bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of dexmedetomidine in combination with midazolam in pediatric sedation: a systematic review and meta-analysis
Authors: Nie Juan , Li Chenxi , Yang Ge , Chang Huihui , Ding Guicong 
Published: June 2024

Abstract
Background
Dexmedetomidine and midazolam are commonly used sedatives in children. We conducted a systematic review and meta-analysis to compare the safety and effectiveness of sedation provided by dexmedetomidine combined with midazolam versus other sedatives including chloral hydrate, midazolam and other sedatives in pediatric sedation.

Methods
The Embase, Web of Science, Cochrane Library, and PubMed databases, and Clinicaltrials.gov register of controlled trials were searched from inception to June 2022. All randomized controlled trials used dexmedetomidine-midazolam in pediatric sedation were enrolled. The articles search, data extraction, and quality assessment of included studies were performed independently by two researchers. The success rate of sedation was considered as the primary outcome. The secondary outcomes included onset time of sedation, recovery time of sedation and occurrence of adverse events.

Results
A total of 522 studies were screened and 6 RCTs were identified; 859 patients were analyzed. The administration of dexmedetomidine combined with midazolam was associated with a higher sedation success rate and a lower incidence of nausea and vomiting in computed tomography, magnetic resonance imaging, Auditory Brainstem Response test or fiberoptic bronchoscopy examinations than the other sedatives did (OR = 2.92; 95% CI: 1.39–6.13, P = 0.005, I2 = 51%; OR = 0.23, 95% CI: 0.07–0.68, P = 0.008, I2 = 0%, respectively). Two groups did not differ significantly in recovery time and the occurrence of adverse reactions (WMD = − 0.27, 95% CI: − 0.93 to − 0.39, P = 0.42; OR 0.70; 95% CI: 0.48–1.02, P = 0.06, I2 = 45%. respectively). However, the results of the subgroup analysis of ASA I-II children showed a quicker onset time in dexmedetomidine-midazolam group than the other sedatives (WMD=−3.08; 95% CI: −4.66 to − 1.49, P = 0.0001, I2 = 30%).

Conclusions
This meta-analysis showed that compared with the control group, dexmedetomidine combined with midazolam group provided higher sedation success rates and caused a lower incidence of nausea and vomiting in completing examinations, indicating a prospective outpatient clinical application for procedural sedation.
The association between internet use and the choice of medical institution among Chinese older adults
Authors: Wang Liuying , Cheng Zirong , Ye Li , Rong Lijuan , Chien Ching-Wen , Tung Tao-Hsin 
Published: June 2024

Abstract
Background
As older people have complex medical needs and still encounter challenges in accessing online health information, the relationship between Internet use and the choice of medical institution made by them is unclear, and we aimed to examine this relationship.

Methods
Data from the newly released 2020 China Family Panel Survey database were used. Furthermore, we used descriptive statistics to analyze the background characteristics of the sample and a logistic regression model to estimate the impact of Internet use on the choice of medical institution made by older adults. We conducted a stratified analysis to explore the influence of different characteristics on the relationship between Internet use and the choice of medical institution.

Results
Totally 4,948 older adults were included. Multivariate logistic regression showed that, compared to non-Internet users, Internet users were less likely to choose community health service centers over general hospitals (P < 0.001, OR = 0.667, 95CI%: 0.558–0.797). The subgroup analyses found that Internet use only had an impact on the choice of medical institution in older adults aged 65–69 years, those with partners, those with primary or secondary education, those residing in urban areas, those without medical insurance, those with a self-rated health status as average or healthy, those with unchanged or better health trend, and those without chronic disease. The effect of Internet use on the choice of medical institution did not differ by sex, satisfaction, or trust in doctors.

Conclusion
Internet use may significantly affect older adults’ tendency to choose general hospitals to meet their daily medical needs. The subgroup analyses indicated that different characteristics of older people affected this association.
Predicting perioperative myocardial injury/infarction after noncardiac surgery in patients under surgical and medical co-management: a prospective cohort study
Authors: Xi Shaozhi , Wang Bin , Su Yanhui , Lu Yan , Gao Linggen 
Published: June 2024

Abstract
Background
Perioperative myocardial injury/infarction (PMI) following noncardiac surgery is a frequent cardiac complication. This study aims to evaluate PMI risk and explore preoperative assessment tools of PMI in patients at increased cardiovascular (CV) risk who underwent noncardiac surgery under the surgical and medical co-management (SMC) model.

Methods
A prospective cohort study that included consecutive patients at increased CV risk who underwent intermediate- or high-risk noncardiac surgery at the Second Medical Center, Chinese PLA General Hospital, between January 2017 and December 2022. All patients were treated with perioperative management by the SMC team. The SMC model was initiated when surgical intervention was indicated and throughout the entire perioperative period. The incidence, risk factors, and impact of PMI on 30-day mortality were analyzed. The ability of the Revised Cardiac Risk Index (RCRI), frailty, and their combination to predict PMI was evaluated.

Results
613 eligible patients (mean [standard deviation, SD] age 73.3[10.9] years, 94.6% male) were recruited consecutively. Under SMC, PMI occurred in 24/613 patients (3.9%). Patients with PMI had a higher rate of 30-day mortality than patients without PMI (29.2% vs. 0.7%, p = 0.00). The FRAIL Scale for frailty was independently associated with an increased risk for PMI (odds ratio = 5.91; 95% confidence interval [CI], 2.34–14.93; p = 0.00). The RCRI demonstrated adequate discriminatory capacity for predicting PMI (area under the curve [AUC], 0.78; 95% CI, 0.67–0.88). Combining frailty with the RCRI further increased the accuracy of predicting PMI (AUC, 0.87; 95% CI, 0.81–0.93).

Conclusions
The incidence of PMI was relatively low in high CV risk patients undergoing intermediate- or high-risk noncardiac surgery under SMC. The RCRI adequately predicted PMI. Combining frailty with the RCRI further increased the accuracy of PMI predictions, achieving excellent discriminatory capacity. These findings may aid personalized evaluation and management of high-risk patients who undergo intermediate- or high-risk noncardiac surgery.
Model correction of diagnostic coding-based RSV incidence for children 0–4 years in the US
Authors: Nduaguba Sabina O. , Tran Phuong T. , Winterstein Almut G. 
Published: June 2024

Abstract
Background
Although administrative claims data have a high degree of completeness, not all medically attended Respiratory Syncytial Virus-associated lower respiratory tract infections (RSV-LRTIs) are tested or coded for their causative agent. We sought to determine the attribution of RSV to LRTI in claims data via modeling of temporal changes in LRTI rates against surveillance data.

Methods
We estimated the weekly incidence of LRTI (inpatient, outpatient, and total) for children 0–4 years using 2011–2019 commercial insurance claims, stratified by HHS region, matched to the corresponding weekly NREVSS RSV and influenza positivity data for each region, and modelled against RSV, influenza positivity rates, and harmonic functions of time assuming negative binomial distribution. LRTI events attributable to RSV were estimated as predicted events from the full model minus predicted events with RSV positivity rate set to 0.

Results
Approximately 42% of predicted RSV cases were coded in claims data. Across all regions, the percentage of LRTI attributable to RSV were 15–43%, 10–31%, and 10–31% of inpatient, outpatient, and combined settings, respectively. However, when compared to coded inpatient RSV-LRTI, 9 of 10 regions had improbable corrected inpatient LRTI estimates (predicted RSV/coded RSV ratio < 1). Sensitivity analysis based on separate models for PCR and antigen-based positivity showed similar results.

Conclusions
Underestimation based on coding in claims data may be addressed by NREVSS-based adjustment of claims-based RSV incidence. However, where setting-specific positivity rates is unavailable, we recommend modeling across settings to mirror NREVSS’s positivity rates which are similarly aggregated, to avoid inaccurate adjustments.
Genetic variation of TLR3 gene is associated with the outcome of hepatitis b infection in mauritanian patients: case control study
Authors: Soumbara Tetou , Bonnet Crystel , Hamed Cheikh Tijani , Veten Fatimetou , Hemeyine Mohamed , Fall-Malick F-Zahra , El Yezid Mohamed Mahmoud , Diallo Aichetou , Mounah Moustapha Mouhamedou , Houmeida Ahmed 
Published: June 2024

Abstract
Background
Toll-Like receptors (TLRs) play an important role in the immune response during hepatitis B virus (HBV) infection. In this study, we evaluated the association between two SNP variants (TLR3 rs3775290 and TLR4 rs4986790) and susceptibility to chronic HBV infection in Mauritania.

Subjects and methods
: A total of 188 subjects were recruited for this study: 102 chronically infected patients and 86 individuals with spontaneously resolved HBV infection who were considered controls. Targeted PCR products were sequenced using Sanger sequencing.

Results
We found that TLR3 rs3775290 was significantly more frequent in patients with chronic HBV than in the control population (p = 0.03). However, no association was found between the TLR4 rs3775290 polymorphism and chronic infection.

Conclusion
Our results suggest that the TLR3 rs3775290 polymorphism may be a risk factor for susceptibility to chronic HBV infection in the Mauritanian population.
DOK7 congenital myasthenic syndrome: case series and review of literature
Authors: Ziaadini Bentolhoda , Ghaderi Yazdi Bardyia , Dirandeh Elham , Boostani Reza , Karimi Narges , Panahi Akram , Kariminejad Ariana , Fadaee Mahsa , Ahangari Fatemeh , Nafissi Shahriar 
Published: June 2024

Abstract
Background
Congenital myasthenic syndromes (CMS) are among the most challenging differential diagnoses in the neuromuscular domain, consisting of diverse genotypes and phenotypes. A mutation in the Docking Protein 7 (Dok-7) is a common cause of CMS. DOK7 CMS requires different treatment than other CMS types. Regarding DOK7’s special considerations and challenges ahead of neurologists, we describe seven DOK7 patients and evaluate their response to treatment.

Methods
The authors visited these patients in the neuromuscular clinics of Tehran and Kerman Universities of Medical Sciences Hospitals. They diagnosed these patients based on clinical findings and neurophysiological studies, which Whole Exome Sequencing confirmed. For each patient, we tried unique medications and recorded the clinical response.

Results
The symptoms started from birth to as late as the age of 33, with the mean age of onset being 12.5. Common symptoms were: Limb-girdle weakness in 6, fluctuating symptoms in 5, ptosis in 4, bifacial weakness in 3, reduced extraocular movement in 3, bulbar symptoms in 2 and dyspnea in 2 3-Hz RNS was decremental in 5 out of 6 patients. Salbutamol was the most effective. c.1124_1127dupTGCC is the most common variant; three patients had this variant.

Conclusion
We strongly recommend that neurologists consider CMS in patients with these symptoms and a similar familial history. We recommend prescribing salbutamol as the first-choice treatment option for DOK7 patients.
Apatinib combined with temozolomide in diffuse midline glioma: a novel and effective therapy
Authors: Li Yu-An , Zhao Chuan , Ge Jing-Jing , Li Cheng , Xue Feng-Jun , Qi Shao-Pei , Zhao Chi , Kong Chen-Chen , Zhang Jun-Ping 
Published: June 2024

Abstract
Purpose
Diffuse midline glioma (DMG), H3 K27M-mutant is a type of diffuse high-grade glioma that occurs in the brain midline carrying an extremely poor prognosis under the best efforts of surgery, radiation, and other therapies. For better therapy, we explored the efficacy and toxicity of a novel therapy that combines apatinib and temozolomide in DMG.

Methods
A retrospective analysis of 32 patients with DMG who underwent apatinib plus temozolomide treatment was performed. Apatinib was given 500 mg in adults, 250 mg in pediatric patients once daily. Temozolomide was administered at 200 mg/m2/d according to the standard 5/28 days regimen. The main clinical data included basic information of patients, radiological and pathological characteristics of tumors, treatment, adverse reactions, prognosis.

Results
The objective response rate was 24.1%, and the disease control rate was 79.3%. The median PFS of all patients was 5.8 months, and median OS was 10.3 months. A total of 236 cycles of treatment were available for safety assessment and the toxicity of the combination therapy was relatively well tolerated. The most common grade 3 toxicities were myelosuppression including leukopenia (5.08%), neutropenia (4.24%), lymphopenia (2.12%), thrombocytopenia (1.69%) and anemia (1.27%). Grade 4 toxicities included neutropenia (2.12%), thrombocytopenia (2.12%) and proteinuria (1.69%). All the adverse events were relieved after symptomatic treatment or dose reduction.

Conclusions
Apatinib plus temozolomide could be an effective regimen with manageable toxicities and favorable efficacy and may outperform temozolomide monotherapy, particularly in newly diagnosed adults with tumors located outside the pons. The novel therapy deserves further investigation in adult DMG patients.
Correlation between hemoglobin and the risk of common malignant tumors: a 1999–2020 retrospective analysis and causal association analysis
Authors: Li Guo-Sheng , Huang Tao , Li Jing-Xiao , Liu Jun , Gao Xiang , Yang Nuo , Zhou Hua-Fu 
Published: June 2024

Abstract
Background
The role of hemoglobin (HGB) in common malignant tumors remains unclear.

Methods
A retrospective analysis was conducted to identify the correlation between HGB levels and risk of 15 malignant tumors using 50,085 samples from the National Health and Nutrition Examination Survey. Mendelian Randomization analyses (MRAs) were performed based on genome-wide association study data to assess the causal relationship between HGB levels and these malignant tumors using more than 700,000 samples. The robustness of the MRA results was confirmed through various analytical methods. Fifty-six in-house samples were used to investigate the correlation between HGB levels and the prognosis in prostate cancer (PRCA) using the Kaplan-Meier curve.

Results
High HGB levels were associated with a higher risk for patients with cervix cancer, melanoma, and non-melanoma skin cancer (OR > 1.000, p < 0.05). It served as a protective factor for colon cancer, esophagus cancer, stomach cancer, bone cancer, lung cancer, renal cancer, and PRCA (OR < 1.000, p < 0.05). Furthermore, MRAs suggested that elevated HGB levels were correlated with a reduced risk of PRCA (OR = 0.869, p < 0.05), with no significant association observed between this marker and the remaining 14 malignant tumors. No pleiotropy or heterogeneity was found in the ultimate results for MRAs (p-values > 0.05), suggesting the robustness of the results. The results derived from the in-house data revealed a relationship between higher HGB values and a more favorable prognosis in PRCA (p < 0.05).

Conclusion
High circulating HGB levels may play a protective prognostic role for PRCA and serve as a protective factor against the occurrence of PRCA.
Genetically evaluating the causal role of peripheral immune cells in colorectal cancer: a two-sample Mendelian randomization study
Authors: Huang Runze , Jin Xin , Jiang Ziting , Wang Yixiu , Wu Yibin , Wang Lu , Zhu Weiping 
Published: June 2024

Abstract
Background
Investigating novel therapeutic strategies for colorectal cancer (CRC) is imperative. However, there is limited research on the use of drugs to target peripheral blood immune cells in this context. To address this gap, we performed a two-sample Mendelian randomization (MR) analysis to identify potential therapeutic targets for CRC.

Methods
We applied two-sample MR to identify the causal relationship between peripheral blood immune cells and CRC. GWAS data were obtained from the IEU OPEN GWAS project. Based on the implications from the MR results, we conducted a comprehensive database search and genetic analysis to explore potential underlying mechanisms. We predicted miRNAs for each gene and employed extensive research for potential therapeutic applications.

Results
We have identified causal associations between two peripheral immune cells and colorectal cancer. Activated & resting Treg %CD4 + cell was positively associated with the risks of CRC, while DN (CD4-CD8-) %leukocyte cell exhibited a protective role in tumor progression. NEK7 (NIMA related kinase 7) and LHX9 (LIM homeobox 9) expressed in Treg cells were positively associated with CRC risks and may play a vital role in carcinogenesis.

Conclusions
This study identified causal relationship between peripheral immune cell and CRC. Treg and DN T cells were implicated to own promoting and inhibiting effects on CRC progression respectively. NEK7 and LHX9 in Treg cells were identified as potential biotarget for antitumor therapies.
Community-dwelling older adults’ perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing
Authors: Zhai Shaoqi , Zhang Zhiying , Zhang Ruyi , Peng Yingchun , Zhang Jiaying , Zhang Yiyao , Jin Qilin , Zhou Jiaojiao , Chen Jingjing 
Published: June 2024

Abstract
Background
With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks.

Methods
Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach.

Results
Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy.

Conclusions
The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.
Pulp stones in unerupted teeth: a retrospective analysis using cone-beam computed tomography
Authors: Kaabi Hassan Hamed , Riyahi Abdullah Mahmoud , Bakrman Abdullah Khalid , Almutaw Yazeed Ali , Alrumayyan Saleh Firas , Al-Maflehi Nassr Saleh 
Published: June 2024

Abstract
Background
A pulp stone is a calcified mass that develops in the dental pulp of any tooth. Despite many studies examining the relationship between pulp stone formation and non-oral factors, the methods used in these studies have been unable to explain the exact role of these factors alone as distinct from probable effects within the oral cavity environment. Considering that totally unerupted (impacted or developing) teeth are unexposed to the oral cavity’s environmental and functional conditions, they provide a more suitable material for studying the effects of these non-oral factors on pulp stone formation. This research study aimed to investigate pulp stones in unerupted teeth and the associated factors in a Saudi subpopulation.

Methods
The study included 644 cone-beam computed tomography images, with 496 (50.9%) maxillary and 479 (49.1%) mandibular teeth. Of the investigated patients, 293 (45.5%) were men, and 351 (54.5%) were women. The age range was 15–76 years. A chi-square test was used to investigate the associations between pulp stones and age, gender, and history of systemic disease and chronic medication use.

Results
Pulp stones in unerupted teeth were present in 24.2% of the examined dental jaws and 18.6% of the examined teeth. There was no statistically significant relationship between pulp stones and gender (p > 0.05). A significantly greater percentage of pulp stones were found with increasing age (p = 0.000). Additionally, a significantly increased number of pulp stones was observed in patients with systemic diseases and chronic medications (p < 0.05).

Conclusions
The results support the idea that pulp stones can be present in any type of unerupted tooth. This study provides additional evidence of the increased incidence of pulp stones with age, systemic disease, and chronic medications.