bluuebunny/crossref_metadata_2025_split huggingface dataset:
A retrospective study of patients with Stenotrophomonas maltophilia peritonitis undergoing peritoneal dialysis
Authors: Shima Hisato , Okamoto Takuya , Tashiro Manabu , Inoue Tomoko , Iwaki Maho , Wariishi Seiichiro , Okada Kazuyoshi , Doi Toshio , Minakuchi Jun 
Published: April 2023

Abstract
Background
Stenotrophomonas maltophilia (S. maltophilia) is being increasingly recognized as an important cause of nosocomial infections, particularly in immunocompromised patients, such as patients undergoing dialysis. S. maltophilia peritonitis is strongly associated with the loss of peritoneal catheter among patients undergoing peritoneal dialysis (PD) owing to its resistance to different groups of antibiotics. Thus, the aim of this study was to investigate the characteristics of and risk factors for S. maltophilia peritonitis in patients undergoing PD.

Methods
This single-center, retrospective, case–control study was conducted between April 2013 and October 2022. Patients who were undergoing PD at Kawashima Hospital and were diagnosed with S. maltophilia peritonitis were included in this study. Controls were randomly selected from among patients who were undergoing PD and were diagnosed with peritonitis caused by microorganisms other than S. maltophilia. The demographic data, clinical characteristics, and initial treatment data of the patients were analyzed to determine the risk factors for PD-related S. maltophilia peritonitis.

Results
Five patients with S. maltophilia peritonitis and 15 controls (three controls to one case) were included in this study. The incidence of S. maltophilia peritonitis was significantly more frequent among patients with diabetes mellitus (80.0% vs. 20.0%; p = 0.031) and among patients with higher white blood cell counts in the dialysate after appropriate antibiotic therapy (2561/µL [349–4654/µL] vs. 20/µL [20–23/µL]; p = 0.0006) than among the control patients. Although all the patients were treated with appropriate antibiotics after the identification of S. maltophilia, they had a significantly higher rate of catheter removal than the controls (80.0% vs. 0.0%; p = 0.001).

Conclusions
Diabetes mellitus may be an important risk factor for S. maltophilia peritonitis in patients undergoing PD.
Is there more than meets the eye in PSMA imaging in prostate cancer with PET/MRI? Looking closer at uptake time, correlation with PSA and Gleason score
Authors: Bogdanovic Borjana , Solari Esteban L. , Villagran Asiares Alberto , van Marwick Sandra , Schachoff Sylvia , Eiber Matthias , Weber Wolfgang A. , Nekolla Stephan G. 
Published: April 2023

Abstract
Background
In patients with increasing PSA and suspicion for prostate cancer, but previous negative biopsies, PET/MRI is used to test for tumours and target potential following biopsy. We aimed to determine different PSMA PET timing effects on signal kinetics and test its correlation with the patients’ PSA and Gleason scores (GS).

Methods
A total of 100 patients were examined for 900 s using PET/MRI approximately 1–2 h p.i. depending on the tracer used (68Ga-PSMA-11, 18F-PSMA-1007 or 18F-rhPSMA7). The scans were reconstructed in static and dynamic mode (6 equal frames capturing “late” PSMA dynamics). TACs were computed for detected lesions as well as linear regression plots against time for static (SUV) and dynamic (SUV, SUL, and percent injected dose per gram) parameters. All computed trends were tested for correlation with PSA and GS.

Results
Static and dynamic scans allowed unchanged lesion detection despite the difference in statistics. For all tracers, the lesions in the pelvic lymph nodes and bones had a mostly negative activity concentration trend (78% and 68%, resp.), while a mostly positive, stronger trend was found for the lesions in the prostate and prostatic fossa following RPE (84% and 83%, resp.). In case of 68Ga-PSMA-11, a strong negative (Rmin = − 0.62, Rmax = − 0.73) correlation was found between the dynamic parameters and the PSA. 18F-PSMA-1007 dynamic data showed no correlation with PSA, while for 18F-rhPSMA7 dynamic data, it was consistently low positive (Rmin = 0.29, Rmax = 0.33). All tracers showed only moderate correlation against GS (Rmin = 0.41, Rmax = 0.48). The static parameters showed weak correlation with PSA (Rmin = 0.24, Rmax = 0.36) and no correlation with GS.

Conclusion
“Late” dynamic PSMA data provided additional insight into the PSMA kinetics. While a stable moderate correlation was found between the PSMA kinetics in pelvic lesions and GS, a significantly variable correlation with the PSA values was shown depending on the radiotracer used, the highest being consistently for 68Ga-PSMA-11. We reason that with such late dynamics, the PSMA kinetics are relatively stable and imaging could even take place at earlier time points as is now in the clinical routine.
Social support, religiosity, and quality of life among haemodialysis patients in Aseer region, Saudi Arabia
Authors: Asiri Waddah Alalmaei , Asiri Anas Ali Hadi , Almutlaq Ahmed Hussain , Almutairi Khalid Hussein , Alotaibi Abdulelah Eid , Alshahrani Mohammed Saad , Hassan Emad Eldin Abdelfattah 
Published: April 2023

Abstract
Background
Chronic kidney disease patients on haemodialysis (HD) experience negative consequences in the quality of life (QOL), which is affected by factors such as perceived social support and spirituality/religiosity. The purpose of the study was to assess perceived social support, religiosity, and QOL among HD patients in Aseer, Saudi Arabia.

Results
A total of 162 HD patients were included in the study. Patient ages ranged from 18 to 64 years with mean age 44.6 ± 11.9. Duration of HD was <5 years among 41.4% of patients, and ≥10 years in 21%. Perceived social support was high among 79.6% of patients. Religiosity score ranged from 26 to 52 (out of 65) with mean score 36.6 ± 5.2. There was a significant correlation between perceived social support, religiosity, and the life satisfaction domain of QOL (P<0.05).

Conclusions
High perceived social support alongside high religiosity had a significant effect on patients’ life satisfaction domain of health-related QOL (HRQOL). Therefore, social support and religiosity assessment are important in HD patient care. Further studies should assess the benefit of religious/spiritual counselling as part of a holistic multi-disciplinary approach.
Maternal hypovitaminosis D presenting as late-onset hypocalcemic seizure in a term neonate: a case report
Authors: Mallick Achinta Kumar , Yadav Raj Kumar , Sannalli Kiran , Bewal Nitul Mohan 
Published: April 2023

Abstract
Background
Vitamin D deficiency is a known morbidity among pregnant women. Maternal hypovitaminosis D results in poor fetal transplacental vitamin D accretion and decreased stores in the neonate. This in turn may lead to hypocalcemia in neonates, having presentations from being asymptomatic and tremors to hypocalcemic seizures. There are fewer case reports of hypocalcemic neonatal seizures as a result of maternal vitamin D deficiency.

Case presentation
A term male neonate developed multiple episodes of multifocal seizures on day six of life associated with hypocalcemia. He was also found to have hyperphosphatemia, raised alkaline phosphatase, and elevated parathormone levels with normal serum magnesium and renal function tests. Neonate and maternal serum vitamin D3 levels were also low. A diagnosis of late-onset hypocalcemic seizure secondary to maternal hypovitaminosis D was made and the baby made an uneventful recovery with parenteral calcium and oral vitamin D supplementation. On follow-up with therapy, the baby remained asymptomatic with normal serum calcium, phosphate, and vitamin D3 levels.

Conclusion
Hypovitaminosis D must also be considered as a contributing factor for late-onset hypocalcemic seizure in neonates.
Comparison of cardiogenic NEC and classical NEC in the fourth level neonatal intensive care center
Authors: Öztaş Tülin , Bilici Salim , Okur Nilüfer Matur 
Published: April 2023

Abstract
Background
The most common inflammatory gastrointestinal disorder in newborn infants is necrotizing enterocolitis (NEC). Despite the multifactorial etiology of NEC, its pathogenesis is the same regardless of the etiology—a decrease in enteric perfusion that results in enteritis, dysmotility, necrosis, and sepsis. This study aims to evaluate whether the characteristics of NEC in infants with congenital heart disease (CHD) are different from those of classical NEC.
The records of 39 NEC patients were reviewed retrospectively. Based on the presence or absence of CHD, the patients were divided into two groups. The group with NEC and CHD was named cardiogenic NEC and the other group was named classical NEC. The two groups were compared in terms of mode of delivery, gestational age, birth weight, age at onset of NEC, surgical treatment rate, NEC localization, and mortality rate.

Results
The cardiogenic NEC group consisted of 25 patients, and the classical NEC group consisted of 14 patients. The results indicate that there were no differences between the two groups in terms of sex, mode of delivery, and location of the NEC. There were higher levels of gestational age, birth weight, and age at which NEC was diagnosed in the cardiogenic group. The mortality rate of the cardiogenic NEC group (72%) was higher than that of the classical NEC group (28.6%). In addition, the surgical treatment rate of the cardiogenic NEC group (84%) was higher than that of the classical NEC group (57.2%).

Conclusions
The clinical course of NECs with CHD is different from that of classical NEC. In NEC, CHD can be identified as an important risk factor.
Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in depressed patients with suicidal behavior: A systematic review
Authors: Velasco A , Lengvenyte A , Rodriguez-Revuelta J , Jimenez-Treviño L , Courtet P , Garcia-Portilla MP , Bobes J , Sáiz PA 
Published: April 2023

Abstract

Background
Inflammatory biomarkers are reportedly increased in depressed patients. Several studies have been conducted using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR). The objective of this systematic review was to study the relationship between these peripheral biomarkers and suicidality in depressed patients with/without suicidal behavior, including suicide attempts and ideation, and healthy controls.

Methods
We searched the following relevant terms in the PubMed, Web of Science, and Scopus databases published in the last 5 years. We assessed the methodological quality of included studies using the Oxford criteria and reviewed the evidence following PRISMA guidelines.

Results
Eleven studies were retained for the data synthesis, with a total sample of 1,701 participants, of which the majority (819) were patients with depression and suicidal behavior, 494 were depressed patients without suicidal behavior, and only 388 were healthy participants. Our results reinforce the idea that NLR could be an attractive, convenient, and cost-effective trait marker of suicidal vulnerability in patients with major depressive disorder (MDD).

Conclusion
Future large-scale replication studies are needed to examine the apparently understudied role of PLR and MLR in depressed patients in greater depth.
Alkaline Phosphatase and Hyperphosphatasemia in Vitamin D Trial in Healthy Infants and Toddlers
Authors: Pontán Freja , Hauta-alus Helena , Valkama Saara , Rosendahl Jenni , Enlund-Cerullo Maria , Andersson Sture , Mäkitie Outi , Holmlund-Suila Elisa 
Published: April 2023

Abstract

Context
Childhood hyperphosphatasemia is usually transient and may be associated with infections. It remains less well known how hyperphosphatasemia is related to growth and bone mineralization.

Objective
We explored alkaline phosphatase (ALP) concentrations and prevalence of hyperphosphatasemia, and their association with vitamin D, growth, infections, and bone parameters in healthy children.

Methods
The study was a secondary analysis of a vitamin D intervention trial. Participants received vitamin D3 10 or 30 µg daily from age 2 weeks to 2 years. Children with data on ALP at 12 and/or 24 months (n = 813, girls 51.9%) were included. Anthropometrics and bone parameters were measured at 12 and 24 months. Infections were recorded prospectively by the parents.

Results
Boys had higher ALP than girls at 12 months (median [IQR] 287 [241-345] U/L vs 266 [218-341] U/L; P = .02). At 24 months concentrations were lower than at 12 months (240 [202-284]; P &lt; .001) but without sex difference. The prevalence of hyperphosphatasemia (ALP &gt; 1000 U/L) at 12 months was 5.3% and at 24 months 0.6%. Body size, growth rate, and bone mineral content associated positively with ALP, while vitamin D intervention had no effect. Infants with hyperphosphatasemia were smaller than infants with ALP ≤ 1000 U/L. Hyperphosphatasemia was not associated with previous infections.

Conclusion
Approximately 5% of infants had hyperphosphatasemia at 12 months, but &lt;1% at 24 months. ALP concentrations and hyperphosphatasemia were associated with sex, anthropometry, and bone mineralization. Infections did not contribute to hyperphosphatasemia.
Targeted Axillary Dissection with 125I Seed Placement Before Neoadjuvant Chemotherapy in a Danish Multicenter Cohort
Authors: Munck Frederikke , Andersen Inge S. , Vejborg Ilse , Gerlach Maria K. , Lanng Charlotte , Kroman Niels T. , Tvedskov Tove H. F. 
Published: April 2023

Abstract
Background
Targeted axillary dissection (TAD), with marking of the metastatic lymph node before neoadjuvant chemotherapy (NACT), is increasingly used for breast cancer axillary staging. In the case of axillary pathological complete response (ax-pCR), axillary lymph node clearance can be omitted. Several marking methods exist, most using re-marking before surgery. Feasibility, learning curve, and identification rate (IR) vary. Marking with 125I seed before NACT makes re-marking at surgery redundant, possibly increasing feasibility and IR. Here, TAD with 125I seed placed before NACT is evaluated in a Danish multicenter cohort.

Methods
Patients staged with 125I TAD in Denmark between 1 January 2016 and 31 August 2021 were included. Patients were identified in radioactivity-emitting implant registries at the radiology departments and from the Danish Breast Cancer Group database. Data were extracted from patients’ medical records. Information on patient/tumor characteristics, 125I seed activity, marking period, TAD success, number of sentinel nodes (SNs), the histopathological status of excised nodes, and whether the marked lymph node (MLN) was an SN were registered.

Results
142 patients were included. The IR of the MLN was 99.3%, and the IR of the SLNB was 91.5%. TAD success was 91.5%. Minor challenges in marking or removal of the MLN were noted in three patients. In 72.3% of the patients, the MLN was a sentinel node. Overall, 40.8% had axillary pCR.

Conclusion
TAD with 125I seed marking before NACT is feasible without re-marking at surgery and with only minor surgical challenges. The IR is high. Staging with TAD spares 41% of breast cancer patients an axillary dissection.
Causes and characteristics of unexpected sudden cardiac death in octogenarians/nonagenarians
Authors: Puolitaival Elisa , Vähätalo Juha , Holmström Lauri , Haukilahti M. Anette E. , Pakanen Lasse , Ukkola Olavi H. , Junttila M. Juhani , Huikuri Heikki V. , Perkiömäki Juha S. 
Published: April 2023

Introduction
The risk for sudden cardiac death (SCD) increases with ageing.

Methods
We evaluated causes and characteristics of unexpected SCD in SCD victims aged ≥ 80 years in a consecutive series of 5,869 SCD victims in Northern Finland. All the victims underwent medico-legal autopsy as medico-legal autopsy is mandatory in cases of unexpected sudden death in Finland. All the non-cardiac deaths such as pulmonary embolism and cerebral hemorrhage were excluded from the study, as were unnatural deaths such as intoxications.

Results
Among SCD victims ≥ 80 years, 91.0% of SCDs were due to ischemic heart disease (IHD) determined in autopsy and 9.0% due to non-ischemic heart disease (NIHD), whereas among those < 80 years, only 72.6% of SCDs were due to IHD and 27.4% due to NIHD (P < .001). Severe fibrosis in myocardium was more common whereas heart weight and liver weight, body mass index and abdominal fat thickness, were lower among SCD victims aged ≥ 80 years than among victims aged < 80 years. In those with IHD as etiology of SCD, at least 75% stenosis in one or more major coronary vessels was more common in SCD victims aged ≥ 80 years than among victims aged < 80 years (P = .001). SCD victims 80 years or older were less likely to die during physical activity than those under 80 years old (5.6% vs. 15.9%, P < .001). Dying in sauna was more common among those ≥ 80 years than among those < 80 years (5.5% vs. 2.6%, P < .001).

Conclusion
In victims of unexpected SCD aged ≥ 80 years, the autopsy-based etiology of SCD was more commonly IHD than in those aged < 80 years. In SCD victims aged ≥ 80 years, severe fibrosis in myocardium, representing arrhythmic substrate, was more common than in the younger ones.
Public Debt and Budget Deficit Threshold Levels on New Fiscal Sustainability Indicator
Authors: Cahyadin Malik , Sarmidi Tamat , Khalid Norlin , Law Siong Hook 
Published: April 2023

Fiscal sustainability can be determined and assessed using financial technology (FinTech). Consequently, a new indicator of fiscal sustainability can be constructed. This study also estimates threshold levels of public debt and budget deficit by considering institutions for 88 developing and 35 developed countries in 2014 and 2017. The principal component analysis (PCA) and the cross-section threshold regression are employed. The main findings revealed that the threshold levels of public debt-to-GDP ratio for developed and developing countries in 2014 were 100.37% and 63.04%, while that in 2017 were 90.09% and 84.28%, respectively. Moreover, the threshold levels of budget deficit-to-GDP ratio for developed and developing countries in 2014 were -3.04% and -1.24%, while those in 2017 were -0.97% and -5.75%, respectively. Therefore, policymakers should emphasize a certain public debt and budget deficit level to warrant a fiscally sustainable level.JEL Classification: C13, E62, H60 How to Cite:Cahyadin, M., Sarmidi, T., Khalid, N. & Law, S. H. (2023). Public Debt and Budget Deficit Threshold Levels on New Fiscal Sustainability Indicator. Signifikan: Jurnal Ilmu Ekonomi, 12(1), 97-116. https://doi.org/10.15408/sjie.v12i1.31005.
Clinical profile and outcome of children presenting with diabetic ketoacidosis at a tertiary care hospital in Dakshina Kannada
Authors: Panakkal Sejal J. , Diksha Shirodkar  , Praksh R. M. Saldanha  
Published: April 2023

Background: Diabetic ketoacidosis (DKA) is the most serious metabolic disturbance of type 1 diabetes mellitus (T1DM) and about 25 to 40% of the newly diagnosed T1DM children present with DKA. This research was conducted to study the clinical profile and identify the precipitating factors at time of presentation of DKA and to correlate the type onset of disease with the severity of DKA and the treatment outcome.
Methods: Ambispective record based study of children admitted in in the paediatric ward of a tertiary care hospital with DKA between 01 July 2019 and 31 January 2022.
Results: A total of 19 patients were enrolled and the mean age of presentation was 10.79±4.17 years with a female predominance. The family history of type 2 DM was noted in 73.7% and osmotic symptoms in 68.4% of the patients. 52.6% of the patients presented in severe DKA. Mean HbA1C noted was 15.14±2.74%. Acute Kidney Injury was present in 10.5% of the patients. Pneumonia was the major precipitating factor. The average length of hospital stay was 7.42±3.27 days. There was no significant correlation with the type of onset of T1DM and the treatment outcome. There was a significant reduction in HbA1c (p<0.05) on follow-up.
Conclusions: This study highlights the need for creating awareness, early referral and timely management of T1DM presenting not only in DKA but also during the ambulatory management.
Frequencies, clinicopathological features, and risk factors of type I and type II endometrial cancer; a retrospective observational study at a tertiary care hospital in Pakistan
Authors: Nawaz Muhammad Talha , Hameed Ayesha Nasir , Tauqeer Hassan , Angez Meher , Aziz Aliya Begum 
Published: April 2023

Background: Endometrial cancer (EC) is the most common gynecological malignancy worldwide. The death rates for EC have increased by more than 100% over the past 2 decades. EC is subdivided into two types based on distinct histological and clinical features: type I and type II. Our study aims to determine the risk factors and clinicopathological features of both type I and type II EC and draw a comparison between the two types based on frequency, risk factors and clinicopathological features.
Methods: It was a retrospective observational study including patients of a single tertiary care center. The study included Patients diagnosed, treated, and followed up for type I and type II endometrial cancer at the study center over the past 19 years from 1st January 2000 to 31st December 2018. All the patients with metastatic endometrial cancer were excluded from the study. SPSS version 26 was used for statistical analysis.
Results: A total of 376 patients were included in this study. Among these 343 (91.7) patients had endometroid adenocarcinoma (Type I) and 32 (8.3) had serous and clear cell tumor (type II). Type I EC had a mean age of 57.56 (SD±10.42) while patients with type II EC presented with a mean age of64.97 (SD±6.59). Hypertension and Diabetes were the most common comorbid in EC patients. HRT prior to EC was found to have an association with risk of EC. Compared to patients who were on HRT, patients who were not on HRT prior to diagnosis of EC had 80% less chance of developing endometrial cancer. (Confidence interval: 0.056-0.114, p=0.016).
Conclusions: In summary our study demonstrates that both sub types of endometrial cancer have many risk factors that are similar to each other. Despite the difference between the population of both subgroups we were able to prove associations between risk factors and endometrial cancer. However further research is needed at provincial and national level with larger and relatively comparable sample sizes for both subgroups to recognize risk factors and numerically associate them to EC for Pakistani population.
Biomechanical analysis of the effect of ‘intermediate screws’ in short segment posterior fixation of unstable burst fractures of thoracolumbar spine in calf spine model
Authors: Azad Sait  , Monosha Priyadarshini  , Raj N. Arunai Nambi , David Kenny Samuel 
Published: April 2023

Background: Efforts in preserving motion levels in unstable thoracolumbar burst fractures steered to short segment fixation. However, short segment spanning fixation in clinical scenario reported high failure rates. Augmentation of spanning fixation by inserting intermediate screws into the fracture level is proposed to enhance stability. An experimental comparative study was performed to assess the biomechanical role of the ‘intermediate screws.’
Methods: Five calf spine specimens were freshly prepared to record the biomechanical characteristics, range of motion (ROM), and stiffness. CT scan confirmed an unstable burst fracture in each specimen. Each specimen was instrumented with short-segment posterior fixation with an intermediate screw. The same test protocols were repeated with and without intermediate screws.
Results: Intermediate screws contribute to 20.2%, 16.5%, 14.5% and 23% decrease in ROM and 15.4%, 25.6%, 48.3%, and 160.2% increase in construct stiffness.
Conclusions: Intermediate screws significantly increase the construct stiffness and decrease the ROM.