Miracle-dz/UniFAR-FTUs huggingface dataset:
Predicting in-hospital mortality in adult non-traumatic emergency department patients: a retrospective comparison of the Modified Early Warning Score (MEWS) and machine learning approach

Background A feasible and accurate risk prediction systems for emergency department (ED) patients is urgently required. The Modified Early Warning Score (MEWS) is a wide-used tool to predict clinical outcomes in ED. Literatures showed that machine learning (ML) had better predictability in specific patient population than traditional scoring system. By analyzing a large multicenter dataset, we aim to develop a ML model to predict in-hospital morality of the adult non traumatic ED patients for different time stages, and comparing performance with other ML models and MEWS. Methods A retrospective observational cohort study was conducted in five Taiwan EDs including two tertiary medical centers and three regional hospitals. All consecutively adult (>17 years old) non-traumatic patients admit to ED during a 9-year period (January first, 2008 to December 31th, 2016) were included. Exclusion criteria including patients with (1) out-of-hospital cardiac arrest and (2) discharge against medical advice and transferred to other hospital (3) missing collect variables. The primary outcome was in-hospital mortality and were categorized into 6, 24, 72, 168 hours mortality. MEWS was calculated by systolic blood pressure, pulse rate, respiratory rate, body temperature, and level of consciousness. An ensemble supervised stacking ML model was developed and compared to sensitive and unsensitive Xgboost, Random Forest, and Adaboost. We conducted a performance test and examine both the area under the receiver operating characteristic (AUROC) and the area under the precision and recall curve (AUPRC) as the comparative measures. Result After excluding 182,001 visits (7.46%), study group was consisted of 24,37,326 ED visits. The dataset was split into 67% training data and 33% test data for ML model development. There was no statistically difference found in the characteristics between two groups. For the prediction of 6, 24, 72, 168 hours in-hospital mortality, the AUROC of MEW and ML mode was 0.897, 0.865, 0.841, 0.816 and 0.939, 0.928, 0.913, 0.902 respectively. The stacking ML model outperform other ML model as well. For the prediction of in-hospital mortality over 48-hours, AUPRC performance of MEWS drop below 0.1, while the AUPRC of ML mode was 0.317 in 6 hours and 0.2150 in 168 hours. For each time frame, ML model achieved statistically significant higher AUROC and AUPRC than MEWS (all P < 0.001). Both models showed decreasing prediction ability as time elapse, but there was a trend that the gap of AUROC values between two model increases gradually (P < 0.001). Three MEWS thresholds (score >3, >4, and >5) were determined as baselines for comparison, ML mode consistently showed improved or equally performance in sensitivity, PPV, NPV, but not in specific. Conclusion Stacking ML methods improve predicted in-hospital mortality than MEWS in adult non-traumatic ED patients, especially in the prediction of delayed mortality.
Schrödinger’s T Cells: Molecular Insights Into Stemness and Exhaustion

T cell stemness and exhaustion coexist as two key contrasting phenomena during chronic antigen stimulation, such as infection, transplant, cancer, and autoimmunity. T cell exhaustion refers to the progressive loss of effector function caused by chronic antigen exposure. Exhausted T (TEX) cells highly express multiple inhibitory receptors and exhibit severe defects in cell proliferation and cytokine production. The term T cell stemness describes the stem cell-like behaviors of T cells, including self-renewal, multipotency, and functional persistence. It is well accepted that naïve and some memory T cell subsets have stem cell-like properties. When investigating the exhaustive differentiation of T cells in chronic infection and cancer, recent studies highlighted the stemness of “precursors of exhausted” T (TPEX) cells prior to their terminal differentiation to TEX cells. Clinically successful checkpoint blockades for cancer treatment appear to invigorate antitumor TPEX cells but not TEX cells. Here we discuss the transcriptional and epigenetic regulations of T cell stemness and exhaustion, with a focus on how systems immunology was and will be utilized to define the molecular basis underlying the transition of TPEX to TEX cells. We suggest a “stepwise model” of T cell stemness and exhaustion, in which loss of stemness and exhaustion progression are gradual multi-step processes. We provide perspectives on the research needed to define T cell stemness and exhaustion in the transplantation setting, in which allogenic T cells are also chronically exposed to alloantigens. A better understanding of T cell stemness and exhaustion will shed light on developing novel strategies for immunotherapies.
Acupuncture Modulation Effect on Pain Processing Patterns in Patients With Migraine Without Aura

Introduction In this retrospective study, resting-state functional connectivity (FC) in patients with migraine was analyzed to identify potential pathological pain processing patterns and compared them to those in healthy controls (HCs). The FC patterns in patients between pre- and post-acupuncture sessions were also analyzed to determine how acupuncture affects neurological activity and pain perception during the migraine interictal period. Methods In total, 52 patients with migraine without aura (MwoA) and 60 HCs were recruited. Patients with migraine were given acupuncture treatment sessions for 4 weeks. As a primary observation, functional magnetic resonance images were obtained at the beginning and end of the sessions. HCs received no treatment and underwent one functional magnetic resonance imaging (fMRI) scan after enrollment. After the fMRI data were preprocessed, a region of interest (ROI)-to-ROI analysis was performed with predefined ROIs related to pain processing regions. Results The first analysis showed significantly different FCs between patients with MwoA and HCs [false discovery rate corrected p-value (p-FDR) < 0.05]. The FCs were found to be mainly between the cingulate gyrus (CG) and the insular gyrus, the CG and the inferior parietal lobule (IPL), the CG and the superior frontal gyrus, and the middle frontal gyrus and the IPL. The second analysis indicated that acupuncture treatment partly restored the different FCs found in the first analysis (p-FDR < 0.05). Furthermore, subgroup analysis found different brain activity patterns in headache-intensity restored condition and headache-frequency restored condition. Lastly, the correlation analysis suggested a potential correlation between FCs and clinical symptoms (p < 0.05). Conclusion This study suggests that pain processing is abnormal in migraine, with significantly abnormal FCs in the frontal, parietal, and limbic regions. This finding could be a typical pathological feature of migraine. Acupuncture has been identified to relieve headache symptoms in two ways: it restores the pain processing function and regulates pain perception.
Genetic‐based adaptive momentum estimation for predicting mortality risk factors for COVID‐19 patients using deep learning

The mortality risk factors for coronavirus disease (COVID‐19) must be early predicted, especially for severe cases, to provide intensive care before they develop to critically ill immediately. This paper aims to develop an optimized convolution neural network (CNN) for predicting mortality risk factors for COVID‐19 patients. The proposed model supports two types of input data clinical variables and the computed tomography (CT) scans. The features are extracted from the optimized CNN phase and then applied to the classification phase. The CNN model's hyperparameters were optimized using a proposed genetic‐based adaptive momentum estimation (GB‐ADAM) algorithm. The GB‐ADAM algorithm employs the genetic algorithm (GA) to optimize Adam optimizer's configuration parameters, consequently improving the classification accuracy. The model is validated using three recent cohorts from New York, Mexico, and Wuhan, consisting of 3055, 7497,504 patients, respectively. The results indicated that the most significant mortality risk factors are: CD 8+ T Lymphocyte (Count), D‐dimer greater than 1 Ug/ml, high values of lactate dehydrogenase (LDH), C‐reactive protein (CRP), hypertension, and diabetes. Early identification of these factors would help the clinicians in providing immediate care. The results also show that the most frequent COVID‐19 signs in CT scans included ground‐glass opacity (GGO), followed by crazy‐paving pattern, consolidations, and the number of lobes. Moreover, the experimental results show encouraging performance for the proposed model compared with different predicting models.
Current Management and Image Review of Skull Base Chordoma: What the Radiologist Needs to Know

Chordomas of the skull-base are typically slow-growing, notochord-derived tumors that most commonly originate along the clivus. Skull base chordoma is treated with surgery and radiotherapy. Local recurrence approaches 50% at 10 years. Radiologists play a critical role in diagnosis, treatment planning, and follow-up. Surgeons and radiation oncologists rely on radiologists for pre-operative delineation of tumor and adjacent anatomy, identification of post-treatment changes and disease recurrence, and radiation treatment effects. This review provides an overview of clinical characteristics, surgical anatomy, indications for radiotherapy, identification of treatment complications, and patterns of disease recurrence for radiologists to provide value in the management of these lesions.
Emerging Antibacterial Strategies with Application of Targeting Drug Delivery System and Combined Treatment

Abstract At present, some bacteria have developed significant resistance to almost all available antibiotics. One of the reasons that cannot be ignored is long-term exposure of bacteria to the sub-minimum inhibitory concentration (MIC) of antibiotics. Therefore, it is necessary to develop a targeted antibiotic delivery system to improve drug delivery behavior, in order to delay the generation of bacterial drug resistance. In recent years, with the continuous development of nanotechnology, various types of nanocarriers that respond to the infection microenvironment, targeting specific bacterial targets, and targeting infected cells, and so on, are gradually being used in the delivery of antibacterial agents to increase the concentration of drugs at the site of infection and reduce the side effects of drugs in normal tissues. Here, this article describes in detail the latest research progress on nanocarriers for antimicrobial, and commonly used targeted antimicrobial strategies. The advantages of the combination of nanotechnology and targeting strategies in combating bacterial infections are highlighted in this review, and the upcoming opportunities and remaining challenges in this field are rationally prospected.
Use of eosin-nigrosine staining in assessing plasma membrane integrity of ram spermatozoa supplemented with melatonin.

Parte de dissertação do primeiro autor. 2 Mestrandos do Curso de Pós-Graduação em Ciência Animal (CPGCA), Universidade Federal do Vale do São Francisco (Univasf), Petrolina-PE, *email: wilde@zootecnista.com. br 3 Professora do Colegiado de Zootecnia e CPGCA, Univasf, Petrolina-PE. 4 Doutorando do Curso de Pós-graduação em Ciências Veterinárias (FAVET), Universidade Estadual do Ceará 5 Discente do Curso de Medicina Veterinária, Univasf, Petrolina-PE, 6 Bioestatístico Embrapa Semiárido – CPATSA, Petrolina-PE-Brasil. USO DA COLORAÇÃO EOSINA-NIGROSINA NA AVALIAÇÃO DA INTEGRIDADE
Co0.5Mn0.5Fe2O4@PMMA Nanoparticles Promotes Preosteoblast Differentiation through Activation of OPN-BGLAP2-DMP1 Axis and Modulates Osteoclastogenesis under Magnetic Field Conditions

The prevalence of osteoporosis in recent years is rapidly increasing. For this reason, there is an urgent need to develop bone substitutes and composites able to enhance the regeneration of damaged tissues which meet the patients’ needs. In the case of osteoporosis, personalized, tailored materials should enhance the impaired healing process and restore the balance between osteoblast and osteoclast activity. In this study, we fabricated a novel hybrid material (Co0.5Mn0.5Fe2O4@PMMA) and investigated its properties and potential utility in the treatment of osteoporosis. The material structure was investigated with X-ray diffraction, Fourier-transform infrared spectroscopy with attenuated total reflectance, FTIR-ATR, transmission electron microscopy (TEM), scanning electron microscopy (SEM) and selected area (electron) diffraction (SAED). Then, the biological properties of the material were investigated with pre-osteoblast (MC3T3-E1) and pre-osteoclasts (4B12) and in the presence or absence of magnetic field, using RT-qPCR and RT-PCR. During the studies, we established that the impact of the new hybrids on the pre-osteoblasts and pre-osteoclasts could be modified by the presence of the magnetic field, which could influence on the PMMA covered by magnetic nanoparticles impact on the expression of genes related to the apoptosis, cells differentiation, adhesion, microRNAs or regulating the inflammatory processes in both murine cell lines. In summary, the Co0.5Mn0. 5Fe2O4@PMMA hybrid may represent a novel approach for material optimization and may be a way forward in the fabrication of scaffolds with enhanced bioactivity that benefits osteoporotic patients.
Greening Wine Exports? Changes in the Carbon Footprint of Spanish Wine Exports

Spain is one of the leading wine-producing and -exporting countries and has traditionally been dominant in trade and world production in the sector. In an increasingly changing context, in which worldwide wine exports are growing exponentially, it is essential to study their impact on climate change as the transport of goods generates a significant volume of greenhouse gas emissions. The aim of this work, then, was to analyse the variation in the carbon footprint generated by Spanish wine exports between 2011 and 2016. To this end, a multi-regional input–output (MRIO) model was used, showing that the emissions associated with wine operations have increased less than exports, which might suggest that sustainable growth has been included as a goal in the wine supply chain. The methodology used has the advantage of allowing the calculation of direct and indirect emissions. At the same time, the results can provide relevant information to practitioners and policymakers due to the expected evolution of European environmental regulations and trades, in terms of carbon footprint.
Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: Case Reports

Platelet-rich fibrin (PRF) is an autologous blood concentrate obtained without anticoagulants by centrifugation of patients’ peripheral venous blood. PRF is considered to enhance the formation of new bone. The aim of this manuscript was to present two case reports of permanent teeth with closed apexes with periapical lesions, treated endodontically with the use of PRF. The root canals were mechanically cleaned and shaped with NiTi files and irrigated with 5.25% sodium hypochlorite (NaOCl), 40% citric acid (CA), and triple distillated water. Before the canal systems were obturated, A-PRF was used as a scaffold and was placed below the cementodentinal junction with hand pluggers. Cone beam computerized tomography (CBCT) was used to assess the resolutions of periapical radiolucencies. After 6 months, the measurements of both periapical lesions were significantly reduced. Although the performed root canal treatments (RCTs) can definitely be recognized as successful, it must be emphasized that mechanical shaping and cleaning of the root canals with special disinfecting solutions significantly affect the clinical efficacy of RCT. It seems impossible to state that PRF played a leading role in the healing process of the presented periapical lesions. Further studies must be performed to assess whether RCT of mature teeth with an additional PRF application is superior to RCT performed alone.
Review of the 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation—What Has Changed and How Does This Affect Daily Practice

The high prevalence of atrial fibrillation (AF) in the overall population and its association with substantial morbidity, increased mortality and health care cost has instigated significant basic and clinical research efforts over recent years. The publication of multiple new high-quality randomized multi-center trials in the area of AF management and the rapidly evolving technological progress in terms of diagnostic possibilities and catheter ablation in recent years demanded a revision of the previous ESC AF Guidelines from 2016. The 2020 guidelines provide up-to-date, evidence-based guidance for the management of AF. One of the most important innovations is the presentation of a new concept for structural characterization of AF (the “4S AF scheme”) replacing the traditional classification based on its temporal pattern alone (paroxysmal-persistent-permanent). The 4S-AF-scheme highlights the importance of systematic assessment of stroke risk, severity of symptoms, total AF burden and underlying substrate as the foundation for effective and individualized AF treatment for each and every patient. Further novelties relate to the presentation of an easy and intuitive management pathway (“ABC pathway”) and strengthening the recommendations for early rhythm control, in particular the role of first line catheter ablation in heart failure. Another core component of the guidelines is the focus on patient involvement to achieve optimal outcomes. Patient education, shared decision making and incorporation of patient values and patient reported outcome of treatment interventions as well as integrated care by a multidisciplinary team all have a central role in the proposed management pathway for AF.
Effect of Ultraviolet Irradiation on Polystyrene Containing Cephalexin Schiff Bases

The scale of production of polystyrene has escalated in the recent past in order to meet growing demand. As a result, a large quantity of polystyrene waste continues to be generated along with associated health and environmental problems. One way to tackle such problems is to lengthen the lifetime of polystyrene, especially for outdoor applications. Our approach is the synthesis and application of new ultraviolet photostabilizers for polystyrene and this research is focused on four cephalexin Schiff bases. The reaction of cephalexin and 3-hydroxybenzaldehyde, 4-dimethylaminobenzaldehyde, 4-methoxybenzaldehyde, and 4-bromobanzaldehyde under acidic condition afforded the corresponding Schiff bases in high yields. The Schiff bases were characterized and their surfaces were examined. The Schiff bases were mixed with polystyrene to form homogenous blends and their effectiveness as photostabilizers was explored using different methods. The methods included monitoring the changes in the infrared spectra, weight loss, depression in molecular weight, and surface morphology on irradiation. In the presence of the Schiff bases, the formation of carbonyl group fragments, weight loss, and decrease in molecular weight of polystyrene were lower when compared with pure polystyrene. In addition, undesirable changes in the surface such as the appearance of dark spots, cracks, and roughness were minimal for irradiated polystyrene containing cephalexin Schiff bases. Mechanisms by which cephalexin Schiff bases stabilize polystyrene against photodegradation have also been suggested.
The novel bronchodilator navafenterol: a phase 2a, multicentre, randomised, double-blind, placebo-controlled crossover trial in COPD

Background Navafenterol (AZD8871) belongs to a new class of bronchodilator, the single-molecule muscarinic antagonist and β-agonist, developed for the treatment of COPD. This study aimed to evaluate the efficacy, pharmacokinetics and safety of navafenterol versus placebo and an active comparator treatment for moderate-to-severe COPD. Methods This phase 2a, randomised, multicentre (Germany and UK), double-blind, double-dummy, three-way complete crossover study (ClinicalTrials.gov identifier: NCT03645434) compared 2 weeks’ treatment of once-daily navafenterol 600 µg via inhalation with placebo and a fixed-dose combination bronchodilator (umeclidinium/vilanterol (UMEC/VI); 62.5 µg/25 µg) in participants with moderate-to-severe COPD. The primary outcome was change from baseline in trough forced expiratory volume in 1 s (FEV1) on day 15. Secondary end-points included change from baseline in peak FEV1; change from baseline in Breathlessness, Cough and Sputum Scale (BCSS); change from baseline in COPD Assessment Tool (CAT); adverse events; and pharmacokinetics. Results 73 participants were randomised. After 14 days, trough FEV1 was significantly improved with navafenterol compared with placebo (least-squares (LS) mean difference 0.202 L; p<0.0001). There was no significant difference in FEV1 between navafenterol and UMEC/VI (LS mean difference −0.046 L; p=0.075). COPD symptoms (CAT and BCSS) showed significantly greater improvements with both active treatments versus placebo (all p<0.005). Novel objective monitoring (VitaloJAK) showed that cough was reduced with both active treatments compared with placebo. Safety profiles were similar across the treatment groups and no serious adverse events were reported in the navafenterol treatment period. Conclusion Once-daily navafenterol was well tolerated, improved lung function and reduced COPD-related symptoms, similar to an established once-daily fixed-dose combination bronchodilator. Navafenterol, a novel dual-pharmacology bronchodilator for COPD, improved lung function, reduced COPD symptoms and decreased objective cough counts, to a similar extent to umeclidinium/vilanterol https://bit.ly/3lV886y
Livestock sustainability research in Africa with a focus on the environment

July 2021, Vol. 11, No. 4 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. © Balehegn, Kebreab, Tolera, Hunt, Erickson, Crane, Adesogan Perspectives Livestock sustainability research in Africa with a focus on the environment