bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case of Bullous Pemphigoid with Significant Infiltration of CD4-Positive T Cells during Treatment with Pembrolizumab, Accompanied by Pembrolizumab-Induced Multi-Organ Dysfunction
Authors: Mima Yoshihito , Ohtsuka Tsutomu , Ebato Ippei , Nakazato Yoshimasa , Norimatsu Yuta
Published: September 2024

Immune checkpoint inhibitors (ICIs) activate T cells, causing immune-related adverse events (irAEs). Skin manifestations are common among irAEs, but ICI-associated bullous pemphigoid (BP) is rare. Inhibiting programmed death (PD)-1 signaling, in addition to causing epitope spreading, may disrupt B and T cell balance, causing excessive autoantibody production against the skin’s basement membrane, leading to BP. A 70-year-old woman developed late-onset multi-organ irAEs, including diarrhea, thyroid dysfunction, and BP, while receiving pembrolizumab, a PD-1 inhibitor. This highlights the long-term risk of irAEs, which can occur 2–3 years after starting ICIs. In cases of multi-organ irAE, C-reactive protein levels and neutrophil/lymphocyte ratio are often low. These characteristics were observed in our case. Few papers address multiple organ involvement, highlighting the need to consider irAEs in a multi-organ context. While it is known that drug-induced skin reactions worsen as blood eosinophil counts increase, in our case, the eosinophil count remained normal, suggesting that ICI-associated BP might have been controlled without discontinuing the ICI and through tapering of low-dose oral prednisone treatment. Additionally, in this case, significant CD4-positive T cell infiltration was observed in the immunostaining examination of the blisters, indicating that severe CD4-positive T cell infiltration induced by the ICI might have led to multi-organ involvement, including severe diarrhea. Few reports focus on blood eosinophil counts in BP cases or discuss CD4 and CD8 immunostaining in BP cases. Therefore, future research should explore the relationship between blood eosinophil counts, immunostaining results, and the prognosis of irAEs, including BP, in treatment courses.
Diagnosis and Treatment of Infections in the Burn Patient
Authors: Greenhalgh David G. , Kiley John L.
Published: September 2024

Infection is very common in burn patients because they lose the primary barrier from microorganism invasion, the skin. While there are attempts to prevent infections, topical antimicrobials and systemic prophylaxis tend to lead to more resistant organisms. After the initial resuscitation, the most common cause of death is from sepsis and multiple organ dysfunction syndrome. The diagnosis is difficult in the burn population because the constant exposure from the open wound leads to an inflammatory response that leads to persistent hypermetabolism. This paper reviews the current understanding and treatment of infection and sepsis in burns.
A Systematic Review of Synthetic Data Generation Techniques Using Generative AI
Authors: Goyal Mandeep , Mahmoud Qusay H.
Published: September 2024

Synthetic data are increasingly being recognized for their potential to address serious real-world challenges in various domains. They provide innovative solutions to combat the data scarcity, privacy concerns, and algorithmic biases commonly used in machine learning applications. Synthetic data preserve all underlying patterns and behaviors of the original dataset while altering the actual content. The methods proposed in the literature to generate synthetic data vary from large language models (LLMs), which are pre-trained on gigantic datasets, to generative adversarial networks (GANs) and variational autoencoders (VAEs). This study provides a systematic review of the various techniques proposed in the literature that can be used to generate synthetic data to identify their limitations and suggest potential future research areas. The findings indicate that while these technologies generate synthetic data of specific data types, they still have some drawbacks, such as computational requirements, training stability, and privacy-preserving measures which limit their real-world usability. Addressing these issues will facilitate the broader adoption of synthetic data generation techniques across various disciplines, thereby advancing machine learning and data-driven solutions.
A CMOS Rail-to-Rail Class AB Second-Generation Voltage Conveyor and Its Application in a Relaxation Oscillator
Authors: Djurić Radivoje , Popović-Božović Jelena
Published: September 2024

In this paper, we present a CMOS rail-to-rail second-generation voltage conveyor (VCII) suitable for low power applications, implemented in 180 nm CMOS technology with a supply voltage of ± 0.9 V. The proposed VCII consists of a current and voltage buffer operating in class AB. At the input of the voltage buffer, there is a bulk-driven differential amplifier, which provides a rail-to-rail input common-mode voltage. A common source output stage in class AB provides rail-to-rail at the output of the voltage buffer. The transistors are designed to operate in moderate inversion, achieving a relatively large current and voltage buffer bandwidth of 298.3 MHz and 173.2 MHz, respectively, with a power consumption of 157 μW. A sine wave with an amplitude of 1.5 Vpp and a frequency of 1 MHz on the output buffer has a total harmonic distortion of only 0.29%. The application of VCII in a relaxation oscillator with a frequency of up to 10 MHz is demonstrated, as well as its comparative characteristics with reference to other relevant square-wave generators published in the literature.
Three-Dimensional Object Detection Network Based on Multi-Layer and Multi-Modal Fusion
Authors: Zhu Wenming , Zhou Jia , Wang Zizhe , Zhou Xuehua , Zhou Feng , Sun Jingwen , Song Mingrui , Zhou Zhiguo
Published: September 2024

Cameras and LiDAR are important sensors in autonomous driving systems that can provide complementary information to each other. However, most LiDAR-only methods outperform the fusion method on the main benchmark datasets. Current studies attribute the reasons for this to misalignment of views and difficulty in matching heterogeneous features. Specially, using the single-stage fusion method, it is difficult to fully fuse the features of the image and point cloud. In this work, we propose a 3D object detection network based on the multi-layer and multi-modal fusion (3DMMF) method. 3DMMF works by painting and encoding the point cloud in the frustum proposed by the 2D object detection network. Then, the painted point cloud is fed to the LiDAR-only object detection network, which has expanded channels and a self-attention mechanism module. Finally, the camera-LiDAR object candidates fusion for 3D object detection(CLOCs) method is used to match the geometric direction features and category semantic features of the 2D and 3D detection results. Experiments on the KITTI dataset (a public dataset) show that this fusion method has a significant improvement over the baseline of the LiDAR-only method, with an average mAP improvement of 6.3%.
Analysis of the Effects of Different Nitrogen Application Levels on the Growth of Castanopsis hystrix from the Perspective of Three-Dimensional Reconstruction
Authors: Wang Peng , Wang Xuefeng , Chen Xingjing , Shi Mengmeng
Published: September 2024

Monitoring tree growth helps operators better understand the growth mechanism of trees and the health status of trees and to formulate more effective management measures. Computer vision technology can quickly restore the three-dimensional geometric structure of trees from two-dimensional images of trees, playing a huge role in planning and managing tree growth. This study used binocular reconstruction technology to measure the height, canopy width, and ground diameter of Castanopsis hystrix and compared the growth differences under different nitrogen levels. In this research, we proposed a wavelet exponential decay thresholding method for image denoising. At the same time, based on the traditional semi-global matching (SGM) algorithm, a cost search direction is added, and a multi-line scanning semi-global matching (MLC-SGM) algorithm for stereo matching is proposed. The results show that the wavelet exponential attenuation threshold method can effectively remove random noise in red cone images, and the denoising effect is better than the traditional hard-threshold and soft-threshold denoising methods. The disparity images produced by the MLC-SGM algorithm have better disparity continuity and noise suppression than those produced by the SGM algorithm, with more minor measurement errors for C. hystrix growth factors. Medium nitrogen fertilization significantly promotes the height, canopy width, and ground diameter growth of C. hystrix. However, excessive fertilization can diminish this effect. Compared to tree height, excessive fertilization has a more pronounced impact on canopy width and ground diameter growth.
Unveiling Acetobacter syzygii from Tibetan Kefir Grain: Fermentation-Enhanced Anti-Tyrosinase, and Anti-Melanin
Authors: Zhong Lin , He Qi , Xu Meng , Chen Fang-Fang , Li Fei , Chen Yu-Pei
Published: September 2024

Acetobacter syzygii CCTCC M 2022983 was isolated and characterized from Tibetan kefir grains, which is utilized as a functional food with diverse bioactive properties. After 6 days of fermentation by A. syzygii, Acetobacter fermented extract (AFE) showed significantly higher antioxidant, anti-tyrosinase, and anti-melanin effects compared to the unfermented yeast extract (UFY). Western blotting confirmed that AFE reduced melanogenesis-related proteins (MITF, TYR, TRP-1, TRP-2). LC-MS/MS analysis identified 4-hydroxybenzoic acid as abundant in AFE, contributing to its antioxidant capacity. Succinic acid and citric acid emerged as the major compound and a type of mixed inhibitor against mushroom tyrosinase, with IC50 values of 2.943 mM and 1.615 mM, respectively. Fluorescence spectra analysis revealed that these acids caused conformational changes in tyrosinase. Moreover, succinic acid and citric acid prevented L-DOPA from auto-oxidation with IC50 values of 0.355 mM and 0.261 mM, respectively. Molecular docking analysis suggested that these acids interacted with the association of the H and L subunits of tyrosinase, thereby reducing its stability. In B16-F10 cells, succinic and citric acids significantly reduced melanin production in a dose-dependent manner. Thus, succinic acid and citric acid revealed promising potential for applications in the food and medicine industries as melanogenesis inhibitors due to their safety.
Natural Food Components as Biocompatible Carriers: A Novel Approach to Glioblastoma Drug Delivery
Authors: Rajendran Arunraj Tharamelveliyil , Vadakkepushpakath Anoop Narayanan
Published: September 2024

Efficient drug delivery methods are crucial in modern pharmacotherapy to enhance treatment efficacy, minimize adverse effects, and improve patient compliance. Particularly in the context of glioblastoma treatment, there has been a recent surge in interest in using natural dietary components as innovative carriers for drug delivery. These food-derived carriers, known for their safety, biocompatibility, and multifunctional properties, offer significant potential in overcoming the limitations of conventional drug delivery systems. This article thoroughly overviews numerous natural dietary components, such as polysaccharides, proteins, and lipids, used as drug carriers. Their mechanisms of action, applications in different drug delivery systems, and specific benefits in targeting glioblastoma are examined. Additionally, the safety, biocompatibility, and regulatory considerations of employing food components in drug formulations are discussed, highlighting their viability and future prospects in the pharmaceutical field.
Research on Slope Early Warning and Displacement Prediction Based on Multifractal Characterization
Authors: Sun Xiaofei , Su Ying , Yang Chengtao , Tan Junzhe , Liu Dunwen
Published: September 2024

The occurrence of landslide hazards significantly induces changes in slope surface displacement. This study conducts an in-depth analysis of the multifractal characteristics and displacement prediction of highway slope surface displacement sequences. Utilizing automated monitoring devices, data are collected to analyze the deformation patterns of the slope surface layer. Specifically, the multifractal detrended fluctuation analysis (MF-DFA) method is employed to examine the multifractal features of the monitoring data for slope surface displacement. Additionally, the Mann–Kendall (M-K) method is combined to construct the α indicator and f(α) indicator criteria, which provide early warnings for slope stability. Furthermore, the long short-term memory (LSTM) model is optimized using the particle swarm optimization (PSO) algorithm to enhance the prediction of slope surface displacement. The results indicate that the slope displacement monitoring data exhibit a distinct fractal sequence characterized by h(q), with values decreasing as the fluctuation function q decreases. Through this study, the slope landslide warning classification has been determined to be Level III. Moreover, the PSO-LSTM model demonstrates superior prediction accuracy and stability in slope displacement forecasting, achieving a root mean square error (RMSE) of 0.72 and a coefficient of determination (R2) of 91%. Finally, a joint response synthesis of the slope landslide warning levels and slope displacement predictions resulted in conclusions. Subsequent surface displacements of the slope are likely to stabilize, indicating the need for routine monitoring and inspection of the site.
Landscapes of Watermills: A Rural Cultural Heritage Perspective in an East-Central European Context
Authors: Dragan Alexandru , Crețan Remus , Terian Mădălina Ionela
Published: September 2024

Recent studies in rural heritage tourism have highlighted that watermills could stand as an important part of the pre-industrial tourism heritage. We contribute to rural heritage tourism by basing our study on the perceptions of tourists and local officials on the Rudăria Watermills, Romania. Based on survey and interview data, we document the strengths and limits of local watermills for tourism and describe the entrepreneurial agents involved in path development. Our findings point to the important role played by a local NGO in developing a path for tourism for the watermills, as well as the active involvement of local authorities and other local cultural leaders in including the mills in national and international tourism circuits.
The Ceramic Production and Distribution Network in the Ancient Kingdom of Navarre (Spain) during the 12th–15th Centuries
Authors: Ruiz-Ardanaz Iván , Araiz-González Sayoa , Lasheras Esther , Durán Adrián
Published: September 2024

The Kingdom of Navarre was a Christian kingdom located in the north of the Iberian Peninsula during the Middle Ages. Its location on the west of the isthmus between the Iberian Peninsula and the European continent allowed an exchange of cultural currents. The main pottery production centres were in Estella, Lumbier, Pamplona, Tafalla, and Tudela. Ceramic pastes from various mediaeval sites were analysed for both elemental and mineralogical composition determination. The results were evaluated using Principal Component Analysis and allowed us to identify each production centre. Each manufacturing centre showed a different and characteristic composition of raw materials. Ceramics from Tudela were Ca-, Mg-, Na-, and Sr-rich. Ceramics from Estella were richer in Al, K, and Ti. Ca, Sc, and Sr contents were higher in Tafalla ceramics. Lumbier ceramics stood out for being enriched in Si, Mn, Fe, and Zr. Pamplona ceramics showed intermediate values. The analysis of samples from other Navarrese locations allowed us to begin to define what the commercial ceramic network in the Kingdom of Navarre was like during the Middle Ages. Therefore, two aims were defined for this paper: to characterise the ceramic pastes for each of the producing centres and to know where the ceramics were exported to.
Ultraviolet-C Light Effects in Actinidia spp. Infected by Pseudomonas syringae pv. actinidiae
Authors: Lucioli Simona , Bollanti Sarah , Murra Daniele , Nota Paolo , Scortichini Marco , Caboni Emilia , Lai Antonia , Bacchetta Loretta , Di Lazzaro Paolo
Published: September 2024

Several studies have demonstrated that ultraviolet-band-C (UV-C) irradiation can enhance plants’ natural resistance to pathogens and diseases. A suitable dose of UV-C radiation induces the production of metabolites that strengthen plant defenses, an effect known as “hormesis”. Hormesis presents a promising alternative that could supplement and reduce the use of pesticides, which pose risks to the environment and human health. This paper investigates the effects of UV-C radiation emitted by an array of Light-Emitting Diodes (LEDs) in generating a hormetic response in three kiwifruit species, namely A. chinensis var. deliciosa cv. Hayward, A. chinensis var. chinensis cv. Soreli®, and A. arguta plantlets, grown in vitro and in pots, exposed to the pathogen Pseudomonas syringae pv. actinidiae (Psa) either before or after UV-C irradiation. Analyses of morpho-physiological parameters and spectrophotometric assays were conducted to evaluate changes in chlorophyll a and b content, carotenoids, total phenols, and antioxidant activity in relation to the UV-C irradiation. Results indicate partial protection against Psa infection and increased levels of chlorophylls, carotenoids, polyphenols and antioxidant activity. The optimal UV-C dose was determined to be 2.2 kJ/m2 for in vitro shoots and 1.3 kJ/m2, for ex vitro plants.
Design, Synthesis, and Characterization of Novel Cannabidiol-Based Derivatives with Potent Antioxidant Activities
Authors: Peretz Eliav , Musa Sanaa
Published: September 2024

In recent years, extensive research has focused on cannabidiol (CBD), a well-studied non-psychoactive component of the plant-derived cannabinoids. CBD has shown significant therapeutic potential for treating various diseases and disorders, including antioxidants and anti-inflammatory effects. Due to the promising therapeutic effect of CBD in a wide variety of diseases, synthetic derivatization of this compound has attracted the attention of drug discovery in both industry and academia. In the current research, we focused on the derivatization of CBD by introducing Schiff base moieties, particularly (thio)-semicarbazide and aminoguanidine motifs, at the 3-position of the olivetolic ring. We have designed, synthesized, and characterized new derivatives based on CBD’s framework, specifically aminoguanylhydrazone- and (thio)-semicarbazones-CBD-aldehyde compounds. Their antioxidant potential was assessed using FRAP and DPPH assays, alongside an evaluation of their effect on LDL oxidation induced by Cu2+ and AAPH. Our findings suggest that incorporating the thiosemicarbazide motif into the CBD framework produces a potent antioxidant, warranting further investigation.
Identity-Based Online/Offline Encryption Scheme from LWE
Authors: Zuo Binger , Li Jiguo , Zhang Yichen , Shen Jian
Published: September 2024

With quantum computers, the quantum resistance of cryptographic systems has gradually attracted attention. To overcome the shortcoming of existing identity-based encryption (IBE) schemes in resisting quantum attacks, we introduce an IBE scheme based on learning with errors (LWE). In addition, devices with limited computing power are becoming increasingly common in practice, making it increasingly important to improve the efficiency of online computation of encryption algorithms. The classic solution is to directly improve the efficiency of the Gaussian sampling algorithm, thereby increasing the overall efficiency of the scheme. However, our scheme combines the efficient Gaussian sampling algorithm, G-trapdoor, with online/offline method to further improve the online encryption efficiency of the encryption algorithm. Our scheme completes partial computation before knowing the message and receiver’s identity, and once the message and receiver’s identity are obtained, the online part encryption can be efficiently completed. We construct an identity-based online/offline encryption (IBOOE) scheme from LWE with G-trapdoor, improve the efficiency of online encryption while achieving quantum resistant security. We prove the scheme’s security under the standard model for chosen-plaintext attack (CPA). By comparing with relevant schemes in terms of experiments and analysis, our scheme has improved efficiency by 65% to 80% compared to the classical LWE IBE scheme (increasing with LWE security parameters), and by 60% to 70% compared to the recent IBE scheme from LWE. This greatly improves the efficiency of online computing for low-power encryption devices while ensuring security.
Adopting Business Intelligence Techniques in Healthcare Practice
Authors: Huang Hui-Chuan , Wang Hui-Kuan , Chen Hwei-Ling , Wei Jeng , Yin Wei-Hsian , Lin Kuan-Chia
Published: September 2024

With the rapid development of information technology, digital health technologies have become increasingly prevalent in the field of healthcare. In this study, business intelligence (BI) techniques were combined with research-based prediction models to increase the efficiency and quality of healthcare practices. A data scenario involving 200 older adults with various measurements, including health beliefs, social support, self-efficacy, and disease duration, was used to establish a medication adherence prediction model in a BI system. A regression model, logistic regression model, tree model, and score-based prediction model were used to predict medication adherence among older adults. The developed BI-based prediction model has visualization, real-time feedback, and data updating functionality. These features enhanced the effectiveness of prediction models in clinical practice. Healthcare professionals can incorporate the proposed system into their care practice for health assessments and management, and patients can use the system to manage themselves. The developed BI-based care system can also be used to achieve effective communication and shared decision-making between care managers and patients. Further empirical studies integrating prediction models into the proposed BI system for assessment, management, and decision-making in healthcare practice are warranted.
Effects of Environmental Factors on the Diversity of Grasshopper Communities along Altitude Gradients in Xizang, China
Authors: Li Yonghui , Liu Qing , Zhang Xiaoming , Mao Benyong , Yang Guohui , Shi Fuming , Bi Jingui , Ma Zhibin , Tang Guowen
Published: September 2024

To determine the grasshopper species composition, altitudinal distribution patterns, and their main drivers, we conducted a study in Xizang using 33 sample plots ranging from 600 to 4100 m. Grasshoppers were collected from August to October during 2020–2022 using sweep nets. A total of 1159 grasshoppers from six families, 28 genera, and 44 species were identified, with Omocestus cuonaensis and Aserratus eminifrontus as the dominant species, comprising 30.03% and 10.26% of total grasshoppers, respectively. The results showed that species richness and the Margalef richness index of grasshopper communities decreased significantly (p < 0.05) with increasing altitude, peaking at 1100–1600 m and lowest values at 2600–3100 m. Similarly, the Shannon–Wiener index and Simpson dominance index also decreased significantly (p < 0.05) with an increase in altitude, showing the highest and lowest values at 600–1100 m and 3100–3600 m, respectively. The Jaccard similarity coefficients among grasshopper communities varied from 0 to 0.40 across altitudinal gradients, indicating different degrees of dissimilarity. The results of Pearson correlation analyses showed that the Shannon–Wiener index, species richness, Margalef richness index, and Simpson dominance index of grasshopper communities were significantly negatively correlated with the temperature factors and soil pH, but they were significantly positively correlated with the moisture factors. Hierarchical partitioning identified annual mean temperature–daily difference, precipitation in the coldest season, and driest month precipitation as the primary factors explaining variance in grasshopper community diversity in Xizang. These findings provided greater insights into the mechanisms underlying insect community structure, distribution patterns, and diversity in Xizang ecosystems, including implications for the effects of global warming on insect communities.
Use of a Fundus Image-Based Titration Strategy for Selective Retina Therapy for Central Serous Chorioretinopathy
Authors: Jeon Seung Hee , Kim Minhee , Roh Young-Jung
Published: September 2024

Background/Objectives: This study evaluated the clinical outcomes of selective retina therapy (SRT) for treating central serous chorioretinopathy. A fundus image-based titration method was used for laser irradiation. Methods: This retrospective cohort study included 29 eyes (29 patients) that underwent SRT for CSC. Both the pulse energy and number of micropulses were adjusted according to the fundus image. Mean best-corrected visual acuity (BCVA), central foveal thickness (CFT), and subretinal fluid (SRF) height were measured 1, 2, 3, 4, and 6 months after SRT. Mean deviation (MD) was measured using microperimetry at 3 and 6 months post-treatment. Results: At 6 months after SRT treatment, SRF was completely resolved in 89.7% of cases (26/29 eyes). The mean Snellen BCVA significantly improved from 0.34 ± 0.31 logMAR (logarithm of the minimum angle of resolution) (20/40) at baseline to 0.24 ± 0.24 logMAR (20/32) at 6 months (p = 0.009). The 0.1 improvement in mean BCVA is equivalent to a 5-letter gain on the ETDRS chart. The mean CFT decreased significantly from 309.31 ± 81.6 μm at baseline to 211.07 ± 50.21 μm at 6 months (p < 0.001). The mean SRF height also decreased significantly from 138.36 ± 56.78 μm at baseline to 23.75 ± 61.19 μm at 6 months (p < 0.001). The mean MD was improved from −1.56 ± 1.47 dB at baseline to −1.03 ± 2.43 dB at 6 months (p = 0.07) after treatment. Conclusions: SRT using fundus image-based titration can yield favorable functional and anatomical outcomes in the treatment of CSC.
Unsupervised Pattern Analysis to Differentiate Multiple Sclerosis Phenotypes Using Principal Component Analysis on Various MRI Sequences
Authors: van der Weijden Chris W. J. , Pitombeira Milena S. , Peretti Débora E. , Campanholo Kenia R. , Kolinger Guilherme D. , Rimkus Carolina M. , Buchpiguel Carlos Alberto , Dierckx Rudi A. J. O. , Renken Remco J. , Meilof Jan F. , de Vries Erik F. J. , de Paula Faria Daniele
Published: September 2024

Background: Multiple sclerosis (MS) has two main phenotypes: relapse-remitting MS (RRMS) and progressive MS (PMS), distinguished by disability profiles and treatment response. Differentiating them using conventional MRI is challenging. Objective: This study explores the use of scaled subprofile modelling using principal component analysis (SSM/PCA) on MRI data to distinguish between MS phenotypes. Methods: MRI scans were performed on patients with RRMS (n = 30) and patients with PMS (n = 20), using the standard sequences T1w, T2w, T2w-FLAIR, and the myelin-sensitive sequences magnetisation transfer (MT) ratio (MTR), quantitative MT (qMT), inhomogeneous MT ratio (ihMTR), and quantitative inhomogeneous MT (qihMT). Results: SSM/PCA analysis of qihMT images best differentiated PMS from RRMS, with the highest specificity (87%) and positive predictive value (PPV) (83%), but a lower sensitivity (67%) and negative predictive value (NPV) (72%). Conversely, T1w data analysis showed the highest sensitivity (93%) and NPV (89%), with a lower PPV (67%) and specificity (53%). Phenotype classification agreement between T1w and qihMT was observed in 57% of patients. In the subset with concordant classifications, the sensitivity, specificity, PPV, and NPV were 100%, 88%, 90%, and 100%, respectively. Conclusions: SSM/PCA on MRI data revealed distinctive patterns for MS phenotypes. Optimal discrimination occurred with qihMT and T1w sequences, with qihMT identifying PMS and T1w identifying RRMS. When qihMT and T1w analyses align, MS phenotype prediction improves.
Dietary Counseling Outcomes in Patients with Lung Cancer in an Upper-Middle-Income Country: An Open-Label Randomized Controlled Trial
Authors: Chewaskulyong Busyamas , Malairungsakul Haritchanan , Buranapin Supawan , Jesadaporn Panas , Ketpueak Thanika , Suksombooncharoen Thatthan , Charoentum Chaiyut
Published: September 2024

Background: Malnutrition harms treatment outcomes, QoL, and survival in lung cancer patients. Effective dietary counseling can improve nutrition, but few randomized controlled trials have focused on lung cancer patients. The objective of this study was to determine if dietary counseling improves nutritional and treatment outcomes when compared to routine care. Methods: This open-label parallel RCT was conducted at Maharaj Nakorn Chiang Mai Hospital in Thailand. The investigators used computer-generated blocked randomization to assign patients to dietary counseling by a nutritionist or routine care. The nutritionist sessions occurred before treatment, with follow-ups at 3–4 weeks and 12 weeks. The primary outcome was the mean percentage change in the body weight of patients at 12 weeks. Secondary outcomes included changes in the BMI, nutrition score, QoL, serum albumin level, lymphocyte count, energy and protein intake, treatment response, PFS, and OS. Results: Between April 2020 and May 2022, after completing recruitment, 80 lung cancer patients were randomized: 43 to dietary counseling and 37 to routine care. The dietary counseling group showed significant benefits, with smaller decreases in body weight at 3–4 weeks (−0.8% vs. −2.6%, p = 0.05) and 12 weeks (−1.1% vs. −4.3%, p = 0.05). They also had higher energy and protein intake levels and better treatment response rates. The secondary outcomes and significant adverse events did not differ significantly between the groups. Conclusions: Dietary counseling helps to maintain body weight, maintain dietary intake, and enhance treatment responses in lung cancer patients. Although not all nutritional markers or survival outcomes were affected, these findings highlight the importance of early nutritional interventions.
Clinical History of Patients with Hypertrophic Cardiomyopathy—How to Improve the Initiation Process of the Diagnosis?
Authors: Bieczek Dominika , Ściślicka Adrianna , Adamiec Agnieszka , Cader Aleksandra , Wandasiewicz Monika , Basiaga Bartosz , Niemiec Małgorzata , Mizia-Stec Katarzyna
Published: September 2024

Background: Regardless of genetic origin and recommended screening methods, hypertrophic cardiomyopathy (HCM) is commonly diagnosed late in the advanced stages of the disease. The aim of this study was to analyse the case history of patients with HCM in order to obtain an initiation of the diagnostic process. Methods: This study was a retrospective, tertiary, single-centre cohort analysis of 85 consecutive pts with HCM (mean age at the time of HCM diagnosis: 51 ± 15 years; F/M: 42/43) who were hospitalized during the period from 1 January 2013 to 31 December 2022. Type of referral to the hospital, the reason for hospitalization as well as accompanying symptoms, comorbidities, and family history were analysed to obtain an initiation of the diagnostic process. The analysis was limited to hospitalizations in which the diagnosis of HCM was stated for the first time. Results: An analysis of the type of referral to the hospital revealed the following data: 18% of patients were admitted as urgent hospitalizations (UHs) and 82% as elective hospitalizations (EHs). Among the UHs, the majority of patients were transferred from another hospital (13%), and among the EHs, 65% of patients were referred from a specialised outpatient medical care (SMC) facility. The majority of patients in both the UH and EH groups were symptomatic: 84% in the EH group (the most common symptom was exertional dyspnea in 56% of pts) and 93% in the UH group (the most common symptom was syncope in 60% of pts). Among the analysed population, the most frequent comorbidities were systemic hypertension (51%), lipid metabolism disorders (38%) and obesity (23%). Conclusions: A diagnosis of HCM is often made at an advanced age in symptomatic patients, mainly during an EH. Nearly one-fifth of the Polish HCM population is diagnosed during a UH after a sudden event, which suggests the need for improvements in medical care in Poland.
Uncovering the Differences: How DLQI and WHO-5 Scores Vary in Moderate-to-Severe Psoriasis Patients Treated with Tildrakizumab 100 mg vs. 200 mg?
Authors: Trovato Emanuele , Dragotto Martina , Capalbo Eugenio , Cartocci Alessandra , Rubegni Pietro , Calabrese Laura
Published: September 2024

Background/Objectives: Psoriasis (PsO) is a chronic inflammatory skin disease that severely impacts patients’ quality of life (QoL). Its global prevalence is about 2%, with significant regional variations. PsO manifests in the form of erythematous and scaly plaques, causing intense pruritus and discomfort and limiting daily activities. The condition often includes comorbidities such as psoriatic arthritis, cardiovascular diseases, and metabolic syndrome, further deteriorating QoL. Psychological well-being is notably affected, with high levels of depression and anxiety due to the visible lesions, leading to social stigma and isolation. QoL indexes like WHO-QoL and SF-36 assess various well-being aspects, while patient-reported outcomes (PROs) provide a comprehensive understanding of PsO’s impact. However, there are no universally shared PROs in outpatient practice to fully understand the impact of the disease and associated therapies. This study aims to evaluate differences between DLQI and WHO-5 in adult patients with moderate-to-severe PsO treated with tildrakizumab 100 mg or 200 mg. Methods: The study was conducted at the University Hospital of Siena, Italy, from May 2023 to April 2024. Data from 15 patients treated with tildrakizumab 200 mg and 15 patients treated with tildrakizumab 100 mg, observed for at least 28 weeks, were recorded. Demographic data, PASI, DLQI, and WHO-5 scores were analyzed. Patients in the 100 mg group (G100) were selected to match the demographic characteristics of the 200 mg group (G200). Reduction rates of DLQI and WHO-5 were assessed at baseline values and after 4, 16, and 28 weeks. Results: Both groups experienced improvements in QoL. The group treated with 200 mg showed more pronounced and rapid reductions in DLQI and WHO-5 scores compared to the 100 mg group. WHO-5 demonstrated faster improvements in overall well-being than DLQI, indicating its greater sensitivity to changes in mental well-being and overall QoL. No differences in adverse events were observed between the two groups, with no major adverse events reported. Conclusions: In our study, WHO-5 proved more sensitive than DLQI in capturing well-being changes in PsO patients treated with tildrakizumab. However, a combined use of both WHO-5 and DLQI questionnaires should be encouraged in clinical practice. Furthermore, this study confirmed the superior QoL improvement associated with tildrakizumab 200 mg compared to 100 mg. Future research should explore the long-term impact on QoL and comparative effectiveness among other biologic therapies in diverse patient populations.
Cyclosporin A as an Add-On Therapy to a Corticosteroid-Based Background Treatment in Patients with COVID-19: A Multicenter, Randomized Clinical Trial
Authors: Llanos Jiménez Lucía , Alvarez-Alvarez Beatriz , Fonseca Aizpuru Eva , Peces-Barba Germán , Pindao Quesada Gloria , Rodríguez Nieto Mª Jesús , Ruiz-Hornillos Francisco J. , Seijo Maceiras Luis , Robles Barrena Ignacio , Mena-de-Cea Alvaro , Meijide-Míguez Héctor , Sánchez-Pernaute Olga
Published: September 2024

Background: In susceptible hosts, SARS-CoV2-induced hyperinflammation accounts for an increased mortality. The search of adjuvant immunomodulatory therapies has been ongoing ever since the pandemic outbreak. Aim: Our purpose was to evaluate the efficacy of cyclosporin A (CsA) as an add-on therapy to the standard of care (SoC) in patients with severe COVID-19 pneumonia. Methods: We conducted a randomized clinical trial in patients admitted to eight Spanish tertiary hospitals. Patients were stratified into two severity categories and randomized in a 1:1 ratio to receive a corticosteroid-based standard therapy with or without CsA. The primary endpoint was FiO2 recovery by Day 12 without relapses. Results: 109 patients were included and randomized, and 98 of them considered for the mITT population (51 assigned to the CsA + SoC group and 47 to the SoC group). A total of 35 (68.6%) patients from the CsA + SoC group and 32 (71.1%) patients from the SoC group reached the primary endpoint in the mITT analysis. No differences were found after stratification into age groups, in the severity level at admission, or in a combination of both. Overall, the time to FiO2 normalization was 7.4 days vs. 7.9 days in the experimental and control groups, respectively. Global mortality was 8.2%. Severe adverse events were uncommon and equally distributed between arms. Conclusion: The addition of CsA did not show differences over a corticosteroid-based treatment in the clinical course of the included patients. A better identification of candidates who will benefit from receiving immunomodulatory drugs is necessary in future studies.
Association between Flexibility, Measured with the Back-Scratch Test, and the Odds of Oxytocin Administration during Labour and Caesarean Section
Authors: Aparicio Virginia A. , Marín-Jiménez Nuria , Castro-Piñero Jose , Flor-Alemany Marta , Coll-Risco Irene , Baena-García Laura
Published: September 2024

Objective: This study explored whether assessing flexibility levels in clinical settings might predict the odds of oxytocin administration and caesarean section to stimulate labour. Methods: Pregnant women from the GESTAFIT Project (n = 157), participated in this longitudinal study. Maternal upper-body flexibility was assessed at 16 gestational weeks (g.w.) through the Back-scratch test. Clinical data, including oxytocin administration and type of birth, were registered from obstetric medical records. Results: Pregnant women who required oxytocin administration or had caesarean sections showed lower flexibility scores (p < 0.05 and p < 0.01, respectively). The receiver operating characteristic curve analysis showed that the Back-scratch test was able to detect the need for oxytocin administration ((area under the curve [AUC] = 0.672 (95% confidence interval [CI]: 0.682 (95% CI: 0.59–0.78, p = 0.001)). The AUC to establish the ability of flexibility to discriminate between vaginal and caesarean section births was 0.672 (95% CI: 0.60–0.77, p = 0.002). A Back-scratch test worse than 4 centimetres was associated with a ~5 times greater increased odds ratio of requiring exogenous oxytocin administration (95% CI: 2.0–11.6, p = 0.001) and a ~4 times greater increased odds ratio of having a caesarean section (95% CI: 1.7–10.2, p = 0.002). Conclusions: These findings suggest that lower flexibility levels at the 16th g.w. discriminates between pregnant women who will require oxytocin and those who will not, and those with a greater risk of a caesarean section than those with a vaginal birth. Pregnant women below the proposed Back-scratch test cut-offs at 16th g.w. might specifically benefit from physical therapies that include flexibility training.
Screening of Anal HPV Precancerous Lesions: A Review after Last Recommendations
Authors: Natale Alessio , Brunetti Tullio , Orioni Gionathan , Gaspari Valeria
Published: September 2024

Over the last decades, the incidence of anal cancer has increased worldwide. The discovery of the HPV virus as its primary cause and the natural progression of the disease, involving precancerous lesions, have resulted in significant interest in screening for anal cancer. The use of cytology testing, high-risk HPV DNA research, high-resolution anoscopy, and their combination has been adopted with variable success in detecting anal HPV precancerous lesions. Various studies have been carried out to evaluate the sensitivity and specificity of these techniques in different populations. High-risk populations for developing anal cancer have been identified through study of incidence and prevalence. Therefore, different scientific societies and experts worldwide have provided different recommendations for screening, but a universal approach has not yet been established. The inhomogeneity of different risk groups, the variable accessibility to specifical techniques, and the lack of data regarding the cost–benefit ratio of screening are the main problems to address in order to define a consensus guideline acceptable worldwide. The purpose of this paper is to provide a comprehensive review of the literature on HPV precancerous lesions and its screening, particularly after the release of recent recommendations.
Experimental Design and Optimization of Machining-Induced Cutting Force and Its Effect on Surface Roughness during Milling of Fiber-Reinforced Polymer Composites
Authors: Murthy B. R. N. , Harisha S. R. , Deepak G. Divya , Hiremath Pavan
Published: September 2024

In this study, we performed milling machining on carbon-epoxy polymer composites and jute-epoxy composites using a CNC vertical machining center. We focused on spindle speed, feed rate, depth of cut, and flute number and analyzed the cutting force and surface roughness. The optimal parameter combination to reduce cutting force in both composites was as follows: S = 600 rpm, FR = 100 mm/min, DOC = 0.25 mm, and FN = 6. The jute-epoxy composites required less cutting force (11.85 N/m2) compared to the carbon-epoxy composites (18.77 N/m2). The average surface roughness of the carbon-epoxy composites (6.685 µm) is higher than that of the jute-epoxy composites (3.08 µm). The type of reinforced material used greatly affects the cutting force and surface roughness during milling.
The Knowledge and Application of Economics in Healthcare in a High-Income Country Today: The Case of Belgium
Authors: Standaert Baudouin , Vandenberghe Désirée , Connolly Mark P. , Hellings Johan
Published: September 2024

Healthcare is a huge business sector in many countries, focusing on the social function of delivering quality health when people develop illness. The system is essentially financed by public funds based on the solidarity principle. With a large financial outlay, the sector must use economic evaluation methods to achieve better efficiency. The objective of our study was to evaluate and to understand how health economics is used today, taking Belgium as an example of a high-income country. The evaluation started with a historical view of healthcare development and ended with potential projections for its future. A literature review focused on country-specific evaluation reports to identify the health economic methods used, with a search for potential gaps. The first results indicated that Belgium in 2021 devoted 11% of its GDP, 17% of its total tax revenue, and 30% of the national Social Security Fund to health-related activities, totalizing EUR 55.5 billion spending. The main health economic method used was a cost-effectiveness analysis linked to budget impact, assigning reimbursable monetary values to new products becoming available. However, these evaluation methods only impacted at most 20% of the money circulating in healthcare. The remaining 80% was subject to financial regulations (70%) and budgeting (10%), which could use many other techniques of an economic analysis. The evaluation indicated two potentially important changes in health economic use in Belgium. One was an increased focus on budgeting with plans, time frames, and quantified treatment objectives on specific disease problems. Economic models with simulations are very supportive in those settings. The other was the application of constrained optimization methods, which may become the new standard of practice when switching from fee-for-service to pay-per-performance as promoted by value-based healthcare and value-based health management. This economic refocusing to a more constrained approach may help to keep the healthcare system sustainable and affordable in the face of the many future challenges including ageing, climate change, migration, pandemics, logistical limitations, and financial instability.
Quantitative Assessment of Typhoon Disaster Risk at County Level
Authors: Guo Guizhen , Yin Jie , Liu Lulu , Wu Shaohong
Published: September 2024

Using the historical disaster records of 28 typhoons in Cangnan County since 2000, combining typhoon paths and hazard-bearing bodies data and based on the theoretical framework of climate change risk, the social and economic risks of typhoon disasters in Cangnan County with four intensity levels—severe tropical storm, typhoon, severe typhoon, and super typhoon—were quantitatively assessed. The results show that with the increase in typhoon disaster intensity, the spatial pattern of typhoon disaster hazard in Cangnan County changes from high in the west and low in the east to high in the south and low in the north. Super typhoons mainly affected Mazhan town and Dailing town in the south. The vulnerability shows an obvious upward trend. Super typhoons cause more than 40% of the population to be affected, more than 20% of direct economic losses and house collapse, and nearly 30% of crops to be affected in Cangnan County. The spatial pattern of risks that typhoon disasters have on populations, economies, crops, and houses change from low in south and high in north to high in north and south, and these risks increase gradually. The comprehensive risk of typhoon disasters is higher in the north and lower in the south, with the risk level being higher in the central and northern regions.