bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends of anemia, spatiotemporal patterns, and their associated factors among pregnant mothers in Ethiopia using Ethiopian demographic and health surveys (2005, 2011, and 2016)
Authors: Demis Teshome
Published: May 2023

Introduction: -Pregnant women in low- and middle-income countries have high rates of anemia. Anemia among pregnant women is an important factor associated with an increased risk of maternal, fetal, and neonatal mortality. Anemia in pregnancy contributes to the foremost cause of indirect maternal morbidity and mortality. Even though WHO has set a global target of achieving a 50% reduction of anemia among women of reproductive age by 2025, this isn't easy to achieve with the current trend. This study aimed to assess the direction, geographical distribution, and determinants of anemia in pregnant mothers from 2005 to 2016 using the EDHS report.
Methods: -. 3350 pregnant mothers were included in the three consecutive Ethiopian Demographic and Health Surveys (2005, 2011, and 2016). The trend of anemia among pregnant women over the three surveys was shown. Determinant factors of anemia among pregnant women were identified using logistic regression, multivariate analysis, spatial autocorrelation, hotspot analysis, interpolation, and spatial scan statistics.
Results: -The trend of anemia among pregnant women significantly decreased, from 30.9% in 2005 to 21.5% in 2011, and increased from 21.5% in 2011 to 29.6% in 2016. Being from a female-headed household, being from a household of the highest wealth quintile, being in the second and third trimesters of pregnancy, being a working woman, and living in the Somalia region were significant determinants of anemia among pregnant women. The spatial patterns of anemia among pregnant women were found to be non-random during the 2016 EDHS. The hotspot areas were found in Somalia, Dire Dawa, Afar, and Harari in the 2016 survey. The spatial window for these clusters was located in the entire Somali and eastern border areas of the Dire Dawa and Oromia regions.
Conclusion: - Anemia during pregnancy increased from 2011 to 2016, with hotspot areas in Somali, Dire Dawa, Afar, and Harari. Programmatic interventions targeting the poorest households, and second and third-trimester pregnant, Somali regions are needed to decrease anemia.
Adequacy of In-Mission Training to Treat Tibial Shaft Fractures in Mars Analog Testing
Authors: Manon Julie , Saint-Guillain Michael , Pletser Vladimir , Buckland Daniel Miller , Vico Laurence , Dobney William , Baatout Sarah , Wain Cyril , Jacobs Jean , Comein Audrey , Drouet Sirga , Meert Julien , Casla Ignacio Sanchez , Chamart Cheyenne , Vanderdonckt Jean , Cartiaux Olivier , Cornu Olivier
Published: May 2023

Long bone fractures are a concern in long-duration exploration missions (LDEM) where crew autonomy will exceed the current Low Earth Orbit paradigm. Current crew selection assumptions require extensive complete training and competency testing prior to flight for off-nominal situations. Analog astronauts (n=6) can be quickly trained to address a single fracture pattern and then competently perform the repair procedure. An easy-to-use external fixation (EZExFix) was employed to repair artificial tibial shaft fractures during an inhabited mission at the Mars Desert Research Station (Utah, USA). Bone repair safety zones were respected (23/24), participants achieved 79.2 % repair success, and median completion time was 50.04 minutes. Just-in-time training in-mission was sufficient to become autonomous without pre-mission medical/surgical/mechanical education, regardless of learning conditions (p>0.05). Similar techniques could be used in LDEM to increase astronauts’ autonomy in traumatic injury treatment and lower skill competency requirements used in crew selection.
Identification of Stage-Specific Differentially Expressed Genes and Network Meta-Analysis Reveals Potential Molecular Signatures in Chronic Hepatitis E Virus Infection
Authors: Shafat Zoya , Farooqui Anam , Tamkeen Naaila , Islam Asimul , Chaudhary Anis Ahmad , Alawam Abdullah S. , Almuqri Eman Abdullah , Parveen Shama
Published: May 2023

Background
Hepatitis E virus (HEV) is the major pathogen responsible for chronic hepatitis infection (CHE) in solid organ transplant recipients. As CHE seems to be dependent on patient’s immunological status, in this context, a comprehensive assessment of gene-, pathway-, and network-level interaction was accomplished to identify key regulators in CHE. To our knowledge, this study conducted novel analysis on the NCBI-GEO obtained mRNA expression profile comprising all three HEV infection stages, i.e., mild, moderate and severe.
Methods
The patients with CHE were separated into 3 groups according to the time of HEV clearance (early, late, or no HEV clearance at the time of analysis). Gene expression analysis was applied on microarray profile dataset, consisting of control samples (kidney transplant recipients without HEV) and infected samples (kidney transplant recipients with HEV), to unveil the differentially expressed genes (DEGs). Interrelationship among DEGs was studied to identify the overlapping DEGs, which were utilized for the construction of the protein-protein interaction (PPI) network. Additionally, the significant modules were identified form the PPI network. Gene term and pathway enrichment analyses were employed on the identified DEGs. Subsequently, the identified hub gene-associated miRNAs were undertaken for enrichment analysis.
Results
Our analysis revealed a total of 69, 157, and 411 specific DEGs which included 34 upregulated and 35 downregulated genes, 138 upregulated and 19 downregulated genes, and 326 upregulated and 85 downregulated genes for mild, moderate, and severe CHE respectively. Interestingly, we found upregulated expression levels of 8 genes BATF2, OASL, IFI44L, IFIT3, RSAD2, IFIT1, RASGRP3 and IFI27, which shows their association with persistent HEV infection. Of these genes, 6 (OASL, IFI27, IFIT1, IFIT3, RSAD2 and IFI44L) made into the PPI network and were common at each stage, thus, could serve as important area of interest for further research. Enrichment analysis showed DEGs association with binding and catalytic activities, viral replication and interferon signaling pathways. Furthermore, we identified key gene associated-miRNAs (miR-129-2-3p, miR-130a-3p, miR-138-5p, miR-212-3p, miR-221-3p, miR-27b-3p and miR-29c-3p).
Conclusions
The current study might provide insights into these identified key genes and pathways which could be targeted to offer better interventions for CHE in future biological research.
Long-term outcomes of delayed clozapine initiation in treatment-resistant schizophrenia: A multicenter retrospective cohort study
Authors: Hatano Masakazu , Kamei Hiroyuki , Takeuchi Ippei , Gomi Kazuhiko , Sakakibara Takashi , Hotta Shogo , Esumi Satoru , Tsubouchi Kiyotaka , Shimizu Yoshihito , Yamada Shigeki
Published: May 2023

Background
Clozapine is the only antipsychotic medication with proven efficacy against treatment-resistant schizophrenia. This multicenter retrospective cohort study aimed to evaluate the impact of a delay in clozapine initiation on long-term outcomes.
Methods
Patients who initiated clozapine treatment between July 2009 and December 2018 were included in this study. According to the length of time from the diagnosis of schizophrenia to the clozapine initiation, the patients were categorized into one of three groups: early (≤ 9 years), intermediate (10–19 years), and late (≥ 20 years) initiation. The endpoints were psychiatric rehospitalization, all-cause clozapine discontinuation, and treatment failure at 3 years. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using the Fine and Gray method or the Cox proportional hazards model.
Results
The incidence rates of rehospitalization at 3 years according to the cumulative incidence function were 32.3% for early, 29.7% for intermediate, and 62.2% for late initiation, respectively. Late initiation had a significantly higher risk of rehospitalization than both early (HR, 2.94; 95% CI, 1.01– 8.55; P = 0.016 by the Gray's test) and intermediate initiation (HR, 3.13; 95% CI, 1.34–7.30; P = 0.0025 by the Gray's test). The incidence rate of all-cause clozapine discontinuation at 3 years using the Kaplan–Meier method were 13.0% for early, 10.6% for intermediate, and 20.1% for late initiation. The risk of all-cause clozapine discontinuation was not significantly among the groups. The late initiation group showed significantly increased risk of treatment failure only when using univariate analysis. The late initiation group had more patients discontinuing because of death due to physical diseases than the other groups.
Conclusions
The study suggests that clozapine should be initiated promptly in patients with treatment-resistant schizophrenia to prevent psychiatric rehospitalization during long-term treatment. Further studies of higher quality, with appropriate consideration of patient characteristics, and with larger sample sizes are needed.
Cdk5rap3 as a modulator of the UFMylation pathway is indispensable for survival and function of pancreatic acinar cells
Authors: Yonghong Huang , Quintero Michaela , Siyang Liu , Cong Liu , Zhu Guangxun , Yafei Cai , Dong Zheng , Bollag Roni , Sabbatini Maria Eugenia , Honglin Li
Published: May 2023

The acinus is the functional unit of the exocrine pancreas that produces and secretes a large amount of digestive enzymes. Damage and dysfunction of pancreatic acinar cells (PACs) may lead to malnutrition, pancreatitis and other pathological conditions. To cope with the high demand of protein synthesis and secretion, PACs possess an extensive network of rough endoplasmic reticulum (RER) where proteins are translated, modified and transported to Golgi apparatus for further modifications and packaging into zymogen granules (ZGs). The UFM1 (Ubiquitin fold modifier 1) conjugation system has been reported to clear up jammed nascent proteins on the ER membrane and maintain the ER homeostasis. Cdk5rap3 is one of the key components of the UFM1 system and its physiological function and working mechanism is currently under active investigation. We investigated its role in pancreatic homeostasis of protein synthesis using a PAC-specific knockout mouse model. We found that ablation of Cdk5rap3 in PACs led to fewer ZGs, loss of RER, acinar to ductal metaplasia (ADM) and degeneration of the acini compartment. Then, we further tested if it is involved in co-translational quality control of ER proteins. Interestingly, we found that the protein level of the ribosomal stalling reporter was much higher in Cdk5rap3 knockout cells, suggesting that Cdk5rap3 is a part of the quality control mechanism of ER proteins. Furthermore, we found that the reduced level of Cdkrap3 was correlated with human pancreatic diseases. Together, our results strongly suggest that Cdk5rap3 is essential for the survival and function of pancreatic acinar cells.
A process-based analysis of Arctic Ocean warming in response to increasing CO2
Authors: Saenko Oleg , Gregory Jonathan , Tandon Neil
Published: May 2023

Using an ensemble of atmosphere–ocean general circulation models (AOGCMs) in an idealized climate change experiment, this study evaluates the contribution of different ocean processes to Arctic Ocean warming. On the AOGCM-mean, the Arctic Ocean warming is greater than the global ocean warming in the volume mean, and at most depths within the upper 2000~m. The Arctic warming is greatest a few 100~m below the surface and is dominated by the import of extra heat which is added to the ocean at lower latitude and is conveyed to the Arctic via the large-scale barotropic ocean circulation. The change in strength of this circulation in the North Atlantic is relatively small and not correlated with the Arctic Ocean warming. The Arctic Ocean warming is opposed and substantially mitigated by the weakening of the Atlantic meridional overturning circulation (AMOC), though the magnitude of this effect has a large model spread. By reducing the northward transport of heat, the AMOC weakening causes a redistribution of heat from high latitude to low latitude. Within the Arctic Ocean, the propagation of heat anomalies is influenced by broadening of cyclonic circulation in the east and weakening of anticyclonic circulation in the west. On the model-mean, the Arctic Ocean warming is most pronounced in the Eurasian Basin, with large spread across the AOGCMs, and accompanied by subsurface cooling by diapycnal mixing and heat redistribution by mesoscale eddies.
Block-chain Abnormal Transaction Detection Method Based on Auto-encoder and Attention Mechanism
Authors: Xiong Ao , Qiao Chenbin , Tong Yuanzheng , Qi Baozhen , Jiang Chengling
Published: May 2023

The significant changes brought by block-chain technology have posed many challenges to financial services, ecological security, and privacy protection. Therefore, in order to achieve intelligent block-chain supervision and assess the risk of potential money laundering, terrorist financing, and other financial crimes of customers, anomaly detection of blockchain networks is required. Structurally, blockchain data is essentially represented by a graph, where nodes represent addresses and edges represent behaviors such as transactions, and the model after constructing the transaction graph can extract high-dimensional features in the graph structure relationships. Existing anomaly detection methods ignore the interaction information between network structure and node attributes and have limited ability to detect anomalies. Based on this, this paper proposes GraphAEAtt, a deep learning framework based on self-encoder and attention mechanism, which consists of a structural auto-encoder and an attribute auto-encoder to jointly learn node and attribute feature vector representations, and in addition, introduces an attention mechanism to learn the correlation between nodes and their neighboring nodes. First the structural encoder converts the observed raw node attributes into a vector representation of the low-dimensional potential space, and then the shared attention mechanism is used to aggregate the embeddings of all neighboring nodes to finally generate node embedding. The attribute encoder uses a multi-layer perceptron to map the observed attribute data into a potential attribute embedding representation. Then, a structure decoder is used to reconstruct the adjacency matrix and an attribute decoder to reconstruct the attribute matrix, and the reconstruction error of the nodes is measured from both structure and attribute perspectives as the objective function for neural network training. Then anomaly detection is implemented based on the reconstruction error of the nodes measured from both structure and attribute perspectives. Finally, a large number of experiments are conducted to verify the effectiveness of the proposed method in real datasets.
Designing an Improved Deep Learning-based Model for COVID-19 Recognition in Chest X-ray Images: A Knowledge Distillation Approach
Authors: BabaAhmadi AmirReza , Khalafi Sahar , ShariatPanahi Masoud , Ayati Moosa
Published: May 2023

Background and Objectives:
COVID-19 has adversely affected humans and societies in different aspects. Numerous people have perished due to inaccurate COVID-19 identification and, consequently, a lack of appropriate medical treatment. Numerous solutions based on manual and automatic feature extraction techniques have been investigated to address this issue by researchers worldwide. Typically, automatic feature extraction methods, particularly deep learning models, necessitate a powerful hardware system to perform the necessary computations. Unfortunately, many institutions and societies cannot benefit from these advancements due to the prohibitively high cost of high-quality hardware equipment. As a result, this study focused on two primary goals: first, lowering the computational costs associated with running the proposed model on embedded devices, mobile devices, and conventional computers; and second, improving the model's performance in comparison to previously published methods (at least performs on par with state of the art models) in order to ensure its performance and accuracy for the medical recognition task.
Methods
This study used two neural networks to improve feature extraction from our dataset: VGG19 and ResNet50V2. Both of these networks are capable of providing semantic features from the nominated dataset. Streaming is a fully connected classifier layer that feeds richer features, therefore feature vectors of these networks have been merged, and this action resulted in satisfactory classification results for normal and COVID-19 cases. On the other hand, these two networks have many layers and require a significant amount of computation. To this end, An alternative network was considered, namely MobileNetV2, which excels at extracting semantic features while requiring minimal computation on mobile and embedded devices. Knowledge distillation (KD) was used to transfer knowledge from the teacher network (concatenated ResNet50V2 and VGG19) to the student network (MobileNetV2) to improve MobileNetV2 performance and to achieve a robust and accurate model for the COVID-19 identification task from chest X-ray images.
Results
Pre-trained networks were used to provide a more useful starting point for the COVID-19 detection task. Additionally, a 5-fold cross-validation technique was used on both the teacher and student networks to evaluate the proposed method's performance. Finally, the proposed model achieved 98.8% accuracy in detecting infectious and normal cases.
Conclusion
The study results demonstrate the proposed method's superior performance. With the student model achieving acceptable accuracy and F1-score using cross-validation technique, it can be concluded that this network is well-suited for conventional computers, embedded systems, and clinical experts' cell phones.
The Effect of Eight Weeks of Stop-X and FIFA 11+ Kids Warm-Up on Proprioception and Balance in Football Players with Dynamic Knee Valgus
Authors: Eslami Adeleh , Sahebozamani Mansour , Bahiraei Saeid
Published: May 2023

Background
This study examined the effect of neuromuscular programs on proprioception and balance in athletes with dynamic knee valgus (DKV) defects.
Methods
The present investigation involved the purposive and random allocation of 45 male soccer players with dynamic knee valgus (DKV) defects into three distinct groups: a control group (n = 15, age = 11.40 ± .74, weight = 36.24 ± 5.31, height = 140.73 ± 3.34, BMI = 19.93 ± 3.74, sport experience = 2.47 ± .52), Fifa11 + kids group (n = 15, age = 11.07 ± .88, weight = 32.61 ± 3.53, height = 138.40 ± 3.38, BMI = 16.03 ± 2.18, sport experience = 2.39 ± .42), and Stop-X group (n = 15, age = 11.40 ± .74, weight = 37.00 ± 4.10, height = 141.47 ± 4.63, BMI = 17.27 ± 2.22, sport experience = 2.27 ± .46). The leg landing test (ICC = 0.87), knee proprioception (ICC = 0.801), and stork balance (ICC = 0.76) were utilized for both pre- and post-implementation of the training protocol. After identifying the variables, the participants in the training cohort underwent an eight-week intervention consisting of the Stop X and FIFA 11 + Kids programs. The training programs included three sessions per week, each lasting between 20 and 25 minutes, while the control group followed their usual warm-up routine. A Mixed Repeated Measurement analysis was conducted using SPSS 26 software at a significance level of 0.05 to assess the differences between pre-test and post-test results.
Results
The study's results indicate a significant difference among the three groups in the Mixed Repeated Measurement test (p = 0.01). The Stop-X group showed significant differences compared to the control group (p = 0.01) and the FIFA11 + Kids group (p = 0.04) in terms of AKJPS. Moreover, the knee valgus in both the Stop-X (p = 0.03) and FIFA11 + Kids (p = 0.007) groups significantly differed from the control group. Additionally, there was a significant difference in stork balance before and after the intervention between the intervention groups and the control group.
Conclusion
The study findings suggest that Stop-X exercises are more effective than FIFA 11 + exercises in improving dynamic knee valgus and balance among young football players with knee valgus abnormalities.
Atezolizumab and Bevacizumab Combination in Advanced Hepatocellular Carcinoma; A Systematic Review of Economic Evaluations
Authors: Mohammadnezhad Ghader , Esmaily Hadi , Talebi Maryam , Jafari Matin
Published: May 2023

Background: Atezolizumab (ATZ) plus bevacizumab (BVC) co-administration is one of the newest systemic interventions in advanced hepatocellular carcinoma (AHCC). This treatment approach is more costly and more effective than other therapeutic interventions, and significantly improved AHCC survival and health-related quality of life.
Objectives: This economic study aimed to systematically review all cost-effectiveness analyses of ATZ/BVC combination in AHCC.
Method: To find all related economic evaluations, a comprehensive search in scientific databases was performed by a highly sensitive syntax. The target population was AHCC patients. The intervention was ATZ/BVC which was compared with sorafenib, nivolumab, and other anticancer strategies. We included studies that reported quality-adjusted life-years (QALYs) and/or life-years, costs, and incremental cost-effectiveness ratio (ICER), and finally, the characteristics of included studies were categorized.
Results: Out of 315 identified records, 12 cost-effectiveness analyses were eligible for inclusion in the systematic review. Treatment costs were significantly higher with ATZ/BVC in all studies (From 61,397 to 253,687 USD compared to sorafenib and nivolumab, respectively). Incremental QALYs varied from 0.35 to 0.86 compared to sintilimab/BVC and sorafenib, respectively. Although ICERs for drugs varied widely, all were united in the lack of cost-effectiveness of the ATZ/BVC. The willingness-to-pay threshold in all studies was lower than the ICER, which indicated a reluctance to pay for this treatment strategy by the health systems.
Conclusion: It can be concluded that ATZ/BVC combination is an expensive approach in AHCC management. Significant discounts in ATZ and BVC prices are essential for this novel approach to be cost-effective and extensively used.
U-Shaped Association Between Serum 25-hydroxyvitamin D concentrations and Urinary Leakage Among Adult Females Aged 45 Years and Over in the United States: A Cross-Sectional Study
Authors: Li Zeyu , Lu Xinzhuo , Zhang Keshuai , Wu Shuangyan , Yu Wei , Chen Xiaoling , Zheng Wenzhong
Published: May 2023

Background
The relationship between serum vitamin D status and urinary leakage (UL) among middle-aged females remains to be further studied. In this study, we aimed to evaluate the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with UL among American females ages 45 years and over.
Methods
We used seven cycles of the National Health and Nutrition Examination Survey (NHANES) with self-report UL data. A total of 9525 women, 45 years and older, were enrolled in this study. Univariate and multivariate logistic regression models and the smooth curve fitting were used to analyze the association between clinical UL and serum 25-hydroxyvitamin D [25(OH)D] concentrations.
Results
We observed a non-linear relationship between serum 25(OH)D concentrations and clinical UL. We found that when serum 25(OH)D concentration was higher than the inflection point 63.5, there was a positive correlation between serum 25(OH)D concentrations and clinical UL ([OR]: 1.007, 95%CI: 1.005–1.009, P < 0.01). However, when serum 25(OH)D concentration was lower than the inflection point 63.5, there was a negative correlation between serum 25(OH)D concentrations and clinical UL ([OR]: 0.993, 95%CI: 0.989–0.996, P < 0.01).
Conclusions
The association between serum vitamin D and the risk of UL followed an U-shaped relation among US middle-aged females, with an inflection point at 63.5 nmol/L serum 25(OH)D concentrations.
The spatiotemporal variability in precipitation gradients based on meteorological station observations in mountainous areas of Northwest China
Authors: Zhang Xi , Xu Min , Kang Shichang , Wu Hao , Han Haidong
Published: May 2023

Exploration of the spatiotemporal variability in precipitation gradients (PGs) is important for understanding the spatial differences in precipitation and optimizing hydrological process simulations. Here, the spatiotemporal distribution of precipitation and PG was analyzed in the Tianshan and Qilian Mountains based on national meteorological station data from 1961–2017. The relationships between PG and relative humidity and wind speed were explored. The results show that precipitation exhibits a significant increasing trend during last decades. Precipitation in the Tianshan Mountains is greater in the north and west, the maximum precipitation height (MPH) occurs at 1942.5 m a.s.l., and the precipitation change rate is higher in the west than in the east. Precipitation in the eastern Qilian Mountains is greater, the MPH is approximately 2850 m a.s.l., and the precipitation change rate decreases from the middle to the western and eastern sections. There are noticeable differences in PG between the two mountain areas. Annually, the PG in the Tianshan and Qilian Mountains, except for the Yili Valley, has increased significantly. The PG change rate in the western Qilian Mountains is higher. Monthly, the PG increases most significantly from June-August. Precipitation is positively correlated with elevation in the Tianshan Mountains from May-September and in the western and eastern sections of the Qilian Mountains every month, while that in the middle Qilian Mountains decreases with increasing elevation from November-January. The PG in both mountain regions experienced abrupt changes around the 1970s-1980s, and most areas increased significantly after the abrupt changes, showing a clear humidification phenomenon. Except for some subregions, PG is directly proportional to relative humidity and inversely proportional to wind speed.
Episode-specific change in hippocampal CA1 neurons: real-time temporal dynamics in multi-unit firings
Authors: Ishikawa Junko , Tomokage Takuto , Mitsushima Dai
Published: May 2023

Episodic memory contains “what-where-when” information of personal experience. There are innumerable episodes, but how the brain processes each episode remains unknown. We discovered episode-specific synchronized activities by multiple neurons in the hippocampal CA1, which were characterized by super burst, ripple-firing, and no-firing silent periods. Since CA1 neurons exhibited episode-specific and cell-dependent diversification of plasticity at excitatory/inhibitory synapses, super burst may be a trigger event for synaptic plasticity induction, contributing to episode encoding by ripple-firings. This study demonstrated the spatiotemporal coding of episodes by multiple-CA1 neurons and the synaptic mechanisms that underpin them. These findings revealed the existence of variety of episode-specific mechanisms of CA1 neurons; episode-specific super bursts that promote diversity at excitatory/inhibitory synapses could generate thousands of ripple-firings including past memory.
A narrative review of the neurological manifestations of human adenosine deaminase 2 deficiency
Authors: Mariia Dzhus , Ehlers Lisa , Wouters Marjon , Jansen Katrien , Schrijvers Rik , De Somer Lien , Vanderschueren Steven , Baggio Marco , Moens Leen , Verhaaren Benjamin , Lories Rik , Bucciol Giorgia , Meyts Isabelle
Published: May 2023

Deficiency of human adenosine deaminase type 2 (DADA2) is a complex systemic autoinflammatory disorder characterized by vasculopathy, immune dysregulation, and hematologic abnormalities. The most notable neurological manifestations of DADA2 are strokes that can manifest with various neurological symptoms and are potentially fatal. However, neurological presentations can be diverse. We here present a review of the neurological manifestations of DADA2 to increase clinical awareness of DADA2 as the underlying diagnosis. We reviewed all published cases of DADA2 from 1 January 2014 until 19 July 2022 found via PubMed. 129 articles describing the clinical features of DADA2 were included in the analysis. 628 patients diagnosed with DADA2 were included in the review. 50.3% of patients had at least signs of one reported neurological event, which was the initial or sole manifestation in 5.7% and 0,6%, respectively. 77.5% of patients with neurological manifestations had at least signs of one cerebrovascular accident, with lacunar strokes being the most common and 35.9% of them having multiple stroke episodes. There is a remarkable predilection for the brain stem and gray matter, with 37.3% and 41.6% of ischemic strokes, respectively. Other neurological involvement included neuropathies, focal neurological deficits, ophthalmological findings, convulsions, headaches. In summary, neurological manifestations affect a significant proportion of patients with DADA2, and the phenotype is broad. Neurological manifestations can be the first and single manifestation of DADA2. Therefore, stroke, encephalitis, posterior reversible encephalopathy syndrome, mono- and polyneuropathy, and Behçet's disease-like presentations should prompt the neurologist to exclude DADA2, especially but not only in childhood.
Development and validation of a nomogram for predicting overall survival of resected N2 non-small cell lung cancer patients undergoing neoadjuvant radiotherapy.
Authors: Shi Jiaxin , Peng Bo , Wang Chenghao , Zhou Xiang , Lu Tong , Xu Ran , Chang Xiaoyan , Shen Zhiping , Wang Kaiyu , Xu Chengyu , Zhang Linyou
Published: May 2023

Introduction Currently, the prognosis of resected N2 non-small cell lung cancer patients undergoing neoadjuvant radiotherapy is poor. The goal of this research was to develop and validate a novel nomogram for exactly predicting the overall survival (OS) of resected N2 NSCLC patients undergoing neoadjuvant radiotherapy.Methods The data applied in our research were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. We divided selected data into a training cohort and a validation cohort using R software, with a ratio of 7:3. Univariate Cox regression and multivariate Cox regression were utilized to select significant variables to build the nomogram. In order to validate our nomogram, calibration curves, receiver operating characteristic curves (ROC), decision curve analysis (DCA), and Kaplan-Meier survival curves were employed. The nomogram model was also compared with the tumor-node-metastasis (TNM) staging system by utilizing Net reclassification index (NRI) and Integrated Discrimination Improvement (IDI).Results Eight variables—age, sex, operative type, LN removed number, chemotherapy, AJCC stage, M stage, histology—were statistically significant in the multivariate Cox Regression Analysis and were selected to develop our nomogram. Based on ROC curves, calibration curves, and DCA analysis, our novel nomogram demonstrated good predictive accuracy and clinical utility. Using Kaplan-Meier (KM) survival curves and log-rank tests, the risk stratification system was able to stratify patients based on their estimated mortality risk. The nomogram performed better than the TNM staging system based on the NRI and IDI indexes.Conclusions We developed and validated a nomogram to predict prognosis of resected N2 NSCLC patients undergoing neoadjuvant radiotherapy. By using this nomogram, Clinicians may find this nomogram useful in predicting OS of targeted patients and making more appropriate treatment decisions.
Clinical Effect of the Internal Fixation for Rib Fracture with Single Utility Port Complete Video-Assisted Thoracoscopic Surgery
Authors: Wang Jindong , Sun Zhiguang , Liu Yongshuai , Gong Weiyong , Wang Jianxin , Deng Junyi , Fu Yue , Lan Jishan
Published: May 2023

Backgrounds: The internal fixation for rib fracture with a single utility port complete video-assisted thoracoscopic surgery (VATS)isa promising surgical approach for treating multiple rib fractures. The study aimed to investigate the minimally invasive surgical procedure’s clinical effect in treating multiple rib fractures．
Methods: Seventy-three patients with multiple rib fractures were divided into two groups according to surgical procedure. In the study group, 42 patients were operated on with the internal fixation of rib fracture with a single utility port complete VATS. In the control group, this study performed the open operative internal fixation for rib fracture with traditional thoracotomy on 31 patients. The surgical-related indexes were retrospectively analyzed. These included the operative time, the intraoperative blood loss, the drainage amount of the chest tube, the placement time of the chest tube, the postoperative hospital stay, the incidence of postoperative complications, the imaging efficacy of rib fixation of rib fractures, and visual analog scale of pain scoring (VAS scoring).
Results: There was no difference in the operative time between the study and control groups (P = 0.806). Theintraoperative blood loss, the chest tube drainage amount, the chest tube placement time, the postoperative hospital stay, and the incidence of postoperative complications in the study group were lower than those in the control group (P < 0.05). There was no significant difference in the imaging efficacy of rib fixation of rib fractures between the two groups (P = 0.806). VAS scores in the study group on the seventh postoperative day were significantly reduced compared with the control group (P= 0.026).
Conclusion: The internal fixation for rib fractures with single utility port complete VATS is a feasible, safe, simple, and minimally invasive surgical procedure to treat multiple rib fractures, which is worthy of clinical application.
Physicians' acceptance of drug-drug interaction alerts from clinical decision support systems: A systematic review and meta-analysis
Authors: Felisberto Mariano , Lima Geovana dos Santos , Celuppi Ianka Cristina , Fantonelli Miliane dos Santos , Zanotto Wagner Luiz , Oliveira Júlia Meller Dias , Mohr Eduarda Talita Bramorski , Santos Ranieri Alves , Scandolara Daniel Henrique , Cunha Célio Luiz , Hammes Jades Fernando , Rosa Júlia Salvan , Demarchi Izabel Galhardo , Wazlawick Raul Sidnei , Dalmarco Eduardo Monguilhott
Published: May 2023

Background
To reduce the risk of adverse drug events related to drug-drug interaction (DDI), healthcare systems worldwide are developing and implementing electronic health records with clinical decision support systems (CDSS). Primary studies have demonstrated that despite being useful, most of the alerts generated by these systems are ignored by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians.
Materials and methods
The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases. Blinded reviewers screened 1873 records and 86 full studies, and 16 articles were included for analysis. Quality assessment was performed by JBI critical appraisal tools, and the meta-analysis was performed using the R software.
Results
The overall prevalence of alert generated by CDSS was 13% (CI95% 5–24%, p-value < 0.0001, I^2 = 100%), and the overall prevalence of alert override by physicians was 90% (CI95% 85–95%, p-value < 0.0001, I^2 = 100%). Only 2 of the 16 studies showed moderate or low methodological quality.
Discussion
This systematic review presents data obtained from primary studies showing a high rate of alert overrides, even after CDSS adjustments that significantly reduced the number of alerts. After analyzing the articles included in this review, it was clear that the CDSS alerts physicians about potential DDI should be developed with a focus on the user experience, thus increasing their confidence and satisfaction, which may increase patient clinical safety.
Carbon Negative Replacements of Gasoline and Diesel fuel
Authors: Tyurin Michael Vladislavovich
Published: May 2023

We offer new Gasoline replacements Carbon Negative fuel n-Butanol or fuel Isobutanol both alone or in combination with Diacetyl alcohol (the mixture 80 (vol/vol) fuel n-Butanol or fuel Isobutanol and 20% (vol/vol) DAA) for the States where the air temperature goes below 34oF. We offer the new Diesel fuel replacement Diacetyl alcohol (DAA). Explosive energy of DAA is much higher that that of Diesel fuel therefore we recommend our customers to check their engine combustion chamber gaskets with the dealerships mechanics on a regular basis. However we did not detect any damage of said gaskets ourselves during the 20,000 miles testing period. We offer the new type of gas stations selling not only Carbon Negative fuels but also distilled water and foods for home cooking to save time of valuable customers. Offer of Carbon Negative Gasoline replacement will help to the reduction of the air CO2 content which will shortly (10–25 years from now) cause the shortness of fresh water on Earth and the resulting from that Global Starvation.
Definition and validation of the nursing diagnosis label “wish to die”: A research protocol.
Authors: Monforte-Royo Cristina , Goni-Fuste Blanca , Crespo Iris , Pergolizzi Denise , Martin-Delgado Leandra , Pilar Fuster , Bellido-Perez Mercedes , Tomas-Sabado Joaquin , Rodriguez-Prat Andrea
Published: May 2023

Background: Euthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care.
This study-protocol aims to define and validate the nursing diagnosis wish to diein patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis.
Methods: A prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an overview of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring’s diagnostic content validation model; Phase-C) Consensus validation of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care will be recruited as participants across the three phases.
Discussion: The definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.
Telehealth palliative care interventions for patients with advanced cancer: a scoping review
Authors: Mathews Jean Jacob , Chow Ronald , Wennberg Erica , Lau Jenny , Hannon Breffni , Zimmermann Camilla
Published: May 2023

Purpose:Telehealth allows patients to maintain contact with healthcare providers without necessitating travel, and is becoming increasingly utilized. The purpose of this study is to describe the components of telehealth palliative care interventions for patients with advanced cancer before the COVID-19 pandemic; identify any intervention components associated with improvements in outcomes; and evaluate reporting of interventions.
Methods: This scoping review was registered on the Open Science Framework. We searched 5 medical databases from inception to June 19, 2020. Inclusion criteria were: age ≥18, advanced cancer, asynchronous or synchronous telehealth intervention, and specialized palliative care interventions in any setting. We assessed the quality of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist.
Results: Twenty-three studies met the inclusion criteria: 15 (65%) quantitative (7 randomized controlled trials, 5 feasibility trials, 3 retrospective chart reviews); 4 (17%) mixed methods, and 4 (17%) qualitative. Most quantitative and mixed methods studies were conducted in North America (12/19, 63%), reported on hybrid (in-person and telehealth) interventions (9/19, 47%), and were delivered by nurses (12/19, 63%) in the home setting (14/19, 74%). In most studies that reported improvements in patient- or caregiver-reported outcomes, the content was psychoeducational and resulted in improvements for psychological symptoms. No study provided complete reporting on all 12 TIDieR checklist items.
Conclusion: Telehealth studies are needed that reflect palliative care’s mission to provide multidisciplinary team-based care that improves quality of life in diverse settings, and that provide detailed reporting of interventions.
HDL inhibits inflammation by suppressing dendritic cell maturation and modulating CD4+ T cell subtypes in collagen-induced arthritis mice
Authors: Wang Xin , Lu Shulai , Li Dong , Zhang Juan , Dong Qingzhe , Jia Dongmei , Wang Yunlong , Liu Bin
Published: May 2023

Background
To investigate the mechanism of anti-inflammatory effect of High-density lipoprotein (HDL) in collagen-induced arthritis (CIA) mice.
Methods
The CIA animal model was constructed, and the mice were separated into three groups: control, CIA and CIA + HDL. In the CIA + HDL group, HDL was given on day 40, and an additional injection was administered every 3 days for a total of five doses. The levels of mouse HDL were measured by using ELISA kits, and liver, heart, kidney and colon tissue sections were stained with H&E. Additionally, the splenic CD4 + T cell phenotypes in each group were analyzed. Immature DCs were stimulated with LPS in the presence or absence of HDL, and the expression of surface markers was investigated by FACS.
Results
HDL decreased the ratio of Th1/Th2 cells and increased the Th1/Th17 cell ratio in the CIA + HDL group compared with those of the CIA one (P < 0.05). In vitro, the expression of MHC-II, CD86, and CD40 in CD11c + BMDCs was suppressed by HDL. The level of HDL in the CIA group was significantly reduced compared with that of the control one (P < 0.05), and there were no significant pathological changes in the liver, heart, kidney and colon tissues of the mice among the three groups.
Conclusion
HDL exerts anti-inflammatory effect in CIA mice by suppressing DCs maturation and modulating CD4 + T cell subtypes.
Non-destructive prediction of rosmarinic acid content in basil plants using a portable hyperspectral imaging system and ensemble learning algorithms
Authors: Yoon Hyo In , Ryu Dahye , Park Jai-Eok , Kim Ho-Youn , Yang Jung-Seok , Park Soo Hyun
Published: May 2023

Background: Rosmarinic acid (RA) is a phenolic antioxidant naturally occurring in plants of the Lamiaceae family, including basil (Ocimum basilicum L.). Existing analytical methods for determining RA content in leaves are time-consuming and destructive, which poses limitations on quality assessment and control during cultivation. In this study, we aimed to develop non-destructive prediction models for RA content in basil plants using a portable hyperspectral imaging (HSI) system and machine learning algorithms. The basil plants were grown in a vertical farm module with controlled environments, and the HSI of the whole plant was captured using a portable HSI camera in the range of 400–850 nm. The average spectra were extracted from the segmented regions of the plants. We employed several spectral data pre-processing methods and ensemble learning algorithms, such as Random Forest, AdaBoost, XGBoost, and LightGBM, to develop the RA prediction model and feature selection based on feature importance.
Results: The best RA prediction model was the LightGBM model with feature selection by AdaBoost algorithm and spectral pre-processing through logarithmic transformation and 2nd derivative. This model performed satisfactorily for practical screening with R2p = 0.81 and RMSEP = 3.92. The HSI images obtained using the developed model successfully estimated and visualized the RA distribution in basil plants growing in the greenhouse.
Conclusions: Our findings demonstrate the potential use of a portable HSI system for monitoring and controlling pharmaceutical quality in medicinal plants during cultivation. This non-destructive and rapid method can provide a valuable tool for assessing the quality of RA in basil plants, thereby enhancing the efficiency and accuracy of quality control during the cultivation stage.
Scientific note: behavioral dynamics of pollen storage in Melipona quadrifasciata
Authors: Miranda-Pinto Patrícia , Cappelini Luciana Teresa Dias , MORAIS MICHELLE MANFRINI
Published: May 2023

Stingless bees are important eusocial insects found in tropical and subtropical regions. They store nectar and pollen from flowers to survive periods of scarcity. During storage, nectar and pollen undergo fermentation processes, resulting in honey and fermented pollen. However, the fermentation process of pollen collected by stingless bees is not well understood. Understanding these processes not only clarifies pollen fermentation in different stingless bee species but also sheds light on the transformation process of pollen. This knowledge can be applied to produce fermented feeds using specific microorganisms. Therefore, this study aimed to observe pollen storage behavior within colonies to understand the fermentation process and aid in the development of fermented feeds for bees. A Melipona quadrifasciata colony from the Experimental Meliponary of the Universidade Federal de São Paulo, Brazil, was observed for 30 days. Daily observations were conducted in the morning and night, and pollen pots were marked with random colors to differentiate them and collect data on worker bee dynamics. Observations showed no consistent patterns in the opening and closing of the pots, with worker bees frequently entering and exiting the open pollen pots. This suggests an ongoing fermentation process involving gas exchange and nutrient flow. The lack of regularity in handling pollen storage in M. quadrifasciata indicates its noteworthy variability. These findings are crucial for advancing meliponiculture techniques and developing fermented protein supplements globally and locally.