bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of stereotactic optical navigation for needle positioning in percutaneous nephrolithotomy
Authors: Spenkelink I. M. , Zhu X. , Fütterer J. J. , Langenhuijsen J. F.
Published: March 2024

Background

This study assessed the feasibility of acquiring single-attempt access to the pelvicalyceal system during percutaneous nephrolithotomy (PCNL) using stereotactic optical navigation combined with cone-beam CT (CBCT) imaging.

Methods

Patients with a PCNL indication were prospectively included in this IRB approved study. After sterile preparation, fiducial markers were attached to patients’ skin. An initial intraprocedural CBCT scan was acquired, on which the urologist planned the needle trajectory using the navigation software. After verifying that no critical structures were crossed, the needle guide was aligned with the plan. A needle was manually inserted through the needle guide to the indicated depth and a second CBCT scan was performed for needle position confirmation. Both, scanning and needle insertion, were performed under apnea. The study evaluated technical success, accuracy, procedure time, complication rate, and radiation dose.

Results

Between June 2022 and April 2023, seven patients were included. In all patients, the navigation system allowed safe puncture. However, the technical success rate was only 29%. In 42% of the cases, pelvicalyceal access was achieved by a small manual adjustment. In the remaining 29%, the needle was retracted and positioned per clinical standard. The average deviation between the needle and target was 5.9 ± 2.3 mm. The average total procedure time was 211 ± 44 min. The average radiation exposure was 6.4 mSv, with CBCT scanning contributing to 82% of this exposure.

Conclusions

The optical navigation system facilitated safe needle insertion but did not consistently ensure accurate one-attempt needle positioning for PCNL. Real-time visualization and trajectory correction may improve the technical success rate.
PSA-density, DRE, and PI-RADS 5: potential surrogates for omitting biopsy?
Authors: Falkenbach Fabian , Ambrosini Francesca , Kachanov Mykyta , Ortner Gernot , Maurer Tobias , Köhler Daniel , Beyersdorff Dirk , Graefen Markus , Budäus Lars
Published: March 2024

Objective

In contrast to other malignancies, histologic confirmation prior treatment in patients with a high suspicion of clinically significant prostate cancer (csPCA) is common. To analyze the impact of extracapsular extension (ECE), cT-stage defined by digital rectal examination (DRE), and PSA-density (PSA-D) on detection of csPCA in patients with at least one PI-RADS 5 lesion (hereinafter, “PI-RADS 5 patients”).

Materials and methods

PI-RADS 5 patients who underwent MRI/Ultrasound fusion biopsy (Bx) between 2016 and 2020 were identified in our institutional database. Uni- and multivariable logistic-regression models were used to identify predictors of csPCA-detection (GGG ≥ 2). Risk models were adjusted for ECE, PSA-D, and cT-stage. Corresponding Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were calculated.

Results

Among 493 consecutive PI-RADS 5 patients, the median age and PSA was 69 years (IQR 63–74) and 8.9 ng/ml (IQR 6.0–13.7), respectively. CsPCA (GGG ≥ 2) was detected in 405/493 (82%); 36/493 patients (7%) had no cancer. When tabulating for PSA-D of > 0.2 ng/ml/cc and > 0.5 ng/ml/cc, csPCA was found in 228/253 (90%, PI-RADS5 + PSA-D > 0.2 ng/ml/cc) and 54/54 (100%, PI-RADS5 + PSA-D > 0.5 ng/ml/cc). Finally, a model incorporating PSA-D and cT-stage achieved an AUC of 0.79 (CI 0.74–0.83).

Conclusion

In PI-RADS 5 patients, PSA-D and cT-stage emerged as strong predictors of csPCA at biopsy. Moreover, when adding the threshold of PSA-D > 0,5 ng/ml/cc, all PI-RADS 5 patients were diagnosed with csPCA. Therefore, straight treatment for PCA can be considered, especially if risk-factors for biopsy-related complications such as obligatory dual platelet inhibition are present.
Dynamic proportional rankings
Authors: Israel Jonas , Brill Markus
Published: March 2024

Proportional ranking rules aggregate approval-style preferences of agents into a collective ranking such that groups of agents with similar preferences are adequately represented. Motivated by the application of live Q&A platforms, where submitted questions need to be ranked based on the interests of the audience, we study a dynamic extension of the proportional rankings setting. In our setting, the goal is to maintain the proportionality of a ranking when alternatives (i.e., questions)—not necessarily from the top of the ranking—get selected sequentially. We propose generalizations of well-known ranking rules to this setting and study their monotonicity and proportionality properties. We also evaluate the performance of these rules experimentally, using realistic probabilistic assumptions on the selection procedure.
The impact of ultrasound on testicular loss in cases of testicular torsion in children
Authors: Buch Kjeldgaard Anastasia , Kinder-Klausen Maren Sofie , Nerstrøm Malene , Cohen Jonathan , Henriksen Birthe Merete , Thorup Jørgen Mogens
Published: March 2024

Purpose

Ultrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss.

Methods

Patients’ records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0–15 years admitted during 2015–2019 at Copenhagen University Hospital, Rigshospitalet were included.

Results

In total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound.

Conclusion

In a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.
Validation of the Investigator Global Assessment of Chronic Hand Eczema (IGA–CHE): a new clinician reported outcome measure of CHE severity
Authors: Silverberg Jonathan I. , Agner Tove , Baranowski Keith , Plohberger Ursula , Thoning Henrik , Arbuckle Rob , Grant Laura , Skingley George , Bissonnette Robert
Published: March 2024

The Investigator Global Assessment of Chronic Hand Eczema (IGA–CHE) is a novel Clinician-Reported Outcome measure that allows investigators to assess cross-sectional CHE global disease severity using clinical characteristics of erythema, scaling, lichenification/hyperkeratosis, vesiculation, oedema, and fissures as guidelines for overall severity assessment. This study aimed to evaluate the psychometric properties of the IGA–CHE for use as an outcome measure in CHE clinical trials and clinical practice. Psychometric analyses were performed using data from a sample of 280 patients with moderate to severe CHE from a phase 3 trial of delgocitinib cream, pooled across treatment groups. Test–retest reliability results were moderate to strong with kappa coefficients ranging from 0.63 to 0.76. Correlations with measures assessing related concepts were moderate or strong (range 0.65–0.72) and exceeded a priori hypotheses, providing evidence of convergent validity. Known-groups validity was supported by statistically significant differences between severity groups (< 0.001). Within-group effect sizes were consistently larger for improved groups compared to stable groups, providing evidence of ability to detect change. Anchor-based analyses generated within-subject meaningful change estimates ranging from – 0.8 to – 2.3. A correlation weighted average suggested a single value of – 1.7 in change from baseline. These findings provide evidence the IGA–CHE scale has strong reliability, construct validity, and ability to detect change, supporting its use as an endpoint in CHE clinical trials and clinical practice. Based on the evidence, 2-level changes in IGA–CHE score are considered a conservative meaningful change threshold; however, findings also indicate 1-level change in IGA–CHE scores reflects a clinically meaningful improvement for patients.

Clinical trial registration: NCT04871711.
CELSR3 is a prognostic marker in HNSCC and correlates with immune cell infiltration in the tumor microenvironment
Authors: Wu Zhongbiao , Zhu Zhongyan , Wu Weikun , Hu Shiping , Cao Jian , Huang Xinmei , Xie Qiang , Deng Chengcheng
Published: March 2024

Purpose

To look at the diagnostic value of the CELSR receptor 3 (CELSR3) gene in head and neck squamous cell carcinoma (HNSCC) and its effect on tumor immune invasion, which is important for enhancing HNSCC treatment.

Methods

Several bioinformatics tools were employed to investigate CELSR3’s putative oncogenic pathway in HNSCC, and datasets from The Tumor Genome Atlas (TCGA), Tumor Immune Estimation Resource (TIMER), Gene Expression Profile Interaction Analysis (GEPIA) and LinkedOmics were extracted and evaluated. CELSR3 has been linked to tumor immune cell infiltration, immunological checkpoints, and immune-related genes. CELSR3’s putative roles were investigated using Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and pathway enrichment analysis. The expression level of CELSR3 in HNSCC tissues and cells was detected by RT-qPCR. The effects of CELSR3 on proliferation of HNSCC cells were detected by CCK-8 assay.

Results

CELSR3 was shown to be expressed differently in different types of cancer and normal tissues. CELSR3 gene expression was linked to pN-stage and pM-stage. Patients with high CELSR3 expression also have a well prognosis. CELSR3 expression was found to be an independent predictive factor for HNSCC in both univariate and multivariate Cox regression analyses. We discovered the functional network of CELSR3 in HNSCC using GO and KEGG analysis. CELSR3 expression levels were found to be favorably associated with immune cell infiltration levels. Furthermore, CELSR3 expression levels were significantly correlated with the expression levels of many immune molecules, such as MHC genes, immune activation genes, chemokine receptors, and chemokines. CELSR3 is highly expressed in HNSCC tissues and cells. CELSR3 overexpression significantly inhibited the proliferation of HNSCC cells. CELSR3 expression may affect the immune microenvironment and, as a result, the prognosis of HNSCC.

Conclusion

CELSR3 expression is elevated in HNSCC tumor tissues, and high CELSR3 expression is associated with well prognosis, which inhibited the proliferation of NHSCC cells. CELSR3 has the potential to influence tumor formation by controlling tumor-infiltrating cells in the tumor microenvironment (TME). As a result, CELSR3 may have diagnostic significance in HNSCC.
Evaluation of the usefulness of insertion-null markers in critical skeletal remains
Authors: Haarkötter Christian , Saiz María , Gálvez Xiomara , Vinueza-Espinosa Diana C. , Medina-Lozano María Isabel , Álvarez Juan Carlos , Lorente Jose Antonio
Published: March 2024

Forensic DNA analysis in compromised skeletal remains may pose challenges due to DNA degradation, often resulting in partial or negative autosomal STRs profiles. To address this issue, alternative approaches such as mitochondrial DNA or SNPs typing may be employed; however, they are labour-intensive and costly. Insertion-null alleles (INNULs), short interspersed nuclear elements, have been suggested as a valuable tool for human identification in challenging samples due to their small amplicon size. A commercial kit including 20 INNULs markers along with amelogenin (InnoTyper® 21) has been developed. This study assesses its utility using degraded skeletal remains, comparing the results obtained (the number of detected alleles, RFU values, PHR, and the number of reportable markers) to those obtained using GlobalFiler™. Subsequently, the random match probability of the two profiles for each sample was determined using Familias version 3 to evaluate the power of discrimination of the results obtained from each kit. In every sample, InnoTyper® 21 yielded more alleles, higher RFU values, and a greater number of reportable loci. However, in most cases, both profiles were similarly informative. In conclusion, InnoTyper® 21 serves as a valuable complement to the analysis of challenging samples in cases where a poor or negative profile was obtained.
Metal and oxidative potential exposure through particle inhalation and oxidative stress biomarkers: a 2-week pilot prospective study among Parisian subway workers
Authors: Sauvain Jean-Jacques , Hemmendinger Maud , Charreau Thomas , Jouannique Valérie , Debatisse Amélie , Suárez Guillaume , Hopf Nancy B. , Guseva Canu Irina
Published: March 2024

Objective

In this pilot study on subway workers, we explored the relationships between particle exposure and oxidative stress biomarkers in exhaled breath condensate (EBC) and urine to identify the most relevant biomarkers for a large-scale study in this field.

Methods

We constructed a comprehensive occupational exposure assessment among subway workers in three distinct jobs over 10 working days, measuring daily concentrations of particulate matter (PM), their metal content and oxidative potential (OP). Individual pre- and post-shift EBC and urine samples were collected daily. Three oxidative stress biomarkers were measured in these matrices: malondialdehyde (MDA), 8-hydroxy-2′deoxyguanosine (8-OHdG) and 8-isoprostane. The association between each effect biomarker and exposure variables was estimated by multivariable multilevel mixed-effect models with and without lag times.

Results

The OP was positively associated with Fe and Mn, but not associated with any effect biomarkers. Concentration changes of effect biomarkers in EBC and urine were associated with transition metals in PM (Cu and Zn) and furthermore with specific metals in EBC (Ba, Co, Cr and Mn) and in urine (Ba, Cu, Co, Mo, Ni, Ti and Zn). The direction of these associations was both metal- and time-dependent. Associations between Cu or Zn and MDAEBC generally reached statistical significance after a delayed time of 12 or 24 h after exposure. Changes in metal concentrations in EBC and urine were associated with MDA and 8-OHdG concentrations the same day.

Conclusion

Associations between MDA in both EBC and urine gave opposite response for subway particles containing Zn versus Cu. This diverting Zn and Cu pattern was also observed for 8-OHdG and urinary concentrations of these two metals. Overall, MDA and 8-OHdG responses were sensitive for same-day metal exposures in both matrices. We recommend MDA and 8-OHdG in large field studies to account for oxidative stress originating from metals in inhaled particulate matter.
XPR1: a regulator of cellular phosphate homeostasis rather than a Pi exporter
Authors: Burns David , Berlinguer-Palmini Rolando , Werner Andreas
Published: March 2024

Phosphate (Pi) is an essential nutrient, and its plasma levels are under tight hormonal control. Uphill transport of Pi into cells is mediated by the two Na-dependent Pi transporter families SLC34 and SLC20. The molecular identity of a potential Pi export pathway is controversial, though XPR1 has recently been suggested by Giovannini and coworkers to mediate Pi export. We expressed XPR1 in Xenopus oocytes to determine its functional characteristics. Xenopus isoforms of proteins were used to avoid species incompatibility. Protein tagging confirmed the localization of XPR1 at the plasma membrane. Efflux experiments, however, failed to detect translocation of Pi attributable to XPR1. We tested various counter ions and export medium compositions (pH, plasma) as well as potential protein co-factors that could stimulate the activity of XPR1, though without success. Expression of truncated XPR1 constructs and individual domains of XPR1 (SPX, transmembrane core, C-terminus) demonstrated downregulation of the uptake of Pi mediated by the C-terminal domain of XPR1. Tethering the C-terminus to the transmembrane core changed the kinetics of the inhibition and the presence of the SPX domain blunted the inhibitory effect. Our observations suggest a regulatory role of XPR1 in cellular Pi handling rather than a function as Pi exporter. Accordingly, XPR1 senses intracellular Pi levels via its SPX domain and downregulates cellular Pi uptake via the C-terminal domain. The molecular identity of a potential Pi export protein remains therefore elusive.
Distinguishing benign and malignant thyroid nodules using plasma trimethylamine N-oxide, carnitine, choline and betaine
Authors: Shi Liang , Guo Muhong , Shi Cuixiao , Gao Gu , Xu Xianghong , Zhang Chuan , Fu Jingjing , Ni Yudan , Wang Feng , Xue Xue , Yu Fei
Published: March 2024

Purpose

Trimethylamine N-oxide (TMAO), a gut microbiome–derived metabolite, and its precursors (carnitine, choline, betaine) have not been fully examined in relation to thyroid cancer (TC) risk. The aim of this study was to assess the value of TMAO and its precursors in diagnosis of benign and malignant thyroid nodules.

Methods

In this study, high-performance liquid chromatography-tandem mass spectrometry was utilized to measure the levels of plasma TMAO and its precursors (choline, carnitine, and betaine) in 215 TC patients, 63 benign thyroid nodules (BTN) patients and 148 healthy controls (HC). The distribution of levels of TMAO and its precursors among the three groups were compared by the Kruskal–Wallis test. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the sensitivity, specificity, and the predictive accuracy of single and combined biomarkers.

Results

In comparison to HC, TC showed higher levels of TMAO and lower levels of its precursors (carnitine, choline, and betaine) (all P < 0.001). Plasma choline (P < 0.01) and betaine (P < 0.05) were declined in BTN than HC. The levels of carnitine (P < 0.001) and choline (P < 0.05) were significantly higher in BTN than that in TC group. Plasma TMAO showed lower levels in TC with lymph node metastasis (101.5 (73.1–144.5) ng/ml) than those without lymph node metastasis (131 (84.8–201) ng/ml, P < 0.05). Combinations of these four metabolites achieved good performance in the differential diagnosis, with the area under the ROC curve of 0.703, 0.741, 0.793 when discriminating between TC and BTN, BTN and HC, TC and HC, respectively.

Conclusion

Plasma TMAO, along with its precursors could serve as new biomarkers for the diagnosis of benign and malignant thyroid nodules.
Longitudinal patient-reported outcomes after minimally invasive McKeown esophagectomy for patients with esophageal squamous cell carcinoma
Authors: Miao Yan , Nie Xin , He Wen-Wu , Luo Chun-Yan , Xia Yan , Zhou Ao-Ru , Wei Si-Rui , Wang Cheng-Hao , Fang Qiang , Peng Lin , Leng Xue-Feng , Han Yong-Tao , Luo Lei , Xie Qin
Published: March 2024

Purpose

Surgery for esophageal squamous cell carcinoma (ESCC) is characterized by a poor prognosis and high complication rate, resulting in a heavy symptom burden and poor health-related quality of life (QOL). We evaluated longitudinal patient-reported outcomes (PROs) to analyze the correlations between symptoms and QOL and their changing characteristics during postoperative rehabilitation.

Methods

We investigated patients with ESCC who underwent minimally invasive McKeown esophagectomy at Sichuan Cancer Hospital between April 2019 and December 2019. Longitudinal data of the clinical characteristics and PROs were collected. The MD Anderson Symptom Inventory and European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires were used to assess symptoms and QOL and compare the trajectories of PROs during the investigation.

Results

A total of 244 patients with ESCC were enrolled in this study. Regarding QOL, role and emotional functions returned to baseline at 1 month after surgery, and cognitive and social functions returned to baseline at 3 months after surgery. However, physical function and global QOL did not return to baseline at 1 year after surgery. At 7 days and 1, 3, 6, and 12 months after surgery, the main symptoms of the patients were negatively correlated with physical, role, emotional, cognitive, and social functions and the overall health status (P < 0.05).

Conclusion

Patients with ESCC experience reduced health-related QOL and persisting symptoms after minimally invasive McKeown esophagectomy, but a recovery trend was observed within 1 month. The long-term QOL after esophagectomy is acceptable.
Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system?
Authors: Hinojosa-Ramirez F. , Tallon-Aguilar L. , Tinoco-Gonzalez J. , Sanchez-Arteaga A. , Aguilar-Del Castillo F. , Alarcon-Del Agua I. , Morales-Conde S.
Published: March 2024

Introduction

There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System).

Materials and methods

A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach.

Results

A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias.

Conclusions

The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.
Lazy model checking for recursive state machines
Authors: Dubslaff Clemens , Wienhöft Patrick , Fehnker Ansgar
Published: March 2024

Recursive state machines (RSMs)are state-based models for procedural programs with wide-ranging applications in program verification and interprocedural analysis. Model-checking algorithms for RSMs and related formalisms have been intensively studied in the literature. In this article, we devise a new model-checking algorithm for RSMs and requirements incomputation tree logic (CTL)that exploits the compositional structure of RSMs by ternary model checking in combination with a lazy evaluation scheme. Specifically, a procedural component is only analyzed in those cases in which it might influence the satisfaction of the CTL requirement. We implemented our model-checking algorithms and evaluate them on randomized scalability benchmarks and on an interprocedural data-flow analysis ofJavaprograms, showing both practical applicability and significant speedups in comparison to state-of-the-art model-checking tools for procedural programs.
Online as-Built Building Information Model Update for Robotic Monitoring in Construction Sites
Authors: Spinner Alon , Degani Amir
Published: March 2024

Today, automated techniques for the update of as-built Building Information Models (BIM) make use of offline algorithms restricting the update frequency to an extent where continuous monitoring becomes nearly impossible. To address this problem, we propose a new method for robotic monitoring that updates an as-built BIM in real-time by solving a Simultaneous Localization and Mapping (SLAM) problem where the map is represented as a collection of elements from the as-planned BIM. The suggested approach is based on the Rao-Blackwellized Particle Filter (RBPF) which enables explicit injection of prior knowledge from the building’s construction schedule, i.e., from a 4D BIM, or its elements’ spatial relations. In the methods section we describe the benefits of using an exact inverse sensor model that provides a measure for the existence probability of elements while considering the entire probabilistic existence belief map. We continue by outlining robustification techniques that include both geometrical and temporal dimensions and present how we account for common pose and shape mistakes in constructed elements. Additionally, we show that our method reduces to the standard Monte Carlo Localization (MCL) in known areas. We conclude by presenting simulation results of the proposed method and comparing it to adjacent alternatives.
Soil type and moisture content alter soil microbial responses to manure from cattle administered antibiotics
Authors: Shawver Sarah , Ishii Satoshi , Strickland Michael S. , Badgley Brian
Published: March 2024

Growing concerns about the global antimicrobial resistance crisis require a better understanding of how antibiotic resistance persists in soil and how antibiotic exposure impacts soil microbial communities. In agroecosystems, these responses are complex because environmental factors may influence how soil microbial communities respond to manure and antibiotic exposure. The study aimed to determine how soil type and moisture alter responses of microbial communities to additions of manure from cattle treated with antibiotics. Soil microcosms were constructed using two soil types at 15, 30, or 45% moisture. Microcosms received biweekly additions of manure from cattle given cephapirin or pirlimycin, antibiotic-free manure, or no manure. While soil type and moisture had the largest effects on microbiome structure, impacts of manure treatments on community structure and individual ARG abundances were observed across varying soil conditions. Activity was also affected, as respiration increased in the cephapirin treatment but decreased with pirlimycin. Manure from cattle antibiotics also increased NH4+ and decreased NO3− availability in some scenarios, but the effects were heavily influenced by soil type and moisture. Overall, this work demonstrates that environmental conditions can alter how manure from cattle administered antibiotics impact the soil microbiome. A nuanced approach that considers environmental variability may benefit the long-term management of antibiotic resistance in soil systems.
Should Patients with Traumatic Brain Injury with Significant Contusions be Treated with Different Neurointensive Care Targets?
Authors: Svedung Wettervik Teodor , Hånell Anders , Lewén Anders , Enblad Per
Published: March 2024

Background

Patients with traumatic brain injury (TBI) with large contusions make up a specific TBI subtype. Because of the risk of brain edema worsening, elevated cerebral perfusion pressure (CPP) may be particularly dangerous. The pressure reactivity index (PRx) and optimal cerebral perfusion pressure (CPPopt) are new promising perfusion targets based on cerebral autoregulation, but they reflect the global brain state and may be less valid in patients with predominant focal lesions. In this study, we aimed to investigate if patients with TBI with significant contusions exhibited a different association between PRx, CPP, and CPPopt in relation to functional outcome compared to those with small/no contusions.

Methods

This observational study included 385 patients with moderate to severe TBI treated at a neurointensive care unit in Uppsala, Sweden. The patients were classified into two groups: (1) significant contusions (> 10 mL) and (2) small/no contusions (but with extra-axial or diffuse injuries). The percentage of good monitoring time (%GMT) with intracranial pressure > 20 mm Hg; PRx > 0.30; CPP < 60 mm Hg, within 60–70 mm Hg, or > 70 mm Hg; and ΔCPPopt less than − 5 mm Hg, ± 5 mm Hg, or > 5 mm Hg was calculated. Outcome (Glasgow Outcome Scale-Extended) was assessed after 6 months.

Results

Among the 120 (31%) patients with significant contusions, a lower %GMT with CPP between 60 and 70 mm Hg was independently associated with unfavorable outcome. The %GMTs with PRx and ΔCPPopt ± 5 mm Hg were not independently associated with outcome. Among the 265 (69%) patients with small/no contusions, a higher %GMT of PRx > 0.30 and a lower %GMT of ΔCPPopt ± 5 mm Hg were independently associated with unfavorable outcome.

Conclusions

In patients with TBI with significant contusions, CPP within 60–70 mm Hg may improve outcome. PRx and CPPopt, which reflect global cerebral pressure autoregulation, may be useful in patients with TBI without significant focal brain lesions but seem less valid for those with large contusions. However, this was an observational, hypothesis-generating study; our findings need to be validated in prospective studies before translating them into clinical practice.
Cerebral Microbleeds in Critically Ill Patients with Respiratory Failure or Sepsis: A Scoping Review
Authors: Chen Bing Yu , Dang Johnny , Cho Sung-Min , Harnegie Mary Pat , Uchino Ken
Published: March 2024

Background

Cerebral microbleeds (CMBs) have been described in critically ill patients with respiratory failure, acute respiratory distress syndrome (ARDS), or sepsis. This scoping review aimed to systematically summarize existing literature on critical illness–associated CMBs.

Methods

Studies reporting on adults admitted to the intensive care unit for respiratory failure, ARDS, or sepsis with evidence of CMBs on magnetic resonance imaging were included for review following a systematic search across five databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science) and a two-stage screening process. Studies were excluded if patients’ CMBs were clearly explained by another process of neurological injury.

Results

Forty-eight studies reporting on 216 critically ill patients (mean age 57.9, 18.4% female) with CMBs were included. Of 216, 197 (91.2%) patients developed respiratory failure or ARDS, five (2.3%) patients developed sepsis, and 14 (6.5%) patients developed both respiratory failure and sepsis. Of 211 patients with respiratory failure, 160 (75.8%) patients had coronavirus disease 2019. The prevalence of CMBs among critically ill patients with respiratory failure or ARDS was 30.0% (111 of 370 patients in cohort studies). The corpus callosum and juxtacortical area were the most frequently involved sites for CMBs (64.8% and 41.7% of all 216 patients, respectively). Functional outcomes were only reported in 48 patients, among whom 31 (64.6%) were independent at discharge, four (8.3%) were dependent at discharge, and 13 (27.1%) did not survive until discharge. Cognitive outcomes were only reported in 11 of 216 patients (5.1%), all of whom showed cognitive deficits (nine patients with executive dysfunction and two patients with memory deficits).

Conclusions

Cerebral microbleeds are commonly reported in patients with critical illness due to respiratory failure, ARDS, or sepsis. CMBs had a predilection for the corpus callosum and juxtacortical area, which may be specific to critical illness–associated CMBs. Functional and cognitive outcomes of these lesions are largely unknown.
The inscrutable baseline and the problem of attribution
Authors: Waite Stephen P.
Published: March 2024

This paper examines the problem of attribution in the evaluation of energy efficiency program impact. The methodological problem concerns the observability of consumer behavior under the baseline condition of no program intervention. The statistical solution to the problem, which entails randomized exposure of targeted individuals to program influence, is not a viable alternative in most applications. Randomized opt-in and randomized encouragement designs do not conform to this requirement because all targeted individuals are encouraged to participate in the program, resulting in negative exposure bias. Quasi-experimental methods which utilize non-targeted individuals or targeted nonparticipants as baseline surrogates are further subject to selection bias of unknown magnitude and direction. Valid attribution in the general case of unrestricted eligibility depends on prior knowledge of the determinants of measure adoption and program participation. In default of such knowledge, evaluators must rely upon structural assumptions that have no foundation in empirical science. On the other hand, established measurement and verification methods which exploit scientific knowledge of the determinants of end-use energy consumption should be utilized to obtain unbiased estimates of individual measure and gross program energy savings.
Omission of adjuvant radiotherapy in low-risk elderly males with breast cancer
Authors: Vo Kim , Ladbury Colton , Yoon Stephanie , Bazan Jose , Glaser Scott , Amini Arya
Published: March 2024

Purpose

Randomized clinical trials demonstrate that lumpectomy + hormone therapy (HT) without radiation therapy (RT) yields equivalent survival and acceptable local–regional outcomes in elderly women with early-stage, node-negative, hormone-receptor positive (HR +) breast cancer. Whether these data apply to men with the same inclusion criteria remains unknown.

Methods

The National Cancer Database was queried for male patients ≥ 65 years with pathologic T1-2N0 (≤ 3 cm) HR + breast cancer treated with breast-conserving surgery with negative margins from 2004 to 2019. Adjuvant treatment was classified as HT alone, RT alone, or HT + RT. Male patients were matched with female patients for OS comparison. Survival analysis was performed using Cox regression and Kaplan − Meier method. Inverse probability of treatment weighting (IPTW) was applied to adjust for confounding.

Results

A total of 523 patients met the inclusion criteria, with 24.4% receiving HT, 16.3% receiving RT, and 59.2% receiving HT + RT. The median follow-up was 6.9 years (IQR: 5.0–9.4 years). IPTW-adjusted 5-yr OS rates in the HT, RT, and HT + RT cohorts were 84.0% (95% CI 77.1–91.5%), 81.1% (95% CI 71.1–92.5%), and 93.0% (95% CI 90.0–96.2%), respectively. On IPTW-adjusted MVA, relative to HT, receipt of HT + RT was associated with improvements in OS (HR: 0.641; p = 0.042). RT alone was not associated with improved OS (HR: 1.264; p = 0.420).

Conclusion

Among men ≥ 65 years old with T1-2N0 HR + breast cancer, RT alone did not confer an OS benefit over HT alone. Combination of RT + HT demonstrated significant improvements in OS. De-escalation of treatment through omission of either RT or HT at this point should be done with caution.
Microfluidic-based systems for the management of diabetes
Authors: Zhang Shuyu , Staples Anne E.
Published: March 2024

Diabetes currently affects approximately 500 million people worldwide and is one of the most common causes of mortality in the United States. To diagnose and monitor diabetes, finger-prick blood glucose testing has long been used as the clinical gold standard. For diabetes treatment, insulin is typically delivered subcutaneously through cannula-based syringes, pens, or pumps in almost all type 1 diabetic (T1D) patients and some type 2 diabetic (T2D) patients. These painful, invasive approaches can cause non-adherence to glucose testing and insulin therapy. To address these problems, researchers have developed miniaturized blood glucose testing devices as well as microfluidic platforms for non-invasive glucose testing through other body fluids. In addition, glycated hemoglobin (HbA1c), insulin levels, and cellular biomechanics-related metrics have also been considered for microfluidic-based diabetes diagnosis. For the treatment of diabetes, insulin has been delivered transdermally through microdevices, mostly through microneedle array-based, minimally invasive injections. Researchers have also developed microfluidic platforms for oral, intraperitoneal, and inhalation-based delivery of insulin. For T2D patients, metformin, glucagon-like peptide 1 (GLP-1), and GLP-1 receptor agonists have also been delivered using microfluidic technologies. Thus far, clinical studies have been widely performed on microfluidic-based diabetes monitoring, especially glucose sensing, yet technologies for the delivery of insulin and other drugs to diabetic patients with microfluidics are still mostly in the preclinical stage. This article provides a concise review of the role of microfluidic devices in the diagnosis and monitoring of diabetes, as well as the delivery of pharmaceuticals to treat diabetes using microfluidic technologies in the recent literature.

Graphical abstract
Rich phenomenology of the solutions in a fractional Duffing equation
Authors: Hamaizia Sara , Jiménez Salvador , Velasco M. Pilar
Published: March 2024

In this paper, we characterize the chaos in the Duffing equation with negative linear stiffness and a fractional damping term given by a Caputo fractional derivative of order $$\alpha $$
α
ranging from 0 to 2. We use two different numerical methods to compute the solutions, one of them new. We discriminate between regular and chaotic solutions by means of the attractor in the phase space and the values of the Lyapunov Characteristic Exponents. For this, we have extended a linear approximation method to this equation. The system is very rich with distinct behaviours. In the limits $$\alpha $$
α
to 0 or $$\alpha $$
α
to 2, the system tends to basically the same undamped system with a behaviour clearly different from the classical Duffing equation.
Trade-offs and Trait Integration in Tree Phenotypes: Consequences for the Sustainable Use of Genetic Resources
Authors: Climent Jose , Alía Ricardo , Karkkainen Katri , Bastien Catherine , Benito-Garzon Marta , Bouffier Laurent , De Dato Giovanbattista , Delzon Sylvain , Dowkiw Arnaud , Elvira-Recuenco Margarita , Grivet Delphine , González-Martínez Santiago C. , Hayatgheibi Haleh , Kujala Sonja , Leplé Jean-Charles , Martín-Sanz Ruth C. , de Miguel Marina , Monteverdi M. Cristina , Mutke Sven , Plomion Christophe , Ramírez-Valiente José Alberto , Sanchez Leopoldo , Solé-Medina Aida , Soularue Jean-Paul , Steffenrem Arne , Teani Angela , Westin Johan , Whittet Richard , Wu Harry , Zas Rafael , Cavers Stephen
Published: March 2024

Purpose of Review

In this review, we synthesise current knowledge on trade-offs among traits in key fitness dimensions and identify major research gaps with the intention of laying the groundwork for a rapid advance in tree breeding for multiple objectives as a key contribution to the sustainability of planted forests in the future.

Recent Findings

Trade-offs among growth, reproduction, defence, stress tolerance and product quality predicted theoretically have been reported experimentally in many breeding programmes. Among these trade-offs, the genetic linkage between resistance against biotic threats and growth (or other relevant traits) is particularly critical for the current and future management of forest genetic resources. Maintaining tree growth and wood quality in the novel environments of the future requires the assessment of genetic correlations of target traits with phenology, closely linked to survival to temperature extremes. Improving our current knowledge on the genetic trade-offs of drought tolerance as a breeding objective in forest trees obligates a more precise definition of both the specific traits and the experimental conditions. Published evidence suggests that common target traits in breeding programmes may trade-off with reproductive success and fire-adaptation, and the simultaneous improvement of growth and wood quality traits still remains as a constraint in traditional tree breeding.

Changing environments combined with pests and diseases are challenging plantation forestry worldwide, which implies an urgent need to develop new improvement strategies to build the resilience of forestry for our future environments. It is essential to have a better understanding of how traits interact, especially those important for production, climate and biotic threat resilience, but much of the information is still missing. Since many key trade-offs are affected by the environment, we need new studies under novel environments to forecast levels of multi-trait integration in breeding populations.
Understanding Heterogeneous Passenger Route Choice in Municipal Rail Transit with Express and Local Trains: An Empirical Study in Shanghai
Authors: Peng Wei , Teng Jing , Wang Hui
Published: March 2024

The express/local mode of municipal rail transit provides passengers with multiple alternatives to achieve more efficient and superior travel, in contrast to the conventional all-stop operation mode. However, the various route choices (including direct express trains, direct local trains, or transfers) covering different passenger groups pose a significant challenge to passenger flow assignment. To understand route choice behavior, it is crucial to measure the passenger heterogeneity (variability in individual and trip attributes) in order to propose targeted solutions for operation schemes and service planning. This paper proposes a hybrid model by integrating structural equation modeling and the mixed logit model under express/local mode to estimate the impact of passenger heterogeneity on route choice. An empirical study with revealed preference and stated preference surveys carried out in Shanghai revealed how individual and trip attributes quantitatively impact the sensitivity of factors in route choice. The results show that age and trip purpose are more significant factors. Compared to the control group, the probability of express trains is reduced by 10.22% for the elderly and by 11.36% for non-commuters. Our findings can provide support for more reasonable operation schemes and more targeted services.
Effectiveness of research ethics and integrity competence development – what do learning diaries tell us about learning?
Authors: Tammeleht Anu , Löfström Erika , Rajando Kertu
Published: March 2024

Due to the variety of research ethics and integrity training formats it may be challenging to use a common instrument to monitor and evaluate the development of competencies and learning progress as well as determine the effectiveness of the training. The present study scrutinises the use of learning diaries as one possible measure to evaluate the development of ethics competencies. The aim of the study was to increase understanding about how learning diaries capture development of research ethics and integrity competencies of participants and explore the use of diaries as a measure of training effectiveness. In the evaluative case study, a micro-credential programme was used as the context of the study and data was analysed using deductive content analysis. As a result, we outline criteria for analysis to be used in ethics training programmes for learning diaries. Results indicated that learning diaries submitted in the forum format (compared to individual submissions) provide peer support, so learners display more content knowledge on high levels of reflection and understanding. Submitting learning diaries over a longer period and making submissions repeatedly can improve writing and reflection competencies. The quality of learning diary entries may also depend on learner characteristics, such as commitment and motivation. Keeping a learning diary can help retain obtained competencies over a longer period. The article ends with a set of recommendations for implementing learning diaries as one measure of evaluation.
Algorithmically-driven writing and academic integrity: exploring educators' practices, perceptions, and policies in AI era
Authors: Gustilo Leah , Ong Ethel , Lapinid Minie Rose
Published: March 2024

Background

Despite global interest in the interface of Algorithmically-driven writing tools (ADWTs) and academic integrity, empirical data considering educators' perspectives on the challenges, benefits, and policies of ADWTs use remain scarce.

Aim

This study responds to calls for empirical investigation concerning the affordances and encumbrances of ADWTs, and their implications for academic integrity.

Methods

Using a cross-sectional survey research design, we recruited through snowball sampling 100 graduate students and faculty members representing ten disciplines. Participants completed an online survey on perceptions, practices, and policies in the utilization of ADWTs in education. The Technology Acceptance Model (TAM) helped us understand the factors influencing the acceptance and use of ADWTs.

Results

The study found that teacher respondents highly value the diverse ways ADWTs can support their educational goals (perceived usefulness). However, they must overcome their barrier threshold such as limited access to these tools (perception of external control), a perceived lack of knowledge on their use (computer self-efficacy), and concerns about ADWTs' impact on academic integrity, creativity, and more (output quality).

Conclusion

AI technologies are making headway in more educational institutions because of their proven and potential benefits for teaching, learning, assessment, and research. However, AI in education, particularly ADWTs, demands critical awareness of ethical protocols and entails collaboration and empowerment of all stakeholders by introducing innovations that showcase human intelligence over AI or partnership with AI.
Helping School Students Deal with Peer Provocations and Avoid Hostile Attribution Bias with the CATZ Cross-Age Teaching Zone Intervention
Authors: Boulton Michael J. , Macaulay Peter J. R.
Published: March 2024

Cross-age tutoring and co-operative group work have been shown to help student tutors and tutees acquire academic and non-academic skills and knowledge. A novel intervention (Cross-Age Teaching Zone, CATZ) that combined them was tested for its effects on student tutors’ thinking skills associated with (i) dealing pro-socially with peer provocations and (ii) avoiding hostile attribution bias. Small co-operative groups of 11- and 15-year-old students (N = 228) designed a CATZ lesson on these themes and delivered it to younger students. The CATZ tutors, but not matched controls (N = 189), showed significant improvements on both outcome measures. Participants aged 9 to 15 years (N = 469) were also asked about: (1) their willingness to act as CATZ tutors/tutees, (2) how effective they think such CATZ activities would be, (3) how much they valued autonomy in how they might deliver CATZ, and (4) their relative preference for being taught by older students versus teachers. Overall, participants expressed positive views of CATZ, which also helped students learn patterns of thinking that can help them avoid aggressive and conflict behavior. This initial evidence on the effectiveness of CATZ calls for further research to use CATZ across a range of social, emotional, and behavioral domains to support its wider uptake in schools.