bluuebunny/crossref_metadata_2025 huggingface dataset:
Dairy farmworkers’ knowledge of causes, risk factors, and clinical signs of bovine lameness in South Africa
Authors: MATSHETSHENI SIBULELE , Jaja Ishmael Festus
Published: October 2023

Lameness has been identified as the most serious welfare issue in dairy cows, and its observation is the most representative animal-based indicator of dairy cattle well-being. The data was conducted to 11 dairy farms, with a questionnaire. The questionnaire was divided into five sections, the first of which contained demographic information (age, gender, experience, level of study), and the second of which contained farm information such as farm size and grazing method. However, section C discusses farm workers knowledge on lameness and risk factors, Section D discusses clinical signs of lameness, and Section E discusses treatment and management of lameness The study aimed to assess the dairy farmworkers’ knowledge of causes, risk factors, and clinical signs of bovine lameness in Kwa-Zulu Natal Province, South Africa. The highest prevalence of lameness (85.5%) occurs in summer compared to other seasons such as Autumn (15%). Furthermore, the results for seasons were significant (P < 0.05). Respondents reported that a decrease in appetite (93%), reduced milk yield (94%), increase lying time (90%) are the most common sings of lameness... Nevertheless, the results also demonstrate a significant (P < 0.05) correlation between knowledge of clinical signs of lameness and localities. The movement problem was related to age, gender, and occupation level (P < 0.05). Furthermore, training is required in the dairy industry to improve farm workers' knowledge. In addition, the training and retraining of farm workers is necessary to management and mitigation of bovine lameness.
Sustainable Development and Financial Resilience: Linking Greenhouse Gas Emissions, Risk, and Green Growth with Innovation, Inclusion, Renewables, and Infrastructure
Authors: Nauman Muhammad , Naheed Rehana , Khan Junaid
Published: October 2023

Sustainable development has gained significant attention recently as societies face mounting environmental, social, and economic challenges. This paper undertakes a comprehensive examination of sustainable development, aiming to understand its multifaceted dimensions and propose a roadmap for its achievement. The study begins by providing a theoretical foundation for sustainable development, exploring its origins, principles, and frameworks. It investigates the interconnectedness of environmental conservation, social equity, and economic prosperity, emphasizing the need for an integrated approach to address complex issues. The study follows a research model, dependent variable (greenhouse gas emissions). However, the independent variables include financial risk, green growth, technology innovation, renewable energy, financial inclusion, and soft infrastructure. The methodology followed for this study is a quantitative approach with secondary data ranging from 2004 to 2019. The data is collected from the World Development Indicators and the Organization for Economic Cooperation and Development database. For the green growth, the index is made with the entropy-weighted method to represent the variable indicators better. The diagnostic tests were used to solve the issue of the panel data set, which includes correlation, VIF, cross-sectional dependency, stationarity tests, and cointegration. The diagnostic test results suggested that the appropriate method to follow for this panel is a Fully Modified ordinary least square. The results suggest greenhouse gases, financial inclusion, and soft infrastructure have significant positive and green growth; renewable energy and technology innovation have a significant negative relationship with financial risk; long run variance is 55%. The results suggest that the government to give incentives to the institutions in the field of alternative energy to institutions should shift toward renewable energy and contribute to improving environmental quality. Government can develop policies and regulate the fund toward sustainable development, which can be helpful in environmental sustainability. The results suggest that the government to give incentives to the institutions in the field of alternative energy to institutions should shift toward renewable energy and contribute to improving environmental quality. Government can develop policies and regulate the fund toward sustainable development, which can be helpful in environmental sustainability.
Survey to orthopedics surgeons in Italy about Leg length discrepancy and total hip arthroplasty: postoperative management
Authors: Stimolo Davide , Giudice Salvatore Lo , Matassi Fabrizio , Innocenti Matteo , Civinini Roberto , Boniforti Filippo
Published: October 2023

Background
We created a Survey for Italian orthopaedics surgeons on how they approach leg length discrepancy (LLD) when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow literature recommendations during clinical practice.
Methods
The Survey was composed of 25 questions divided in 4 sections: surgeon’s profile, preoperative and intraoperative evaluation, postoperative management. In this paper we report absolute and relative frequencies of answers to section 4 “postoperative management”. Then regarding the treatment of residual LLD we reported if trauma surgeons (TR) and experts in reconstructive surgery (RS) had higher odds ratio (OR) to give the “literature based” answers than orthopaedics physicians (OP)
Results
Only four questions received more than 70% of agreement on one of the answers. The OR to give the “literature based” answer taking OP as reference was 1.57 for TR and 1.72 for RS for 10 mm LLD at first follow up (FU) and 1.23 TR and 1.32 RS when 20 mm. When 10 mm LLD at 3 months FU the OR was 0.88 TR and 1.15 RS. The OR for treatment of LLD after the first examination of a new patient was 2.16 TR and 1.85 RS.
Conclusions
LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition, treatment of LLD during clinical practice often differs from literature recommendations.
Four novel variants identified in genes causing very-long-chain acyl-coenzyme A dehydrogenase deficiency in four unrelated Chinese families
Authors: li lulu , tang yue , zhao jinqi , gong lifei , yang nan , wang shunan , yang haihe , kong yuanyuan
Published: October 2023

Background This article reports and discusses the biochemical and genetic characteristics of four very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD) patients, clarifying their pathogenic genetic factors and evaluating the application value of genetic diagnosis in the early diagnosis of VLCADD.Methods Patients underwent blood tandem mass spectrometry (MS/MS), urine gas chromatography (GC/MS) and high-throughput sequencing technology. New mutations were analyzed for pathogenicity using bioinformatics software. Using Swiss PDB Viewer software to predict the effect of mutation on the structure of very-long-chain acyl-CoA dehydrogenase (VLCAD)protein.Result A total of four VLCADD patients were diagnosed. They revealed elevated levels of C14, C14:1, C14:2, C14:1/C2, C14:1/C10 and C14:1/C12:1. Two patients were early-onset neonatal cases and died during infancy and neonatal period,respectively. Seven kinds of mutations were detected, including four novel mutations. The bioinformatics software revealed that the mutations were harmful, and the Swiss PDB Viewer results suggest that variation affects protein conformation.Conclusions This study identified four novel ACADVL gene mutations. These findings contribute to the understanding of the genetic basis and pathogenesis of VLCADD. Meanwhile, the study enriches the genetic mutation spectrum and the correlation between genotypes and phenotypes of VLCADD, indicating that genetic diagnosis plays an essential role in the early diagnosis and treatment of VLCADD.
Significant liver histological change is not uncommon in ALT normal HBeAg-positive chronic hepatitis B
Authors: Duan Menghui , Xiao Huanming , Shi Meijie , Xie Yubao , Zhao Pengtao , Li Sheng , Chi Xiaoling , Liu Xueen , Zhuang Hui
Published: October 2023

Background and Aims:
Numerous HBeAg-positive chronic hepatitis B(CHB) patients with persistently normal ALT have significant liver histopathology,it is imperative to identify true "immune tolerant" patients.We aimed to evaluate the liver histopathology features of HBeAg-positive CHBpatients with normalALT, and the incidence of liver cirrhosis and HCC in CHB patients during follow-up.
Methods:179 HBeAg-positiveCHB patients with normalALT whoperformed liver biopsy from 2009 to 2018 were retrospectively analyzed.Liver necroinflammation ≥ G2 and/or liver fibrosis ≥ S2was defined as significant liver histopathological change.
Results:57.5% patients were in the indeterminate phase with significant liver histological changes. The proportion of the patients with evident livernecroinflammation was higher in thehigh-normal ALT group (21-40U/L) when compared with the low-normal ALT group (≤ 20 U/L) (51.3% vs 30.0%, p < 0.05),and patients aged ≥ 40 years had a higher proportion of significant fibrosis than those aged < 40 years (64.5% vs 39.9%, p < 0.05).The percentage of patients with ≥ S2and ≥ G2/S2in the HBV DNA < 107 IU/mL group were higher than those in the HBV DNA ≥ 107 IU/mL group (72.7% vs 40.1%, p < 0.01; 81.8% vs 54.1%, p < 0.05). During follow-up, two of immune tolerant patients and four of indeterminate patients developed into cirrhosis, and one of immune tolerant patients and one of indeterminate patients developed into HCC, respectively.
Conclusions:HBeAg-positive CHBpatients with high-normal ALT or HBV DNA < 107 IU/mL were tend to be indeterminate, liver biopsy or noninvasive approaches are recommended to evaluateliver histopathology, and antiviral therapyare recommendedfor patients with significant liver histopathology.
Development of a Coagulation-Related Genes Model for Prognostication, Immune Response, and Treatment Prediction in Lung Adenocarcinoma
Authors: Zhu Liangming , LI JIA , Sun Xiaoming , Gao Xuedi , Wei Jiaheng , Li Hao , Lv Lin , Huang Haiqi
Published: October 2023

Backgroud:
Lung adenocarcinoma(LUAD) is the most prevalent form of lung cancer worldwide. But the diagnosis and prognosis of LUAD patients remain poor. Studies have shown that LUAD patients with tumors tend to have abnormal coagulation factors.Therefore, the objective of this study is to develop a biomolecular model focusing on coagulation-related factors in LUAD.
Methods：
In this study, we obtained LUAD patients gene expression information and clinical information from The Cancer Genome Atlas (TCGA) database and coagulation-related genes through The Molecular Signature Database (MsigDB), thereby obtaining differentially expressed coagulation-related genes. Predictive models were constructed through LASSO Cox regression. The risk score from the model was used to build high risk set versus low risk set.Additionally, We verify the accuracy of prognostic models through a range of methods. Finally,we applied tumor immune dysfunction and exclusion (TIDE) algorithms to assess immune escape and immunotherapy in relation to coagulation-related genes.
Result:
We developed a prognosis model using four genes to estimate the survival rate of patients with LUAD. High risk patients exhibited lower overall survival (OS) rates compared to low risk patients. Kaplan-Meier(K-M) curves,progression-free survival curves (PFS),ROC curves,principal component analysis (PCA) and nomograms can verify the accuracy of the model.Furthermore,the dual effects of high risk and low tumor mutation burden (TMB) led to poorer survival in patients with LUAD. TIDE analysis revealed a higher likelihood of immune evasion in individuals classified as high risk.
Conclusion：
The prognosis model can accurately predict the prognosis of LUAD patients and provide ideas for future immunotherapy.
The other-race effect of pupil contagion in infancy
Authors: Tsuji Yuki , Kanazawa So , Yamaguchi Masami K.
Published: October 2023

Pupil contagion refers to the observer’s pupil-diameter changes in response to changes in the pupil diameter of others. Recent studies on the other-race effect on pupil contagion have mainly focused on using eye region images as stimuli, revealing the effect in adults but not in infants. To address this research gap, the current study used whole-face images as stimuli to assess the pupil-diameter response of 5–6-month-old and 7–8-month-old infants to changes in the pupil-diameter of both upright and inverted other-race faces. The study initially hypothesized that there would be no pupil contagion in either upright or inverted other-race faces, based on our previous finding of pupil contagion occurring only in own-race faces among 5–6-month-old infants. Notably, the current results indicated that 5–6-month-old infants exhibited pupil contagion in both upright and inverted other-race faces, while 7–8-month-old infants showed this effect only in upright other-race faces. These results demonstrate that the face inversion effect of pupil contagion does not occur in 5–6-month-old infants, thereby suggesting the presence of the other-race effect in pupil contagion among this age group. Overall, this study provides the first evidence of the other-race effect on infants’ pupil contagion using face stimuli.
RARB, a gene associated with MSI gastric cancer, affects progression and prognosis of gastric cancer
Authors: Cai Xufan , Lin Wenfa , Wu Fang , Song Guangyuan , Wang Yu , Qian Zhenyuan
Published: October 2023

MSI gastric cancer exhibits greater sensitivity to immunotherapy due to its own characteristics. Here, we firstly identified the RARB gene associated with MSI gastric cancer, which was positively correlated with mismatch repair proteins(MMR).Although relatively low in expression in MSI gastric cancer, RARB promotes gastric cancer progression and leads to poor prognosis. However, we found that in cellular experiments, lowering the expression of RARB accelerated the proliferation, invasion and migration of cancer cells and promoted the EMT. The contradictory reasons for these two results may be related to the tumor immune microenvironment. RARB may be a potential target for the treatment of gastric cancer.
Anesthesia recovery nursing of radical prostatectomy assisted by Da Vinci robot
Authors: Huang Liufang , Wu Wenyan , Wu Yaoye , Li Fang , Chen Xusu , Huang Yuchan , Zhou Qiao , Zhang Huaying , Luo Yongli , Liu Huixian , Tan Jiayu , Wen Shihong
Published: October 2023

Objective To explore the anesthetic recovery nursing of laparoscopic radical prostatectomy with Da Vinci robot.
Methods A total of 100 patients who underwent Da Vinci robotic laparoscopic radical prostatectomy at our hospital between July 2021 and July 2022 were randomly assigned to 2 groups with 50 patients in each group. Patients in the control group were treated with routine nursing, patients in the research group were treated with Da Vinci specialist group perianaesthesia nursing on the basis of the control group, and the difference of anesthesia recovery nursing effect between the two groups was compared.
Results The waking time, spontaneous breathing time, extubation time and total recovery time in the study group were significantly lower than those in the control group, and the daily sleep time was significantly higher than that in the control group, with statistical significance (P<0.05). HR, MAP, VAS and PSQI in study group were lower than those in control group. The difference was statistically significant (P<0.05). The nursing satisfaction of patients in the study group was significantly higher than that in the control group, and the incidence of nursing risk events was significantly lower than that in the control group, with statistical significance (P<0.05).
Conclusion The Da Vinci robot can effectively reduce the pain in the early stage of recovery, improve the sleep quality, shorten the recovery time from anesthesia, improve the psychological state of patients and reduce the occurrence of nursing risk events, which is worth promoting in clinical practice.
Investigation the effect of wearing N95 respirators during COVID-19 pandemic on salivary PH and flow rate of dentistry stuffs and students of QAZVIN Dental Faculty
Authors: loo Mehrshad Faghih , shadvar Mohammadreza Samadi , Lamei Nima , mohammadloo Saeid Beik , Mirzadeh Monirsadat , Zarabadipour Mahdieh
Published: October 2023

Background: Recent pandemic (covid-19) led to wearing face masks for hours a day by healthcare workers. The effect of wearing N95 respirators on salivary pH and flow rate during the COVID-19 pandemic evaluated in this study.
Methods: In this semi-experimental study recruited 100 participants. They asked to use the standard face masks (N95 respirators) for 4 hours and then salivary pH and flow rate was evaluated. Data analysis was done using SPSS software version 23.
Results: There wasn’t a statistically significant difference between mean values of salivary pH and its secretion flow rate before and after mask use with respect to smoking and drinking alcohol status. T Pre- and post-mask analysis demonstrated that the mean salivary pH value differed significantly among participants with positive history of COVID-19, but not the flow rate.
Conclusion: According to the present study, the pH values and salivary flow rate did not change before and after using the face masks, but among the people who had a history of covid-19, the salivary pH value changed.
Classification of Flow-based Network Applications using Fuzzy Logic
Authors: Khan Afaq Ahmad , Farooq Muhammad Umar
Published: October 2023

Ever since the boom of social media, the internet has drastically changed our lives. From social mediaplatforms, Industry 4.0, Big Data, Cloud Computing to Augmented and Virtual reality, the amountof data on the internet has increased on an unprecedented scale, and it is not going to decrease in theyears to come. This increasing amount of data puts a huge strain on today’s network infrastructure. Itis the need of the hour to keep the internet infrastructure up-to-date to tackle the upcoming challenges.Internet Network Traffic Classification is thus a new paradigm in which lightweight sophisticatedalgorithms are designed and tested on live networks. This problem has been focused a lot with thehelp of Machine and Deep learning tools. These models do provide a high accuracy of result, but canbecome complex problems depending upon the specific application. In this paper, a Fuzzy Logic basedLightweight Classification Architecture is proposed and implemented to successfully identify Audioand Video from other Network Traffic (NT) applications. A detailed elaboration of features extractedfrom a variety of applications is presented. Fuzzy logic is used to distinguish among the classes basedon human intuition based rules. To verify the proposed algorithm, flow-based network captures isused to identify whether the correct class of network traffic is predicted or not. The results obtainedfrom the Fuzzy logic is also compared with traditional Logistic regression and kNN based MachineLearning algorithms to showcase the superiority of Fuzzy logic.
Effects of Machining Parameters on Spectral Entropy of Acoustic Emission Signals in the Electroerosion
Authors: Ferreira Samuel Soares , Maia Luís Henrique Andrade , Amorim Fred Lacerda
Published: October 2023

Understanding and optimizing mechanical manufacturing processes is essential for sustainable industrial development. Among unconventional machining methods, Electrical Discharge Machining (EDM) distinguishes itself by its capability to remove material through successive electrical discharges submerged in a dielectric fluid. EDM encompasses intricate phenomena influenced by machine parameters, dielectric choice, and the materials involved. Unlike conventional machining, EDM operates with the tool electrode in close proximity to, but not in physical contact with, the workpiece, achieving material removal through localized overheating. This study focuses on monitoring EDM phenomena during the machining of AISI H13 steel, exploring variations in machining parameters and electrode materials (electrolytic copper and graphite). Acoustic Emission (AE) signals and Machine Learning (ML) are employed for experimental characterization and data analysis. Spectral Entropy is applied to AE signals, quantifying inherent signal uncertainty. The findings reveal remarkable accuracy (97.7%) and underscore the superior control achieved with graphite electrodes in managing machining phenomena compared to electrolytic copper electrodes.
Hospital management and Challenges During COVID-19 Outbreaks: lessons from a level 1 hospital in the southeast of Iran-case study
Authors: Esmaeilian Saeid , Mohajeri Elham , Hoseinyazdi Meisam , Ghorbani Mohammad , Rahmanipour Elham , Sarmast Kamran
Published: October 2023

Introduction: The global outbreak of COVID-19 has presented hospitals worldwide, particularly those in low-resource settings, with unparalleled difficulties. This case study outlines our experiences in the management of a level 1 hospital located in the southeastern part of Iran, characterized by significant poverty rates and low health indices.Case presentation: Our two years of experience in our Hospital in Rask, Iran, from 2020 to 2022, described encountered many obstacles, including deficiencies in infrastructure, personnel, resources, equipment, financial means, and external assistance. In addition, a range of measures were undertaken, including infrastructure repairs and renovations, the expansion of bed capacity, the establishment of an intensive care unit, staff training initiatives, collaboration with external influencers, and the localization of protocols. The experience yielded useful insights, highlighting the significance of a dynamic and efficient management team, establishing connections with pre-hospital care units, engaging in effective communication with external influencers, and integrating workers in the decision-making process.Conclusion: We anticipate that our case Study will offer valuable insights and guidance for other healthcare facilities facing comparable circumstances.
Emergence of the invasive beetle Anomala denuda Arrow 1819 (Coleoptera: Scarabaeidae) adult as a major pest of maize in Côte d’Ivoire
Authors: GBON Gueu Adolphe , BOGA Jean-Pierre , JOHNSON Félicia , KISSI Thérèse Appoh Perrine , TOFEL Haman Katamssadan
Published: October 2023

In previous studies, the adult A. denula beetle was not classified as a major crop insect pest. The objective of this study was to elucidate the beetle's potential to inflict substantial damage to the crop as its larvae. The study was carried out on an experimental plot covering 2592m2, in the South region of Côte d'Ivoire. Peaks of A. denuda beetle abundance on the plot occur during the flowering stage of maize, between the 48th and 58th days after sowing. The study of the daily influx period revealed that the feeding and mating activities of the beetle were high between 10 pm and 12 am. Attack by this beetle has a significant impact on maize production when it happens between 1 and 6 days after flowering. Over the course of the three cropping years, yield losses of 26.62%, 32.31% and 21.35% were recorded in 2019, 20202 and 2021 respectively, resulting in an average loss of 26.76% attributable to the adult A. denuda. These results underscore the severity of A. denuda adult attacks on maize cultivation in the Guinean zone, questioning the previous notion that only larval stage was considered to cause serious damages. The present study reveals that the adult of this beetle is, therefore, capable of causing significant damage to maize crops, thus emphasising the necessity to implement effective and environmentally friendly control methods against A. denuda.
Oral Candida carriage and resistance against common antifungal agents in hematopoietic stem cell transplantation recipients
Authors: Mauramo Matti , Tonoz Nurgül , Halter Jörg , Joseph Betsy , Waltimo Tuomas
Published: October 2023

Purpose
Allogeneic hematopoietic stem cell transplant (HSCT) recipients receiving long-term and high-dose immunosuppressive medications suffer commonly from oral candida infections. This prospective cohort study examined oral fungal carriage in HSCT recipients and screened the susceptibility against commonly used antifungal agents. An increasing oral occurrence of Candida spp. and the development of resistance against clinically administered fluconazole were hypothesized.
Methods
Two hundred HSCT recipients were included and followed up for two years post-HSCT. Oral microbiological specimens were analyzed with Matrix-Assisted Laser Desorption / Ionization -Time of Flight Mass Spectrometry assays (MALDI-TOF). The colorimetric method was applied for the susceptibility testing by commercially available Sensititre YeastOne (SYO®, TREK Diagnostics Systems, Thermo-Fisher, UK).
Results
The prevalence of oral Candida spp. carriage increased statistically significantly after a year post-HSCT being 30, 26, 35, 44, and 47%, pre-HSCT, 3, 6, 12, and 24 months post-HSCT, respectively. Altogether 169 clinical oral Candida strains were isolated. Fourteen Candida spp. were identified, and C. albicans was predominant in 74% of the isolates pre-HSCT with a descending prevalence down to 44% two years post-HSCT. An increasing relative proportion of non-albicans species post-HSCT was evident. No development of resistance of C. albicans against fluconazole was found. Instead, a shift from C. albicans towards non-albicans species, especially C. dubliensis, C. glabrata and relatively seldom found C. krusei, was observed.
Conclusion
Oral Candida carriage increase after HSCT. Instead of the expected development of resistance of C. albicans against fluconazole, the relative proportion of non-albicans strains with innate resistance against azole-group antifungals increased.
Development of electron optical capabilities for manufacturing of large components by Electron Beam Welding
Authors: Dutilleul Thomas , Widdison Robert , Kyffin William
Published: October 2023

Electron beam welding (EBW) is a fast process that shows promise to use for high productivity welding of thick section components in the nuclear Industry. Nuclear AMRC has been working for many years on devloping the use of EBW for Small Modular Reactor (SMR) applications, such as joining thick section pressure vessel components. The major strength of EB is the single pass process that can radically reduce fabrication times. This is also one of the major issues with EB. The stress on the welding operator is high as any error generally means failure. For in chamber EB operation, such as the Pro-beam K2000 system at Nuclear AMRC, once the chamber is closed the only interaction between the operator and the work piece is through a camera or the electron beam. Tracking features of the material or the joint line is important to gather as much information on the situation as possible. Nuclear AMRC have used the functions of the Pro-beam multimode to gain reliability during welding. The team has demonstrated that the beam can be setup to high precision, assess whether a work piece has been correctly installed, a large joint can be fully seam tracked and features can be extracted from the data giving indication whether a joint can be safely welded or not. The system can automatically warn the operator if some situations are reached i.e., too large joint gap, too high magnetism and can correct itself.
Enfortumab vedotin prolonged overall survival in metastatic urothelial carcinoma compared to standard of care following pembrolizumab treatment
Authors: Uemura Koichi , Ito Hiroki , Kawahara Takashi , Jikuya Ryosuke , Tatenuma Tomoyuki , Ito Yusuke , Komeya Mitsuru , Muraoka Kentaro , Hasumi Hisashi , Hayashi Narihiko , Uemura Hiroji , Makiyama Kazuhide
Published: October 2023

Objective
In December 2021, enfortumab vedotin (EV), an antibody-drug conjugate (ADC) directed against nectin-4, was approved as a new treatment after platinum-containing chemotherapy and PD-1/PD-L1 inhibitors in Japan. This study aimed to evaluate, using real-world data, the efficacy and safety of EV therapy in patients with metastatic urothelial carcinoma (mUC).
Materials and Methods
Exactly 50 patients with mUC who discontinued pembrolizumab therapy due to disease progression between June 2018 and December 2022 at Yokohama City University Hospital were retrospectively evaluated. Of the 50 patients, 20 received EV therapy (EV group) and 30 received standard care (SOC group). All patients who underwent EV therapy were diagnosed with disease progression after EV approval in Japan.
Results
The median (interquartile range) follow-up period after pembrolizumab discontinuation was 4.2 (1.3–11.3) months. There were six (30%) deaths due to cancer in the EV group, with 27 (90.0%) in the SOC group. The overall survival (OS) after pembrolizumab discontinuation was not reached versus 2.6 months (p < 0.001) in the EV and SOC groups. Multivariate analysis revealed that lactate dehydrogenase levels (hazard ratio [HR] 1.01; 95% confidence interval [CI] 1.00–1.05; p = 0.04) and treatment after pembrolizumab (EV versus SOC group; HR 0.10; 95%CI 0.04–0.29; p < 0.001) were independent prognostic factors for OS.
Conclusion
EV prolonged OS in mUC patients compared with the standard of care following pembrolizumab treatment.
Artificial Neural Network-Based Surface Reconstruction Model of Wire-Arc Additively Manufactured Surfaces using Discrete Cosine Transfer
Authors: Banaee Seyed Aref , Sharma Abhay
Published: October 2023

The unique arc-based additive manufacturing process boasts exceptionally high deposition rates, but it comes with a trade-off – the generation of highly irregular surfaces that demand extensive post-machining efforts. These post-processing activities not only consume critical raw materials but also substantial energy resources. To mitigate these challenges and enhance process efficiency, it is crucial to develop predictive capabilities for surface topography based on key process parameters like wire feed speed and travel speed. In this study, a surface topography model is meticulously developed to reconstruct surfaces, utilizing wire feed speed, travel speed, and inter-pass temperature as input parameters. The initial phase involves identifying pertinent surface features that collectively define the surface. Out of the features examined, eight representative attributes emerge, including spatial average roughness, spatial peak height, spatial maximum valley depth, spatial skewness, spatial kurtosis, maximum flatness, and waviness. The surface reconstruction model employs the discrete cosine transform (DCT), necessitating a minimum of 30 DCT parameters for accurate surface reconstruction. Additionally, an ANN model is established to predict DCT parameters based on wire feed speed, travel speed, and inter-pass temperature inputs. Validation using the 309L stainless steel test material demonstrates the model's impressive accuracy in predicting DCT parameters, enabling precise forecasts of overall surface topography and machining allowances. This model lays the foundation for simulation-based additive-subtractive process design by identifying optimal deposition conditions and corresponding machining parameters. Furthermore, it streamlines the integration of realistic surfaces into computational models for additive process simulations, offering significant potential for improving additive manufacturing processes.
Modifiable Risk Factors for Cancer in the Middle East and North Africa: A scoping Review
Authors: Mansour Razan , Al-Ani Abdallah , Al-Hussaini Maysa , Abdel-Razeq Hikmat , Al-Ibrahim Akram , Mansour Asem H.
Published: October 2023

Purpose: This scoping review examines controllable predisposing factors attributable to cancer in the Middle East and North Africa (MENA) region's adult population, highlighting opportunities to enhance cancer prevention programs.
Design: We systematically searched the PubMed, Science Direct, and CINAHL, EMBASE, and Cochrane Library databases from 1997 to 2022 for articles reporting on the impact of modifiable risk factors on adult patients with cancer in the MENA region.
Results: The review identified 42 relevant articles, revealing that tobacco consumption, obesity, physical inactivity, and diet are significant modifiable risk factors for cancer in the region. Tobacco smoking is a leading cause of lung, bladder, squamous cell carcinoma, and colorectal cancer. A shift towards a westernized, calorie-dense diet has been observed, with some evidence suggesting that a Mediterranean diet may be protective against cancer. Obesity is a known risk factor for cancer, particularly breast malignancy, but further research is needed to determine its impact in the MENA region. Physical inactivity has been linked to colorectal cancer, but more studies are required to establish this relationship conclusively. Alcohol consumption, infections, and exposure to environmental carcinogens are additional risk factors, although the literature on these topics is limited.
Conclusion: The review emphasizes the need for further research and the development of targeted cancer prevention strategies in the MENA region.
Exploring van der Waals materials with high anisotropy: geometrical and optical approaches
Authors: Novoselov Kostya , Slavich Aleksandr , Ermolaev Georgy , Tatmyshevskiy Mikhail , Toksumakov Adilet , Matveeva Olga , Grudinin Dmitriy , Voronin Kirill , Mazitov Arslan , Kravtsov Konstantin , Syuy Alexander , Tsymbarenko Dmitry , Mironov Mikhail , Novikov Sergey , Kruglov Ivan , Ghazaryan Davit , Vyshnevyy Andrey , Arsenin Aleksey , Volkov Valentyn
Published: October 2023

The emergence of van der Waals (vdW) materials resulted in the discovery of their giant optical, mechanical, and electronic anisotropic properties, immediately enabling countless novel phenomena and applications. Such success inspired an intensive search for the highest possible anisotropic properties among vdW materials. Furthermore, the identification of the most promising among the huge family of vdW materials is a challenging quest requiring innovative approaches. Here, we suggest an easy-to-use method for such a survey based on the crystallographic geometrical perspective of vdW materials followed by their optical characterization. Using our approach, we found As2S3 as a highly anisotropic vdW material. It demonstrates rare giant in-plane optical anisotropy, high refractive index and transparency in the visible range, overcoming the century-long record set by rutile. Given these benefits, As2S3 opens a pathway towards next-generation nanophotonics as demonstrated by an ultrathin true zero-order quarter-wave plate that combines classical and the Fabry-Perot optical phase accumulations. Hence, our approach provides an effective and easy-to-use method to find vdW materials with the utmost anisotropic properties.
Exploring potential opportunities and strategies of using the new WHO Labour Care Guide to improve labour monitoring and health outcomes among health care providers in Uganda: A Qualitative Study
Authors: Mugyenyi Godfrey R , Atukunda Esther C , Tumuhimbise Wilson , Farjardo Yarine F , Byamugisha Josaphat
Published: October 2023

Background: Prolonged labour remains a major pathway to common labour complications. WHO Labor Care Guide (LCG) has been developed for health care providers (HCPs) to timely identify deviations from normal through regular assessment. We explored potential opportunities and strategies of using this LCG to improve labour monitoring among HCPs and MOH officials in Uganda.
Methods: Between June and September 2023, we purposively selected and conducted in-depth qualitative face-to-face interviews with 30 HCPs, and 6 MOH/WHO officials exposed to the LCG in Uganda. Interviews were digitally recorded in a private setting following informed consent. Translated transcripts were generated and coded. Coded data was iteratively reviewed and sorted to inductively construct categories describing multilevel factors that might influence HCP’s sustained engagement in labour monitoring, LCG uptake and implementation.
Results: The median age of the interviewed HCPs was 36 years(IQR,27-54). All participants demonstrated great enthusiasm, describing the new LCG as a simple, better, detailed, easy-to-use and comprehensive tool that could quickly and accurately detect prolonged labor for timely management, if modified appropriately. HCPs identified LCG’s potential to facilitate sustained use through perceived ability to; correctly define active labour at a more acceptable 5cm of cervical dilatation, have major labour parameters recorded on one-A4-paper for easy comparison and reference, stimulate HCP-patient-labour companion interaction for social support, undergo customization to address user needs, enhance accountability and reduce over-documentation, and workloadsince the same A4 paper could capture all the necessary details needed to make a “one-stop quick and effective clinical decision”. HCPs underscored the role and sustained benefitsof off-site training, team building, guidelines accessibility, real-time feedback, peer mentorships and championships. Noted LCG pitfalls included; small fonts, observation ordering that needed modifications to facilitate an easy-to-use interface, missing record of social-demographic and key outcome data, plus fields/parameters deemed redundant/inappropriate.
Conclusion: Our data demonstrates a responsive, enthusiastic and supportive environment that has potential to facilitate LCG customization, uptake and scale up. The high LCG expectations are important considerations in developing sustainable and acceptable implementation strategies that meet user needs. More work is needed to refine and evaluate the tool’s effectiveness in improving labour monitoring in Uganda.
Effects of a symptom cluster management intervention on the symptom cluster of pain-cough-fatigue-shortness of breath-anorexia and quality of life among post-thoracoscopic-surgery patients with lung cancer: A randomized controlled trial
Authors: Wang Xiaoxu , Liu Jiaxun , Duan Haiyang , Wei Holly , Dong Qiaona , Meng Qinghui
Published: October 2023

Purpose
To construct a symptom cluster management intervention based on symptom cluster theory for patients with non-small cell lung cancer (NSCLC) undergoing 3D thoracoscopic lobectomy and evaluate the efficacy and feasibility of the intervention on a five-symptom cluster, including pain, cough, fatigue, shortness of breath, anorexia, and quality of life (QoL) and hospital stay time of patients with lung cancer in the early period after lung cancer surgery.
Methods
A total of 100 patients with NSCLC after surgery from a hospital in a city in northern China from October 2019 to December 2019 were randomly assigned to either the intervention group (N = 50) or the control group (N = 50). The participants in the intervention group received symptom cluster management intervention based on the symptom management theory, while the control group received only usual care. The study outcomes, including pain, cough, shortness of breath, anorexia, fatigue, and QoL, were evaluated at baseline and on the first and fourth postoperative days.
Results
The baseline characteristic was comparable between the two groups. Pain, daytime cough, nighttime cough, fatigue, and shortness of breath were similar in both groups on the first postoperative day (all P > 0.05). Compared with the control group, the intervention group reported less pain, cough, fatigue, shortness of breath, and anorexia and more QoL on the fourth postoperative day, and shorter postoperative hospital stay time (all P < 0.05).
Conclusion
The symptom management intervention appears to be a feasible and acceptable method to manage the five-symptom cluster, promote QoL, and reduce postoperative hospital stay time in patients with NSCLC. Future studies are needed to examine the long-term effects of this intervention.
Trial registration
This study is retrospectively registered at Chinese Clinical Trial Registry (ChiCTR2300076312).
Preliminary utilization of high-resolution direct MRI fistulography with hydrogen peroxide in diagnosing anorectal fistula
Authors: Chang Cancan , Qiao Longhu , Zhang Zhenqi , Tian Xiao , Zhang Yu , Cheng Wenwen , Wang Xia , Yang Qing
Published: October 2023

Background: Fistula-in-ano is an abnormal tunnel formation linking the anal canal with the perineum and perianal skin. Multiple imagining methods are available to evaluate it, among which magnetic resonance imaging (MRI) is the most advanced noninvasive preoperative method. However, it is limited in its visualization function. Therefore, this study aims to investigate the feasibility of using a specific mixture of 3% hydrogen peroxide (HP) and gadolinium as a direct contrast agent for high-resolution MRI (HPMRI) of perianal fistula. Additionally, it investigated the value of this new method for preoperative examination of complex or recurrent fistula via a preliminary study.
Methods: Preoperative physical examination, conventional ultrasonography, MRI plain scan, and high-resolution direct HPMRI fistulography data from nine patients with surgically confirmed complex or recurrent fistula-in-ano were retrospectively analyzed. We also assessed the detection rates of fistula tracks and their associated internal openings, including the connection between them and the internal and external anal sphincters. Furthermore, the detection of perianal abscess was analyzed relative to the intraoperative observations.
Results: Surgical confirmation revealed nine cases of anal fistula, including 17 internal openings, 18 fistula tracks, 21 external openings, and six perianal abscesses. ROC curve analysis revealed that the effectiveness of the physical examination, conventional ultrasound, and MRI plain scans for detecting internal openings was lower than that of high-resolution direct HPMRI fistulography (Z = 3.739, 2.642, 2.642, all p < 0.05). The efficacy of physical examination and conventional ultrasound in detecting fistula tracks was lower than that of high-resolution direct HPMRI fistulography (Z = 2.394, 2.503, all p < 0.05). The effectiveness of physical examination in detecting perianal abscess was inferior to that of high-resolution direct HPMRI fistulography (Z = 3.417, p < 0.05). No statistically significant difference was observed in the ability of MRI plain scan to detect fistula tracks or in the capacity of conventional ultrasound to detect perianal abscesses than that of high-resolution direct HPMRI fistulography.
Conclusions: This novel high-resolution direct HPMRI fistulography technique enhances the visualization of recurrent and complex fistula-in-ano, enabling visualization of branched fistulas, thereby improving surgical outcomes.
Fiscal space and government-spending cyclicality: Disparity between the procyclical and the countercyclical
Authors: Lin Yi-Chen , Deng Wen-Shuenn
Published: October 2023

This study employs quantile regression analysis on a dataset encompassing 160 countries spanning the period from 1990 to 2020. Its primary objective is to investigate the relationship between fiscal space and various conditional quantiles of government-spending cyclicality. Unlike prior literature, which predominantly centers on government debt sustainability, our study introduces a comprehensive perspective on fiscal space, encompassing dimensions that have received comparatively limited attention. These dimensions include sovereign balance sheet vulnerability, contingent liabilities arising from risks associated with external and private sector debt, and market perceptions of sovereign risk. Our analysis suggests that fiscal space is statistically significant only at the upper part of the conditional government-spending cyclicality distribution, i.e., fiscally procyclical countries. We also find that, in fiscally procyclical countries, the share of foreign currency debt in total government debt, the share of government debt held by nonresidents in total government debt, the share of short-term external debt in total external debt, the ratio of government debt to tax revenue, natural resource dependence, and inflation rate are associated with higher government-spending procyclicality. In contrast, factors such as sovereign debt rating, financial depth, and the share of short-term debt in total external debt are associated with lower government-spending cyclicality.
JEC codes: H30, H60, H63
A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach
Authors: Weydandt Laura , Lia Massimiliano , Schöne Amanda , Hoffmann Janine , Dornhöfer Nadja , Aktas Bahriye , Stepan Holger
Published: October 2023

Background
Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimize blood loss.
Methods
We conducted a monocentric retrospective cohort study including all patients operated for PAS between 2006 and 2023. During this period, one-step surgery was abandoned and a two-step surgical approach was adopted. The number of units of red blood cells (RBC) needed during surgery were the primary outcomes used to compare these two approaches.
Results
A total of 43 cases were included in this analysis. Median blood loss during surgery was 2000 ml and 2800 ml for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBC was 0.28 (95%-CI: 0.063 ‒ 1.15, p = 0.067). Longer interval between the caesarean section and the second operation showed a trend to lower blood loss (p = 0.065) and were associated with a significantly lower number of RBC units needed during surgery (p = 0.019).
Conclusion
Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction of blood transfusion. Leaving the placenta in situ and delay final operation represents a possible alternative to traditional cesarean hysterectomy (one-step surgery).