Miracle-dz/UniFAR-FTUs huggingface dataset:
Low neutrophil-to-lymphocyte ratio predicts overall survival benefit in advanced NSCLC patients with low PD-L1 expression and receiving chemoimmunotherapy

Although combination therapy including chemotherapy and immune checkpoint inhibitors (ICIs) improves overall survival (OS) of patients with non-small-cell lung cancer (NSCLC), there is a higher incidence of adverse events and treatment discontinuation. Since programmed death-ligand 1 (PD-L1) could not serve as a predictive biomarker, we investigated the neutrophil-to-lymphocyte ratio (NLR) as a predictive biomarker. In our previous research, we demonstrated that a low NLR could predict survival benefits when patients with high PD-L1 expression (> 50%) received chemoimmunotherapy as opposed to immunotherapy alone. In this current study, our objective is to evaluate this predictive capacity in patients with low PD-L1 expression (< 50%). A total of 142 patients were enrolled, 28 receiving combination therapy and 114 receiving chemotherapy alone. Progression-free survival (PFS) and OS were estimated using the Kaplan-Meier method and compared using the log-rank test. Patients who received combination therapy had significantly better PFS and OS than those who received monotherapy. In the subgroup of patients with low NLR, those who received combination therapy exhibited extended PFS and OS with clinical significance, which was also confirmed by multivariate Cox regression analysis. Our study demonstrates the potential use of NLR as a biomarker for predicting survival benefits when receiving combination therapy with chemotherapy and ICIs in patients with advanced NSCLC and low PD-L1 expression.
Quantification of carotid plaque composition with a multi-contrast atherosclerosis characterization (MATCH) MRI sequence

Background and purpose Carotid atherosclerotic plaques with a large lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and a thin or ruptured fibrous cap are associated with increased stroke risk. Multi-sequence MRI can be used to quantify carotid atherosclerotic plaque composition. Yet, its clinical implementation is hampered by long scan times and image misregistration. Multi-contrast atherosclerosis characterization (MATCH) overcomes these limitations. This study aims to compare the quantification of plaque composition with MATCH and multi-sequence MRI. Methods MATCH and multi-sequence MRI were used to image 54 carotid arteries of 27 symptomatic patients with ≥2 mm carotid plaque on a 3.0 T MRI scanner. The following sequence parameters for MATCH were used: repetition time/echo time (TR/TE), 10.1/4.35 ms; field of view, 160 mm × 160 mm × 2 mm; matrix size, 256 × 256; acquired in-plane resolution, 0.63 mm2× 0.63 mm2; number of slices, 18; and flip angles, 8°, 5°, and 10°. Multi-sequence MRI (black-blood pre- and post-contrast T1-weighted, time of flight, and magnetization prepared rapid acquisition gradient echo; acquired in-plane resolution: 0.63 mm2 × 0.63 mm2) was acquired according to consensus recommendations, and image quality was scored (5-point scale). The interobserver agreement in plaque composition quantification was assessed by the intraclass correlation coefficient (ICC). The sensitivity and specificity of MATCH in identifying plaque composition were calculated using multi-sequence MRI as a reference standard. Results A significantly lower image quality of MATCH compared to that of multi-sequence MRI was observed (p < 0.05). The scan time for MATCH was shorter (7 vs. 40 min). Interobserver agreement in quantifying plaque composition on MATCH images was good to excellent (ICC ≥ 0.77) except for the total volume of calcifications and fibrous tissue that showed moderate agreement (ICC ≥ 0.61). The sensitivity and specificity of detecting plaque components on MATCH were ≥89% and ≥91% for IPH, ≥81% and 85% for LRNC, and ≥71% and ≥32% for calcifications, respectively. Overall, good-to-excellent agreement (ICC ≥ 0.76) of quantifying plaque components on MATCH with multi-sequence MRI as the reference standard was observed except for calcifications (ICC = 0.37–0.38) and fibrous tissue (ICC = 0.59–0.70). Discussion and conclusion MATCH images can be used to quantify plaque components such as LRNC and IPH but not for calcifications. Although MATCH images showed a lower mean image quality score, short scan time and inherent co-registration are significant advantages.
The effect of intermittent versus continuous enteral feeding for critically ill patients: a meta-analysis of randomized controlled trials

Objectives The appropriate strategy for enteral feeding in critically ill patients still remains controversial. Therefore, we conducted this meta-analysis to compare the effect of intermittent versus continuous enteral feeding method for critically ill patients. Methods Electronic databases including PubMed, Embase, Scopus, and Cochrane Library were searched up to April 10th, 2023 for randomized controlled trials evaluating the effect of intermittent versus continuous enteral feeding for critically ill patients. The primary outcomes were feeding intolerances, including diarrhea, vomiting, distension, constipation, gastric retention, and aspiration pneumonia. The secondary outcomes were mortality in intensive care unit (ICU), length of stay in ICU, and achievement of nutritional goal. Results Thirteen studies with a total of 884 patients were analyzed in this meta-analysis. Overall, the use of intermittent enteral feeding was associated with higher incidence of diarrhea (OR 1.66, 95%CI 1.13 to 2.43, I2 = 16%) and distension (OR 2.29, 95%CI 1.16 to 4.51, I2 = 0%), lower incidence of constipation (OR 0.58, 95%CI 0.37 to 0.90, I2 = 0%), and longer length of ICU stay (MD 1.09, 95%CI 0.53 to 1.64, I2 = 0%). Moreover, no significant difference was identified for other outcome measures. Conclusion In critically ill patients, the implementation of intermittent enteral feeding was associated with higher incidence of diarrhea and distension, longer length of ICU stay, but lower occurrence of constipation. Nevertheless, the absence of sufficient high-quality randomized controlled clinical trials precludes any definitive conclusions regarding the optimal approach to enteral feeding in this population. There is an imperative need for more studies to further assess the efficacy of the two enteral feeding strategies.
The Simultaneous Effect Dividend Policy and Debt Policy

This study aims to examine dividend policies for companies listed on the Indonesia Stock Exchange during the 2018-2022 period. Agency theory argues that dividend policy can reduce agency costs and reduce agency conflicts. The percentage of institutional ownership is used as a proxy for agency costs and can be used as a mechanism for lowering agency conflict. The total sample is 44 companies listed on the IDX. The estimation uses the pooling data method and 3SLS. This research develops a simultaneous system econometric model. This study argues that high institutional ownership leads to higher agency conflict, as management and institutions collaborate to prioritize their interests over other shareholders. Conversely, low institutional ownership leads to disputes between management, low institutional, and public shareholders. The entrenchment argument predicts higher conflict in high institutional ownership, while the convergence argument predicts common agency conflict in common institutional ownership.
Laser patterning of large-scale perovskite single-crystal-based arrays for single-mode laser displays

Lead halide perovskites have attracted considerable attention as potential candidates for high-performance nano/microlasers, owing to their outstanding optical properties. However, the further development of perovskite microlaser arrays (especially based on polycrystalline thin films) produced by the conventional processing techniques is hindered by the chemical instability and surface roughness of the perovskite structures. Herein, we demonstrate a laser patterning of large-scale, highly crystalline perovskite single-crystal films to fabricate reproducible perovskite single-crystal-based microlaser arrays. Perovskite thin films were directly ablated by femtosecond-laser in multiple low-power cycles at a minimum machining line width of approximately 300 nm to realize high-precision, chemically clean, and repeatable fabrication of microdisk arrays. The surface impurities generated during the process can be washed away to avoid external optical loss due to the robustness of the single-crystal film. Moreover, the high-quality, large-sized perovskite single-crystal films can significantly improve the quality of microcavities, thereby realizing a perovskite microdisk laser with narrow linewidth (0.09 nm) and low threshold (5.1 μJ/cm2). Benefiting from the novel laser patterning method and the large-sized perovskite single-crystal films, a high power and high color purity laser display with single-mode microlasers as pixels was successfully fabricated. Thus, this study may offer a potential platform for mass-scale and reproducible fabrication of microlaser arrays, and further facilitate the development of highly integrated applications based on perovskite materials.
Examination of existing facilities management approaches to climate change and future directions

It is widely accepted that human activities have contributed to changing the world’s climate and that the pace of this change is ever increasing. Two approaches are being promoted by the international community to address the issue of climate change (1) Mitigation, seeking to reduce the amount of CO2; (2) Adaptation, which seeks to alter the way humankind live and work in response to the changing climate. Whilst facilities managers and their organisations have prioritised mitigation action, there is less evidence to suggest that they are addressing the implications that a changing climate may have on the demands being placed on their organisation’s hard and soft facilities (adaptation). This paper reports findings from a case study and questionnaire survey to ascertain the present approach taken by facilities managers to address mitigation and adaptation, their respective drivers, their view on climate change and their environmental inclination. It concludes that the facilities manager's approach to climate change is derived by a combination of factors; namely a) Organisation approach to climate change b) Legislation and c) the facilities mangers perception of the risks posed by future climate change and of the use of risk assessment methods and climate change projection data. The study concludes that the prevailing measure for addressing climate change impacts is reactive in nature, taking the form of Disaster Recovery and Business Continuity Planning. The practical implication of the work is in the realization that mitigation, being quantifiable and legislative driven, is viewed as a strategic issue and of importance to an organisations Corporate Social Responsibility agenda which can be planned over the longer term (10-20 yrs). Adaptation on the other hand is measured through successful survival, increased resilience and adaptive capacity (absence of quantitative performance target), each of which are viewed as short term operational issues and as such adaptation struggles to find strategic importance. If organisations are to adapt to inevitable climate change then this situation needs to change.
Bergamot Polyphenolic Extract Combined with Albedo and Pulp Fibres Counteracts Changes in Gut Microbiota Associated with High-Fat Diet: Implications for Lipoprotein Size Re-Arrangement

Evidence exists that the gut microbiota contributes to the alterations of lipid metabolism associated with high-fat diet (HFD). Moreover, the gut microbiota has been found to modulate the metabolism and absorption of dietary lipids, thereby affecting the formation of lipoproteins occurring at the intestinal level as well as systemically, though the pathophysiological implication of altered microbiota composition in HFD and its role in the development of atherosclerotic vascular disease (ATVD) remain to be better clarified. Recently, evidence has been collected indicating that supplementation with natural polyphenols and fibres accounts for an improvement of HFD-associated intestinal dysbiosis, thereby leading to improved lipidaemic profile. This study aimed to investigate the protective effect of a bergamot polyphenolic extract (BPE) containing 48% polyphenols enriched with albedo and pulp-derived micronized fibres (BMF) in the gut microbiota of HFD-induced dyslipidaemia. In particular, rats that received an HFD over a period of four consecutive weeks showed a significant increase in plasma cholesterol, triglycerides and plasma glucose compared to a normal-fat diet (NFD) group. This effect was accompanied by body weight increase and alteration of lipoprotein size and concentration, followed by high levels of MDA, a biomarker of lipid peroxidation. Treatment with a combination of BPE plus BMF (50/50%) resulted in a significant reduction in alterations of the metabolic parameters found in HFD-fed rats, an effect associated with increased size of lipoproteins. Furthermore, the effect of BPE plus BMF treatment on metabolic balance and lipoprotein size re-arrangement was associated with reduced gut-derived lipopolysaccharide (LPS) levels, an effect subsequent to improved gut microbiota as expressed by modulation of the Gram-negative bacteria Proteobacteria, as well as Firmicutes and Bacteroidetes. This study suggests that nutraceutical supplementation of HFD-fed rats with BPE and BMP or with their combination product leads to restored gut microbiota, an effect associated with lipoprotein size re-arrangement and better lipidaemic and metabolic profiles.
Steady flow of a viscous ice stream across a no-slip/free-slip transition at the bed

Abstract An exact, analytic description of the steady, downhill flow of a viscous ice stream across a no-slip to free-slip transition in basal boundary condition suggests ways in which such transitions might be detected by observations of ice-stream surface properties. We find that the best expression of this transition is in the free-surface profile, which dips over the point of transition and becomes horizontal far downstream. The streamwise velocity at the surface shows a gradual change across the transition, and this is in disagreement with previous studies which suggest a marked change. Basal shear stress and basal pressure exhibit singularities at the point of transition. As concluded in previous study, the former singularity is a likely point of strong basal erosion. The latter singularity is problematical, however, because it violates the assumptions which make the exact solution possible. It is not clear how this problem can be overcome without appealing to thermodynamics, non-Newtonian material properties, cavitation or wake separation.
The northeastern area's objectives and beliefs toward national forests and grasslands

The Northeastern Area, an organizational unit of the State and Private Forestry branch of the U.S. Forest Service, serves the Northeastern and Midwestern United States. For this study, residents of the Northeastern Area were asked about their objectives for the management, use, and conservation of forests and grasslands and beliefs about the role the Forest Service should play in fulfilling those objectives on public land. This paper summarizes the Northeastern Area results and compares these results with the other states.
A Wealth Distribution Agent Model Based on a Few Universal Assumptions

We propose a new agent-based model for studying wealth distribution. We show that a model that links wealth to information (interaction and trade among agents) and to trade advantage is able to qualitatively reproduce real wealth distributions, as well as their evolution over time and equilibrium distributions. These distributions are shown in four scenarios, with two different taxation schemes where, in each scenario, only one of the taxation schemes is applied. In general, the evolving end state is one of extreme wealth concentration, which can be counteracted with an appropriate wealth-based tax. Taxation on annual income alone cannot prevent the evolution towards extreme wealth concentration.
Low Levels of Serum and Intracellular Vitamin C in Hospitalized COVID-19 Patients

Vitamin C is a crucial micronutrient for human immune cell function and has potent antioxidant properties. It is hypothesized that vitamin C serum levels decline during infection. However, the precise mechanisms remain unknown. To gain deeper insights into the true role of vitamin C during infections, we aimed to evaluate the body’s vitamin C storage during a SARS-CoV-2 infection. In this single-center study, we examined serum and intracellular vitamin C levels in peripheral blood mononuclear cells (PBMCs) of 70 hospitalized COVID-19 patients on the first and fifth days of hospitalization. Also, clinical COVID-19 severity was evaluated at these timepoints. Our findings revealed a high prevalence of hypovitaminosis C and vitamin C deficiency in hospitalized COVID-19 patients (36% and 15%). Moreover, patients with severe or critical disease exhibited a higher prevalence of low serum vitamin C levels than those with moderate illness. Serum vitamin C levels had a weak negative correlation with clinical COVID-19 severity classification on the day of hospitalization; however, there was no correlation with intracellular vitamin C. Intracellular vitamin C levels were decreased in this cohort as compared to a healthy cohort and showed further decline during hospitalization, while serum levels showed no relevant change. Based on this observation, it can be suggested that the reduction of intracellular vitamin C may be attributed to its antioxidative function, the need for replenishing serum levels, or enhanced turnover by immune cells. These data give an incentive to further investigate the role of intracellular vitamin C in a larger and more heterogeneous cohort as well as the underlying mechanisms.
Outcomes Research in Review Section editorS

Main results. Mean age was 71 years, 38% of patients were women, 50% of patients had mild HF, and 50% had moderate to severe HF. 339 patients received control therapy, 340 received basic support, and 344 received intensive support. Among the study groups, there were no significant differences in the combined incidence of HF rehospitalization and death, with 42% of control patients compared with 41% and 38% for patients in the basic and intensive support groups (hazard ratio [HR], 0.96 and 0.93, respectively; P = 0.73 and P = 0.52, respectively). There were no significant differences in per-patient days lost to the combined endpoint (median, 12 days in the control group [interquartile range, 0– 173 days], 9 days in the basic support group [interquartile range, 0–88 days; P = 0.81 vs. control], and 7.5 days in the intensive support group [interquartile range, 0–86.5 days; P = 0.49 vs. control]). There were no significant differences in separate secondary endpoints of all-cause mortality and readmission for HF, but there was a nonsignificant trend towards lower all-cause mortality (HR, 0.85 [95% confidence interval, 0.66–1.08]) and higher rates of hospitalization for HF in the combined intervention groups.
Thymoma; clinical presentations, pathology, and prognostic factors – a surgery point of view

Thymomas are rare tumors that can present with a wide range of clinical characteristics. The presence of symptoms and paraneoplastic syndromes, such as myasthenia gravis, along with the histological subtype and stage of the tumor, are important factors that guide the treatment approach and prognosis for patients with thymomas. The prognosis for thymoma varies depending on several factors, including the stage and type of the tumor, as well as the presence of associated autoimmune diseases. Generally, early-stage thymomas have a better prognosis compared to advanced-stage tumors. Regular follow-up with a multidisciplinary team, including oncologists and thoracic surgeons, is essential for long-term management and surveillance of patients.
Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty—A Retrospective Multicenter Analysis

Total hip arthroplasty (THA) is commonly performed using off-the-shelf implants. In the case of a severe mismatch between the anatomy of the proximal femur and the geometry of the stem, the use of custom-made stems might become necessary. The goal of this study was to investigate the precision of the implantation of custom-made stems of one manufacturer (CTX stem, AQ Implants) and to determine risk factors for malpositioning. All patients receiving a custom-made CTX stem between 2014 and 2020 at six high-volume academic centers were retrospectively recruited. The achieved position of the stem, as determined by stem version, stem coronal angle, and implantation depth on radiographs, was compared to the plan. The influence of radiographic and demographic parameters on the position was investigated. The results revealed a high variability of the achieved implant position in relation to the preoperative plan. While the stem coronal angle only differed slightly from the intended position, the stem version and the implantation depth showed a high frequency and amount of deviation. Right stems showed significantly higher positions than planned. Surgeons must be aware of this potential problem when implanting custom-made stems.