bluuebunny/crossref_metadata_2025 huggingface dataset:
A new immune-prognostic signature of 6 differentially expressed cytokine/cytokine receptor pathway-related genes in clear cell renal cell carcinoma
Authors: Zhan Yating , Jin Yan , Zhu Kai , Bao Menglu , Li Yeping
Published: July 2024

Background: To explore the hub genes related with prognostic pathway based on tumor microenvironment (TME) in clear cell renal cell carcinoma (ccRCC), a prognostic risk signature was identified to evaluate ccRCC patients’ prognosis.
Methods: The immune scores of ccRCC patients were calculated via “ESTIMATE” package. The hub genes of the key pathway were selected using univariate cox and Lasso regression analysis. Cluster analysis and risk signature construction were performed in accordance with the expression levels and lasso coefficient of the hub genes.
Results:Cytokine/cytokine receptor intersection pathway was considered as a key prognostic pathway in ccRCC. 6 differentially expressed cytokine/cytokine receptor pathway-related genes (DECCRGs) (CCR10, CXCL5, IL20RB, INHBE, KDR and RELT) were subsequently selected. Results of the cluster analysis revealed that the overall survival (OS) of the patients in cluster1 was better. Then, a 6-DECCRG immune-prognostic risk signature was established and used to evaluate the OS of ccRCC patients. This risk signature exhibited a good prognostic prediction ability in TCGA training cohort, which was further confirmed in TCGA testing cohort, whole cohort, GSE22541 cohort and a local cohort. Notably, the cluster groups and risk scores had a close connection to immune infiltration levels, respectively. CCR10, one of 6 DECCRGs, was further validated in renal cancer cells. Interestingly, reduced CCR10resulted in the inhibition of proliferation and migration in renal cancer cells.
Conclusion: Collectively, a novel 6-DECCRG immune-prognostic risk signature contributes to the accurate prediction of ccRCC prognosis.
Genomic diversity of phages infecting the globally widespread genus Sulfurimonas
Authors: Cheng Ruolin , Li Xiaofeng , Zhang Chuan-Xi , Shao Zongze
Published: July 2024

The bacterial genus Sulfurimonas is globally widespread and occupies a key ecological niche in different habitats. However, phages infecting Sulfurimonas have never been isolated and characterized. Here we systematically investigated the genetic diversity, taxonomy and interaction patterns of Sulfurimonas-associated phages based on sequenced microbial genomes and metagenome datasets. High-confidence phage contigs related to Sulfurimonas were identified from various ecosystems, clustered into 61 viral operational taxonomic units across 3 viral realms. Most Sulfurimonas-associated phages were tailed viruses of Caudoviricetes; these were assigned to 19 genus-level viral clusters, the majority of which were distantly related to previously known viruses. Phages encoding double jelly-roll major capsid proteins represented another group of double-stranded DNA phage with diverse gene compositions. Inovirus-like single-stranded DNA phages were primarily identified as integrated prophages or extrachromosomal viral genomes, suggesting chronic infections in hosts. Historical and current phage-host interactions were revealed, implying the viral impact on host evolution. Additionally, phages encoding auxiliary metabolic genes might benefit the infected bacteria by compensating or augmenting host metabolisms. This study highlights the remarkable diversity and novelty of Sulfurimonas-associated phages with highly divergent tailless lineages, providing basis for further investigation of phage-host interactions within this genus.
Increased superficial calcification clusters is a risk factor for carotid atherosclerosis after carotid artery stenting: a retrospective cohort study
Authors: Zhu Jiaqi , Tang Hanfei , Guo Daqiao , Tang Xiao , Han Tonglei , Yan Dong
Published: July 2024

Background
The role of calcification in carotid atherosclerosis before and after carotid artery stenting (CAS) is contradictory. This study assessed the relationship between the extent of calcification in target carotid plaque and the prognosis of patients with carotid stenosis undergoing carotid artery stenting.
Methods
A total of 293 subjects with carotid stenosis after CAS were consecutively and retrospectively recorded in this cohort. All subjects underwent outpatient and telephone follow-up using major adverse cardiovascular event (MACE). Finally, 211 subjects who completed 2-year follow-up were included. χ2 test, Student’s t-test and Wilcoxon test was used between MACE and no-MACE groups. Cox proportional hazard models were used to figure out the risk factor of calcification characteristics.
Result
Over a median follow-up period of 1.92 years, 14 composite endpoints were recorded. The symptom status (P = 0.0116), abuse of alcohol (P = 0.0091), the amount of total calcification clusters (P = 0.0428) and superficial calcification clusters (P = 0.0022) showed statistics significance in univariable Cox models. After adjusting for demographic characteristics and surgical-related factors, the amount of superficial calcification clusters maintained its statistical significance [P = 0.0232, hazard ratio (HR) = 1.694, 95% CI (confidence interval): 1.0744–2.6720].
Conclusion
The present study established that the amount of superficial calcification clusters independently serves as a prognostic risk factor in patients with carotid atherosclerosis underwent carotid artery stenting.
Connectivity Transition Characteristics of Historical Districts' Construction Land Networks and Road Networks in Southwest China: A Case Study of Guiyang
Authors: Lin Zhixin , Huang Zongsheng , Xiang Huiwen , Chen Yuanduo , Lu Shaowei
Published: July 2024

In the era of rapid urbanization, preserving historical districts is vital, especially in culturally rich regions. By focusing on Guiyang city, a key transport hub in southwestern China, this study explores urban evolution and development principles through network analysis. It examines changes in construction land and road networks across four historical periods: the Early Ming Dynasty, the Early Qing Dynasty, the Republic of China, and the 1980s. The findings show a linear decrease in construction land network density and fluctuating decline in road network density. Centrality trends declined from the early Ming to the early Qing but increased in the 1980s, moving towards equilibrium. Overall efficiency increases with decreasing in clustering coefficient, indicating reduced vulnerability. Social, productivity, and topographical factors influence these changes. This study contrasts with European and Southeast Asian research, revealing unique trends in mountainous city evolution. Constrained by terrain and limited outward expansion, cities transition from unipolar to multipolar spatial structures. Faced with administrative constraints, they adopt concentrated spatial development. The findings suggest strategies for global mountainous city development and confirm the applicability of complex network analysis to urban spatial networks, highlighting implications for understanding transformations within China's national pattern across various dimensions.
Dynamic changes in monocytic myeloid-Derived suppressor cells unveil insights into acute coronary syndrome pathogenesis and therapeutic potential
Authors: Tan Yinsheng , Ren Mingde , Hou Jie , Hou Tao , Lin Xianhe
Published: July 2024

Purpose:
This study aimed to investigate the dynamic changes in monocytic myeloid-derived suppressor cells (M-MDSCs) and their implications in the pathogenesis of acute coronary syndrome (ACS), shedding light on potential therapeutic targets.
Experimental Design:
Peripheral blood samples were collected from 68 ACS patients, 35 stable angina pectoris (SAP) patients, and 30 healthy controls. Multi-parameter flow cytometry was employed for analysis of M-MDSCs, explored with disease characteristics and progression.
Results:
ACS patients exhibited an increased frequency of circulating M-MDSCs compared to SAP patients and healthy controls. M-MDSCs levels demonstrated associations with ACS type, coronary artery lesions, multi-vessel disease, and cardiac dysfunction severity. Higher M-MDSCs levels were found in obese patients. Notably, therapy led to a significant decrease in M-MDSCs frequency. Furthermore, ACS patients exhibited elevated levels of interleukin (IL)-6, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor-α (TNF-α) in the cytokine profile associated with M-MDSCs. Increased expression of arginase-1(Arg-1) was observed in ACS patients, with positive correlations between M-MDSCs levels and IL-6, GM-CSF, and Arg-1 expression. The diagnostic performance of triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and M-MDSCs levels varied in predicting the severity of coronary artery stenosis, with TG showing higher specificity, HDL-C displaying higher sensitivity, and M-MDSCs levels demonstrating balanced sensitivity and specificity.
Conclusions:
Assessment of M-MDSCs frequency holds promise as a predictive marker for disease progression, therapy response, and severity of coronary artery stenosis. The elevated presence of M-MDSCs suggests their potential role in modulating ACS-related inflammation.
Cone Beam Computed Tomography Analysis of the Root and Canal Morphology of the Maxillary Second Molars in a Syrian Subpopulation
Authors: Allawi Safaa , Al-Tayyan Mouhammad , Achour Hassan , Toutangy Eyad , Tolibah Yasser Alsayed
Published: July 2024

Aim
To investigate the root number and morphology of the maxillary second molars in the Syrian population besides bilateral symmetry, and the effect of gender.
Methods
250 Cone Beam Computed Tomography (CBCT) images (140, 110 males) were examined by two endodontists. The detailed analysis included the number of roots, the number of canals and their configurations, bilateral symmetry, and relation to gender. The evaluation was made according to Vertucci classification by analyzing the CBCT images at all levels (Axial, Coronal, Sagittal, Oblique, and 3D). The Chi-square statistical analysis was performed to compare the canals’ morphologies and bilateral symmetry in both genders via SPSS.
Result
The most common shape of the upper second molars is three roots (90.4%). There were significant differences between males and females regarding the symmetry of the number of roots (P < 0.05). The root canal configuration was mainly Vertucci type I classification in the Distobuccally (93.4%) and palatal root (99.6%). The most common type in the mesial root was type I (29.5%), showing all varieties of Vertucci classifications (except VII, and VIII) percentage of MB2 of 70.5%. The ratio of symmetry was (59.6%) with no significant statistical difference between the genders (P = 0.708).
Conclusion
Most maxillary second molars in the examined Syrian population had three roots with four root canals, mostly types (II). In terms of symmetry, the number of roots surpassed the canal configuration. Males had a greater symmetrical tendency in the number of roots than females.
The Effect of Using Simulator and Video-assisted Teaching on the Acquisition of Blood Pressure Measurement Skills: a Quasi̇-experi̇mental Study
Authors: CERKEZOGLU NILAY , OZDEMIR HANDAN
Published: July 2024

Background: Blood pressure assessment, which is widely used in clinical practices, is an important practice that is under the responsibility of the nurse. Blood pressure measurement is also one of the most important indicators affecting nursing practices and many medical decisions during the evaluation of the health of the society.
Methods: The study was aimed at investigating the effect of teaching performed with the blood pressure measurement-training simulator and video education on nursing students’ blood pressure measuremet skill levels. The study was designed as a randomized controlled quasi-experimental study. Recruited 62 students who were assigned to the experimental (n = 31) and control (n = 31) groups using the simple random sampling method. The experimental group received blood pressure measurement skills training on the blood pressure measurement simulator, and the control group received the same training on a video.
Results: In the study, the mean scores in the control group were 27.84 for psychomotor skills, 6.55 for self-confidence. The mean scores in the experimental group were 34.06 for psychomotor skills, 7.84 for self-confidence.
Conclusion: The results show that the students learning with the simulator showed better learning performance than those who received the video method. However, both learning methods increased students' measurement skills.
Multi-task MSSP model can accurately predict selective Src inhibitors
Authors: Tian Xuecong , Han Luyang , Su Ying , Sun Haiqing , Zhang Sizhe , Chen Chen , Chen Cheng , Li Chen xi , Lv Xiaoyi , Li Jinyao
Published: July 2024

Src family kinases (SFKs), non-receptor tyrosine kinases, crucially contribute to invasion, tumor progression, epithelial-mesenchymal transition, angiogenesis, and metastasis. Thus, Src inhibitors offer a promising avenue for cancer therapy. This study introduced a multitask MSSP deep learning model to predict molecule inhibitory activity across multiple Src subtypes. Comparative assessment against four traditional machine learning methods—Random Forest (RF), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), eXtreme Gradient Boosting (XGBoost)—established the superior performance of the multitask MSSP model. It demonstrated the best comprehensive performance, achieving F1-Score and AUC values of 0.906 and 0.975, respectively. An online web server, "SRC-Predictor," was created to aid the practical application of the multitask MSSP model, predicting compounds' potential inhibitory activity against Src. Finally, compounds ranking in the top twenty based on model predictions were selected for experimental validation. Literature search for these compounds revealed limited research on four of them concerning Src. Molecular docking identified Doramapimod as exhibiting better affinity towards Src compared to reference compounds. It significantly inhibited Lyn kinase activity and influenced the secretion levels of inflammatory factors in LPS-induced macrophages. Experimental validation confirmed that our study provides a novel approach for identifying and screening lead compounds as Src inhibitors.
Exploring Polypharmacy and Drug Interactions in Geriatric Patients: A Cross-Sectional Study from India
Authors: Khaiser Umaima Farheen , Sultana Rokeya , Das Ranajit , Fareed Mohammad , Abullais Shahabe Saquib , Alahmari Manea M , Chaudhary Anis Ahmad , Shahid Mohammad , Alzahrani Saeed G.
Published: July 2024

Background Polypharmacy and potential drug-drug interactions (pDDIs) present challenges in managing elderly individuals with multiple comorbidities. Understanding their prevalence and associated factors is vital for enhancing medication safety and therapeutic outcomes. Objective This study aimed to assess the prevalence of polypharmacy and pDDIs among elderly individuals aged 60 years and above at Yenepoya Medical College and Hospital. Methods A prospective observational study was conducted at the hospital's in-patient and out-patient wards following ethics committee approval. Patient records were reviewed, and prescriptions were screened for pDDIs using Medscape and UpToDate. SPSS 26.0 analyzed data to identify polypharmacy patterns and characterize pDDIs. Results Predominantly older adults participated (mean age approximately 70.25 years), with notable polypharmacy prevalence, especially among in-patients. Gender disparities were evident, with females receiving more medications on average (p = 0.036). Moderate (50%) interactions were most common among various severity levels. Age correlated positively (r = 0.897) with prescribed medications, but age categories showed no significant association with drug interactions (p > 0.05). However, a significant relationship existed between prescribed medication quantity and drug interaction prevalence (p = 4.77e-05). Conclusion The study highlights the prevalence of polypharmacy and potential drug-drug interactions among elderly individuals, emphasizing the challenges in medication management. We found a significant prevalence of polypharmacy, particularly in older adults with complex health conditions, and observed a pervasive nature of moderate drug interactions.
Comparative analysis of the efficacy of drip drainage surgery and bone cement placement surgery in the treatment of haematogenous osteomyelitis of the extremities
Authors: Wang Hu , Lu Shuaikun , Luo Wen , Fu Congxiao , Gao Hao , Wang Guoliang , Zhu Zhenfeng , Liu Wei , Liu Chuan , Ren Jun , Liu Xiang , Zhang Yong , Zhang Yunfei
Published: July 2024

Background: The classical surgical treatment for hematogenous osteomyelitis is debridement and drip drainage surgery, and in recent years, antibiotic bone cement placement surgery has gradually gained widespread use.
Method: Information on 129 Hematogenic osteomyelitis (HO) patients, 67 treated with bone cement placement surgery and 62 with drip drainage surgery, was collected from January 2015 to January 2023. Baseline data, osteomyelitis classification, and clinical regression were compared between the two groups, with a mean follow-up of 2 years.
Result: Bone cement placement surgery had a higher infection control rate than drip drainage surgery (94% vs. 82.3%, P<0.001), and the EuroQol five-dimensional questionnaire (EQ-5D-3L)effect value was higher (0.763±0.29 vs. 0.717±0.42, P = 0.192). The efficacy of drip drainage surgery for Acute Hematogenic Osteomyelitis (AHO) was greatly improved, and the overall infection control rate was increased from 82.3% to 93.1%, which was even slightly higher than that of bone cement placement surgery (P = 0.452); bone cement placement surgery had a higher rate of infection control in chronic patients (94.5% vs. 72.7%, P = 0.004) and was more effective in treating metaphyseal focal osteomyelitis (97.5% vs. 71.4%, P = 0.002). The use of calcium sulfate calcium phosphate complex (CS/CP) was superior to polymethylmethacrylate (PMMA) (100% vs. 88.69%, P<0.001).
Conclusion: Bone cement placement surgery is recommended for the treatment of HO; drip drainage surgery is only indicated for AHO with long marrow cavity lesions; and CS/CP bone cement is preferred to PMMA, which requires a second removal to achieve good results because failure to remove it predisposes to recurrence of osteomyelitis.
Development and Performance Analysis of Machine Learning Methods for Predicting the Occurrence of Constipation and its Risk Factors Responsible Among College Going Girl
Authors: Ghosh Joyeta , Sanyal Poulomi
Published: July 2024

The study aimed to determine the most useful model for predicting functional constipation (FC) among college-bound girls in Kolkata by evaluating the applicability of multiple models and assessing the forecasting accuracy of prediction methods, such as regression-based and machine learning models.The observational descriptive study involved 300 college girls aged 18–25 from Kolkata, randomly selected via social media. Data were collected through an online questionnaire, and 19 attributes were selected for the prediction study. Weka version 3.8.0 software was used for predictive modeling, performance analysis, and building an FC prediction system. The data were divided into 70% training and 30% test datasets for each investigation. The results showed that 96.00% of instances were correctly classified, with a Kappa value of 0.875, a root mean squared error of 0.19, and an accuracy of 96.3%. The model achieved a weighted precision of 96%, 96% true positives, 0.05% false positives, an F-measure of 0.961, and an ROC curve of 0.994. Surprisingly, all six evaluators predicted Bristol's Stool Consistency Scale as the number one predictor of FC among college-going girls, followed by "Pain and discomfort in the abdomen" as the second predictor. In conclusion, this machine learning model-based automated approach for predicting functional constipation can assist medical professionals in identifying younger individuals more likely to experience constipation.
Risk for ventral hernia related to parity: A populationbased register study
Authors: Katawazai Asmatullah , Pettersson Hans , Wallin Göran , Sandblom Gabriel
Published: July 2024

Introduction: The association between pregnancy and risk for ventral hernia recurrence is not clear. This study aims to assess (1) the incidence of ventral hernia in women, and (2) whether increasing parity is associated with a greater risk for developing ventral hernia. Method: This nationwide cohort study included women born 1950–1980 who were registered in the Swedish Birth Register (MBR). Data on pregnancies and vaginal or caesarian section were retrieved from the Birth Register. The cohort was cross-matched with the National Patient Register (NPR) to identify subsequent primary hernia repairs. Result: A total of 1,630,754 women born between 1950 and 1980 were included in the study. Among them, 1,588,609 (92.3%) were registered for at least one birth. The incidence rate for Umbilical Hernia Repair (UHR) and Epigastric Hernia Repair (EHR) was 13.21 per 100,000 person-years and 5.4 per 100,000 person-years, respectively. When compared with women registered for one delivery, the incidence rate ratio for UHR was higher among those with two deliveries registered (1.3, 95% CI: 1.26–1.33) and among those registered with ≥ 3 deliveries (1.6, 95% CI: 1.58–1.68). The incidence rate ratios were (1.29, 95% CI: 1.20–1.39) and 1.34 (1.34, 95% CI: 1.24–1.45) for EHR among women with two and ≥ 3 registered deliveries, respectively. Conclusion: A history of more than one pregnancy is associated with increased incidences of umbilical and epigastric hernias.
Ridge slope failure mode analysis using strength reduction method based on double shear unified strength criterion
Authors: Wang Jianxiu , Liu Pengfei , Si Pengfei , Cao Ansheng , Long Yanxia , Li Huboqiang
Published: July 2024

Intermediate principal stress (IPS) may influence the stability of a slope under three-dimensional (3D) failure modes. However, the influence of IPS is seldom considered in slope stability evaluation. In this study, the 3D stability and failure mode of a ridge slope is analyzed by considering the influence of IPS. The mathematical model of double-shear unified strength theory was established using the UMAT subroutine in the Abaqus software. The influence of IPS on the deformation and damage modes of the homogeneous ridge slope was studied using strength reduction method. The results calculated by the Mohr-Coulomb strength criterion were very close to those the unified strength UMAT subroutine. Both have a safety coefficient of approximately 1.6. When the IPS coefficient b was 0, the safety factor was 6.95. And when the IPS coefficient increased to 0.2, the stability factor of the double-sided ridge slope was 9.44. The slop stability was enhanced obviously due to the existence of the IPS. After the excavation of the ridge side slope, the rock mass of ridge slope was not failure easily at the ridge line of the double-sided ridge slope. However, the rock mass at the side of the flank was prone to cracking damage. Moreover, the rock mass was prone to extrusion failure at the foot of the double-sided ridge slope. The calculations provide a new method and knowledge on the concrete evaluation of the failure and stability of a slope.
A Familial Chromosome 4p16.3 Terminal Microdeletion That Does Not Cause Wolf-Hirschhorn (4p-) syndrome
Authors: Osundiji Mayowa Azeez , Kahn Eva , Lanpher Brendan
Published: July 2024

Chromosome 4p16.3 microdeletions are known to cause Wolf–Hirschhorn syndrome (WHS), which is characterized by a distinct craniofacial gestalt and multiple congenital malformations. The 4p16.3 region encompasses WHS critical region 1 (WHSCR1) and 2 (WHSCR2). The WHSCR contains several genes that have been implicated in the WHS phenotype including: WHS candidate 1 [WHSC1(aka NSD2, OMIM 602952)], WHS candidate 2 [WHSC2 (aka NELFA, OMIM 606026)], and LETM1 (OMIM 604407). Although several patients harboring 4p16.3 microdeletions that are associated with WHS phenotypes have been reported, the precise molecular underpinnings of WHS are subjects of active investigations. The potential role(s) of genes within the 4p16.3 are increasingly being investigated. Here we report the first documented case of 4p16.3 terminal microdeletion that is not associated with the characteristic WHS phenotype. We studied Individual A (7-months-old female) and her father, Individual B (27-year-old), who both carry a terminal 4p16.3 microdeletion (about 555kb) that is distal to the WHSCR [(WHSCR1) and (WHSCR2)], and does not include WHSC1, WHSC2, or LETM1. Overall, our findings expand the phenotypic spectrum associated with 4p16.3 microdeletions and suggest that, in some individuals, microdeletions within 4p16.3 region may not be sufficient to cause WHS.
A study of maxillary sinus volume in Han Chinese adults with unilateral cleft lip and palate
Authors: Gao Ming , Tao Yongwei , Bi Sisi , Li Jinfeng , Xin Xiaomin , Ren Zhanping
Published: July 2024

Objective
This study aimed to evaluate maxillary sinus volume in Han Chinese adults with unilateral cleft lip and palate.
Methods
The maxillary sinus volumes of 50 Han Chinese adult unilateral cleft lip and palate (UCLP) patients and 53 age- and sex-matched control (non-cleft) individuals were measured on CT three-dimensional reconstructed images using Mimics software, and the results were compared and analyzed.
Results
1. There was no statistically significant difference in the maxillary sinus volume between the cleft side and the non-cleft side in the UCLP group (P > 0.05). 2. There was no statistically significant difference in the volume of the left and right maxillary sinuses between the two groups (P > 0.05).3. The left and right maxillary sinus volume of male in the UCLP group was significantly higher than that of the female group (P < 0.05).4. There was a significant correlation between left and right maxillary sinus volume in UCLP group (P < 0.05).
Conclusion
There was no significant difference in maxillary sinus volume between Han Chinese adult patients with unilateral cleft lip and palate and healthy adults, nor was there a significant difference in maxillary sinus volume between the cleft side and the non-cleft side of cleft lip and palate patients. However, the maxillary sinus volume of male patients was significantly larger than that of female patients. The presence of unilateral cleft lip and palate had no significant effect on maxillary sinus volume in Han Chinese adults.
SCC-NET: Segmentation of Clinical Cancer image for Head and Neck Squamous Cell Carcinoma
Authors: Huang Chien Yu , Tsai Cheng-Che , Hwang Lisa Alice , Kang Bor-Hwang , Lin Yaoh-Shiang , Su Hsing-Hao , Shen Guan‐Ting , Hsieh Jun-Wei
Published: July 2024

Background: Head and neck cancer predominantly originates from the mucosal layer of the upper aerodigestive tract, with squamous cell carcinoma representing the majority of cases. Therefore, a comprehensive oral and upper aerodigestive tract endoscopy examination serves as the primary diagnostic method for these cancers. While deep learning, particularly in computer vision, has been extensively researched for lesion segmentation in various diagnostic endoscopies such as colon polyps and gastric lesions, there have been limited reports on deep learning algorithms specifically tailored for segmenting head and neck squamous cell carcinoma.
Methods: This study comprises a case series investigating artificial intelligence algorithms, focusing on head and neck squamous cell carcinoma (HNSCC) endoscopic images captured between 2016 and 2020. The images were sourced from the Department of Otolaryngology-Head and Neck Surgery at Kaohsiung Veterans General Hospital, a tertiary medical center in southern Taiwan. All photos were rigid endoscopy documentation of tumors histologically confirmed as SCC through biopsy or surgical excision. Importantly, these tumors were captured at the initial presentation of the disease, prior to any surgical or chemo-radiotherapy intervention.
We introduce a novel modification of the Neural Architecture Search (NAS) - U-Net-based model, termed SCC-Net, tailored for segmenting the enrolled endoscopic photos. This modification incorporates a new technique termed "Learnable Discrete Wavelet Pooling," which devises a new formulation by combining outputs from different layers using a channel attention module, assigning weights based on their importance in information flow. Additionally, we integrated the cross-stage-partial design from CSPnet. To evaluate performance, we compared SCC-Net with eight other state-of-the-art image segmentation models.
Results: We collected a total of 556 pathologically confirmed SCC photos of oral cavity, oropharynx, hypopharynx and glottis. The new SCC-Net algorithm achieves high mean Intersection over Union (mIOU) of 87.2%, accuracy of 97.17%, and recall of 97.15%. When comparing the performance of our proposed model with 8 different state-of-the-art image segmentation artificial neural network models, our model performed best in mIOU, DSC, accuracy and recall.
Conclusions: Our proposed SCC-Net architecture successfully segmented lesions from white light endoscopic images with promising accuracy, demonstrating consistent performance across all upper aerodigestive tract areas.
A Propensity-Score Weighted Analysis of Short-Term Corticosteroid Therapy for Refractory Pain Following Spontaneous Subarachnoid Hemorrhage
Authors: Kardon Adam , Kim Dowon , Ren Haoyu , Jaffa Matthew N. , Elsaesser Dina , Armahizer Michael , Busl Katharina M. , Badjatia Neeraj , Parikh Gunjan , Ciryam Prajwal , Simard J. Marc , Chen Chixiang , Morris Nicholas A.
Published: July 2024

Background and Objectives Corticosteroids are prescribed for refractory headache in patients with spontaneous subarachnoid hemorrhage (SAH) despite limited supporting evidence. We hypothesized that a short course of corticosteroids would reduce pain.
Methods We reviewed all patients who received corticosteroids for refractory headache following spontaneous SAH within our institutional database. Pain was measured by a numeric rating scale (NRS) every two hours. The primary outcome was maximum daily NRS; secondary outcomes were the mean daily NRS and daily opioid consumption. Propensity scores were developed using potential predictors of corticosteroid use, including age, sex, pre-treatment 24-hour pain burden, and the number of analgesics being used to control pain. Inverse probability treatment weighting (IPTW) was used to balance baseline covariate distributions between patients receiving corticosteroids and control patients. Generalized estimating equations were used to analyze longitudinal NRS and oral morphine equivalents based on the weighted cohort.
Results A total of 213 patients were included; mean (SD) age was 55 (13) years, 141/213 (66%) were female. 195/213 (92%) had a low clinical grade (i.e., Hunt-Hess 1-3). Seventy patients received corticosteroids prescribed on average on post-bleed day 5 (SD 3.3) with an average of 26 (SD 10) mg of dexamethasone over 48 hours. Patients receiving corticosteroids and controls were well balanced on baseline predictors of treatment status. After IPTW, we found that corticosteroid therapy reduced daily maximum pain NRS by 0.59 (SE=0.39, p=.12), 0.96 (SE =0.42, p=.02) and 0.91 (SE=0.46, p=.048) on days 1-3, respectively, after adjusting for control effects. The mean daily pain NRS and daily opioid use were non-significantly reduced in the three days following corticosteroid initiation after adjusting for control effects.
Conclusion Short term corticosteroids only slightly reduced maximum pain severity after spontaneous SAH. Other analgesic strategies are required to manage refractory pain in this population.
Assessing Healthcare Pathway through patient experience with Completing Cancer Treatment Incentive (CCTI) Program for Low-Income Populations in Malaysia
Authors: Halim Nur Hidayati Abdul , Zainuddin Nur Azmiah , Aminuddin Farhana , Naserruddin Nurul Athirah , Hassan Nor Zam Azihan Mohd
Published: July 2024

Background
Cancer diagnosis imposes a significant economic burden on healthcare systems, patients, and their families. Technological advancements in cancer detection and treatment, leading to improved cancer detection rates and increased treatment uptake, have intensified this burden particularly among the economically disadvantaged. Despite efforts like universal health coverage and financial assistance programs, challenges persist in addressing the financial impact of cancer on patients.
Methods
Using qualitative methods, the study explores cancer patients’ experiences with the Completing Cancer Treatment Incentive (CCTI) in Malaysia. Interviews were conducted with both CCTI recipients and non-applicants from eight public hospitals. The RE-AIM framework was employed to evaluate dimensions such as reach, adoption, and implementation.
Results
Patients’ awareness of CCTI varied, with recipients mostly informed through acquaintances, media, or healthcare providers. Non-recipients lacked awareness, with limited information provided by healthcare personnel. CCTI was viewed positively by recipients, particularly for easing transportation costs, but challenges in the application process were evident. Patients faced difficulties navigating complex procedures, redundant health screenings, and limited communication about application progress.
Conclusions
The study highlights the need for improved implementation of CCTI to mitigate financial burdens on low-income cancer patients. Simplifying application processes, enhancing information dissemination, and addressing challenges such as redundant health screenings are crucial. The findings underscore the importance of proactive measures in policy implementation to improve CCTI effectiveness and accessibility for low-income cancer patients.
Evaluation of mycotoxins, mycobiota and toxigenic fungi in the traditional medicine Radix Dipsaci
Authors: Hu Min , Wang Lulu , Su Dapeng , Yuan Qingsong , Xiao Chenghong , Guo Lanping , Wang Meidan , Kang Chuanzhi , Zhou Tao , Zhang Jinqiang
Published: July 2024

Radix Dipsaci is commonly utilized in traditional Chinese medicine and is susceptible to contamination with mycotoxins. Here, we evaluated the mycotoxins, mycobiota and toxigenic fungi in the traditional medicine Radix Dipsaci. Among the sixty-three batches of Radix Dipsaci samples, we found that a total of twenty-eight batches (44.4%) were contaminated with mycotoxins including AFB1, AFG1, OTA, ZEN, AFG2 and T-2. More than 60% of the contaminated samples were combined with multiple mycotoxins. Fungal diversity and community were altered in the Radix Dipsacicontaminated with various mycotoxins. The abundance of Aspergillus and Fusariumincreased in the Radix Dipsacicontaminated with aflatoxins and ZEN. A total of ninety-five strains of toxigenic fungi were isolated from the samples contaminated with mycotoxins, predominantly comprising Aspergillus (73.7%), Fusarium (20.0%), and Penicillium (6.3%). Through morphological identification, molecular identification, mycotoxin synthase gene identification and toxin production verification, we confirmed that AFB1 and AFG1 derive from A. flavus, OTA derives from A. westerdijkiae, ZEN derives from F. oxysporum, and T-2 derives from F. graminearum in Radix Dipsaci. These data may help to provide useful information for effective prevent, control, and degrade contaminants strategies to ensure the safety of traditional medicine Radix Dipsaci.
Social influences complement environmental cues to stimulate migrating juvenile salmon
Authors: Kururvilla Maria , Quinn Thomas P. , Anderson Joseph H. , Scheuerell Mark D. , Miller Erika M. , Berger Andrew G. , Okasaki Connie , McMillan John R. , Pess George R. , Westley Peter A.H. , Berdahl Andrew M.
Published: July 2024

Background
The large-scale seasonal migrations undertaken by many species require complex navigational and timing decisions. Animals migrating in groups might benefit from collective decision making, especially if the environment is noisy (i.e., has high degree of local variation rather than smooth gradients in, for example, salinity or temperature), unpredictable, or the migrants cannot rely on individually acquired information. We focus on juvenile salmon whose migration from fresh water to the ocean is timed to match suitable conditions for growth and survival. While the environmental and physiological factors that influence the timing of migration have been well studied, the influence of social interactions on migration timing is poorly understood.
Method
We compiled juvenile salmon data, collected at trap over 19 years, during their downstream seaward migration in three rivers in Washington state along with a suite of relevant environmental time series. We developed state space statistical models to estimate the influence of hatchery-produced salmon to stimulate the downstream migration of wild salmon, while also incorporating potential environmental stimuli.
Results
Our results are consistent with the “pied-piper” hypothesis that large numbers of migrating hatchery-origin salmon provide a social cue stimulating migration of co-occurring wild salmon. The number of hatchery salmon counted at the trap was a strong predictor of the number of wild sub-yearling Chinook salmon in the Dungeness and Puyallup rivers and on yearling coho salmon in the Puyallup and Skagit rivers. Migration timing was also influenced by a suite of physical factors related to temperature, river flow, photoperiod, and lunar phase.
Conclusions
Our findings highlight the potential for social cues to affect migration timing of downstream migrating salmon, in concert with environmental factors. Incorporating social information into timing decisions may allow animals to benefit from collective decision making strategies and better time their migrations. Moreover, understanding the effects of large-scale hatchery releases on wild salmon migration may provide valuable insights for planning the timing and duration of hatchery releases.
The diagnostic value of a hybrid quantitative flow ratio–FFR strategy for ischemia-causing stenosis in patients with unstable angina and its impact on revascularization strategy
Authors: XIAO Yanan , Xiao Wentao , YE Famin , GUO Suping , ZHANG Jingjing , QU Yongsheng , Liu Xiaoqing , Zhang Jing , Chuanyu GAO
Published: July 2024

Quantitative flow fraction (QFR) is a functional test without a guide wire based on coronary angiography. In this study, flow reserve fraction (FFR) was used as the reference standard to verify the diagnostic value of QFR in patients with unstable angina pectoris with critical coronary artery disease (coronary artery stenosis degree of 40%-70%) functional stenosis, and to evaluate the effect of fusion strategies of QFR-FFR on revascularization strategies in such patients.This retrospective study included patients with unstable angina pectoris who were admitted to Fuwai Central China Cardiovascular Hospital from June 1, 2018 to June 1, 2023 and underwent coronary flow reserve fraction examination. QFR values of target vessels were analyzed offline by AngioPlus (Shanghai Pulsation Medical Imaging Technology Co., LTD.), the second-generation QFR detector, and anatomical parameters of the diseased vessels were recorded as follows: minimal luminal diameter (MLD), percent diameter stenosis (DS%), minimal luminal area (MLA), percent area stenosis (AS%). Functional coronary artery stenosis is defined as FFR≤0.80. Using FFR as the gold standard, the AUC values of contrast-flow QFR (cQFR) and fixed-flow QFR (fQFR) for identifying functional coronary artery stenosis in patients with unstable angina pectoris were 0.832（95%CI：0.772~0.892，P=0.000）and 0.817（95%CI：0.756~0.877，P=0.000）, respectively. The diagnostic accuracy, sensitivity and specificity of cQFR and fQFR were 85.52%、78.57%、89.78% and 79.19%、75.00%、81.75%, respectively. Delong test showed that there was no significant difference between cQFR and fQFR in the diagnostic value of functional stenosis in patients with unstable angina. When in the QFR "gray zone" (0.77 to 0.87), compared with fQFR, cQFR had a higher AUC for diagnosing coronary critical lesion functional stenosis in patients with unstable angina pectoris (0.881 vs 0.705). Furthermore, a fusion strategy using cQFR-FFR avoided invasive FFR measurements in 71.49% of patients. With FFR as the gold standard, QFR has a certain diagnostic value for coronary artery critical lesion functional stenosis in patients with unstable angina pectoris. When QFR is in the "gray area", the diagnostic value of cQFR is higher. At this time, the fusion strategy of cQFR-FFR can avoid FFR measurement in some patients.
C-reactive protein flare-response predicts the efficacy of PD-1/PD-L1 monoclonal antibodies in metastatic gastric cancer
Authors: Lei YiHui , Lin Li , Wang Yayue , Chen Weiping , Liu Guoyan
Published: July 2024

Currently, predictive biomarkers for the efficacy of immunotherapy in metastatic gastric cancer (mGC) during the era of immune checkpoint inhibitorsare still under evaluation. This retrospective study investigated the predictive value of early C-reactive protein (CRP) kinetics on the efficacy of programmed cell death protein-1(PD-1)/programmed cell death ligand 1 (PD-L1)monoclonal antibody treatment in mGC. A total of 42 mGC patients included in this study, who treated with PD-1/PD-L1 monoclonal antibodies between 2019 and 2022. Based on early CRP kinetics, patients were categorized into three groups: CRP flare-responders: those whose CRP levels increased to more than twice the baseline within one month of initiating PD-1/PD-L1 monoclonal antibodies and then decreased to below baseline within three months; (2) CRP responders: those whose CRP levels decreased by ≥30% within three months of treatment; (3) non-CRP responders: the remaining patients. The objective response rates for CRP flare-responders, CRP responders, and non-CRP responders were 57.1%, 26.6%, and 7.7%(p=0.042), respectively. The median overall survivals (OS) of the CRP flare-responder, CRP responder, and non-CRP responder groups were not reached, not reached, and 11.9 months(p=0.006), respectively. The median progression-free survivals (PFS) of the CRP flare-responder, CRP responder, and non-CRP responder groups were not reached, 8 months, and 4.5 months (p=0.003), respectively. Multivariate analysis revealed that early CRP kinetics were independent predictors of objective response (p=0.033), OS (p=0.026), and PFS (p=0.004). Our study showed that in mGC patients receiving PD-1/PD-L1 monoclonal antibody therapy, CRP flare-response was associated with significant tumor shrinkage and improved survival outcomes. Early CRP kinetics have predictive value for the therapeutic efficacy of PD-1/PD-L1 monoclonal antibodies.
Efficacy and Safety of Two Simplified Regional Citrate Anticoagulation for Intermittent Hemodialysis: A Randomized Cross-over Trial
Authors: Yuan Shizhu , Tao Mei , Tu Qiudi , Shen Huajuan , Zhou Meiling , Jia Yanqing , He Qiang , Liu Yueming , Shen Xiaogang
Published: July 2024

In recent years, due to the low risk of bleeding, regional citrate anticoagulation (RCA) is being tried for intermittent hemodialysis (IHD). Simplified regional citrate anticoagulation (S-RCA) has been attempted in IHD. This randomized cross-over trial was designed to compared the efficacy and safety of two RCAs in heparin-free dialysis patients, which were named S-RCA and two-stage simplified regional citrate anticoagulation (TS-RCA). In summary, the anticoagulation effect of TS-RCA is better than that of S-RCA in IHD, especially in the anticoagulation of venous bubbles trap. And these two RCAs were safe for IHD patient with high bleeding risk. Trial Registration: Chinese Clinical Trial Registry (CHICTR): Registration Number ChiCTR2000034314; Registration date 28 September 2020.
“What if the patient has a severe reaction, and it is my fault?” A qualitative study exploring factors for sustainable implementation of penicillin allergy delabelling.
Authors: Alnæs Marie Bjørbak , Skodvin Brita , Jahnsen Jan Anker , Velure Grete Kalleklev , Oppegaard Oddvar , Kittang Bård Reiakvam , Storaas Torgeir , Schaufel Margrethe Aase
Published: July 2024

Background
Penicillin allergy delabelling (PAD) is a key target in antibiotic stewardship, but uptake of the procedure outside clinical studies is limited. We aimed to explore factors that need to be addressed to sustainably implement a clinical pathway for PAD.
Methods
We conducted a qualitative study based on semi-structured interviews with focus groups consisting of a purposive sample of twenty-five nurses and physicians working on three different hospitals in Western Norway. Systematic text condensation was applied for analysis.
Results
Psychological safety was reported as crucial for clinicians to perform PAD. A narrative of uncertainty and anticipated negative outcomes were negatively associated with PAD performance. Education, guidelines, and colleague- and leadership support could create psychological safety and empower health personnel to perform PAD. Key factors for sustainable implementation of PAD were to facilitate the informant’s profound motivation for providing optimal health care and for reducing antimicrobial resistance. Informants were motivated by the prospect of a simplified PAD procedure.
We identified three main needs for implementation of PAD: 1) creating psychological safety; 2) utilising clinicians’ inherent motivation and 3) optimal organisational structures.
Conclusion
A planned implementation of PAD must acknowledge clinicians’ need for psychological safety and aid reassurance through training, leadership, and guidelines. To implement PAD as an everyday practice it must be minimally disruptive and provide a contextually adaptive logistic chain. Also, the clinician’s motivation for providing the best possible healthcare should be utilised to aid implementation. The results of this study will aid sustainable implementation of PAD in Norway.
A systematic review and meta-analysis protocol on low back pain prevalence and associated factors among nurses in Ethiopia
Authors: Bitew Sintayehu Tsegaye , Mekonnen Yeshiwas Genanaw , Gutema Olantu Mekonnen
Published: July 2024

Introduction: Nurses frequently experience low back pain (LBP), which is a serious health problem that impairs both their physical and occupational well-being.
Objective: To review and synthesis the prevalence and associated factors of Low Back Pain among Nurses in Ethiopia.
Method: Databases such as PubMed, EMBASE and Google scholar will be searched. Inclusion criteria included articles with prevalence of LBP and associated factors among Nurses in Ethiopia. The keywords “prevalence, associated factors, low back pain, nurses”, and “Ethiopia” will be used as part of this search. For data extraction, a form will be designed that included the following variables: Author names, sample size, age, gender, marital status, work experience, body mass index, job type, smoking status, year of publication, type of standard questionnaire, prevalence of LBP, studies’ quality score and associated factors. Data analysis will be carried out using random effects model. Heterogeneity between studies will be assessed by using the I2 and Q tests. This review will be reported following the PRISMA Guidelines for Meta- Analysis and Systematic Reviews of Observational Studies.
Discussion: This systematic review and meta-analysis will be among the first to thoroughly examine and consolidate the available evidence on the prevalence and factors associated with Low Back Pain among Nurses in Ethiopia. The study's findings will guide future research and offer practitioners and clinicians insights into the nature and consequences of workplace injuries among nurses, suggesting appropriate interventions.
Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42024552833)