bluuebunny/crossref_metadata_2025 huggingface dataset:
Technology Empowering Innovation: The Impact of Artificial Intelligence on Global Entrepreneurial Activities
Authors: Wang Xiaowen , Tian Yuqi , Chen Nanxu
Published: January 2025

The emergence of artificial intelligence technology has led to transformative advancements across various industries, particularly in innovative sectors, creating both new challenges and opportunities. This study systematically examines the impact of artificial intelligence technology on global entrepreneurial activities. The basic theoretical framework is constructed using entrepreneurial factor theory and human capital theory, and a two-way fixed effects model along with a mediation effect model are employed to study the impact of artificial intelligence technology on corporate entrepreneurial activities in 36 countries and regions from 2010 to 2023, spanning a total of 14 years. The results revealed that innovation in artificial intelligence technology significantly promotes entrepreneurial activities, particularly opportunity-driven ventures. Notably, the impact is especially significant for entrepreneurs aged 18–34 and those in the tertiary sector. Additionally, artificial intelligence technology positively influences entrepreneurial activities through two paths: entrepreneurship education and artificial intelligence investment. In terms of research contributions, this study first identified two paths through which artificial intelligence technology influences entrepreneurial activities. It revealed the heterogeneous effects of artificial intelligence technology across different entrepreneurial types, age groups, and industries. The research also made academic contributions to the application of artificial intelligence technology in economics and innovation sectors, providing valuable insights and support for relevant stakeholders.
Direct crosstalk between adult human retinas as suggested by interocular transfer of neurovascular coupling through photic stimulation
Authors: Jordão João , Figueira João , Morgado Miguel , Guimarães Pedro , Serranho Pedro , Castro-Farías Daniela , DeBuc Delia Cabrera , Castelo-Branco Miguel , Paques Michel , Bernardes Rui
Published: January 2025

Crosstalk mechanisms between retinas were never documented in humans despite being documented for several other species, including non-human primates. Here, we report the results of the first-in-human study that documents the crosstalk between retinas by measuring the vascular response in one retina to the photic stimulation of the contralateral eye in health and disease. We developed a stimulation apparatus and integrated it into an adaptive-optics fundus camera to image 32 healthy control (HC) subjects and 20 type 1 diabetes mellitus (DM) patients. We documented both the ipsilateral and the contralateral neurovascular coupling effect and established criteria to consider an actual response to find positive and negative responses. Ten (31.2%) and two (6.2%) subjects of the HC group presented contralateral positive and negative responses, respectively, and three (15.0%) positive and four (20.0%) negative responses were found for the DM group. Also, statistically significant differences in the ipsilateral and contralateral responses were found for the HC group, rejecting the null (non-response) hypothesis. This finding raises the need to revisit the current knowledge of neurovascular coupling mechanisms and the association between its dysregulation and neurological disorders. Further studies involving distinct populations and imaging centers are necessary to validate the findings herein.
Preliminary study on the treatment of acute angle-closure glaucoma with high-intensity focused ultrasound cycloplasty
Authors: Wang Wei , Wang Chunmiao , Zhou Yi , Yan Shuxi , Li Xiangji , Xie Lin
Published: January 2025

High-intensity focused ultrasound cycloplasty (UCP) can effectively reduce intraocular pressure in glaucoma patients. This work aimed to analyze the efficacy, safety, and mechanism of UCP in treating acute angle-closure glaucoma. We collected and retrospectively analyzed the preoperative and postoperative clinical data of 16 cases (16 eyes) with acute angle-closure glaucoma, including the number of sectors activated, intraocular pressure (IOP), central anterior chamber depth (ACD), lens zonule length (LZL), ciliary muscle thickness (CMT), and trabecular-ciliary process angle (TCA). Of the 16 eyes, one received a single UCP procedure with 8 sectors and the others with 10 sectors. The mean IOP at follow-up time points after UCP was significantly lower than before UCP. The mean ACD at follow-up time points after UCP was significantly higher than before UCP. The mean LZL in the superior, inferior, nasal, and temporal quadrants on postoperative day 1, week 1, and month 1 was significantly shorter than those before UCP. The mean CMT in the superior, inferior, and nasal quadrants on postoperative day 1 and in the superior and inferior quadrants on postoperative week 1 were significantly larger than those before UCP. The mean TCA in the temporal quadrant on postoperative month 3 was significantly smaller than that before UCP. In conclusion, UCP is safe and effective in treating acute angle-closure glaucoma. The special mechanism of lowering IOP after UCP may be attributed to the increased depth of the central anterior chamber and the reopening of some non-adhesive closed angles.
Examination of the Occurrence of Dental Caries and Contributing Factors in School-Aged Left-Behind Children in Rural Regions of Western China
Authors: Duan Ran , Xiao Yang , Tang luoyan , Tan Yujing , Jiang Junjun , Li Hua , li Qiuzhong
Published: January 2025

Purpose
Gaining insight into the dental caries conditions and contributing factors affecting school-aged left-behind children in rural China lays the groundwork and offers theoretical backing for future studies focused on preventing and treating dental caries in these children, as well as for early interventions in their oral health.
Method
A cluster random stratified sampling approach was utilized to carry out oral health assessments and survey questionnaires among 1,613 school-aged children, both left-behind and non-left-behind, in rural western China. The research aimed to compare the rates of dental caries between these two groups of children and used chi-square tests and logistic regression analysis to investigate the factors that affect the development of dental caries in children.
Result
The research findings indicate that the overall rate of dental caries in the studied population is 93.37%. Specifically, the prevalence among left-behind children is 94.97%, compared to 91.73% for non-left-behind children. This difference is statistically significant, with left-behind children showing a notably higher rate of dental caries (χ2 = 6.83, P = 0.009). The total filling rate stands at 8.76%, with left-behind children having a rate of 7.36% and non-left-behind children at 10.25%. A comparison of the filling rates between these two groups reveals a statistically significant difference (χ2 = 3.906, P = 0.048). The overall sealant rate is 3.72%, with left-behind children at 2.09% and non-left-behind children at 5.39%. Similarly, the comparison of sealant rates between the two groups also indicates a statistically significant difference (χ2 = 12.279, P < 0.001).The findings from the multi-factor logistic analysis indicate that being female (OR = 2.933, 95% CI: 1.253–6.862) and not using fluoride toothpaste (OR = 3.416, 95% CI: 1.062–10.992) are associated with an increased risk of dental caries in left-behind children (P < 0.05). Conversely, irregular fluoride use (OR = 0.334, 95% CI: 0.132–0.847), regular fluoride use (OR = 0.032, 95% CI: 0.010–0.097), and maintaining a consistent brushing schedule (OR = 0.195, 95% CI: 0.045–0.836) serve as protective factors against dental caries in this population (P < 0.05).
Conclusion
In rural western China, left-behind children experience a notably high rate of dental caries, and the current prevention and control measures are inadequate. The rates of cavity fillings and the application of pit and fissure sealants are low, highlighting the urgent need to improve dental caries prevention among these children. It is essential to create targeted intervention strategies, conduct regular oral health check-ups for children, and educate caregivers about oral health. These efforts will aid children in developing proper oral hygiene practices, increase their awareness of oral health, and ultimately decrease the prevalence of dental caries.
Construction of A Clinical Prediction Model for Overall Survival and Cancer-Specific Survival in Malignant Phyllode Tumor of the Breast Based on the SEER Database
Authors: Pan Chenggeng , Han Ruokuo , Xia Senzhe , Fan Dingwei , Yang Daqing , Ma Haiguang
Published: January 2025

Objective
Malignant Phyllodes Tumor of the Breast (MPTB) represents a distinct breast tumor subtype associated with a poor prognosis. The objective of this research was to create and verify a nomogram to predict both overall survival (OS) and breast cancer-specific survival (BCSS) for individuals with a diagnosis of MPTB.
Methods
From the Surveillance, Epidemiology, and End Results (SEER) database, clinicopathological data of MPTB patients diagnosed between 2000 and 2020 were collected. We performed logistic regression analyses to determine the independent factors that predict both OS and BCSS. Subsequently, a nomogram was developed integrating these significant predictors. Model performance was assessed using metrics such as the calibration curve, area under receiver operating characteristic curve (AUC), and decision curve analysis (DCA). Based on the nomogram scores, patients were categorized into low-risk and high-risk groups, and survival differences were then assessed through the log-rank test and Kaplan-Meier curves.
Results
The study encompassed 1692 MPTB patients, randomly allocated into a training cohort (N = 1188, 70%,) and a validation cohort (N = 504, 30%). Eight independent predictors for OS were identified through univariate and multivariate analyses: age, marital status, income, stage, tumor stage, nodal stage, surgery, and chemotherapy. Additionally, six independent predictors for BCSS were identified through the same analytical approach: age, stage, tumor stage, nodal stage, surgery, and chemotherapy. Nomograms were constructed based on these variables to forecast OS and BCSS rates for patients with MPTB. Evaluation of the model's discriminative ability using AUC demonstrated satisfactory predictive performance for OS and BCSS in both cohorts. Strong concordance between the probabilities observed and those predicted was indicated by the calibration curve. Furthermore, DCA underscored the clinical utility of the nomogram.
Conclusions
In this investigation, a nomogram was effectively constructed and internally confirmed to forecast OS and BCSS among individuals with MPTB. This predictive tool provides clinicians with essential prognostic information to guide their clinical decision-making processes.
A nomogram to predict respiratory failure development in severe fever with thrombocytopenia syndrome patients with pneumonia
Authors: Zhang Zhongwei , Hu Xue , Jiang Qunqun , Du Qian , Chen Qianhui , Chen Xiaoping , Luo Mingqi , Deng Liping , Xiong Yong
Published: January 2025

Pneumonia is common in patients with severe fever with thrombocytopenia syndrome (SFTS), and respiratory failure is one of its most severe complications. The aim of this study was to establish a nomogram for predicting respiratory failure development in SFTS patients with pneumonia. Data of demographics, comorbidities, clinical manifestations, laboratory parameters, complications, and outcomes of SFTS patients with pneumonia were collected. Independent predictors of respiratory failure development on multivariate logistic regression were used to construct the predictive model. Of the 167 SFTS patients with pneumonia we studied, 45 (26.9%) patients developed respiratory failure. Patients who developed respiratory failure had a higher incidence of invasive pulmonary aspergillosis, nosocomial infections, myocarditis, stage 2 or 3 acute kidney injury (AKI), rhabdomyolysis, shock, and systemic inflammatory response syndrome (SIRS). Among them, 35 patients died and all non-respiratory failure patients survived. On multivariate regression analysis, neurological manifestations, nosocomial infections, stage 2 or 3 AKI, SIRS, serum levels of albumin, and CKMB were proven to be independent predictors for respiratory failure development, which were adopted as parameters of the nomogram. The nomogram showed good calibration and discrimination, with an area under the receiver operating characteristic curve of 0.932 (95% CI 0.888–0.975). Decision curve analysis confirmed the clinical utility of the predictive model. Respiratory failure is associated with adverse outcomes including severe complications and death in SFTS patients with pneumonia. Clinicians could apply the nomogram to identify the high-risk pneumonic patients for developing respiratory failure.
Assessment of the public health literacy based on the preferences of the general population of the Kingdom of Saudi Arabia, A strategy to improve public health
Authors: Naggar Marwa Ahmed El , Allehaibi Nouf Abdulelah , Alsulami Hani Hathath , Alruwaili Majidah Ghati , Alruwaili Khulud Saud Baqi , Alsadun Razan Saud , Bayyumi Duaa Fahad , Alotaibi May Saud , Alruwaili Ohoud Saud Bagi
Published: January 2025

Background: Public health literacy plays a vital role in empowering individuals to make informed health decisions and effectively navigate healthcare systems.
Aim: This study aims to assess the public's interest in health literacy topics and identify preferred sources and methods for disseminating health information in Saudi Arabia.
Methods: Questionnaire Star was used to conduct a large sample of random online surveys and distributed in all provinces in KSA, 603 questionnaires were issued, 10 invalid questionnaires were eliminated, and 565 were recovered, with an effective rate of 93.70%. IBM SPSS Statistics 28 was utilised to analyse the survey data. A cross-sectional survey was conducted, predominantly among highly educated and middle-aged people.
Results: The findings revealed that participants expressed the greatest need for health literacy in areas such as nutrition and fitness (4.04 points), first aid knowledge (3.83 points), and psychological health (3.7 points), while there was lower demand for medical technology (3.05 points) and cosmetic surgery (2.51 points). The study found that 56.1% of participants considered medical institutions as the primary source for health information, followed by public health literacy service providers (41.6%), media (26%), and community organizations (13.1%). Preferred channels for obtaining health literacy were phone calls and social media, community education/engagement and billboards. The study also revealed that digital platforms, particularly TikTok (51.9%), Facebook (45.7%), and search engines (44.9%), were commonly used for accessing health information, especially among younger participants.
Conclusions: This exploratory study underscores the critical role of health sectors in enhancing public health literacy through targeted, evidence-based approaches. By understanding and addressing the diverse needs and preferences of the population, health education can be more effectively tailored to improve public health outcomes across various demographic groups.
Impact of Periampullary Diverticulum Types on Post-ERCP Hyperamylasemia: A Retrospective Observational Study
Authors: Akca Serdar , Atar Galip Egemen , Ocal Serkan , Buldukoglu Osman Cagin , Koker Gokhan , Isik Muhammed Devran , Kaya Besir , Deniz Hatice , Harmandar Ferda Akbay , Cekin Ayhan Hilmi
Published: January 2025

Background
This study aimed to assess the incidence of periampullary diverticulum (PAD) among endoscopic retrograde cholangiopancreatography (ERCP) patients in Southwestern Turkey and investigate the association between the new PAD classification, post-ERCP hyperamylasemia, and post-ERCP pancreatitis (PEP).
Materials and Methods
We retrospectively reviewed 1,317 ERCP procedures performed between January 1, 2022, and December 31, 2023, at Antalya Training and Research Hospital. The PAD type was determined according to the He-xian Shi classification. Hyperamylasemia was defined as an increase of three times the normal level of amylase at 4-6 h, and PEP was defined as hyperamylasemia along with abdominal pain lasting more than 24 hours.
Results
A total of 594 naive patients who underwent ERCP were analyzed. PAD was present in 137 patients (23.1%), and the success rate of choledochal cannulation in the first ERCP procedure was 94.3%. There was no difference in the choledochal cannulation rate between patients with and without PAD (95.6%-93.9%, p=0.53). Asymptomatic hyperamylasemia was observed in 19.0% of the patients. Post-ERCP hyperamylasemia rates were similar between patients with and without PAD (16.1%-19.9%, p=0.38). PEP was observed in 8.8% of the patients. PAD was not a risk factor for post-ERCP pancreatitis (7.3% vs. 9.2%, p=0.60). When we checked the results according to the type of PAD, the prevalence of post-ERCP hyperamylasemia was significantly lower in patients with type 2b PAD than in those with PAD of other types and in patients without PAD.
Conclusion
PAD is a common finding in ERCP patients, with an incidence of 23.1% in our cohort. The rate of choledochal cannulation, post ERCP hyperamylasemia and PEP did not differ between the patients with and without PAD. However, the type of PAD is important; post-ERCP hyperamylasemia is significantly lower in patients with type 2b PAD than in all other PAD types and patients without PAD. Different subtypes of PAD may have different impacts on ERCP outcomes. Further investigations with new PAD classification systems developed for ERCP purposes are needed.
Type II Kounis syndrome induced by bee sting: a case report and literature review
Authors: Zhu Dewen , Meng Jianqiang , Lu Yuanben , Chen Lina
Published: January 2025

Kounis Syndrome (KS) encompasses a spectrum of clinical manifestations, including unstable angina pectoris and myocardial infarction, and is postulated to result from an exaggerated hypersensitivity reaction. This case report elucidates an instance of type II Kounis Syndrome precipitated by a bee sting, culminating in myocardial infarction—an often underrecognized and frequently misdiagnosed condition.
Sharp uniform stabilization of a shallow shell with internal rotational inertia dissipation and a nonlinear boundary feedback under free boundary conditions
Authors: Lasiecka Irena , Li S.-J , Triggiani Roberto
Published: January 2025

The motion of a shell is characterized by a system of two coupled hyperbolic partial differential equations: (i) an elastic wave in the two-dimensional in-plane displacement, and (ii) a plate-like Kirchhoff equation in the scalar normal displacement. A dynamic shallow shell is defined on a two-dimensional bounded, smooth manifold with elastic deformations accounting for vertical and in-plane oscillations. In this paper, we investigate the uniform stabilization of a dynamic shallow shell model, which is subject to nonlinear dissipation on part of its boundary under absorbing boundary conditions corresponding to the wave equation, while the plate equation incorporates rotary inertia terms along with inertial dissipation and inertial boundary spill-over. The model is motivated by applications to flutter suppression [1] in bridges and buildings, where the flutter occurs due to the interaction between the flow of gas and the structure. The uniform stabilization for a shell model is established by energy method in the Riemannian geometric setting and microlocal analysis techniques. The geometric approach offers an intrinsic, coordinate - independent framework along with an initial observability-type inequality. Meanwhile, microlocal analysis provides the needed sharp trace estimates crucial for solving the stabilization problem concerning the elastic wave. Moreover, it enables the removal of geometric constraints on the controlled portion of the boundary. The final result provides uniform decay rates of the energy which are quantitative via an ODE algorithm based on the behavior of the boundary dissipation at the origin.
Mathematics Subject Classification (2020). 35B35; 74K25; 93C20; 93D15; 93D20.
Design and testing of high-voltage ground wire repair robot based on adaptive sliding mode control strategy
Authors: Daguang XU , LIU Huan , Congjiu XIE , Huijuan RAN , FANG Jing
Published: January 2025

High-voltage ground wire repair robots play a critical role in the maintenance of power lines, where the precision of motor control and the reliability of mechanical structures directly impact the robot's repair efficiency and job safety. This paper improves the robot from both the control algorithm and mechanical structure aspects. To enhance the control accuracy of the motors used in high-voltage ground wire repair robots, based on the adaptive sliding mode controller designed in this paper, the robustness of sliding mode control is combined with adaptive adjustment of the control of sliding mode. Control is combined with adaptive adjustment to improve the system's adaptability to parameter variations and external disturbances. Furthermore, an improved phase-locked loop (PLL) is proposed. Improved phase-locked loop (PLL) control is proposed to achieve better rotor position tracking. Simulation and experimental results show that the proposed control strategy has a faster dynamic response and higher control accuracy compared to traditional control methods, effectively enhancing the quality of ground wire repair work and the reliability of the robot's operation. Finally, this paper designs the ground wire breakage repair device and pre-stranding winding device for the high-voltage ground wire repair robot and completes their fabrication. Test results indicate that the robot can efficiently and accurately complete ground wire repair work with control commands responding quickly and accurately, and the repair effects are satisfactory.
Outcomes of continuous kidney replacement therapy in pediatric patients: The impact of timing and predictors of mortality
Authors: Alrashdi Abdulsalam S , Alshammari Jaser N , Abdullah Sulaiman K , Alqannas Sulaiman , Faqeehi Hassan , Albatati Sawsan , Rahim Khawla A , Sandokji Ibrahim A , Alanazi Abdulkarim S , Zabali Saeed Mohammed Al
Published: January 2025

Background While critically ill children receiving continuous kidney replacement therapy (CKRT) are at increased risk of mortality, few studies have examined the predictors of mortality in this population. This study aimed to evaluate CKRT outcomes, focusing on predictors of mortality.Methods This cohort study included children aged 0–14 years who received CKRT. It collected baseline, clinical, and laboratory data. Descriptive analyses were performed. Least absolute shrinkage and selection operator (LASSO) regression was used to select the best predictors of mortality. A multivariable logistic regression model was constructed and validated with 1000 bootstraps.Results This study included 113 children who received CKRT, of whom 83 (73.5%) survived and 30 (26.6%) died. Children admitted to the intensive care unit with a higher Pediatric Risk of Mortality III score, sepsis, longer intubation, or hypoalbuminemia (< 30 g/dL) were more likely to die. Multifactorial acute kidney injury was more common in those who died than in those who survived (83.3% vs. 31.3%, p < 0.01). As the exclusive indication for CKRT, fluid overload was more common in those who died than in those who survived (26.7% vs. 6.0%, p = 0.01). LASSO and multivariable regression models identified hemodynamic instability, as evidenced by inotropic support use, and abnormal coagulation, as evidenced by not using anticoagulation, as independent predictors of morality. Initiating CKRT late (> 48 hours) was associated with mortality in the univariate but not the multivariate analysis.Conclusion Hemodynamic instability was the best predictor of mortality in critically ill children receiving CKRT.
A Scheme for Network Programmability and Backup Automation Using Python Netmiko Library on Cisco; the Case Study of the Komfo Anokye Teaching Hospital Local Area Network
Authors: Osei-Wusu Franco , Asiedu William , Frimpong Kwame Asamoah , Yeboah Donald , Muntaka Siddique Abubakr
Published: January 2025

The need for programmability and backup automation in modern network administration has become increasingly critical. In environments that facilitate and heavily depend on essential network operations, such as hospitals, ensuring secure, stable, and reliable processes in network management is imperative. This study proposes an automated framework for the Komfo Anokye Teaching Hospital (KATH) Local Area Network (LAN), leveraging Python and the Netmiko library to streamline backups of Cisco devices, significantly improving upon the limitations of manual processes used by the hospital's networking professionals. Experimental results demonstrated that the proposed automated scheme effectively addressed the challenges posed by these conventional yet error-prone manual processes. This was validated through performance evaluation metrics such as backup completion time, success rate, and resource utilization.
Antennas Modelling based on Consensus Gaussian Process
Authors: Tian Yubo , Zhu Zhiwei , Meng Fei
Published: January 2025

When optimizing the antennas, the traditional method is using the swarm-based global optimal algorithms combining full-wave electromagnetic simulation software. The biggest shortcoming of the method is low efficiency because it needs many times calling the simulation software which is very time-consuming. In this study, we adopt machine learning methods to replace EM simulation software, fasting the optimal process of the antennas, in which the most important thing is its accuracy and generalization ability. We propose an ML surrogate model based on the consensus concept exploiting Gaussian process. Specifically, we model the optimized antenna independently several times by GPs, considering that GP is suitable for the small sample antenna issue. Then, we obtain the final surrogate model by either consistency or aggregation based on the trained GPs, where a consistency algorithm is used when the difference between the GPs is small whereas an aggregation algorithm is used when the difference between the GPs is big, in order to guarantee the good reliability and excellent accuracy of the results. The experiments of an ultra-wideband antenna and a multiple-input and multiple-output antenna demonstrate the proposed method with great generalization ability, where the evaluation metrics are excellent.
RUNX1A isoform is overexpressed in acute myeloid leukemia and is associated with FLT3 internal tandem duplications
Authors: Cumbo Cosimo , Tarantini Francesco , Parciante Elisa , Anelli Luisa , Zagaria Antonella , Biondi Giuseppina , Caratozzolo Mariano Francesco , Orsini Paola , Coccaro Nicoletta , Tota Giuseppina , Redavid Immacolata , Conserva Maria Rosa , Minervini Angela , Minervini Crescenzio Francesco , Gagliardi Vito Pier , Delia Mario , Marzano Flaviana , Telegrafo Claudia , Cox Sharon Natasha , Natalicchio Annalisa , Balech Bachir , Tullo Apollonia , Gentile Mattia , Giorgino Francesco , Specchia Giorgina , Musto Pellegrino , Albano Francesco
Published: January 2025

Background. RUNX1A is the shortest and least expressed of the RUNX1 three main isoforms (A, B, C); despite this, the leukemogenic role of its overexpression has been clearly described. Several studies have shown RUNX1A involvement in different blood cancers and pilot observations in acute leukemia have been reported.
Methods. In this context, we evaluated RUNX1 isoformsexpression in a cohort of acute myeloid leukemia (AML) patients and associated our data with significant AML clinical and biological parameters. A focus was performed on FLT3 mutated cases. Genome-wide methylation data from the TF-1 cell line were studied to investigate the possible role of epigenetic regulation in RUNX1 expression. To verify whether RUNX1Aupregulation is linked to a specific transcriptional profile, high-throughput RNA sequencing was conducted.
Results. At diagnosis, we found RUNX1A and RUNX1B overexpression,with higher median levels in thrombocytopenic cases. No difference was observed for RUNX1C. RUNX1A overexpression is higher in more immature AML phenotypes. According to the mutational profile, FLT3 internal tandem duplication (ITD) positive cases have the highest RUNX1A levels and the presence of FLT3-ITD was the only molecular variable able to influence RUNX1Aexpression. RUNX1A overexpression is disease-related, associated with a specific transcriptional profile, and reappears at relapse, with no clear kinetics except in FLT3-ITD cases.
Conclusions. Overall, we demonstrate RUNX1A overexpression in AML and its association with the FLT3-ITD molecular subtype. Our data shed light on the dark side of RUNX1 deregulation, paving the way for further investigations.
Ziziphus mauritiana Leaf Extract Induces ROS-dependent Apoptosis by Downregulation of CD81 in MDA- MB 231 Triple Negative Breast Cancer Cells
Authors: Lestari Dian Yuliartha , Mastutik Gondo , Mukono Indri Safitri
Published: January 2025

Background. Breast cancer (BC) is the most prevalent cancer among women, with triple-negative breast cancer (TNBC) representing a particularly aggressive subtype. Current treatments often have limited efficacy and significant toxicity, highlighting the need for alternative therapeutic strategies. Ziziphus mauritiana (ZM) leaf extract contains triterpenoids which have been proven to be used as anticancer agents, but have not been studied in TNBC cells.
Aim. To examine the triterpenoid content in ZM, especially BA and OA, ZM cytotoxicity, intracellular ROS levels, the amount of apoptosis, and CD81 expression on MDA-MB 231 cells after being given ZM.
Material and Methods. The extract was prepared using a sequential extraction method. The presence of triterpenoids was confirmed via HPLC and LC-MS analysis. The cytotoxicity of the extract was assessed using the CCK-8 assay, while flow cytometry was employed to analyze CD81 expression and ROS levels. Apoptosis was quantified using an Annexin V-FITC/PI detection kit.
Results. Based on HPLC, the BA content in ZM is 28.3 µg/ml, and the OA content is 13.4 µg/ml. ZM significantly reduced MDA-MB 231 cell viability by 28.28% at 400 µg/ml after 48 hours. Flow cytometry revealed a notable downregulation of CD81 expression (p < 0.0001) and an increase in intracellular ROS levels (p < 0.0001). Furthermore, ZM induced early and late apoptosis in treated cells, with increases of 2.34-fold and 2.66-fold, respectively.
Conclusion. ZM leaf extract exhibits potent cytotoxic effects against MDA-MB 231 through ROS-dependent apoptosis and CD81 downregulation, suggesting its potential as a novel therapeutic agent for TNBC treatment.
Scalable and sustainable DMF-free solid-phase synthesis of liraglutideby 1-tert-butyl-3-ethylcarbodiimide-mediated couplings and catch-and-release acylation and purification strategies
Authors: Pacini Lorenzo , Muthyala Manoj Kumar , Zitterbart Robert , Marder Oleg , Rovero Paolo , Papini Anna Maria
Published: January 2025

The growing need for sustainable practices in pharmaceutical manufacturing has stimulated advancements in peptide synthesis. This study focuses on applying green chemistry principles to the synthesis of the Glucagon-Like Peptide-1 analog liraglutide, using novel and sustainable solid-phase synthetic strategies. By adopting the safer coupling reagent 1-tert-butyl-3-ethylcarbodiimide (T-Bec®) in combination with eco-friendly binary solvents like dimethyl sulfoxide and butyl acetate, we demonstrated that it is possible to significantly reduce the environmental impact while maintaining high efficiency and quality of the synthesis. T-Bec® minimizes hazardous byproducts, such as hydrogen cyanide, and enhances solvent compatibility, achieving crude purities and yields comparable to conventional syntheses. Two synthetic strategies were developed for liraglutide production. The first strategy based on a “direct synthesis”, incorporating a lipidated lysine building block into the peptide sequence, achieving 86% HPLC purity after catch-and-release purification. The second strategy based on “catch-lipidation-and-release” approach, allowed to obtain the peptide precursor without the lipid moiety, which was later linked during a controlled lipidation step. This latter strategy yielded purities exceeding 90% and reduced reliance on preparative HPLC. These findings highlight the effectiveness of T-Bec® and green solvent systems to optimize scalable and sustainable SPPS processes. These methods improve resource efficiency and reduce environmental impact, to allow a viable pathway to produce therapeutic peptide ingredients like liraglutide. This work underscores the potential of green chemistry to align pharmaceutical innovation with environmental responsibility.
Human capital, social mobility, and TESOL:Aninterview with PeterSaye
Authors: Uysal HUSEYIN , Sayer Peter
Published: January 2025

This interview explores the intersection of social mobility and inequalities in TESOL (Teaching English to Speakers of Other Languages) through an interview with PeterSayer. His research focuses on the complexities of TESOL within multilingual contexts, particularly in Mexico and the United States. He challenges the myth of international Englishas a forcein alleviating poverty and promoting social change. Peter Sayer discusses the implications of Human Capital Theory on English education, critiquing its focus on skills acquisition. He advocates for a plurilingual approach through translanguaging by emphasizing the importance of leveraging students’ linguistic repertoires in the classroom. Peter Sayerenvisions the directions of his future research in TESOL in practice and aimsto bridge theory and practice while addressing the challenge of making English education more relevant and accessible to students from diverse socioeconomic backgrounds
Moving Away from the Blame Culture: The Way Forward to Manage Medical Errors
Authors:   Department of Medical Ethics and Law, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia, Yusof Aimi Nadia Mohd , Razali Hazdalila Yais Haji ,   Department of Medical Ethics and Law, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia
Published: January 2025

When a medical error occurs, the instinct to blame healthcare professionals may seems like a way to ensure they learn from their mistakes. However, in today’s healthcare landscape, the blame culture, coupled with the fear of litigation, proves detrimental to improving patient care. This culture fosters a reluctance among healthcare professionals to openly disclose mistakes, depriving them of valuable learning opportunities. These professionals, often referred to as second victims, deserve as much attention and support as the patients who are affected by the errors. Given that medical errors are inevitable, it becomes imperative to effectively manage the aftermath to ensure all parties involved are adequately supported and shielded from adverse consequences. This article delves into the ethical complexities of medical errors, advocating for a shift from a blame-centric culture to one that prioritises support for second victims. The aim of this article is to underscore the crucial importance of addressing medical errors within the healthcare sector by fostering an environment that promotes learning and growth post-error.
The Outcome of Hospital-Acquired Bloodstream Infection and Its Associated Factors in Critical Care Unit
Authors:   Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Mohamed Shukri Nurul Rahatul Ilyani , Hassan Shamsul Kamalrujan ,   Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Md Noor Siti Suraiya ,   Hospital Pakar Universiti Sains Malaysia, Kelantan, Malaysia, Ab Hamid Siti Azrin ,   Hospital Pakar Universiti Sains Malaysia, Kelantan, Malaysia, Nik Mohamad Nik Abdullah ,   Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Wan Muhd Shukeri Wan Fadzlina ,   Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Mazlan Mohd Zulfakar ,   Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
Published: January 2025

Background: Hospital-acquired bloodstream infections (BSI) are associated with high morbidity and mortality rates. This study was conducted to describe the outcomes and the prognosis of hospital-acquired BSI in the Critical Care Unit, Hospital Pakar Universiti Sains Malaysia (HPUSM), as well as to identify associated factors of treatment failure and mortality at 28 days. Methods: This prospective cohort study was conducted in the Critical Care Unit of HPUSM from September 2019 to March 2021. Eligible participants included patients with a positive blood culture recorded after 48 hours of admission to hospital. Results: There was a total of 250 patients, whose positive blood cultures were isolated. The main isolated organisms were Klebsiella pneumonia (23.6%), Pseudomonas spp. (19.2%), Escherichia coli (12.8%) and Acinetobacter sp. (9.2%). The mortality of hospital-acquired BSI was 27.6%. Multiple logistic regression analysis revealed that age [adjusted odds ratio (OR) = 1.06; 95% confidence interval (CI): 1.03, 1.09; p < 0.001], cases with extended-spectrum betalactamases (ESBL) (adjusted OR = 5.57; 95% CI: 2.04, 15.21; p = 0.001), with multidrug-resistant (MDR) organisms (adjusted OR = 14.70; 95% CI: 3.97, 54.48; p < 0.001) and those with a sequential organ failure assessment (SOFA) score > 11 (adjusted OR = 4.16; 95% CI: 1.31, 13.19; p = 0.015) had statistically significant associations with treatment failure. Factors significantly associated with 28-day mortality included age (adjusted OR: 1.06: 95% CI; 1.03, 1.09; p < 0.001), MDR organisms (adjusted OR = 14.70; 95% CI: 3.97, 54.48; p < 0.001) and SOFA score > 11 (adjusted OR = 4.16; 95% CI: 1.31, 13.19; p = 0.015). Conclusion: The elderly, ESBL, MDR organisms and high SOFA scores were associated with treatment failure and 28-day mortality in hospital-acquired BSI.
National Health Insurance Role in Hospital Utilisation in Disadvantaged Areas: Evidence from Indonesia
Authors:   Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia, Wulandari Ratna Dwi , Latifah Leny ,   National Research and Innovation Agency, Jakarta, Indonesia, Laksono Agung Dwi ,   National Research and Innovation Agency, Jakarta, Indonesia, Nugraheni Wahyu Pudji ,   National Research and Innovation Agency, Jakarta, Indonesia, Suryati Tati ,   National Research and Innovation Agency, Jakarta, Indonesia, Rachmawati Tety ,   National Research and Innovation Agency, Jakarta, Indonesia, Yunitawati Diah ,   National Research and Innovation Agency, Jakarta, Indonesia, Mubasyiroh Rofingatul ,   National Research and Innovation Agency, Jakarta, Indonesia, Ardani Irfan ,   National Research and Innovation Agency, Jakarta, Indonesia, Kusnali Asep ,   National Research and Innovation Agency, Jakarta, Indonesia
Published: January 2025

Background: The Indonesian government policy regarding obtaining universal coverage through National Health Insurance (NHI) is expected to increase public access to health service facilities, including in disadvantaged areas. This study analysed the role of NHI in hospital utilisation in underprivileged areas of Indonesia. Methods: Data from the 2023 National Socioeconomic Survey were used in this crosssectional study that included 130,331 participants. Hospital utilisation was the dependent variable and NHI membership was the independent variable. Residence, age, sex, marital status, education, occupation, and wealth status were control factors. A multinomial logistic regression was employed in the final stage for data evaluation. Results: In 2023, the hospital utilisation rate in Indonesia’s disadvantaged regions was 1.5% and the percentage of NHI members was 74.5%. People with an NHI membership were 3.01 times more likely to utilise the hospital than those without [95% confidence interval (CI) 2.583.50]. Seven control variables related to hospital utilisation were identified, namely, residence type, age, sex, marital status, education level, employment status, and wealth status. Conclusion: This study concluded that NHI membership influenced hospital utilisation in disadvantaged areas of Indonesia. Individuals with NHI membership were three times more likely to visit hospitals.
Performance of Antibody-Detection Tests for Human Melioidosis: A Systematic Review and Meta-analysis
Authors:   Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kelantan, Malaysia, Selvam Kasturi , Najib Mohamad Ahmad ,   Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kelantan, Malaysia, Khalid Muhammad Fazli ,   Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kelantan, Malaysia, Harun Azian ,   Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Aziah Ismail ,   Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kelantan, Malaysia
Published: January 2025

Melioidosis is a life-threatening infectious disease caused by the bacterium Burkholderia pseudomallei. Although culture is the gold standard for diagnosing melioidosis, it is timeconsuming and delays timely treatment. Non-culture-based diagnostic techniques are interesting alternatives for the rapid detection of melioidosis. This systematic review provides an overview of the performance of antibody-detection tests for melioidosis. A thorough literature search was conducted in two databases to identify relevant studies published until 31 December 2023. Among the 453 studies identified, 29 were included for further analysis. Various antibodydetection methods have been developed, primarily enzyme-linked immunosorbent assays (ELISAs). Recombinant outer membrane protein A–(OmpA)-specific immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin D (IgD) exhibited the highest accuracy, with a sensitivity of 95.0% and a specificity of 98.0% in ELISA. Furthermore, immunochromatographic testing has emerged as a promising rapid diagnostic test (RDT), with haemolysin co-regulated protein 1 (Hcp1) demonstrating significant accuracy, a sensitivity of 88.3%, and a specificity of 91.6%. Additionally, IgG against Burkholderia invasion protein D (BipD) showed excellent accuracy, with a sensitivity of 100.0% and a specificity of 100.0% in surface plasmon resonance assay. Combining multiple antigens or employing different detection techniques can enhance the accuracy of melioidosis diagnosis.
Current Trend and Outcomes on Immunonutrition in Medical and Surgical Fields: An Updated Perspective
Authors:   Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, Koo Thai Hau , Leong Xue Bin ,   School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia, Zakaria Andee Dzulkarnaen ,   School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
Published: January 2025

Immunonutrition, which involves the targeted use of specific nutrients to enhance immune function and mitigate inflammation, has recently become a mainstay for both medical and surgical benefits. This review explores the evolution, mechanisms, and clinical applications of immunonutrition, with a focus on essential nutrients, such as omega-3 fatty acids, glutamine, arginine, and vitamins. These immunonutrients modulate immune responses, reduce pro-inflammatory cytokines, and support tissue repair. Clinical evidence indicates that immunonutrition reduces postoperative complications, shortens the duration of hospitalisation, and lowers the rate of infection, mainly in high-risk surgical patients and those with cancer or chronic diseases. In this regard, nutrients such as glutamine and omega-3 fatty acids have improved the nutritional status and recovery of cancer patients, while omega-3 fatty acids and antioxidant vitamins have exerted an anti-inflammatory effect, improving heart health in patients with cardiovascular disease. Immunonutrition has bright prospects in the management of infectious diseases, where certain nutrients, including vitamin D and zinc, aid in fighting immune defences and reducing the severity of infection. Future studies should investigate the molecular mechanisms underlying immunonutrition and its role in personalised nutrition. This could revolutionise dietary interventions based on genetic and proteomic profiling.
Prevalence and Associated Factors of Children Tuberculosis in Southeast Asia Countries: A Systematic Review
Authors:   Research Centre for Public Health and Nutrition, Research Organisation for Health, National Research and Innovation Agency (BRIN), Bogor, West Java, Indonesia, Faisal Debri Rizki , Noveyani Adistha Eka ,   Faculty of Public Health, Universitas Jember, East Java, Indonesia, Purwatiningsih Yuni ,   Research Centre for Public Health and Nutrition, Research Organisation for Health, National Research and Innovation Agency (BRIN), Bogor, West Java, Indonesia, Lestyoningrum Sinta Dewi ,   Research Centre for Public Health and Nutrition, Research Organisation for Health, National Research and Innovation Agency (BRIN), Bogor, West Java, Indonesia, Putro Wahyu Gito ,   Faculty of Medicine, Universitas Muhammadiyah Semarang, Central Java, Indonesia, Mikrajab Muhammad Agus ,   Research Centre for Public Health and Nutrition, Research Organisation for Health, National Research and Innovation Agency (BRIN), Bogor, West Java, Indonesia, Nugraheni Wahyu Pudji ,   Research Centre for Public Health and Nutrition, Research Organisation for Health, National Research and Innovation Agency (BRIN), Bogor, West Java, Indonesia
Published: January 2025

Southeast Asia (SEA) countries are characterised by a high burden of tuberculosis (TB). This research seeks to compile evidence of the prevalence and risk factors associated with TB among children in SEA countries. The searching of articles was conducted for four databases (PubMed, Scopus, Embase, and the Web of Science) published between 2013 and 2023 in the English language. The quality of articles was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for Assessment of Risk Bias for Cross-Sectional studies. This research was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. Eight studies were included in the systematic review. The prevalence of paediatric TB in SEA countries varies between 1.50% and 38.10%. Risk factors associated with the occurrence of TB in children include the nutritional status, the Bacillus Calmette-Guérin (BCG) vaccine status, close contact with TB patients, parental smoking behaviour, unhealthy living conditions, and socioeconomic determinants. The continued high prevalence of TB in several SEA countries, particularly among children, remains a significant public health concern. The various risk factors summarised can serve as a basis for implementing interventions aimed at reducing cases and preventing the transmission of TB among children.