bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Anesthetic Patient Education Through the Utilization of Large Language Models for Improved Communication and Understanding
Authors: Ratnagandhi Jeevan Avinassh , Godavarthy Praghya , Gnaneswaran Mahindra , Lim Bryan , Vittalraj Rupeshraj
Published: January 2025

Background/Objectives: The rapid development of Large Language Models (LLMs) presents promising applications in healthcare, including patient education. In anesthesia, where patient anxiety is common due to misunderstandings and fears, LLMs could alleviate perioperative anxiety by providing accessible and accurate information. This study explores the potential of LLMs to enhance patient education on anesthetic and perioperative care, addressing time constraints faced by anesthetists. Methods: Three language models—ChatGPT-4, Claude 3, and Gemini—were evaluated using three common patient prompts. To minimize bias, incognito mode was used. Readability was assessed with the Flesch–Kincaid, Flesch Reading Ease, and Coleman–Liau indices. Response quality was rated for clarity, comprehension, and informativeness using the DISCERN score and Likert Scale. Results: Claude 3 required the highest reading level, delivering detailed responses but lacking citations. ChatGPT-4o offered accessible and concise answers but missed key details. Gemini provided reliable and comprehensive information and emphasized professional guidance but lacked citations. According to DISCERN and Likert scores, Gemini had the highest rank for reliability and patient friendliness. Conclusions: This study found that Gemini provided the most reliable information, followed by Claude 3, although no significant differences were observed. All models showed limitations in bias and lacked sufficient citations. While ChatGPT-4o was the most comprehensible, it lacked clinical depth. Further research is needed to balance simplicity with clinical accuracy, explore Artificial Intelligence (AI)–physician collaboration, and assess AI’s impact on patient safety and medical education.
Tea Polyphenol Protects the Immune Barrier and Inhibits TLR2/NF-κB/MLCK Signal Activation to Prevent Inflammatory Injury in the Intestines of Common Carp (Cyprinus carpio L.)
Authors: Qian Man , Yang Jie , Xue Yao , Wu Jiawei , Li Ziyi , Luo Jilong , Zhao Bing , Gao Xuejiao
Published: January 2025

Tea polyphenol (TP) is a kind of natural macromolecular compound present in tea extract with rich biological potential. The purpose of this study was to explore the protective effect of TP on the intestinal immune barrier and the related mechanisms of TP alleviating intestinal injury. Models of common carp (Cyprinus carpio L.) and primary intestinal epithelial cells treated with TP and lipopolysaccharide (LPS) were established. The qPCR and ELISA results showed that TP increased the levels of lysozyme (LZ), alkaline phosphatase (ALP), complement component 3 (C3), complement component 4 (C4), immunoglobulin T (IgT), immunoglobulin D (IgD), and immunoglobulin M (IgM) to activate intestinal immune ability. Molecular docking indicated that TP had a strong interaction with TLR2. Meanwhile, TP alleviated LPS-induced intestinal inflammatory damage as evidenced by reducing the mRNA levels of TNF-α, IL-6, IL-1β, TLR2, MyD88, P65, and IκBα, which were consistent with those of ELISA and Western blotting results. Moreover, the qPCR and Western blotting results revealed TP promoted the levels of tight junction-related proteins (claudins, occludin, and ZOs) and inhibited the phosphorylation of MLC, which showed the opposite trend after LPS treatment. In summary, the present study indicated that TP improved immune ability and inhibited the activation of the TLR2/NF-κB/MLCK pathway to attenuate LPS-induced inflammatory injury in the intestines of common carp.
Calcium Release-Activated Calcium Modulator ORAI1-Sensitive Serine Dehydratase Regulates Fatty Acid-Induced CD4+ Th17/Treg Imbalance in Dairy Cows
Authors: Zhang Bingbing , Wang Jingjing , Li Ming , Wen Jianan , Loor Juan J. , Wang Shuang , Ji Ziwei , Lv Xinquan , Wang Guihua , Xia Cheng , Yang Wei , Xu Chuang
Published: January 2025

High concentrations of free fatty acids (FFAs) caused by negative energy balance render the cow more prone to inflammatory diseases in part due to an imbalance in the types of immune cells and their specific functions. We previously demonstrated that ORAI calcium release-activated calcium modulator 1 (ORAI1) was associated with increased CD4+ Th17 content, but the precise mechanisms remain unclear. The purpose of this study was to evaluate the efficacy of FFAs on CD4+ T cell inflammatory response. High FFAs in dairy cows caused the transcript level of the pro-inflammatory factor IL-17A, plasma concentration of IL-17A, and amount of intracellular IL-17A to increase while the transcript levels and intracellular amount of the anti-inflammatory factor FOXP3 were downregulated. These changes indicated Th17/Treg imbalance and inflammation in dairy cows with high FFA. Moreover, ORAI1 and SDS abundance was elevated in dairy cows with high FFAs by transcriptomics, QPCR, and Western blot. Knockdown of SDS (siSDS) did not alter ORAI1 expression in CD4+ T cells from high-FFA cows, while it decreased the expression of inflammatory factors. Transfection of CD4+ T cells using siRNA knockdown for ORAI1 (siORAI1) revealed that SDS and inflammatory factor abundance decreased. Serine can be catabolized to pyruvate by the action of serine dehydratase (SDS). Data from this study suggested that high FFAs caused by negative energy balance after calving regulates the Th17/Treg balance via SDS, but SDS does not regulate ORAI1 abundance. The above data suggested a pro-inflammatory mechanism in CD4+ T cells regulated by the ORAI1-sensitive SDS pathway in early postpartum cows experiencing high-FFA conditions. Thus, targeting this pathway may represent a new therapeutic and interventional approach for preventing immune-related disorders around parturition.
Maternal Roughage Sources Influence the Gastrointestinal Development of Goat Kids by Modulating the Colonization of Gastrointestinal Microbiota
Authors: Du Haidong , Li Kenan , Guo Wenliang , Na Meila , Zhang Jing , Na Renhua
Published: January 2025

During pregnancy and lactation, maternal nutrition is linked to the full development of offspring and may have long-term or lifelong effects. However, the influence of the doe’s diet on the gastrointestinal (GI) tract of young kids remains largely unexplored. Therefore, we investigated the effects of doe roughage sources (alfalfa hay, AH, or corn straw, CS) during pregnancy and lactation on kid growth, GI morphology, barrier function, metabolism, immunity, and microbiome composition. The results indicate that, compared with the CS group, does fed an AH diet had significantly higher feed intake (p < 0.01). However, CS-fed does exhibited higher neutral detergent fiber (NDF) digestibility (p < 0.05). There were no significant differences in animal (doe or kid) weight among the groups (p > 0.05). In the rumen of goat kids, the AH group exhibited a higher papillae width and increased levels of interleukin-10 (IL-10) compared with the CS group (p < 0.05). In the jejunum of goat kids, the AH group showed a higher villus-height-to-crypt-depth (VH/CD) ratio, as well as elevated levels of secretory immunoglobulin A (SIgA), immunoglobulin G (IgG), IL-10, acetate, and total volatile fatty acids (TVFAs), when compared with the CS group (p < 0.05). Transcriptome analysis revealed that the source of roughage in does was associated with changes in the GI transcriptome of the kids. Differentially expressed genes (DEGs) in the rumen were mainly associated with tissue development and immune regulation, while the DEGs in the jejunum were mainly associated with the regulation of transferase activity. Spearman correlation analyses indicated significant associations between GI DEGs and phenotypic indicators related to GI development, immunity, and metabolism. LEfSe analysis identified 14 rumen microbial biomarkers and 6 jejunum microbial biomarkers. Notably, these microorganisms were also enriched in the rumen or day 28 milk of the does. Further microbial composition analysis revealed significant correlations between the rumen and milk microbiomes of does and the rumen or jejunum microbiomes of kids. Association analyses indicated that microbial biomarkers interact with host genes, thereby affecting the development and function of the GI system. Additionally, correlation analyses revealed significant association between milk metabolites and the rumen and jejunum microbiomes of kids. This study demonstrated that maternal diet significantly influences the development of microbial ecosystems in offspring by modulating microbial communities and metabolite composition. The early colonization of GI microorganisms is crucial for the structural development, barrier function, immune capacity, and microbial metabolic activity of the GI system.
Optimal Operation of CCHP Smart Distribution Grid with Integration of Renewable Energy
Authors: Bilal Ghassan A. , Al-Saadi Mohammed K. , Al-Sultany Ghaidaa A. , Al-Maliki Wisam Abed Kattea
Published: January 2025

Recently, electric distribution grids supply not only electric loads but also heating and cooling loads simultaneously to increase the efficiency of the system and reduce the emission of greenhouse gases. An energy management system (EMS) to reduce the combined total expense including environmental damage cost of the combined cooling, heating, and power (CCHP) smart distribution grids in a cooperative framework is proposed in this paper. The entire problem is modelled as a unit commitment interval mixed integer quadratic program (UCIMIQP). The UC is developed to respond to the operation of the electric, heating, and cooling systems and takes into consideration the exchange of energy between these systems. In addition, the demand response (DR) is incorporated with the optimization problem as a decision variable to shave the peak load and reduce the total system cost. The environmental damage is converted to expense, and the entire combined problem is converted to a unified function that is possible to solve in one step, where this is suitable for online operation. Furthermore, a set of realistic constraints is considered to make the approach close to a real scenario. To verify the effectiveness and robustness of the proposed model, the analysis is applied to the distribution grids, which include electrical, heating, and cooling systems, where these systems operated cooperatively. The interaction between these systems makes the operation more flexible and economical. The results show that the total cost is reduced through an exchange in energy between the systems. Additionally, the consideration of the demand response reduces the maximum load and decreases the total cost.
Real-Time Communication Aid System for Korean Dysarthric Speech
Authors: Park Kwanghyun , Hong Jungpyo
Published: January 2025

Dysarthria is a speech disorder characterized by difficulties in articulation and vocalization due to impaired control of the articulatory system. Around 30% of individuals with speech disorders have dysarthria, facing significant communication challenges. Existing assistive tools for dysarthria either require additional manipulation or only provide word-level speech support, limiting their ability to support effective communication in real-world situations. Thus, this paper proposes a real-time communication aid system that converts sentence-level Korean dysarthric speech to non-dysarthric normal speech. The proposed system consists of two main parts in cascading form. Specifically, a Korean Automatic Speech Recognition (ASR) model is trained with dysarthric utterances using a conformer-based architecture and the graph transducer network–connectionist temporal classification algorithm, significantly enhancing recognition performance over previous models. Subsequently, a Korean Text-To-Speech (TTS) model based on Jointly Training FastSpeech2 and HiFi-GAN for end-to-end Text-to-Speech (JETS) is pipelined to synthesize high-quality non-dysarthric normal speech. These models are integrated into a single system on an app server, which receives 5–10 s of dysarthric speech and converts it to normal speech after 2–3 s. This can provide a practical communication aid for people with dysarthria.
Modeling the Chemical Hydrolysis of Mesquite (Prosopis laevigata) Seed Husk Using Response Surface Methodology and Artificial Neural Networks
Authors: Pérez-Cadena Rogelio , Vázquez-Maldonado Silvana , Téllez-Jurado Alejandro , Serna-Diaz Maria Guadalupe , Medina-Marin Joselito
Published: January 2025

The increasing emission of greenhouse gases that comes with the rise in industrialization is harmful to the environment. Thus, finding new renewable energy sources is becoming increasingly important in the energy field. One such renewable energy source is biomass, which provides valuable energy carriers—for example, biofuels. The objective of this work was to evaluate the release of total reducing sugars (TRSs) from mesquite pod seed hulls by chemical and enzymatic hydrolysis. The husks were crushed and separated by screens (#16, #30 and #50). The effect of hydrolysis time (10, 20, and 30 min) and sulfuric acid concentration (0, 0.25, and 0.5 N) was analyzed. The #50 mesh showed the highest TRS release, increasing from 3.19 to 17.49 g/L as the reaction time was extended. Additionally, enzymatic hydrolysis with endo-1, 4-β-xylanase and β-glucanase enzymes was evaluated on the solid and liquid fractions obtained. Statistical analysis with Design Expert showed that, for the solid fractions, after 31 h there were no significant differences, reaching 79.46 g/L TRS. In the liquid fractions, the TRS released reached 113.37 g/L after 54 h of enzymatic treatment. The release of TRS by chemical hydrolysis was also modeled with artificial neural networks, considering the particle size, the hydrolysis time, and the sulfuric acid concentration. The coefficient of determination (r2) indicates that the ANNs present a better data fit (r2 > 0.99) to predict the experimental conditions that maximize the study variables.
Road Extraction from Remote Sensing Images Using a Skip-Connected Parallel CNN-Transformer Encoder-Decoder Model
Authors: Gui Linger , Gu Xingjian , Huang Fen , Ren Shougang , Qin Huanhuan , Fan Chengcheng
Published: January 2025

Extracting roads from remote sensing images holds significant practical value across fields like urban planning, traffic management, and disaster monitoring. Current Convolutional Neural Network (CNN) methods, praised for their robust local feature learning enabled by inductive biases, deliver impressive results. However, they face challenges in capturing global context and accurately extracting the linear features of roads due to their localized receptive fields. To address these shortcomings of traditional methods, this paper proposes a novel parallel encoder architecture that integrates a CNN Encoder Module (CEM) with a Transformer Encoder Module (TEM). The integration combines the CEM’s strength in local feature extraction with the TEM’s ability to incorporate global context, achieving complementary advantages and overcoming limitations of both Transformers and CNNs. Furthermore, the architecture also includes a Linear Convolution Module (LCM), which uses linear convolutions tailored to the shape and distribution of roads. By capturing image features in four specific directions, the LCM significantly improves the model’s ability to detect and represent global and linear road features. Experimental results demonstrate that our proposed method achieves substantial improvements on the German-Street Dataset and the Massachusetts Roads Dataset, increasing the Intersection over Union (IoU) of road class by at least 3% and the overall F1 score by at least 2%.
A Memetic Algorithm Approach for the Job-Shop Scheduling Problem with Variable Machine Efficiency and Maintenance Activities
Authors: Freud David , Elalouf Amir
Published: January 2025

Variable machine efficiency (VME) and maintenance activities (MA) are critical factors often unexplored in job scheduling problems. This paper introduces a new problem termed the job-shop scheduling problem with variable machine efficiency and maintenance activities (JSSP-VME-MT), wherein, unlike the traditional JSSP, machine efficiency and maintenance activities are explicitly incorporated into the scheduling process. The study proposes a novel memetic algorithm (MA) underpinned by a variable neighborhood descent (VND) local search strategy to address this complex problem. This methodology demonstrates significant improvements, achieving mean makespan reductions ranging from 2.22% to 5.77% across diverse problem instances with varying numbers of machines and jobs. Key contributions include the development of an encoding scheme to model maintenance activities and machine-specific constraints, along with the design of a hybrid metaheuristic framework combining global exploration and local refinement. This work provides a foundation for future comparative studies, algorithm enhancements, and practical industrial applications. The approach offers a scalable and flexible solution to job-shop scheduling challenges involving dynamic efficiency and planned maintenance activities.
Improved Confidence-Interval Estimations Using Uncertainty Measure and Weighted Feature Decisions for Cuff-Less Blood-Pressure Measurements
Authors: Lee Soojeong , Al-antari Mugahed A. , Joshi Gyanendra Prasad
Published: January 2025

This paper presents a method to improve confidence-interval (CI) estimation using individual uncertainty measures and weighted feature decisions for cuff-less blood-pressure (BP) measurement. We obtained uncertainty using Gaussian process regression (GPR). The CI obtained from the GPR model is computed using the distribution of BP estimates, which provides relatively wide CIs. Thus, we proposed a method to obtain improved CIs for individual subjects by applying bootstrap and uncertainty methods using the cuff-less BP estimates of each subject obtained through GPR. This study also introduced a novel method to estimate cuff-less BP with high fidelity by determining highly weighted features using weighted feature decisions. The standard deviation of the proposed method’s mean error is 2.94 mmHg and 1.50 mmHg for systolic blood pressure (SBP) and (DBP), respectively. The mean absolute error results were obtained by weighted feature determination combining GPR and gradient boosting algorithms (GBA) for SBP (1.46 mmHg) and DBP (0.69 mmHg). The study confirmed that the BP estimates were within the CI based on the test samples of almost all subjects. The weighted feature decisions combining GPR and GBA were more accurate and reliable for cuff-less BP estimation.
Pediatric “Found Down” Trauma Diagnosis and Therapy for Associated Clinical Pictures Using the “STAND UP 4C” Approach
Authors: Mohrmann Chris , Fiedler Kai M. , Heep Axel , Beck Christiane E. , Lange Matthias
Published: January 2025

Background: Although “found down” trauma patients are not subject to any general definition in Germany, the term describes a recurrent clinical picture in the care of adult patients, especially in pre-hospital emergency settings. It is characterized by immobilization-related morbidity due to rhabdomyolysis and electrolyte disturbance-related severe arrhythmias. The aim of this work is to identify cases of pediatric “found down” patients treated at our institution and to define diagnostic and therapeutic measures. Methods: In a retrospective, monocentric observational study, the hospital information system was searched for “found down”-associated diagnoses on admission to the pediatric intensive care unit (PICU) of the University of Oldenburg for the period 1 January 2011 to 31 December 2022. After viewing 17 patient records, an interdisciplinary consensus concerning the clinical picture of “found down” was identified in five patients, and these patients were analyzed. Results: The mean age of patients was 8.73 (0.17–17.35) years, and patients were at the PICU for an average of 18.2 (14–24) days. Prolonged immobilization (n = 1), acute trauma (n = 2), and acute (n = 1) and chronic (n = 1) neurometabolic disorders were identified as triggers. The survival rate was 100%. Numerous associated disease symptoms, such as central nervous deficits, were detected. Conclusions: There are various causes for the pediatric clinical picture of “found down” trauma patients. However, pediatric “found down” trauma describes a complex, life-threatening disease affecting multiple organ systems. The diversity of the underlying causes of the diseases represents a challenge for adequate management. The acronym “STAND UP 4C” aims to provide guidance for the diagnosis and therapy.
CytoSorb® Hemadsorption in Cardiogenic Shock: A Real-World Analysis of Hemodynamics, Organ Function, and Clinical Outcomes During Mechanical Circulatory Support
Authors: Kreutz Julian , Harbaum Lukas , Barutcu Cem Benin , Rehman Amar Sharif , Patsalis Nikolaos , Mihali Klevis , Chatzis Georgios , Choukeir Maryana , Syntila Styliani , Schieffer Bernhard , Markus Birgit
Published: January 2025

Background: Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such as CytoSorb® have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical circulatory support (MCS) systems, remains limited. Methods: This retrospective study analyzed data from 129 CS patients treated with CytoSorb® at the University Hospital of Marburg between August 2019 and December 2023. Those patients receiving MCS were grouped according to MCS type: (1) Impella, (2) VA-ECMO, and (3) ECMELLA. The hemodynamic parameters of circulatory support (e.g., MCS flow rates and vasoactive inotropic score, VIS) and laboratory and ventilation parameters were assessed 24 h before start of CytoSorb® therapy (T1) and 24 h after completion of CytoSorb® therapy (T2). Results: Of 129 CS patients (mean age: 64.7 ± 13.1 years), 103 (79.8%) received MCS. Comparing T1 and T2, there was a significant reduction in VIS in the entire cohort (T1: 38.0, T2: 16.3; p = 0.002), with a concomitant significant reduction in the level of MCS support in all subgroups, indicating successful weaning. Analysis of laboratory parameters showed significant reductions in lactate (T1: 2.1, T2: 1.3 mmol/L; p = 0.014), myoglobin (T1: 1549.0, T2: 618.0 µg/L; p < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; p = 0.048), and procalcitonin (T1: 2.9, T2: 1.6 µg/L; p < 0.001). However, a significant decrease in platelets (T1: 140.0, T2: 54.0 tsd/µL; p < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; p < 0.001) was also documented. The median SOFA score of the entire cohort was 15.0 (IQR 12.0–16.0), predicting a mortality rate of >80%, which could be reduced to 60.5% in the present study. Conclusions: During CytoSorb® therapy in CS, a significant reduction in VIS was demonstrated, resulting in improved organ perfusion. Therefore, the results of this study underline that CytoSorb® therapy can be considered a useful “component” in the complex management of CS, especially when combined with MCS. To refine and optimize treatment strategies in CS, prospective studies are needed to better define the role of hemadsorption.
Extraction and Purification of the FrHb1 Fraction from Commercial Natural Latex of Hevea brasiliensis for Biomedical Applications
Authors: Silva Ana Karoline Almeida da , Nunes Gustavo Adolfo Marcelino de Almeida , Faria Rafael Mendes , Favilla Ana Luiza Coutinho , Dornelas Jéssica , Fonseca Marcos Augusto Mountinho , Benavides Angie Daniela Ibarra , da Costa Lindemberg Barreto Mota , Fleury Rosa Mário Fabrício , da Rocha Adson Ferreira , Rosa Suelia de Siqueira Rodrigues Fleury
Published: January 2025

Biomaterials interact with biological systems, influencing their responses. Different types of polymers—both natural and synthetic—are widely used in biomedical engineering, among a plethora of healthcare applications, to promote tissue regeneration. The natural rubber latex extracted from Hevea brasiliensis is a biopolymer that whose biocompatibility makes it a valuable study object. Its great regenerative properties are largely associated with the fraction FrHB1, which has demonstrated angiogenic and wound-healing potential by inducing blood vessel formation, collagen synthesis, and fibroblast migration—crucial factors for tissue repair. This study aimed to develop scalable methods for extracting and purifying the F1 protein fraction from industrialized natural latex for biomedical applications. We tested two types of industrial latex, bi-centrifuged and pre-vulcanized latex as well as 60% centrifuged natural latex to determine the most effective composition used in subsequent extractions and fractionation steps. Then, we isolated FrHB1 from the pre-vulcanized latex using selective precipitation, ultrafiltration, and affinity chromatography. The yield of the first batch of this serum was 40.62% with protein concentration of 1.52 ± 0.06 mg/mL. The second batch had a yield of 49.74%; however, due to results lying outside the analytical curve, its protein concentration could not be calculated. The yield of the third batch was 57.19%, and its protein concentration was 1.8477 ± 0.033 mg/mL. This approach facilitates large-scale therapeutic applications utilizing a commercially viable and accessible resource. Moreover, these findings highlight industrialized natural latex as a sustainable source of bioactive molecules, contributing to advancements in regenerative medicine and tissue engineering.
Modeling ALS with Patient-Derived iPSCs: Recent Advances and Future Potentials
Authors: Dawoody Nejad Ladan , Pioro Erik P.
Published: January 2025

Amyotrophic lateral sclerosis (ALS) is a terminal complex neurodegenerative disease, with 10–15% of cases being familial and the majority being sporadic with no known cause. There are no animal models for the 85–90% of sporadic ALS cases. More creative, sophisticated models of ALS disease are required to unravel the mysteries of this complicated disease. While ALS patients urgently require new medications and treatments, suitable preclinical in vitro models for drug screening are lacking. Therefore, human-derived induced pluripotent stem cell (hiPSC) technology offers the opportunity to model diverse and unreachable cell types in a culture dish. In this review, we focus on recent hiPSC-derived ALS neuronal and non-neuronal models to examine the research progress of current ALS 2D monocultures, co-cultures, and more complex 3D-model organoids. Despite the challenges inherent to hiPSC-based models, their application to preclinical drug studies is enormous.
Efficacy of Body Representation Rehabilitation Training for Adults with Unilateral Brain Damage: A Preliminary Study
Authors: Cropano Maria , Gaita Mariachiara , Dolce Erica , Canino Silvia , Angelillo Valentina Gerarda , Di Vita Antonella , Boccia Maddalena , Raimo Simona , Palermo Liana
Published: January 2025

Background/Objectives: Body representations (BRs) are essential for guiding movements, maintaining spatial awareness, and achieving effective interactions with the environment. Several studies suggest that BRs are frequently impaired following unilateral brain damage, emphasising the need for tailored rehabilitation interventions; however, there is a lack of studies evaluating the effectiveness of training specifically designed to improve different kinds of functional BRs after stroke. Therefore, the present study aimed to present and implement a specific rehabilitation training program for BR alterations and evaluate its effectiveness in a sample of adults with unilateral brain damage. Methods: Nine adults with unilateral brain damage and seven age- and education-matched healthy controls were recruited. Both groups underwent a neuropsychological assessment to evaluate BR (action- and nonaction-oriented). Additionally, functional autonomy and motor functioning were assessed in the patient group. Following an initial assessment (T0), the patients participated in a BR-specific rehabilitation intervention. At the end of the rehabilitation program (T1), both groups were re-evaluated with the same tasks used at T0. Results: At T0, the patient group performed worse on BR tasks than the controls. At T1, a significant improvement in the nonaction-oriented BR and functional autonomy was observed in the patient group. Conclusions: This preliminary study suggests the effectiveness of a targeted rehabilitation intervention for BR in promoting enhanced body boundary awareness and greater accuracy in the perception of body part positions, possibly leading to increased functional autonomy. These findings highlight the importance of incorporating BR training in rehabilitation programs for adults with acquired brain damage, alongside motor rehabilitation.
Effect of Sm2O3 Doping of CeO2-Supported Ni Catalysts for H2 Production by Steam Reforming of Ethanol
Authors: Chirinos Carlos Andrés , Liu Sichen , Cortés Corberán Vicente , Gómez-Sainero Luisa María
Published: January 2025

Hydrogen is a priority energy vector for energy transition. Its production from renewable feedstock like ethanol is suitable for many applications. The performance of a Ni catalyst supported on samaria-doped ceria in the production of hydrogen by the reforming of ethanol is investigated, adding Sm2O3 to CeO2 in molar ratios of 1:9, 2:8, and 3:7. A CeO2-supported Ni catalyst was also evaluated for comparative purposes. The supports were prepared by the coprecipitation method and Ni was incorporated by incipient wetness impregnation to obtain catalysts with a Ni/(Ce+Sm) molar ratio of 4/6. The catalysts were characterized by a nitrogen adsorption isotherm, X-ray diffraction (XRD), transmission electron microscopy (TEM), and X-ray photoelectron spectroscopy (XPS). Increasing Sm2O3 content leads to a more homogeneous distribution of Sm2O3 and Ni particles on the support, and higher oxygen mobility, favoring the catalytic properties. The catalyst with a Sm2O3/CeO2 molar ratio of 3/7 showed outstanding behavior, with an average ethanol conversion of 97%, hydrogen yield of 68%, and great stability. The results suggest that the main route for hydrogen production is ethanol dehydrogenation, followed by steam reforming of acetaldehyde, and acetone and ethylene formation are promoted by increasing Sm content in the outer surface of the catalyst.
Mesenchymal Stem-Cell-Derived Exosomes as Novel Drug Carriers in Anti-Cancer Treatment: A Myth or Reality?
Authors: Harrell Carl Randall , Volarevic Ana , Djonov Valentin , Volarevic Vladislav
Published: January 2025

Although cancer therapy has significantly advanced in recent decades, patients and healthcare professionals are still quite concerned about adverse effects due to the non-targeted nature of currently used chemotherapeutics. Results obtained in a large number of recently published experimental studies indicated that mesenchymal stem-cell-derived exosomes (MSC-Exos), due to their biocompatibility, ability to cross biological barriers, and inherent targeting capabilities, could be used as a promising drug-delivery system for anti-cancer therapies. Their lipid bilayer protects cargo of anti-cancer drugs, making them excellent candidates for the delivery of therapeutic agents. MSC-Exos could be engineered to express ligands specific for tumor cells and, therefore, could selectively deliver anti-cancer agents directly in malignant cells, minimizing side effects associated with chemotherapeutic-dependent injury of healthy cells. MSC-Exos can carry multiple therapeutic agents, including anti-cancer drugs, micro RNAs, and small bioactive molecules, which can concurrently target multiple signaling pathways, preventing tumor growth and progression and overcoming resistance of tumor cells to many standard chemotherapeutics. Accordingly, in this review article, we summarized current knowledge and future perspectives about the therapeutic potential of MSCs-Exos in anti-cancer treatment, opening new avenues for the targeted therapy of malignant diseases.
Quality Improvement Project to Improve Adherence to Best Practices to Decrease Incidence of Necrotizing Enterocolitis in Preterm Infants
Authors: Allana Ahreen , Bashir Sidra , Hand Ivan
Published: January 2025

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC in our level III NICU. Methods: Our QI team implemented a bundle of nine of these evidenced-based practices for NEC prevention and disseminated information among the NICU team. Items in the bundle included delayed cord clamping, parental education on the importance of breast milk, obtaining early consent for donor breast milk, adherence to the unit’s feeding protocol, avoiding routine gastric residual checks, the discontinuation of antibiotics at 48 h once blood cultures were negative, restricting the use of antacids, nasogastric tube (NGT) replacement every 72 h and the removal of central lines once a feeding volume of 100 mL/kg/day was attained. The baseline incidence of clinically proven NEC was found to be 7% at the start of the intervention. We conducted two Plan-Do-Study-Act (PDSA) cycles over a 2-year period from 1 January 2021 to 31 December 2022. Results: There were 74 infants who met the inclusion criteria of being <1500 g and/or at <32 weeks of gestation. The adherence to our process measures improved over the course of our two PDSA cycles from 78% adherence to 91.6%, p < 0.05. The incidence of NEC decreased from 7% to 5.3% following the first PDSA cycle, a 24% reduction. Following the second PDSA cycle, the incidence decreased even further from 5.3% to 2.8%, a 60% reduction from baseline, although this was not statistically significant due to the small sample size. Conclusions: In this QI initiative, we achieved improved adherence to several evidence-based interventions over a two-year period with the aim of reducing the incidence of NEC at our institution.
Survey of Indigenous Bacteria as a Simplified Alternative to Produce Self-Healing Cementitious Matrices
Authors: Muller Vinicius , Kramer Henrique dos Santos , Pacheco Fernanda , Ehrenring Hinoel Zamis , Christ Roberto , Valiati Victor , Modolo Regina Célia Espinosa , Fonseca Tutikian Bernardo
Published: January 2025

The cracks in concrete serve as pathways for aggressive agents, leading to deterioration. One approach to addressing these cracks and enhancing structures durability is the use of self-healing agents, such as bacteria used to heal cracks in cementitious matrices. Bacteria can be found in several environments, and their identification and healing viability must be evaluated prior to their use in cementitious matrices. In this study, distinct indigenous bacteria were collected from soil in industrial yards associated with the cement industry. These bacteria were identified and incorporated in cement and mortar mixtures with 18% entrained air. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed to characterize the formed products, and compressive strength testing was conducted to evaluate the mechanical properties of the mortars. The identified bacteria were of the genus Cronobacter, Citrobacter, Bacillus, and Pseudomonas, and their potential to form self-healing products was evaluated with microscopic and mineral analyses. Results showed that all bacteria could form calcite (CaCO3) crystals, with full crack healing in some of the samples. Mechanical testing indicated increases in average compressive strength of up to 108% at 28 days with respect to a reference mortar.
Calcium Antagonist-Induced Gingival Overgrowth: A Case Report and Literature Review
Authors: Speroni Stefano , Giuffrè Marco , Tura Tommaso , Al Jawaheri Qamar Ammar Salman , Antonelli Luca , Coccoluto Luca , Bortune Giulia , Sarnelli Francesco , Abati Silvio
Published: January 2025

Background: Drug-induced gingival enlargement is a commonly documented adverse effect in patients administered with calcium antagonist medications. Nifedipine is the medicine most frequently linked to instances of gingival enlargement; nevertheless, amlodipine, likewise a calcium antagonist, can elicit this adverse effect. This case report aims to detail a case of amlodipine-induced gingival hyperplasia, emphasizing the significance of a multidisciplinary approach and outlining its therapy across various surgical phases. Methods: A 48-year-old hypertensive patient using amlodipine therapy presents with aberrant gingival tissue growth in the upper arch. Intraoral examination reveals localized inflammation and tissue enlargement in the papillae areas of the upper arch gingiva, leading to partial covering of the dental crowns. The patient experienced painful sensations and episodes of spontaneous bleeding in the enlarged gingival tissue. Following an initial professional dental hygiene treatment, which included root planning in the upper quadrants, and in consultation with the referring cardiologist, it was determined to discontinue amlodipine and initiate a replacement therapy with olmesartan medoxomil. Fifteen days following the cessation of amlodipine, surgical excision of the thickened interdental gingival tissues in the anterior region was conducted to obtain biopsies for histological confirmation of the observed pathological condition. Results: Histopathological examination validated the diagnosis of drug-induced gingival enlargement, characterized by chorion fibrosis and significant lymphoplasmacytic infiltration. Specifically, parakeratotic and acanthotic characteristics were seen in the gingival epithelium. Adjacent to the inflammatory regions, fibrosis was noted, along with the presence of cytoid bodies, which are typically linked to pathological diseases driven by inflammatory processes. These histological characteristics were consistent with the diagnosis of drug-induced gingival enlargement. Conclusions: A multidisciplinary approach involving the treating physician, dentist, and hygienist, incorporating drug replacement and targeted oral hygiene sessions, is crucial for the management and resolution of calcium channel blocker-induced gingival enlargement.
High Incidence of False Positives in EGFR S768I Mutation Detection Using the Idylla qPCR System in Non-Small Cell Lung Cancer Patients
Authors: Carnero-Gregorio Miguel , Perera-Gordo Enzo , de-la-Peña-Castro Vanesa , González-Martín Jesús María , Delgado-Sánchez Julio José , Rodríguez-Cerdeira Carmen
Published: January 2025

Background/Objectives: The accurate detection of EGFR mutations, particularly the rare S768I variant, is crucial for guiding treatment decisions in non-small cell lung cancer (NSCLC) patients. This study investigated the incidence of false positives in S768I mutation detection using the IdyllaTM qPCR system and compared results with next-generation sequencing (NGS). Methods: A prospective observational study was conducted at the Dr. Negrín University Hospital between July 2023 and July 2024. Six NSCLC patient samples with S768I variant detection by IdyllaTM were analyzed from all NSCLC cases tested during the study period. Initial testing was performed on tissue samples (Idylla1), followed by replicate analysis using extracted DNA (Idylla2). Results were compared with NGS as the reference method. Statistical analysis included the calculation of sensitivity, specificity, accuracy, and Kappa concordance index. Results: Initial Idylla testing showed an 80% false positive rate, with only one of five positive results confirmed by NGS. The first analysis demonstrated high sensitivity (100%) but low specificity (20%), with an accuracy of 0.333 and poor concordance with NGS (Kappa = 0.077). Repeat testing using extracted DNA showed improved performance, with increased accuracy (0.833) and better agreement with NGS (Kappa = 0.571). Analysis of amplification curves revealed that false positives typically showed normalized fluorescence values below 12 points, with no clear correlation between false positives and factors such as sample quantity or tumor content. Conclusions: While the IdyllaTM system shows high sensitivity for S768I detection, its initial specificity is problematic, leading to frequent false positives. These findings emphasize the importance of confirming positive S768I results through alternative methods like NGS, particularly when these results could influence therapeutic decisions. Results suggest the need to refine the system’s interpretation algorithms to improve specificity.
Development of a Children’s Visual Function Quality of Life (CVF-QoL) Instrument for Rural School-Going Children with Visual Impairments Within a South African Context: Item Generation and Validation
Authors: Magakwe Tshubelela Sello Simon , Hansraj Rekha , Xulu-Kasaba Zamadonda Nokuthula
Published: January 2025

Background: Assessing visual function and quality of life in children with visual impairments is crucial for understanding its impact and evaluating interventions. While tools exist for developed countries, there is a lack of instruments for rural school-going children in middle- to low-income countries. This study aimed to develop and validate an instrument to measure Children’s Visual Function Quality of Life (CVF-QoL) for South African children aged 6 to 17 with uncorrected refractive errors, visual impairments, or blindness. Methods: The CVF-QoL instrument was created through a literature review and focus group discussions with experts and children. Readability was assessed, resulting in two versions of the CVF-QoL instrument. The contents of both versions were validated by experts, and pre-testing was performed with school children aged 6–17 years. Results: From the literature review, 769 items were identified, and 477 statements were generated from focus group discussions. After merging and eliminating duplicates, 91 items were classified into eight domains. The tool was divided into Version 1.1 for ages 10–17 (89 items) and Version 2.1 for ages 6–9 (63 items), both demonstrating strong clarity, coherence, and relevance. Conclusions: The CVF-QoL instruments are valid for evaluating the quality of life-related to visual function among rural school-going children with visual impairments in South Africa. This instrument thus provides an additional QoL tool to those already existing that may be more appropriate for measuring quality of life for rural school-going children in low- and middle-income countries.
Ultradiluted Eupatorium perfoliatum Prevents and Alleviates SARS-CoV-2 Spike Protein-Induced Lung Pathogenesis by Regulating Inflammatory Response and Apoptosis
Authors: Roy Anirban , Sarkar Avipsha , Roy Asit Kumar , Ghorai Tanusree , Nayak Debadatta , Kaushik Subhash , Das Satadal
Published: January 2025

Background/Objectives: SARS-CoV-2 provokes acute oxidative stress in the lungs via cytokines, inflammatory mediators, and apoptotic factors, which might cause alveolar injury followed by severe respiratory syndrome during COVID-19 infection. The lack of particular antivirals for SARS-CoV-2 has opened novel avenues of complementary and alternative medicine as a potential remedy. The current study explored the mechanistic role of the ultradiluted formulation of Eupatorium (UDE) against SARS-CoV-2 recombinant S protein-mediated oxidative stress and mitochondriopathy. Methods: Cell line and BALB/c mice were used to report that SARS-CoV-2 S protein caused an inflammatory response and subsequent cytokine storm via the NF-κB pathway in the lung along with oxidative damage. Morphological examination was performed using DAPI staining and histology for treated cells and lung tissues of animals, respectively. The molecular mechanism of action of UDE was investigated through qRT-PCR for the genetic expressions of various cytokines, inflammatory, and apoptotic mediators; ELISA, immunofluorescence, immunohistochemistry, and Western blot for the translational expression of the same molecules assayed for genetic expressions; and biochemical assays for various enzymes and ROS. Results: UDE treatment suppressed the inflammatory cell infiltration and tissue-level oxidative stress and safeguarded mitochondrial integrity from free radical-mediated oxidative damage. Additionally, UDE played a direct role in restoring cellular redox homeostasis and reducing the inflammatory response by suppressing NF-κB, IL-1β, IL-18, caspase-1 expression, and ROS formation. Further, a plausible mechanism of action of UDE against S protein-induced damage was proposed. Conclusions: This study described a novel therapeutic approach against S protein-mediated hyperinflammation, apoptosis, and oxidative damage. Hence, UDE may be considered as a prospective alternative to combat life-threatening consequences of SARS-CoV-2 infection.
Semi-Nonlinear Deep Efficient Reconstruction for Unveiling Linear and Nonlinear Spatial Features of the Human Brain
Authors: Zidan Arif Hassan , Jahin Afrar , Bao Yu , Zhang Wei
Published: January 2025

Deep learning has become indispensable for identifying hierarchical spatial features (SFs), which are crucial for linking neurological disorders to brain functionality, from functional Magnetic Resonance Imaging (fMRI). Unfortunately, existing methods are constrained by architectures that are either linear or nonlinear, limiting a comprehensive categorization of spatial features. To overcome this limitation, we introduce the Semi-Nonlinear Deep Efficient Reconstruction (SENDER) framework, a novel hybrid approach designed to simultaneously capture both linear and nonlinear spatial features, providing a holistic understanding of brain functionality. In our approach, linear SFs are formed by directly integrating multiple spatial features at shallow layers, whereas nonlinear SFs emerge from combining partial regions of these features, yielding complex patterns at deeper layers. We validated SENDER through extensive qualitative and quantitative evaluations with four state-of-the-art methods. Results demonstrate its superior performance, identifying five reproducible linear SFs and eight reproducible nonlinear SFs.
Extension of Interval-Valued Hesitant Fermatean Fuzzy TOPSIS for Evaluating and Benchmarking of Generative AI Chatbots
Authors: Ilieva Galina
Published: January 2025

To aid in the selection of generative artificial intelligence (GAI) chatbots, this paper introduces a fuzzy multi-attribute decision-making framework based on their key features and performance. The proposed framework includes a new modification of the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), adapted for an interval-valued hesitant Fermatean fuzzy (IVHFF) environment. This TOPSIS extension addresses the limitations of classical TOPSIS in handling complex and uncertain data capturing detailed membership degrees and representing hesitation more precisely. The framework is applicable for both static and dynamic evaluations of GAI chatbots in crisp or fuzzy assessments. Results from a practical example demonstrate the effectiveness of the proposed approach for comparing and ranking GAI chatbots. Finally, recommendations are provided for selecting and implementing these conversational agents in various applications.