bluuebunny/crossref_metadata_2025 huggingface dataset:
Pilot Study on Using Large Language Models for Educational Resource Development in Japanese Radiological Technologist Exams
Authors: Kondo Tatsuya , Okamoto Masashi , Kondo Yohan
Published: April 2024

In this study, we evaluated the potential of large language models (LLMs) in the development of educational materials for healthcare professional licensure exams with multiple choice questions (MCQs) in non-English-speaking countries, focusing on Japan's Radiological Technologist National Exam. We adapted MCQs from the exam, categorizing them into image-based, calculation, and textual questions, and generated explanatory texts using Microsoft Bing's Copilot. We assessed the quality of explanatory texts on a 0–4-point scale. Our findings showed that LLMs scored highly in text-based questions, demonstrating strong capabilities in processing textual information. However, we identified significant challenges in formula construction and the calculation process associated with calculation questions. Additionally, despite LLMs' multimodal functions, image-based questions received lower scores, which suggests the need for alternative approaches to these questions. In this study, we highlighted the effectiveness of LLMs in creating educational materials for medical licensure exams in non-English-speaking contexts while also noting the challenges in ensuring students' accuracy when they independently used LLM-generated information.
Examination of the Impact of Lumbar Interbody Fusion Surgery on Renal Function in Elderly Patients
Authors: Serikyaku Hisashi
Published: April 2024

Introduction:
Perioperative acute kidney injury (AKI) can have devastating outcomes, including surgical site infection, progression to chronic renal failure or death. In this study, patients aged 60 years or older who underwent lumbar single interbody fusion alone at our hospital were investigated whether the invasiveness of single level lumbar interbody fusion affect the perioperative renal function in elderly patients.
Materials and methods
One hundred twenty-seven patients who underwent single level posterior lumbar intervertebral body fusion at L3/4, L4/5 or L5/S level due to back pain, lower limb numbness and pain were divided into two groups: those aged 60–79 years and those 80 years or over. Serum total protein (TP), hemoglobin (Hb), blood urea nitrogen (BUN), creatinine phosphokinase (CPK), creatinine (CRE), and estimated glomerular filtration rate (eGFR) preoperatively, the day after surgery and seven days after surgery and the rate of change were examined and compared between the two groups for the presence of rhabdomyolysis and AKI associated with surgical invasion.
Results
Rhabdomyolysis was not observed in those over 80 years of age, but two patients in the 60–79 age group. Seven days after surgery, there were no cases of deteriorating renal function in the group aged 80 years or older, but four cases in the group aged 60–79 years. AKI did not occur in both groups.
Conclusions
Posterior lumbar intervertebral fusion might be performed relatively safely even in patients over 80 years of age with renal function below G3b.
Exploring Public Knowledge and Perceptions of ADHD-related web searches: An Infodemiology study in 15 countries
Authors: Cherrez-Ojeda Ivan , Robles-Velasco Karla , Sagñay-Pinilla Juan , Crespo-Shijin Carolina , Cherrez Michelle , Rodas-Valero Gabriela , Hysenaj Flavia , Maquilon Jaime Rosero
Published: April 2024

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one the most common neuropsychiatric disorders particularly affecting children with a worldwide distribution. The aim of this study was to examine the near real-time spread of health information regarding ADHD through Internet data in 15 countries.
Materials and Methods: On October 13, through Google Trends (GTr) we applied the most used terms referring to ADHD, determining the relative search volume (RSV) of ADHD-related searches from 15 countries. We analyzed the data both qualitatively and quantitatively, the last one using a 12-month predictive ARIMA model.
Results: The most searched categories in the 15 countries were Definition, Age, and Signs and Symptoms with Treatment being the least searched. Additionally, we observed a rising pattern in interest over time (IOT) with a peak in 2020.
Conclusion: There is a growing interest among the general population in understanding what is ADHD, which reveals the areas where we can improve information resources available for patients as well as implement the use Information and Communication Technologies (ICT) to bridge this gap.
The varus/valgus angle of the femoral component relative to the tibial component can lead to a deviation of the bearing position in mobile bearing unicompartmental knee arthroplasty which can increase the risk of bearing dislocation
Authors: Li Hai-Feng
Published: April 2024

Purpose: This study aimedto evaluate the relationship between the bearing position and relative angle of the femoral and tibial components using postoperative radiological measurements.
Methods: This study included 120 patients who underwent MB-UKA at our hospital between January and August 2023. Standard anteroposterior-view radiographs were obtained postoperatively using C-arm fluoroscopy. We developed a 3D-2D image matching method to measure the femoral component varus/valgus angle and internal/external rotation (IR/ER) relative to the tibial component. The bearing position parameters were measured. Patients were divided into varus/valgus groups and IR/ER groups according to the femoral component varus/valgus angle and IR/ER angle. The bearing position parameters of each group were compared separately.
Results: There were 57 patients in the varus group, 63 in the valgus group, 59 in the IR group, and 61 in the ER group. The W-BED (the distance between the bearing lateral edge and the lateral wall) was significantly lower in varus group than in the valgus group (1.9 (0 to 6.4) vs 2.8 (0.3 to 7.7) mm; P<0.001). No differences were observed in any bearing position parameters. The varus/valgus angle of the femoral component showed a significant negative correlation with the W-BED. The IR/ER angle of the femoral component showed no significant correlation with any of the positional parameters.
Conclusion: The varus/valgus angle of the femoral component relative to the tibial component can lead to a deviation of the bearing position. The IR/ER of the femoral component had no effect on the final bearing position.
Voltage-Induced Void Formation in High-Temperature Oxide Scales of Boiler Tubes
Authors: Rosdin Muhammad Rafiq Haikal , Bakar Syed Noh Syed Abu , Hamid Abd Malek Abdul , Ismail Ahmad Abdul Mun’im , Ani Mohd Hanafi
Published: April 2024

The formation of voids in the oxide scale during high temperature oxidation is one of critical issues that leads to poor oxide scale adherence, fouling, spalling and materials loss, which affect substrate’s performance. Visual inspection is currently the sole way to detect corrosion process at high temperature environment. At room temperature, under the standard condition, cathodic protection has been successfully employed to monitor and control the corrosion. Understanding the development of voids in oxide scale is crucial to develop mitigation strategies and predictive maintenance. Thus, this study was intended to serve as a preliminary step to emulate the cathodic protection technique at high temperature. By polarizing the sample, it is postulated that it may affects the diffusivity of cation/anion in oxide scale, which is the rate determining step of the oxidation process. Ueda et al and Maruyama et al has shown that the difference in flux, or chemical potential of the oxygen species is the sole factor for the formation of void in oxide scale in controlled environment. In this study, the amount of voids present was measure directly on T91 alloys exposed at 823 K under various induced voltageT91 alloy which consists of Fe-9%Cr was externally induced with voltages of 0V, 50V and 300V for 43.2 ks, 259.2 ks and 432 ks at 923 K in air (\({P}_{{O}_{2}}\)) = 0.21 atm = 2.1 × 104 Pa). The presence of oxide layers was analysed using X-Ray Diffraction (XRD) and the void formed was inspected using Scanning Electron Microscopy (SEM). XRD results reveal that peaks of Fe2O3, Fe3O4, FeCr2O3 and Cr2O3 were formed on all sample. The parabolic rate constant, Kp was calculated as 3.83 × 10–14 m2/s, 2.17 × 10–14 m2/s and 9.25 × 10–14 m2/s respectively, verifying that the reaction occurred was a solid state diffusion. Changes in Kp at different induced voltages is clear evidence that the diffusivity was altered by external electrical potential. It was observed that the overall void formation decreased by 17%. Apparently, inducing voltage onto T91 alloy effects the ionic diffusivity and changes the void formation. Conversely, it may be used to promote diffusivity of more inert species such as Cr to form protective layer at early stage of oxidation.
Association Between Spinal Canal Sagittal Diameter Dynamics and T2- Weighted MRI Intramedullary Hyperintensity in Cervical Spondylotic Myelopathy Patients
Authors: Zu Feiyu , Qi Hao , Wang Chenchen , Zhao Zenghui , Wang Zhaoxuan , Wang Chenxi , Xue Rui , Chen Wei , Hou Zhiyong , Zhang Di
Published: April 2024

Objective This study aimed to explore the dynamic changes in the spinal canal sagittal diameter and their association with increased intramedullary signal intensity on MRI T2-weighted imaging (T2WI) in patients with cervical spondylotic myelopathy (CSM), providing clinical guidance for diagnosing and selecting appropriate treatment approaches.Materials and Methods Clinical data from 72 patients diagnosed with CSM and treated at the Third Hospital of Hebei Medical University were collected and subjected to comparative analysis. The patients were divided into two groups based on the signal intensity on preoperative cervical MRI T2WI (Group I, which exhibited hyperintensity, and Group II, which showed no signal changes). Statistical analysis was conducted comparing the two groups in terms of gender, lesion segment, age, BMI, duration of symptoms, preoperative JOA score, spinal cord compression rate, cervical curvature, total cervical ROM, intervertebral space ROM, and the sagittal diameter of the cervical spinal canal in lateral, hyperextension, and hyperflexion positions.Results The study included 40 males and 32 females, with an average age of 51.49 ± 7.23 years. No significant differences were found in age, BMI, symptom duration, preoperative JOA score, spinal cord compression rate, cervical physiological curvature, total cervical ROM, intervertebral space ROM, and the distribution of gender and segment (p>0.05). However, both the total superior and inferior variation values of the cervical canal sagittal diameter during neck flexion and extension activities were significantly lower in Group I than in Group II (p = 0.001), indicating negative changes. The interobserver reliability was high.Conclusion The dynamics of the sagittal diameter of the cervical spinal canal play a crucial role in the progression of CSM. This aspect should be given significant attention and can inform the assessment and selection of clinical treatment plans for patients with CSM.
Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment
Authors: Dong Shi , Lin Honghua , Qiu Enyi , zhang Hao , Jin Wenqi , Xu Yajing , Han Ruozhen
Published: April 2024

Background
This study aimed to compare dosimetry of the target region and organ at risk (OAR) according to two different radiation plans for patients after breast-conserving surgery (BCS), hypofractionated whole breast irradiation (HFWBI) combined with an additional sequential boost (SEQ) versus simultaneous integrated boost (SIB), and further explore better radiotherapy after breast-conserving surgery.
Methods
We included 56 patients with early-stage left-sided breast cancer. Hybrid volumetric modulated arc therapy (H-VMAT) plus sentinel lymph node biopsy was given to all participants. The following SIB and SEQ treatments were planned for each patient. The radiation doses delivered to OAR and dose-volume histogram were analyzed. The comparison of the max dose (Dmax), the mean dose (Dmean), the min dose (Dmin), and the volume of each organ that received x Gy (Vx) was accomplished.
Results
The V5, V10, and V20 of the heart and the ipsilateral lung were lower in the SIB plan than SEQ, while among patients receiving the SIB plan, the V5 and V10 of the right and the left ventricle were lower. The Dmean for the heart, left anterior descending (LAD), right ventricle, left ventricle and the ipsilateral lung was lower for the SIB plan (heart: 5.24 ± 0.75 Gy vs. 6.92 ± 0.92Gy, p < 0.001; lad: 9.27 ± 1.07Gy vs. 11.86 ± 1.40Gy, p < 0.001; right ventricle 6.39 ± 1.54Gy vs. 8.39 ± 1.88Gy, left ventricle 6.10 ± 1.33Gy vs. 8.54 ± 1.80Gy, p < 0.001; lung: 9.28 ± 1.07Gy vs. 11.86 ± 1.41Gy, p < 0.001).
Conclusions
Regarding the dosimetry among the heart, LAD, ventricle, and left lung, SIB radiotherapy achieved better results, suggesting that the SIB plan might be more suitable for postoperative radiotherapy after BCS for early-stage breast cancer patients. We also witnessed that large daily radiation doses could be safe and effective when combined with the radiobiology of breast cancer.
Windsock Mitral Valve After Prior Aortic Valve Endocarditis
Authors: Kang Augustine , Wang Hanjay , Liebert Diane , Berry Gerald J. , Boyd Jack H.
Published: April 2024

Background: Windsock deformities, though rare, represent a severe form of valvular aneurysm distinguished by localized balloon-like protrusions of the leaflet body. Here, we present a compelling case of windsock mitral valve (MV) formation subsequent to incompletely managed aortic valve (AV) endocarditis. The case is illustrated through radiographic, intraoperative, and histopathologic images.
Case Presentation: We present the case of a 44 year old male patient who presented with symptoms suggestive of infective endocarditis. Despite initiation of appropriate antimicrobial therapy and surgical intervention for AV involvement, the patient developed progressive valvular dysfunction. Subsequent imaging studies revealed the emergence of windsock deformity in the mitral valve apparatus. Intraoperative assessment confirmed the presence of this rare valvular anomaly, which was further corroborated by histopathologic examination.
Conclusions: We provide, for the first time in the literature, a clear intraoperative view and example of windsock mitral valve (MV) developing after incompletely treated aortic valve (AV) endocarditis.
Context explains much of patient-perceived physician empathy in general practice
Authors: Lelorain Sophie , Descamps Axel , Grignoli Nicola , Pruvost Thomas , Dhelft Antoine , Rouhier Marie-Anne , Lallemant Elise , Sebbah Alissa , Pinçon Claire
Published: April 2024

Background.
Patient-perceived physician empathy (PPPE) is associated with numerous positive outcomes for patients, quality of care and health expenditure. Research into the factors that explain PPPE is therefore crucial, but the focus has often been placed on physician-related predictors of PPPE. In general practice, however, many barriers to empathy may be contextual, such as lack of time, or patient-related, such as multimorbidity. Consequently, our aim was to explore the effect of these variables on PPPE in general practice.
Methods.
In a cross-sectional design, 50 randomly recruited physicians were compelled to include 20 consecutive adult patients with one or more chronic disease(s). The characteristics of the doctors and their work environment were collected (e.g. gender, age, peer-group participation or lack of participation, urban or rural area, working alone or with other colleagues, caseload, etc.). Physicians filled in patients’ diseases, and patients filled in validated questionnaires on their health, emotional skills (i.e their ability to identify, express and regulate emotions) and their perception of physician empathy (CARE scale). Multilevel linear regressions were performed using SAS.
Results.
The median PPPE was 45 (n = 762), with higher rates in patients who had had seven or more consultations with the physicians in the last 12 months and lower in patients with genitourinary and upper gastrointestinal diseases. In consultations ≤ 20 minutes, the length of consultation was associated with higher PPPE in interaction with patients’ emotional skills: the positive effect of longer consultations on PPPE was stronger in patients with low emotional skills, whereas patients with high emotional skills were able to perceive high empathy even in very short consultations of 5–10 minutes. Among the 11 physician-related candidate variables, only physician age had a significant effect.
Conclusions.
Patient-related and, especially, contextual variables explained PPPE much more than physician-related variables. Consultations with infrequently seen patients and patients with low emotional skills should ideally last at least 20 minutes to allow the empathic process to unfold. Patients with genitourinary and upper-gastrointestinal diseases should be given special consideration, as they may encounter intimate issues or specific needs requiring more attention.
Recognizing Multiple Ingredients in Food Images Using a Single-Ingredient Classification Model
Authors: Fu Kun , Ｄａｉ Ｙｉｎｇ
Published: April 2024

Recognizing food images presents unique challenges due to the variable spatial layout and shape changes of ingredients with different cooking and cutting methods. This study introduces an advanced approach for recognizing multiple ingredients segmented from food images. The method localizes the candidate regions of the ingredients using the locating and sliding window techniques. Then, these regions are assigned into ingredient classes using a convolutional neural network (CNN)-based single-ingredient classification model trained on a dataset of single-ingredient images. To address the challenge of processing speed in multi-ingredient recognition, a novel model pruning method is proposed to enhances the efficiency of the classification model. Subsequently, the multi-ingredient identification is achieved through a decision-making scheme, incorporating a novel top n algorithm with integrating the classification results from various candidate regions to improve the ingredient recognition accuracy. The single-ingredient image dataset, designed in accordance with the “New Food Ingredients List FOODS 2021”, encompasses 9,982 images across 110 diverse categories, emphasizing variety in ingredient shapes. In addition, a multi-ingredient image dataset is developed to rigorously evaluate the performance of our approach. Experimental results validate the effectiveness and efficiency of our method, particularly highlighting its competitive capability in recognizing multiple ingredients to SOTA methods. Furthermore, it is found that the CNN-based pruned model enhances the ingredient segmentation accuracy of food images. This marks a significant advancement in the field of food image analysis.
Docosahexaenoic acid (DHA); a driving force regulating gene expression in bluefin tuna (Thunnus thynnus) larvae development
Authors: Koven William , Yanowski Eran , Gardner Luke , Nixon Oriya , Block Barbara
Published: April 2024

This study elucidated the role of DHA-modulated genes in the development and growth of Atlantic bluefin tuna (Thunnus thynnus) larvae ingesting increasing levels of DHA in their rotifer prey. The effect of feeding low, medium, and high rotifer (Brachionus rotundiformis) DHA levels (2.0, 3.6 and 10.9 mg DHA g− 1 DW, respectively) was tested on 2–15 days post hatching (dph) bluefin tuna larvae. Larval DHA content markedly (P < 0.05) increased in a DHA dose-dependent manner (1.5, 3.9, 6.1 mg DHA g− 1 DW larva, respectively), that was positively correlated with larval prey consumption, and growth (P < 0.05). Gene ontology enrichment analyses of DEGs demonstrated dietary DHA significantly (P < 0.05) affected different genes and biological processes at different developmental ages. The number of DHA up-regulated DEGs was highest in 10 dph larvae (408), compared to 5 (11) and 15 dph fish (34), and were mainly involved in neural and synaptic development in the brain and spinal cord. In contrast, DHA in older 15 dph larvae elicited fewer DEGs but played critical roles over a wider range of developing organs. The emerging picture underscores the importance of DHA-modulated gene expression as a driving force in bluefin tuna larval development and growth.
How does the prevalence of alcohol use and associations with psychological distress differ across ethnic groups in England: A cross-sectional analysis of eight national surveys
Authors: Puddephatt Jo-Anne , Onwumere Juliana , Gage Suzanne H. , Coomber Ross , Das-Munshi Jayati , Goodwin Laura
Published: April 2024

Purpose Differences in patterns of alcohol and mental health across ethnic groups are not well-understood. Using multiple secondary datasets and across ethnic groups, this study aimed to examine the prevalence and associations of i)alcohol use and binge-drinking, ii)alcohol use and binge-drinking with psychological distress, and iii)pooled prevalence and associations for i)and ii)across multiple data sources. Methods A secondary analysis of eight representative surveys in England was conducted (N = 112,831). Alcohol was assessed using validated measures and categorised as i)non-,ii)low-risk,iii)increased-risk, and iv)binge-drinker. Psychological distress was assessed using validated measures. Ethnicity was categorised using the most specific categories available. Multinomial and logistic regression models were conducted to address aims one and two. A meta-analysis was conducted to address aim three. Results Minority ethnic groups were more likely to be non-drinkers, and less likely to be increased-risk or binge-drinkers, compared to White British groups. Among those experiencing psychological distress, White British groups were more likely to be a non-drinker (OR = 1.46,95%CI = 1.34–1.59), Indian groups were more likely to be an increased-risk drinker (OR = 1.43,95%CI = 1.05–1.96), Black African and White British groups were more likely to be binge-drinkers (OR = 1.98,95%CI = 1.00-3.92;OR = 1.14, 95%CI = 1.08–1.20), compared to those of the same ethnicity but without psychological distress. Conclusion There were differences in the level of alcohol use between specific ethnic groups despite minority ethnic groups often being combined. Ethnic groups with the overall highest levels of drinking did not have the higher odds of increased-risk drinking when individuals experienced psychological distress. There is a need to better understand the reasons for drinking among minority ethnic groups experiencing psychological distress.
Cohort multiple Randomized Controlled trial in pediatric asthma to assess the long- and short-term effects of eHealth interventions: protocol of the CIRCUS study
Authors: Ruuls Tamara , Sprengers Romi , Hengeveld Vera , Thio Boony , Tabak Monique , Zagers Deborah , Palen Job van der , Kamp Mattiènne van der
Published: April 2024

Background
Asthma is one of childhood's most prevalent chronic conditions that significantly impact the quality of life. Current asthma management lacks real-time, objective, and longitudinal monitoring reflected by a high prevalence of uncontrolled asthma (46–60%). Long-term (home) monitoring holds promise to establish new clinical endpoints for timely anticipation. Also, the integration of eHealth interventions holds promise for timely and appropriate medical anticipation for controlling symptoms and preventing asthma exacerbations. This study aims to provide a pragmatic study design for gaining insight into longitudinal monitoring, assessing, and comparing eHealth interventions' short- and long-term effects on improving pediatric asthma care.
Methods
For this cohort multiple randomized controlled trial (cmRCT), we establish a dynamic cohort of 300 pediatric asthma patients at Medisch Spectrum Twente (Enschede, the Netherlands), referred to as the CIRCUS cohort. The CIRCUS study gathers observational and patient-reported measurements at set moments, including patient characteristics, asthma outcomes, clinical outcomes, healthcare utilization, and environmental outcomes. We randomly appoint eligible participants to the intervention or control group. The effects of the eHealth interventions are assessed and compared to the control group, deploying the CIRCUS outcomes. The participants continue in the CIRCUS cohort after completing the intervention and its follow-up. This process repeats for every intervention, allowing re-approaching participants.
Discussion
The CIRCUS study results can provide a rich and unique data set that can improve insight into risk factors of asthma exacerbations and yield new clinical endpoints. Furthermore, the effects of eHealth interventions can be assessed and compared with each other in both the short- and long-term. Additionally, patient groups within the patient population can be discerned which can be used to tailor eHealth interventions to the personalized needs to improve asthma management. In conclusion, CIRCUS can provide valuable clinical data to discern risk factors for asthma exacerbations, identify and compare effective scalable eHealth solutions, and improve pediatric asthma care.
Trial Registration
This study was ethically approved by the Medical Research Ethics Committee (NL85668.100.23) on February 15th, 2024. The study protocol is registered at ClinicalTrials.gov (NCT06278662).
Infectious intestinal diseases increase neurodegenerative disease risk: A nationwide population-based cohort study
Authors: Hsu Fang-Chin , Weng Zi-Xeng , Pu Ta-Wei , Jao Shu-Wen , Chen Chao-Yang , Hu Je-Ming , Chien Wu-Chien
Published: April 2024

Infectious intestinal diseases (IIDs) pose a significant health and economic burden worldwide. Recent observations at the Tri-Service General Hospital, Taiwan, suggest a potential association between IIDs and neurodegenerative diseases, prompting an investigation into this relationship. This study explored interactions between IIDs and neurodegenerative diseases. We conducted a population-based retrospective cohort analysis using data from the National Health Insurance Research Database (NHIRD) of Taiwan. Patients diagnosed with IIDs between 2000 and 2015 were identified along with a matched control group. Covariates, including demographics, comorbidities, and healthcare utilization were considered. The hazard ratios (HRs) of neurodegenerative diseases were assessed using a Cox proportional regression analysis. This study included 297,438 patients: 99,146 and 198,292 patients in the IID and control groups, respectively. Patients with IIDs showed a significantly higher overall risk of neurodegenerative diseases (adjusted hazard ratio [aHR] = 1.144, P < 0.001). Subgroup analyses revealed an elevated risk of Parkinson's disease, multiple sclerosis, and other neurodegeneration-associated disorders in the IID group. Additionally, a positive correlation was observed between the frequency of medical visits for IIDs and neurodegenerative disease risk. This study provides evidence for a significant association between IIDs and the neurodegenerative disease risk. Early detection and management of IIDs may have implications for long-term neurological health outcomes. Further research is required to elucidate underlying mechanisms and develop targeted interventions and preventive strategies.
Bone marrow involvement in solid tumors - a retrospective observational study
Authors: ZHANG BICHENG , JIN LAN , WU DANG , XU JING , GUO SIYU , LI JINGJING , WEI QICHUN , ZHANG TING
Published: April 2024

Background
Solid tumor patients with bone marrow involvement (BMI) typically have a poor prognosis. However, some patients still exhibit a relatively good prognosis following aggressive treatment. This study aimed to identify prognostic factors to stratify patients and screen those who may benefit from aggressive treatment.
Methods
A total of 41 consecutive patients diagnosed with a bone marrow biopsy were enrolled between January 1, 2016, and December 31, 2021. Then, their clinical features and laboratory data were assessed using the Chi-square test. Overall survival (OS) rates were plotted over time using the Kaplan-Meier method. Lastly, the survival time of solid tumor patients with BMI with distinct clinical symptoms, peripheral hematologic profiles, biochemical profiles, and coagulation function were analyzed using the Kaplan-Meier method.
Results
The median OS of the whole cohort was 23 days. Specifically, the median OS of patients (n = 40) receiving anti-tumor treatment (n = 12) and supportive care (n = 28) was 158 days and 13 days, respectively ( P < 0.001 ). Interestingly, the prognosis of patients with BMI and normal leukocyte count, platelet count, glutamic-pyruvic transaminase (GPT) level, and plasma prothrombin time (PT), as well as lactate dehydrogenase (LDH) level less than twice the normal upper limit and alkaline phosphatase (AKP) less than five times the normal upper limit, was relatively favorable. Conversely, elevated levels of LDH, AKP, GPT, prolonged PT, abnormal leukocyte count, and thrombocytopenia were associated with a poor prognosis.
Conclusions
Solid tumor patients with BMI can benefit from aggressive anti-tumor treatments. Additionally, early diagnosis of BMI in solid tumor patients, selection of patients with a potential good prognosis, and administering appropriate anti-tumor treatments are key factors in prolonging the survival time of BMI patients.
Influence of the Indian Ocean Dipole (IOD) on Hydro-climate variability in Dwangwa River Basin, Malawi
Authors: Chirwa Aubren C. , Ngongondo Cosmo , Vunain Ephraim
Published: April 2024

Large-scale climate processes such as the Indian Ocean Dipole (IOD) have significant roles in modulating rainfall and hydrological systems. Understanding such processes can inform adaptation measures for climate change and variability, as well as water resource management and planning. This study investigated the impact of IOD on rainfall and discharge variability in the Dwangwa River Basin (DRB) in Malawi, a key inflow to Lake Malawi. Specifically, the study analysed annual rainfall variability trends from 1985 to 2015 using the Coefficient of Variation (CV) and the annual Precipitation Concentration Index (PCI). The significance and direction of rainfall and discharge trends were quantified using the Mann-Kendall trend test at the α = 0.05 significance level. To evaluate the association between rainfall and IOD, the Pearson product moment used three IOD phases: positive, negative, and neutral. Simple linear regression was utilised to check the response of the river during the concerned IOD phases. The study found CVs below 30%, typical of climates with moderate monthly rainfall variability. The PCI ranged from 20–30%, suggesting a strongly seasonal and highly variable temporal intra-annual rainfall distribution in the DRB. Moreover, the Mann-Kendall test statistics showed insignificant annual rainfall trends. Further, the findings demonstrated an insignificant negative correlation between rainfall and positive IOD, with rainfall increases associated with negative IOD, whereas positive IOD is associated with decreased river discharge. Consequently, El Niño and a positive IOD could cause DRB to have low water availability.
1D Poiseuille Plane Channel Flow by Second Order Response Matrix
Authors: Ganapol Barry D.
Published: April 2024

With increasing miniaturization of diagnostic devices for more effective detection of blood-borne pathogens for example, Poiseuille molecular flow in micro channels has become increasingly relevant. Since continuum mechanics no longer applies for Poiseuille flow when the Knudson number is near or larger than unity, kinetic theory is required to capture the microscopic molecular scattering responsible for channel molecular flow and the velocity profile across a channel. Here, we apply a response matrix solution to the 1D Poiseuille flow with a BGK approximation featuring simplicity with precision by following a consistent numerical formulation leading to high precision, 8-place benchmarks.
Mathematics Subject Classification. 34K10, 34A05, 34A30, 82C40, 82C70, 86–08.
Deciphering seasonal depression variations and interplays between weather changes, physical activity, and depression severity in real-world settings: Learnings from RADAR-MDD longitudinal mobile health study
Authors: Zhang Yuezhou , Folarin Amos A. , Ranjan Yatharth , Cummins Nicholas , Rashid Zulqarnain , Conde Pauline , Stewart Callum , Sun Shaoxiong , Vairavan Srinivasan , Matcham Faith , Oetzmann Carolin , Siddi Sara , Lamers Femke , Simblett Sara , Wykes Til , Mohr David C. , Haro Josep Maria , Penninx Brenda W.J.H. , Narayan Vaibhav A. , Hotopf Matthew , Dobson Richard J.B. , Pratap Abhishek , consortium RADAR-CNS
Published: April 2024

Prior research has shown that changes in seasons and weather can have a significant impact on depression severity. However, findings are inconsistent across populations, and the interplay between weather, behavior, and depression has not been fully quantified. This study analyzed real-world data from 428 participants (a subset; 68.7% of the cohort) in the RADAR-MDD longitudinal mobile health study to investigate seasonal variations in depression (measured through a remote validated assessment - PHQ-8) and examine the potential interplay between dynamic weather changes, physical activity (monitored via wearables), and depression severity. The clustering of PHQ-8 scores identified four distinct seasonal variations in depression severity: one stable trend and three varying patterns where depression peaks in different seasons. Among these patterns, participants within the stable trend had the oldest average age (p = 0.002) and the lowest baseline PHQ-8 score (p = 0.003). Mediation analysis assessing the indirect effect of weather on physical activity and depression showed significant differences among participants with different affective responses to weather. Specifically, the temperature and day length significantly influenced depression severity, which in turn impacted physical activity levels (p < 0.001). For instance, among participants with a negative correlation between depression severity and temperature, a 10°C increase led to a total daily step count rise of 655.4, comprised of 461.7 steps directly due to the temperature itself and 193.7 steps because of decreased depressive severity (1.9 decrease in PHQ-8). In contrast, for those with a positive correlation, a 10°C rise directly led to a 262.3-step rise; however, it was offset by a 141.3-step decrease due to increased depression severity (2.1 increase in PHQ-8) from higher temperatures, culminating in an insignificant overall increase of 121 steps. These findings illustrate the heterogeneity in individuals' seasonal depression variations and responses to weather, underscoring the necessity for personalized approaches to help understand the impact of environmental factors on the real-world effectiveness of behavioral treatments.
A monocenter study on pediatric Alport syndrome featuring nephrotic syndrome as the primary manifestation
Authors: Qian Pei
Published: April 2024

Background: Alport Syndrome (AS) is a genetic kidney disorder characterized by progressive kidney failure. It is often misdiagnosed as other kidney diseases due to its clinical phenotypic heterogeneity and the lack of specific clinical symptoms in early childhood.
Methods: This study retrospectively analyzed clinical data of 7 pediatric patients admitted to Xi'an Children's Hospital between 2016 and 2022 due to clinical manifestations of nephrotic syndrome.
Results: The 7 patients were from six families, and 4 patients had a family history of kidney disease. The median(IQR) age at presentation was 9.8 (7.8, 10.8) years and median follow-up was 4.4 (2.4–8.0) years.They all had hematuria, nephrotic proteinuria and hypoproteinemia. Kidney biopsy revealed focal segmental glomerulosclerosis (FSGS) on light microscopy. Among the patients, 8 pathogenic gene mutations were detected, 6 patients had mutations in the COL4A5gene. Furthermore, the mutations in 6 patients (85.7%) were severe.Treatment involved administering renin-angiotensin-aldosterone system (RAAS) inhibitors to all the patients starting from their first visit. Up to the present follow-up time, all the 7 patients exhibited varying degrees of reduction in proteinuria, with 1 of them experiencing kidney function decline, and 1 progressing to end-stage kidney disease (ESKD).
Conclusion: AS should be considered in patients co-exhibiting nephrotic syndrome and hematuria, especially those with a poor response to steroid therapy or with a family history of hematuria. Additionally, AS should be considered in the genetic diagnosis of patients with kidney pathology consistent with FSGS. The most common pathogenic gene in AS patients with nephrotic syndrome is the COL4A5 gene, and most of them have severe mutations.
A Genome-wide association study of panicle blast resistance (PBR) to Magnaporthe Oryzae in Rice
Authors: Jinlong Hu , Yu Zhang , Ruizhi Wang , Xiaoyu Wang , Zhiming Feng , Qiangqiang Xiong , Nianbing Zhou , Yong Zhou , Haiyan Wei , Hongcheng Zhang , Zhu Jinyan
Published: April 2024

Rice blast, caused by Magnaporthe Oryzae (M. oryzae), is one of the most serious diseases all over the world. Development of blast-resistant rice varieties can effectively control the damage of rice blast and reduce the application of chemical pesticides. In this study, 477 sequenced rice germplasms from 48 countries were inoculated and identified at booting stage. We found that 23 germplasms displayed high panicle blast resistance against M. oryzae. 43 quantitative trait loci (QTLs) significantly (P < 10− 4) associated with rice panicle blast resistance were identified by genome-wide association analysis (GWAS). These QTL intervals contain four genes (OsAKT1, OsRACK1A, Bsr-k1 and Pi25/Pid3) have been reported to be involved in rice blast resistance. We select QTLs with -Log10(Pvalue) higher than 6.0 or those detected in two-year replicates, totaling 12 QTLs, for candidate gene analysis. We identified three blast resistance candidate genes (Os06g0316800, Os06g0320000, Pi25/Pid3) based on the significant SNP distribution of annotated gene sequences in these 12 QTL and the difference of expression levels among blast resistant varieties after 72h inoculation. Os06g0316800 encodes a protein similar to Glycine-rich protein, an important component of plant cell walls involved in cellular stress responses and signaling, named as OsGrp6. Os06g0320000 encodes a protein of unknown function DUF953, belonging to the thioredoxin-like family, crucial for maintaining reactive oxygen species (ROS) homeostasis in vivo, named as OsTrxl1. Lastly, Pi25/Pid3 encodes a disease resistance protein, emphasizing its potential significance in plant biology. By analyzing the haplotypes of these 3 genes, we identified the favorable haplotypes with blast resistance, which will provide genetic resources for future rice blast resistance breeding.
MMIF: Multimodal medical image fusion network based on multi-scale mixed attention
Authors: Liu Jianjun , Wang Xiaohui , Sun Xiaoting , Li Yang
Published: April 2024

Multimodal image fusion plays an important role in image analysis and applications. Multimodal medical image fusion helps to combine contrast features from two or more input imaging modalities to represent fused information in a single image. One of the critical clinical applications of medical image fusion is to fuse anatomical and functional modalities for rapid diagnosis of malignant tissues. This paper proposes a multimodal medical image fusion network (MMIF-Net) based on multiscale mixed attention. The method first decomposes the original image to obtain the low-rank and significant parts. Then, to utilize the features at different scales, we add a multiscale mechanism that uses three filters of different sizes to extract the features in the encoded network. Also, a hybrid attention module is introduced to obtain more image details. Finally, the fused images are reconstructed by decoding the network. We conducted experiments with clinical images from brain computed tomography/magnetic resonance/. The experimental results show that the multimodal medical image fusion network method based on multiscale hybrid attention works better than other advanced fusion methods.
“Luck of the draw really”: A qualitative exploration of trainee doctors’ experiences of mandatory research in Australia and New Zealand
Authors: Brandenburg Caitlin , Hilder Joanne , Noble Christy , Liang Rhea , Forrest Kirsty , Joshi Hitesh , Keijzers Gerben , Mickan Sharon , Pearson David , Scott Ian A. , Veysey Emma , Stehlik Paulina
Published: April 2024

BackgroundMany medical trainees are required to complete a scholarly project to fulfil research curricula and achieve specialist status. The usefulness of this requirement has been the subject of debate. The aim of this study was to gain an in-depth understanding of trainees’ experiences and satisfaction of conducting mandatory scholarly projects in Australia and New Zealand.MethodsA qualitative descriptive approach was used. Semi-structured interviews with trainees were undertaken between May 2021 and June 2022. Australian and New Zealand medical trainees who had completed a scholarly project as part of specialty training within the past five years were invited to participate. The purposive sample was drawn from participants in a survey on the same topic who had indicated interest in participating in an interview. Interviews explored trainees’ overall experience of and satisfaction with conducting scholarly projects, as well as their perceptions of research training, support, barriers, enablers, and perceived benefits. Interviews were transcribed verbatim and thematically analysed.ResultsSixteen medical doctors from seven medical colleges were interviewed. Trainee experience and satisfaction was highly variable between participants and was shaped by four factors: 1) trainees entered their specialty training with their own perspectives on the value and purpose of the scholarly project, informed by their previous experiences with research and perceived importance of research in their planned career path; 2) in conducting the project, enablers including protected time, supervisor support and institutional structures, were vital to shaping their experience; 3) trainees’ access to these enablers was variable, mediated by a combination of luck, and the trainees’ own drive and research skill; and 4) project outcomes, in terms of scholarly success, learning, career benefits and impacts on patient care.ConclusionsTrainee experiences were mixed, with positive experiences often attributed to chance rather than an intentionally structured learning experience. We believe alternatives to mandatory trainee research projects must be explored, including recognising other forms of research learning activities, and directing scarce resources to supporting the few trainees who plan to pursue clinician researcher careers.
Hydrodissection and Femtosecond Laser Assisted Surgery in Posterior Polar Cataract
Authors: Assia Ehud I. , Nemet Arie Y.
Published: April 2024

Purpose:
To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract
Methods:
Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of PPC, were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery (FLACS). In all cases careful hydrodissection was done to separate the lens material from the posterior capsule.
Results:
There were 3 men and 3 females, ages 39–73 years (average 52.5years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes.
Conclusions:
Hydrodissection can be safely performed in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.
Melatonin alleviates palmitic acid–induced mitochondrial dysfunction by decreasing oxidative stress and enhancing autophagy combined in bovine endometrial epithelial cells
Authors: Wang Yi , Zhu Huabin , Zhao Shanjiang , Gong Jianfei , Heng Nuo , Hu Yingfan , Wang Rui , Wang Huan , He Wei , Zhu Ni , Hu Zhihui , Hao Haisheng
Published: April 2024

Background: Negative energy balance (NEB) typically occurs in dairy cows after delivery, with those in high yielding being more likely to experience significant NEB. Such metabolic imbalance could cause ketosis, which is often accompanied by a decline in reproductive performance, but the molecular mechanism has not been fully elucidated. During excessive NEB, the body fat is extensively broken down, resulting in abnormal accumulation of non-esterified fatty acids (NEFA), represented by palmitic acid (PA), within the uterus. Such an abnormal accumulation has the potential to damage bovine endometrial epithelial cells (BEECs), while the molecular mechanisms underlying its involvement in the PA-induced injury of BEECs is poorly understood. Melatonin (MT) is recognized for its regulatory role in maintaining the homeostasis of mitochondrial reactive oxygen species (mitoROS). However, less is known about whether MT could ameliorate the damage of PA on BEECs and its molecular mechanism.
Results: Our results demonstrated that 0.2 mM PA stress increased the level of cellular and mitochondrial oxidative stress. Further, we observed mitochondrial dysfunction, including an abnormal incidence of mitochondrial structure and respiratory function, reduction in mitochondrial membrane potential and mitochondrial copy number, which in turn induced apoptosis. Notably, we also found an upregulation of autophagy protein (PINK, Parkin, LC3B et al), however, the P62 protein was also increased. As we expected, 100uM MT pre-treatment attenuated PA-induced mitochondrial ROS and restored mitochondrial respiratory function. Meanwhile, pre-treated MT reversed the upregulation of P62 induced by PA and activate the AMPK-mTOR-Beclin-1 pathway, contributing to increase of autophagy and decline apoptosis.
Conclusions: These findings indicate that PA could induce mitochondrial dysfunction and also enhance autophagy in BEECs. In addition, MT is hypothesized to not only reduce mitochondrial oxidative stress but also facilitate the clearance of damaged mitochondria through the regulation of autophagy pathways, thereby safeguarding the mitochondrial pool and promoting cellular viability. Our study helps better understand the molecular mechanism involved in excessive NEB's impact on the fertility outcomes of high yielding dairy cows.