. Moreover, changes in FIO2 did not significantly affect lung injury or inflammation. In contrast, hypoxemia observed in the low FIO2 group caused injury to organs other than the lungs.
Conclusions
Raising FIO2 levels did not attenuate tissue hypoxia, inflammation, or injury in the atelectatic lung region in experimental ARDS. Our results indicate that raising FIO2 levels to attenuate atelectasis-induced lung injury cannot be rationalized.