bluuebunny/crossref_metadata_2025 huggingface dataset:
A distance-aware approach for reliable out-of-distribution detection of wind turbine gearbox fault diagnosis
Authors: Zhou Jingxin , Zhao Yao
Published: November 2024

Fault diagnosis of wind turbine gearbox is essential to ensure operational efficiency and prevent costly downtime. However, conventional deep learning models often struggle with domain shift, where the distribution of testing data differs from that of training data. This issue is more pronounced with out-of-distribution inputs—data outside the conditions the model was trained on. These challenges can lead to unreliable diagnostic results and potentially hazardous situations. To address this, we introduce Spectral Normalization and Gaussian Process methods into Res2Net framework to enhance its ability to detect out-of-distribution data. Spectral Normalization and Gaussian Process improve the model’s ability to assess the distance between test and training data. This model can handle out-of-distribution data due to both epistemic and aleatory uncertainty. The experiment collected raw vibration signals from gearbox under varied conditions. Unknown faults simulated epistemic uncertainty, while noisy samples resulted in aleatory uncertainty. These signals were converted into images using the Gramian Angular Difference Field transformation. The resulting images were then fed into the Res2Net model, enhanced with Spectral Normalization and Gaussian Process. The model outputs include classification results and corresponding uncertainty values based on distance awareness. With quantified uncertainty values, the model can reflect the trustworthiness of the diagnostic results. By comparing these uncertainty values with predefined thresholds, it is possible to distinguish whether the data are out-of-distribution or not. Experiments have proven the superiority of the Distance-Aware Res2Net in out-of-distribution detection and fault diagnosis.
Healthcare providers’ experiences of maternity care service delivery during the COVID-19 pandemic in the United Kingdom: a follow-up systematic review and qualitative evidence synthesis
Authors: Dasgupta Tisha , Bousfield Emily , Pathak Yosha , Horgan Gillian , Peterson Lili , Mistry Hiten D. , Wilson Milly , Hill Meg , Smith Valerie , Boulding Harriet , Sheen Kayleigh S. , Van Citters Aricca D. , Nelson Eugene C. , Duncan Emma L. , von Dadelszen Peter ,   The RESILIENT Study Group, Silverio Sergio A. , Magee Laura A.
Published: November 2024

Problem and background

During the COVID-19 pandemic, there was substantial reconfiguration of maternity care services, affecting both users and healthcare providers (HCPs), in the United Kingdom (UK) and globally.

Aim

To further our understanding of the impact of maternity service reconfigurations in the UK, from the perspective of maternity HCPs.

Methods

Scopus, MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane COVID Study Register were searched for relevant studies reporting qualitative data from the UK, published in English between 01 June 2021 and 30 September 2023. Qualitative data on HCPs’ experiences of maternity care reconfiguration during the pandemic were extracted from 15 studies. Data were subjected to thematic synthesis according to key service reconfigurations.

Results

Nine themes were identified: Care-seeking and Care Experience: Changes to existing care, Limitations placed on the partner, Mental health and lack of support networks, and Barriers to successful implementation of reconfiguration strategies; Virtual Care: Impact on quality of care, Increased convenience and flexibility, and Digital exclusion; and Ethical Future of Maternity Care Services: Optimising patient care, and Service users and staff as the driving force for change. No studies reported on the concepts of Self-monitoring or COVID-19 vaccination.

Discussion and conclusion

The review findings highlight HCPs’ views of the need for greater inclusion of partners, choice of virtual or in-person care for women and birthing people; and a need for co-designed services for future policy-making.
Optimization of thermal stress thresholds on regional coral bleaching monitoring by satellite measurements of sea surface temperature
Authors: Liu Bailu , Foo Shawna A. , Guan Lei
Published: November 2024

Coral bleaching events have become more frequent in recent years due to the impact of widespread marine heatwaves. The Coral Reef Watch (CRW) program, part of the National Oceanic and Atmospheric Administration (NOAA), assesses bleaching risk by considering measures of daily coral heat stress (Hotspot, HS) and accumulated heat stress (Degree Heating Week, DHW). However, there is a mismatch between coral bleaching alerts through satellite monitoring and records of coral bleaching in the South China Sea (SCS) and its surrounding seas in the historical database. Through comparison with field records of bleaching events in the SCS, this study examined the optimization of the DHW under a fixed or variable HS threshold, evaluating the accuracy of coral bleaching monitoring through a range of evaluation indices, including the Peirce Skill Score (PSS) and the Area Under the Curve (AUC). Our results show that when the DHW index was calculated based on the current operational HS threshold (1°C), reducing the DHW threshold from 4°C to 1.86°C-weeks significantly improved PSS from 0.17 to 0.66, and AUC from 0.58 to 0.83. Further, by optimizing both HS and DHW, evaluation statistics were further improved, with the PSS increasing to 0.71 and the AUC increasing to 0.85. While both methods could significantly optimize the operational bleaching alert level for the SCS, the results suggest that optimization of both the HS and DHW thresholds is better than optimizing DHW alone. As marine heatwaves become more frequent, accurately predicting when and where coral bleaching is likely to occur will be critical to improving the estimation of regional coral stress due to climate change and for understanding coral reefs’ response to recurrent bleaching events.
Influence of scour depth and flow velocity field on large-diameter pier group pile foundations
Authors: Shi Junfeng , Han Changhai , Guo Huijuan , Yu Kaiwen , Han Kang
Published: November 2024

Sea-crossing bridges face critical challenges due to scour, which can destabilize foundations. This study investigates the scour characteristics of the large-diameter main pier of the Haiwen Bridge, with a pile diameter of 4.3 meters. Seabed changes were monitored over 630 days using field tests and numerical simulations. The study analyzed the relationship between flow velocity and scour depth, revealing that the maximum recorded scour depth was 3.65 meters at the upstream side. A linear regression model, developed from 75 sets of field data, produced a formula to estimate maximum local scour depth. Validation against field measurements showed a strong correlation, with the calculated values deviating by less than 10% from observed data. The findings indicate that upstream scour pits were 1.5 times wider and deeper than those downstream, while a shallow triangular scour zone, extending 1.2 times the pile diameter, formed downstream. Recommendations for scour protection include hydrological considerations, particularly on the upstream side and areas lacking sediment sources.
Navigating regulatory and policy challenges for AI enabled combination devices
Authors: Santra Snigdha , Kukreja Preet , Saxena Kinshuk , Gandhi Sanyam , Singh Om V.
Published: November 2024

In recent years, the Artificial Intelligence (AI) has enabled conventional Combination Devices (CDs) to innovate in healthcare merging with technology sectors. However, the challenges like reliance on predicate devices in US Food and Drug Administration (FDA's 510(k) pathway, especially for perpetually updating AI are stressed. Though the European Union (EU's new Medical Device Regulations address software and AI, fitting adaptive algorithms into conformity assessments remains difficult. The urgent need for frameworks cognizant of AI risks like model degradation and data biases is emphasized. Insights from recalled devices and case studies elucidate challenges in regulatory navigation for manufacturers. Adaptive policy frameworks balancing patient safeguards and rapid innovation are proposed. Recommendations target regulators and policy makers, advocating global standards to enable safe, effective and equitable AI adoption. This article aims to examine AI-enabled combination device regulation, inspecting US and EU strategies as well as obstacles for manufacturers and regulators.
Myeloperoxidase enzyme-catalyzed breakdown of zero-dimension carbon quantum dots
Authors: Singh Pooja , Singh Lalit Kumar
Published: November 2024

Carbon quantum dots (CQDs) have shown considerable interest in multiple fields including bioimaging, biosensing, photocatalysis, ion sensing, heavy metal detection, and therapy due to highly tunable photoluminescence and good photostability. Apart from having optical properties CQDs offer several advantages such as low toxicity, environmental friendliness, affordability, and simple synthesis methods. Furthermore, by modifying their surface and functionality, it's possible to precisely control their physical and chemical characteristics. Nevertheless, the growing utilization of carbon-based nanomaterials (CNMs) requires thorough examination of their potential toxicity and long-term impacts on human health and biological systems. In this study, carbon quantum dots (CQDs) were synthesized via a microwave-assisted method using citric acid and urea as precursors, resulting in an average particle diameter of 10.73 nm. The CQDs were further characterized using SEM and FTIR analysis. The CQDs exhibited an excitation wavelength of 320 nm, displaying an emission peak at 430 nm. The enzymatic biodegradation of CQDs by human myeloperoxidase enzyme has been thoroughly investigated here. It is very crucial to understand how these carbon quantum dots interact with the innate immune system that plays a vital role in recognizing and clearing foreign particles. Human myeloperoxidase (MPO), a key enzyme highly expressed in neutrophil granulocytes during inflammatory responses, has been shown to facilitate the biodegradation of carbon quantum dots and various carbon-based nanomaterials through oxidative processes. As a member of the peroxidase family, MPO produces hypochlorous acid (HOCl) and a range of reactive intermediates to eliminate pathogens. Consequently, the study of the biodegradability of CQDs within biological systems is essential for accelerating technological advancements. Here, we have assessed breakdown of CQDs through an oxidative process facilitated by a myeloperoxidase (MPO)-based peroxide system. The human MPO enzyme acted as a catalyst for the CQD degradation, and the addition of hydrogen peroxide (H2O2) and sodium chloride (NaCl) was found to accelerate the reaction.
Prevalence and antibiotic resistance profile of UTI-causing uropathogenic bacteria in diabetics and non-diabetics at the Maternity and Children Hospital in Jeddah, Saudi Arabia
Authors: Farag Peter F. , Albulushi Hamzah O. , Eskembaji Mohammed H. , Habash Mohammad F. , Malki Mohammed S. , Albadrani Muayad S. , Hanafy Ahmed M.
Published: November 2024

Introduction

One of the most prevalent and recurrent infectious diseases that can range from moderate to fatal is urinary tract infection (UTI). Broad-spectrum antibiotics are the only management strategy for UTIs in ambulators and hospital stays. Due to the ongoing emergence of antibiotic resistance among uropathogens, there is a need for proper selection of antibiotics for empirical therapy against UTIs. This study aimed to compare the etiological profiles and antibiotic susceptibility patterns between diabetic and non-diabetic UTI female patients from the Maternity and Children Hospital in Jeddah, Saudi Arabia.

Methods

Urine samples from different age categories of female UTI patients were collected from January 2021 to June 2023. The positive urine cultures with a single pathogen were selected and all bacterial isolates were identified by MALDI-TOF/MS system. Antibiotic susceptibility testing was done using VITEK-2. Our study included 2,245 female patients, of which 1825 (81%) were non-diabetic and 420 (19%) were diabetic.

Results

The results showed a significant relationship (p = 0.00063) between the average age and the number of diabetic UTI patients. Gram-negative bacilli were more dominant (84.7%, n = 1903) than gram-positive cocci (15.3%, n = 342). Escherichia coli (40.8%) was the most prevalent pathogen identified with a significant (p < 0.0001) increase in non-diabetic (45.26%) than diabetic UTI patients (21.43%). Proteus mirabilis (10.2%) and Pseudomonas aeruginosa (8.7%) followed E. coli in pathogen distribution. Among gram-positive species, Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus saprophyticus were found in all age groups of diabetic and non-diabetic UTI patients. The findings showed that the most resistant bacteria from patients with non-diabetic UTIs were found to be resistant to amoxicillin (37.7%) and ampicillin (40%), while the most resistant bacteria from patients with diabetes were found to be resistant to tetracycline (43.3%) and cephalothin (43.5%). In patients with UTIs, ciprofloxacin was found to be the most effective antibiotic against all bacterial species.

Discussion

According to the results, we concluded that the UTI etiological profiles varied among different ages. Ciprofloxacin is a safe medication with optimal sensitivity that can be used to treat both gram-positive and gram-negative bacteria.
Bridging veins: an analysis of surgical anatomy and histology correlated with interhemispheric approaches
Authors: Ye Yuanliang , Lan TianCai , Zeng Xiangbo , Yang Jianqing , Wei Ruixiang , Zhu Jiale , Liu Moukun , Zhu Xiaowen
Published: November 2024

Damage to bridging veins could lead to disastrous complications during interhemispheric approaches. We investigated the morphological and histological characteristics of bridging veins. A total of 10 cadaveric heads and 86 patients were analyzed with either anatomic dissection or neuroimaging. The morphological features of the bridging veins and superior sagittal sinus were analyzed by the endoscope. The histology of the junction between the bridging veins and superior sagittal sinus was evaluated under the microscope with staining for H&E, elastic fiber, and Masson’s staining. We found three types of bridging vein configurations in the junction between the bridging vein and superior sagittal sinus: direct connection (type A), vein runs a certain distance below the dural wall tightly (type B), and vein runs a certain distance on the lateral sinus (type C). Valvular-like fibrous cords were present on the opening of type A, trabecular in type B, and arachnoid granules in type C. Loose connective tissue connected the venous wall and dura mater in type A, sinus wall forms the inner wall of the bridging vein in type B, bridging vein accompanied by arachnoid granules in the type C. This classification enables surgeons to predict various bridging vein configurations, followed by safely achieving the optimal dissection during interhemispheric approaches.
Networks through the lens of high-frequency oscillations
Authors: Herlopian Aline
Published: November 2024

To date, there is no neurophysiologic or neuroimaging biomarker that can accurately delineate the epileptogenic network. High-frequency oscillations (HFO) have been proposed as biomarkers for epileptogenesis and the epileptogenic network. The pathological HFO have been associated with areas of seizure onset and epileptogenic tissue. Several studies have demonstrated that the resection of areas with high rates of pathological HFO is associated with favorable postoperative outcomes. Recent studies have demonstrated the spatiotemporal organization of HFO into networks and their potential role in defining epileptogenic networks. Our review will present the existing literature on HFO-associated networks, specifically focusing on their role in defining epileptogenic networks and their potential significance in surgical planning.
The efficacy of ultrasound-guided pulsed radiofrequency in the treatment of primary glossopharyngeal neuralgia
Authors: Li Fubo , Lu Hongcheng , Gong Gege , Ou Cehua , Zhang Yue
Published: November 2024

Objective

This study evaluates the clinical efficacy and safety of ultrasound-guided long duration, high voltage pulse radiofrequency (PRF) in managing primary glossopharyngeal neuralgia (GPN).

Methods

Clinical data were retrospectively analyzed for 13 patients with primary GPN who underwent this treatment between August 2019 and October 2022. Visual Analog Scale (VAS) scores were assessed pre-treatment and at 1 week, 1 month, 3 months, and 6 months post-treatment. Additionally, the rates of discontinuation of oral oxcarbazepine and pregabalin, efficacy, and complication rates at 6 months post-procedure were monitored.

Results

Significant post-treatment pain relief, was observed across all patients, with statistically significant improvements in VAS scores (p < 0.05). Discontinuation rates for oxcarbazepine and pregabalin were also high (p < 0.05). At the 6-month follow-up, 69.23% of patients achieved excellent and good efficacy, 84.61% demonstrated overall effectiveness, while 15.38% showed poor efficacy. No critical complications were reported in any case.

Conclusion

Ultrasound-guided, long-term, high-voltage PRF effectively relieves primary glossopharyngeal neuralgia and improves quality of life. Featuring ease of operation, high safety and minimal complications making it a promising approach for clinical application.
Differences in the effect of repetitive transcranial magnetic stimulation and median nerve electrical stimulation in patients with prolonged disorders of consciousness after intracerebral hemorrhage: a randomized controlled trial protocol
Authors: Zhao Guoshun , Fang Mingzhu , Han Shiyu , Peng Xiaoke , Dong Anqin
Published: November 2024

Background

Repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNES) are two non-invasive neuromodulation techniques that have demonstrated potential in facilitating the recovery of consciousness in patients with impaired consciousness. However, existing studies on awakening interventions for patients with prolonged disorders of consciousness (pDoC) following intracerebral hemorrhage remains limited. In particular, systematic comparisons of the efficacy of rTMS versus MNES in this specific patient population are lacking.

Methods

This is a single-center randomized controlled trial in which 45 patients will be randomly assigned to the control group, rTMS group and MNES group. The intervention period will lasts 4 weeks. All patients underwent multimodal assessments before and at the end of treatment, which were used to comprehensively evaluate their recovery of consciousness and changes in brain function. The assessments includes the Coma Recovery Scale, electroencephalogram, event-related potentials (P300 and mismatched negative) and functional near-infrared spectroscopy.

Discussion

This study represents the first systematic comparison of the efficacy between rTMS and MNES in patients with pDoC following intracerebral hemorrhage. The objective is to employ multimodal assessment techniques to provide clinical references into the individualized application of these neuromodulation therapies.

Clinical trial registration

https://www.chictr.org.cn/, identifier ChiCTR2400082022.
The preoperative hemoglobin, albumin, lymphocyte, and platelet score (HALP) as a prognostic indicator in patients with non-small cell lung cancer
Authors: Liu Qiteng , Xie Hailun , Cheng Wenjuan , Liu Tong , Liu Chenan , Zhang Heyang , Lin Shiqi , Liu Xiaoyue , Tian Haiying , Li Xiangrui , Zheng Xin , Chen Yue , Shi Jinyu , Zhao Hong , Shi Hanping
Published: November 2024

Background

The Hemoglobin, Albumin, Lymphocyte, and Platelet score (HALP) is an inflammatory nutrition-related biomarker based on hemoglobin and albumin levels, as well as the lymphocyte and platelet load index, which has been reported to be associated with the prognosis of various types of tumors. This study aims to investigate the prognostic value of HALP in patients with non-small cell lung cancer (NSCLC).

Methods

A total of 2,428 patients with NSCLC were enrolled in the INSCOC study. Time-patient survival trends were validated using Kaplan–Meier curves and log-rank tests. The Restricted Cubic Spline function was used to analyze the relationship between the HALP index and overall survival (OS). The Cox regression model was used for univariate and multivariate analyses.

Results

The study included 2,053 patients with detailed biological information and follow-up data, consisting of 1,346 men (65.6%) and 707 women (34.4%). Within this cohort, 138 patients (6.7%) had stage I disease, 282 (13.7%) had stage II, 477 (23.2%) had stage III, and 1,156 (56.3%) had stage IV. A total of 536 patients (26.1%) underwent surgery, 1,494 (72.8%) received chemotherapy, and 271 (13.2%) received radiotherapy. The 1-, 2-, 3-, and 5-year survival rates for patients with NSCLC were 68.6, 48.6, 37.4, and 30.9%, respectively. The optimal cut-off for HALP was determined to be 29.71, with a sensitivity of 53.1% and specificity of 62.9%, leading to the categorization of patients into low (<29.71) (n = 963) and high (≥29.71) (n = 1,090) HALP groups. Patients with a high HALP demonstrated a significantly higher 5-year overall survival (OS) rate compared to those with a low HALP (38% vs. 23%, p < 0.001). Multivariable Cox proportional hazards regression analysis identified that low HALP was an independent risk factor for the survival of patients with non-small cell lung cancer.

Conclusion

The HALP index can be used as an independent prognostic factor for patients with NSCLC, offering clinicians a reference to identify high-risk patient with poor long-term prognoses and improve individualized treatment.
Serum trimethylamine N-oxide and its precursors are associated with the occurrence of mild cognition impairment as well as changes in neurocognitive status
Authors: Bai He , Zhang Yao , Tian Peiying , Wu Yani , Peng Ruiheng , Liang Bin , Ruan Wenli , Cai Enmao , Lu Ying , Ma Mingfeng , Zheng Liqiang
Published: November 2024

Background

This study aims to examine the association between gut microbe-dependent trimethylamine N-oxide (TMAO) and its precursors (choline, betaine, and carnitine) levels and mild cognition impairment (MCI), alongside changes in the Chinese version of the Montreal Cognitive Assessment-Basic (ΔMoCA-BC) score in rural adults.

Methods

Drawing data from a large-scale epidemiological study conducted in rural areas of Fuxin County, Liaoning Province, China. 1,535 participants free from brain-related ailments were initially surveyed. MCI was assessed through the MoCA-BC score. Logistic regression models and restricted cubic spline were used to investigate the association between TMAO and its precursors levels and MCI. Additionally, the association between TMAO and its precursors levels and ΔMoCA-BC was analyzed using a generalized linear model in the longitudinal study.

Results

The average age of the study participants was 58.6 ± 9.4 years and the prevalence rate of MCI was 34.5%. With the second quartile as the reference in the logistic regression model, the OR for risk of MCI in the highest quartile for TMAO, betaine, and carnitine was 1.685 (95% CI: 1.232–2.303, p = 0.001), 2.367 (95% CI: 1.722–3.255, p < 0.001), and 2.239 (95% CI: 1.742–3.295, p < 0.001), respectively. The OR of choline for the highest versus lowest quartile was 2.711 (95% CI: 2.012–3.817, p < 0.001) for the risk of MCI. We find a J-shaped association between betaine (Pnon-linear = 0.001) and carnitine (Pnon-linear = 0.003) levels and MCI. Furthermore, TMAO and its precursors levels were associated with ΔMoCA-BC in the third and fourth quartiles group (All p < 0.05).

Conclusion

The findings suggest the existence of an optimal concentration range for serum levels of TMAO, betaine, and carnitine that mitigates MCI risk, paving the way for enhanced dietary interventions aimed at preventing and treating MCI.
Ketogenic diet in treating sepsis-related acquired weakness: is it friend or foe?
Authors: Miao Yanmei , Xie Leiyu , Chen Shaolin , Zhang Xiaoming , Liu Wenjie , Xie Peng
Published: November 2024

Background

Sepsis is the body’s extreme response to an infection leading to organ dysfunction. Sepsis-related acquired weakness (SAW), a critical illness closely related to metabolic disorders, is characterized by generalized sepsis-induced skeletal muscle weakness, mainly manifesting as symmetrical atrophy of respiratory and limb muscles. Muscle accounts for 40% of the body’s total mass and is one of the major sites of glucose and energy absorption. Diet affects skeletal muscle metabolism, which further impacts physiology and signaling pathways. The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that has shown benefits in patients with a variety of neuromuscular disorders. Patients with SAW are in a hypermetabolic state and can consume approximately 1% of total body muscle mass in a day. Due to the decreased total body energy expenditure secondary to starvation, skeletal muscles enter a low metabolic state, with reduced gluconeogenesis and protein consumption and elevated levels of ketone bodies. The latest research suggests that KD may be a new strategy for SAW prevention and treatment, but its mechanism is still unclear.

Objective

Our article aims to explore the effect and mechanism of KD on SAW. And we hope that our review will inspire further research on the KD and foster the exploration of novel strategies for combating SAW.

Methods

Search medical databases and related academic websites, using keywords such as “Sepsis-related acquired weakness,” “ketogenic diet,” and “skeletal muscle,” and select representative literature. Using the method of induction and summary, analyze the effect and mechanism of KD on SAW.

Results

Compared with early nutrition, KD has a more protective effect on SAW, but its mechanism is complex. Firstly, KD can alter energy metabolism substrates to affect SAW’s energy metabolism; Secondly, KD can directly act as a signaling molecule to improve mitochondrial function in skeletal muscle and stimulate skeletal muscle regeneration signaling molecules; Thirdly, KD can affect the gut microbiota to exert anti-inflammatory effects, enhance immunity, and thus protect SAW.

Conclusion

KD has a protective effect on SAW, which includes improving energy metabolism, stimulating muscle regeneration signals, optimizing gut microbiota composition, and reducing inflammation and oxidative stress.
Correlation of insulin resistance-related indicators and obesity-related indicators with sarcopenic obesity and development of diagnostic models: NHANES 1999–2006
Authors: Zhang Chen , Huang Xintao , Lu Hao , Chen Mo , Wang Junyu , Deng Huisheng
Published: November 2024

This study investigates the correlation between insulin resistance and obesity indicators with sarcopenic obesity (SO) and develops diagnostic models. Utilizing the 1999–2006 National Health and Nutrition Examination Survey (NHANES) database, the research included 5,574 adults. Sarcopenic obesity was defined following the 2022 consensus by ESPEN and EASO. The study analyzed indicators such as the triglyceride-glucose index (TyG), homeostasis model assessment of insulin resistance (HOMA-IR), body roundness index (BRI), and lipid accumulation product (LAP). Results indicated a significant positive correlation between these indicators and SO, with the strongest association observed for TyG-WHtR. Predictor variables were identified through logistic and Lasso regression, including age, sex, weight-height ratio (WHtR), and TyG-WCR. The diagnostic model demonstrated good predictive performance with AUC values of 0.897 for internal validation and 0.853 for external validation. The study underscores the importance of early identification of SO patients and provides a theoretical foundation for future prevention and management strategies. Limitations include the cross-sectional study design and the potential limited generalizability of the model based on the American population.
Comparative analysis of six nutritional scores in predicting prognosis of COVID-19 patients
Authors: Zou Shangpu , Lin Pengcheng , Chen Xiaoyu , Xia Lijing , Liu Xiling , Su Shanshan , Zhou Ying , Li Yuping
Published: November 2024

Background

Identifying nutritional risk in COVID-19 patients poses a challenge due to the unique qualities of every nutritional screening instrument. The objective was to assess the efficacy of six nutritional scores, including the Nutritional Risk Screening 2002 (NRS-2002) score, the NUTRIC (nutrition risk in the critically ill) score, the modified NUTRIC score, the prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, TCB index (TCBI), predicting prognosis of COVID-19 patients.

Methods

Clinical data were collected from COVID-19 patients admitted to the First Affiliated Hospital of Wenzhou Medical University between December 2022 and February 2023. Participants in this research were divided into two groups: all patients and those specifically from the intensive care unit (ICU). Each group was further stratified into two groups: survivors and non-survivors.

Result

506 COVID-19 patients and 190 COVID-19 patients in intensive care unit (ICU) were evaluated. In all COVID-19 patients, we found that NRS-2002 (p < 0.001) and TCBI (p = 0.002) were statistically significant independent predictors in multivariate analyses, while APACHE II score (p = 0,048) and the mNUTRIC score (p = 0.025) were statistically significant independent predictors in multivariate analyses in ICU patients. The NRS-2002 demonstrated a higher AUC value (0.687) than other nutritional scores in all patients, with an optimum cut-off value of 3, translating into a corresponding sensitivity of 66.2% and specificity of 68.7%. With an optimum cut-off value of 4, the mNUTRIC score demonstrated a higher AUC value (0.884) in ICU patients, resulting in a sensitivity of 88.4% and a specificity of 76.9%. By using the discrimination and clinical application (DCA) curve, NRS-2002 demonstrated the greatest net benefit in all patients, while NUTRIC score and mNUTRIC score offered the more significant overall advantage than other nutritional scores in ICU patients. Kaplan–Meier analyses showed lower survival rates in patients in low nutritional risk.

Conclusion

Malnutrition was common in COVID-19 patients. The mNUTRIC score and NRS-2002 were, respectively, more effctive scoring systems of prognosis in all COVID-19 patients and severe or critical COVID-19 patients of the intensive care unit (ICU).
How legal personhood and markets can partner to help save the whale
Authors: Chami Ralph , Bender Michelle , Bramley Belinda , Cosimano Thomas , Iles Roger , Nieburg Dinah , Rosa Elena , Takoko Mere , Fullenkamp Connel
Published: November 2024

Recently, the Māori People of Aotearoa, Cook Islands, and Tahiti supported a resolution to endorse their ancestors, the whales, as Ocean Ambassadors to the United Nations and to protect their legal personhood. This historic move aims to help protect the whales against dangers such as ship strikes as they migrate through their South Pacific waters. This paper explores how markets can further strengthen this declaration by providing incentives that reward responsible behavior of maritime vessels as they navigate Māori waters. Legal steps needed to engender market support and extend protection to other cetaceans and localities are also discussed. By combining personhood declaration with legal actions and market-based incentives, we show how this novel approach can enhance conservation outcomes and reshape the market in favor of protecting whales, nature, and its stewards.
Negative response to immunotherapy in dMMR or MSI-H gastric cancer with APC and PTEN mutations: a case report
Authors: Liu Jiang , Zhang Xiumei , Ren Qun , Song Chuanjun , Yu Jianhe , Cai Yin , Chen Dadong
Published: November 2024

Background

Microsatellite instability-high (MSI-H) or deficient mismatch repair (dMMR) represents a distinct molecular phenotype observed in malignant tumors. These tumors typically exhibit high levels of programmed cell death 1 ligand 1 (PD-L1) expression and high tumor mutational burden (TMB), resulting in an enhanced response to immune checkpoint inhibitors (ICI) therapy. The emergence of ICI has transformed the therapeutic strategy of gastric cancer (GC). Immune checkpoint blockade significantly improves the survival of gastric cancer patients, especially those with MSI-H or dMMR. However, it’s worth noting that not all patients with MSI-H respond favorably to this treatment. It has been reported that factors such as tumor heterogeneity, alterations in the tumor microenvironment, and aberrant activation of tumor-related signaling pathways have been linked with resistance to ICI therapy.

Case presentation

Here, we describe a case of dMMR and MSI-H GC with adenomatous polyposis coli (APC) and phosphatase and tensin homolog deleted on chromosome ten (PTEN) mutations that failed to respond to anti-PD-1 combined with anti-HER2 (human epidermal growth factor receptor-2) therapy and chemotherapy. We attempted to elucidate the underlying causes and mechanisms behind this lack of response, and to provide new insights into treatment options for these patients.

Conclusions

Mutations of key genes within tumor-related signaling pathways and the infiltration of CD8+T cells in the tumor microenvironment may influence the efficacy of immunotherapy for MSI-H solid tumors.
Lactylation-related gene signature accurately predicts prognosis and immunotherapy response in gastric cancer
Authors: Sun Xuezeng , Dong Haifeng , Su Rishun , Chen Jingyao , Li Wenchao , Yin Songcheng , Zhang Changhua
Published: November 2024

Background

Gastric cancer (GC) is a malignant tumor associated with significant rates of morbidity and mortality. Hence, developing efficient predictive models and directing clinical interventions in GC is crucial. Lactylation of proteins is detected in gastric cancer tumors and is linked to the advancement of gastric cancer.

Methods

The The Cancer Genome Atlas (TCGA) was utilized to analyze the gene expression levels associated with lactylation. A genetic pattern linked to lactylation was created using Univariate Cox regression and least absolute shrinkage and selection operator (LASSO) regression. The predictive ability of the model was evaluated and confirmed in the Gene Expression Omnibus (GEO) cohort, where patients were divided into two risk groups based on their scores. The study examined the relationship between gene expression and the presence of immune cells in the context of immunotherapy treatment. In vitro cytotoxicity assays, ELISA and PD-1 and PD-L1interaction assays were used to assess the expression of PD-L1 while knocking down SLC16A7.

Results

29 predictive lactylation-related genes with differential expression were discovered. A signature consisting of three genes was developed and confirmed. Patients who had higher risk scores experienced worse clinical results. The group with lower risk showed increased Tumor Immune Dysfunction and Exclusion (TIDE) score and greater responsiveness to immunotherapy. The tumor tissues secrete more lactate acid than normal tissues and express more PD-L1 than normal tissues, that is, lactate acid promotes the immune evasion of tumor cells. In GC, the lactylation-related signature showed strong predictive accuracy. Utilizing both anti-lactylation and anti-PD-L1 may prove to be an effective approach for treating GC in clinical settings. We further proved that one of the lactate metabolism related genes, SCL16A7 could promote the expression of PD-L1 in GC cells.

Conclusion

The risk model not only provides a basis for better prognosis in GC patients, but also is a potential prognostic indicator to distinguish the molecular and immune characteristics, and the response from Immune checkpoint inhibitors (ICI) therapy and chemotherapy in GC.
Risk association model for atelectasis complication in Mycoplasma pneumoniae pneumonia patients following standardized treatment
Authors: Xu Mingyi , Fan Minhao , Wang Huixia , Qian Jun , Jiang Yi , Zhu Yifan , Zhao Deyu , Liu Feng , Guo Yun , Li Ling
Published: November 2024

Background

Mycoplasma pneumoniae pneumonia (MPP) is a common disease of childhood pneumonia, and atelectasis is a serious comorbidity. Traditional diagnostic methods for MPP are limited by low accuracy, emphasizing the need for improved diagnostic approaches. This study aimed to establish a predictive scoring model for early detection of MPP complicated with atelectasis following standardized treatment.

Methods

A total of 572 children were retrospectively enrolled, including 40 patients with MPP complicated by atelectasis despite standardized treatment and 532 patients in the non-atelectasis group. Clinical, laboratory, and imaging data within 24 h of admission were collected, including demographic information and various biomarkers. Multivariate logistic regression analysis was employed to identify risk factors and construct a predictive model, evaluated using receiver operating characteristic (ROC) curve analysis.

Results

Significant differences were observed between the MPP complicated with atelectasis group and the non-atelectasis group in terms of age, hospital admission time, fever duration, neutrophil percentage and count, CRP, ALT, and LDH levels (P < 0.05). According to the multivariate logistic regression analysis, length of fever, neutrophil ratio, platelet count, ALT, LDH, age were incorporated into the nomogram. The predictive model exhibited a sensitivity of 87.97% and specificity of 77.50% according to the ROC curve.

Conclusion

Our study presents a preliminary risk association model incorporating clinical indicators such as fever duration, neutrophil ratio, platelet count, ALT value, LDH value, and age to aid in the early prediction of atelectasis in children with MPP. Given the methodological limitations, the generalizability of our findings is constrained, and this model should be viewed as an initial framework for clinical assessment rather than a definitive tool.
Congenital intrahepatic portosystemic shunt in 27 children: an experience and treatment strategy of a single centre in China
Authors: Zhang Jin-Shan
Published: November 2024

Objective

To evaluate treatment strategies for congenital intrahepatic portosystemic shunt (CIPSS) based on the experience of treating 27 children.

Methods

Between August 2017 and January 2024, our team treated 27 children with CIPSS. Twelve patients underwent surgical ligation of the portosystemic shunt, while 15 patients diagnosed prenatally received conservative treatment without surgery. All patients were followed up after diagnosis or surgery. During follow-up, blood ammonia and biochemistry tests, along with ultrasound examinations, were conducted. Clinical presentations were recorded.

Results

The prenatal diagnosis rate for CIPSS using ultrasound was 74.1% (20/27). Hyperammonemia was the most common clinical manifestation, occurring in 81.5% (22/27) of cases. Jaundice and abnormal liver function were the next most frequent presentations in patients with prenatal diagnosis, with incidences of 80% (16/20) and 65% (13/20), respectively. In 12 patients undergoing surgical ligation, blood ammonia levels returned to normal, the abnormal shunt disappeared as confirmed by ultrasound and CT, and no patients developed portal vein thrombosis or portal hypertension postoperatively. In 15 patients receiving conservative treatment, 53.3% (8/15) experienced spontaneous closure of the abnormal shunt within 1–7 months (median: 3 months). Jaundice and hyperammonemia were completely resolved within 1–8 months in patients receiving conservative treatment.

Conclusion

CIPSS is a curable congenital anomaly. Prenatal ultrasound is effective for detection. Conservative treatment is recommended until the age of one, followed by surgical ligation or interventional treatment for patients with persistent shunts after 1 year.
Narrative review of methodological advances in human milk fortification: for better preterm infant growth
Authors: Yang Jiabin , Tang Qin , Zhou Ping
Published: November 2024

It is generally suggested that human milk alone might not be enough to meet the nutritional requirements of very preterm infants, necessitating the use of nutritional fortification. The composition of human milk varies among individuals and changes over time, challenging the assumption that protein content and energy density remain constant during standard fortification. Consequently, it has led to suboptimal body growth rates in most very preterm infants compared to fetuses of the same gestational age. In light of this, personalized fortification and innovative fortification strategies have been introduced. This paper aims to review the importance of fortification and the shortcomings of standard fortification, as well as describe and evaluate the advantages and limitations of various individualized fortifications. The optimal use of human milk fortification, in accordance with the nutrient content of human milk and the physiological maturity and growth of preterm infants, is a crucial aspect of the field of preterm infant nutrition.
Multi-omics insights into beagle dog fed with a sucking-rewarded automatic feeding device
Authors: Jiao Yang , Wang Xin , Yu Aizhen , Wu Li , Li Hongping
Published: November 2024

Background

Facilitating the development of the sucking function in early stages of preterm infants holds substantial potential for influencing their long-term outcomes. To this end, our team has devised a sucking-rewarded automatic feeding device specifically tailored for preterm infants. The present study is designed to investigate the impacts of this innovative device, utilizing a multi-omics profiling approach, on beagle dogs as a surrogate model.

Methods

This study involved seven-day-old male newborn beagle puppies, carefully selected and matched in terms of body weights. The participants were stratified into two groups: the experimental group (AFG, sucking-rewarded feeding group) and the control group (PFG). After a 14-day intervention period, fecal and blood samples were systematically collected from each dog. The collected samples were then subjected to distinct profiling analyses, encompassing the assessment of gut microbial composition, plasma metabolic profiles, and proteomic expression profiles.

Results

The gut microbial data showed a significant difference between the AFG and PFG groups based on Bray-Curtis dissimilarity (P = 0.048), and the relative abundance of Lactobacillus was significantly more abundant in the AFG group compared to the PFG group. The significantly different metabolites between the two groups were enriched in functional metabolic pathways related to amino acids, fatty acid metabolism, and the nervous system. Notably, neurotransmitter L-glutamic acid was significantly up-regulated in the AFG group. Moreover, the significantly different proteins between the two groups were enriched in GO terms related to oxygen transport, oxygen binding, iron ion binding, hemoglobin complex, and heme binding. Among them, proteins A0A8C0MTD2, P60524, P60529 were significantly up-regulated in the AFG group. Notably, Lactobacillus, L-glutamic acid, A0A8C0MTD2, P60524, and P60529 were correlated with each other through correlation analysis, these molecules play important roles in the neural function and neurodevelopment.

Conclusion

Our investigation elucidated discernible modifications in gut microbial composition, plasma metabolic profiles, and proteomic expression patterns in beagle dogs subjected to the sucking-rewarded automatic feeding device.
Integration of genomics, clinical characteristics and baseline biological profiles to predict the risk of liver injury induced by high-dose methotrexate
Authors: Lin Chenquan , Ma Rui , Zeng Xiao , Zhang Bikui , Cao Ting , Jiao Shimeng , Chen Hui , He Yifang , Liu Mouze , Cai Hualin
Published: November 2024

Background

High-dose methotrexate (HD-MTX) is commonly employed in the treatment of malignant tumors in children and young adults due to its distinctive therapeutic efficacy. Nonetheless, the systemic exposure to MTX often results in liver injury (drug induced liver injury, DILI), thereby imposing limitations on the sustained administration of HD-MTX. Additionally, individual variations including genetic underpinnings attributable to disparities in therapeutic effects and clinical toxicity remain to be elucidated.

Methods

A total of 374 patients receiving initial HD-MTX treatment were selected for this study, which aimed to establish a predictive model using binary logistic regression and a visual nomogram for DILI risk assessment. Demographic and clinical characteristics were collected at baseline and post-HD-MTX to explore their correlations with the occurrence of DILI. Additionally, genotyping of 25 single nucleotide polymorphisms from drug transporters and enzymes in the folic acid cycle was performed.

Result

G allele mutation in ABCB1 rs1128503, *1b/*1b and *1b/*15 haplotypic mutation in SLCO1B1, female gender, and MTX dosage were identified as independent factors for moderate/severe DILI. Patients with GA or AA genotype in ABCB1 rs1128503 showed significant higher 24h MTX concentration than GG, and those with *1b/*1b haplotype group in SLCO1B1 exhibited lower dose adjusted concentration (C/D) than *1a/*1a group. Besides, patient administrated with HD-MTX were more prevalent to have higher C/D levels when using intravenous plus triple intrathecal injection route than those who were using intravenous injection alone. The composite predictive model (ROC curve: AUC = 0.805), comprising above four factors and 24h MTX concentration, exhibited high accuracy.

Conclusion

Female gender, recessive mutation in ABCB1 rs1128503, and a range of MTX concentration may be risk factors for increased susceptibility to DILI. Conversely, the *1b/*1b and *1b/*15 mutations in SLCO1B1 may have a protective effect against DILI. The proposed predictive model facilitates early individual risk assessment, enabling the implementation of proactive prevention strategies.
Investigation of the effects of Periplaneta americana (L.) extract on ischemic stroke based on combined multi-omics of gut microbiota
Authors: Yang Xin , Hong Canhui , Guan Tangfei , Zhang ChengGui , Xiao Peiyun , Yang Yongshou , Xiao Huai , He Zhengchun
Published: November 2024

Ischemic stroke (IS) is a highly lethal type of cardiovascular and cerebrovascular disease. Improving survival rates and promoting recovery in patients with IS pose significant challenges, however, recent research has identified the gut–brain axis as a therapeutic target. In this study, we evaluated the regulatory effect of Periplaneta americana (L.) extract (PAS840), which has established anti-inflammatory, antioxidant, and neuroprotective effects, on the gut microbiota using a rat model of temporary middle cerebral artery occlusion (tMCAO). We evaluated the protective effects of PAS840 on brain damage in IS rats through TTC (triphenyltetrazolium chloride), Nissl staining, and pathological section analysis. Additionally, we investigated the impact of PAS840 on the gut microbiota and metabolites using 16S rRNA sequencing, untargeted metabolomics of gut contents, and transcriptomics analyses of brain tissues to explore its mechanism of action. PAS840 intervention resulted in significant changes in the gut microbiota, including an increase in the abundance of probiotic flora, decrease in the abundance of harmful flora, and significant changes in metabolite profiles. It also attenuated brain damage, decreased platelet activity, inhibited oxidative stress and genes related to inflammation, and improved neurological function in rats. These findings suggest that PAS840 has preventive and therapeutic effects against IS via the gut–brain axis by regulating the gut microbiota and related metabolites. Accordingly, PAS840 is a candidate therapeutic drug for further research.