bluuebunny/crossref_metadata_2025 huggingface dataset:
A Phase I/II clinical trial of ex-vivo expanded human bone marrow derived allogeneic mesenchymal stromal cells in adult patients with perianal fistulizing Crohn’s Disease
Authors: Swaroop Shekhar , Vuyyuru Sudheer Kumar , Kante Bhaskar , Kumar Peeyush , Mundhra Sandeep Kumar , Arora Umang , Goyal Ankur , Kandasamy Devasenathipathy , Sharma Raju , Kabilan Kavirajan , Kedia Saurabh , Dash Nihar Ranjan , Ahuja V
Published: November 2023

Background
Perianal fistulas affect one-third patients with Crohn’s disease with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells in this population.
Methods
An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn’s disease refractory to standard therapies. Clinical severity and biomarkers were assessed at baseline and periodically till 104 weeks, and MRI at 24 and 104 weeks. Primary and secondary objectives were to assess safety and efficacy respectively. Fistula remission was complete closure of fistula openings with < 2cm perianal collection on MRI, and fistula response was decrease in drainage by ≥ 50%. Change in perianal disease activity index, quality-of-life and Van Assche index on MRI over time was assessed using mixed-effect linear regression model.
Results
Ten patients (male:8, mean age:27.4 ± 12.0years) were recruited. Self-resolving procedure-related adverse events occurred in three patients, with no follow-up adverse events. In intention to treat analysis at week 24, two patients (20%) achieved fistula remission and seven (70%) had fistula response. At week 52, two (20%) patients were in remission and seven (70%) maintained response. At 104 weeks, two (20%) patients maintained response and one (10%) was in remission. Statistically significant decrease in perianal disease activity index(P = 0.008), Van Assche Index(P = 0.008) and improvement in quality-of-life(P = 0.001) were observed over time.
Conclusions
Allogeneic BMSCs are safe and effective for the treatment of PF in CD with significant improvement in clinical severity and radiological healing.
Trial registration
The study was prospectively registered on Clinical trials registry – India (CTRI), CTRI/2020/01/022743 on 14 January 2020, http://ctri.nic.in
Early Warning Systems Achieve Their Goals When Data is Tied to an Intervention
Authors: Clausen Robin
Published: November 2023

Early Warning Systems (EWS) are research-based analytics that use statistical models to assess dropout risk. School leaders use this analytic to consolidate data about a student and provide actionable data to craft an intervention. Little is currently known about the processes involved in school implementation. This is important as it guides use of the tool, especially for those schools using data from Statewide Longitudinal Data Systems. Our study analyzes the Montana EWS data for the past ten years to see if data is used in interventions whose outcomes demonstrate a linkage back to the data. This study distinguishes between schools - high, low, and non-adopters based on an opt-in model. High adopters implement the model based on shared vision, value, and communication practices. There are questions whether low adopters engaged the data and if they offer their students dropout prevention services. Non adopters have many core traits (student outcome and institutional) indicating that there is less of a demand in these school communities. The scale of the program is determined by whether schools opt-in and set priorities for dropout prevention. High adopters share many indicators of disadvantage as low adopters. The difference is that certain school level factors (e.g., long teacher tenure) enabled high adopters to prioritize dropout prevention and integrate data in the process.
Developmental atlanto-stenosis with Klippel-Feil syndrome showing "snake eye sign" on MRI：Case report and reflection Abstract
Authors: liu yan , LI NIANHU
Published: November 2023

A patient with "snake eye" developmental atlanteal stenosis complicated with Klippel-Feil syndrome and cervical spinal cord injury was admitted to our hospital in March 2022. X-ray, CT and MRI examinations were performed. It was found that the patient had atlanto-spinal stenosis, C2-C6 fusion deformity, cervical instability, thoracolumbar disc herniation, and L5-S1 fusion deformity combined with cervical spinal cord signal changes. The patient underwent posterior cervical resection of posterior atlas arch for decompression of vertebral canal + C6/7 total laminectomy for decompression of vertebral canal and posterior lateral bone grafting with C5-T1 nail rod system for internal fixation, which resulted in poor functional recovery. Summarize and reflect on its treatment ideas, and further deepen the understanding of this kind of disease.
The hidden dimension of information diffusion: A latent space representation of Social Media News Sharing behavior
Authors: Pozo Sofía M. del , Pinto Sebastián , Serafino Matteo , Cicchini Tomás , Moss Federico , Makse Hernán A. , Balenzuela Pablo
Published: November 2023

In times marked by an abundance of news sources and the widespread use of social media for staying informed, acquiring accurate data faces increasing challenges. Today, access to information plays a crucial role in shaping public opinion and is significantly influenced by interactions on social media. Therefore, studying the dissemination of news on these platforms is vital for understanding how individuals stay informed. In this paper, we study emergent properties of media outlet sharing behavior by users in social media. We quantify this behavior in terms of coordinates in a latent space proposing a metric called Media Sharing Index (MSI). We observe that the MSI shows a bimodal distribution in this latent dimension, reflecting the preference of large groups of users for specific groups of media outlets. This methodology allows the study of the extent to which communities of interacting users are permeable to different sources of information. Additionally, it facilitates the analysis of the relationship between users' media outlet preferences, their political leanings, and the political leanings of the media outlets.
The role of single-dose prophylactic methotrexate in the prevention of post-molar gestational trophoblastic neoplasia in patients with high-risk molar pregnancy
Authors: Akhavan Setare , Hoorshad Niloufar , Mousavi Azam sadat , Sheikhhasani Shahrzad , Rezayof Elahe , Zamani Narges
Published: November 2023

Introduction: Prophylactic chemotherapy (PC) has been suggested to be effective in prevention of post molar gestational trophoblastic neoplasia (PGTN) in patients with high-risk molar pregnancies. The goal of this study is to assess the efficacy of single dose methotrexate as PC in terms of spontaneous remission, time to remission, and progression to PGTN.
Materials and methods: Patients with molar pregnancy were recruited to the study and underwent cervical dilation and suction curettage. Patients who had pathologically proven complete hydatidiform mole were evaluated with abdominal ultrasonography to confirm complete evacuation and absence of remnants. These patients were allocated to two groups: group one received Methotrexate 50mg/m2 via intramuscular injection, while group two did not. PGTN was defined according to the 2018 FIGO criteria. For patients with confirmed PGTN, the following variables were recorded: occurrence of metastasis, resistance to first-line chemotherapy and time to βHCG level normalization.
Results: Eighty patients were enrolled to the study, of which 22 cases (27.5%) received PC. It was found that PC with MTX did not significantly influence spontaneous remission (18 (81.8%) Vs 37 (63.7%), p value: 0.12) or time to remission (57 ± 22.5 Vs 61.24 ± 21.78 days, p value: 0.46) in high-risk molar pregnancies. Moreover, among patients in PC group and control group, 4 cases (18.2%) and 21 patients (36.3%) progressed to PGNT, respectively (p value: 0.12). Although patients in PC group tended to be diagnosed in lower stages compared to patients in control group, this difference was insignificance (p value: 0.95). Among patients who developed to PGTN, PC did not reduce the frequency of metastatic disease, resistance to first-line chemotherapy, or the time interval to serum βHCG level normalization (all p values > 0.05).
Conclusion: This study suggests that a single-dose MTX as PC may not be an effective therapeutic option for preventing PGTN in patients with high-risk molar pregnancy.
Five-year outcomes in patients with multivessel coronary artery disease undergoing surgery or percutaneous intervention.
Authors: Jonik Szymon , Kageyama Shigetaka , Ninomiya Kai , Onuma Yoshinobu , Kochman Janusz , Grabowski Marcin , Serruys Patrick , Mazurek Tomasz
Published: November 2023

The outcomes from real-life clinical studies regarding the optimal revascularization strategy in patients with multivessel coronary artery disease (MVD) are still poorly investigated. In this retrospective study we assessed 5-year outcomes: primary, secondary endpoints and quality of life of 1035 individuals with severe coronary artery disease (CAD) treated either with coronary artery bypass grafting (CABG) – 356 patients or percutaneous coronary intervention (PCI) – 679 patients according to the recommendation of a local Heart Team (HT). At 5 years no significant difference in overall mortality and rates of myocardial infarctions (MI) were observed between CABG and PCI cohorts (11.0% vs. 13.4% for PCI, P=0.27 and 9.6% vs. 12.8% for PCI, P=0.12, respectively). The incidence of major adverse cardiac and cerebrovascular events (MACCE), mainly driven by increased rates of repeat revascularization (RR) were higher in PCI-cohort than in CABG-group (56.1% vs. 40.4%, P<0.01 and 26.8% vs. 12.6%, P<0.01, respectively), while CABG-patients experienced stroke more often (7.3% vs. 3.1% for PCI, P<0.01). In real-life practice with long-term follow-up, none of the two revascularization modalities implemented following HT decisions showed overwhelming superiority: occurrence of death and MI were similar, rates of RR favoured CABG, while incidence of strokes advocated PCI.
Accumulation of Airborne Microplastics on Forest Canopy Leaves: Insights from Trichomes and Epicuticular Waxes
Authors: Natsu Sunaga , Okochi Hiroshi , Niida Yasuhiro , Miyazaki Akane
Published: November 2023

Airborne microplastics (AMPs) on konara oak (Quercus serrata Murray) leaves collected at a small forest in the Tokyo metropolitan area were analyzed. The leaves underwent a three-step treatment process: (i) washing with Milli-Q water, (ii) sonication in Milli-Q water, and (iii) extraction with a 10% KOH solution. The average number of AMPs found in solutions (i), (ii), and (iii) were 0.01, 0.05, and 0.07 microplastics (MP) /cm2 leaf, respectively. More than 50% of the total AMPs recovered from the aqueous samples were detected in the KOH solution. Scanning electron microscopy (SEM) observation revealed that the KOH solution significantly altered the leaf surfaces, while rinsing and ultrasonication with Milli-Q water had little effect. These results emphasize the strong adsorption of AMPs to epidermal waxes and the importance of using KOH solutions in addition to conventional water washing methods to prevent underestimation of AMPs intercepted by forest canopy leaves. Using data from the growing season, it was estimated that a small forest in the metropolitan area captures approximately 2.2 billion AMP particles per year. This indicates that forests may play an important role as sinks for AMPs in the terrestrial environment.
Orthopnea Secondary to Brachial Plexitis with Bilateral Diaphragmatic Paralysis
Authors: Labban Mohamad El , Bauer Philippe R.
Published: November 2023

Background: Diaphragmatic paralysis can present with orthopnea. We report a unique presentation of bilateral diaphragmatic paralysis, an uncommon diagnosis secondary to an unusual cause, brachial plexitis. This report thoroughly describes the patient’s presentation, workup, management, and outcome. It also reviews the literature on diaphragmatic paralysis and Parsonage-Turner syndrome.
Case presentation: A 50-year-old male patient developed insidious orthopnea associated with left shoulder and neck pain over three months with no associated symptoms. On examination, marked dyspnea was observed when the patient was asked to lie down; breath sounds were present and symmetrical, and the neurological examination was normal. The chest radiograph showed an elevated right hemidiaphragm. Echocardiogram was normal. There was a 63% positional reduction in Forced Vital Capacity and maximal inspiratory and expiratory pressures on pulmonary function testing. The electromyogram was consistent with neuromuscular weakness involving both brachial plexus and diaphragmatic muscle (Parsonage and Turner syndrome).
Conclusions: Compared to unilateral, bilateral diaphragmatic paralysis may be more challenging to diagnose. On PFT, reduced maximal respiratory pressures, especially the maximal inspiratory pressure, are suggestive. Parsonage-Turner syndrome is rare, usually with unilateral diaphragmatic paralysis, but bilateral cases have been reported.
Handwritten Character Recognition Using Convolutional Neural Network for Asante Twi Language Alphabets
Authors: Drah Kingsley , Osei Eric Opoku , Okoampah Ernerst , Sey Robert
Published: November 2023

The Handwritten Character Recognition (HWCR) system is a tool that recognizes handwritten characters in papers, photographs, and other sources and converts them into editable computer characters for future use. A significant barrier still exists in the accurate recognition of complex formed compound handwritten characters. By learning discriminatory qualities from vast volumes of raw data, convolutional neural network (CNN) technology has recently made significant advancements in HWCR systems. In identification of the Vernacular (Twi) language characters from off-line training and testing datasets, convolutional neural network was applied in this study. The primary goal of this research is to examine the convolutional neural network's ability to identify Twi characters from the supplied image datasets and the identification accuracy after training and testing. In order to differentiate among characters, convolutional neural network evaluates their differences in styles, shapes and topographies. To determine the accuracy of handwritten characters, the convolutional neural network implementation is tested using the novel Twi language dataset. On the basis of the test findings, a dataset set of 13, 200 images from the Twi dataset achieved an accuracy of 88.15% during training and a test accuracy of 79.31%. This study aids in knowing the suitable architecture that can be fused into an optical character recognition device to recognize Asante Twi handwritten letters found in documents of this particular language and translate them into editable formats.
Research on the correlation between crustal deformation characteristics and impact geopressure in the Hegang mining area based on GNSS monitoring
Authors: Fu Xing , Liu Tianhao , Zhang Tuo , Zhang Hongwei , Ji Minglu , Chen Shiwei
Published: November 2023

The crustal deformation characteristics of the mining area are a reflection of the evolution of the overburden rock structure force and deformation of coal seam mining, Impact geopressure is a result of the overburden rock movement, which disrupts the stress balance of the coal rock body surrounding the quarry, leading to a dynamic disaster, and the crustal deformation characteristics are closely related to Impact geopressure.To gain a deeper understanding of the relationship between crustal deformation and impact ground pressure in the Hegang mining region. Using the available GNSS observation data from the study area, six new GNSS observation stations in the key areas of the mining region have been encrypted, a thorough analysis is conducted on both the regional microseismic events catalog and the mine earthquake events catalog, which are under the surveillance of seismic stations, and the regional crustal deformation overtime during the occurrence of larger energy events is studied quantitatively. The findings indicate a direct relationship between the frequency of energy occurrences in the mining region and the vertically aligned time series of the GNSS stations, as the vertical direction experiences a rapid decline, the magnitude increases and the greater the cumulative energy emitted by the subsequent energy occurrences. The findings of this research can serve as a point of reference for proactively alerting and averting microseismic energy incidents in the southern mining region of Hegang
Lethal Borna disease virus 1 (BoDV-1) infections of humans and animals – in-depth molecular epidemiology and phylogeography
Authors: Rubbenstroth Dennis , Ebinger Arnt , Santos Pauline , Pfaff Florian , Dürrwald Ralf , Kolodziejek Jolanta , Schlottau Kore , Ruf Viktoria , Liesche-Starnecker Friederike , Ensser Armin , Korn Klaus , Ulrich Reiner , Fürstenau Jenny , Matiasek Kaspar , Hansmann Florian , Seuberlich Torsten , Nobach Daniel , Müller Matthias , Neubauer-Juric Antonie , Suchowski Marcel , Bauswein Markus , Niller Hans-Helmut , Schmidt Barbara , Tappe Dennis , Cadar Daniel , Homeier-Bachmann Timo , Haring Viola , Pörtner Kirsten , Frank Christina , Mundhenk Lars , Hoffmann Bernd , Herms Jochen , Baumgärtner Wolfgang , Nowotny Norbert , Schlegel Jürgen , Ulrich Rainer G. , Beer Martin
Published: November 2023

Borna disease virus 1 (BoDV-1) is the causative agent of Borna disease, a progressive and mostly fatal neurologic disorder of domestic mammals and humans, resulting from spill-over infection from its natural reservoir host, the bicolored white-toothed shrew (Crocidura leucodon). The known BoDV-1 endemic area is remarkably restricted to parts of Germany, Austria, Switzerland and the Principality of Liechtenstein.
To gain comprehensive data on the occurrence of BoDV-1, we analysed diagnostic material from suspected fatal BoDV-1-induced encephalitis cases in domestic mammals and humans. BoDV-1 infection was confirmed by RT-qPCR in 207 of 231 domestic mammals (89.6%), 28 of 29 humans (96.6%) and seven shrews, mainly within the known endemic area. By reporting multiple unpublished cases, this study raises the number of published laboratory-confirmed human BoDV-1 infections to 46 and provides a first comprehensive summary.
Generation of 136 new complete or partial BoDV 1 genome sequences from animals and humans facilitated an in-depth phylogeographic analysis. Consistent with the low mobility of its reservoir host, BoDV-1 sequences showed a remarkable geographic association, with individual phylogenetic clades occupying distinct and barely overlapping dispersal areas. The closest genetic relatives of most human-derived BoDV-1 sequences were located at distances of less than 40 km from the patient’s residence, indicating that spill-over transmission from the natural reservoir usually occurs in the region of the patient´s residence.
In summary, the novel and extended phylogeographic data allow for the definition of risk areas for zoonotic BoDV-1 transmission and facilitate the assessment of geographical sources for individual infection events.
Comprehensive Assessment of Adolescent and Youth Friendly Sexual Reproductive Health Services in South Sudan.
Authors: Jolem Mwanje , Imunu Sunday
Published: November 2023

Introduction: Adolescent and Youth Friendly Sexual Reproductive Health and Rights (SRHR) services play a crucial role in addressing the unique health needs of young people. This study aimed to comprehensively assess the availability, perception, quality, and utilization of these services in South Sudan. Methods: The study employed a mixed-methods approach, combining both quantitative and qualitative data collection techniques to provide a comprehensive understanding of the current state of these services. The study utilized a purposive sampling strategy to select young people (aged 10–24 years) seeking SRH services at health facilities. The minimum sample size was calculated to be 294 individuals. Data collection methods included client interviews, focus group discussions, and a desk-based review of secondary data. Supervisors and research assistants were trained to ensure quality data collection, and ethical considerations were prioritized throughout the study. Findings: The study revealed several key findings, including demographic characteristics of the adolescents, factors influencing their utilization of youth-friendly health services, and their access to reproductive health services. The study also highlighted challenges faced by pregnant adolescents and the performance of health facilities in providing services to adolescents. Conclusion: The study's findings underscore the importance of addressing barriers such as limited access to education, lack of awareness and education on sexual and reproductive health, and challenges in accessing health services. The study also generated recommendations to improve adolescent youth-friendly health services, emphasizing the need for comprehensive strategies to promote the well-being of adolescents in South Sudan.
Thickening human milk: the effect of time, temperature, and thickener for infants with dysphagia
Authors: Brooks Laura , Clayton Haley , Gethers Casiel
Published: November 2023

Objective
The aim of this study was to investigate the effect of time, temperature, and thickening agents on expressed human milk thickened for infants with dysphagia. Thickening agents included oatmeal cereal, commercial thickeners (Gelmix, Purathick), pureed fruits, pureed vegetables, yogurt, and pudding.
Methods
The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was used to measure the thickness level across samples at various temperatures (40º, 70º, 98.6ºF) and times (0, 5, 10, and 20 minutes). Statistical analysis included one-way ANOVA with Tukey post-hoc test and multiple linear regression.
Results
Fruit purees mixtures, particularly banana, achieved the thickest mixture at all temperatures and maintained a similar thickness over time. Vegetable puree mixtures were minimally effective at thickening, i.e. between 0–1 ml on IDDSI flow test, with exception of squash at 40ºF only. Commercial thickeners (Gelmix and Purathick) mixtures continued to thicken over time. The yogurt mixture at 40ºF thickened initially and thinned slightly over time. The pudding mixture at 40ºF thickened immediately but quickly became a thin liquid. The oatmeal cereal mixtures thinned or thickened over time depending on the temperature of the human milk (cold thinned over time, warm thickened over time).
Conclusions
Time, temperature, and thickening agents have a significant impact on the thickness level when added to expressed human milk. Certain foods such as fruit purees, squash, yogurt, and ground oatmeal may effectively thickened human milk and maintained a similar thickness level over the course of 20 minutes, and could be considered for older infants with dysphagia if cleared by the medical team.
Skilled Lactation Support Using Telemedicine in the Neonatal Intensive Care Unit
Authors: Leong Melanie , Obaid Maria , Ramos Maria Fernandez , Eichenberger Regina , John Annamma , Krumholtz-Belkin Patricia , Roeder Tina , Parvez Boriana
Published: November 2023

NICU mothers face unique challenges in initiating and sustaining breastfeeding. Previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of breastfeeding outcomes before and after implementing telelactation. Pre-Telemedicine (PTM) mothers received in-person support by NICU lactation consultants, while Telemedicine (TM) mothers received solely telemedicine consults after maternal discharge. Exclusive breastmilk feeding at discharge increased in the TM group. Notably, babies in the TM cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge. This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.
Turbulent Growth: Business Dynamism and Aggregate Productivity
Authors: Massari Filippo
Published: November 2023

Turbulence is the process of endogenous reallocation of resources (e.g., jobs) across firmsdue to entry, exit, and churning (movements within the firm-size distribution). This paperformulates a model of turbulent endogenous growth built on the insight that the forces thatdrive aggregate productivity growth also drive turbulence because the two are manifestationsof a single underlying process: profit-driven competition for market share through innovation.When firms increase their technological knowledge, they gain market share by loweringtheir relative price, thus reducing the marginal value of further gains in market share. Thisleads to the emergence of diminishing returns in relative terms.Therefore, incentives to innovate decline in relative size, all else constant, generating churning endogenously as mean-reversion. This mechanism delivers a stationary, non-degenerate,and endogenous firm-size distribution dependent on R&D. Meanwhile, constant returns to thecumulative factor (technological knowledge) drive a trendless aggregate growth rate determined by R&D. Endogenous entry and exit entail selection effects that shape the characteristicsof the firm population, and generate a firm life cycle, affecting R&D, thus growth.
(JEL: E19, L11, O14, O31, O41)
Development of a Shared Digital Decision Aid for HPV Vaccination in French General Practice: A Pragmatic Study
Authors: Hagiu Dragos-Paul , Tron Arthur , Zuo Minghui , Ecollan Marie , Pinot Juliette , Rossignol Louise , Partouche Henri , Gilberg Serge , Bel Josselin Le , Gauchet Aurélie , Gagneux-Brunon Amandine , Michel Morgane , Mueller Judith E. , Thilly Nathalie , Bruel Sébastien
Published: November 2023

Background: Human papillomaviruses (HPV) are responsible for the most common sexually transmitted infection in the world and persistent infection of oncogenic types is associated with an increased risk of cancers. This infection could be prevented by vaccination. However, in a time of vaccine hesitancy, the decision to get vaccinated or to have a child vaccinated is the result of a complex process and decision aids are tools that may be of help in this context.
Objective: The aim of this article is to present the development of a shared decision aid for HPV vaccination in France, destined to be used during general practice consultations.
Methods: In order to develop the shared decision aid, we followed the steps recommended by the International Patient Decision Aids Standard (IPDAS), i.e. scoping and defining the objectives, assembling the steering group, designing (carrying out two focus groups and a narrative review of the literature) and testing in a alpha test phase (carrying out three focus groups and 11 individual interviews). The tool was co-constructed with adolescents, parents and general practitioners.
Results: We created an online shared decision aid which included the definition of HPV, epidemiological data, the mode of contamination, the different locations of the disease, the development of cancer, the importance of Pap smears, the effectiveness of the vaccination as well as the possible side effects. The various focus groups as well as individual interviews made it possible to determine the values ​​and expectations of patients and physicians thus improving the decision aid. This development also made it possible to confirm an existing need for this type of tool for both patients and physicians.
Conclusions: We have developed a shared decision aid that could help general practitioners communicate about HPV vaccination and get more patients vaccinated. The impact of its use during the consultation will be evaluated on criteria such as the resolution of the decision-making conflict and ultimately on the vaccination coverage, as part of the PrevHPV study.
Safety of Bubble Nasal Intermittent Positive Pressure Ventilation (NIPPV) versus Bubble Nasal Continuous Positive Airway Pressure (NCPAP) in preterm infants with respiratory distress
Authors: John Stephen , Garg Mehak , Muttineni Mounika , Brearley Ann , Rao Praveen , Bhandari Vineet , Slusher Tina , Murki Srinivas
Published: November 2023

Objective Nasal Intermittent Positive Pressure Ventilation (NIPPV) is an effective therapy for infants in respiratory distress. We here report the safety of a novel, low-cost, non-electric bubble NIPPV device in comparison with bubble NCPAP.Study Design: At Paramitha Children’s Hospital (Hyderabad, India), preterm (n = 60) neonates with moderate respiratory distress were pragmatically allocated to bubble NCPAP (5–8 cm H2O) or bubble NIPPV (Phigh 8–12 cm H2O/Plow 5–8 cm H2O) based on staff and equipment availability. Primary outcomes to assess safety included clinically relevant pneumothorax, nasal septal necrosis, or abdominal distention.Results One patient in each arm developed minor nasal septal injury (grade 3 on NCPAP, grade 2 on NIPPV); no patients in either arm developed a clinically significant pneumothorax or abdominal distention.Conclusion The similar rates of nasal septal injury, pneumothorax and abdominal distention suggest that bubble NIPPV has a similar safety profile as bubble NCPAP for preterm infants in respiratory distress.
Radiomics Models of Dynamic Contrast-Enhanced MRI for Evaluation of the Expression Levels of CD3+, CD4+ & CD8+ Tumor-Infiltrating Lymphocytes in Advanced Gastric Carcinoma
Authors: huang huizhen , Li Zhiheng , Wang Dandan , Yang Ye , Jin HongYan , Lu Zengxin
Published: November 2023

Objective
To explore the effectiveness of machine learning classifiers based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the expression levels of CD3+, CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in patients with advanced gastric cancer (AGC).
Materials and Methods
This study investigated 103 patients with confirmed AGC through DCE-MRI and immunohistochemical staining. Utilizing Omni Kinetics software, radiomics features (Ktrans, Kep, and Ve) were extracted and underwent selection via variance threshold, SelectKBest, and LASSO methods. A logistic regression model was constructed, and 10-fold cross-validation assessed its performance. Immunohistochemical staining was used to evaluate CD3+, CD4+, and CD8+ T-cell expression. A receiver operating characteristic curve was used to calculate the model performance.
Results
Eight radiomics characteristics were used in the CD3 model to produce AUCs of 0.857 (training) and 0.863 (test). The CD4 model used seven characteristics to produce AUCs of 0.867 (training) and 0.817 (test). The CD8 model used six characteristics to attain AUCs of 0.876 (training) and 0.820 (test). Clinical usefulness was verified by a careful decision curve study.
Conclusions
Machine learning classifiers based on DCE-MRI have the potential to accurately predict CD3+, CD4+, and CD8+ tumor-infiltrating lymphocyte expression levels in patients with AGC.
Kinesiophobia is associated with quality of life after total hip arthroplasty: A short-term prospective observational study
Authors: Hidaka Ryo , Tanaka Takeyuki , Hashikura Kazuaki , Oka Hiroyuki , Matsudaira Ko , Matsuda Kenta , Moro Toru , Kawano Hirotaka , Tanaka Sakae
Published: November 2023

Background: Kinesiophobia and pain catastrophizing are key factors that affect outcomes after total knee arthroplasty. However, its impact on outcomes after total hip arthroplasty (THA) remains unclear. This study aimed to determine whether kinesiophobia, assessed by the Tampa Scale for Kinesiophobia (TSK)-11, and pain catastrophizing, assessed by the Pain Catastrophizing Scale (PCS), were associated with quality of life (QOL) at 12 months after THA.
Methods: Ninety consecutively patients were evaluated prospectively at 12 months after THA. QOL scores were assessed by disease-specific QOL (the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) and general QOL (the EuroQOL-5 Dimensions), pain intensity was used by Visual Analog Scale, and TSK-11 and PCS were evaluated pre-operative and at 12 months after THA. Each QOL score at 12 months was used for multivariate analysis.
Results: Pain intensity and TSK-11 were independently correlated with the disease-specific and general QOL at 12 months after THA in the multiple regression analysis. PCS was not correlated with each QOL at 12 months after THA.
Conclusions: Kinesiophobia and pain intensity were independently associated with disease-specific and general QOL at 12 months after THA. Higher kinesiophobia and pain intensity were potential factors that lower QOL at 12 months after THA.
Follow-up Neutrophil–Lymphocyte Ratio as a Predictor for Postoperative Pneumonia After Endovascular Treatment in Aneurysmal Subarachnoid Hemorrhage Patients: A Retrospective Analysis
Authors: Huang Xinyue , Guo Xiumei , Gao Wen , Guo Liming , Xiong Yu , Chen Chunhui , Zheng Hanlin , Pan Zhigang , Lin Qingxin , Zheng Shuni , Ke Chuhan , Hu Weipeng , Zheng Feng
Published: November 2023

The association between NLR and postoperative pneumonia (POP) in patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent endovascular treatment remains poorly understood. Patients with aSAH who underwent endovascular treatment between January 2019 and April 2023 were included. The follow-up endpoint was the presence of POP at 30 days postoperatively. Logistic regression analysis was conducted using POP as the dependent variable. NLR was calculated at admission (NLR1), 24 h after endovascular treatment (NLR2), and 3–7 days after endovascular treatment (NLR3). Four prediction models were constructed: Model 1 (variables with p < 0.05, except for the NLR); Model 2 (Model 1 plus NLR1); Model 3 (Model 1 plus NLR2); and Model 4 (Model 1 plus NLR3). Among the 154 patients with aSAH, POP occurred in 101 (65.6%) patients. Higher NLRs at admission (odds ratio [OR] = 1.08; 95% Confidence Interval [CI] 1.02, 1.16; p = 0.019), 24 h postoperatively (OR = 1.14; 95% CI 1.05, 1.25; p = 0.005) and 3-7days postoperatively (OR = 1.17; 95% CI 1.02, 1.38; p = 0.04) were independently associated with the occurrence of POP. Follow-up NLR may be an independent predictor of POP in aSAH patients treated endovascularly. Elevated NLR at admission, 24 h postoperatively and 3–7 days postoperatively correlated with a high risk for POP.
Rational Combinatorial Targeting by Adapter CAR T Cells (AdCAR-T) Prevents Antigen Escape in Acute Myeloid Leukemia (AML)
Authors: Atar Daniel Bünyamin , Ruoff Lara , Mast Anna-Sophia , Krost Simon , Moustafa-Oglou Moustafa , Scheuermann Sophia , Kristmann Beate , Feige Maximilian , Canak Aysegül , Wolsing Katrin , Schilbach Karin , Zekri Latifa , Ebinger Martin , Nixdorf Daniel , Subklewe Marion , Schulte Johannes , Lengerke Claudia , Werchau Niels , Mittelstaet Joerg , Lang Peter , Handgretinger Rupert , Schlegel Patrick , Seitz Christian Martin
Published: November 2023

Targeting AML by chimeric antigen receptor T cells (CAR-T) has been challenging due to the promiscuous expression of AML-associated antigens on healthy hematopoietic stem and progenitor cells as well as a high degree of inter- and intratumoral heterogeneity. Consequently, we did not yet see dramatic clinical successes, as in B-phenotypic malignancies treated with CD19- or BCMA-directed CAR-T cells. In the present study, we analyzed the inter- and intratumoral heterogeneity of AML-associated antigens in 30 primary pediatric AML samples at single-cell resolution. We identified CD33, CD38, CD371, IL1RAP and CD123 as the most frequently expressed. Notably, high variability was observed not only across the different patient samples but also among leukemic cells of the same patient, which indicates that multiplexed targeting approaches will be needed to target all leukemic cells. To address this need, we utilized our modular Adapter CAR (AdCAR) platform, enabling precise qualitative and quantitative control over CAR-T-cell function. We show highly efficient and target-specific activity for newly generated adapter molecules (AMs) against CD33, CD38, CD123, CD135 and CD371, both in vitro and in vivo. Importantly, we prove that inherent intratumoral heterogeneity in antigen expression translates into antigen escape and therapy failure to monotargeted CAR-T therapy. For the first time, we demonstrate in a PDX model that rational combinatorial targeting by AdCAR-T cells can cure heterogenic disease. In conclusion, we elucidate the clinical relevance of heterogeneity in antigen expression in pediatric AML and present a novel concept for precision immunotherapy by combinatorial targeting utilizing the AdCAR platform.
Playing for Cognition: Investigating the Feasibility and User Experience of a Virtual Reality Serious Game for Cognitive Assessment in Children with Congenital Heart Disease
Authors: de Wouw Charlotte Van , Bousché Eileen , Schooneveld Monique Van , Nijenhuis HP , Huygelier Hanne , Nijboer Tanja , Breur Hans
Published: November 2023

Background
In order to facilitate the development and implementation of innovative technology in clinical practice, it is important to understand the user experience of end-users. Virtual Reality (VR) offers the possibility to assess cognitive functioning in a dynamic environment that simulates real-world situations. The purpose of this cross-sectional study was to investigate the feasibility of a VR Serious Game for cognitive assessment in school-aged children with congenital heart disease (CHD). The sub-aims were two-fold: (1) to objectively evaluate the feasibility of the VR Serious Game in children with CHD in comparison to typically developing (TD) children and (2) to explore the user experience of both groups following their interaction with the VR Serious Game.
Results
A total of 101 children participated in this study; 98 children were included in the final analysis (CHD: n = 54; TD: n = 47). The VR Serious Game appeared feasible for both children with CHD and TD children, with 88% children completing the innovative VR assessment without encountering any issues. There were no discernible differences in completion rates between groups. Children with CHD reported significantly lower scores than TD children on three user experience scales: Engagement, Flow and Presence. Nonetheless, the scores for Engagement and Flow were still considered "moderate to good". Both groups reported minimal adverse physiological reactions.
Conclusions
The findings suggested that the VR Serious Game was feasible for children with CHD and that the user experience was positive. Future research should investigate the effectiveness of the VR Serious Game compared with a conventional or digital NPA, prioritising the development of novel outcome measures that can better estimate and explain the impact of cognitive impairment on daily functioning.
Costs of delivering COVID-19 vaccine in Botswana during the height of the pandemic: A retrospective study
Authors: Vaughan Kelsey , Mokena Onalenna T , Rankgoane-Pono Goabaone , Keetile Moses , Griffiths Ulla Kou
Published: November 2023

Background
The development, distribution and delivery of COVID-19 vaccines following the outbreak of the global coronavirus pandemic in February 2020 is the largest global immunization action in history. To assist with planning and resource mobilization efforts, a global-level model using data from the literature on childhood and adult flu vaccine delivery estimated expected COVID-19 vaccine delivery costs. However, country-level studies were needed to validate these estimates, learn lessons for future pandemics, and plan for future COVID-19 vaccination of priority groups.
Methods
We tested several methodological innovations to estimate total costs and costs per dose of COVID-19 vaccine delivery in Botswana. Costs incurred by all government sectors, parastatals, donors and non-governmental organizations were included. Both fiscal costs (financial outlays) and the value of selected, existing human resources and donated vaccines (economic costs) were included.
Results
Total, fiscal delivery costs of COVID-19 vaccination were estimated at US$49.8 million for a 13-month period, with over half accounting for newly hired human resources. Newly hired staff supported not just vaccine delivery, but also co-ordination and social mobilization efforts. The value of existing human resources redeployed to support COVID-19 vaccination was US$36.6 million. Based on 2.6 million doses delivered, the fiscal and economic delivery cost per dose were US$19 and US$33, respectively. Vaccines were procured and donated at an average price per dose of US$13.46, increasing the economic cost per dose delivered to approximately US$47.
Conclusions
In Botswana, costs were substantially higher than modelled estimates for COVID-19 vaccine delivery and the cost of delivering routine childhood vaccines. This suggests that rolling out a new vaccine to an entire population in the middle of a pandemic requires additional financial investments beyond what has been typical for immunization services in the past.
CO2 emissions prediction from coal used in power plants using univariate and multivariate machine learning models
Authors: Prakash Ankit , Singh Sunil Kumar
Published: November 2023

Carbon dioxide (CO2 ) emission has increased rapidly due to the predominant usage of fossil fuels. The energy sector contributes a considerable amount towards the total share that belongs to CO2 emissions worldwide. In this work, we have applied the Multivariate and Univariate variants of time-series, machine learning and deep learning models over the CO2 emissions dataset. The dataset is collected central electricity authority containing the attributes as coal supply information, CO2 emissions, peak demand, and peak met. The performance of the applied models is tested using performance metrics such as RMSPE, MAE, RMSE, MSE, MAPE, SMAPE, and RAE. The dataset is collected from 2005-2021 to perform the test and train, and further, we have forecasted the CO2 emission from 2022-2050 by applying the best performing models. The findings of the work show that autoregression is the best-performing model and obtained the best rank i.e. 1.85 by applying the Friedman ranking. A comparative study is also done over multivariate and univariate analysis.
Cloudy: A Python-based Simulator for Modern Cloud Environments
Authors: Siavashi Ahmad , Momtazpour Mahmoud
Published: November 2023

Cloud computing is a pervasive technology, underpinning numerous modern services. However, understanding and optimizing cloud environments can be complex and challenging, demanding sophisticated simulation tools. Existing cloud simulators, predominantly developed in languages like Java, often lack flexibility, struggle with rapid adaptation to emerging technologies, and can be difficult to integrate with contemporary libraries, especially in Artificial Intelligence (AI) and Linear Programming (LP) domains. To address these limitations , we introduce Cloudy, a Python-based simulator designed to model and simulate modern cloud environments. As Python offers simplicity, readability, and extensive library support, Cloudy provides an easily accessible, yet powerful , tool for comprehensive cloud simulations. It leverages Python's seamless integration with AI and LP libraries for advanced experimentation and supports modern cloud peripherals, such as GPUs. Moreover, Cloudy accommodates various cloud service models, making it highly versatile for different cloud-based scenarios. Compared to the established CloudSim simulator, Cloudy demonstrated a significant reduction in memory usage and simulation time by 15.6x and 2.75x, respectively. This paper offers an in-depth exploration of the Cloudy simulator, its features, and potential applications.
The Combined Anti-Tumor Effects of 5-Fluorouracil and Neurokinin Receptor Inhibitor, Aprepitant, against Colorectal Cancer: In vitro and In vivo Study
Authors: Alalikhan Abbas , Ebrahimi Safieh , Aliee Ali. , Mirzavi Farshad , Hashemy Seyed Isaac
Published: November 2023

Background
Colorectal cancer (CRC) is one of the world's largest health concerns with growing global incidence and mortality. The potential value of the neurokinin-1 receptor as a therapeutic target has been reported in several tumor types, including CRC. Here we examined the potential anti-tumor effects of a clinically approved neurokinin -1 receptor antagonist, aprepitant, alone and its combination with Fluorouracil (5-FU) as a first choice CRC chemotherapeutic drug, in both in vitro and in vivo models of CRC.
Methods
MTT assay was employed for assessing cell proliferation. mRNA expression levels were determined by quantitative real-time PCR (qRT-PCR). Flow cytometric analysis of apoptosis was performed using an Annexin-V/propidium iodide assay kit. We finally conducted an in vivo experiment in a mouse model of CRC to confirm the in vitro antiproliferative activity of aprepitant and 5-FU.
Results
We found that aprepitant and 5-FU significantly reduced CRC cell viability. The combination of drugs exhibited potent synergistic growth inhibitory effects on CRC cells. Moreover, aprepitant and 5-FU induced apoptosis and altered the levels of apoptotic genes (up-regulation of Bax, p53, p53 along with downregulation of Bcl-2). Importantly, the aprepitant-5-FU combination showed a more pronounced impact on apoptosis and associated genes than either of the agents alone. Furthermore, aprepitant reduced tumor growth in vivo and led to significantly longer survival time, and this effect was more prominent when using the aprepitant -5-FU combination.
Conclusions
Collectively, combinatory treatment with aprepitant and 5-FU potentially exerts synergistic growth inhibition and apoptosis induction in CRC, deserving further consideration as a novel strategy for CRC patients.