bluuebunny/crossref_metadata_2025 huggingface dataset:
All are interesting to invest, I fear of missing out (FOMO): a comparative study among self-employed and salaried investors
Authors: Kumar Jitender , Rani Manju , Rani Garima , Rani Vinki
Published: September 2024

Purpose

This paper aims to examine how fear of missing out (FOMO) and investment intention mediate the relationship between behavioral biases and investment decisions of retail investors in the Indian stock market.

Design/methodology/approach

The present research comprises two cross-sectional quantitative studies, where Study A involves data from 405 self-employed and Study B involves 393 salaried investors. Data was attained through questionnaires – the partial least squares structural equation modeling was used for data analysis.

Findings

The outcomes show that herding, overconfidence and loss aversion bias significantly impact investment intention and FOMO on both studies. Furthermore, the outcomes also indicate that herding and loss aversion bias significantly influence investment decisions in studies (A and B); however, overconfidence bias insignificantly affects the investment decisions in Study A. Besides, the results also reveal a substantial relationship between FOMO, investment intention and investment decision.

Practical implications

The findings of this paper assist practitioners (financial analysts and retail investors) in considering the various ways of analyzing investment decision outcomes by considering the joint effect of several biases.

Originality/value

This paper is an initial attempt to propose a new theoretical framework and empirically examine the impact of behavioral biases on investment decisions by considering the FOMO and investment intention among self-employed and salaried investors. This study also contributes to the behavioral finance literature; other researchers may find it valuable to attain their goals.
The door opens inward: meeting Linda Tuhiwai Smith
Authors: Meyer Manulani Aluli , Tualaulelei Eseta
Published: September 2024

Purpose

This article demonstrates the reach of Tuhiwai Smith’s ideas across Pacific research. It discusses the theoretical and practical influence of her seminal work Decolonizing Methodologies: Research and Indigenous Peoples through “holographic epistemology”, an indigenous way of viewing knowledge.

Design/methodology/approach

The authors present a talanoa (Pacific-style relational conversation) to explore Tuhiwai Smith’s legacy for Pacific Islander researchers and research. The talanoa between two academics at different career stages draws upon personal and professional research experiences and peer-reviewed published sources to explore the expansive and enduring legacy of Tuhiwai Smith’s life and ideas.

Findings

Decolonizing Methodologies has helped Pacific Islander researchers flourish, and Pacific Island research approaches gain legitimacy in higher education. Its epistemological influence can be seen in research which utilises knowledge of body, mind and spirit – holographic epistemology – and in indigenous innovations to qualitative research.

Originality/value

This article has value for those seeking to understand the epistemological underpinnings of indigenous approaches to research. It has originality in its presentation as a talanoa between two researchers who have found affirmation and academic freedom with Tuhiwai Smith’s ideas. It is also original in offering a Pacific perspective from a Hawaiian and a Samoan academic about the immense koha (gift) they have received from a Maori tuahine (sister).
Silvicultural regime shapes understory functional structure in European forests
Authors: Chianucci Francesco , Napoleone Francesca , Ricotta Carlo , Ferrara Carlotta , Fusaro Lina , Balducci Lorenzo , Trentanovi Giovanni , Bradley Owen , Kovacs Bence , Mina Marco , Cerabolini Bruno E. L. , Vandekerkhove Kris , De Smedt Pallieter , Lens Luc , Hertzog Lionel , Verheyen Kris , Hofmeister Jeňýk , Hošek Jan , Matula Radim , Doerfler Inken , Müller Jörg , Weisser Wolfgang W. , Helbach Jan , Schall Peter , Fischer Markus , Heilmann‐Clausen Jacob , Riis‐Hansen Rasmus , Goldberg Irina , Aude Erik , Kepfer‐Rojas Sebastian , Kappel Schmidt Inger , Riis Nielsen Torben , Mårell Anders , Dumas Yann , Janssen Philippe , Paillet Yoan , Archaux Frederic , Xystrakis Fotios , Tinya Flóra , Ódor Péter , Aszalós Réka , Bölöni János , Cutini Andrea , Bagella Simonetta , Sitzia Tommaso , Brazaitis Gediminas , Marozas Vitas , Ujházyová Mariana , Ujházy Karol , Máliš František , Nordén Björn , Burrascano Sabina
Published: September 2024

Managing forests to sustain their diversity and functioning is a major challenge in a changing world. Despite the key role of understory vegetation in driving forest biodiversity, regeneration and functioning, few studies address the functional dimensions of understory vegetation response to silvicultural management.

We assessed the influence of the silvicultural regimes on the functional diversity and redundancy of European forest understory. We gathered vascular plant abundance data from more than 2000 plots in European forests, each associated with one out of the five most widespread silvicultural regimes. We used generalized linear mixed models to assess the effect of different silvicultural regimes on understory functional diversity (Rao's quadratic entropy) and functional redundancy, while accounting for climate and soil conditions, and explored the reciprocal relationship between three diversity components (functional diversity, redundancy and dominance) across silvicultural regimes through a ternary diversity diagram.

Intensive silvicultural regimes are associated with a decrease in functional diversity and an increase in functional redundancy, compared with unmanaged conditions. This means that although intensive management may buffer communities' functions against species or functional losses, it also limits the range of understory response to environmental changes.

Policy implications. Different silvicultural regimes influence different facets of understory functional features. While unmanaged forests can be used as a reference to design silvicultural practices in compliance with biodiversity conservation targets, different silvicultural options should be balanced at landscape scale to sustain the multiple forest functions that human societies are increasingly demanding.
Change in functional trait diversity mediates the effects of nutrient addition on grassland stability
Authors: Chen Qingqing , Wang Shaopeng , Seabloom Eric W. , Isbell Forest , Borer Elizabeth T. , Bakker Jonathan D. , Bharath Siddharth , Roscher Christiane , Peri Pablo Luis , Power Sally A. , Donohue Ian , Stevens Carly , Ebeling Anne , Nogueira Carla , Caldeira Maria C. , MacDougall Andrew S. , Moore Joslin L. , Bagchi Sumanta , Jentsch Anke , Tedder Michelle , Kirkman Kevin , Alberti Juan , Hautier Yann
Published: September 2024

Nutrient enrichment impacts grassland plant diversity such as species richness, functional trait composition and diversity, but whether and how these changes affect ecosystem stability in the face of increasing climate extremes remains largely unknown.

We quantified the direct and diversity‐mediated effects of nutrient addition (by nitrogen, phosphorus, and potassium) on the stability of above‐ground biomass production in 10 long‐term grassland experimental sites. We measured five facets of stability as the temporal invariability, resistance during and recovery after extreme dry and wet growing seasons.

Leaf traits (leaf carbon, nitrogen, phosphorus, potassium, and specific leaf area) were measured under ambient and nutrient addition conditions in the field and were used to construct the leaf economic spectrum (LES). We calculated functional trait composition and diversity of LES and of single leaf traits. We quantified the contribution of intraspecific trait shifts and species replacement to change in functional trait composition as responses to nutrient addition and its implications for ecosystem stability.

Nutrient addition decreased functional trait diversity and drove grassland communities to the faster end of the LES primarily through intraspecific trait shifts, suggesting that intraspecific trait shifts should be included for accurately predicting ecosystem stability. Moreover, the change in functional trait diversity of the LES in turn influenced different facets of stability. That said, these diversity‐mediated effects were overall weak and/or overwhelmed by the direct effects of nutrient addition on stability. As a result, nutrient addition did not strongly impact any of the stability facets. These results were generally consistent using individual leaf traits but the dominant pathways differed. Importantly, major influencing pathways differed using average trait values extracted from global trait databases (e.g. TRY).

Synthesis. Investigating changes in multiple facets of plant diversity and their impacts on multidimensional stability under global changes such as nutrient enrichment can improve our understanding of the processes and mechanisms maintaining ecosystem stability.
Adenylate cyclase 1 knockdown attenuates pirarubicin‐induced cardiotoxicity
Authors: Zhang Wenqing , Shu Zhiyun , Huang Peng , Cheng HongYuan , Ji Jiahua , Wei Dexian , Ren Liqun
Published: September 2024

This study aimed to investigate the effects and possible mechanisms of adenylate cyclase 1 (ADCY1) on pirarubicin‐induced cardiomyocyte injury. HL‐1 cells were treated with pirarubicin (THP) to induce intracellular toxicity, and the extent of damage to mouse cardiomyocytes was assessed using CCK‐8, Edu, flow cytometry, ROS, ELISA, RT‐qPCR and western blotting. THP treatment reduced the viability of HL‐1 cells, inhibited proliferation, induced apoptosis and triggered oxidative stress. In addition, the RT‐qPCR results revealed that ADCY1 expression was significantly elevated in HL‐1 cells, and molecular docking showed a direct interaction between ADCY1 and THP. Western blotting showed that ADCY1, phospho‐protein kinase A and GRIN2D expression were also significantly elevated. Knockdown of ADCY1 attenuated THP‐induced cardiotoxicity, possibly by regulating the ADCY1/PKA/GRIN2D pathway.
Addressing immortal time bias in precision medicine: Practical guidance and methods development
Authors: Weymann Deirdre , Krebs Emanuel , Regier Dean A.
Published: September 2024

Objective

To compare theoretical strengths and limitations of common immortal time adjustment methods, propose a new approach using multiple imputation (MI), and provide practical guidance for using MI in precision medicine evaluations centered on a real‐world case study.

Study Setting and Design

Methods comparison, guidance, and real‐world case study based on previous literature. We compared landmark analysis, time‐distribution matching, time‐dependent analysis, and our proposed MI application. Guidance for MI spanned (1) selecting the imputation method; (2) specifying and applying the imputation model; and (3) conducting comparative analysis and pooling estimates. Our case study used a matched cohort design to evaluate overall survival benefits of whole‐genome and transcriptome analysis, a precision medicine technology, compared to usual care for advanced cancers, and applied both time‐distribution matching and MI. Bootstrap simulation characterized imputation sensitivity to varying data missingness and sample sizes.

Data Sources and Analytic Sample

Case study used population‐based administrative data and single‐arm precision medicine program data from British Columbia, Canada for the study period 2012 to 2015.

Principal Findings

While each method described can reduce immortal time bias, MI offers theoretical advantages. Compared to alternative approaches, MI minimizes information loss and better characterizes statistical uncertainty about the true length of the immortal time period, avoiding false precision. Additionally, MI explicitly considers the impacts of patient characteristics on immortal time distributions, with inclusion criteria and follow‐up period definitions that do not inadvertently risk biasing evaluations. In the real‐world case study, survival analysis results did not substantively differ across MI and time distribution matching, but standard errors based on MI were higher for all point estimates. Mean imputed immortal time was stable across simulations.

Conclusions

Precision medicine evaluations must employ immortal time adjustment methods for unbiased, decision‐grade real‐world evidence generation. MI is a promising solution to the challenge of immortal time bias.
Financial Transparency of Private Firms: Evidence from a Randomized Field Experiment
Authors: GASSEN JOACHIM , MUHN MAXIMILIAN
Published: September 2024

This paper examines why private firms choose to be financially transparent or opaque by conducting a field experiment with more than 25,000 firms in Germany. We inform a randomly chosen set of firms about a disclosure option that allows eligible firms to restrict access to their otherwise publicly available financial statements. We also vary the messaging in subtle ways to induce experimental variation in the probability that firms take transacting (capital providers or customers and suppliers) versus non‐transacting stakeholders (competitors or general interest parties) into consideration when making their filing decision. Based on each firm's actual filing decision, we find that treated firms are 15% more likely to restrict access to their financial statements. This intention‐to‐treat effect is persistent and concentrated among firms that should derive lower net benefits from disclosure (smaller, more mature firms in less capital‐intensive industries). These findings indicate that informational constraints affect firms’ disclosure practice. Additionally, we show that the treatment effect is almost 40% larger for firms that have a higher, exogenously induced, probability of considering non‐transacting stakeholders when making their disclosure decision. By analyzing subsequent firm activity and complementary survey evidence, we also provide suggestive evidence that disclosure requirements put an undue burden on very small private firms.
Selection strategy for endoscopic necrosectomy approaches of infected walled‐off pancreatic necrosis: Analysis of 101 patients from a single center with long‐term follow‐up
Authors: Luo Jie , Zhang Sheng Wei , He Jia Lin , Tian Li Xing , Peng Xue , Nie Xu Biao , Ye Shao Song , Zuo Ying , Lin Hui , Bai Jian Ying , Liu En , Yang Shi Ming , Fan Chao Qiang
Published: September 2024

Objectives

Endoscopic necrosectomy (EN) is a promising minimally invasive approach for treating infected walled‐off pancreatic necrosis (WOPN). Multiple EN approaches are currently available, though criteria for selecting the optimal approaches are lacking. We aimed to propose a rational selection strategy of EN and to retrospectively evaluate its safety and effectiveness.

Methods

Altogether 101 patients who underwent EN for infected WOPN at a tertiary hospital between June 2009 and February 2023 were retrospectively included for analysis. Demographic characteristics, details of the EN procedures, procedure‐related adverse events, and clinical outcomes were investigated.

Results

Among these 101 patients with WOPN, 56 (55.4%) underwent transluminal EN, 38 (37.6%) underwent percutaneous EN, and seven (6.9%) underwent combined approach, respectively. Clinical success was achieved in 94 (93.1%) patients. Seven (6.9%) experienced procedure‐related adverse events, and seven (6.9%) died during the treatment period. During a median follow‐up of 50 months, 5 (5.3%) of the 94 patients had disease recurrence, 17.0% (16/94) had new‐onset diabetes mellitus, and 6.4% (6/94) needed oral pancreatic enzyme supplementation. The clinical success rate, procedure‐related adverse event rate, and long‐term follow‐up outcomes were not significantly different among the three groups. High APACHE‐II scores (≥15) and organ failure were identified as factors related to treatment failure.

Conclusions

A selection strategy for EN approaches, based on the extent of necrosis and its distance from the gastrointestinal lumen (using a threshold of 15 mm), is safe and effective for treating infected WOPN in both short‐term and long‐term outcomes.
The prevalence and clinical features of leflunomide‐associated peripheral neuropathy in patients with rheumatic disease in a New Zealand cohort
Authors: Kaur Gursimran , Barclay Murray , Mitchell Joanne , Jordan Sarah , Stebbings Simon
Published: September 2024

Objective

To identify the prevalence and clinical features of leflunomide‐associated peripheral neuropathy in patients with rheumatic disease over a 42‐month observational period between January 1, 2016 and June 30, 2019.

Methods

A retrospective observational study was conducted using regional prescription data identifying all patients treated with leflunomide for rheumatic diseases in the Southern District Health Board of New Zealand. Medical records were used to identify patients who developed peripheral neuropathy while receiving treatment with leflunomide. Demographic characteristics, co‐therapies, and additional risk factors for peripheral neuropathy were also recorded.

Results

A total of 482 patients were identified as receiving leflunomide for the treatment of rheumatic during the study period. In total, 23 patients developed leflunomide‐induced peripheral neuropathy within the cohort giving a prevalence of 4.7%. Nerve conduction studies (NCS) performed in 18 (78.2%) of these patients confirmed a distal axonal, sensory, or sensorimotor peripheral neuropathy. The majority of patients (n = 22; 95.6%) either improved, stabilized, or resolved on cessation of the drug, with or without medication washout. Adverse symptoms were reported in association with peripheral neuropathy in 15 of the 23 patients (65.2%): these included pain, poor sleep, compromised skin integrity, poor balance, and a Charcot‐like arthropathy. Additional treatment was required to manage symptoms of peripheral neuropathy including nine patients (39%) who received pain relief.

Conclusions

This study supports the previously reported association between leflunomide treatment and the development of a peripheral neuropathy. However, our findings suggest that this is more common than the previous estimates. In patients with psoriatic arthritis and previous tarsitis, there appeared to be an association with a Charcot's‐like arthropathy, a complication not previously noted in the literature.
Sex‐specific high‐sensitivity troponin T cut‐points have similar safety but lower efficacy than overall cut‐points in a multisite U.S. cohort
Authors: Montgomery Connor M. , Ashburn Nicklaus P. , Snavely Anna C. , Allen Brandon , Christenson Robert , Madsen Troy , McCord James , Mumma Bryn , Hashemian Tara , Supples Michael , Stopyra Jason , Wilkerson R. Gentry , Mahler Simon A.
Published: September 2024

Background

Data comparing the performance of sex‐specific to overall (non–sex‐specific) high‐sensitivity cardiac troponin (hs‐cTn) cut‐points for diagnosing acute coronary syndrome (ACS) are limited. This study aims to compare the safety and efficacy of sex‐specific versus overall 99th percentile high‐sensitivity cardiac troponin T (hs‐cTnT) cut‐points.

Methods

We conducted a secondary analysis of the STOP‐CP cohort, which prospectively enrolled emergency department patients ≥ 21 years old with symptoms suggestive of ACS without ST‐elevation on initial electrocardiogram across eight U.S. sites (January 25, 2017–September 6, 2018). Participants with both 0‐ and 1‐h hs‐cTnT measures less than or equal to the 99th percentile (sex‐specific 22 ng/L for males, 14 ng/L for females; overall 19 ng/L) were classified into the rule‐out group. The safety outcome was adjudicated cardiac death or myocardial infarction (MI) at 30 days. Efficacy was defined as the proportion classified to the rule‐out group. McNemar's test and a generalized score statistic were used to compare rule‐out and 30‐day cardiac death or MI rates between strategies. Net reclassification improvement (NRI) index was used to further compare performance.

Results

This analysis included 1430 patients, of whom 45.8% (655/1430) were female; the mean ± SD age was 57.6 ± 12.8 years. At 30 days, cardiac death or MI occurred in 12.8% (183/1430). The rule‐out rate was lower using sex‐specific versus overall cut‐points (70.6% [1010/1430] vs. 72.5% [1037/1430]; p = 0.003). Among rule‐out patients, the 30‐day cardiac death or MI rates were similar for sex‐specific (2.4% [24/1010]) vs. overall (2.3% [24/1037]) strategies (p = 0.79). Among patients with cardiac death or MI, sex‐specific versus overall cut‐points correctly reclassified three females and incorrectly reclassified three males. The sex‐specific strategy resulted in a net of 27 patients being incorrectly reclassified into the rule‐in group. This led to an NRI of −2.2% (95% CI −5.1% to 0.8%).

Conclusions

Sex‐specific hs‐cTnT cut‐points resulted in fewer patients being ruled out without an improvement in safety compared to the overall cut‐point strategy.
Regional Analysis of the Immune Microenvironment in Human Endometrium
Authors: Yang Lingtao , Su Yiyi , Cai Songchen , Ma Huan , Yang Jing , Xu Mingjuan , Li Yuye , Huang Chunyu , Zeng Yong , Li Qiyuan , Feng Mingqian , Li Hanjie , Diao Lianghui
Published: September 2024

Problem

Endometrial immune cells are essential for maintaining homeostasis and the endometrial receptivity to embryo implantation. Understanding regional variations in endometrial immune cell populations is crucial for comprehending normal endometrial function and the pathophysiology of endometrial disorders. Despite previous studies focusing on the overall immune cell composition and function in the endometrium, regional variations in premenopausal women remain unclear.

Method of Study

Endometrial biopsies were obtained from four regions (anterior, posterior, left lateral, and right lateral) of premenopausal women undergoing hysteroscopy with no abnormalities. A 15‐color human endometrial immune cell‐focused flow cytometry panel was used for analysis. High‐dimensional flow cytometry combined with a clustering algorithm was employed to unravel the complexity of endometrial immune cells. Additionally, multiplex immunofluorescent was performed for further validation.

Results

Our findings revealed no significant variation in the distribution and abundance of immune cells across different regions under normal conditions during the proliferative phase. Each region harbored similar immune cell subtypes, indicating a consistent immune microenvironment. However, when comparing normal regions to areas with focal hemorrhage, significant differences were observed. An increase in CD8+ T cells highlights the impact of localized abnormalities on the immune microenvironment.

Conclusions

Our study demonstrates that the endometrial immune cell landscape is consistent across different anatomical regions during the proliferative phase in premenopausal women. This finding has important implications for understanding normal endometrial function and the pathophysiology of endometrial disorders.
Current sessile serrated lesion incidence: implications for future clinical practice
Authors: Bone Emma , Kumar Shiristi , Richards Simon , McCombie Andrew , Chalmers‐Watson Teresa , Glyn Tamara , Eglinton Tim
Published: September 2024

Background

Sessile serrated lesions (SSL) account for up to 30% of colorectal carcinoma pathogenesis. With multiple classification changes and improvements in colonoscopy equipment and technique, historical reporting may have underestimated the true incidence of SSLs. This study aimed to determine the incidence of SSLs in patients undergoing colonoscopic investigation in Canterbury, New Zealand over a 1‐year period and describe their clinical and pathological characteristics.

Methods

Electronic records were searched to identify all lower endoscopy procedures with polypectomy performed from 1 January 2022 to 1 December 2022 (inclusive). Patients' electronic records were used to collect histological classification, location and size of each polyp removed during their procedure. The primary outcome was the number of procedures that had one or more SSL, adenoma or hyperplastic polyp identified. Secondary outcomes included histological classification, location and size of each polyp removed.

Results

There were 4346 procedures completed during the study period. Of these, 64.1% (2786) had a polypectomy and 18.6% (808) had at least one SSL excised. Individual polyp analysis was completed on 9166 polyps and found that 24.0% of polyps removed were SSLs and they were found predominately in the right colon (65.1% right colon, 32.6% left colon, 2.3% rectum). SSLs were typically <10 mm (84.8%).

Conclusion

This study found a higher incidence of SSLs compared to previous research. These results raise questions regarding whether SLL rates have been historically underestimated, whether SSL detection rate should be included as a key performance indicator and raises further concerns regarding the use of computed tomography colonography as a screening tool.
Home‐based elderly care development in Hebei Province, China: A systematic literature review
Authors: Cao Ruoyi , Yusof Masarah Mohamad , Ali Isahaque
Published: September 2024

Hebei, one of China's most populous provinces, is facing increasing pressure on its elderly care services due to a rapidly aging population. Home‐Based Elderly Care (HBEC) has emerged as a potential solution to alleviate this pressure. However, this care model is significantly impacted by various external environmental changes. The study employed a literature analysis method, conducting a PEST analysis, to examine the environmental factors influencing the progress of HBEC in Hebei Province, China. The findings offer novel research perspectives to inform strategic development in the HBEC industry. The study identified 19 environmental factors, both favorable and adverse, shaping the development of HBEC in Hebei Province. Based on these findings, the study recommends integrating laws, regulations, and systems, clarifying government roles, optimizing funding structure, expanding service delivery channels, enhancing public awareness of elderly care, and broadening professional talent development pathways. These insights can be valuable for policymakers, educators, and researchers seeking to understand the challenges and opportunities in the field, ultimately improving the well‐being of China's elderly population.
Trends in Distress‐Free Life Expectancy in Japan, 2010–2022
Authors: Minagawa Yuka
Published: September 2024

Extensive literature exists on the physical health of the Japanese population whereas relatively little is known about their mental health. Moreover, most studies have assessed physical and mental health separately, and this further confounds the relationship between the two. Using the concept of health expectancy, this study investigated the trends in the relationship between physical and mental health among Japanese men and women aged 20 years or more between 2010 and 2022. Psychological distress, based on the Comprehensive Survey of Living Conditions, was used as an indicator of mental health. We employed Sullivan's method to estimate the length of life with or without distress of varying degrees. Our results showed substantial improvements in distress‐free life expectancy for both genders during the study period. Younger people have gained more distress‐free years than their older counterparts, placing older individuals, especially men, at an increased risk of psychological distress. These findings contribute to the literature on longevity in Japan by quantifying the role of mental health in the population's overall health. Given the recent increase in mental health problems, greater policy emphasis on the relationship between physical and mental health status is required.
Exploring the role of Large Language Models in haematology: A focused review of applications, benefits and limitations
Authors: Mudrik Aya , Nadkarni Girish N. , Efros Orly , Glicksberg Benjamin S. , Klang Eyal , Soffer Shelly
Published: September 2024

Large language models (LLMs) have significantly impacted various fields with their ability to understand and generate human‐like text. This study explores the potential benefits and limitations of integrating LLMs, such as ChatGPT, into haematology practices. Utilizing systematic review methodologies, we analysed studies published after 1 December 2022, from databases like PubMed, Web of Science and Scopus, and assessing each for bias with the QUADAS‐2 tool. We reviewed 10 studies that applied LLMs in various haematology contexts. These models demonstrated proficiency in specific tasks, such as achieving 76% diagnostic accuracy for haemoglobinopathies. However, the research highlighted inconsistencies in performance and reference accuracy, indicating variability in reliability across different uses. Additionally, the limited scope of these studies and constraints on datasets could potentially limit the generalizability of our findings. The findings suggest that, while LLMs provide notable advantages in enhancing diagnostic processes and educational resources within haematology, their integration into clinical practice requires careful consideration. Before implementing them in haematology, rigorous testing and specific adaptation are essential. This involves validating their accuracy and reliability across different scenarios. Given the field's complexity, it is also critical to continuously monitor these models and adapt them responsively.
Contemporary short‐term peri‐operative outcomes of open primary retroperitoneal lymph node dissection
Authors: McFadden Jacob D. , Masterson Timothy A. , Cary Clint
Published: September 2024

Objectives

To provide current peri‐operative outcomes and short‐term complication rates for open primary retroperitoneal lymph node dissection (RPLND), with analysis of risk factors for complications.

Patients and Methods

Using the Indiana University Testicular Cancer database, we performed a retrospective analysis of all patients who underwent open primary RPLND over the study period (2018–2021). The primary outcomes of interest were the preoperative profile of patients undergoing surgery, complication rates, and identification of risk factors associated with complications. We used chi‐squared, Fisher's exact and unpaired t‐tests in our analyses.

Results

A total of 165 patients were identified. The median body mass index (BMI) was 28.6 kg/m2. Patients most often had clinical stage IIA (39%) or IIB testicular cancer (36%). The median estimated blood loss was 150 mL, with no transfusions required. Higher BMI was noted in patients that sustained any complication vs those with normal recovery (34.95 vs 28 kg/m2; P = 0.0042). The median length of hospital stay was 3 days. The overall complication rate was low (8.48%), with two major postoperative complications, including one case of chylous ascites (0.6%), and no deaths in the 30‐day period. The study was limited by its retrospective design and short‐term follow‐up.

Conclusions

We found that open primary RPLND has an acceptable morbidity profile, even among a predominantly overweight cohort. Low blood loss, short hospital stay, minimal chylous ascites risk, and rare major postoperative complications should be the benchmark for retroperitoneal lymph node dissection.
A novel histopathological feature of spatial tumor–stroma distribution predicts lung squamous cell carcinoma prognosis
Authors: Taki Tetsuro , Koike Yutaro , Adachi Masahiro , Sakashita Shingo , Sakamoto Naoya , Kojima Motohiro , Aokage Keiju , Ishikawa Shumpei , Tsuboi Masahiro , Ishii Genichiro
Published: September 2024

We used a mathematical approach to investigate the quantitative spatial profile of cancer cells and stroma in lung squamous cell carcinoma tissues and its clinical relevance. The study enrolled 132 patients with 3–5 cm peripheral lung squamous cell carcinoma, resected at the National Cancer Center Hospital East. We utilized machine learning to segment cancer cells and stroma on cytokeratin AE1/3 immunohistochemistry images. Subsequently, a spatial form of Shannon's entropy was employed to precisely quantify the spatial distribution of cancer cells and stroma. This quantification index was defined as the spatial tumor–stroma distribution index (STSDI). The patients were classified as STSDI‐low and ‐high groups for clinicopathological comparison. The STSDI showed no significant association with baseline clinicopathological features, including sex, age, pathological stage, and lymphovascular invasion. However, the STSDI‐low group had significantly shorter recurrence‐free survival (5‐years RFS: 49.5% vs. 76.2%, p < 0.001) and disease‐specific survival (5‐years DSS: 53.6% vs. 81.5%, p < 0.001) than the STSDI‐high group. In contrast, the application of Shannon's entropy without spatial consideration showed no correlation with patient outcomes. Moreover, low STSDI was an independent unfavorable predictor of tumor recurrence and disease‐specific death (RFS; HR = 2.668, p < 0.005; DSS; HR = 3.057, p < 0.005), alongside the pathological stage. Further analysis showed a correlation between low STSDI and destructive growth patterns of cancer cells within tumors, potentially explaining the aggressive nature of STSDI‐low tumors. In this study, we presented a novel approach for histological analysis of cancer tissues that revealed the prognostic significance of spatial tumor–stroma distribution in lung squamous cell carcinoma.
Prostate cancer treatment recommendation study based on machine learning and SHAP interpreter
Authors: Tang Shengsheng , Zhang Hongzheng , Liang Junhao , Tang Shishi , Li Lin , Li Yuxuan , Xu Yuan , Wang Daohu , Zhou Yi
Published: September 2024

This study utilized data from 140,294 prostate cancer cases from the Surveillance, Epidemiology, and End Results (SEER) database. Here, 10 different machine learning algorithms were applied to develop treatment options for predicting patients with prostate cancer, differentiating between surgical and non‐surgical treatments. The performances of the algorithms were measured using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value. The Shapley Additive Explanations (SHAP) method was employed to investigate the key factors influencing the prediction process. Survival analysis methods were used to compare the survival rates of different treatment options. The CatBoost model yielded the best results (AUC = 0.939, sensitivity = 0.877, accuracy = 0.877). SHAP interpreters revealed that the T stage, cancer stage, age, cores positive percentage, prostate‐specific antigen, and Gleason score were the most critical factors in predicting treatment options. The study found that surgery significantly improved survival rates, with patients undergoing surgery experiencing a 20.36% increase in 10‐year survival rates compared with those receiving non‐surgical treatments. Among surgical options, radical prostatectomy had the highest 10‐year survival rate at 89.2%. This study successfully developed a predictive model to guide treatment decisions for prostate cancer. Moreover, the model enhanced the transparency of the decision‐making process, providing clinicians with a reference for formulating personalized treatment plans.
High‐quality expert annotations enhance artificial intelligence model accuracy for osteosarcoma X‐ray diagnosis
Authors: Hasei Joe , Nakahara Ryuichi , Otsuka Yujiro , Nakamura Yusuke , Hironari Tamiya , Kahara Naoaki , Miwa Shinji , Ohshika Shusa , Nishimura Shunji , Ikuta Kunihiro , Osaki Shuhei , Yoshida Aki , Fujiwara Tomohiro , Nakata Eiji , Kunisada Toshiyuki , Ozaki Toshifumi
Published: September 2024

Primary malignant bone tumors, such as osteosarcoma, significantly affect the pediatric and young adult populations, necessitating early diagnosis for effective treatment. This study developed a high‐performance artificial intelligence (AI) model to detect osteosarcoma from X‐ray images using highly accurate annotated data to improve diagnostic accuracy at initial consultations. Traditional models trained on unannotated data have shown limited success, with sensitivities of approximately 60%–70%. In contrast, our model used a data‐centric approach with annotations from an experienced oncologist, achieving a sensitivity of 95.52%, specificity of 96.21%, and an area under the curve of 0.989. The model was trained using 468 X‐ray images from 31 osteosarcoma cases and 378 normal knee images with a strategy to maximize diversity in the training and validation sets. It was evaluated using an independent dataset of 268 osteosarcoma and 554 normal knee images to ensure generalizability. By applying the U‐net architecture and advanced image processing techniques such as renormalization and affine transformations, our AI model outperforms existing models, reducing missed diagnoses and enhancing patient outcomes by facilitating earlier treatment. This study highlights the importance of high‐quality training data and advocates a shift towards data‐centric AI development in medical imaging. These insights can be extended to other rare cancers and diseases, underscoring the potential of AI in transforming diagnostic processes in oncology. The integration of this AI model into clinical workflows could support physicians in early osteosarcoma detection, thereby improving diagnostic accuracy and patient care.
Exploration in 4‐year‐old children is guided by learning progress and novelty
Authors: Poli Francesco , Meyer Marlene , Mars Rogier B. , Hunnius Sabine
Published: September 2024

Humans are driven by an intrinsic motivation to learn, but the developmental origins of curiosity‐driven exploration remain unclear. We investigated the computational principles guiding 4‐year‐old children's exploration during a touchscreen game (N = 102, F = 49, M = 53, primarily white and middle‐class, data collected in the Netherlands from 2021–2023). Children guessed the location of characters that were hiding following predictable (yet noisy) patterns. Children could freely switch characters, which allowed us to quantify when they decided to explore something different and what they chose to explore. Bayesian modeling of their responses revealed that children selected activities that were more novel and offered greater learning progress (LP). Moreover, children's interest in making LP correlated with better learning performance. These findings highlight the importance of novelty and LP in guiding children's exploration.
Remote ischemic preconditioning prevents high‐altitude cerebral edema by enhancing glucose metabolic reprogramming
Authors: Han Rongrong , Yang Xiaoyan , Ji Xunming , Zhou Bing
Published: September 2024

Aims

Incidence of acute mountain sickness (AMS) ranges from 40%–90%, with high‐altitude cerebral edema (HACE) representing a life‐threatening end stage of severe AMS. However, practical and convenient preventive strategies for HACE are lacking. Remote ischemic preconditioning (RIPC) has demonstrated preventive effects on ischemia‐ or hypoxia‐induced cardiovascular and cerebrovascular diseases. This study aimed to investigate the potential molecular mechanism of HACE and the application of RIPC in preventing HACE onset.

Methods

A hypobaric hypoxia chamber was used to simulate a high‐altitude environment of 7000 meters. Metabolomics and metabolic flux analysis were employed to assay metabolite levels. Transcriptomics and quantitative real‐time PCR (q‐PCR) were used to investigate gene expression levels. Immunofluorescence staining was performed on neurons to label cellular proteins. The fluorescent probes Mito‐Dendra2, iATPSnFR1.0, and CMTMRos were used to observe mitochondria, ATP, and membrane potential in cultured neurons, respectively. TUNEL staining was performed to detect and quantify apoptotic cell death. Hematoxylin and eosin (H&E) staining was utilized to analyze pathological changes, such as tissue swelling in cerebral cortex samples. The Rotarod test was performed to assess motor coordination and balance in rats. Oxygen–glucose deprivation (OGD) of cultured cells was employed as an in vitro model to simulate the hypoxia and hypoglycemia induced by RIPC in animal experiments.

Results

We revealed a causative perturbation of glucose metabolism in the brain preceding cerebral edema. Ischemic preconditioning treatment significantly reprograms glucose metabolism, ameliorating cell apoptosis and hypoxia‐induced energy deprivation. Notably, ischemic preconditioning improves mitochondrial membrane potential and ATP production through enhanced glucose‐coupled mitochondrial metabolism. In vivo studies confirm that RIPC alleviates cerebral edema, reduces cell apoptosis induced by high‐altitude hypoxia, and improves motor dysfunction resulting from cerebral edema.

Conclusions

Our study elucidates the metabolic basis of HACE pathogenesis. This study provides a new strategy for preventing HACE that RIPC reduces brain edema through reprogramming metabolism, highlighting the potential of targeting metabolic reprogramming for neuroprotective interventions in neurological diseases caused by ischemia or hypoxia.
Effect of uneven tolerance to human disturbance on dominance interactions of top predators
Authors: Villalva Pablo , Palomares Francisco , Zanin Marina
Published: September 2024

Anthropogenic activities may alter felid assemblage structure, facilitating the persistence of tolerant species (commonly mesopredators), excluding ecologically demanding ones (top predators) and, consequently, changing coexistence rules. We aimed to determine how human activities influence intraguild relationships among top predators and their cascading effects on mesopredators, which remain poorly understood despite evidence of top carnivore decline. We used structural equation modeling at a continental scale to investigate how habitat quality and quantity, livestock density, and other human pressures modified the intraguild relations of the 3 species that are at the top of the food chain in the Neotropics: jaguars (Panthera onca), pumas (Puma concolor), and ocelots (Leopardus pardalis). We included presence–absence data derived from systematic studies compiled in Neocarnivores data set for these felid species at 0.0833° resolution. Human disturbance reduced the probability of jaguar occurrence by −0.35 standard deviations. Unexpectedly, the presence of sheep (Ovis aries) or goats (Capra aegagrus hircus) and jaguars was positively related to the presence of pumas, whereas puma presence was negatively related to the presence of ocelots. Extent of forest cover had more of an effect on jaguar (β = 0.23) and ocelot (β = 0.12) occurrences than the extent of protected area, which did not have a significant effect. The lack of effect of human activities on puma presence and the positive effect of small livestock supports the notion that pumas are more adaptable to habitat disturbance than jaguars. Our findings suggest that human disturbance has the potential to reverse the hierarchical competition dominance among large felids, leading to an unbalanced community structure. This shift disadvantages jaguars and elevates the position of pumas in the assemblage hierarchy, resulting in the exclusion of ocelots, despite their relatively lower susceptibility to anthropogenic disturbance. Our results suggest that conservation efforts should extend beyond protected areas to encompass the surrounding landscape, where complexities and potential conflicts are more pronounced.
Capability of big data to capture threatened vertebrate diversity in protected areas
Authors: Cordier Javier M. , Osorio‐Olvera Luis , Huais Pablo Y. , Tomba Ana N. , Villalobos Fabricio , Nori Javier
Published: September 2024

Protected areas (PAs) are an essential tool for conservation amid the global biodiversity crisis. Optimizing PAs to represent species at risk of extinction is crucial. Vertebrate representation in PAs is assessed using species distribution databases from the International Union for Conservation of Nature (IUCN) and the Global Biodiversity Information Facility (GBIF). Evaluating and addressing discrepancies and biases in these data sources are vital for effective conservation strategies. Our objective was to gain insights into the potential constraints (e.g., differences and biases) of these global repositories to objectively depict the diversity of threatened vertebrates in the global system of PAs. We assessed differences in species richness (SR) of threatened vertebrates as reported by IUCN and GBIF in PAs globally and then compared how biased this information was with reports from independent sources for a subset of PAs. Both databases showed substantial differences in SR in PAs (t = −62.35, p ≤ 0.001), but differences varied among regions and vertebrate groups. When these results were compared with data from independent assessments, IUCN overestimated SR by 575% on average and GBIF underestimated SR by 63% on average, again with variable results among regions and groups. Our results indicate the need to improve analyses of the representativeness of threatened vertebrates in PAs such that robust and unbiased assessments of PA effectiveness can be conducted. The scientific community and decision makers should consider these regional and taxonomic disparities when using IUCN and GBIF distributional data sources in PA assessment. Overall, supplementing information in these databases could lead to more robust and reliable analyses. Additional efforts to acquire more comprehensive and unbiased data on species distributions to support conservation decisions are clearly needed.
Bronchoscopic Interventional Therapy Combined With Pembrolizumab in the Treatment of Pulmonary Large Cell Neuroendocrine Carcinoma: A Case Report
Authors: Fan Yingyi , Wang Yingying , Ji Yanrong , Li Shuang , Zhang Jian , Hao Xingliang
Published: September 2024

This study reports a significant clinical outcome following the use of bronchoscopic interventional therapy combined with pembrolizumab for treating pulmonary large cell neuroendocrine carcinoma (LCNEC), showcasing a novel approach in managing this aggressive cancer.
Efficacy and safety of dapagliflozin add‐on to evogliptin plus metformin therapy in patients with type 2 diabetes: A randomized, double‐blind, placebo‐controlled study
Authors: Jeong In‐Kyung , Choi Kyung Mook , Han Kyung Ah , Kim Kyoung‐Ah , Kim In Joo , Han Seung Jin , Lee Won Young , Yoo Soon Jib
Published: September 2024

Aim

To evaluate the efficacy and safety of dapagliflozin versus placebo as an add‐on in patients with type 2 diabetes who did not achieve adequate glycaemic control with evogliptin and metformin combination.

Patients and Methods

In this multicentre, randomized, double‐blind, placebo‐controlled Phase 3 trial, patients with glycated haemoglobin (HbA1c) levels ≥7.0% (≥53 mmol/mol) and ≤10.5% (≤91 mmol/mol) who had received stable‐dose metformin (≥1000 mg) and evogliptin (5 mg) for at least 8 weeks were randomized to receive dapagliflozin 10 mg or placebo once daily for 24 weeks. Participants continued treatment with metformin and evogliptin. The primary endpoint was change in HbA1c level after 24 weeks of treatment from baseline level.

Results

In total, 198 patients were randomized, and 195 patients were included in the efficacy analyses (dapagliflozin: 96, placebo: 99). At Week 24, dapagliflozin significantly reduced HbA1c levels. The least squares mean difference in HbA1c level change from baseline after 24 weeks of treatment was −0.70% (−7.7 mmol/mol) (p < 0.0001). The proportion of participants achieving HbA1c <7.0% (≥53 mmol/mol) was higher in the dapagliflozin group than in the placebo group. Compared to placebo, dapagliflozin significantly reduced fasting plasma glucose, mean daily glucose, 2‐h postprandial plasma glucose, fasting insulin, uric acid and gamma‐glutamyl transferase levels, homeostatic model assessment for insulin resistance index, body weight, hepatic steatosis index, and albuminuria. Adiponectin level significantly increased from baseline level after 24 weeks of dapagliflozin treatment. Adverse event rates were similar in the two groups.

Conclusion

Dapagliflozin add‐on to evogliptin plus metformin improved glycaemic control and was well tolerated by the target patients.