bluuebunny/crossref_metadata_2025 huggingface dataset:
Latency‐Sensitive Service Function Chains Intelligent Migration in Satellite Communication Driven by Deep Reinforcement Learning
Authors: Zhang Peiying , Li Yilin , Tan Lizhuang , Liu Kai , Wen Miao , Hao Hao
Published: October 2024

Satellite communication technology solves the problem that the traditional wired network infrastructure is difficult to achieve global communication coverage. However, factors such as satellite orbits introduce frequent changes to the network topology, and challenges like satellite failures and communication link interruptions are prevalent. In the face of these issues, service function chain (SFC) migration becomes a crucial method for swiftly adjusting SFCs during faults, maintaining service continuity and availability. This article proposes a latency‐sensitive SFC migration algorithm tailored to satellite networks. The algorithm first models the satellite network as a multi‐domain virtual network, capturing the constraints faced during SFC migration. Subsequently, a deep reinforcement learning algorithm integrated attention mechanism is designed to more accurately capture and understand the complex network environment and dynamic satellite network topology and derive optimal SFC migration strategies for superior performance. Finally, through experimentation and evaluation of the deep reinforcement learning‐driven latency‐sensitive service function chain intelligent migration algorithm (LS‐SFCM) in satellite communication, this study validates the effectiveness and superior performance of the algorithm in latency‐sensitive scenarios. It provides a new avenue for enhancing the service quality and efficiency of satellite communication networks.
Lightweight and conformal acousto‐ultrasonic sensing network for multi‐scale structural health monitoring: A review
Authors: Li Yehai , Guo Shifeng , Su Zhongqing , Ding Keqin , Loh Xian Jun
Published: October 2024

Structural health monitoring (SHM) has been increasingly investigated for decades. Different physical principles have been developed for damage identification, such as electronics, mechanics, magnetics, etc., with different coverage (i.e., global, large‐area, and local monitoring) and sensitivity. Mechanical acousto‐ultrasonic‐based methods have formed a big family in SHM technologies. Multiple wave/resonance modes have been utilized for versatile SHM tasks. The permanently integrated sensing networks play a significant role in achieving a cost‐effective and reliable SHM system, with major concerns including weight increase for large‐scale deployment and conformity for complex geometry structures. In this review, typical acousto‐ultrasonic sensors made of different material systems are discussed, along with advantages and limitations. Moreover, advanced network installation methods have been introduced, including surface‐mounting with pre‐integrated networks on substrates and in situ printing, and embedding with composite layup and metal additive manufacturing. Sensor versatility and usage in multi‐scale SHM techniques are then highlighted. Different wave/resonance modes are transmitted and received with corresponding elements and network designs. In conclusion, this systematic review mainly covers a collection of acousto‐ultrasonic sensors, two modalities of network installation, and their employment with various SHM methods, hopefully providing a useful guide to building lightweight and conformal networks with passive or active‐passive sensors, and developing complete and reliable SHM strategies by integrating different damage identification methods on multiple scales.
Long‐term reprogramming of primed microglia after moderate inhibition of CSF1R signaling
Authors: León‐Rodríguez Ana , Grondona Jesús M. , Marín‐Wong Sonia , López‐Aranda Manuel F. , López‐Ávalos María D.
Published: October 2024

In acute neuroinflammation, microglia activate transiently, and return to a resting state later on. However, they may retain immune memory of such event, namely priming. Primed microglia are more sensitive to new stimuli and develop exacerbated responses, representing a risk factor for neurological disorders with an inflammatory component. Strategies to control the hyperactivation of microglia are, hence, of great interest. The receptor for colony stimulating factor 1 (CSF1R), expressed in myeloid cells, is essential for microglia viability, so its blockade with specific inhibitors (e.g. PLX5622) results in significant depletion of microglial population. Interestingly, upon inhibitor withdrawal, new naïve microglia repopulate the brain. Depletion‐repopulation has been proposed as a strategy to reprogram microglia. However, substantial elimination of microglia is inadvisable in human therapy. To overcome such drawback, we aimed to reprogram long‐term primed microglia by CSF1R partial inhibition. Microglial priming was induced in mice by acute neuroinflammation, provoked by intracerebroventricular injection of neuraminidase. After 3‐weeks recovery, low‐dose PLX5622 treatment was administrated for 12 days, followed by a withdrawal period of 7 weeks. Twelve hours before euthanasia, mice received a peripheral lipopolysaccharide (LPS) immune challenge, and the subsequent microglial inflammatory response was evaluated. PLX5622 provoked a 40%–50% decrease in microglial population, but basal levels were restored 7 weeks later. In the brain regions studied, hippocampus and hypothalamus, LPS induced enhanced microgliosis and inflammatory activation in neuraminidase‐injected mice, while PLX5622 treatment prevented these changes. Our results suggest that PLX5622 used at low doses reverts microglial priming and, remarkably, prevents broad microglial depletion.
Splicing dysregulation in glioblastoma alters the function of cell migration‐related genes
Authors: Seong Minu , Bak‐Gordon Pedro , Liu Zhaoqi , Canoll Peter D. , Manley James L.
Published: October 2024

Glioblastoma (GBM) has a poor prognosis with a high recurrence and low survival rate. Previous RNA‐seq analyses have revealed that alternative splicing (AS) plays a role in GBM progression. Here, we present a novel AS analysis method (Semi‐Q) and describe its use to identify GBM‐specific AS events. We analyzed RNA‐seq data from normal brain (NB), normal human astrocytes (NHAs) and GBM samples, and found that comparison between NHA and GBM was especially informative. Importantly, this analysis revealed that genes encoding cell migration‐related proteins, including filamins (FLNs) and actinins (ACTNs), were among those most affected by differential AS. Functional assays revealed that dysregulated AS of FLNA, B and C transcripts produced protein isoforms that not only altered transcription of cell proliferation‐related genes but also led to enhanced cell migration, resistance to cell death and/or mitochondrial respiratory function, while a dysregulated AS isoform of ACTN4 enhanced cell migration. Together, our results indicate that cell migration and actin cytoskeleton‐related genes are differentially regulated by AS in GBM, supporting a role for AS in facilitating tumor growth and invasiveness.
Functional connectivity in resting‐state networks relates to short‐term global cognitive functioning in cardiac arrest survivors
Authors: Verhulst Marlous M. L. H. , Keijzer Hanneke M. , van Gils Pauline C. W. , van Heugten Caroline M. , Meijer Frederick J. A. , Tonino Bart A. R. , Bonnes Judith L. , Delnoij Thijs S. R. , Hofmeijer Jeannette , Helmich Rick C.
Published: October 2024

Long‐term cognitive impairment is common in cardiac arrest survivors. Screening to identify patients at risk is recommended. Functional magnetic resonance brain imaging (fMRI) holds potential to contribute to prediction of cognitive outcomes. In this study, we investigated the possible value of early changes in resting‐state networks for predicting short and long‐term cognitive functioning of cardiac arrest survivors. We performed a prospective multicenter cohort study in cardiac arrest survivors in three Dutch hospitals. Resting‐state fMRI scans were acquired within a month after cardiac arrest. We primarily focused on functional connectivity within the default‐mode network (DMN) and salience network (SN), and additionally explored functional connectivity in seven other networks. Cognitive outcome was measured using the Montreal Cognitive Assessment (MoCA) during hospital admission and at 3 and 12 months, and by neuropsychological examination (NPE) at 12 months. We tested mixed effects models to evaluate the value of connectivity within the networks for predicting global cognitive outcomes at the three time points, and long‐term cognitive outcomes in the memory, attention, and executive functioning domains. We included 80 patients (age 60 ± 11 years, 72 (90%) male). MoCA scores increased significantly between hospital admission and 3 months (ΔMoCAhospital‐3M = 2.89, p < 0.01), but not between 3 and 12 months (ΔMoCA3M–12M = 0.38, p = 0.52). Connectivity within the DMN, SN, and dorsal attention network (DAN) was positively related to global cognitive functioning during hospital admission (βDMN = 0.85, p = 0.03; βSN = 1.48, p < 0.01; βDAN = 0.96, p = 0.01), but not at 3 and 12 months. Network connectivity was also unrelated to long‐term memory, attention, or executive functioning. Resting‐state functional connectivity in the DMN, SN, and DAN measured in the first month after cardiac arrest is related to short‐term global, but not long‐term global or domain‐specific cognitive performance of survivors. These results do not support the value of functional connectivity within these RSNs for prediction of long‐term cognitive performance after cardiac arrest.
A (sub)field guide to quality control in hippocampal subfield segmentation on high‐resolution T2‐weighted MRI
Authors: Canada Kelsey L. , Mazloum‐Farzaghi Negar , Rådman Gustaf , Adams Jenna N. , Bakker Arnold , Baumeister Hannah , Berron David , Bocchetta Martina , Carr Valerie A. , Dalton Marshall A. , de Flores Robin , Keresztes Attila , La Joie Renaud , Mueller Susanne G. , Raz Naftali , Santini Tales , Shaw Thomas , Stark Craig E. L. , Tran Tammy T. , Wang Lei , Wisse Laura E. M. , Wuestefeld Anika , Yushkevich Paul A. , Olsen Rosanna K. , Daugherty Ana M. ,   the Hippocampal Subfields Group
Published: October 2024

Inquiries into properties of brain structure and function have progressed due to developments in magnetic resonance imaging (MRI). To sustain progress in investigating and quantifying neuroanatomical details in vivo, the reliability and validity of brain measurements are paramount. Quality control (QC) is a set of procedures for mitigating errors and ensuring the validity and reliability of brain measurements. Despite its importance, there is little guidance on best QC practices and reporting procedures. The study of hippocampal subfields in vivo is a critical case for QC because of their small size, inter‐dependent boundary definitions, and common artifacts in the MRI data used for subfield measurements. We addressed this gap by surveying the broader scientific community studying hippocampal subfields on their views and approaches to QC. We received responses from 37 investigators spanning 10 countries, covering different career stages, and studying both healthy and pathological development and aging. In this sample, 81% of researchers considered QC to be very important or important, and 19% viewed it as fairly important. Despite this, only 46% of researchers reported on their QC processes in prior publications. In many instances, lack of reporting appeared due to ambiguous guidance on relevant details and guidance for reporting, rather than absence of QC. Here, we provide recommendations for correcting errors to maximize reliability and minimize bias. We also summarize threats to segmentation accuracy, review common QC methods, and make recommendations for best practices and reporting in publications. Implementing the recommended QC practices will collectively improve inferences to the larger population, as well as have implications for clinical practice and public health.
The role of emergency medicine specialists and general practitioners in yellow zone patient management: A case in the Sakarya Province
Authors: Aslan Nuray , Guneysu Fatih , Guner Necip Gokhan , Durmuş Ensar , Akdeniz Sacit , Yurumez Yusuf
Published: October 2024

Background

Emergency departments in Turkey employ both emergency medicine specialists (EMSs) and general practitioners due to an insufficient number of EMSs. Patients are triaged into green, yellow, and red codes based on urgency. Typically, EMSs manage more critical patients (yellow and red codes), while general practitioners handle less urgent cases (green codes).

Objective

This study investigates differences in patient management approaches between EMSs and general practitioners in the yellow zone of an emergency department in the Sakarya Province.

Method

This retrospective, cross‐sectional study was conducted at the Sakarya Training and Research Hospital from 31 December 2020 to 31 December 2021. The study included patients aged 18 and older who were assigned to the yellow zone and discharged by the attending physician. Data on patient monitoring times, consultation requests, hospitalization rates, resource utilization, readmission rates, and hospital revenue contributions were collected and analyzed. Statistical analyses were performed using IBM SPSS version 21, comparing the performance of EMSs and general practitioners.

Result

The study included 59 physicians (14 EMSs and 45 general practitioners) and a large number of patients. EMSs had significantly more experience, shorter consultation request times, and higher ICU admission rates. They also ordered fewer MRIs and USGs per patient and made more consultation requests. There was no significant difference between EMSs and general practitioners in terms of the number of examinations, patient observation times, ward hospitalization rates, CT orders, readmission rates, and hospital revenue contributions.

Conclusion

EMSs demonstrated more efficient use of emergency department resources, effective consultation processes, and higher ICU admission rates, indicating better patient management. Despite the limited scope of this single‐center study, the findings highlight the importance of EMSs in improving emergency care quality. Further research is needed to validate these results across multiple centers.
Unmasking hidden challenges for migrant learners with few prior experiences with formal education: An exploration of language learning textbooks
Authors: Triulzi Marco , DeCapua Andrea , Maahs Ina‐Maria
Published: October 2024

The German government requires all migrants without sufficient German language proficiency to enroll in integration courses. Many of these migrants had few prior experiences with formal education, yet, regardless of degree of literacy in any language, they are placed in classes based on language proficiency. How well do government‐approved language textbooks for integration courses meet the needs of migrant learners with few prior experiences with formal education and emergent literacy skills? We present a qualitative exploration of approved German language textbooks to identify hidden challenges. Results indicate that the textbooks require literacy practices, assume sociocultural practices, and demand ways of thinking largely unfamiliar to these learners. Moreover, promotion of a/n (ideal) German culture and western views of knowledge fosters deficit perspectives while rendering invisible the knowledges, and strengths of these learners. Thus, providing effective language education for these migrants requires a mind shift. The findings, discussion, and suggestions have relevance to educators globally.
Heteropolyacids combined with Y zeolite as superior solid acid catalysts to accelerate lactic acid esterification
Authors: Quan Cui , Zhou Yingying , Chu Hua , Fan Xiaolei , Gao Ningbo
Published: October 2024

BACKGROUND

Ethyl lactate produced via esterification between lactic acid and ethanol can be used in plastics, polymers and food industries and renowned for its biodegradability and low toxicity. However, lactic acid self‐catalyzed esterification presents a slow reaction process, and acid catalysts are needed to improve the catalysis. Homogeneous acid catalysts like H2SO4 are corrosive, as well as being difficult to be seperated from the reaction media; therefore, advanced heterogeneous catalysts are more ideal. In this study, two kinds of heteropolyacid–zeolite catalysts, involving loading silicotungstic acid and phosphotungstic acid onto Y zeolite, were synthesized, characterized using X‐ray diffraction, NH3 temperature‐programmed desorption and scanning electron microscopy and analyzed for their catalytic efficiency in the catalytic esterfication.

RESULTS

Results showed that the Keggin structures of heteropolyacids were retained during the preparation process and strong acid sites of Y zeolite were enriched, which made the main contribution to the esterification of lactic acid and ethanol. Furthermore, the initial‐stage reaction rate of esterification was significantly enhanced. During the first hour of esterification, the conversion of lactic acid increased from 18% to 65%. Exp Dec1 index model was employed to determine the activation energies of 60HSiW‐Y and 60HPW‐Y, which exhibit values of 29.3 and 28.2 kJ mol−1, respectively.

CONCLUSION

This study indicates that Keggin structures of heteropolyacids play a key role in the esterification and heteropolyacid–zeolite catalysts can effectively catalyze the esterification. Meanwhile, the results of the kinetic experiments can be of reference significance for large‐scale industrial processes involving esterification. © 2024 Society of Chemical Industry (SCI).
Power, data and social accountability: defining a community‐led monitoring model for strengthened health service delivery
Authors: Rambau Ndivhuwo , Policar Soeurette , Sharp Alana R. , Lankiewicz Elise , Nsubuga Allan , Chimhanda Luke , Yawa Anele , Mwehonge Kenneth , Tobaiwa Donald Denis , Alfred Gérald Marie , Kavanagh Matthew M. , Russell Asia , Baptiste Solange , Kalama Onesmus Mlewa , Marte Rodelyn M. , Ledan Naïké , Honermann Brian , Lauer Krista , Rafif Nadia , Perez Susan , Sun Gang , Grimsrud Anna , Sprague Laurel , Mienies Keith
Published: October 2024

Introduction

Despite international commitment to achieving the end of HIV as a public health threat, progress is off‐track and existing gaps have been exacerbated by COVID‐19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community‐led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence‐based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services.

Discussion

Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community‐led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community‐led advocacy, with the aim of increasing duty‐bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long‐term approach to building meaningful engagement in systems‐wide improvements rather than discrete interventions.

Conclusions

The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.
Effects of ensemble‐forecasted key environmental factors on the distribution, active constituents, and transcription regulation in Ligusticum chuanxiong Hort
Authors: Zhang Tingting , Zhou Lili , Han Ying , Feng Wanqing , Chen Chao , Wen Jiawei , Peng Cheng , He Yang
Published: October 2024

BACKGROUND

Ligusticum chuanxiong Hort., with over 2000 years of medicinal use and cultivation history, is extensively used in clinical settings for treating heart disease, headache, dysmenorrhea, and amenorrhea. Constructing the geographic distribution pattern of L. chuanxiong and identifying the environmental factors limiting its range, as well as clarifying the effects of key environmental factors on the content of major active constituents and transcription regulation, could provide a scientific foundation for the conservation and effective management of this valuable medicinal resource.

RESULTS

The results reveal that the predominant environmental factors influencing the distribution were the minimum temperature of the coldest month (Bio6) and solar radiation (Srad), with cumulative account for 87.46% of the importance. Correlation analysis further reveals significant negative correlations between Bio6 and the content of major active constituents in L. chuanxiong, with Srad exhibiting a negative correlation with these constituents. The gene differential expression analysis indicated that the expression levels of some genes associated with growth and active constituent biosynthesis pathways, such as RPT2_13888, UVR8_16871, CLPB3_3155, and 4CLL5_116, varied significantly among locations influenced by differing key environmental factors. Consequently, alterations in the environment were found to influence the gene expression levels within these pathways, resulting in variations in the content of active constituents.

CONCLUSIONS

These findings contribute to an enhanced understanding of how environmental factors impact the distribution and quality of medicinal plants and offer a theoretical reference for the introduction, cultivation, quality improvement, resource utilization and management of L. chuanxiong. © 2024 Society of Chemical Industry.
Sargassum beaching on mangrove sediments shifts microbial and crab metabolisms and enhances blue carbon storage
Authors: Chynel Mathias , Abril Gwenaël , Narayaninsamy Mélissa , Deirmendjian Loris , Guérin Frédéric , Dromard Charlotte , Meziane Tarik
Published: October 2024

Benthic metabolism and net carbon accumulation in mangroves sediments strongly depend on the quantity and quality of organic matter (OM) supplied, including material brought by coastal waters such as the macroalgae Sargassum spp. Mesocosms were used to assess the effect of eutrophication by Sargassum on mangrove sediments. The concentration of fatty acids (FAs), organic carbon and its carbon isotopic signature, and the sediments–air CO2 fluxes were used to follow the evolution of sedimentary OM in surface and subsurface sediments for 60 d. Sargassum beaching shifted microbial and crab metabolism, leading to a preferential degradation of the labile fraction of OM from both Sargassum (δ13C = −17.7‰ and high concentration of essential FAs) and mangrove leaves (δ13C: −28.9‰ and high concentrations of 18:2ω6 and 18:3ω3). Fatty acids composition of crabs hepatopancreas revealed they preferentially fed on Sargassum and these invertebrates also increased the particulate OM tidal export. In addition, microbial activity at the sediment surface was enhanced, as revealed by strong production of branched FAs and higher CO2 fluxes in mesocosms containing Sargassum. However, Sargassum beaching also increased the transfer and preservation of more refractory OM from mangrove leaves found in higher quantity in subsurface sediments (6–8 cm) after 60 d. Inputs of macroalgae induced a negative priming effect and enhanced the preservation of blue carbon in the sediments. This negative priming effect was enhanced by crab activities. These biotic interactions that include microbial communities apparently make mangrove efficient in storing carbon in a context of growing eutrophication of the tropical ocean.
How loneliness affects consumers' reluctance to let go of used possessions
Authors: Hu Bingyan , Cole Cathy , Wang Jing
Published: October 2024

We investigate the impact of loneliness on consumer disposition of used, yet still useful possessions. Both loneliness and how consumers handle used products have emerged as important societal and research topics. While existing literature primarily addresses how loneliness influences product acquisition, our research delves into its effect on the disposition of used products. Studies 1–3 demonstrate that lonely consumers are less willing to let go of their used possessions because they form stronger self‐product attachments. Study 4 further examines an unstudied factor that moderates the effect—the relational meanings of a product (whether the item was a gift from someone else or acquired by the owner themselves). Our work contributes to the loneliness literature by showing how lonely consumers attach to possessions with different relational meanings. We also contribute to the growing disposition literature by investigating the joint influence of the disposers' traits and product characteristics. Our findings suggest communication strategies to facilitate lonely consumers' decluttering and disposal decisions.
Cardiomyopathy: pathogenesis and therapeutic interventions
Authors: Huang Shitong , Li Jiaxin , Li Qiuying , Wang Qiuyu , Zhou Xianwu , Chen Jimei , Chen Xuanhui , Bellou Abdelouahab , Zhuang Jian , Lei Liming
Published: October 2024

Cardiomyopathy is a group of disease characterized by structural and functional damage to the myocardium. The etiologies of cardiomyopathies are diverse, spanning from genetic mutations impacting fundamental myocardial functions to systemic disorders that result in widespread cardiac damage. Many specific gene mutations cause primary cardiomyopathy. Environmental factors and metabolic disorders may also lead to the occurrence of cardiomyopathy. This review provides an in‐depth analysis of the current understanding of the pathogenesis of various cardiomyopathies, highlighting the molecular and cellular mechanisms that contribute to their development and progression. The current therapeutic interventions for cardiomyopathies range from pharmacological interventions to mechanical support and heart transplantation. Gene therapy and cell therapy, propelled by ongoing advancements in overarching strategies and methodologies, has also emerged as a pivotal clinical intervention for a variety of diseases. The increasing number of causal gene of cardiomyopathies have been identified in recent studies. Therefore, gene therapy targeting causal genes holds promise in offering therapeutic advantages to individuals diagnosed with cardiomyopathies. Acting as a more precise approach to gene therapy, they are gradually emerging as a substitute for traditional gene therapy. This article reviews pathogenesis and therapeutic interventions for different cardiomyopathies.
Thalamic Local Field Potentials and Closed‐Loop Deep Brain Stimulation in Orthostatic Tremor
Authors: Fung Wilson K.W. , Sumarac Srdjan , Sorrento Gianluca , Santyr Brendan , Milosevic Luka , Lang Anthony E. , Lozano Andres M. , Kalia Suneil K. , Fasano Alfonso
Published: October 2024

Background

Orthostatic tremor (OT) is a rare movement disorder characterized by a feeling of unsteadiness and a high‐frequency tremor in the legs (13–18 Hz) relieved by sitting or walking.

Objectives

The aims were to study the brain electrophysiology captured chronically in a person with medication‐refractory OT while standing and walking and in the semi‐recumbent position using bilateral ventral intermedius nucleus deep brain stimulation (DBS) (Medtronic Percept PC) and to describe the clinical use of closed‐loop DBS.

Methods

A sensing survey was used to capture baseline local field potentials (LFPs) while standing. Livestreamed LFPs were synchronized with data collected from two accelerometers (legs) and gait analysis during OFF stimulation and continuous and closed‐loop DBS.

Results

Strong oscillatory coupling between thalamic LFP and leg tremor with significant coherence at 14.65 Hz was found during weight‐bearing. Single‐threshold adaptive DBS (sensing at this frequency) was superior to continuous stimulation in reducing tremor and stimulation‐related gait ataxia.

Conclusions

This study provides new insights into both the pathophysiology and management of OT. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Clinical and Cost‐Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta‐Analysis
Authors: Singaravelu Ashokkumar , McCarrick Cathleen , Potter Shirley , Cahill Ronan A.
Published: October 2024

Background

Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost‐effectiveness across various plastic and reconstructive surgery procedures.

Methods

A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta‐analysis concerned perfusion‐related complications and cost data.

Results

Twenty‐five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty‐one studies were AHRQ Standard ‘Good’; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta‐analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re‐operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta‐analysis.

Conclusions

ICGFA appears to be a useful, cost‐effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.
Unilateral and Bilateral Transcutaneous Tibial Nerve Stimulation in Women With Overactive Bladder Syndrome: A Randomized Controlled Study (UBTTNS‐OAB Study)
Authors: Galhardo Letícia Martinelli , Giorgenon Geovanna Volta , Rótoli Marina , de Araújo Camila Carvalho , Brito Luiz G. O. , Juliato Cássia R. T.
Published: October 2024

Introduction

The efficacy of unilateral versus bilateral Transcutaneous Tibial Nerve Stimulation (TTNS) for women with Overactive Bladder Syndrome (OAB) remains uncertain.

Objective

To compare the efficacy of unilateral and bilateral TTNS in the tibial region in women with OAB.

Methods

This randomized, controlled, triple‐blind clinical trial included women with OAB or urgency‐predominant urinary incontinence (UUI). Participants were randomized (1:1) into the Unilateral Tibial Group or Bilateral Tibial Group. Before treatment, they underwent a pre‐assessment including peripheral sensitivity examination and completion of sociodemographic data and seven validated questionnaires on urinary symptoms, quality of life, sleep, and psycho‐emotional aspects. TTNS interventions were administered twice weekly (12 sessions, 30 min each). Posttreatment, participants underwent another physical examination and completed the same questionnaires, with a 30‐day follow‐up. Categorical variables were analyzed using Chi‐square or Fisher's Exact Test, while numerical variables were assessed with the Mann‐Whitney test. Group comparisons over time utilized intention‐to‐treat ANOVA (p < 0.05).

Results

Thirty‐five women participated: 17 in the unilateral group and 18 in the bilateral group. Mean ages were 55.1 (±14.7) years and 52.7 (±12.6) years, respectively (p = 0.680). Initial OAB severity (ICIQ‐OAB) did not differ significantly between groups (p = 0.561). Both groups showed significant improvement in ICIQ‐OAB scores: unilateral group from 10.1 (±3.4) to 5.8 (±3.4) (p < 0.001), bilateral group from 9.3 (±3.3) to 5.1 (±4) (p < 0.001), with no intergroup difference (p = 0.395). Improvement in UUI symptoms was observed: unilateral group from 2.2 (±1.4) to 0.7 (±1.5), bilateral group from 1.5 (±1.9) to 0.2 (±0.5), without significant intergroup difference (p = 0.645). Quality of life scores improved similarly between groups (p = 0.055).

Conclusion

TTNS appears to be effective in improving bladder storage and UUI symptoms in women with OAB, with no difference between unilateral and bilateral applications.

Clinical Trial Registration

Brazilian Registry of Clinical Trials (REBEC) (RBR: 96f2fgkn).
Impact of nutrition‐related laboratory tests on mortality of patients who are critically ill using artificial intelligence: A focus on trace elements, vitamins, and cholesterol
Authors: Park Dong Jin , Baik Seung Min , Lee Hanyoung , Park Hoonsung , Lee Jae‐Myeong
Published: October 2024

Background

This study aimed to understand the collective impact of trace elements, vitamins, cholesterol, and prealbumin on patient outcomes in the intensive care unit (ICU) using an advanced artificial intelligence (AI) model for mortality prediction.

Methods

Data from ICU patients (December 2016 to December 2021), including serum levels of trace elements, vitamins, cholesterol, and prealbumin, were retrospectively analyzed using AI models. Models employed included category boosting (CatBoost), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and multilayer perceptron (MLP). Performance was evaluated using area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1‐score. The performance was evaluated using 10‐fold crossvalidation. The SHapley Additive exPlanations (SHAP) method provided interpretability.

Results

CatBoost emerged as the top‐performing individual AI model with an AUROC of 0.756, closely followed by LGBM, MLP, and XGBoost. Furthermore, the ensemble model combining these four models achieved the highest AUROC of 0.776 and more balanced metrics, outperforming all models. SHAP analysis indicated significant influences of prealbumin, Acute Physiology and Chronic Health Evaluation II score, and age on predictions. Notably, the ratios of selenium to age and low‐density lipoprotein to total cholesterol also had a notable impact on the models' output.

Conclusion

The study underscores the critical role of nutrition‐related parameters in ICU patient outcomes. Advanced AI models, particularly in an ensemble approach, demonstrated improved predictive accuracy. SHAP analysis offered insights into specific factors influencing patient survival, highlighting the need for broader consideration of these biomarkers in critical care management.
Improved visualization of cochlear implant electrodes on photon counting detector CT
Authors: Schroeder Dane G. , Farnsworth Paul J. , Carr Carrie M. , DeLone David R. , Benson John C. , Carlson Matthew L. , Leng Shuai , Mark Ian T. , Kassmeyer Blake A. , Lane Jack I.
Published: October 2024

Background

Cochlear implants (CIs) are used to rehabilitate moderate to profound sensorineural hearing loss and stimulate the auditory system via a multichannel electrode array positioned in the scala tympani. Imaging evaluation of CIs is substantially degraded by metallic artifacts. Photon‐counting detector (PCD)‐CT has the potential to minimize such artifacts, though this has not been convincingly established in prior studies. This study compared the visualization of CI electrodes on PCD‐CT to conventional energy integrating detector (EID)‐CT.

Materials and Methods

Five patients with CIs were prospectively recruited to undergo temporal bone imaging on both EID‐CT and PCD‐CT scanners yielding 2D and 3D Volume Rendering Technique (VRT) images. Three nonblinded neuroradiologists reviewed 2D and 3D VRT images for the ability to resolve CI electrode leads using a Likert scale. The average Likert scores of PCD‐CT versus EID‐CT were calculated for each reader for both 2D and 3D VRT images. (Likert scores 1–5 based on inferior to superior rating of PCD‐CT compared to EID‐CT). Inter‐rater agreement was assessed using Krippendorff's alpha with ordinal weights. 

Results

Five patients underwent temporal bone CT for CI array evaluation. As evidenced by 5‐point Likert scales that were independently used by the three reviewers, this study demonstrated superior resolution of CI electrode array using PCD‐CT as compared to EID‐CT with an average score of 4.2 ± 0.8 for 2D images and 4.9 ± 0.4 for 3D VRT images.

Conclusions

PCD‐CT is superior to EID‐CT in the visualization of CI electrodes, particularly in 3D VRT imaging.
Social classroom seating assignment problems
Authors: Hill Alessandro , Hom David , Peuker Steffen , Mourtos Ioannis
Published: October 2024

University students benefit academically, personally and professionally from an expansion of their in‐class social network. To facilitate this, we present a novel and broadly‐applicable optimization approach that exposes individuals to as many as possible peers that they do not know. This novel class of “social seating assignment problems” is parameterized by the social network, the physical seating structure and “tie potentials” representing the likelihood for two neighbors to connect. The resulting problem is NP‐hard and belongs to assignment problems with an elaborate objective that depends on the relation of both seats and individuals assigned to them. We develop compact integer programming formulations and strengthen them with valid inequalities to improve performance. In parallel, we suggest fast heuristics that are guided by network centrality measures. Finally, we present the necessary modeling techniques to integrate practically relevant instructor preferences and special student needs. Combining the above, we experiment on a set of 320 realistic instances with up to 200 students forming both sparse and dense social networks and for both rectangular and circular classrooms. For sparse or small instances we present optimality gaps under 1.3% within a few minutes, whereas in larger or denser cases the algorithmic performance decreases. We also evaluate our approach from both a quantitative and a qualitative perspective on three actual classes with more than 70 students. A network‐analysis‐based comparison of a priori and a posteriori networks shows that 40% of opportunities led to new connections, while feedback from both instructor and student is particularly favorable for our method.
Music Therapy for Pain Management for People With Advanced Cancer: A Randomized Controlled Trial
Authors: Bradt Joke , Leader Amy , Worster Brooke , Myers‐Coffman Kate , Bryl Karolina , Biondo Jacelyn , Schneible Brigette , Cottone Carrie , Selvan Preethi , Zhang Fengqing
Published: October 2024

Objective

To improve mechanistic understanding, this randomized controlled trial examined anxiety, mood, emotional support, and pain‐related self‐efficacy as mediators of music therapy for pain management in people with advanced cancer.

Methods

People with advanced cancer who had chronic pain were randomized (1:1) to 6 weekly individual music therapy or social attention control sessions. We measured mediators and pain outcomes (pain interference and pain intensity) using self‐report measures at baseline, session 4, and post‐intervention. We included outcome expectancy/treatment credibility, music reward, adult playfulness, and baseline pain interference and pain intensity as moderators.

Results

Participants (n = 92) had a mean age of 56 years. Most were female (71.7%), white (47.8%) or Black (39.1%), and had stage IV cancer (75%). Self‐efficacy was found to be a significant mediator of music therapy for pain intensity (indirect effect ab = 0.79, 95% CI 0.01–1.82) and pain interference (indirect effect ab = 1.16, 95% CI 0.02–2.51), while anxiety, mood, and emotional support were not. The mediating effect of pain‐related self‐efficacy was significantly moderated by baseline pain interference but not by the other moderators.

Conclusions

The findings suggest that the impact of music therapy on chronic pain is mediated by self‐efficacy. This knowledge can help optimize music therapy interventions for chronic pain management for people with advanced cancer by capitalizing on teaching music‐based self‐management strategies.

Trial Registration: ClinicalTrials.gov identifier: NCT03432247
Predicting exacerbations in severe preschool wheezers
Authors: Fayon Michael , Beaufils Fabien
Published: October 2024

Simple clinical indices, complex composite phenotyping/endotyping and telehome monitoring now allow us to evaluate the risk of preschool wheezing on a population or individual level. We herein discuss the usefulness of clinical markers which involve underlying issues such as in utero smoke exposure, the pathophysiology of viral‐immunological‐allergic interactions, and changes in airway epithelium, mesenchyme and smooth muscle cells. The most important unmet need in this age group remains disease‐modifying interventions.
PKBOIN‐12: A Bayesian Optimal Interval Phase I/II Design Incorporating Pharmacokinetics Outcomes to Find the Optimal Biological Dose
Authors: Sun Hao , Tu Jieqi
Published: October 2024

Immunotherapies and targeted therapies have gained popularity due to their promising therapeutic effects across multiple treatment areas. The focus of early phase dose‐finding clinical trials has shifted from finding the maximum tolerated dose (MTD) to identifying the optimal biological dose (OBD), which aims to balance the toxicity and efficacy outcomes, thus optimizing the risk–benefit trade‐off. These trials often collect multiple pharmacokinetics (PK) outcomes to assess drug exposure, which has shown correlations with toxicity and efficacy outcomes but has not been utilized in the current dose‐finding designs for OBD selection. Moreover, PK outcomes are usually available within days after initial treatment, much faster than toxicity and efficacy outcomes. To bridge this gap, we introduce the innovative model‐assisted PKBOIN‐12 design, which enhances BOIN12 by integrating PK information into both the dose‐finding algorithm and the final OBD determination process. We further extend PKBOIN‐12 to TITE‐PKBOIN‐12 to address the challenges of late‐onset toxicity and efficacy outcomes. Simulation results demonstrate that PKBOIN‐12 more effectively identifies the OBD and allocates a greater number of patients to it than BOIN12. Additionally, PKBOIN‐12 decreases the probability of selecting inefficacious doses as the OBD by excluding those with low drug exposure. Comprehensive simulation studies and sensitivity analysis confirm the robustness of both PKBOIN‐12 and TITE‐PKBOIN‐12 in various scenarios.
Bayesian Empirical Likelihood Regression for Semiparametric Estimation of Optimal Dynamic Treatment Regimes
Authors: Yu Weichang , Bondell Howard
Published: October 2024

We propose a semiparametric approach to Bayesian modeling of dynamic treatment regimes that is built on a Bayesian likelihood‐based regression estimation framework. Methods based on this framework exhibit a probabilistic coherence property that leads to accurate estimation of the optimal dynamic treatment regime. Unlike most Bayesian estimation methods, our proposed method avoids strong distributional assumptions for the intermediate and final outcomes by utilizing empirical likelihoods. Our proposed method allows for either linear, or more flexible forms of mean functions for the stagewise outcomes. A variational Bayes approximation is used for computation to avoid common pitfalls associated with Markov Chain Monte Carlo approaches coupled with empirical likelihood. Through simulations and analysis of the STAR*D sequential randomized trial data, our proposed method demonstrates superior accuracy over Q‐learning and parametric Bayesian likelihood‐based regression estimation, particularly when the parametric assumptions of regression error distributions may be potentially violated.
Membrane Permeability and Drug Targeting Potential of Phospholipid‐Based Nanocarriers in Lung Cancer Therapy
Authors: Sen Olivia , Sarkar Poulami , Das Stabak , Giri Nayan Kumar , Sarkar Sayantika , Jana Sougata , Nandi Gouranga , Manna Sreejan
Published: October 2024

Lung cancer has become the leading cause of cancer‐related deaths, surpassing all other forms of cancer. Among lung cancers, non‐small cell lung cancer (NSCLC) accounts for approximately 85% of cases. The use of tobacco, genetic traits, and radiation exposure are amongst the major reasons of lung cancer. The ongoing research in the medical field has considered the efficacy of nanocarriers in targeting various cancer cells. Among several biomaterials, lipid‐based nanocarriers have gained special attention due to their excellent compatibility, improved targeting efficacy, and encapsulation ability of diverse therapeutic agents. Phospholipids are naturally occurring amphiphilic moieties found in all living creatures. The presence of phospholipids in biomembrane aids the permeability of phospholipid‐based drug carrier. It can also facilitate targeting of therapeutic agents to cancer microenvironment without degrading the encapsulated drug. Phospholipids can be employed to develop conjugated nanocarriers and vesicular nanoformulation that can result in prolonged circulatory half‐life and controlled release of drugs. Phospholipids are also suitable biomaterials to attach a ligand for tissue‐specific targeting. Recent researches have reported effective targeting of chemotherapeutic agents, genes, and vaccines through phospholipid‐based nanocarriers to lung cancer cells. This review focuses on the rationality and applications of phospholipid‐based nanocarriers in lung cancer therapy.