bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare costs for patients with rare diseases: Evidence from China
Authors: Zhang Xiaoyan , Dai Liyi , Long Yulin , Chen Xin , Alhafi Mohammed A. K. 
Published: October 2023

AbstractObjectiveRare diseases cause a huge financial burden to countless patients and families. It is an important public health issue that requires widespread attention. This study analyzes medical expenses composition and the change in trends of out‐of‐pocket (OOP) expenses for patients with Amyotrophic lateral sclerosis (ALS) and explores the factors influencing these changes.MethodsData were obtained from the Chinese Medical Insurance Department database from 2018 to 2020, including 857 patients with ALS in 60 cities across 30 provinces. We used descriptive methods to analyse the baseline characteristics and medical expenses of outpatients and inpatients with ALS. And we used quantile regression to analyse the differences in patient OOP ratio and the factors influencing them.ResultsIn China, 80.3% of ALS patients chose tertiary hospitals, with an annual direct medical cost of 11,339.7 RMB per patient and an OOP ratio of 41.6%. The annual medical cost for outpatients was 345.1 RMB per patient, with an OOP ratio of 36.7%. The annual medical cost for inpatients was 28,139.8 RMB per patient, with an OOP ratio of 41.7%. Compared to outpatients, inpatients had higher medical costs but lower actual reimbursement rates. The OOP ratio of ALS patients decreased, then increased over time. And the OOP ratio was influenced by medical institution, medical insurance, and age (p < 0.05). Patients who chose tertiary hospitals, those who were covered by the urban resident basic medical insurance and younger patients had relatively higher OOP ratio.ConclusionIn recent years, although China has begun to pay attention to the rights and interests of patients with rare diseases, the government has provided some healthcare security to patients with rare diseases. However, the level of medical insurance coverage was still low, the equity of protection was still insufficient and the financial burden on patients was high. Therefore, the government should further improve the healthcare system to provide full life‐cycle and affordable healthcare services to patients with rare diseases.
Chronic kidney disease and polypharmacy as risk factors for recurrent falls in a nursing home population
Authors: Sarad Nakia , Jannath Syeda Y. , Ogami Takuya , Khedr Shahenda , Omar Hala , Thorson Teagan , Kopp Miroslav 
Published: October 2023

AbstractBackgroundIt is known that nursing home patients who have sustained a previous fall are at a higher average risk for recurrent falls. Therefore, these patients require closer attention and monitoring for fall prevention.MethodsWe conducted a retrospective review in our Level 1 Trauma Center, who sustained a ground‐level fall in a nursing home from January 2017 to December 2018. Inclusion criteria involved patients aged 65 or older, admitted from nursing homes. Logistic regression analysis was performed to identify factors associated with recurrent fall.ResultsA total of 445 patients were identified. Among them, 47 (10.6%) patients sustained recurrent falls, The median age was 83.3 years old and. The recurrent fall group was more likely to have chronic kidney disease (CKD) (27.1% vs. 13.1%, p = 0.02) and diabetes (47.9% vs. 31%, p = 0.02). The median number of medications taken by a patient was 8.78. Overall, 176 (39.5%) patients sustained any injury, and 25 (5.6%) patients died within the study period. The presence of CKD (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.15–4.76, p = 0.02) and polypharmacy (number of medications of 9 or above) (OR, 2.07; 95% CI, 1.12–3.82, p = 0.02) were independent risk factors for recurrent falls.ConclusionsCKD and polypharmacy were associated with a risk of recurrent falls among nursing home patients. The incidence of falls has a multifactorial etiology, and it is important to identify such risk factors to better prevent the morbidities and mortalities associated with fall‐related injuries.
Situation analysis model of hospital emergency department promotion in Iran: A cross‐sectional study
Authors: Asadi Farkhondeh , Anvari Mahrokh , Ramezanghorbani Nahid , Sabahi Azam 
Published: October 2023

AbstractBackground and AimThe present study was conducted to develop a situation analysis model for Iran's hospitals' emergency departments (EDs).MethodsThe current research was a descriptive cross‐sectional applied study in three stages. The studies were reviewed in various library resources and valid sites in the first stage. In the second stage, the analysis model of the ED in Iran was presented. In the third stage, the model was validated based on the Delphi technique, and the final model was presented.ResultsThe final situation analysis model of ED in Iran was approved in four main aspects, including goals, internal factors, external factors, and organizations and institutions participating in the situation analysis, and its implementation schedule was approved by 90% of experts.ConclusionConsidering the importance of situation analysis in developing a strategic plan and improving the quality of health services in the ED of hospitals, implementing a coherent situation analysis model that includes all aspects leading to improving the ED quality and analyzing the internal and external factors is vital.
Correlation between professional quality of life and alarm fatigue symptoms among intensive care unit nurses
Authors: Dehghan Mahlagha , Mokhtarabadi Sima , Rashidi Elham , Rahiminejad Elham , Asadi Neda 
Published: October 2023

AbstractIntroductionMedical devices and equipment are necessary for accurate and continuous monitoring of the patients admitted to intensive care units, one of which is alarm systems. Frequent sounds of alarms can affect nurses' concentration and accuracy when providing care. Complications such as headache, fatigue, and stress occur after repeated alarms, leading to poor quality of professional life among nurses. This study aimed to determine the relationship between quality of professional life and alarm fatigue syndrome among intensive care unit nurses.MethodsThis cross‐sectional study used convenience sampling to select nurses working in intensive care units from three hospitals in southern Iran in 2021 (n = 201). Data were collected using three questionnaires, including sociodemographic form, the professional quality of life questionnaire (ProQOL), and the alarm fatigue symptom (AFS) scale.ResultsThe mean scores of compassion satisfaction (CS), burnout, secondary traumatic stress (STS) (subscales of the ProQOL), and AFS were 34.66 ± 7.54, 28.98 ± 7.59, 27.69 ± 5.87, and 13.48 ± 7.32, respectively. The majority of them had no or mild AFS, moderate CS, burnout, and STS. Among the study variables, only AFS were a significant predictor of CS and STS among ICU nurses. In addition, work experience in ICU, AFS, and a second job were significant predictors of burnout among ICU nurses.ConclusionsThe study results showed a significant relationship between alarm fatigue syndrome, burnout, STS, and CS. Given that more than half of the nurses in the intensive care unit in the present study experienced some degree of alarm fatigue syndrome, it is necessary to plan and implement interventions to better manage the alarms in the intensive care unit.
Differentiating benign and malignant thyroid nodules: A cross‐sectional study on the comparison of diagnostic value of ultrasound elastography and fine needle aspiration biopsy
Authors: Rajabzadeh Farnood , Hassannejad Ehsan , Akhlaghipour Iman , Imen Mohammad Javad , Babazadeh Baghan Atefeh , Goshayeshi Ladan , Taghavi Seyed Morteza , Vojouhi Shohreh , Payandeh Asma , Moodi Ghalibaf AmirAli 
Published: October 2023

AbstractBackground and AimThis study examines the comparison of ultrasound elastography and fine needle aspiration (FNA) in diagnosing thyroid cancers and investigates the use of elastography as the initial diagnostic test of thyroid cancers to avoid the need for invasive diagnostic tests.MethodsIn this study, 28 patients with 48 thyroid nodules (TNs) who were candidates for FNA or surgery were examined within a period of 18 months. Cut‐off and subsequently sensitivity and specificity for elastography results, compared to pathology results as the gold standard, were calculated using the receiver operating characteristic curve (ROC).ResultsBased on ROC, the cut‐off point differentiating the tissue stiffness between benign and malignant TNs was 25.400 kilopascal (kPa) (sensitivity of 90.9% and specificity of 78.4%). It was observed that age affects the tissue stiffness; therefore, the cut‐off was defined as 65.625 kpa for age groups under 50 years old (sensitivity of 100% and specificity of 100%) and 25.400 kpa for the age group above 50 years old (sensitivity of 88.9% and specificity of 70.4%).ConclusionBased on the high sensitivity and specificity of shear wave elastography in the differentiation of benign and malignant TNs, it can be employed as a stand‐alone or in combination with other diagnostic techniques to reduce the need for inessential surgical operations. However, future studies or developments are needed on this promising diagnostic technique.
Reflections on the surge in malaria cases after unprecedented flooding in Pakistan—A commentary
Authors: Tabassum Shehroze , Kalsoom Tuaseen , Zaheer Zaofashan , Naeem Aroma , Afifi Ahmed , Ohadi Laya 
Published: October 2023

AbstractBackgroundMalaria is a parasitic infection primarily caused by four main species of the genus Plasmodium, that is, Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, and Plasmodium malariae. It is transmitted through the bite of the female Anopheles mosquito. It holds the status of one of the leading causes of death in the developing world. Malaria is endemic to Pakistan, and the country experienced the worst floods in its history from April to October 2022. The stagnant flood water served as a breeding ground for mosquitoes, culminating in an alarming spike in malaria cases. According to the World Health Organization (WHO), the number of cases reported till August 2022 was more than in the whole year of 2021. There was more than a twofold rise in cumulative cases in 62 high‐burden Pakistani Districts in August 2022 as compared to August 2021.AimsThis commentary aims to bring this emerging issue to notice and highlight the most effective probable measures to help eliminate and prevent the hazards the current outbreak poses.ResultsRapid planning and execution are needed to ensure the most efficient and rapid elimination of malaria. To educate the general public, the national government must start public awareness efforts in electronic, print, and social media and deploy solar‐powered mobile healthcare units to far‐flung areas. Prophylactic and postexposure treatments should be planned because larvicidal preventive measures are less practical in flood‐affected vicinities.ConclusionThe most effective preventive strategy is drug prophylaxis, followed by insecticide‐treated nets, indoor residual spraying, and untreated nets. Scientists should intensify their investigations for effective medications to alleviate the malaria burden in Pakistan.
Complications in patients with transfusion dependent thalassemia: A descriptive cross‐sectional study
Authors: Faranoush Mohammad , Faranoush Pooya , Heydari Iraj , Foroughi‐Gilvaee Mohammad Reza , Azarkeivan Azita , Parsai Kia Ali  , Sadighnia Negin , Elahinia Ali , Zandi Afsoon , Rezvany Mohammad Reza , Hashemi‐Madani Nahid , Ziaee Amir , Nekouian Reza , Rohani Farzaneh 
Published: October 2023

AbstractBackground and AimsOne of the most common hemoglobinopathies globally related to blood transfusion and iron overload in the body is thalassemia syndrome. Increasing ferritin levels can cause severe damage to the patient's body organs. This study aims to evaluate the complications of iron overload on vital body organs in patients with transfusion‐dependent beta‐thalassemia.MethodsThis descriptive cross‐sectional study was performed in Iran University of Medical Sciences Hospitals on patients with a beta‐thalassemia major with frequent blood transfusions. To evaluate the effect of iron overload on vital body organs, hematologic and blood analysis, echocardiography with measurement of pulmonary artery pressure (PAP) and ejection fraction (EF) tests, bone densitometry, and audiometric tests were performed for all patients.ResultsOf the 1010 patients participating in this study, 497 (49%) were males, 513 were (51%) females aged 5–74 years, and the majority of participants (85%) were over 20 years old. This study demonstrated that increasing ferritin levels had no notable correlation with sex, cholesterol, low‐density lipoprotein, parathyroid hormone, T4, and aspartate aminotransferase. However, elevating ferritin levels had significant correlations with increasing triglyceride, phosphorus, thyroid stimulating hormone, alkaline phosphatase, alanine transaminase, and PAP levels, age, hearing disorders, splenectomy, osteoporosis, and decreasing high‐density lipoprotein, body mass index, calcium, and EF levels.ConclusionImprovement in beta‐thalassemia patients' survival and quality of life can be due to multidisciplinary care in a comprehensive unit through regular follow‐up and early complication detection.
Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center
Authors: Sharifiaghdas Farzaneh , Narouie Behzad , Ahmadzade Mohadese , Rouientan Hamidreza , Najafi Darya , Dadpour Mehdi , Latifi Nariman , Hanafi Bojd Hamideh , Sabzi Sobhan 
Published: October 2023

AbstractBackground/AimTo identify correlations between urodynamic study (UDS) findings and urinary symptoms in children with refractory monosymptomatic and nonmonosymptomatic primary nocturnal enuresis.Materials and MethodsA total of 96 neurologically normal children were enrolled, 44 consecutive boys and 51 consecutive girls, aged 5–18 years, of whom 41 (38.8%) had refractory monosymptomatic nocturnal enuresis (MNE) and 55 (61.2%) had refractory non‐MNE (NMNE). We assessed the urodynamics of all children to detect any underlying bladder overactivity. A comparative analysis was carried out between the two groups of patients.ResultsDetrusor overactivity (DO), low bladder capacity, low compliance, and increased postvoid residual (PVR) were identified in 70 (72.9%), 35 (36.5%), 43, and 76 (79.2%) patients, respectively. The mean bladder compliance was 21.66 ± 14.52 mL/cmH2O (2–75 cmH2O). Of the NMNE patients, 50 (90.9%) had abnormal urodynamic findings, while 40 (97.5%) had abnormal urodynamic findings in the MNE group. There was a statistically significant relationship between NMNE and both increased PVR and abnormal voiding patterns. Both high PVR and DO were significantly associated with obstructive urinary symptoms. Constipation and history of urinary tract infection (UTI) did not significantly correlate with UDS abnormality (p = 1.0 and p = 0.49, respectively).ConclusionThere was a high prevalence of bladder function disorders in both refractory MNE and NMNE patients in our study. This included small functional capacity, low bladder compliance, and marked DO. A nocturnal enuresis may be the only presenting symptom, however, it may be associated with bladder overactivity, UTI, and constipation; the UDS findings may aid in guiding the assessment and treatment of children suffering from primary refractory nocturnal enuresis and its association with bladder and bowel symptoms.
Detection of fetal facial anatomy in standard ultrasonographic sections based on real‐time target detection network
Authors: Liu Zhonghua , Yu Weifeng , Wu Xiuming , Yang Tong , Lyu Guorong , Liu Peizhong , Xue Hao 
Published: October 2023

AbstractAt present, prenatal ultrasound is one of the important means for screening fetal malformations. In the process of prenatal ultrasound diagnosis, the accurate recognition of fetal facial ultrasound standard plane is crucial for facial malformation detection and disease screening. Due to the dense distribution of fetal facial images, no obvious structure contour boundary, small structure area, and large area overlap in the middle of the structure detection frame, this paper regards the fetal facial standard plane and its structure recognition as a universal target detection task for the first time, and applies real‐time YOLO v5s to the fetal facial ultrasound standard plane structure detection and classification task. First, we detect the structure of a single slice, and take the structure of a slice class as the recognition object. Second, we carry out structural detection experiments on three standard planes; then, on the basis of the previous stage, the images of all parts included in the ultrasound examination of multiple fetuses were collected. In the single‐class structure detection experiment and the structure detection and classification experiment of three types of standard planes, the overall recognition effect of Precision and Recall index data is better, with Precision being 98.3% and 98.1%, and Recall being 99.3% and 98.2%, respectively. The experimental results show that the model has the ability to identify fetal facial anatomy and standard sections in different data, which can help the physician to automatically and quickly screen out the standard sections of each fetal facial ultrasound.
Uric acid promotes interleukin‐17 expression to cause kidney injury
Authors: Yang Lina , He Tianwei , Yu Yanming 
Published: October 2023

AbstractUric acid, an oxidation end‐product of purine metabolism, is reportedly to be a risk factor for kidney injury. However, its underlying mechanism is still a mystery. This study aimed to reveal the detailed roles of uric acid in inducing kidney injury and the possible mechanisms. Injection of rats with uric acid significantly increased tubular injury score, and levels of blood urea nitrogen, serum creatinine, and urine kidney injury molecule‐1. Uric acid increased the expression of collagen I, alpha‐smooth muscle actin, tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, and IL‐6. Kyoto Encyclopedia of Genes and Genomes analysis result showed the IL‐17 signaling pathway as the most significantly enriched pathway involved in hyperuricemia‐related kidney injury. Long‐term injection of uric acid induced significant production of IL‐17 and recruitment of Th17 cells. Treating rats with the anti‐IL‐17 mAb attenuated uric acid‐induced kidney injury, accompanied by the inactivation of nuclear factor‐κB (NF‐κB). In conclusion, uric acid was confirmed to be a risk factor for kidney injury via inducing IL‐17 expression. Neutralization of IL‐17 using the specific mAb relieved uric acid‐induced kidney injury via inhibition of NF‐κB signaling.
The mediating effects of anxiety on the relationships between persistent thinking and life satisfaction: A two‐wave longitudinal study in patients with anxiety disorders
Authors: Skalski‐Bednarz Sebastian Binyamin , Konaszewski Karol , Toussaint Loren L. , Harder Jean‐Pierre , Hillert Andreas , Surzykiewicz Janusz 
Published: October 2023

AbstractObjectiveAccording to cognitive theories, anxiety disorders may result from distorted beliefs, sensations, feelings, and decisions, leading to an overestimation of the danger presented by various stimuli.MethodsIn this two‐wave longitudinal study of 435 German patients with anxiety disorders, we assessed the association of negative persistent thinking, anxiety, and life satisfaction.Results & ConclusionStructural equation modeling results suggest that persistent thinking may initiate the occurrence of anxiety, which in turn influences a decrease in life satisfaction. The convergence of the evidence from this longitudinal study with earlier results of evidence‐based trials fortifies the case supporting the need to identify and reduce cognitive distortions in therapeutic interventions to improve health in people with anxiety disorders.
Targeting phosphatidylinositol‐3‐kinase for inhibiting maxillary bone resorption
Authors: Santos Mariana de S. , Lima Virgínia T. M. , Barrioni Breno R. , Vago Juliana P. , de Arruda José Alcides A. , Prazeres Pedro D. , Amaral Flávio A. , Silva Tarcília A. , Macari Soraia 
Published: October 2023

AbstractPrevious studies have suggested a role of phosphatidylinositol‐3‐kinase gamma (PI3Kγ) in bone remodeling, but the mechanism remains undefined. Here, we explored the contribution of PI3Kγ in the resorption of maxillary bone and dental roots using models of orthodontic tooth movement (OTM), orthodontic‐induced inflammatory root resorption, and rapid maxillary expansion (RME). PI3Kγ‐deficient mice (PI3Kγ−/−), mice with loss of PI3Kγ kinase activity (PI3KγKD/KD) and C57BL/6 mice treated with a PI3Kγ inhibitor (AS605240) and respective controls were used. The maxillary bones of PI3Kγ−/−, PI3KγKD/KD, and C57BL/6 mice treated with AS605240 showed an improvement of bone quality compared to their controls, resulting in reduction of the OTM and RME in all experimental groups. PI3Kγ−/− mice exhibited increased root volume and decreased odontoclasts counts. Consistently, the pharmacological blockade or genetic deletion of PI3K resulted in increased numbers of osteoblasts and reduction in osteoclasts during OTM. There was an augmented expression of Runt‐related transcription factor 2 (Runx2) and alkaline phosphatase (Alp), a reduction of interleukin‐6 (Il‐6), as well as a lack of responsiveness of receptor activator of nuclear factor kappa‐Β (Rank) in PI3Kγ−/− and PI3KγKD/KD mice compared to control mice. The maxillary bones of PI3Kγ−/− animals showed reduced p‐Akt expression. In vitro, bone marrow cells treated with AS605240 and cells from PI3Kγ−/− mice exhibited significant augment of osteoblast mineralization and less osteoclast differentiation. The PI3Kγ/Akt axis is pivotal for bone remodeling by providing negative and positive signals for the differentiation of osteoclasts and osteoblasts, respectively.
Brooks' theorem with forbidden colors
Authors: Casselgren Carl Johan 
Published: October 2023

AbstractWe consider extensions of Brooks' classic theorem on vertex coloring where some colors cannot be used on certain vertices. In particular we prove that if is a connected graph with maximum degree that is not a complete graph and is a set of vertices where either

at most colors are forbidden for every vertex in , and any two vertices of are at distance at least 4, or
at most colors are forbidden for every vertex in , and any two vertices of are at distance at least 3,then there is a proper ‐coloring of respecting these constraints. In fact, we shall prove that these results hold in the more general setting of list colorings. These results are sharp.