bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of a Radiopathomics Model Based on CT Scans and Whole Slide Images (WSI) for Discriminating Between Stage I-II and Stage III Gastric Cancer
Authors: Tan Yang , Feng Li-juan , Huang Ying-he , Xue Jia-wen , Long Li-ling , Feng Zhen-Bo
Published: August 2024

Objective
This study aimed to develop and validate an artificial intelligence radiopathological model using preoperative CT scans and hematoxylin and eosin (HE) stained slides to predict the pathological staging of gastric cancer (stage I-II and stage III).
Methods
This study included a total of 202 gastric cancer patients with confirmed pathological staging (training cohort: n = 141; test cohort: n = 61). Pathological histological features were extracted from HE slides, and pathological models were constructed using logistic regression (LR), support vector machine (SVM), and NaiveBayes. The optimal pathological model was selected through ROC curve analysis. Machine algorithms were employed to construct radiomic models and radiopathological models using the optimal pathological model. Model performance was evaluated using ROC curve analysis, and clinical utility was estimated using decision curve analysis (DCA).
Results
A total of 311 pathological histological features were extracted from the HE images, including 101 Term Frequency-Inverse Document Frequency (TF-IDF) features and 210 deep learning features. A pathological model was constructed using 19 selected pathological features through dimension reduction, with the SVM model demonstrating superior predictive performance (AUC, training cohort: 0.949; test cohort: 0.777). Radiomic features were constructed using 6 selected features from 1834 radiomic features extracted from CT scans via SVM machine algorithm. Simultaneously, a radiopathomics model was built using 17 non-zero coefficient features obtained through dimension reduction from a total of 2145 features (combining both radiomics and pathomics features). The best discriminative ability was observed in the radiopathomics model (AUC, training cohort: 0.953; test cohort: 0.851), and clinical decision curve analysis (DCA) demonstrated excellent clinical utility.
Conclusion
The radiopathomics model, combining pathological and radiomic features, exhibited superior performance in distinguishing between stage I-II and stage III gastric cancer. This study is based on the prediction of pathological staging using pathological tissue slides from surgical specimens after gastric cancer curative surgery and preoperative CT images, highlighting the feasibility of conducting research on pathological staging using pathological slides and CT images. It opens the possibility for preoperative biopsy pathology slides and CT images to be used for pathological staging assessments before curative surgery for gastric cancer in the future.
Facet joint fusion by thermal ablation for single-level lumbar spinal stenosis
Authors: Lei Puzhou , Wang Xinyue , Huang Shuai , Wang Linghanqing , Chen Sida , Zhang Siyu , Li Cheng , Li Lei
Published: August 2024

Previous studies demonstrated the presence of bridging bone across the facet joints in postoperative computed tomography (CT) scans of patients who underwent unsuccessful posterior lumbar fusion (PLF) and interbody fusion (IBF) procedures. Recent research shows that facet joint fusion achieved through bone grafting with pedicle screw instrumentation leads to satisfactory clinical outcomes and fusion rates. Building upon these findings, there is a hypothesis that facet joint fusion achieved solely through thermal ablation, without the need for bone grafting, may yield credible fusion rates and clinical outcomes. A retrospective review was conducted on 136 patients who underwent lumbar fusion utilizing thermal ablation of the facet joint. CT and clinical outcomes, including Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI), were evaluated both preoperatively and at the 6-month, 1-year, and 2-year follow-up intervals. At the final assessment, 90.4% of patients achieved excellent or good results, and no technique-related complications were observed in any of the patients. We believe that the compelling clinical outcomes and fusion rates achieved through thermal ablation of the facet joint highlight its potential as a highly feasible alternative method for treating single-level lumbar spinal stenosis, which potentially replaces traditional interbody fusion (IBF) techniques.
The Second-Round Evaluation of Financial Incentives on Malaria Prevalence in the Lake Victoria Basin, Kenya: Updated Study Protocol for a Cluster-Randomized Controlled Trial
Authors: Matsumoto Tomoya , Nagashima Masaru , Kagaya Wataru , Okomo Gordon , Kongere James , Oginga Jared , Opiyo Victor , Gitaka Jesse , Kaneko Akira
Published: August 2024

Background: Despite significant progress in global malaria reduction since 2000, driven primarily by supply-side interventions including improvements in bed nets and medication availability, recent years have seen a stagnation in this decline. In certain regions, cases have even increased (1). This trend is particularly concerning in high-burden areas such as Suba South Sub-county in Homa Bay County, Kenya, where malaria remains a persistent public health challenge. However, demand-side barriers—such as lack of knowledge of the disease and perceived costs of prevention and treatment among residents—have been relatively overlooked in control efforts. To address this gap, we conducted a cluster-randomized controlled trial (cRCT) to investigate the impact of an educational intervention and financial incentives on malaria-related behaviors (2). This second-round cRCT aims to build upon the first-round findings, with modifications to the experimental design and educational content to further explore the potential of demand-side interventions and inform future malaria control strategies.
Methods: This second-round cRCT will re-randomize the original 92 clusters to either conditional cash transfer (CCT), lottery incentive scheme (LIS), or control arms. Each intervention arm will includeupdated malaria education and financial incentives linked to negative malaria test results, with reward amounts adjusted to reflect local inflation. We will re-assess malaria prevalence using RDT, microscopy, and PCR at three and six months post-intervention. The primary outcomes are changes in malaria prevalence, LLIN usage, and knowledge/perception of malaria. The analysis will combine data from both the first and second rounds to improve statistical power and provide a more comprehensive assessment of the intervention's impact.
Discussion: This study addresses the limitations of the first-round trial by increasing statistical power and refining the educational component. By evaluating the effectiveness of demand-side interventions, we aim to inform policy and program design for malaria control in high-burden settings. The resulting evidence on the role of demand-side factors will complement traditional supply-side approaches, ultimately refining future malaria control policies and programs. This research, thereby, has the potential to contribute to the development of sustainable, community-based strategies for malaria elimination.
Trial registration: UMIN000053284, registered on 6th January 2024.
Whole stomach versus narrow gastric tube reconstruction after esophagectomy for esophageal cancer (ATHLETE trial): study protocol for a randomized controlled trial
Authors: Kitadani Junya , Hayata Keiji , Goda Taro , Tominaga Shinta , Fukuda Naoki , Nakai Tomoki , Nagano Shotaro , Ojima Toshiyasu , Shimokawa Toshio , Kawai Manabu
Published: August 2024

Background
There are two types of methods of creating a gastric conduit after esophagectomy for patients with esophageal cancer: narrow gastric tube reconstruction or whole stomach reconstruction. Whole stomach reconstruction with good blood perfusion was reported in a prospective cohort study to be safe and that it has the possibility to prevent anastomotic leakage (AL). We therefore planned a randomized controlled phase III study to investigate the superiority of whole stomach reconstruction over narrow gastric tube reconstruction after esophagectomy for esophageal cancer.
Methods
This is a single center, two-arm, open-label, randomized phase III trial. We calculated that 65 patients in each arm of this study and total study population of 130 patients are required according to our historical data on narrow gastric tube reconstruction and prospective data on whole stomach reconstruction. In the narrow gastric tube group, a 3.5-cm-wide gastric tube is made along the greater curvature of the stomach using linear staplers. Otherwise, in the whole stomach group, after the lymphadenectomy of the lesser curvature and No.2, the stomach is cut just below the esophagogastric junction using a linear stapler. The primary endpoint of this study is the incidence of AL. Secondary endpoints are the occurrence rate of anastomotic stenosis, the occurrence rate of pneumonia, the occurrence rate of all postoperative complications, the occurrence rate of reflux esophagitis, quality of life evaluation by EORTC QLQ-C30 and EORTC OES-18, nutritional evaluation, the amount of blood loss, postoperative hospital stays and blood flow evaluation. Complications are evaluated using the Clavien-Dindo classification (Version 2.0), and those of Grade II or higher are considered to be postoperative complications.
Discussion
If the optimal method for creating a gastric conduit after esophagectomy is clarified, it may be possible to contribute to improving short-term and long-term surgical outcomes for patients undergoing surgery for esophageal cancer.
Trial registration:
The protocol of ATHLETE trial was registered in the UMIN Clinical Trials Registry as UMIN000050677 (http://www.umin.ac.jp/ctr/index.htm). Date of Registration: March 26, 2023. Date of First Participant Enrollment: March 27, 2023.
Designing a Patient Preference Study on Subcutaneous Medical Devices: Incorporating Health Authority Scientific Advice and Patient Perspectives
Authors: Jones Byron , Cook Nigel , Picci Marie , Zhou Mo , Berlin Conny , Christine Sturchler , Martinez Clemence , Baena Irene Garcia , Ziegler Lauren , Gaunt Harriet , Mason Brad , Hamerlijnck Dominique , Majima Yoshiyama
Published: August 2024

This paper describes the planning of a patient preference study for evaluating device features and administrative solutions for the subcutaneous (SC) delivery of high doses / large volumes (e.g., >2mL) of drugs. A mixed-methods approach was used including qualitative research studies, the involvement of patient partners, and solicitation of advice from the FDA. This resulted in the development of a preference study protocol to investigate what Multiple Sclerosis patients consider important regarding medical device features for high dose SC administration, including refinement of the attributes and levels which will be central to the planned quantitative online patient preference study.
Efficacy of Topical Heparin Spray on Donor Site Wound Healing Time Compared to Conventional Dressing Among Patients Undergoing Split Thickness Skin Grafting
Authors: Adil Faraz , Memon Mahak Ali , Akhlaq Faisal , Piprani Farhan Zahid , Awan Asadullah , Siddiqui Saad Uddin
Published: August 2024

Background
All wounds that cannot be closed primarily needs skin coverage earliest to prevent form infections. Skin graft provides earliest and easiest wound coverage, but produces another wound, i.e. donor site wound. This study is conducted to see healing time efficacy of topical heparin spray versus conventional dressing in healing donor site wounds.
METHODOLOGY
The study was designed as a single center, prospective, randomized control trial study. It was conducted in the Department of Plastic and Reconstructive Surgery at Civil Hospital Karachi. The study was carried out for 10 months of the period from Sep 2020 to July 2021. The sample was calculated by using OpenEpi version 3.01.The minimum sample size was calculated to be 8 at 95% confidence level and 80% power, though the study included 60 patients who underwent split thickness skin grafting for healthy granulating wounds. From the next day of surgery heparin dressing and conventional dressings groups were made and dressing was done daily till seventh postoperative day. Data in form of questionnaire and photographic assessment was recorded filled at every change of dressing. This study was a self-controlled trial, therefore every trial participant served as his/her own control. Data was analyzed by using Statistical Package for Social Sciences (SPSS version 24).
RESULT
The results of the analysis showed the mean age of the participants was (35.30 ± 8.87). Male gender predominated with a frequency of 82% while females were 18%. A decrease in soakage of dressing was recorded in 48 (98.0%) male participants at interventional half; however, all females experienced no difference at both dressing sites. Similarly 48 (98.0%) male participants a reduction in itching at intervention site and all females had experienced no difference in itching at both dressing sites. In regard to wound size, 40% of participants showed a reduction in wound size and only 20% showed no improvement at interventional half. During 7days, 81.67% of participants showed improvement in edema at intervention half and 96.7% of participants reported no change in edema with conventional therapy. None of the participants scored worst pain at the intervention area.
CONCLUSION
The study showed heparin irrigation result in better wound healing and significantly reduces pain, edema, enhances faster healing and reduces soakage of dressings.
Trial registration:
The study was approved by Institutional Review Board of Dow University of Health Sciences and was registered at Clinical Trials.gov (ID: NCT04613336).
Radiological characterization related to lithology and risk assessment of bottled natural mineral water
Authors: Martínez Joana , Peñalver Alejandra , Riu Jordi , Aguilar Carme , Borrull Francesc
Published: August 2024

The enhancement of natural radioactivity in groundwater, specifically in natural mineral water, is related to the lithological formations through which water bodies or courses pass. Although natural mineral waters are exempt from monitoring for radioactive substances according to Council Directive 2013/51/EURATOM, this study focuses on the radiological characterization of natural mineral water under Spanish Royal Decree 3/2023. The water studied was taken from Catalan aquifers with different lithological characteristics (sedimentary, metamorphic, or granitic) and is sold on local markets. Moreover, radiological data on the water was correlated with its lithological origin and the health risk for different age groups was assessed. Our results showed that of the 26 natural mineral waters studied, 10 exceeded gross alpha screening value (100 mBq/L), all from granitic aquifers. Further research on natural individual radionuclides was conducted on these 10 samples. 234U and 238U at around 1100–1600 mBq/L. In addition, 210Pb was found in two samples, which also presented the highest 226Ra activity, associated with granitic bedrock and the presence of 210Po. The annual effective dose was 179.0 and 145.9 µSv/y, exceeding 100 µSv/y mainly due to the contribution of 210Pb >234,238U >210Po>226Ra, in this order. After assessing the lifetime cancer risk, these two samples were determined not to pose a health risk due to ingestion. Although no radiological monitoring is required for natural mineral water, further surveillance is recommendable.
How can services better support women with a body mass index ≥25 kg/m2 to breastfeed: a qualitative study.
Authors: Cooke Susan , Heslehurst Nicola , Scott Rebecca , Rankin Judith
Published: August 2024

Aim: This study explores the experiences and perspectives of women with a Body Mass Index (BMI) ≥25 kg/m2 on infant feeding.
Subject and methods: Women with a BMI ≥25 kg/m2 have lower rates of initiating, maintaining and exclusive breastfeeding than women with a BMI <25 kg/m2. There is limited qualitative research on this topic, particularly for women living with overweight (BMI ≥25 kg/m2-29.9 kg/m2). Eighteen women with a BMI ≥25 kg/m2 living in the North East of England and an infant under eighteen months of age participated in a semi-structured interview concerning infant feeding practices during May and June 2021. Participants were recruited through social media platforms. An inductive thematic analysis was undertaken to analyse the interview data.
Results: Two overarching themes were identified: lower confidence and a perceived negative judgement from others for living with higher weight. These themes reduced women’s confidence in their ability to breastfeed and led to negative experiences or avoidance of public feeding. Difficulties with latching and positioning in relation to body shape also reduced confidence in breastfeeding further. Due to these barriers, women felt that they required additional, tailored support to achieve breastfeeding.
Conclusion: Improving breastfeeding support for women with a BMI≥25 kg/m2 requires a whole systems approach involving education systems, healthcare professionals and the community. The impact of terminology, such as labelling a women’s pregnancy ‘high risk’, on women’s breastfeeding confidence needs to be considered further.
Host genetic diversity contributes to disease outcome in Crimean-Congo hemorrhagic fever virus infection
Authors: Rao Deepashri , Lewis Matthew , Meade-White Kimberly , Shaia Carl , Okumura Atsushi , Ferris Martin T. , Schäfer Alexandra , Baric Ralph , Feldmann Heinz , Hawman David W.
Published: August 2024

The Crimean-Congo hemorrhagic fever virus (CCHFV) causes Crimean-Congo hemorrhagic fever (CCHF), a widely distributed disease with significant morbidity and mortality. The virus has high genetic diversity correlated with geographic distribution, but limited temporal evolution within regions. Despite this, cases of CCHF within a region present as a spectrum of disease from often unrecognized asymptomatic infections to a severe, fatal viral hemorrhagic fever, suggesting host factors may play a role in disease outcome. We investigated the effect of host genetic diversity on the outcome of CCHFV infection in the genetically diverse Collaborative Cross mouse model. Infected mice recapitulated the full spectrum of disease recognized in humans and similar to human disease, virus replication, tissue pathology and inflammatory responses were associated with disease severity. Our study demonstrates that host genetics contribute to disease outcome in CCHF infection and establishes the Collaborative Cross mouse resource as a model to understand how host genetic diversity contributes to CCHF outcome.
Multicenter analysis of the efficacy of early cholecystectomy and preoperative cholecystostomy for severe acute cholecystitis: A retrospective study of data from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology
Authors: Abe Tomoyuki , Kobayashi Tsuyoshi , Kuroda Shintaro , Hamaoka Michinori , Mashima Hiroaki , Onoe Takashi , Honmyo Naruhiko , Oishi Koichi , Ohdan Hideki
Published: August 2024

Background
Severe acute cholecystitis (AC) is a challenging disease because it comprises coexisting systemic infections that lead to vital organ dysfunction. This study evaluated the optimal surgical timing and efficacy of preoperative percutaneous cholecystostomy (PC) for patients with severe AC.
Methods
Data of 142 patients who underwent cholecystectomy for severe AC between 2011 and 2021 were retrospectively collected from a multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology and divided into the early cholecystectomy (EC) group (within 72 hours of symptom onset) and delayed cholecystectomy (DC) group. Patients were also subdivided into the upfront cholecystectomy group and preoperative PC after cholecystectomy group. The diagnosis and severity of AC were graded according to the Tokyo Guidelines 2018. Clinicopathological variables and outcomes were compared.
Results
No significant differences in age, body mass index, American Society Anesthesiologist (ASA) classification, and Carlson comorbidity index were observed between the EC and DC groups. Preoperative drainage was more commonly performed in the DC group than in the EC group. Local severe AC features were more commonly detected in the DC group than in the EC group. The postoperative outcomes of the EC and DC groups were comparable. The upfront cholecystectomy group included more patients with ASA physical status ≥ 3 and patients who used oral warfarin than the preoperative PC after cholecystectomy group. Warfarin usage and cardiovascular dysfunction rates of the PC after cholecystectomy group were higher than those of the upfront cholecystectomy group. PC was associated with significantly less intraoperative bleeding and shorter hospital stays.
Conclusions
Patients who can tolerate general anesthesia are good candidates for EC. Patients who use warfarin and those with cardiovascular dysfunction are considered to be at high risk; therefore, PC after cholecystectomy is a better choice than upfront cholecystectomy for these patients.
Contraceptive use in women of childbearing age with bipolar disorder
Authors: Rodríguez-Toscano Elisa , de Chazeron Ingrid , Belzeaux Raoul , Llorca Pierre Michel , Samalin Ludovic
Published: August 2024

Introduction
Unplanned pregnancies are frequent in women with bipolar disorder (BD) while perinatal period is associated with a higher risk of relapse. Effective contraception during childbearing age in BD could reduce the risk of unplanned pregnancy and its consequences. The present study studied the prevalence of contraceptive use and which sociodemographic and clinical variables affect its use in women with BD.
Methods
796 women (18-50 years old) with BD were recruited and evaluated by the MONTRA survey in France among hospital and consultant psychiatrists. Sociodemographic, clinical and treatment variables were compared between patients with and without contraception use. A logistic regression estimated which variables had a predictive effect on the use of contraception.
Results
A 61.2% reported the use of effective contraception. Women who use contraception were in 26-35 (OR=2.40,p<0.001) and 36-45 (OR=1.92,p<0.001) range age, displayed higher levels of education (OR= 5.07,p=0.003), were more active (OR=1.63,p=0.006), did not live alone (OR=1.41,p=0.033) and had fewer manic or mixed episodes (OR=0.50,p=0.007).No association was found with the nature of pharmacological treatment.
Conclusion
Sociodemographic variables were mainly associated with contraception use among BD women. As preventive measures for risk of relapse in BD, contraceptive counseling, including reduction of unplanned pregnancies, should be systematically ensured.
Elucidating fungi pathogens and multi-drug resistance in oculomycosis, and bioprospecting native plants as antifungal therapy
Authors: Badu Kingsley , Boateng Abigail Oforiwaa , Junior Isaiah Osei Duah , Akuffo Kwadwo Owusu , Gyimah Lord
Published: August 2024

Background
Ocular mycoses have a debilitating impact on ocular health and quality of life. However, the burden and etiology of ocular mycoses and the efficacy of clinical antifungal agents used in the management of ocular fungal infections remain unclear. The study assesses the prevalence of ocular fungal pathogens and multi-drug resistance patterns, and further explored native medicinal plants as a source of antifungal agents in Ghana.
Methods
In this multicenter, cross-sectional study, biographic, medical, and ophthalmic data were collected using a structured questionnaire, and conjunctival swabs and corneal samples were collected for microbiological characterization and antifungal susceptibility testing. Patient demographic and clinical data were stratified by sex and differences were tested using chi-squared analysis. Microbiological data were presented as proportions, means, and standard deviations. Bivariate logistic regression was used to test the association between patient characteristics and the likelihood of isolating fungal pathogens from the eyes of persons with presenting eye infections.
Results
Approximately ten percent (9.36%) of ocular specimens were positive for fungal culture with the predominant fungal etiology being Candida albicans. Multi-drug resistance was observed for clinically used antifungal agents; amphotericin B and fluconazole, itraconazole, terbinafine. Alternatively, ethanolic extracts of Cinnamomum verum (C. verum) and Syzygium aromaticum (S. aromaticum), demonstrated potent fungistatic and fungicidal activity against the common implicated pathogen, Candida albicans (C. albicans).
Conclusion
Overall, the study broadens our understanding of the pathogenesis of ocular mycoses in Ghana and the implications of clinical use of antifungal treatments. Leveraging on the medicinal plant screening, we propose characterization of the bioactive compound(s) in C. verum and S. aromaticum for clinical translation into ocular antifungal therapeutics.
The MRI estimations of cervical length and cervical volume correlate with massive hemorrhage in patients with placenta accreta spectrum disorders
Authors: Yue Yongfei , Yan Jun , Song Ye , Zhou Xinfang , Kang Yan , Yuan Min
Published: August 2024

Objective
The purpose of this study is to evaluate the capacity of two MRI parameters to predict massive hemorrhage in pregnancies with placenta accreta spectrum disorders.
Methods and materials:
This case-control study evaluated 174 patients who underwent MRI for placental assessment. MRI images were reviewed by two experienced radiologists blinded to all clinical data. Multivariate logistic regression was performed to analyze the risk factors for patients with massive hemorrhage. The area under the curve were used to compare the predictive ability between cervical length and cervical volume.
Results
Patients with massive hemorrhage exhibited smaller neonatal birthweight (P < 0.001), longer operation time (P < 0.001), and more blood loss (P < 0.001). The percentage of ICU admission and hysterectomy were both significantly higher than patients without massive hemorrhage. The area under the curve of cervical length and cervical volume in predicting MH were 0.812 and 0.845, respectively. And the area under the curve increased to 0.906 by the two combined parameters.
Conclusion
Shorter cervical length and smaller cervical volume are associated with massive hemorrhage during cesarean section. These methods can be utilized to better predict massive hemorrhage in placenta accreta spectrum disorders.
Using patient-reported outcomes in clinical studies for cardiovascular diseases of Traditional Chinese medicine worldwide: a cross-sectional study
Authors: Liu Hao , Guan Xinmiao , Lin Yuanyuan , Luo Minjing , Liang Changhao , Zhang Xinyue , Rong Hongguo , Fei Yutong
Published: August 2024

Background and purpose:
Patient-reported outcomes (PROs) are health condition assessments directly expressed by patients, providing a precise reflection of the patient's perspective. We aim to understand how PROs were being used to provide suggestions for conducting high-quality clinical studies of Traditional Chinese medicine (TCM) for cardiovascular diseases (CVD).
Methods:
We searched clinical studies of TCM for CVD from the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) registered between January 1, 2010, and December 31, 2023. Trial phases, study types, age, gender, TCM interventions, regions and countries, time trends, PROs as primary/secondary/co-primary outcomes, and PRO instruments explicitly specified or implicitly specified were analyzed. We classified the studies that explicitly specified PROs into 14 categories based on the International Classification of Diseases-11 (ICD-11) ,and compared their PRO instruments with the Core Outcome Measures in Effectiveness Trials (COMET).
Results:
487 TCM CVD studies were identified. 194 studies did not mention the use of PRO instruments. 250 studies explicitly specified the PRO tool, while 43 studies implicitly (studies registration mentioned the use of PROs, but PRO instruments were not specified). Out of the 293 studies that included PROs, 84 (17.2%) listed PROs as their primary outcomes, 144 (29.6%) as secondary outcomes and 65 (13.3%) as co-primary outcomes. Chronic coronary heart disease (26.96%), hypertension (15.70%), and heart failure (14.68%) were the most common diseases in that 250 studies. Furthermore, their PRO instruments partially complied with COMET's recommendations ,while other diseases did not. Frequently used PRO instruments included the SAQ (Seattle Angina Questionnaire), the TCMSS (TCM syndrome score), the SF-8/12/36 (Short-Form 8/12/36-item Health Survey), and the VAS (Vsual Analog Scale).
Conclusion:
Over the past decade, there has been a continued increase in the use of PROs as a measure in clinical investigations focused on TCM for CVD. Research and development of PROs core endpoints for different CVD could be improved. Given the current challenges surrounding the use of PROs in clinical studies of TCM, such as the inconsistent availability and absence of standardized PRO instruments for TCM, it is crucial to prioritize research on establishing standardized and normalized scales specifically designed for TCM.
Equine therapy in the management of teenagers with severe anorexia nervosa : a qualitative study
Authors: Lepy Camille , Letranchant Aurélie , Aniorte Jean-Luc , Bedos Julien , Hotchkin Rebecca , Corcos Maurice , Piot Marie-Aude
Published: August 2024

Background
Severe anorexia nervosa is a complex psychiatric pathology with limited therapeutic tools to reduce morbidity and mortality. Equine-assisted therapy could provide additional therapeutic benefits.
Objectives
We aimed to explore the effects of equine assisted therapy on the experience of adolescents with severe anorexia nervosa.
Méthods
Using a qualitative approach based on Interpretative Phenomenological Analysis, we conducted semi-structured interviews with nine participants who had taken part in equine-assisted therapy sessions.
Results
Three super-ordinate themes were found. An experience of insecurity appeared at the forefront of the discovery of the horse which was perceived as a source of fear, and the displacement of the spatiotemporal framework. Equine therapy offered a sense of support and emotional regulation through role-playing that allowed for investment without fear of perceived social judgment, a reassuring experience through relational adjustment with the horse, and an experience of support from the humans present. Last but not least, equine therapy was a transformative learning experience, enabling participants to embody their body bodies, develop emotional regulation and care for someone other than themselves.
Conclusion
Equine-assisted therapy constitutes a therapeutic mediation with bodily, emotional and relational therapeutic benefits in severe anorexia nervosa. The setting, place and function of the equine therapist, the participants' previous experience with horses and the interaction with other care areas seem to be essential to ensure therapeutic conditions.
Computer-Aided Detection of Biparietal Diameter and Femur Length Measurements from Prenatal Ultrasound Images
Authors: abdi Rabah Al , Al-Goraee Ashraf , Hijazi Heba , Ghazal Mohammed , Al-bashir Areen , Alquran Hiam , Sindiani Amer , Abdulhay Enas , Issa Wejdan Bani
Published: August 2024

Background
Routine ultrasound exams for fetal biometry are hindered by the reliance on obstetricians' expertise, emphasizing the necessity for an automated computer-aided method to ensure accurate gestational age estimation. This paper describes a completely automatic method for identifying and accurately measuring two biometrics: biparietal diameter (BPD) and femur length (FL).
Methods
The method uses first- and second-order total variation denoising (FSTVD) to remove speckle noise and preserve edges in prenatal ultrasound images. Automatic estimation of FL and BPD was implemented by selecting and determining regions of interest based on their shape, size, location, and orientation in the filtered images. The method was tested on 431 ultrasound images, and the results were compared with manual measurements made by expert obstetricians. Pearson’s correlation and the Bland–Altman plot were used to assess the agreement between the automatic and manual measurements.
Results
The results showed a strong correlation (r > 0.99) between the automatic and manual measurements for both FL and BPD. A mean error of less than 2 mm was found for the difference between automatic and manual measurements for both FL and BPD. Additionally, the processing time for filtering a regular-sized image and determining FL or BPD using the presented method was less than 0.5 seconds.
Conclusions
The proposed method demonstrates high accuracy in estimating FL and BPD from ultrasound images. Additionally, its short processing time allows for real-time estimation of FL and BPD within ultrasound imaging systems.
‘Watkins’ & ‘Watkins2.0’: Smart Phone Applications (Apps) For Gait- Assessment in Normal Pressure Hydrocephalus And Decompensated Long-Standing Overt Ventriculomegaly
Authors: Tariq Kanza , Thorne Lewis , Toma Ahmed , Watkins Laurence
Published: August 2024

Objective
Gait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-meter-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team.
Methods
10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve.
Results
As compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1–3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25–0.50 meter. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1–2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 meter. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC > 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals.
Conclusion
‘Watkins’ and ‘Watkins2.0’ are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance.
A Preliminary Assessment of Civet “Home Breeding”: Morphological Changes and Conservation Relevance.
Authors: Hooper Jes
Published: August 2024

Indonesia’s Civet Lover clubs are urban and suburban social groups comprised of civet (sp. Viverridae) pet keeping enthusiasts. Civet Lover clubs operate regionally and nationally, with trends in civet pet keeping facilitated in online social media platforms. The breeding of wild civets (known as “home breeding”) for the pet trade, grew in popularity in 2016 in response to consumer demand for civets with unique morphological characteristics. This research aims to analyse the scalability of civet home breeding and to document the morphological changes occurring to civet species through the process of selective breeding. This research is a case study analysis of the most popular home breed enterprise operating on Instagram from 2016 to 2021. Data comprise all Instagram posts shared to the platform during the period of operation, within which the number of civet copulations, births, and sales were recorded along with the featured civet’s species and morphological characteristics. The conservation implications of civet home breeding are discussed.
Developmental Defects of Enamel and Dental Anomalies in Children with Skin Diseases
Authors: Okutan Alev Eda , Yücelten Ayşe Deniz , Menteş Ali
Published: August 2024

Objectives
The common embryologic neural origin of the ectoderm includes the epidermal layer of the skin and the amelodentinal (the enamel and dentine) components of the teeth, which result in a variety of conditions affecting both skin and dentition to different degrees. The aim of the study was to evaluate the occurrence of dental anomalies among pediatric patients with skin diseases.
Materials and Methods
Patients with skin disease (4–16 ages, n = 71) were included in study group and 41 age-gender-matched children were designated as control group. Enamel defects were evaluated with the MIH Index. Panoramic radiographs were taken, and dental anomalies seen in the radiographs (hypodontia, hyperdontia, taurodontism, short root anomaly) were recorded.
Results
MIH was found to be significantly higher in chronic skin diseases group. DDE-not-related MIH, and other dental anomalies were found to be statistically significantly higher in the genodermatoses group.
Conclusion
Current study confirms a connection between MIH and chronic skin diseases, as well as a relationship between genodermatoses, DDD-not-related MIH, and other anomalies.
Clinical Relevance:
Dental screening and management should be taken into account as part of the patient's overall health care plan, and clinicians should be aware of the potential oral health issues associated with skin diseases.
From Data to Decisions: Portfolio Topology Optimization Framework
Authors: Faridnia Rashid
Published: August 2024

Portfolio management in the automotive industry plays a crucial role in optimizing resource allocation, risk management, and financial performance. This article presents an integrated optimization framework that combines the Markowitz model, multi-discipline optimization, and deep learning techniques to enhance portfolio decision-making in the automotive sector. By leveraging advanced analytics and artificial intelligence, companies can develop data-driven strategies to maximize returns, minimize risks, and achieve competitive advantage. A comprehensive methodology for implementing the integrated optimization framework in Python is provided, including data preprocessing, model development, performance analysis, and practical implementation. Empirical results using a real-world dataset demonstrate the effectiveness of the proposed approach in improving portfolio management practices in the automotive industry.
Cross talk between skin microbiota and post-traumatic wound infection: a bidirectional mendelian randomization analysis
Authors: Chen Qingsong , Zhang Yuke , Huang Guangbin , Zhang Bohao , Cheng Yuan , Shi Li , Li Jianxiao , Li Hui , Zhang Qi , He Ping , Li Yongming , Du Dingyuan
Published: August 2024

Background
Post-traumatic wound infection (PTWI) is a major challenge in trauma, burns, and surgeries. The skin microbiota is crucial for defense and may influence PTWI occurrence, though the relationship is unclear. This study explores the causal link between the skin microbiome and PTWI using bidirectional two-sample Mendelian randomization (MR) analysis.
Methods
A two-sample MR analysis was conducted using genome wide association studies (GWAS) data of 147 skin microbiota taxa and PTWI. The inverse-variance weighted (IVW) method was the primary analysis technique, while the MR-Egger and weighted median were used as supplementary analysis methods. Cochran’s Q test was used to perform heterogeneity analysis. The MR-Egger intercept test and MR-PRESSO were employed to assess potential horizontal pleiotropy. The leave-one-out method was utilized to evaluate the impact of individual SNPs on the overall causal effect.
Results
The two-sample MR analysis identified significant causal relationships between 12 skin microbiota species and PTWI. Five species were potentially beneficial: asv045 [Acinetobacter (unc.)] (OR = 0.971, P = 0.044), asv092 [C. kroppenstedtii] (OR = 0.966, P = 6.88e − 03), asv093 [Staphylococcus (unc.)] (OR = 0.911, P = 0.044), genus Finegoldia (OR = 0.965, P = 0.043), and genus Kocuria (OR = 0.95, P = 0.025). Seven species were potentially harmful: asv001 [P. acnes] (OR = 1.187, P = 0.041), asv005 [P. granulosum] (OR = 1.259, P = 6.06e − 03), family Micrococcaceae (OR = 1.24, P = 0.014), family Neisseriaceae (OR = 1.161, P = 0.038), genus Enhydrobacter (OR = 1.039, P = 0.013; OR = 1.202, P = 0.017), and order Bacteroidales (OR = 1.202, P = 0.012). PTWI may also induce skin microenvironment changes, disrupting homeostasis and increasing the likelihood of pathogenic microbiota, such as class Betaproteobacteria, genus Chryseobacterium, asv007 [Anaerococcus (unc.)], and family Flavobacteriaceae. Conversely, PTWI might promote beneficial microbiota, like asv005 [P. granulosum].
Conclusions
This study provides strong evidence of a causal link between the skin microbiome and PTWI, emphasizing their complex interactions. These findings offer new insights for preventing and treating PTWI. Further research on the underlying mechanisms and similar studies in different populations are essential.
Effect of AI intervention programs on the quality of life of older adults: A systematic review and meta-analysis
Authors: JANG TAEJEONG , Seo Kawoun , Seo Jisu
Published: August 2024

With the aging population, the demand for innovative well-being support has intensified. This study analyzed the impact of artificial intelligence (AI) intervention on the quality of life of older individuals through a meta-analysis of 13 domestic and foreign literature reviews. The overall effect size of AI intervention programs on the quality of life of older adults, assessed using the random-effects model, was found to be small (Hedges’ g = 0.30, 95% CI = 0.10–0.51). Additionally, the effect size of quality of life was examined based on the subfactors of the AI intervention program, revealing a range of 5–11 weeks. Robot intervention exhibited a higher effect size than smart device intervention. To improve the quality of life of older patients, further investigation is warranted, including a follow-up study to develop a systematic AI nursing intervention program tailored to the type of AI program and intervention duration.
Assessing and mitigating noise pollution in Sikar city: strategies and solutions
Authors: Kumar Nand , Nussi Keerthi Reddy , S Sajan , Basumatary Udangshree Rani , Kuzhivelil Ivin John , Biyyyathiyil Shahada , Bunty Bhoomika
Published: August 2024

This study investigates noise pollution in Sikar City, focusing on identifying sources, measuring health and environmental impacts, and proposing mitigation strategies. The objectives include analyzing noise pollution sources, assessing their effects on public health and the environment, and reviewing case studies to evaluate current policies and technologies. Data from Sikar City's noise monitoring stations were analyzed to identify significant pollution sources such as traffic, industrial activities, and construction work. Additionally, the Analytic Hierarchy Process (AHP) method was used to determine optimal proposals for the city. A literature review of ten relevant studies provided insights into common noise pollution issues and effective mitigation strategies. The findings revealed that noise levels often exceeded national standards, necessitating targeted strategies for reduction. The proposed mitigation measures aim to support the Rajasthan Pollution Control Board and other stakeholders in enhancing regional environmental management.
Development and Validation of a Nomogram for Predicting Perioperative Hidden Blood Loss in Intertrochanteric Femur Fractures
Authors: linbing Lou , Xu Lei , Li Aoying , Xia Cunyi , Miao Haixiang , Xu Xiaohang , Dai Jihang , Hu Le
Published: August 2024

Background
Hip fractures, prevalent in the elderly, carry significant morbidity and mortality, with perioperative hidden blood loss (HBL) being a critical yet underappreciated factor. The challenge of HBL in intertrochanteric femoral fractures treated with proximal femoral nail antirotation (PFNA) procedures necessitates a predictive tool for improved clinical management.
Objectives
To identify independent risk factors for perioperative HBL and to develop a predictive nomogram for intertrochanteric femoral fractures managed with PFNA.
Methods
We conducted a retrospective cohort study of 231 patients who underwent PFNA at Northern Jiangsu People’s Hospital from 2020 to 2022. Data on demographics and surgery were analyzed using SPSS 25.0 and R 4.2.2 to construct a nomogram predicting HBL.
Results
The study revealed a mean HBL of 1146.91 ± 727.35 ml. Significant predictors included preoperative hemoglobin, platelet count, PT-INR, fracture type by Evans classification, and the interval from admission to surgery. The predictive nomogram demonstrated high accuracy with an AUC of 0.926 for the ROC curve and 0.941 for the PR curve, indicating robust clinical utility.
Conclusion
The validated nomogram offers a novel, practical approach to forecasting HBL in patients undergoing PFNA for intertrochanteric femoral fractures, with implications for optimizing patient care across the perioperative period.
Microwave-Assisted Extraction of Cellulose from Waste Olive Wood Powder Using Deep Eutectic Solvents
Authors: Alam Mohammad Mahbubul , Greco Antonio , Corcione Carola Esposito , Jiménez Alfonso , Garrigós María Carmen
Published: August 2024

Microwave-assisted extraction (MAE) is a very effective and sustainable method for extracting cellulose from lignocellulosic materials due to the substantial reduction in the process time and amounts of solvents required for each process. Deep eutectic solvents (DES) are used for cellulose extraction due to their environmental friendliness and high extraction yields. This work explores the possibility to use microwave-synthesized DES to extract cellulose from olive wood powder (OWP) waste. The conventional process (CP) requires the use of high amounts of chemicals and long times for quantitative extractions. Three techniques for the cellulose extraction were compared: a standard procedure by Technical Association of the Pulp and Paper Industry (TAPPI), CP, and MAE utilizing DES to evaluate the effectiveness of these techniques. Results showed that the TAPPI method yielded 55.0 wt% cellulose, whereas the CP method yielded 50.6 wt% cellulose. The optimum conditions for MAE using choline chloride-lactic acid (ChCl:LA, 1:4) and choline chloride-citric acid (ChCl:CA:H2O, 1:1:6) were found to be 20-min irradiation time at 130 ºC to obtain cellulose yields of 47.8 wt% and 45.6 wt%, respectively, showing that both DES were effective for cellulose extraction from OWP. The comparison between all procedures showed that MAE required shorter times and smaller quantities of chemicals, making it an eco-friendlier option. The extracted cellulose was characterized by thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and Scanning electron microscopy (SEM). Results suggested that MAE with DES is a promising approach, with prospective applications in the packaging, textiles, and paper industries.