bluuebunny/crossref_metadata_2025 huggingface dataset:
Metatechnological Mapping and the Ye Wenjie Effect: Mitigating Civilizational Vulnerabilities
Authors: Ćirković Milan M.
Published: December 2024

In a widely cited study in this Journal, Nick Bostrom has posed the Vulnerable World Hypothesis (VWH): technological development, if occurring under conditions similar to those in the present, will make the devastation of civilization likely. In light of such drastic consequences, the hypothesis is worth serious discussion in both breadth and depth. Two related proposals are hereby made and justified: first, creating a metatechnological map (or “tech tree”) capable of telling in advance where exactly the dangerous technologies are, and second, reducing the size of the apocalyptic residual by antitotalitarian deradicalization and deprogramming. Both are modest proposals in the sense that they imply neither deep restructuring of human nature nor building instruments for potential totalitarian violations of civil rights and liberties.
DNMT3a Deficiency Contributes to Anesthesia/Surgery‐Induced Synaptic Dysfunction and Cognitive Impairment in Aged Mice
Authors: Cong Peilin , Huang Xinwei , Zhang Qian , He Mengfan , Wan Hanxi , Wu Qianqian , Wu Huanghui , Zhang Yuxin , Cheng Chun , Tian Li , Xiong Lize
Published: December 2024

Perioperative neurocognitive disorder (PND) is a severe postoperative complication in older patients. Epigenetic changes are hallmarks of senescence and are closely associated with cognitive impairment. However, the effects of anesthesia and surgery on the aging brain's epigenetic regulatory mechanisms and its impact on cognitive impairment remain unclear. Using a laparotomy PND model, we report significant reduction in DNA methyltransferase 3a (DNMT3a) in hippocampal neurons of aged mice, which causes global DNA methylation decrease. Knockdown of DNMT3a leads to synaptic disorder and memory impairment in aged mice. Mechanistically, bisulfite sequencing revealed that DNMT3a deficiency reduces methylation in the LRG1 promoter region and promotes its transcription. We also show that activation of TGF‐β signaling by the increase in LRG1 level, ultimately impacts the synaptic function. In contrast, both overexpressing DNMT3a or knockdown LRG1 in hippocampus can attenuate the synaptic disorders and rescue postoperative cognitive deficits in aged mice. Our results reveal that DNMT3a is a previously undefined mediator in the pathogenesis of PND, which couples epigenetic regulations with anesthesia/surgery‐induced synaptic dysfunction and represents a therapeutic target to tackle PND.
Designing Confucian democracy: A semi‐parliamentarian framework
Authors: Tong Zhichao
Published: December 2024

Despite Confucian democrats’ successful attempt in establishing Confucian democracy as a normatively plausible ideal, little has been said regarding its institutional design. However, to the extent that Confucian democracy involves some synthesis between a formally democratic regime and substantively Confucian ends, it has to ask for a more specific choice among various possible democratic institutional frameworks, so as to make sure that the exact form of the former is conducive to the realization of the latter. This article addresses such a question by presenting semi‐parliamentarianism as an appropriate institutional framework for designing Confucian democracy. My central claim is that compared with other types of constitutional structure, a semi‐parliamentarian bicameral one is more likely to simultaneously advance Confucian democrats’ dual commitments to benevolent government and deep harmony. The article thus contributes to both the “institutional turn” in democratic theory and the “meritocracy versus democracy” debate in contemporary Confucian political theory.
The Relationship Between Dietary Patterns and the Epidemiology of Food Allergy
Authors: Leung Agnes Sze‐Yin , Xing Yuhan , Fernández‐Rivas Montserrat , Wong Gary Wing‐Kin
Published: December 2024

Food allergies are increasing globally, particularly in Asia; however, the etiologies of allergic diseases remain poorly understood despite comprehensive studies conducted across a variety of populations. Epidemiological research demonstrates that food allergy is more prevalent in Westernized or urbanized societies than in rural or developing ones. As such, comparing the distribution and patterns of food allergies as well as the environmental exposures between regions may provide insight into potential causal and protective factors of food allergy. Diet is an important exposome that has been shown to modulate the immune system both directly and indirectly via pathways involving the microbiota. Changes in dietary patterns, especially the shift to a Westernized diet with reduced dietary fiber and an abundance of processed foods, impact the gut and skin epithelial barrier and contribute to the development of chronic inflammatory diseases, such as food allergy. Although dietary intervention is believed to have tremendous potential as a strategy to promote immunological health, it is essential to recognize that diet is only one of many factors that have changed in urbanized societies. Other factors, such as pollution, microplastics, the use of medications like antibiotics, and exposure to biodiversity and animals, may also play significant roles, and further research is needed to determine which exposures are most critical for the development of food allergies.
Quality evolution of laparoscopic cholecystectomy videos over two decades: a comparative study of YouTube and WebSurg
Authors: Süer Muhammed Salih , Kavasoğlu Lara , Balas Şener
Published: December 2024

Background

Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. With the rise of online platforms like YouTube and WebSurg, surgical videos have become popular educational tools. However, the quality of these videos varies, raising concerns about their reliability. This study evaluates the changes in the quality of laparoscopic cholecystectomy videos over two decades and compares the educational value of YouTube and WebSurg videos.

Methods

Twenty‐four videos were analyzed and divided into four groups: older YouTube, older WebSurg, newer YouTube, and newer WebSurg. Six videos from each group were selected based on relevance and popularity. Three independent surgeons assessed them using standardized scoring systems, including the JAMA Benchmark Score, Global Quality Score (GQS), LAP‐VEGaS, and a new Laparoscopic Cholecystectomy‐Specific Score (LAP Chole‐SS). Video characteristics such as duration, uploader type, and viewer engagement were also considered. Statistical comparisons were made between the groups.

Results

The analysis showed that although newer videos were longer, the difference was not statistically significant (P = 0.74). Newer videos had significantly better image quality (P < 0.001). WebSurg videos consistently outperformed YouTube videos across all evaluation criteria. WebSurg scored higher in the JAMA Benchmark (2.62 versus 1.66), GQS (3.58 versus 2.63), LAP‐VEGaS (13.7 versus 6.58), and LAP Chole‐SS (4.08 versus 2.33).

Conclusion

In conclusion, WebSurg provides higher‐quality, peer‐reviewed content, making it more reliable for surgical education, while YouTube offers accessibility but often lacks educational rigor.
Conceptualizing discrimination against LGBTQ+ workers in the unbounded workplace
Authors: Owens Benjamin , Mills Suzanne
Published: December 2024

The workplace is a key space where LGBTQ+ people face discrimination leading to mental health distress. This paper shows how spatial attributes of work shape experiences and perceptions of discrimination and mental health distress. Building on minority stress theory, we demonstrate how spatial attributes of work can cause, amplify, or mitigate mental health distress among LGBTQ+ people through direct and indirect mechanisms, such as anticipated discrimination, perceived discrimination, and the availability of coping devices. Our findings suggest that understanding the connection between workplace discrimination and poor mental health requires a more nuanced understanding of the workplace, highlighting how workplace stressors are simultaneously emplaced in and exceed the spatiotemporal bounds of the workplace.
Optimal tissue acquisition method for pancreatic mass
Authors: Chung Kwang Hyun , Lee Sang Hyub
Published: December 2024

Pancreatic masses pose a diagnostic difficulty due to the technical complexities related to tissue acquisition. Endoscopic ultrasound (EUS)‐guided tissue acquisition has transformed the field by allowing access to pancreatic lesions through fine‐needle and biopsy. However, diagnostic accuracy differs based on tumor characteristics and procedural factors. This narrative review explores the nuances of tissue acquisition methods for pancreatic tumors, including factors such as tumor location, size, histological characteristics, and needle selection. It assesses the efficacy of different needle designs and maneuvers, including suction techniques and needle passes. Moreover, the diverse tissue preparation methods, including cytological smear, cell block, and direct histology, are discussed, highlighting the importance of tailored approaches based on tumor characteristics. Additionally, the roles of macroscopic on‐site evaluation and rapid on‐site evaluation in optimizing specimen adequacy are investigated. Furthermore, percutaneous ultrasound‐guided biopsy is considered an alternative approach, particularly in settings where EUS is impractical. Additionally, the review emphasizes the emerging trend of using tissue for genetic testing and molecular analysis, requiring high‐quality sample acquisition. Future directions in tissue acquisition techniques and their integration into clinical practice are discussed, providing promising avenues for pancreatic disease diagnosis and treatment.
Peroral endoscopic tumor resection for an esophageal leiomyoma using a novel therapeutic thin endoscope
Authors: Horikawa Haruna , Dohi Osamu , Iwai Naoto
Published: December 2024

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A new perspective on drug‐resistant epilepsy in children with focal cortical dysplasia type 1: From challenge to favorable outcome
Authors: Splitkova Barbora , Mackova Katerina , Koblizek Miroslav , Holubova Zuzana , Kyncl Martin , Bukacova Katerina , Maulisova Alice , Straka Barbora , Kudr Martin , Ebel Matyas , Jahodova Alena , Belohlavkova Anezka , Rivera Gonzalo Alonso Ramos , Hermanovsky Martin , Liby Petr , Tichy Michal , Zamecnik Josef , Janca Radek , Krsek Pavel
Published: December 2024

Objective

We comprehensively characterized a large pediatric cohort with focal cortical dysplasia (FCD) type 1 to expand the phenotypic spectrum and to identify predictors of postsurgical outcomes.

Methods

We included pediatric patients with histopathological diagnosis of isolated FCD type 1 and at least 1 year of postsurgical follow‐up. We systematically reanalyzed clinical, electrophysiological, and radiological features. The results of this reanalysis served as independent variables for subsequent statistical analyses of outcome predictors.

Results

All children (N = 31) had drug‐resistant epilepsy with varying impacts on neurodevelopment and cognition (presurgical intelligence quotient [IQ]/developmental quotient scores = 32–106). Low presurgical IQ was associated with abnormal slow background electroencephalographic (EEG) activity and disrupted sleep architecture. Scalp EEG showed predominantly multiregional and often bilateral epileptiform activity. Advanced epilepsy magnetic resonance imaging (MRI) protocols identified FCD‐specific features in 74.2% of patients (23/31), 17 of whom were initially evaluated as MRI‐negative. In six of eight MRI‐negative cases, fluorodeoxyglucose–positron emission tomography (PET) and subtraction ictal single photon emission computed tomography coregistered to MRI helped localize the dysplastic cortex. Sixteen patients (51.6%) underwent invasive EEG. By the last follow‐up (median = 5 years, interquartile range = 3.3–9 years), seizure freedom was achieved in 71% of patients (22/31), including seven of eight MRI‐negative patients. Antiseizure medications were reduced in 21 patients, with complete withdrawal in six. Seizure outcome was predicted by a combination of the following descriptors: age at epilepsy onset, epilepsy duration, long‐term invasive EEG, and specific MRI and PET findings.

Significance

This study highlights the broad phenotypic spectrum of FCD type 1, which spans far beyond the narrow descriptions of previous studies. The applied multilayered presurgical approach helped localize the epileptogenic zone in many previously nonlesional cases, resulting in improved postsurgical seizure outcomes, which are more favorable than previously reported for FCD type 1 patients.
Between Stockholm and Lausanne
Authors: Gehlin Sara
Published: December 2024

This article examines the relationship between the two ecumenical conferences in Stockholm in 1925 and Lausanne in 1927, which led to the creation of the movements on Life and Work and on Faith and Order, and which merged in 1948 to form the World Council of Churches (WCC). The conferences took place following the First World War amid fears of a new outbreak of war, and in this situation, fellowship was an important aim of those who met in the two cities. The article examines the search for the fellowship that characterized Stockholm and Lausanne, using the vision of an “ecumenism of the heart,” developed in connection with the WCC's 11th Assembly in 2022. The roots of such a search for unity inspired by deep mutual relationships can be found in the two movements that were inspired by the conferences in Stockholm and Lausanne.
Reclaiming the Spirit of Life and Work for Ecumenical Renewal
Authors: Mtata Kenneth
Published: December 2024

This article considers the legacy of the Universal Christian Conference on Life and Work, which met in Stockholm in 1925, for the contemporary ecumenical movement. It asks whether the World Council of Churches and the wider ecumenical movement can reconnect with the spirit of the Life and Work movement, especially that of its first decade or so, to inspire a comprehensive understanding of ecumenical social thought and action in response to contemporary challenges and opportunities. It argues that responses to today's global challenges can build on four foundational principles inspired by the Life and Work movement: creatively reimagining the spirits of the time; embodying an incarnational presence; mobilizing ecumenical efforts for meaningful and empowered action; and recommitting to the principles of life, peace, and justice that were central to the Life and Work movement.
Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta‐Analysis of Randomized Controlled Trials With Trial Sequential Analysis
Authors: Mishra Vivek , Dash Debabrata , Panda Aditya K. , Pathak Sushil Kumar
Published: December 2024

Background

Helicobacter pylori infection is a major global health concern and has been associated with a number of gastrointestinal disorders. Probiotics, especially Lactobacillus spp., have been suggested to have beneficial effect in managing H. pylori infection. This meta‐analysis of randomized control trials (RCTs) aimed to evaluate the effect of Lactobacillus spp. supplementation on H. pylori eradication rates and associated side effects when combined with standard therapy.

Materials and Methods

Relevant studies were retrieved from PubMed, Scopus, Google Scholar and the Cochrane Library. Comprehensive Meta‐Analysis (CMA) Software 4.0 was used for all the statistical analyses. TSA 0.9.5.10 Beta software was used for the trial sequential analysis (TSA). GRADEpro GDT was used to assess the certainty of evidence.

Results

An analysis of 26 selected studies showed that supplementing with Lactobacillus spp. significantly increased the rates of H. pylori eradication in per‐protocol (PP) analysis (Overall risk ratio [RR] = 1.063, p = 0.000, 95% CI of −0.21 to 2.11; adults: RR = 1.050, p = 0.005, 95% CI = −0.55 to 2.03, children: RR = 1.223, p = 0.001, 95% CI = −13.35 to 4.55). In comparison to quadruple therapy, Lactobacillus spp. supplementation to triple therapy showed significant benefit (RR: 1.124; p = 0.000, 95% CI of −0.48 to 2.61). L. reuteri supplementation indicated better efficacy (RR: 1.049; p = 0.055, 95% CI of −0.56 to 3.26) than Lactobacillus GG (RR: 0.980; p = 0.595, 95% CI of −0.69 to 1.21). The 28–30 day (RR: 1.103; p = 0.003, 95% CI of −2.14 to 4.19) and 14‐day supplementation periods (RR: 1.102; p = 0.003, 95% CI of −1.69 to 3.51) showed the most improvement. The analysis also revealed that Lactobacillus spp. significantly reduced gastrointestinal side effects: nausea/vomiting (RR: 0.566; p = 0.037, −3.11 to 1.45), diarrhea (RR: 0.324; p = 0.000, −5.46 to 0.48), and abdominal pain (RR: 0.438; p = 0.007, −5.65 to 4.22). The effect on bloating was non‐significant (RR: 0.820; p = 0.498, −4.01 to 0.96). TSA graphs validated sufficient evidence for the conclusions.

Conclusion

Lactobacillus spp. significantly enhances H. pylori eradication rates and may reduce gastrointestinal side effects when used alongside standard therapy, offering a promising adjunctive treatment option. The evidence was supported by TSA and assessed using GRADEpro, indicating a high certainty of the findings.
Evaluating the impact of the Dietary Approaches to Stop Hypertension diet versus a calorie‐restricted diet on metabolic dysfunction‐associated steatotic liver disease: A meta‐analysis of randomized controlled trials
Authors: Hasan Fariha , Singh Avneet , Garcia Alexander , Qadri Syeda Hafsa , Sattar Hina , Ali Rimmel , Ali Hassam , Nguyen Tommy , Mohan Babu P. , Contino Krysta
Published: December 2024

Aim

Metabolic dysfunction‐associated steatotic liver disease (MASLD) can lead to increased morbidity and mortality. Diets high in refined carbohydrates and saturated fats elevate MASLD risk. The Dietary Approaches to Stop Hypertension (DASH) diet has shown metabolic benefits. This meta‐analysis evaluates the impact of the DASH diet on MASLD progression.

Methods

A systematic search from 2016 to 2023 across PubMed, Embase, Web of Science, and Cochrane databases was conducted to identify studies reporting on the role of the DASH diet in MASLD. Standard meta‐analysis methods were employed using a random‐effects model. Heterogeneity was assessed by I2 statistics.

Results

We identified five randomized controlled trials meeting inclusion criteria, involving 280 participants (140 in the DASH group and 140 in the control group). Mean ages were approximately 41 years, and the proportions of women were similar between groups. Compared with controls, the DASH diet group had a significantly reduced risk of grade 0 and 1 liver fibrosis (RR 1.21, 95% CI 1.04–1.41, p = 0.01). They also showed lower levels of aspartate aminotransferase (MD −4.81, 95% CI −6.98 to −2.64, p < 0.0001), alanine aminotransferase (MD −10.31, 95% CI −13.82 to −6.80, p < 0.00001), body mass index (MD −0.74, 95% CI −1.45 to −0.03, p = 0.04), and cholesterol‐to‐high‐density lipoprotein ratio (MD −0.40, 95% CI −0.68 to −0.11, p = 0.006). No significant differences were found for weight, waist and hip circumference, total cholesterol, low‐density lipoprotein, or high‐density lipoprotein levels. Heterogeneity was low for most outcomes (I2 = 0%).

Conclusion

Based on our meta‐analysis of five randomized controlled trials, the DASH diet may reduce MASLD progression. These findings suggest it could be an effective dietary intervention for MASLD management.
Unbiased Drug Target Prediction Reveals Sensitivity to Ferroptosis Inducers, HDAC and RTK Inhibitors in Melanoma Subtypes
Authors: Pla Indira , Szabolcs Botond L. , Péter Petra Nikolett , Ujfaludi Zsuzsanna , Kim Yonghyo , Horvatovich Peter , Sanchez Aniel , Pawlowski Krzysztof , Wieslander Elisabet , Kuras Magdalena , Murillo Jimmy Rodriguez , Guedes Jéssica , Pál Dorottya M.P. , Ascsillán Anna A. , Betancourt Lazaro Hiram , Németh István Balázs , Gil Jeovanis , de Almeida Natália Pinto , Szeitz Beáta , Szadai Leticia , Doma Viktória , Woldmar Nicole , Bartha Áron , Pahi Zoltan , Pankotai Tibor , Győrffy Balázs , Szasz A. Marcell , Domont Gilberto , Nogueira Fábio , Kwon Ho Jeong , Appelqvist Roger , Kárpáti Sarolta , Fenyö David , Malm Johan , Marko‐Varga György , Kemény Lajos V.
Published: December 2024

Background

The utilization of PD1 and CTLA4 inhibitors has revolutionized the treatment of malignant melanoma (MM). However, resistance to targeted and immune‐checkpoint‐based therapies still poses a significant problem.

Objective

Here, we mine large‐scale MM proteogenomic data to identify druggable targets and forecast treatment efficacy and resistance.

Methods

Leveraging protein profiles from established MM subtypes and molecular structures of 82 cancer treatment drugs, we identified nine candidate hub proteins, mTOR, FYN, PIK3CB, EGFR, MAPK3, MAP4K1, MAP2K1, SRC, and AKT1, across five distinct MM subtypes. These proteins are potential drug targets applicable to one or multiple MM subtypes. Additionally, by integrating proteogenomic profiles obtained from MM subtypes with MM cell line dependency and drug sensitivity data, we identified a total of 162 potentially targetable genes. Lastly, we identified 20 compounds exhibiting potential drug impact in at least one melanoma subtype.

Results

Employing these unbiased approaches, we have uncovered compounds targeting ferroptosis demonstrating a striking 30× fold difference in sensitivity among different subtypes.

Conclusions

Our results suggest innovative and novel therapeutic strategies by stratifying melanoma samples through proteomic profiling, offering a spectrum of novel therapeutic interventions and prospects for combination therapy.
Sintering‐resistant porous BaZrO3 ceramics using a particle‐stabilized foam method for thermal insulation applications
Authors: Liu Bin , Fan Jie , Nian Hongqiang , Li Yiran , Xiang Huimin , Zhou Yanchun
Published: December 2024

Sintering and phase transitions of materials in current large‐area thermal insulation systems are critical problems for hypersonic vehicles. Searching for thermal insulation materials with good structure stability, thermal stability, and superior insulation performance is urgent for the development of these vehicles. Herein, we reported a novel porous BaZrO3 ceramic fabricated by a particle‐stabilized foam method. By controlling the sintering temperature, the porosity (92.96%–94.62%), thermal conductivity (0.088–0.193 W/(m·K)), and strength (0.30–1.31 MPa) of the porous ceramics are tunable. Most importantly, these porous BaZrO3 ceramics exhibit excellent sintering resistance. After being heat treated at 1300°C for 6 h, the shrinkage of porous BaZrO3 ceramics is nearly 0. The shrinkage of the samples heat‐treated even at 1600°C is still lower than 3%, demonstrating outstanding high‐temperature structure stability. Our results demonstrate that porous BaZrO3 ceramics are promising candidates for high‐temperature thermal insulation applications.
Comprehensive Analysis of Bulk RNA‐Seq and Single‐Cell RNA‐Seq Data Unveils Sevoflurane‐Induced Neurotoxicity Through SLC7A11‐Associated Ferroptosis
Authors: Hu Xiaolan , Zhang Yiping , Guo Lian , Xiao Renjie , Yuan Linhui , Liu Fen
Published: December 2024

Sevoflurane's potential impact on cognitive function and neurodevelopment, especially in susceptible populations such as infants and the elderly, has raised widespread concern. This study focuses on how sevoflurane induces ferroptosis in astrocytes and identifies solute carrier family 7 member 11 (SLC7A11) as a mediator of ferroptosis, providing new insights into sevoflurane‐related neurotoxic pathways. We analysed single‐cell sequencing (scRNA‐seq) data from sevoflurane‐exposed mice and control mice, supplemented with bulk RNA‐seq data, to assess gene expression alterations. Additionally, pregnant mice were subjected to in vivo experiments, and in vitro studies using U251 astrocytoma cells were conducted to evaluate sevoflurane's neurotoxic effects on offspring, focusing on ferroptosis markers and SLC7A11 expression. Sevoflurane exposure led to learning, memory and behavioural deficits in offspring, associated with decreased SLC7A11 expression and increased signs of ferroptosis. In U251 cells, sevoflurane reduced cell viability, increased reactive oxygen species (ROS) levels and affected the expression of ferroptosis regulatory factors, supporting the hypothesis that sevoflurane induces astrocyte ferroptosis through SLC7A11 modulation. Molecular docking experiments suggest a direct interaction between sevoflurane and SLC7A11. This study provides mechanistic insights into sevoflurane‐induced neurotoxicity, emphasising the importance of SLC7A11 in regulating astrocyte ferroptosis. Our findings highlight the potential for targeting ferroptosis pathways to mitigate the adverse effects of sevoflurane anaesthesia.
Oxidative balance is associated with diabetic kidney disease and mortality in adults with diabetes mellitus: Insights from NHANES database and Mendelian randomization
Authors: Jiang Li , Jian Jie , Sai Xulin , Yu Hongda , Liang Wanxian , Wu Xiai
Published: December 2024

Objective

To explore and validate the association between the oxidative balance and prevalence of diabetic kidney disease (DKD) and mortality in patients with diabetes.

Study design

A large and representative sample from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016 was analyzed to study the potential association between Oxidative Balance Score (OBS) and prognosis of DKD in adult diabetic patients. Weighted multivariate logistic regression analysis was conducted to examine the relationship between OBS and DKD risk. Subgroup analysis, sensitivity analysis, and mediation effect analysis were conducted to explore the effect of the covariates and assess the robustness of the findings. Mendelian randomization (MR) was employed to evaluate the correlated relationship between mitochondrial reactive oxygen species (ROS) levels and DKD at the genetic level.

Result

The highest OBS quartile showed the most significant negative correlation with DKD compared to the lowest OBS quartile (OR = 0.62, 95% CI 0.41–0.92, P = 0.017). Higher OBS was associated with a reduced risk of DKD (OR = 0.96; 95% CI = 0.93, 0.98; P < 0.001) and mortality (P = 0.021 by log‐rank) in diabetic patients. This association remained robust even after excluding individual OBS components. Subgroup analysis revealed the interaction of metabolic syndrome on OBS was significant. Mediation analyses revealed that OBS's effect on DKD was independent of blood uric acid and cholesterol. Restricted cubic spline (RCS) analysis indicated a typical L‐shaped relationship between OBS and DKD risk. The physical activity was identified as the core variable predicting DKD risk by two machine learning algorithms. MR showed a potential correlated relationship between ROS and microalbuminuria in DKD.

Conclusions

The high level of oxidative balance score was negatively correlated with the risk of DKD and mortality in diabetic patients.
Gastrointestinal symptoms in patients receiving imeglimin in combination with metformin: A post‐hoc analysis of imeglimin clinical trial data
Authors: Ito Jumpei , Hagi Katsuhiko , Kochi Kenji , Ueki Kohjiro , Watada Hirotaka , Kaku Kohei
Published: December 2024

Introduction

An increased rate of gastrointestinal (GI) symptoms is reported in patients with type 2 diabetes receiving imeglimin plus metformin vs monotherapy or in combination with other antidiabetic drugs. This post‐hoc analysis explored GI symptom incidence, risk factors for their occurrence, and the impact on therapeutic efficacy during imeglimin and metformin combination therapy.

Materials and Methods

Data were derived from the 52‐week, open‐label, phase 3 TIMES‐2 trial in Japanese type 2 diabetes patients. Patients in the imeglimin plus metformin group were divided into two subgroups based on the presence of GI symptoms and diarrhea, with efficacy and safety assessed. Factors associated with their occurrence were explored using multivariate logistic regression analysis.

Results

Of 64 patients analyzed, GI symptoms and diarrhea occurred in 40.6% (n = 26) and 17.2% (n = 11) of patients, respectively. Metformin dose and patient age did not significantly affect their incidence. Events occurred more frequently within the first 4 months of treatment. Approximately half resolved within 1 week, and most were mild. Type 2 diabetes duration <5 years was significantly associated with diarrhea (odds ratio = 5.979; P = 0.039). Significant hypoglycemic effects were observed from baseline, irrespective of GI symptoms or diarrhea. However, the degree of HbA1c improvement tended to be greater in patients with GI symptoms and diarrhea.

Conclusions

Increased awareness regarding the potential for GI symptoms, including diarrhea, during imeglimin plus metformin combination therapy is warranted. This data will provide clinicians with useful information regarding symptomatic treatment when it occurs and help determine whether to continue treatment administration and is expected to improve patient adherence.
Percutaneous Transhepatic Cholangioscopy in Hepatolithiasis Associated With Decompensated Cirrhosis: A Retrospective Cohort Study
Authors: Yan Qianyu , Zhang Jie , Chen Rui , Zhang Jingyi , Zhou Rongxing
Published: December 2024

Background

Multiple and complicated hepatolithiasis can be associated with decompensated cirrhosis. Endoscopic retrograde cholangiopancreatography is unavailable for multiple and complicated hepatolithiasis, and the mainstay for decompensated cirrhosis is liver transplantation. However, due to the ethical factors and the complexity of operation, liver transplantation cannot be widely operated. This study aimed to evaluate percutaneous transhepatic cholangioscopy in the extraction of stones and the recompensation of cirrhosis in patients with hepatolithiasis associated with decompensated cirrhosis.

Methods

Between January 2021 and February 2024, we retrospectively reviewed the clinical data of 21 patients with multiple and complicated hepatolithiasis associated with decompensated cirrhosis. Before PTCS, the 21 patients were all assessed by the Model for End‐stage Liver Disease as having indications for liver transplantation. One‐step PTCS (n = 19) and two‐step PTCS (n = 2) were used to remove the stones.

Results

The technical success rate was 100%, and most stones were cleared 90.48% (19/21). After 3 months of PTCS, MELD score of the patients had significantly decreased (10.81 ± 3.31 vs. 17.24 ± 3.40, p < 0.05), and it was lowest at 6 months after the operation (9.94 ± 4.31). After a median follow‐up period of 18 months (up to 40 months), the stone recurrence rate was 28.57% (6/21), 13 patients survived without liver transplantation, three patients underwent liver transplantation and survived, and five patients died of liver failure or cancer (mortality rate 23.81%).

Conclusions

PTCS can significantly improve patients’ liver function in hepatolithiasis associated with decompensated cirrhosis.
The Perception of Unilateral Recessions in the Maxillary Esthetic Zone: A Survey Among Dentists and Non‐Professionals
Authors: Fürhauser Nikolaus , Rosen Rebecca , Fürhauser Lukas , Fürhauser Rudolf
Published: December 2024

Statement of Problem

Esthetic dental features, especially the maxillary anterior teeth, significantly influence perceived attractiveness. Gingival recessions can negatively affect smile esthetics, particularly when asymmetrical.

Purpose

This study aimed to investigate the perception of dentists and non‐professionals regarding subtle variations in the apically displaced soft tissue surrounding a lateral or central incisor.

Materials and Methods

Based on an ideal image of the esthetic zone, asymmetrical modifications of either a central or lateral incisor in the maxillary anterior were created and used in a digital survey asking participants to assess the overall appearance of the smile, using a visual analog scale (VAS). The dental expertise, age, and gender of the participants were recorded. For each image, the question was posed to identify if any of the teeth caused a visible irritation. The mean results of each tooth alteration and the correlation between dental expertise were statistically analyzed.

Results

A total of 114 participants were polled. There was a significant difference in the esthetic perception between the central and lateral incisors (p < 0.001). The perception threshold for a noticeable asymmetrical recession was 1.2 mm for the central and 2.0 mm for the lateral incisor. Gender and age showed no significant difference in the esthetic evaluation, and dental expertise was only significantly different for larger recessions (p < 0.05).

Conclusion

The asymmetric changes were more noticeable for the central incisor than the lateral incisor. A unilateral recession change of 0.8 mm did not appear to influence the assessment of the overall smile. The dental expertise, age, or gender of the participants did not significantly correlate with a stricter esthetic perception.

Clinical Implications

The present study highlights that the perception of unilateral recession changes in the anterior maxilla varies between central and lateral incisors, with lateral incisor recessions being less impactful on the overall appearance of the smile. These findings suggest that small gingival changes can be acceptable for the overall esthetic outcome, underscoring the importance of discussing patient expectations and treatment options before restoration or orthodontic treatment and prioritizing the gingival margin of the central incisor which appeared more noticeable.
Entrepreneurial Resourcefulness: Theoretical Origins, Integrative Review, and Research Agenda
Authors: Williams Trenton Alma , Li Joanna Mingxuan , Zhao Eric Yanfei
Published: December 2024

Entrepreneurial resourcefulness is frequently invoked as an essential quality needed to succeed in the entrepreneurship processes. As such, recent years have seen a proliferation of a diverse body of scholarship on entrepreneurial resourcefulness. While this diversity demonstrates the promise and depth of entrepreneurial resourcefulness, this research is fragmented across disciplines, theories, and levels of analysis, which limits our understanding of when, why, and how entrepreneurial resourcefulness occurs and its effect on the entrepreneurial process. This study reviews and integrates the literature on entrepreneurial resourcefulness, providing a common foundational grounding that coheres diverse yet related streams of research. As an outcome of the review, we offer a definition of entrepreneurial resourcefulness that is anchored in its diverse theoretical origins and synthesize relevant research. In building on the foundation offered by the review, we identify the most critical areas for future research with the potential to build upon and extend the theoretical insights derived from the review.
Disparities in telehealth utilization between US rural and urban areas during the COVID‐19 pandemic
Authors: Bin Abdul Baten Redwan , Zohora Fatema Tuz , Siddiqui Muhammad Umar Hasan
Published: December 2024

Purpose

During the COVID‐19 pandemic, telehealth services were expanded across the United States to meet the increased demand and safety requirements of care. This observational study aims to understand rural‐urban differences in telehealth utilization during the early part of the COVID‐19 pandemic.

Methods

Individual‐level data from the National Health Interview Survey 2020‐2021 (age ≥18) were analyzed for this study. The Propensity Score Matching method with multivariable Ordinary Least Square was used to analyze 2 outcome variables—(1) having a medical appointment by video or phone in the past 12 months and (2) having a virtual one for reasons related to the pandemic. Event study models were analyzed to understand the trend of telehealth utilization throughout 6 quarters of the pandemic. Subgroup analysis by health insurance, age, sex, race, citizenship, and disability status was performed to identify underlying disparities between rural and urban residents.

Findings

Analysis reveals that rural respondents (N = 6,984) were 8.7 percentage points (P<.001) less likely than urban respondents (N = 40,207) to have a medical appointment by video or phone. Rural residents were 8.1 percentage points (P<.001) less likely to have had a virtual medical appointment because of reasons related to the COVID‐19 pandemic than urban users. The event study showed that rural‐urban telehealth utilization disparities persisted throughout the pandemic. Subgroup analysis revealed significant rural‐urban disparities in telehealth utilization by demographic characteristics.

Conclusions

Results demonstrate that rural residents were less likely than urban residents to utilize telehealth services during the COVID‐19 pandemic, highlighting concerns about access to care for rural residents.
Assessing the Use and Acceptability of Virtual Reality to Assist Coping in Children Undergoing Clinical Procedures
Authors: Samnakay Sarah , Bell Emily , Evans Daisy , Sommerfield David , Sommerfield Aine , Hauser Neil , von Ungern‐Sternberg Britta S.
Published: December 2024

Purpose

Virtual reality is used as a distraction tool during medical procedures that can cause anxiety and pain. We assessed the usefulness, engagement, value and feasibility of virtual reality to help children cope with routine clinical procedures.

Design and Methods

Quality improvement study. Children, 4–16 years old, were given the option to use virtual reality during their procedure in oncology, immunology or diabetes clinics, or during an induction of general anesthesia. The emotional state of the child was documented using the children's emotional manifestation scale. We assessed feedback from patients, parents, and clinicians.

Results

Across all clinics, children responded positively to the virtual reality and 80% would choose to use virtual reality again for health‐related procedures. Parents and clinicians, respectively, reported that virtual reality helped children tolerate the procedure (82% and 87%), engaged children well (82% and 89%) and was a valuable tool (85% and 98%). Clinicians (90%) endorsed the feasibility of using virtual reality during procedures.

Practice Implications

This project demonstrated that virtual reality can be implemented as a useful, engaging and feasible tool to help children tolerate a variety of routine medical procedures. However, ensuring comfortable fit of virtual reality devices and diversifying the visual content is necessary.
Aperiodic neural activity distinguishes between phasic and tonic REM sleep
Authors: Rosenblum Yevgenia , Bogdány Tamás , Nádasy Lili Benedikta , Chen Xinyuan , Kovács Ilona , Gombos Ferenc , Ujma Péter , Bódizs Róbert , Adelhöfer Nico , Simor Péter , Dresler Martin
Published: December 2024

Traditionally categorized as a uniform sleep phase, rapid eye movement sleep exhibits substantial heterogeneity with its phasic and tonic constituents showing marked differences regarding many characteristics. Here, we investigate how tonic and phasic states differ with respect to aperiodic neural activity, a marker of arousal and sleep. Rapid eye movement sleep heterogeneity was assessed using either binary phasic‐tonic (n = 97) or continuous (in 60/97 participants) approach. Slopes of the aperiodic power component were measured in the low (2–30 Hz, n = 97) and high (30–48 Hz, n = 60/97) frequency bands with the Irregularly Resampled Auto‐Spectral Analysis applied on electroencephalography. Rapid eye movement amplitudes were quantified with the YASA applied on electrooculography (n = 60/97). The binary approach revealed that the phasic state is characterized by steeper low‐band slopes with small effect sizes and some topographical heterogeneity over datasets. High‐band aperiodic slopes were flatter in the phasic versus tonic state with medium‐to‐large effect sizes over all areas in both datasets. The continuous approach confirmed these findings. The temporal analysis within rapid eye movement episodes revealed that aperiodic activity preceding or following EM events did not cross‐correlate with eye movement amplitudes. This study demonstrates that aperiodic slopes can serve as a reliable marker able to differentiate between phasic and tonic constituents of rapid eye movement sleep and reflect phasic rapid eye movement event intensity. However, rapid eye movement events could not be predicted by preceding aperiodic activity and vice versa, at least not with scalp electroencephalography.
Copyright in the age of artificial intelligence: Navigating access to algorithmic training materials and the three‐step test for text and data mining in Nigeria
Authors: Odeh Morris K.
Published: December 2024

Over the past decade, the Nigerian government has sought to leverage Artificial Intelligence (AI) to drive socio‐economic transformation and improve the welfare of its citizenry. Recent initiatives, such as the establishment of the National Centre for AI and Robotics (NCAIR) and the development of several strategic AI policies, highlight the country's commitment to this objective. This article explores the often‐overlooked issue of how the Nigeria's copyright regime hinders these initiatives, revealing that the regime permits only fair dealing and the transient or incidental reproductions of copyrighted materials for limited technological purposes. This study argues that this regime is unduly restrictive for algorithmic training and risks stifling AI innovation and the development of machine‐learning models in Nigeria. It recommends adopting a bespoke text and data mining (TDM) exception tailored to Nigeria's needs, allowing the use of copyrighted works for training AI models and machine learning activities within defined limits. Drawing on comparative analyses of copyright frameworks in jurisdictions such as Singapore, Japan, the United Kingdom, and the European Union, this study demonstrates that the proposed TDM exception aligns with the three‐step test under international copyright conventions. For instance, the exception is limited to specific users and types of reproductions, applies only to internalized and transformative reproductions, and avoids traditional methods of exploiting copyrighted works that prejudice the legitimate interests of rightsholders. The ultimate goal of this exception is to recalibrate Nigeria's copyright system to justly balance AI innovation with authors' rights, aligning it with foundational principles of the international copyright system in an era of rapid technological advancements.
Automatic steel girder inspection system for high‐speed railway bridge using hybrid learning framework
Authors: Xu Tao , Wu Yunpeng , Qin Yong , Long Sihui , Yang Zhen , Guo Fengxiang
Published: December 2024

The steel girder of high‐speed railway bridges requires regular inspections to ensure bridge stability and provide a safe environment for railway operations. Unmanned aerial vehicle (UAV)‐based inspection has great potential to become an efficient solution by offering superior aerial perspectives and mitigating safety concerns. Unfortunately, classic convolutional neural network (CNN) models suffer from limited detection accuracy or redundant model parameters, and existing CNN‐based bridge inspection systems are only designed for a single visual task (e.g., bolt detection or rust parsing only). This paper develops a novel bi‐task girder inspection network (i.e., BGInet) to recognize different types of surface defects on girder from UAV imagery. First, the network assembles an advanced detection branch that integrates the sparse attention module, extended efficient linear aggregation network, and RepConv to solve the small object with scarce samples and complete efficient bolt defect identification. Then, an innovative U‐shape saliency parsing branch is integrated into this system to supplement the detection branch and parse the rust regions. Smoothly, a pixel‐to‐real‐world mapping model utilizing critical UAV flight parameters is also developed and assembled to measure rust areas. Finally, extensive experiments conducted on the UAV‐based bridge girder dataset show our method achieves better detection accuracy over the current advanced models yet remains a reasonably high inference speed. The superior performance illustrates the system can effectively turn UAV imagery into useful information.
Electroencephalography and Anesthetic Depth in Children Under 2 Years of Age: A Prospective Observational Study
Authors: Yoon Soo‐Bin , Park Jung‐Bin , Kang Pyoyoon , Jang Young‐Eun , Kim Eun‐Hee , Lee Ji‐Hyun , Lee Hyung‐Chul , Kim Jin‐Tae , Kim Hee‐Soo , Ji Sang‐Hwan
Published: December 2024

Background

Processed electroencephalogram (EEG) indices are widely used to monitor anesthetic depth. However, their reliability in children under 2 years of age remains questionable. During anesthesia maintenance in this age group, processed EEG indices frequently exhibit unexpectedly elevated values that exceed the intended target range.

Aim

This study aimed to identify EEG spectral parameters associated with false positive elevations in processed EEG indices and investigate their differences from true positive elevations during emergence.

Methods

This prospective observational study included 50 children aged 4–24 months undergoing general anesthesia. Bispectral index (BIS), patient state index (PSi), and raw EEG were continuously recorded throughout anesthesia. False positive was defined as elevated processed EEG indices when end‐tidal sevoflurane concentration was maintained at 0.7–1.3 minimum alveolar concentration, with heart rate and mean blood pressure between 80% and 120% of baseline values. We analyzed EEG power spectra and band power values during periods of false positives and compared them with those of true positives during emergence. Bonferroni‐corrected p < 0.05 was considered significant.

Results

False positives in processed EEG indices were observed in 35 (70%) of the children during anesthesia maintenance, occupying 28% of the maintenance phase. These false positives were associated with decreased power in delta (269–174 dB) and theta (115–97 dB) bands, but widespread increases in alpha and beta bands, resulting in elevated spectral edge frequency (19–22 Hz). Notably, EEG band power during false positives significantly differed from those observed during emergence (delta: 52 dB, theta: 38 dB) (all p < 0.001).

Conclusions

Processed EEG indices may exhibit unexpectedly elevated values during anesthesia maintenance in children under 2 years of age. Quantitative assessments derived from raw EEG data may improve the evaluation of anesthetic depth in this population.