bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi: an observational study
Authors: Blaise Pascal Furaha Nzanzu , Chikumbanje Singatiya Stella , Mbweza Rachel , Kumitawa Andrew , Kapalamula Tiyamike , Thomson Emma , Borgstein Eric , Pollach Gregor , Namboya Felix 
Published: April 2023

Abstract
Background
Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi.

Methodology
This was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%.

Results
Male children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of anaesthesia to the end of the procedure. Hypoglycaemia was rare. The mean fasting glycaemia was 99.04 mg/dL ± 1.8, 116.95 mg/dL ± 34.2 at 30 min into the procedure and 127.62 mg/dL ± 46.8 at the end of the procedure. The differences in means were statistically significant (p < 0.001). Prolonged fasting times was associated with lower blood glucose means whereas nutrition status, type of the procedure, addition of dextrose in the fluid, and duration of procedure were associated with higher glycaemia means.

Conclusion
Glycaemia increases under anaesthesia and surgery. Recommended fasting times, optimising nutritional status, when possible, no dextrose or lower than 2.5% dextrose in IV maintenance fluid are possible strategies to maintain blood sugar homeostasis during paediatric surgery and anaesthesia.
Mindfulness and compassion training on daily work with patients and within the multiprofessional palliative care team: a retrospective self-assessment study
Authors: Lautwein Franziska , Schallenburger Manuela , Scherg Alexandra , Schlieper Daniel , Karger André , Regel Yesche Udo , Schwartz Jacqueline , Neukirchen Martin 
Published: April 2023

Abstract
Background
Palliative care teams work under challenging conditions in a sensitive setting with difficult tasks. The multi-professional team can play an important role. Mindfulness and compassion-based practices are used to build resilience. Our aim was to examine (1) feasibility and acceptability, (2) satisfaction and impact, and (3) opportunities and limitations of a mindfulness course.

Methods
An eight-week mindfulness and compassion course was delivered in a university-based specialized palliative care unit. A meditation teacher provided preparatory evening sessions and meditation exercises that could be integrated into daily activities. The scientific analysis of the course was based on a questionnaire developed for quality assessmentThe first two parts consisted of demographic, Likert-type, and free-text items. Part 3 consisted of learning objectives that were self-assessed after finishing the course (post-then). In the analysis, we used descriptive statistics, qualitative content analysis, and comparative self-assessment.

Results
Twenty four employees participated. 58% of participants attended 4 or more of the 7 voluntary mindfulness days. 91% expressed moderate to high satisfaction and would recommend the palliative care program to others. Three main categories emerged in the qualitative content analysis: providing feedback on the course, personal impact, and impact on professional life. The opportunity for self-care in a professional context was highlighted. Learning gains (CSA Gain) were high (38.5–49.4%) in terms of knowledge and techniques, moderate (26.2–34.5%) in terms of implementation of learned skills, and rather low (12.7–24.6%) in terms of changes to attitude.

Conclusion
Our evaluation shows that the participants of a mindfulness and compassion course considered it as a feasible and welcome tool to familiarize a multi-professional palliative care team with self-care techniques.

Trial registration
Internal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2018074763 (registered retrospectively on 30th July 2018).
Molecular epidemiology of potential candidate markers for chloroquine resistance in imported Plasmodium vivax malaria cases in Iran
Authors: Pirahmadi Sakineh , Afzali Shima , Mehrizi Akram Abouie , Raz Abbasali , Raeisi Ahmad 
Published: April 2023

Abstract
Background
The spread of Plasmodium vivax strains resistant to chloroquine (CQ) has posed a challenge to control strategies aimed at eliminating malaria. Molecular analysis of candidate resistance markers is very important for monitoring the P. vivax resistance to CQ in different endemic regions. In the present study, the multidrug resistance 1 (pvmdr1) gene, a possible marker for CQ resistance in P. vivax, was evaluated by molecular methods.

Methods
A simple PCR–RFLP method was developed for mutation analysis in pvmdr1 gene. A number of 120 blood spots were obtained from patients with P. vivax mono-infection in 2021. All of the samples were collected from Pakistani patients who travelled to Iran.

Results
None of the samples had any mutation at codon 976 of pvmdr1, while the 1076 mutation was detected in 96.2% of the examined isolates. Only two pvmdr1 haplotypes were identified, including the single mutant (Y976/1076L) as the most prevalent haplotype (with 96.2% frequency) and the wild type (Y976/F1076; with 3.8% frequency).

Conclusions
In this study, the major CQ resistance-mediating mutation and multiple mutant haplotypes of the pvmdr1 gene was not detected. However, continuous monitoring of drug resistance markers and close supervision of the efficacy of CQ is essential to detect the potential emergence of CQ-resistant P. vivax isolates in Iran. This data is important for performing future epidemiological surveillance to monitor CQ resistance in this endemic area and the bordering regions.
Associations between weight-adjusted waist index and fractures: a population-based study
Authors: Tao Jianchun , Zhang Yun , Tan Caixia , Tan Wenfu 
Published: April 2023

Abstract
Introduction
The weight-adjusted waist circumference index (WWI) is a novel obesity evaluation indicator that appears to be superior to body mass index (BMI) and waist circumference (WC) in evaluating muscle and fat mass. The purpose of this study was to investigate the association between WWI and fractures among adults.

Methods
In this cross-sectional study, multivariate logistic regression and smoothed curve fitting were used to investigate linear and nonlinear associations between WWI and fractures, based on data from 28,679 adult participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018.

Results
After adjusting for all covariates, the prevalence of hip/wrist/spine fractures among all participants was 1.09%, 8.87%, and 1.97%, respectively. A 1-unit increase in WWI was associated with a 5% increase in the odds of hip fractures [1.05 (1.01, 1.10)], and a 9% increase in the odds of spine fractures [1.09 (1.06, 1.13)], but not with the prevalence of wrist fractures [0.97 (0.94, 1.06)].

Conclusions
Higher WWI was associated with an increased prevalence of hip fracture and spine fracture, but not wrist fracture.
Tension pyopneumothorax caused by Parvimonas micra: a case report
Authors: Iijima Yoshihito , Iwai Shun , Motono Nozomu , Uramoto Hidetaka 
Published: April 2023

AbstractTension pyopneumothorax is a rare and life-threatening complication of pneumonia, lung abscess, and empyema, and immediate thoracic drainage or surgery is required. A 70-year-old man presented to another hospital 2 weeks after exacerbation of dyspnea and anorexia. Chest X-ray imaging revealed leftward deviation of the mediastinum, pleural effusion, and collapse of the right lung. The patient was referred to our hospital for surgical treatment. He underwent chest drainage immediately after the transfer. The patient’s blood pressure was elevated after drainage. Chest X-ray imaging showed improvement in the mediastinal deviation, but expansion failure of the lung occurred. Debridement and parietal and visceral decortications were performed under thoracotomy. The thoracic cavity was irrigated using a pulse lavage irrigation system with 12,000 mL of saline. The patient underwent fibrinolytic therapy with intrathoracic urokinase postoperatively because of persistent high inflammatory marker levels and multilocular pleural effusion. Parvimonas micra was detected in the preoperative pleural fluid culture. He was discharged on postoperative day 22 and followed up as an outpatient afterwards. Two years have passed since the surgery, and there has been no recurrence of empyema. Decortication of the parietal and visceral pleura and irrigation using a pulse lavage irrigation system were effective.
Figure of eight suture technique in aortic valve replacement decreases prosthesis-patient mismatch
Authors: Rasheed Nabeel F. , Stonebraker Corinne , Li Zhaozhi , Siddiqi Umar , Lee Andy C. H. , Li Willa , Lupo Sydney , Cruz Jennifer , Cohen William G. , Staub Cathy , Rodgers Daniel , Myren Mark , Combs Pamela , Jeevanandam Valluvan , Hibino Narutoshi 
Published: April 2023

Abstract
Background
While the pledget suture technique has been the standard for surgical aortic. valve replacement (AVR), discussion continues regarding the possibility of the nonpledget suture technique to produce superior structural and hemodynamic parameters. This study aims to assess the effectiveness of the figure-of-eight suture technique in AVR, as determined by the incidence of prosthesis-patient mismatch (PPM).

Methods
We reviewed records of patients (N = 629) who underwent a surgical AVR procedure between January 2011 and July 2018 at a single institution. Indexed effective orifice area values and PPM incidence were calculated from implanted valve size and patient body surface area. Incidence of none, moderate, and severe PPM was compared across AVR suture techniques.

Results
A total of 570 pledget and 59 figure-of-eight patients were compared for incidence of PPM. Patients who received AVR with the pledget suture technique had significantly lower echocardiographic measurements of baseline ejection fraction than patients who had received AVR with the figure-of-eight suture technique (p = 0.003). Patients who received the figure-of eight suture had a 14% decrease in moderate PPM compared to patients who received the pledget suture (p = 0.022). Patients who received the figure-of-eight suture also had a significantly higher rate of no PPM (p = 0.044).

Conclusions
The use of the figure-of-eight suture technique in AVR can reduce the incidence of moderate PPM. While the pledget suture is the standard technique in AVR, the figure-of-eight suture technique may offer better structural and hemodynamic outcomes, especially for patients with a smaller aortic annulus.
Specific recommendations to improve the design and conduct of clinical trials
Authors: Kupersmith Mark J. , Jette Nathalie 
Published: April 2023

AbstractThere are many reasons why the majority of clinical trials fail or have limited applicability to patient care. These include restrictive entry criteria, short duration studies, unrecognized adverse drug effects, and reporting of therapy assignment preferential to actual use. Frequently, experimental animal models are used sparingly and do not accurately simulate human disease. We suggest two approaches to improve the conduct, increase the success, and applicability of clinical trials. Studies can apply dosing of the investigational therapeutics and outcomes, determined from animal models that more closely simulate human disease. More extensive identification of known and potential risk factors and confounding issues, gleaned from recently organized “big data,” should be utilized to create models for trials. The risk factors in each model are then accounted for and managed during each study.
Aseptic presentation of interventricular septal abscess with progressive heart block: a case report
Authors: Arun Kumar Pramukh , Patel Boskey , Dasari Mahati , Arun Kumar Sumukh , Shah Neeta , Laidlaw Douglas 
Published: April 2023

Abstract
Background
Infective endocarditis can progress to an intracardiac abscess in 20% to 30% of cases, with interventricular septal abscess (IVSA) being one of the rare complications usually presenting with sepsis. We present a case of IVSA presenting with a new-onset second-degree heart block, which rapidly progressed to a complete heart block.

Case presentation
A 80-year-old Caucasian female with a past medical history of hypertension and hyperlipidemia presented with exertional chest pain, lightheadedness, and shortness of breath with telemetry and electrocardiogram revealing persistent Mobitz type II second degree atrioventricular block. The rest of the vitals were normal. As she was being planned for a pacemaker placement, she spiked a temperature of 103F. Blood cultures grew methicillin-sensitive Staphylococcus aureus, and appropriate antibiotics were initiated. Transthoracic echocardiogram was grossly normal. However, transesophageal echocardiogram revealed a heterogeneous extension of an echodensity from the aortic root, along the aorto-mitral cushion and into the interventricular septum, indicating an interventricular septal abscess. Her course was complicated by altered mental status, with computed tomography of the brain revealing hypodense regions in the left lentiform nucleus and anterior caudate nucleus representing acute/subacute stroke. Surgery was deferred as she was deemed a poor candidate. She succumbed to her illness on day 6 of hospitalization.

Conclusion
Intracardiac abscesses should be considered a possible initial differential in patients with progressive heart block despite aseptic presentation and no risk factors.
Identification of encrypted and malicious network traffic based on one-dimensional convolutional neural network
Authors: Zhou Yan , Shi Huiling , Zhao Yanling , Ding Wei , Han Jing , Sun Hongyang , Zhang Xianheng , Tang Chang , Zhang Wei 
Published: April 2023

AbstractThe rapid advancement of the Internet has brought a exponential growth in network traffic. At present, devices deployed at edge nodes process huge amount of data, extract key features of network traffic and then forward them to the cloud server/data center. However, since the efficiency of mobile terminal devices in identifying and classifying encrypted and malicious traffic lags behind, how to identify network traffic more efficiently and accurately remains a challenging problem. We design a convolutional neural network model: One-dimensional convolutional neural network with hexadecimal data (HexCNN-1D) that combines normalized processing and attention mechanisms. By adding the attention mechanism modules Global Attention Block (GAB) and Category Attention Block (CAB), network traffic is classified and identified. By extracting effective load information from hexadecimal network traffic, our model can identify most categories of network traffic including encrypted and malicious traffic data. The experimental results show that the average accuracy is 98.8%. Our model can greatly improve the accuracy of network traffic data recognition.
Analysis of spatial pattern and influencing factors of private clinics in the main urban area of Guiyang in China from 2021 to 2022 based on multi-source data
Authors: Li Wei , Du Fang-Juan , Ruan Ou 
Published: April 2023

Abstract
Background
Private clinics are important places for residents to obtain daily medical care. However, previous researches mainly focused on public medical institutions but ignored the issue of systematic allocation of social medical resources such as clinics. It is critical to understand the private clinics distribution to analyze the rational allocation of medical resources and the spatial difference.

Methods
Based on the field survey, land census, population density, and economic data from Guiyang, this study analyzes the spatial pattern of private clinics in the main urban area of Guiyang and the influencing factors by using spatial analysis methods such as kernel density, standard deviation ellipses, and geo-detector.

Results
The private clinics in the main urban area of Guiyang are characterized by "inner dense, outer sparse dense," showing an overall spatial clustering feature of "four cores and two belts with many points" and "dense inside and sparse outside." Different types of private clinics have distinct spatial distribution characteristics and agglomeration forms. The growth of private clinics is closely linked to the population growth of mountainous cities. The most important factors influencing the spatial pattern of private clinics are residential land factors, followed by traffic factors and population density. The impact of economic, natural, and spatial factors is minimal. When using a geo-detector, the results of multi-factor interaction differ from those of single factors, and factor interactions have greater explanatory power than single factors in clinic distribution.

Conclusion
This study investigates the geographic distribution and influencing variables of private clinics in typical mountain cities and identifies the causes of the current disparity in the distribution of healthcare resources. It is necessary to gradually develop the primary healthcare system in mountainous cities with legislation, counterpart support, and social resources. While ensuring equal access to health care for low-income people and mobile populations, various medical needs of community members should be fully considered and implemented as soon as possible.
Efficacy of remote ischaemic preconditioning on outcomes following non-cardiac non-vascular surgery: a systematic review and meta-analysis
Authors: Papadopoulou Aikaterini , Dickinson Matthew , Samuels Theophilus L. , Heiss Christian , Forni Lui , Creagh-Brown Ben 
Published: April 2023

Abstract
Background
Remote ischaemic preconditioning (RIPC) has been investigated as a simple intervention to potentially mitigate the ischaemic effect of the surgical insult and reduce postoperative morbidity. This review systematically evaluates the effect of RIPC on morbidity, including duration of hospital stay and parameters reflective of cardiac, renal, respiratory, and hepatic dysfunction following non-cardiac non-vascular (NCNV) surgery.

Methods
The electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from their inception date to November 2021. Studies investigating the effect of local preconditioning or postconditioning were excluded. Methodological quality and risk of bias were determined according to the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Calculation of the odds ratios and a random effects model was used for dichotomous outcomes and mean differences or standardised mean differences as appropriate were used for continuous outcomes. The primary outcomes of interest were cardiac and renal morbidity, and the secondary outcomes included other organ function parameters and hospital length of stay.

Results
A systematic review of the published literature identified 36 randomised controlled trials. There was no significant difference in postoperative troponin or acute kidney injury. RIPC was associated with lower postoperative serum creatinine (9 studies, 914 patients, mean difference (MD) - 3.81 µmol/L, 95% confidence interval (CI) - 6.79 to - 0.83, p = 0.01, I2 = 5%) and lower renal stress biomarker (neutrophil gelatinase-associated lipocalin (NGAL), 5 studies, 379 patients, standardized mean difference (SMD) - 0.66, 95% CI - 1.27 to - 0.06, p = 0.03, I2 = 86%). RIPC was also associated with improved oxygenation (higher PaO2/FiO2, 5 studies, 420 patients, MD 51.51 mmHg, 95% CI 27.32 to 75.69, p < 0.01, I2 = 89%), lower biomarker of oxidative stress (malondialdehyde (MDA), 3 studies, 100 patients, MD - 1.24 µmol/L, 95% CI - 2.4 to - 0.07, p = 0.04, I2 = 91%)) and shorter length of hospital stay (15 studies, 2110 patients, MD - 0.99 days, 95% CI - 1.75 to - 0.23, p = 0.01, I2 = 88%).

Conclusions
This meta-analysis did not show an improvement in the primary outcomes of interest with the use of RIPC. RIPC was associated with a small improvement in certain surrogate parameters of organ function and small reduction in hospital length of stay. Our results should be interpreted with caution due to the limited number of studies addressing individual outcomes and the considerable heterogeneity identified.

Trial registration
PROSPERO CRD42019129503.
The prognostic value of monocyte-to-lymphocyte ratio in peritoneal dialysis patients
Authors: Yang Yan , Xu Yuanyuan , Lu Peiyu , Zhou Hua , Yang Min , Xiang Li 
Published: April 2023

Abstract
Background
The monocyte-to-lymphocyte ratio (MLR) is considered as a new inflammation marker. This study was aimed to investigate the prognostic value of MLR for all-cause mortality and new-onset cardiovascular disease (CVD) events in peritoneal dialysis (PD) patients.

Methods
This study enrolled patients receiving PD treatment for  ≥ 3 months. Baseline characteristics were obtained within 1 week before PD catheterization. The receiver operating characteristic curve analysis was conducted to determine the optimal cut-off value of MLR. The Kaplan–Meier curve estimated the cumulative survival rate and new CVD free survival rate. Univariate and multivariate Cox regression models were preformed to investigate the association between MLR and clinical outcomes.

Results
A total of 369 PD patients participated in this study. During a median follow-up period of 32.83 months, 65 patients (24.2%) died, and 141 patients (52.4%) occurred new-onset CVD events. The Kaplan–Meier curve revealed that survival rate in high MLR group (MLR  > 0.2168) was significantly lower than in low MLR group (P = 0.008). Patients in high MLR group were more likely to experience CVD events (P = 0.002). Even after adjustment of traditional risk factors, including age, diabetes mellitus, CVD history, smoking, hyperlipidemia, high MLR remained an independent predictor of all-cause mortality [hazard ration (HR) = 2.518, 95% confidence intervals (CI) = 1.020–6.214, P = 0.045] and new-onset CVD events (HR = 1.815, 95% CI = 1.157–2.849, P = 0.010).

Conclusions
This study suggested that high MLR was significantly and independently associated with all-cause mortality and CVD events in PD patients. The MLR is an inexpensive and straightforward indicator to reflect systemic inflammation status and help clinicians improve PD management.