Tag: pubmed

Arch Public Health. 2024 Nov 20;82(1):218. doi: 10.1186/s13690-024-01442-x.

ABSTRACT

BACKGROUND: High-need, high-cost (HNHC) patients are a major focus of international healthcare reform. However, research on HNHC children in China remains limited. This study aims to classify HNHC pediatric patients, analyze the differences among groups, and explore the factors influencing HNHC status.

METHODS: Data were obtained from a retrospective observational cohort of hospitalized children in Shanghai, China from 2017 to 2023. K-means clustering, one of the unsupervised learning algorithms, was employed to classify patients according to their HNHC status. Descriptive statistical analysis and the Kruskal-Wallis H test were used to describe and test the differences among different groups, with the logit regression models to analyze the predictors.

RESULTS: 688,131 hospitalized children were classified into three groups: 1,871 persistent HNHC, 32,539 episodic HNHC, and 653,721 non-HNHC. Significant differences were observed among these groups. Persistent HNHC patients have significantly higher costs and longer HNHC durations compared to episodic and non-HNHC patients, who were more likely to be aged 30 days to 1 year or 13-18 years, female with only one type of health insurance, and leukemia was the most prevalent and costly disease. They exhibited distinct healthcare utilization patterns, including emergency admissions, higher surgery rates, longer hospital stays, more frequent hospitalizations, and a preference for tertiary and specialized hospitals in city centers. Multiple influencing factors of persistent HNHC versus episodic HNHC and non-HNHC were identified.

CONCLUSION: This study provides valuable insights into the classification, characteristics, and influencing factors of persistent, episodic, and non-HNHC hospitalized children in China. Persistent HNHC patients warrant targeted interventions to improve health outcomes and reduce healthcare costs. Enhanced medical coverage for key diseases, high-quality healthcare services tailored to their needs, and early interventions are crucial.

PMID:39568040 | DOI:10.1186/s13690-024-01442-x

Thromb J. 2024 Nov 20;22(1):104. doi: 10.1186/s12959-024-00673-w.

ABSTRACT

This critique evaluates a retrospective observational study on the impact of extracorporeal membrane oxygenation (ECMO) treatments on acquired von Willebrand syndrome (AVWS) in patients with out-of-hospital cardiac arrest (OHCA). The study is praised for its detailed observational methodology, robust statistical analyses, and comprehensive overview of patient outcomes. These strengths enhance the applicability of the results to real-world clinical practice. However, the study’s retrospective design poses inherent risks of bias and confounding factors, which the authors acknowledge but do not extensively address. The absence of a control group of OHCA patients who did not receive ECMO is a significant limitation, as it weakens the ability to isolate the impact of ECMO on AVWS development. Additionally, a more in-depth exploration of the mechanisms by which ECMO contributes to AVWS is needed. Despite these limitations, the study contributes valuable insights into ECMO-related complications and underscores the necessity for vigilant management strategies to mitigate AVWS risks in this high-risk population. The critique concludes by calling for future prospective studies and the development of preventative protocols to improve patient outcomes in ECMO-treated OHCA patients.

PMID:39568032 | DOI:10.1186/s12959-024-00673-w

Knee Surg Relat Res. 2024 Nov 20;36(1):35. doi: 10.1186/s43019-024-00244-3.

ABSTRACT

BACKGROUND: The ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model.

METHODS: Thirteen 3D computer models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 to 12 mm (in 1-mm intervals). Multibody simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation, and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion.

RESULTS: The main effects of an ascending compared with a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters.

CONCLUSIONS: Significant differences in the changes in patellofemoral shift, tilt, rotation, and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.

PMID:39568030 | DOI:10.1186/s43019-024-00244-3

Scand J Trauma Resusc Emerg Med. 2024 Nov 20;32(1):117. doi: 10.1186/s13049-024-01292-0.

ABSTRACT

BACKGROUND: Procedural sedation and analgesia is an important part of pediatric emergency care, safe and clinically useful alternatives for adequate management are necessary. The objective of this clinical trial was to evaluate the non-inferiority of intranasal dexmedetomidine to nitrous oxide with respect to analgesia for a painful procedure in children 3-15 years of age.

METHODS: This prospective, equally randomized, open-label, non-inferiority trial was conducted at a Pediatric Emergency Department. Previously healthy children 3-15 years of age, with an extremity fracture or luxation or a burn and requiring procedural sedation and analgesia were eligible. Patients were randomized to receive either intranasal dexmedetomidine or inhaled nitrous oxide. The primary outcome measure was highest pain level during the procedure, assessed with Face, Legs, Activity, Cry, Consolability scale (FLACC). Mann-Whitney U test (continuous variables) and Fisher’s test (categorical variables) were used for statistical analysis.

RESULTS: The highest FLACC was median 4 (IQR 3-6) with intranasal dexmedetomidine and median 4 (IQR 2-6) with nitrous oxide. The median of the difference between samples from each group for FLACC was 0 with 95%CI (0-1), thus intranasal dexmedetomidine was not inferior to nitrous oxide with respect to the level of pain during the procedure. The same method for procedural sedation and analgesia would be accepted by 52/74 (82.5%) children and 65/74 (91.5%) parents in the intranasal dexmedetomidine group respectively 59/74 (88.1%) versus 70/74 (94.6%) with nitrous oxide. No serious adverse events were reported.

CONCLUSIONS: The results of this trial support that intranasal dexmedetomidine is not inferior to 50% nitrous oxide in providing analgesia for a painful procedure in children 3-15 years of age and can be considered as an alternative to 50% nitrous oxide for procedural sedation and analgesia.

TRIAL REGISTRATION: EudraCT 201,600,377,317, April 20, 2017. https://eudract.ema.europa.eu/ .

PMID:39568028 | DOI:10.1186/s13049-024-01292-0

J Transl Med. 2024 Nov 20;22(1):1048. doi: 10.1186/s12967-024-05846-9.

ABSTRACT

BACKGROUND: While high-grade serous ovarian cancer (HGSC) has proven largely resistant to immunotherapy, sporadic incidents of partial and complete response have been observed in clinical trials and case reports. These observations suggest that a molecular basis for effective immunity may exist within a subpopulation of HGSC. Herein, we developed an algorithm, CONSTRU (Computing Prognostic Marker Dependencies by Successive Testing of Gene-Stratified Subgroups), to facilitate the discovery and characterization of molecular backgrounds of HGSC that confer resistance or susceptibility to protective anti-tumor immunity.

METHODS: We used CONSTRU to identify genes from tumor expression profiles that influence the prognostic power of an established immune cytolytic activity signature (CYTscore). From the identified genes, we developed a stratification signature (STRATsig) that partitioned patient populations into tertiles that varied markedly by CYTscore prognostic power. The tertile groups were then analyzed for distinguishing biological, clinical and immunological properties using integrative bioinformatics approaches.

RESULTS: Patient survival and molecular measures of immune suppression, evasion and dysfunction varied significantly across STRATsig tertiles in validation cohorts. Tumors comprising STRATsig tertile 1 (S-T1) showed no immune-survival benefit and displayed a hyper-immune suppressed state marked by activation of TGF-β, Wnt/β-catenin and adenosine-mediated immunosuppressive pathways, with concurrent T cell dysfunction, reduced potential for antigen presentation, and enrichment of cancer-associated fibroblasts. By contrast, S-T3 tumors exhibited diminished immunosuppressive signaling, heightened antigen presentation machinery, lowered T cell dysfunction, and a significant CYTscore-survival benefit that correlated with mutational burden in a manner consistent with anti-tumor immunoediting. These tumors also showed elevated activity of DNA damage/repair, cell cycle/proliferation and oxidative phosphorylation, and displayed greater proportions of Th1 CD4 + T cells. In these patients, but not those of S-T1 or S-T2, validated predictors of immunotherapy response were prognostic of longer patient survival. Further analyses showed that STRATsig tertile properties were not explained by known HGSC molecular or clinical subtypes or singular immune mechanisms.

CONCLUSIONS: STRATsig is a composite of parallel immunoregulatory pathways that mirrors tumor immunogenic potential. Approximately one-third of HGSC cases classify as S-T3 and display a hypo-immunosuppressed and antigenic molecular composition that favors immunologic tumor control. These patients may show heightened responsiveness to current immunotherapies.

PMID:39568014 | DOI:10.1186/s12967-024-05846-9

BMC Oral Health. 2024 Nov 20;24(1):1416. doi: 10.1186/s12903-024-05160-2.

ABSTRACT

BACKGROUND: Congenitally missing permanent canines (CMPC) have a significant impact on function and aesthetics. The prevalence is low, and the availability of rigorous studies on this issue in China is limited. This study was designed to investigate the prevalence and distribution of CMPC in patients and concomitant anomalies. Additionally, we aimed to compare the prevalence of CMPC between two age groups.

METHODS: A total of 10,447 patient’s panoramic radiograph (PR) images from August 2021 to December 2023 were reviewed and data regarding the location and number of CMPCs were recorded. Age and gender were obtained from the clinical records. Additionally, concomitant anomalies such as persistent primary canines, congenitally missing other permanent teeth, supernumerary teeth and microdontia were also recorded in patients with CMPC. 10,447 patients were divided into two groups: group A (< 121 months of age) and group B (≥ 121 months of age) to record the number of patients with CMPC. The data were presented as counts (n) and percentages (%), and statistically analysed using the Chi-square test.

RESULTS: The average age of patients with CMPC was 9.2 years, with a prevalence of 0.69% (n = 72). The difference between genders was not statistically significant (p = 0.950). The prevalence of CMPC in group B (1.08%, 26/2400) was significantly greater than that in group A (0.57%, 46/8047) (p = 0.008). 89.42% (93/104) of the missing permanent canines had visible primary canines in patients. CMPC were more likely to occur in the maxilla (91.67%) than in the mandible (6.94%) (p<0.001). No significant difference was found between the left and right sides (p = 0.844). With respect to concomitant anomalies among those with CMPC, 22 patients had 58 congenitally other permanent teeth missing, 3 patients had 3 supernumerary teeth, and 12 maxillary lateral incisors from 7 patients presented with microdontia.

CONCLUSIONS: The prevalence of CMPC was 0.69%. CMPC were more likely to occur in the maxilla in the presence of persistent primary canines and were not influenced by gender or side. Early panoramic radiographs can improve the detection rate of CMPC, thereby facilitating prompt intervention and timely management.

PMID:39568013 | DOI:10.1186/s12903-024-05160-2

Ital J Pediatr. 2024 Nov 20;50(1):248. doi: 10.1186/s13052-024-01820-9.

ABSTRACT

BACKGROUND: The potential roles of viral infections in neurodevelopmental disorders (NDDs) have been suggested based on previous studies. Given the high prevalence of human herpesviruses (HHVs), the associations between HHVs infection and the risk of NDDs warrant explored.

METHODS: Our study employs a two-sample Mendelian randomization (MR) analysis and systematic review with meta-analysis to investigate whether genetically predicted HHVs infection are linked to three main childhood NDDs-autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS). We utilized genetic variants associated with HHV infections in genome-wide association study (GWAS) summary datasets of European populations to establish instrumental variables and statistics for three NDDs obtained from Psychiatric Genomics Consortium. MR analysis was performed using inverse-variance weighted, MR Egger, weighted median, simple median, weighted mode, and MR-PRESSO. In addition, publications associating HHVs infection with three NDDs were systematically searched using PubMed, Web of Science, and three Chinese databases for meta-analyses.

RESULTS: The MR results found no evidence to support a link between genetically predicted HHVs infection and the risk of NDDs based on existing datasets. Twenty-seven observational studies on children with HHVs infection and NDDs were considered eligible. Meta-analysis showed that cytomegalovirus and HHV-6 infection were related with ASD, while Epstein-Barr virus and cytomegalovirus infection were associated with TD in Chinese population.

CONCLUSIONS: These results contribute to a comprehensive understanding of the possibilities underlying HHV infections in affecting childhood NDDs. Further research is necessary to include larger and more robust statistics of HHV infections and NDDs.

TRIAL REGISTRATION: This systematic review was registered at PROSPERO as CRD42024554169. Retrospectively registered 26 July 2024.

PMID:39568007 | DOI:10.1186/s13052-024-01820-9

BMC Oral Health. 2024 Nov 20;24(1):1414. doi: 10.1186/s12903-024-05149-x.

ABSTRACT

BACKGROUND: A comprehensive understanding of the root form and canal anatomy is essential for successful endodontic treatment. This study aimed to evaluate the root canal anatomy of mandibular premolars in the Pakistani population using cone beam computed tomography (CBCT) and to classify the findings with the new classification proposed by Ahmed et al. METHODS: Ethical exemption was obtained from Aga Khan University Hospital, Karachi. A total of 707 CBCT scans from Karachi and Lahore were included, comprising 592 scans from a tertiary care hospital in Karachi and 115 scans from a radiology center in Lahore. The study focused on sound, fully formed mandibular first and second premolars, excluding those with significant caries, restorations, or prior root canal treatments. Scans from different equipment were used, and calibration was achieved between a specialist endodontist and two dental residents. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 26. Descriptive statistics, Chi-square tests to determine association between the variables, and a significance level set at 5% (p <0.05) were utilized.

RESULTS: A total of 2403 mandibular premolars were analyzed. The most common configuration was ¹MPM¹ (82.90%), with rare variations such as ¹MPM^1-3-1 (0.04%) and ²MPM^{1 B1 L2} (0.04%). Single-rooted premolars were predominant (98.87%), and no significant differences were observed when data was stratified by age or gender.

CONCLUSIONS: This is the first study in Pakistan involving multiple centers and using the classification system by Ahmed et al. to understand the anatomy of mandibular premolars. The findings indicate that while most premolars have a single root and canal, variations exist. These variations highlight the importance of understanding canal morphology for improving the success of endodontic treatment. Future studies should include a larger and more diverse dataset to fully represent the Pakistani population.

PMID:39568006 | DOI:10.1186/s12903-024-05149-x

Plant Methods. 2024 Nov 20;20(1):176. doi: 10.1186/s13007-024-01298-w.

ABSTRACT

In soybean breeding programs, a great deal of time is devoted to the use of methods that perform selection of individual plants during the initial generations. Our hypothesis is that BLUPIS (simulated individual BLUP) can be efficient when applied in the initial stages of soybean breeding programs. This study aimed to explore the potential of BLUPIS in the early generations of a soybean breeding program, as well as to assess the viability of the strategy of dividing the useful area of experimental plots for estimating genotypic effects and plant selection. The experiment involved 84 segregating populations and 15 soybean parents in the F₂ and F₃ generations. Yield data was collected from the 2019/2020 and 2020/2021 cropping seasons. In the F₂ generation, different data exploration methods were applied to determine the most suitable adaptation to be used in the F₃ generation. The individual BLUP (BLUPI) was compared with BLUPIS using information from different replications and/or equal to the information used in BLUPI. The selection conducted by BLUPIS and BLUPI showed high concordance regarding the selected plants. In the F₃ generation, segregating populations were selected based on positive genotypic effects, and individual plants within these populations were further selected according to the number of plants determined by BLUPIS. The division of the plot area was an efficient strategy for selecting segregating populations and individual plants within superior populations in the F₃ generation, resulting in genetic gains of approximately 1.56 g per plant. When combined with the strategy of advancing generations in the off-season, the BLUPIS approach reduces the time required to achieve a high level of homozygosity. Therefore, BLUPIS proved to be a powerful statistical tool for early selection based on grain yield in soybeans.

PMID:39567990 | DOI:10.1186/s13007-024-01298-w

BMC Womens Health. 2024 Nov 20;24(1):614. doi: 10.1186/s12905-024-03464-7.

ABSTRACT

BACKGROUND: The death of women as a result of violent crime has become a major social and health problem worldwide. Most of these crimes are committed by their partners. The Covid-19 pandemic seems to have amplified the problem, given that measures to contain the spread of the disease have exposed women to more prolonged contact with their aggressors.

OBJECTIVE: To describe the epidemiological profile of lethal and intentional violent crimes committed against women in the state of Alagoas, Brazil, from March 2018 to February 2020 (before the pandemic) and from March 2020 to December 2021 (during the first two years of the Covid-19 pandemic).

METHODS: This is an observational study involving all deaths of women due to lethal and intentional violent crimes. The data was obtained from the Alagoas State Secretariat for Public Security. The variables age, type of crime, means used, day of the week and time of the crime were analyzed. The specific mortality rate was calculated for the entire study period. Population data was obtained from the Brazilian Institute of Geography and Statistics (IBGE). Descriptive statistics were used to analyze the data.

RESULTS: There were 316 deaths during the study period. The mortality rate in 2020 (5.33/100,000) was higher than in the years prior to the pandemic (3.88/100,000 in 2018 and 4.84/100,000 in 2019). There was a predominance of the 18-29 (31.31%) and 30-39 (27.95%) age groups in both periods. The proportion of female homicides was 55.19% in the pre-pandemic period and 64.20% in the pandemic period. The proportion of beating deaths was 1.7 times higher in the pandemic period than in the non-pandemic period (15.23% vs. 8.97%). There was also an increase in beatings on Saturdays, with a proportion 1.60 times higher than in the pre-pandemic period (19.75% vs. 12.34%).

CONCLUSION: The victims were predominantly young women, the crimes classified as homicides and with the use of firearms. The study emphasizes that the context of the Covid-19 pandemic may have contributed to the increase in violent crimes against women in Alagoas, highlighting the urgency of preventive measures and support for victims.

PMID:39567966 | DOI:10.1186/s12905-024-03464-7