bluuebunny/crossref_metadata_2025 huggingface dataset:
Tele-education in point-of-care ultrasound training
Authors: Suzuki Reina , Riley William J. , Bushman Matthew S. , Dong Yue , Sekiguchi Hiroshi
Published: October 2024

Background

Traditionally, ultrasound skills have been taught through a one-on-one approach, where instructors physically guide learners’ hands at the bedside or in the workshop. However, this method is frequently challenged by scheduling and cost limitations. Our objective was to create a tele-education model for point-of-care ultrasound training and evaluate its effectiveness and its impact on learners’ perceived workload compared to conventional education and self-directed learning methods.

Methods

We conducted a 3-arm randomized trial, comparing tele-education (TE), conventional education (CE) and self-directed learning (SL) methods. All subjects underwent online didactic lectures prior to a hands-on ultrasound workshop. The TE group utilized an ultrasound machine equipped with a speakerphone, a webcam for direct visualization of learner’s hand maneuvers, and an analog-to-video converter for the real-time streaming of ultrasound images. This configuration enabled remote instructors to provide immediate verbal feedback to learners. In contrast, the CE group received in-person coaching, while the SL group had no instructors present. Following the coaching session, subjects completed a scenario-based skill test and a survey on the National Aeronautics and Space Administration task load index (NASA-TLX) to measure their ultrasound competency and perceived workload, respectively.

Results

Twenty-seven ultrasound novices were randomly allocated into 3 groups. The median skill test score of TE, CE, and SL was 22 [interquartile range (IQR): 18–28], 24 [IQR: 21–31], and 16 [IQR: 15–18], respectively (p < 0.01). Pairwise comparisons of median test scores of 3 groups demonstrated a statistical significance in comparisons of TE vs. SL (22 vs. 16, p = 0.01) and CE vs. SL (24 vs. 16, p < 0.01), but not in TE vs. CE (22 vs. 24, p = 0.56). There was no statistical significance observed in the median NASA-TLX scores among the 3 groups; 54 [IQR:47–61] in TE, 57 [IQR:22–64] in CE, and 66 [IQR: 66–72] in SL (p = 0.05).

Conclusions

Our tele-education model was more effective than self-directed learning. There was no statistically significant difference in effectiveness between the tele-education and the conventional education groups. Importantly, tele-education did not impose a significantly higher workload on learners compared to conventional education or self-directed learning. Tele-education has a substantial potential as an alternative to conventional ultrasound training.
Prediction of microvascular invasion in hepatocellular carcinoma with conventional ultrasound, Sonazoid-enhanced ultrasound, and biochemical indicator: a multicenter study
Authors: Lu Dan , Wang Li-Fan , Han Hong , Li Lin-Lin , Kong Wen-Tao , Zhou Qian , Zhou Bo-Yang , Sun Yi-Kang , Yin Hao-Hao , Zhu Ming-Rui , Hu Xin-Yuan , Lu Qing , Xia Han-Sheng , Wang Xi , Zhao Chong-Ke , Zhou Jian-Hua , Xu Hui-Xiong
Published: October 2024

Purpose

To develop and validate a preoperative prediction model based on multimodal ultrasound and biochemical indicator for identifying microvascular invasion (MVI) in patients with a single hepatocellular carcinoma (HCC) ≤ 5 cm.

Methods

From May 2022 to November 2023, a total of 318 patients with pathologically confirmed single HCC ≤ 5 cm from three institutions were enrolled. All of them underwent preoperative biochemical, conventional ultrasound (US), and contrast-enhanced ultrasound (CEUS) (Sonazoid, 0.6 mL, bolus injection) examinations. Univariate and multivariate logistic regression analyses on clinical information, biochemical indicator, and US imaging features were performed in the training set to seek independent predictors for MVI-positive. The models were constructed and evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis in both validation and test sets. Subgroup analyses in patients with different liver background and tumor sizes were conducted to further investigate the model’s performance.

Results

Logistic regression analyses showed that obscure tumor boundary in B-mode US, intra-tumoral artery in pulsed-wave Doppler US, complete Kupffer-phase agent clearance in Sonazoid-CEUS, and biomedical indicator PIVKA-II were independently correlated with MVI-positive. The combined model comprising all predictors showed the highest AUC, which were 0.937 and 0.893 in the validation and test sets. Good calibration and prominent net benefit were achieved in both sets. No significant difference was found in subgroup analyses.

Conclusions

The combination of biochemical indicator, conventional US, and Sonazoid-CEUS features could help preoperative MVI prediction in patients with a single HCC ≤ 5 cm.

Critical relevance statement

Investigation of imaging features in conventional US, Sonazoid-CEUS, and biochemical indicators showed a significant relation with MVI-positivity in patients with a single HCC ≤ 5 cm, allowing the construction of a model for preoperative prediction of MVI status to help treatment decision making.

Key Points

MVI status is important for patients with a single HCC ≤ 5 cm.

The model based on conventional US, Sonazoid-CEUS and PIVKA-II performs best for MVI prediction.

The combined model has potential for preoperative prediction of MVI status.

Graphical Abstract
Comparison of image quality and lesion conspicuity between conventional and deep learning reconstruction in gadoxetic acid-enhanced liver MRI
Authors: Yoon Jeong Hee , Lee Jeong Eun , Park So Hyun , Park Jin Young , Kim Jae Hyun , Lee Jeong Min
Published: October 2024

Objective

To compare the image quality and lesion conspicuity of conventional vs deep learning (DL)-based reconstructed three-dimensional T1-weighted images in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI).

Methods

This prospective study (NCT05182099) enrolled participants scheduled for gadoxetic acid-enhanced liver MRI due to suspected focal liver lesions (FLLs) who provided signed informed consent. A liver MRI was conducted using a 3-T scanner. T1-weighted images were reconstructed using both conventional and DL-based (AIRTM Recon DL 3D) reconstruction algorithms. Three radiologists independently reviewed the image quality and lesion conspicuity on a 5-point scale.

Results

Fifty participants (male = 36, mean age 62 ± 11 years) were included for image analysis. The DL-based reconstruction showed significantly higher image quality than conventional images in all phases (3.71–4.40 vs 3.37–3.99, p < 0.001 for all), as well as significantly less noise and ringing artifacts than conventional images (p < 0.05 for all), while also showing significantly altered image texture (p < 0.001 for all). Lesion conspicuity was significantly higher in DL-reconstructed images than in conventional images in the arterial phase (2.15 [95% confidence interval: 1.78, 2.52] vs 2.03 [1.65, 2.40], p = 0.036), but no significant difference was observed in the portal venous phase and hepatobiliary phase (p > 0.05 for all). There was no significant difference in the figure-of-merit (0.728 in DL vs 0.709 in conventional image, p = 0.474).

Conclusion

DL reconstruction provided higher-quality three-dimensional T1-weighted imaging than conventional reconstruction in gadoxetic acid-enhanced liver MRI.

Critical relevance statement

DL reconstruction of 3D T1-weighted images improves image quality and arterial phase lesion conspicuity in gadoxetic acid-enhanced liver MRI compared to conventional reconstruction.

Key Points

DL reconstruction is feasible for 3D T1-weighted images across different spatial resolutions and phases.

DL reconstruction showed superior image quality with reduced noise and ringing artifacts.

Hepatic anatomic structures were more conspicuous on DL-reconstructed images.

Graphical Abstract
A radiomics-based interpretable machine learning model to predict the HER2 status in bladder cancer: a multicenter study
Authors: Wei Zongjie , Bai Xuesong , Xv Yingjie , Chen Shao-Hao , Yin Siwen , Li Yang , Lv Fajin , Xiao Mingzhao , Xie Yongpeng
Published: October 2024

Objective

To develop a computed tomography (CT) radiomics-based interpretable machine learning (ML) model to preoperatively predict human epidermal growth factor receptor 2 (HER2) status in bladder cancer (BCa) with multicenter validation.

Methods

In this retrospective study, 207 patients with pathologically confirmed BCa were enrolled and divided into the training set (n = 154) and test set (n = 53). Least absolute shrinkage and selection operator (LASSO) regression was used to identify the most discriminative features in the training set. Five radiomics-based ML models, namely logistic regression (LR), support vector machine (SVM), k-nearest neighbors (KNN), eXtreme Gradient Boosting (XGBoost) and random forest (RF), were developed. The predictive performance of established ML models was evaluated by the area under the receiver operating characteristic curve (AUC). The Shapley additive explanation (SHAP) was used to analyze the interpretability of ML models.

Results

A total of 1218 radiomics features were extracted from the nephrographic phase CT images, and 11 features were filtered for constructing ML models. In the test set, the AUCs of LR, SVM, KNN, XGBoost, and RF were 0.803, 0.709, 0.679, 0.794, and 0.815, with corresponding accuracies of 71.7%, 69.8%, 60.4%, 75.5%, and 75.5%, respectively. RF was identified as the optimal classifier. SHAP analysis showed that texture features (gray level size zone matrix and gray level co-occurrence matrix) were significant predictors of HER2 status.

Conclusions

The radiomics-based interpretable ML model provides a noninvasive tool to predict the HER2 status of BCa with satisfactory discriminatory performance.

Critical relevance statement

An interpretable radiomics-based machine learning model can preoperatively predict HER2 status in bladder cancer, potentially aiding in the clinical decision-making process.

Key Points

The CT radiomics model could identify HER2 status in bladder cancer.

The random forest model showed a more robust and accurate performance.

The model demonstrated favorable interpretability through SHAP method.

Graphical Abstract
Large vessel vasculitis evaluation by CTA: impact of deep-learning reconstruction and “dark blood” technique
Authors: Ding Ning , Yang Xi-Ao , Xu Min , Wang Yun , Jin Zhengyu , Wang Yining , Xue Huadan , Kong Lingyan , Wang Zhiwei , Zhang Daming
Published: October 2024

Objectives

To assess the performance of the “dark blood” (DB) technique, deep-learning reconstruction (DLR), and their combination on aortic images for large-vessel vasculitis (LVV) patients.

Materials and methods

Fifty patients diagnosed with LVV scheduled for aortic computed tomography angiography (CTA) were prospectively recruited in a single center. Arterial and delayed-phase images of the aorta were reconstructed using the hybrid iterative reconstruction (HIR) and DLR algorithms. HIR or DLR DB image sets were generated using corresponding arterial and delayed-phase image sets based on a “contrast-enhancement-boost” technique. Quantitative parameters of aortic wall image quality were evaluated.

Results

Compared to the arterial phase image sets, decreased image noise and increased signal-noise-ratio (SNR) and CNRouter (all p < 0.05) were obtained for the DB image sets. Compared with delayed-phase image sets, dark-blood image sets combined with the DLR algorithm revealed equivalent noise (p > 0.99) and increased SNR (p < 0.001), CNRouter (p = 0.006), and CNRinner (p < 0.001). For overall image quality, the scores of DB image sets were significantly higher than those of delayed-phase image sets (all p < 0.001). Image sets obtained using the DLR algorithm received significantly better qualitative scores (all p < 0.05) in all three phases. The image quality improvement caused by the DLR algorithm was most prominent for the DB phase image sets.

Conclusion

DB CTA improves image quality and provides better visualization of the aorta for the LVV aorta vessel wall. The DB technique reconstructed by the DLR algorithm achieved the best overall performance compared with the other image sequences.

Critical relevance statement

Deep-learning-based “dark blood” images improve vessel wall image wall quality and boundary visualization.

Key Points

Dark blood CTA improves image quality and provides better aortic wall visualization.

Deep-learning CTA presented higher quality and subjective scores compared to HIR.

Combination of dark blood and deep-learning reconstruction obtained the best overall performance.

Graphical Abstract
Towards the prediction of drug solubility in binary solvent mixtures at various temperatures using machine learning
Authors: Bao Zeqing , Tom Gary , Cheng Austin , Watchorn Jeffrey , Aspuru-Guzik Alán , Allen Christine
Published: October 2024

Drug solubility is an important parameter in the drug development process, yet it is often tedious and challenging to measure, especially for expensive drugs or those available in small quantities. To alleviate these challenges, machine learning (ML) has been applied to predict drug solubility as an alternative approach. However, the majority of existing ML research has focused on the predictions of aqueous solubility and/or solubility at specific temperatures, which restricts the model applicability in pharmaceutical development. To bridge this gap, we compiled a dataset of 27,000 solubility datapoints, including solubility of small molecules measured in a range of binary solvent mixtures under various temperatures. Next, a panel of ML models were trained on this dataset with their hyperparameters tuned using Bayesian optimization. The resulting top-performing models, both gradient boosted decision trees (light gradient boosting machine and extreme gradient boosting), achieved mean absolute errors (MAE) of 0.33 for LogS (S in g/100 g) on the holdout set. These models were further validated through a prospective study, wherein the solubility of four drug molecules were predicted by the models and then validated with in-house solubility experiments. This prospective study demonstrated that the models accurately predicted the solubility of solutes in specific binary solvent mixtures under different temperatures, especially for drugs whose features closely align within the solutes in the dataset (MAE < 0.5 for LogS). To support future research and facilitate advancements in the field, we have made the dataset and code openly available.

Scientific contribution

Our research advances the state-of-the-art in predicting solubility for small molecules by leveraging ML and a uniquely comprehensive dataset. Unlike existing ML studies that predominantly focus on solubility in aqueous solvents at fixed temperatures, our work enables prediction of drug solubility in a variety of binary solvent mixtures over a broad temperature range, providing practical insights on the modeling of solubility for realistic pharmaceutical applications. These advancements along with the open access dataset and code support significant steps in the drug development process including new molecule discovery, drug analysis and formulation.

Graphical Abstract
Trend in serological and molecular diagnostic methods for Toxoplasma gondii infection
Authors: Kim Min-ju , Park Soeun J. , Park Hyunwoo
Published: October 2024

Background

Toxoplasma gondii, an intracellular parasite, is a significant cause of zoonotic disease, with an estimated one-third of the world’s human population believed to be infected. T. gondii is transmitted to humans through the consumption of contaminated water, soil, vegetables, fruits, shellfish or undercooked meat, and can also be passed from human to human through vertical transmission, transplants and blood transfusion. While T. gondii infection typically manifests mild symptoms such as colds among immunocompetent individuals, it can prove lethal for those with weakened immune systems.

Methods

To summarize the diagnostic methods for Toxoplasma gondii infection, we performed a literature search on PubMed from 1948 to 2023 using the keywords “T. gondii serological diagnosis” or “T. gondii molecular diagnosis”.

Results

Rapid and accurate diagnosis of T. gondii infection is imperative. Although a diagnostic kit is currently commercially available, there are a number of disadvantages to the validation principles applied to each diagnostic kit. Consequently, multiple diagnostic methods are concurrently employed to offset these limitations. Serological methods for diagnosing T. gondii infection include the Dye Test (DT), Agglutination Test (AT), Modified Agglutination Test (MAT), Latex Agglutination Test (LAT), Enzyme-Linked Immunosorbent Assay (ELISA), and Western Blot. Meanwhile, molecular methods such as polymerase chain reaction (PCR), nested PCR, real-time PCR, loop-mediated isothermal amplification (LAMP), multiplex PCR, and PCR–restriction fragment length polymorphism (PCR–RFLP) are also utilized. Each of these methods possess its own set of advantages and disadvantages.

Conclusions

By summarizing the advantages and disadvantages of different diagnostic techniques, it is hoped that the epidemiology, prevention, and control of toxoplasmosis will be improved in the future through the use of appropriate technologies.
Manufacturing production as a source of growth: the case of Portugal
Authors: Ferraz Ricardo
Published: October 2024

The aim of this paper is to test the relationship between manufacturing production and economic growth in Portugal from the 1950s to the present day, following Nicholas Kaldor’s (1908–1986) thinking, which assumes that manufacturing is the true engine of the economic activity of a country. By estimating a series of econometric models, including a Vector Autoregressive (VAR) model, it was possible to identify a positive relationship between growth and manufacturing production since the 1950s. The results also show that each increase of 1 percentage point (pp) in real growth rate of the production of basic metallurgical industries and manufacture of metallic products in a certain year t−1 for the period 1956–2019, caused an increase of 0.07 pp in the Portuguese economic growth during a following year t on average. We hope that these findings will stimulate new and interesting research regarding the important issues of manufacturing production and economic growth.
Spatial immunogenomic patterns associated with lymph node metastasis in lung adenocarcinoma
Authors: Meng Fanjie , Li Hao , Jin Ruoyi , Yang Airong , Luo Hao , Li Xiao , Wang Peiyu , Zhao Yaxing , Chervova Olga , Tang Kaicheng , Cheng Sida , Hu Bin , Li Yun , Sheng Jianpeng , Yang Fan , Carbone David , Chen Kezhong , Wang Jun
Published: October 2024

Background

Lung adenocarcinoma (LUAD) with lymph node (LN) metastasis is linked to poor prognosis, yet the underlying mechanisms remain largely undefined. This study aimed to elucidate the immunogenomic landscape associated with LN metastasis in LUAD.

Methods

We employed broad-panel next-generation sequencing (NGS) on a cohort of 257 surgically treated LUAD patients to delineate the molecular landscape of primary tumors and identify actionable driver-gene alterations. Additionally, we used multiplex immunohistochemistry (mIHC) on a propensity score-matched cohort, which enabled us to profile the immune microenvironment of primary tumors in detail while preserving cellular metaclusters, interactions, and neighborhood functional units. By integrating data from NGS and mIHC, we successfully identified spatial immunogenomic patterns and developed a predictive model for LN metastasis, which was subsequently validated independently.

Results

Our analysis revealed distinct immunogenomic alteration patterns associated with LN metastasis stages. Specifically, we observed increased mutation frequencies in genes such as PIK3CG and ATM in LN metastatic primary tumors. Moreover, LN positive primary tumors exhibited a higher presence of macrophage and regulatory T cell metaclusters, along with their enriched neighborhood units (p < 0.05), compared to LN negative tumors. Furthermore, we developed a novel predictive model for LN metastasis likelihood, designed to inform non-surgical treatment strategies, optimize personalized therapy plans, and potentially improve outcomes for patients who are ineligible for surgery.

Conclusions

This study offers a comprehensive analysis of the genetic and immune profiles in LUAD primary tumors with LN metastasis, identifying key immunogenomic patterns linked to metastatic progression. The predictive model derived from these insights marks a substantial advancement in personalized treatment, underscoring its potential to improve patient management.
Time synchronisation for millisecond-precision on bio-loggers
Authors: Wild Timm A. , Wilbs Georg , Dechmann Dina K. N. , Kohles Jenna E. , Linek Nils , Mattingly Sierra , Richter Nina , Sfenthourakis Spyros , Nicolaou Haris , Erotokritou Elena , Wikelski Martin
Published: October 2024

Time-synchronised data streams from bio-loggers are becoming increasingly important for analysing and interpreting intricate animal behaviour including split-second decision making, group dynamics, and collective responses to environmental conditions. With the increased use of AI-based approaches for behaviour classification, time synchronisation between recording systems is becoming an essential challenge. Current solutions in bio-logging rely on manually removing time errors during post processing, which is complex and typically does not achieve sub-second timing accuracies.

We first introduce an error model to quantify time errors, then optimise three wireless methods for automated onboard time (re)synchronisation on bio-loggers (GPS, WiFi, proximity messages). The methods can be combined as required and, when coupled with a state-of-the-art real time clock, facilitate accurate time annotations for all types of bio-logging data without need for post processing. We analyse time accuracy of our optimised methods in stationary tests and in a case study on 99 Egyptian fruit bats (Rousettus aegyptiacus). Based on the results, we offer recommendations for projects that require high time synchrony.

During stationary tests, our low power synchronisation methods achieved median time accuracies of 2.72 / 0.43 ms (GPS / WiFi), compared to UTC time, and relative median time accuracies of 5 ms between tags (wireless proximity messages). In our case study with bats, we achieved a median relative time accuracy of 40 ms between tags throughout the entire 10-day duration of tag deployment. Using only one automated resynchronisation per day, permanent UTC time accuracies of ≤ 185 ms can be guaranteed in 95% of cases over a wide temperature range between 0 and 50 °C. Accurate timekeeping required a minimal battery capacity, operating in the nano- to microwatt range.

Time measurements on bio-loggers, similar to other forms of sensor-derived data, are prone to errors and so far received little scientific attention. Our combinable methods offer a means to quantify time errors and autonomously correct them at the source (i.e., on bio-loggers). This approach facilitates sub-second comparisons of simultaneously recorded time series data across multiple individuals and off-animal devices such as cameras or weather stations. Through automated resynchronisations on bio-loggers, long-term sub-second accurate timestamps become feasible, even for life-time studies on animals. We contend that our methods have potential to greatly enhance the quality of ecological data, thereby improving scientific conclusions.
Naked-eye 3D visualization of cultural relics based on integrated imaging
Authors: Wang Lu , Wang Yu , Liu Quanyang , Wang Qi
Published: October 2024

Digital technology has become crucial for the protection of cultural relics, enabling their acquisition, preservation, exhibition, and dissemination in a non-contact manner.At present, the three-dimensional(3D) visualization technology of cultural relics focuses on the research of non-true 3D visualization, which cannot provide continuous viewing angle and takes a long time to render. This paper focuses on the acquisition and reproduction of digital information related to cultural relics, and proposes to achieve the true 3D display of cultural relics from a continuous perspective based on integrated imaging(InIm). Building up on traditional InIm, an Element image array (EIA) generation algorithm based on local depth template matching is designed by using spatial geometry relation. Experimental results show that the algorithm not only enables naked-eye 3D visualization of cultural relics, but also the generation speed is more than twice that of the compared 3D display data source generation algorithm.
Mechanism of lactic acidemia-promoted pulmonary endothelial cells death in sepsis: role for CIRP-ZBP1-PANoptosis pathway
Authors: Gong Ting , Wang Qing-De , Loughran Patricia A. , Li Yue-Hua , Scott Melanie J. , Billiar Timothy R. , Liu You-Tan , Fan Jie
Published: October 2024

Background

Sepsis is often accompanied by lactic acidemia and acute lung injury (ALI). Clinical studies have established that high serum lactate levels are associated with increased mortality rates in septic patients. We further observed a significant correlation between the levels of cold-inducible RNA-binding protein (CIRP) in plasma and bronchoalveolar lavage fluid (BALF), as well as lactate levels, and the severity of post-sepsis ALI. The underlying mechanism, however, remains elusive.

Methods

C57BL/6 wild type (WT), Casp8−/−, Ripk3−/−, and Zbp1−/− mice were subjected to the cecal ligation and puncture (CLP) sepsis model. In this model, we measured intra-macrophage CIRP lactylation and the subsequent release of CIRP. We also tracked the internalization of extracellular CIRP (eCIRP) in pulmonary vascular endothelial cells (PVECs) and its interaction with Z-DNA binding protein 1 (ZBP1). Furthermore, we monitored changes in ZBP1 levels in PVECs and the consequent activation of cell death pathways.

Results

In the current study, we demonstrate that lactate, accumulating during sepsis, promotes the lactylation of CIRP in macrophages, leading to the release of CIRP. Once eCIRP is internalized by PVEC through a Toll-like receptor 4 (TLR4)-mediated endocytosis pathway, it competitively binds to ZBP1 and effectively blocks the interaction between ZBP1 and tripartite motif containing 32 (TRIM32), an E3 ubiquitin ligase targeting ZBP1 for proteasomal degradation. This interference mechanism stabilizes ZBP1, thereby enhancing ZBP1-receptor-interacting protein kinase 3 (RIPK3)-dependent PVEC PANoptosis, a form of cell death involving the simultaneous activation of multiple cell death pathways, thereby exacerbating ALI.

Conclusions

These findings unveil a novel pathway by which lactic acidemia promotes macrophage-derived eCIRP release, which, in turn, mediates ZBP1-dependent PVEC PANoptosis in sepsis-induced ALI. This finding offers new insights into the molecular mechanisms driving sepsis-related pulmonary complications and provides potential new therapeutic strategies.
Abnormally high plasma concentrations of M-4, the active metabolite of edoxaban, at the onset of acute kidney injury in a patient receiving rifampin and clarithromycin: a case report
Authors: Nakagawa Junichi , Ishido Keinosuke , Kimura Norihisa , Nagase Hayato , Wakasa Yusuke , Yokoyama Satoshi , Ueno Kayo , Hakamada Kenichi , Niioka Takenori
Published: October 2024

Background

Edoxaban, the only factor Xa inhibitor with active metabolites, is metabolized by carboxylesterase-1 to its main active metabolite, M-4, which is a substrate of organic anion transporting polypeptide 1B1 (OATP1B1) and is excreted in bile and urine. Because the area under the plasma concentration–time curve ratio of M-4 to parent compound is typically less than 10% in healthy subjects, M-4 is generally considered to exhibit negligible antithrombotic activity in patients treated with edoxaban. However, we identified a case in which drug interactions and kidney impairment led to a substantive increase in plasma M-4 concentrations.

Case presentation

This case report involved a 68-year-old man with pancreatic cancer who was orally administered edoxaban tablets for prevention of thrombus formation in non-valvular atrial fibrillation, in addition to rifampin and clarithromycin (CAM) for treatment of mycobacterium avium complex lung disease. These medications were temporarily discontinued for a pancreaticoduodenectomy but were resumed 8 days post-surgery (POD8). On POD9, the patient developed acute kidney injury, and the trough concentrations of edoxaban and M-4 were 131.1 ng/mL and 115.8 ng/mL, respectively (M-4 ratio: 88.3%). On POD11, the M-4 trough concentration and M-4 ratio increased to 216.2 ng/mL and 186.2%, respectively. The plasma concentration of coproporphyrin-I, an endogenous biomarker of OATP1B1 activity, increased during this period.

Conclusions

This case suggests that in patients with impaired renal function taking edoxaban, co-administration of carboxylesterase-1 inducers such as rifampin and/or OATP1B1 inhibitors such as rifampin or clarithromycin may increase plasma concentrations of M-4 to clinically non-negligible levels.
Stapler-induced vascular injury during uniportal VATS lobectomy: lessons learned from a rare complication case
Authors: Nakashima Yasuhiro , Hanafusa Mariko , Ishibashi Hironori , Hosoda Hiroshi
Published: October 2024

Background

Due to advances in video-assisted thoracic surgery (VATS), the majority of lung resections can be performed safely via VATS with low morbidity and mortality. However, pulmonary artery (PA) bleeding often requires emergency conversion to thoracotomy, potentially leading to a life-threatening situation. We report a case of pulmonary artery injury caused by an unexpected stapler-tissue interaction during uniportal VATS lobectomy, highlighting the importance of recognizing and managing such rare complications to improve patient outcomes.

Case presentation

A 63-year-old man underwent uniportal VATS left upper lobectomy for a suspected primary lung cancer. During the procedure, unexpected bleeding occurred from the third branch of the pulmonary artery (A3) after withdrawal of an unfired stapler. The protruding staple of the A3 stump was inadvertently hooked and stretched by the groove of the staple anvil. Although the bleeding was controlled by compression with the lung, the injured A3 stump required repair. Due to the extensive intimal injury near the central part of the left main pulmonary artery and the potential risk of fatal postoperative complications, we converted to open thoracotomy for definitive vascular repair by suturing. The patient had no postoperative complications and was discharged on postoperative day 8.

Conclusions

This case report provides valuable lessons regarding the rare stapler-related vascular injury during uniportal VATS lobectomy. It is important to note that even during non-vascular dissection, unexpected stapler-tissue interactions can lead to bleeding. To prevent the vessel stump entanglement with stapler components, maintaining separation between the stapler and staple stumps is crucial. In uniportal VATS, manipulation during stapler insertion is one of the most challenging phases for instrument interference, requiring increased caution to prevent complications such as the vascular injury described in this case. Thorough preoperative planning, specific intraoperative precautions, and adapted safety protocols that address the limitations of uniportal VATS are essential for effective management of potential complications. Although techniques for thoracoscopic vascular control exist, they are not always feasible and conversion to open thoracotomy should be considered when necessary to ensure patient safety.
Effect of group psychotherapy on self-care skills in schizophrenia
Authors: Sayed Shymaa Mohammed , Ahmed Gellan K. , Abdullah Saleh O. , Khalifa Sanaa Mostafa
Published: October 2024

Background

Schizophrenia is a serious neurodevelopmental psychiatric disorder that places a considerable strain on the healthcare system on a national, regional, and global scale. This study's objective was to measure the level of self-care among individuals with schizophrenia. In addition, to develop, implement, and evaluate the impact of 3 month group therapy on self-care skills in this specific group of patients. The sample comprised 120 individuals diagnosed with schizophrenia, with 60 assigned to study group (receiving group therapy) and 60 to control group (without group therapy). The Positive and Negative Syndrome Scale (PANSS) and The Exercise of Self-Care Agency Scale (ESCAS) were administered to all subjects. The study group observed a substantial decrease in the mean score of positive symptoms, negative symptoms, and symptoms of general psychopathology from baseline assessment to follow-up assessment.

Results

During the follow-up assessment, the study group exhibited a reduction in the mean of PANNS subscales by more than half and increase more than double in total score of ESCAS compared to the baseline assessment. Consequently, only the study group achieved a 70% increase in self-care in follow-up assessment. Increased self-care was more likely in patients who participated in the program, as indicated by the regression model.

Conclusions

Individuals with schizophrenia who underwent group therapy exhibited a significant decrease in positive, negative symptoms, and symptoms of general psychopathology. In addition, the implementation of group therapy led to a noticeable improvement in self-care skills compared to those without group therapy.
Mechanism of metabolic memory: progression in diabetic nephropathy—a descriptive review
Authors: Begum Farhana , Lakshmanan Karpagavel
Published: October 2024

Diabetes mellitus and its complications exploit significantly impact global human well-being and economic burden. Previous studies and clinical trials have provided insights into the concept of metabolic memory, which sustains even after hyperglycemia has been resolved, causing diabetic complications completely. The term “metabolic memory” refers to the body’s abnormal metabolism, which can have long-term effects and influence both health and disease conditions. It involves various molecular processes causing cellular shifts, tissue and organ dysfunctions, disease progression, and effects on offspring. The conceptual framework of metabolic memory is defined and strengthened, offering a comprehensive understanding of the underlying causes of diabetic nephropathy (DN) and providing a potential new approach for diagnosing and treating the disease. In this review, we elucidated the importance, characteristics, cellular and molecular importance, and therapeutic intervention to eradicate metabolic memory in DN once hyperglycemia has been eliminated. The regulation of metabolic memory is assisted based on an epigenetic mechanism. Therefore, this report traces the significant factors involved in regulating epigenetic modifications such as DNA methylation, histone modification, and chromatin remodeling. This mechanism significantly triggers epigenetic regulation, leading to glucose stress, oxidative stress induction, and apoptosis, causing DN. It occurs beyond various signaling cascades, resulting in alterations in transcription factors and receptor molecules, which enhance the metabolic memory in the post-sustenance of hyperglycemia. This condition can be modulated based on therapeutic interventions involving lifestyle modification and the inclusion of natural substances like bioactive compounds, polyphenols, and terpenoids in the diet, followed by medications acting as epigenetic modifiers.
Effect of body mass index on quadriceps angle and tibial torsion in school-aged children
Authors: Elhoseny Hanaa Ahmed , Eltohamy Amira Mohamed , Diab Olfat Abdelrahman
Published: October 2024

Background

The prevalence of excessive body mass (BMI) is increasing in pediatric population. Accordingly, the number of musculoskeletal problems in this population is also likely to increase. The quadriceps angle (Q-angle) is a clinical measure used to measure knee alignment in relation to the hip, femur, and tibia, as well as evaluating alignment of the patella. Tibial torsion (T.T) is an important morphological feature of human tibia. The aim of that study was to study the relationship between the Q-angle and TT in children 8 to 12 years old, the effect of BMI on Q-angle and T.T, and the difference in Q-angle and TT between dominant and non-dominant side.

Results

“Seventy-five children from primary schools” were enrolled in the study and allocated into 3 groups (25 subjects in each group), according to BMI: group I (normal weight = 25), group II (overweight = 25), and group III (obese = 25). The mean value of age of groups I, II, and III was 10.35 ± 1, 10.74 ± 1.2, and 10.17 ± 1.18 years respectively; the mean value of weight was 29.88 ± 3.94, 43.68 ± 6.55, and 50.06 ± 10.44 kg respectively; the mean value of height was 135.28 ± 7.63, 143.2 ± 8.85, and 140.72 ± 9.3 cm respectively; and the mean value of BMI was 16.22 ± 1, 21.18 ± 1.4, and 25.17 ± 2.67 kg/m2. The number (%) of boys in groups I, II, and III was 15 (60%), 18 (72%), and 17 (68%) respectively and of girls was 10 (40%), 7 (28%), and 8 (32%) respectively.

The significant values were Q-angle and TT. Data were expressed as mean ± SD. ANOVA was used to compare between subjects’ characteristics of the groups. Kolmogorov-Smirnov test was used for testing normality of data distribution. One-way MANOVA was used to compare parametric variables (Q-angle and TT) between the two groups. Compared with normal weight children, there was statistically significant increase in Q-angle and TT angle in overweight and obese children.

Conclusion

Any change in BMI would eventually lead to change in both Q-angle and TT angle. The greater the BMI values, the greater the values of Q-angle and TT angle.
The functions of apolipoproteins and lipoproteins in health and disease
Authors: Ma Zijun , Zhong Jixin , Tu Wei , Li Shiliang , Chen Jun
Published: October 2024

Lipoproteins and apolipoproteins are crucial in lipid metabolism, functioning as essential mediators in the transport of cholesterol and triglycerides and being closely related to the pathogenesis of multiple systems, including cardiovascular. Lipoproteins a (Lp(a)), as a unique subclass of lipoproteins, is a low-density lipoprotein(LDL)-like particle with pro-atherosclerotic and pro-inflammatory properties, displaying high heritability. More and more strong evidence points to a possible link between high amounts of Lp(a) and cardiac conditions like atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis (AS), making it a risk factor for heart diseases. In recent years, Lp(a)'s role in other diseases, including neurological disorders and cancer, has been increasingly recognized. Although therapies aimed at low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) have achieved significant success, elevated Lp(a) levels remain a significant clinical management problem. Despite the limited efficacy of current lipid-lowering therapies, major clinical advances in new Lp(a)-lowering therapies have significantly advanced the field. This review, grounded in the pathophysiology of lipoproteins, seeks to summarize the wide-ranging connections between lipoproteins (such as LDL-C and HDL-C) and various diseases, alongside the latest clinical developments, special emphasis is placed on the pivotal role of Lp(a) in cardiovascular disease, while also examining its future potential and mechanisms in other conditions. Furthermore, this review discusses Lp(a)-lowering therapies and highlights significant recent advances in emerging treatments, advocates for further exploration into Lp(a)'s pathogenic mechanisms and its potential as a therapeutic target, proposing new secondary prevention strategies for high-risk individuals.
Investigating the behavior of vertical trapezoidal CSSWs stiffened with flat steel plate
Authors: Shen Lisen
Published: October 2024

Steel shear wall (SSW) is an efficient system used to construct and improve many structures over the past decades. The main weakness of the traditional flat plate SSW is the premature buckling of the plate, for which the corrugated steel shear wall (CSSW) is a suitable alternative. However, the reduced resistance of CSSW compared to flat SSWs is a disadvantage. In this research, their reinforcement by flat steel plates with different dimensions and thicknesses has been used to improve the behavior of vertical trapezoidal steel shear walls (VTSSW). The samples studied in this research were subjected to cyclic loading after verification in Abaqus finite element software. The outcomes showed that reinforcing CSSWs with flat plates increased strength and energy absorption between 6 to 63% and 16 to 92%, respectively. Also, the equivalent viscous damping has increased between 5 and 82%. Also, due to strengthening the CSSWs, the pinching phenomenon in the hysteresis curves has been reduced, and the sudden decrease in strength after buckling in the CSSWs without stiffener has been significantly reduced.
How do Laboratory Teaching Assistants Learn to Support Science Practices? Exploring the Intersection Between Instructor Reasoning and Actions
Authors: Cooper A. C. , Osness J. B. , Hester S. D. , Bolger M. S.
Published: October 2024

We provide analysis of how TAs implement a curriculum designed to engage introductory biology students in scientific modeling. TAs in-the-moment interactions with students varied, reflecting different instructional purposes and instructor roles. We present mechanisms of TA learning and ideas for professional development.
Quantum nonlocality of density operators and their corresponding density matrices
Authors: Hu K. F. , Guo Z. H. , Cao H. X. , Lu L.
Published: October 2024

Quantum nonlocality represents correlations between subsystems of a composite quantum system, usually including Bell nonlocality, steerability, and entanglement. According to the hypothesis of quantum mechanics, states of a quantum system Q described by a d-dimensional Hilbert space

are denoted by density operators acting on

. Under a basis e for the Hilbert space

, every abstract density operator ρ of the system AB corresponds to a density matrix ρ

e
, which is a state of the

complex Hilbert space

. In this work, we discuss the consistency of quantum nonlocality of density operators ρ and their corresponding density matrices ρ

e
under the chosen basis e. It is proved that only when a basis e is a product one, a density operator ρ is entangled (respectively, Bell nonlocal, steerable) if and only if its density matrix ρ

e
is entangled (respectively, Bell nonlocal, steerable).
Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis
Authors: Abdelmageed Sunny , Sarkar Prottusha , Shlobin Nathan A. , Davila Daniel G. , Potts Matthew B.
Published: October 2024

BACKGROUND AND OBJECTIVES:

The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting.

METHODS:

A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients.

RESULTS:

Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques.

CONCLUSION:

Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.
Welcoming new Editorial Advisory Board members
Authors: Mikimoto Dina , Hooper Kirsty
Published: October 2024

Summary: We welcome five new Editorial Advisory Board members, who help to expand our expertise in areas of cutting-edge disease research and maintain our journal's high publishing standards.
Impact of public health expenditure on malnutrition among Peruvians during the period 2010-2020: A panel data analysis
Authors: Castro Mejía Percy Junior , Morán Santamaría Rogger Orlando , Llonto Caicedo Yefferson , Cúneo Fernández Francisco Eduardo , Lizana Guevara Nikolays Pedro , Pérez Pérez Milagros Judith , Vela Meléndez Lindon
Published: October 2024

Background The study analyzes the impact of public health spending on malnutrition among Peruvians, using data from the National Household Survey, the Central Reserve Bank of Peru, the National Institute of Statistics and Informatics and the Ministry of Economy and Finance from 2010. -2020. Previous studies have revealed the existing relationship of health spending with the reduction of malnutrition. Methods A quantitative approach is considered, with an explanatory type of research using panel data methodology considering the bidimensionality of the data, which allows quantifying this effect for the Peruvian case using the National Household Survey, data from the Central Reserve Bank of Peru, as well as information from the National Institute of Statistics and Informatics and the Transparency Portal of the Ministry of Economy and Finance in the period 2010-2020. Results The results show that public expenditure on health has a negative relationship with malnutrition; the rural sector has a positive relationship with malnutrition given the limitations present for access to adequate food. Similarly, the unemployment rate shows a positive relationship with malnutrition, given that being unemployed leads to a higher cause of malnutrition in the population, and the gross domestic product has a negative relationship with malnutrition, given that greater economic growth produces an impact on reducing malnutrition, with the greatest impact being on the rural population and the gross domestic product. Conclusions In the analysis period 2010-2020 in Peru, based on the panel data analysis, the impact of public health expenditure on reducing malnutrition is observed in 10 departments, achieving a reduction in malnutrition; while in 14 departments, this indicator has not been reduced.