bluuebunny/crossref_metadata_2025 huggingface dataset:
Wellens Syndrome: Prevalence, Risk Factors and Coronary Angiographic Variation. A Cross-Sectional Study
Authors: Mohamed Sami , Abdelaziz Samoal
Published: October 2023

Background: Wellens syndrome complicates acute coronary syndrome and, if unmanaged, can lead to immanent myocardial infarction. This study aimed towards determining the prevalence of Wellens syndrome among acute coronary syndrome patients while focusing on both types and identifying the associated risk factors, then exploring the variation in affected coronary arteries within patients fulfilling Wellens syndrome criteria.
Methods: Implementing a descriptive cross sectional hospital based observational study design, at Ahmed Gasim Teaching Hospital for Cardiac Surgery and Renal Transplantation in Khartoum North, Sudan, the study was conducted following using a non probability convenience sampling of patients fitting the inclusion criteria. Data was collected using closed ended structured questionnaires. Ethical clearance was obtained from relevant authorities. Statistical analysis was done using descriptive and comparative data analysis with the aid of the SPSS software, and STROBE guidelines were followed.
Results: A total of 120 patients were included, 70 males and 50 females, majority in their fifth decade. 14 patients had no documented risk factors. 42.5% had STEMI, 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%), 55.6% of them were type A and 44.4% were type B. Most frequently encountered risk factor among Wellens syndrome patients was Diabetes (50%). Out of 16 Wellens syndrome patients who underwent coronary angiography, 50% had mid LAD involvement, most were type A; 25% had proximal LAD involvement and 25% had normal coronary angiography. There was some association between Wellens syndrome and NSTEMI, but no significant association with any specific risk factor.
Conclusion: Wellens syndrome is not a rare condition although uncommon, it can present even without a specific predisposing risk factor and coronary angiographic variation other than the proximal part of the LAD artery may occur, including multiple vessels involvement.
Condensed Abstract: This is a descriptive cross sectional study conducted at Ahmed Gasim Teaching Hospital in Sudan, to determine the prevalence and risk factors of Wellens syndrome. Data was collected using questionnaires and analyzed with the SPSS software. Out of 120 patients, 14 patients had no documented risk factors. 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%). The commonest risk factor among Wellens syndrome patients was Diabetes (50%). 50% of Wellens syndrome patients had mid LAD involvement. The study concluded that Wellens syndrome is not rare, it can present without specific risk factor and coronary angiographic variation other than the proximal LAD artery can occur.
Neutrophil swarms containing myeloid-derived suppressor cells are crucial for limiting oral mucosal infection by C. albicans
Authors: Edgerton Mira , Rojas Isolde , Kumar Rohitashw , Li Rui , Salvatori Ornella , Abrams Scott , Irimia Daniel
Published: October 2023

Oral mucosal colonization by C. albicans (Ca) is benign in healthy people but progresses to deeper infection known as oropharyngeal candidiasis (OPC) that may become disseminated when combined with immunosuppression. Cortisone-induced immunosuppression is a well-known risk factor for OPC, however the mechanism by which it permits infection is poorly understood. Neutrophils are the primary early sentinels preventing invasive fungal growth, and here we identify that in vivo neutrophil functional complexes known as swarms are crucial for preventing Ca invasion which are disrupted by cortisone. Neutrophil swarm function required leukotriene B4 receptor 1 (BLT1) expression, and swarms were further characterized by peripheral association of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) showing that OPC recruits PMN-MDSCs to this site of infection. Furthermore, PMN-MDSCs associated with Ca hyphae had no direct antifungal effect but showed prolonged survival times and increased autophagy. Thus in vivo neutrophil swarms are complex structures with spatially associated PMN-MDSCs that likely contribute immunoregulatory functions to resolve OPC. These swarm structures have an important function in preventing deep invasion by Ca within the oral mucosa and represent a mechanism for increased disease severity under immune deficient clinical settings.
Repeated Fire and Extended Drought Influence Forest Resilience in Arizona Sky Islands
Authors: Fule Miles , Falk Donald A.
Published: October 2023

Background
Wildfire size, severity, and frequency have been increasing in the southwestern US since the mid-1980s as a direct result of anthropogenic climate change and land management practices. Significantly, high severity burn area in Arizona and New Mexico has been increasing at a rate of about 1,000 ha per year since 1985. More frequent, higher severity wildfire, combined with two decades of drought, threatens the persistence, regeneration, and resilience of conifer trees in the dry pine forests of Southern Arizona’s sky islands. Failure of conifers to recover may result in ecosystem reorganization as forested areas are replaced by oak or shrub woodlands. Here we report on radial tree growth, conifer regeneration, and community composition in the Santa Catalina Mountains following a series of wildfires in 2002, 2003 and 2020.
Results
In our tree growth analysis, we found a striking resilience to both drought and wildfire in three dominant conifers. Ponderosa pines (Pinus ponderosa) and Southwestern white pines (Pinus strobiformis) that survived both high and low severity fire showed non-significant positive growth trajectories following wildfire exposure in 2003. Douglas-fir (Pseudotsuga menziesii) growth was more climate-dependent and less fire-dependent than Pine growth. For areas that burned only in the earlier fires, conifer regeneration over the 17–18-year interval was found in the majority of burned plots, although density varied greatly. Community composition analysis in these areas indicated some loss of conifer overstory dominance in areas burned at high severity; in general, these were replaced mainly by Aspen (Populus tremuloides) in higher elevation stands, not deciduous or evergreen oaks.
Conclusions
Early post fire vegetation responses following the 2020 fire event were highly variable, in contrast to longer-term successional processes seen 17–18 years after the initial fire events. This wide variability one-year post-fire may be seen as a starting point for future trajectories of change in Southwestern forests under the influence of changing climate and fire regimes.
Antimicrobial use of patients with sexually transmitted infection symptoms prior to presentation at five health facilities in Southern Ghana
Authors: Attram Naiki , Dela Helena , Behene Eric , Ocansey Karen , Yanney Jennifer , Nyarko Edward Owusu , Kyei Nicholas N. A. , Addo Kennedy Kwasi , Koram Kwadwo , Fox Anne T. , Letizia Andrew , Sanders Terrel
Published: October 2023

Background Unregulated and inappropriate antimicrobial use are major contributors to the evolution of antimicrobial resistance worldwide. It is important to monitor and collect data on the use of antibiotics at health facilities and in the general population in order to support antimicrobial stewardship programs. Methods As part of a gonorrhea surveillance study, we administered a questionnaire to elicit information on the types of antimicrobials used by individuals to treat symptoms of a gonorrhea infection, prior to presenting at five health facilities in Southern Ghana. Results Almost one third (383/1,349; 28%) of study participants admitted to having taken one or more antimicrobial type before hospital presentation, while 138/383 (36%) of those who took antimicrobials could not remember what they ingested. Penicillin and its derivatives as well as ciprofloxacin and doxycycline were the most used, while a few individuals reported taking drugs such as kanamycin and rifampin. Males were more likely than females to take an antimicrobial, prior to attending a health center. Conclusion In order to curb excessive and inappropriate antimicrobial use, antibiotics that were used by patients prior to showing up at hospitals ought to be investigated by healthcare providers. It is recommended that health professionals be reminded of the consequences of unregulated antimicrobial use. Educational programs by the Health Ministry should inform the Ghanaian population on antimicrobial use practices that drive antimicrobial resistance. The sale of antibiotics by unauthorised persons should be curbed. These practices would help to mitigate the development and spread of antimicrobial resistance inNeisseria gonorrhoeaeand other disease pathogens.
Video-based Estimation of Blood Pressure
Authors: Tucker Conrad , Dasari Ananyananda , Jeni Laszlo
Published: October 2023

In this work, we propose a non-contact video-based approach that estimates an individual’s blood pressure. The estimation of blood pressure is critical for monitoring hypertension and cardiovascular diseases such as coronary artery disease or stroke. Estimation of blood pressure is typically achieved
using contact-based devices which apply pressure on the arm through a cuff. Such contact-based devices are cost-prohibitive as well as limited in their scalability due to the requirement of specialized equipment. The ubiquity of mobile phones and video-based capturing devices motivates the development
of a non-contact blood pressure estimation method - Video-based Blood Pressure Estimation (V-BPE). We leverage the time difference of the blood pulse arrival at two different locations in the body (Pulse Transit Time) and the inverse relation between the blood pressure and the velocity of blood in the artery to analytically estimate the blood pressure. Through statistical hypothesis testing, we demonstrate that Pulse Transit Time-based approaches to estimate blood pressure require
knowledge of subject specific blood vessel parameters, such as the length of the blood vessel. We utilize a combination of computer vision techniques and demographic information (such as the height and the weight of the subject) to capture and incorporate the aforementioned subject specific blood
vessel parameters into our estimation of blood pressure. We demonstrate the robustness of V-BPEby evaluating the efficacy of blood pressure estimation in demographically diverse, outside-the-lab conditions. V-BPE is advantageous in two ways; 1) it is non-contact-based, reducing the possibility of infection due to contact and 2) it is scalable, given the ubiquity of video recording devices.
Back Pain During Pregnancy in Indonesia: Characteristics, Prevalence, and Impact on Quality of Life
Authors: Djawas Faizah Abdullah , Noviana Mita , Pahlawi Riza , Pratama Aditya Denny , Roa-Alcaino Sonia
Published: October 2023

Background:Back pain is one of the most common musculoskeletal disorders experienced during certain periods of pregnancy. Though not life-threatening, pregnancy-related LBP and PGP may affect daily activities and impact quality of life. Our study aims to identify the risk factors linked with LBP and PGP and gauge the level of disability experienced by expectant mothers.Methods:A cross-sectional study was conducted throughout Indonesia. Data for this study were collected through self-administered questionnaires, with 341 women participating. The study required participants to answer a series of questionnaires that covered socio-demographics, medical information, characteristics of back pain, and quality of life. To evaluate the severity of pain and physical limitations, the study utilized the VAS and Indonesian versions of the Oswestry Disability Index (ODI), respectively.Results:There is no significant difference in the incidence of back pain among individuals with varying backgrounds in education and occupation. The odds ratio value of the age variable is 0.932, indicating that with each year's increase in age, there is a 6.8% decrease in the probability of developing back pain. A person who has had three pregnancies has a 0.2084 chance of experiencing back pain compared to those who are pregnant more than three times. Pregnant women who experience back pain have a disability level of 0.190645 (19.0645%), while those who do not experience back pain have an average of 0.013139 (1.3139%). This suggests that expectant mothers who experience back pain have a lower quality of life than those who do not.Conclusion:Pregnant women in Indonesia experience a high occurrence of back pain, which can significantly reduce their quality of life. Younger age and number of pregnancy is associated with the incidence of back pain.
Diagnostic Utility of Capnography in Emergency Department Triage for Screening Acidemia: A Pilot Study
Authors: Peng Paul , Manini Alex F.
Published: October 2023

Background: Capnography is a quantitative and reliable method of determining the ventilatory status of patients. We describe the test characteristics of capnography obtained during Emergency Department triage for screening acidemia.
Results: We performed an observational, pilot study of adult patients presenting to Emergency Department (ED) triage. The primary outcome was acidemia, as determined by the basic metabolic panel and/or blood gas during the ED visit. Secondary outcomes include comparison of estimated and measured respiratory rates (RR), relationships between end-tidal CO2 (EtCO2) and venous partial pressure of CO2, admission disposition, in-hospital mortality during admission, and capnogram waveform analysis.
A total of 100 adult ED encounters were included in the study and acidemia ([HCO3- ]≤22 "mEq/L" or pH< 7.35) was identified in 28 patients. The measured respiratory rate (20.3±6.4 breaths/min) was significantly different from the estimated rate (18.4 ±1.6 breaths/min), and its area under the receiver operating curve (c-statistic) to predict acidemia was only 0.60 (95% CI 0.51-0.75, p = 0.03). A low end-tidal CO2 (EtCO2 < 32 mmHg) had positive (LR+) and negative (LR-) likelihood ratios of 4.68 (95% CI 2.59-8.45) and 0.34 (95% CI 0.19-0.61) for acidemia, respectively—corresponding to sensitivity 71.4% (95% CI 51.3-86.8) and specificity 84.7% (95% CI 74.3-92.1). The c-statistic for EtCO2 was 0.849 (95% CI 0.76-0.94, p = 0.00). Waveform analysis further revealed characteristically abnormal capnograms that were associated with underlying pathophysiology.
Conclusions: Capnography is a quantitative method of screening acidemia in patients and can be implemented feasibly in Emergency Department triage as an adjunct to vital signs. While it was shown to have only modest ability to predict acidemia, triage capnography has wide generalizability to screen other life-threatening disease processes such as sepsis or can serve as an early indicator of clinical deterioration.
Is Remnant Preservation in Anterior Cruciate Ligament Reconstruction Superior to the Standard Technique? An overview of systematic reviews
Authors: Zhang Yunsong , Xiao Xiangyu , Deng Wei , Wang Jianyu , Han Jicheng , Gao Hongwei
Published: October 2023

Background: Anterior cruciate ligament injury is a common knee joint injury. Anterior cruciate ligament reconstruction is the best way to treat anterior cruciate ligament injury. It may have certain advantages to retain the ligament stump during the operation, but the results of systematic evaluation on whether to retain the ligament stump are different. The conclusion is still controversial, and the quality needs to be strictly evaluated.
Objective: To evaluate the methodological quality, risk of bias, reporting quality and evidence quality of the systematic review of remnant preservation in anterior cruciate ligament reconstruction, and to provide reference for clinical work.
Methods: We systematically searched the system evaluations in 8 electronic databases, the languages were limited to Chinese and English, and the time limit was from the establishment of the database to June 2023. Two reviewers independently screened literature and extracted data. The methodological quality, risk of bias, reporting quality and quality of evidence were evaluated by AMSTAR-2, ROBIS, PRISMA and GRADE tools.
Results: A total of 14 systematic reviews were included. The evaluation results showed that the methodological quality of the included systematic reviews was relatively low, of which 5 were low quality and 9 were critically low quality. A small number of systematic reviews were low risk of bias. The system evaluation reports are relatively complete, but the lack of program registration is a common problem. A total of 111 clinical evidence were extracted from the included systematic reviews. The quality of evidence was generally low, with only 7 high-quality evidence, 45 medium-quality evidence, and the rest were low and very low-quality evidence. Among the reasons for relegation, imprecision is the most common, followed by inconsistency and indirectness.
Conclusion: The existing evidence shows that patients after anterior cruciate ligament reconstruction with remnant preservation have certain advantages in knee joint function, joint stability and proprioception recovery, which may be a more effective surgical method. At the same time, it may increase the incidence of postoperative complications and adverse reactions. The disadvantage should also be taken seriously. However, at present, the quality of evidence is generally low, and the reliability of the conclusion is insufficient. It still needs to be verified and further in-depth research is needed.
BERT-based model to predict cardiovascular disease by analyzing healthcare utilization behavior of patients newly diagnosed with metabolic diseases
Authors: Chang Hyuk-Jae , Song Shinjeong , Kim Gaeun , Kim Taeyoung , Shin Dongyup , Kim Sunhee , Park Jeongho , Bae Jaehyung , Kong Junsik , Sung Jimin
Published: October 2023

Background
The rise in cardiovascular disease (CVD) worldwide is causing enormous social and economic costs. Accordingly, the field of precision medicine aims to improve care through personalized prediction and prevention. In South Korea, we have health insurance claims data (HIRA) covering almost every citizen, which provides all the information about healthcare utilization behavior. Health insurance users can access their data through a simple authentication process. This data can be used to predict their personalized risk factors. Recently, bidirectional encoder representations from transformers (BERT) and related models have achieved tremendous success in the natural language processing domain. We adapt the BERT framework originally developed for the text domain to the structured HIRA data. The study aimed to predict secondary cardiovascular diseases in patients with newly diagnosed metabolic diseases (hypertension, diabetes, hyperlipidemia) using HIRA claims data and BERT.
Methods
Each disease was assigned to the training, validation, and test sets in the ratio of 7:2:1 through data augmentation. Patients' diagnoses and prescribed medications were embedded as input sequences, and age was used for positional encoding to distinguish visits. The predictive ability of the model was evaluated by measuring the area under curve(AUC).
Result
In each group of patients diagnosed with hypertension, diabetes, and dyslipidemia, BERT achieved mean receiver operating characteristic curve (AUC) areas of 97.9%, 97.8%, and 97.8%, respectively.
We found that the top-ranked conditions for self-attendance were hypertension, diabetes, dyslipidemia, and diagnoses and medications that are more common in older adults.
Conclusion
BERT performs good cardiovascular disease prediction using only diagnosis names and medication prescriptions on a relatively small training dataset. This study suggests that BERT can be used to advance personalized predictive healthcare models and patient care.
A digital twin for parallel NMR spectroscopy
Authors: Korvink Jan , He Mengjia , MacKinnon Neil , Cheng Yen-Tse , Jouda Mazin , Luy Burkhard
Published: October 2023

One approach to increasing NMR measurement sample throughput is to implement multiple, independent NMR detection sites. However, the presence of radio frequency interference poses a significant challenge in multi-detector NMR systems, particularly in unshielded coil arrays lacking sufficient electrical isolation. This issue can lead to unwanted coupling of inductive coils, resulting in excitation pulse interference and signal transfer among multiple detection sites. To address this problem, we propose a theoretical framework that combines electromagnetic simulation with spin-dynamic calculations. This framework enables the evaluation of coil coupling effects, the design of parallel pulse sequences to mitigate inter-channel coupling, and the separation of composite Free Induction Decays (FIDs) obtained from multiple detectors. These results provide valuable insights for the design of parallel NMR hardware and for exploring the limits of parallelization capacity within a fixed magnet system.
Prophylactic mastectomies and bilateral salpingo-oophorectomies in patients with breast cancer and BRCA mutation: an Austrian registry
Authors: Leser Carmen , Deutschmann Christine , Dorffner Georg , Gschwantler-Kaulich Daphne , Abayev Sara , Stübler Madeleine , Reitsamer Roland , Singer Christian
Published: October 2023

Objectives
Risk-reducing surgeries are common in patients with breast cancer gene (BRCA) mutations. Certain patients develop breast cancer before they opt for these surgeries. We examined the frequency of risk-reducing mastectomies and salpingo-oophorectomy among Austrian patients with breast cancer and BRCA mutations.
Methods
In 2014, we established an Austrian registry of BRCA1 and BRCA2 mutation carriers. From onset until 2018, 111 patients were recruited from four breast cancer centers. Data on the type of mastectomy, reconstructions, and complications were collected.
Results
A small proportion of patients (13.5%) had bilateral breast cancer. Among patients with unilateral breast cancer, the majority (86.8%) opted for prophylactic mastectomy on the contralateral side. Those who underwent modified radical mastectomy were more likely to choose prophylactic surgery (p = 0.001). A total of 19.4% of patients experienced cancer relapse postoperatively. Immediate reconstructions were recorded (71.3%). In addition, patients undergoing immediate reconstruction were more likely to undergo a prophylactic operation on the contralateral side than those with delayed reconstruction (p = 0.001). A mesh was used in only 47.8% of all reconstructions. The subpectoral implant position was present in 75.6% of patients and the pre-pectoral position in 13.3%. A mesh was inserted in all patients with a the pre-pectoral implant position.
Conclusion
The results indicate that the patients understood the procedures considering their willingness for risk-reducing surgeries and the expectation of good cosmetic outcomes in immediate reconstructions.
Attitudes, Practices and Understanding of health workers and caregivers regarding the relationship between severe pneumonia and malnutrition in children: A Qualitative Study
Authors: Nalwanga Damalie , Opoka Robert Opika , Ssemata Andrew Sentoogo , Kakooza Lawrence , Kiggwe Andrew , Musiime Victor , Kiguli Sarah
Published: October 2023

Background Severe Pneumonia is still the leading cause of morbidity and mortality among children worldwide. Many children with severe pneumonia are reported to die in hospital as well as following discharge due to malnutrition. Severe pneumonia is a catabolic illness, which predisposes to severe malnutrition. WHO and United Nations Children’s Fund (UNICEF), recommend ‘continued’ feeding but do not give any specific recommendations for nutritional support. This could influence health workers’ and caregivers’ attitudes, practices and understanding regarding the topic. This study aimed to explore the attitudes, practices and understanding of health workers regarding the relationship between severe pneumonia and malnutrition.Methods We conducted an exploratory qualitative study among health workers and caregivers of children hospitalized with severe pneumonia at Mulago National Referral Hospital in Uganda. Data were collected using focus-groups involving caregivers and key informant interviews with health workers and analysed using the content-thematic analysis approach. Both manual coding and Atlas Ti software were used to support the analysis.Results Some of the health workers and caregivers were aware of the relationship between severe pneumonia and malnutrition to various degrees, citing reduced appetite, difficulty in breathing and persistent vomiting as pathways to malnutrition in patients with severe pneumonia, which called for a balanced diet and more frequent breastfeeding. Suppressed immunity in malnourished children was mentioned as the pathway to severe pneumonia. Some caregivers confessed not knowing anything about the relationship between the two conditions.Conclusion Attitudes, practices and understanding regarding the deadly relationship between severe pneumonia and malnutrition among care givers could further be improved by health education and mass sensitization. Clarifying practice guidelines could further enhance attitudes and practices of health workers to reduce preventable pneumonia deaths.
Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score- matched analysis based on the MIMIC-IV database
Authors: Xu Fuchao , Xu Jianxin , Ma Jinjin , Xu Wenbo , Gu Shuangshuang , Lu Geng , Wang Jun
Published: October 2023

Background
Nutrition therapy is an integral part of the management of patients with sepsis. Recently, published guidelines recommend early initiation of enteral nutrition in adults with sepsis who can be fed enterally. However, early enteral nutrition's optimal timing and clinical benefits are still unclear. This study aimed to evaluate whether early enteral nutrition improves clinical outcomes in patients with sepsis compared with delayed enteral nutrition.
Methods
We utilized data from septic patients in the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2 database and categorized those who began enteral nutrition (EN) within 3 days of admission to the ICU as the early enteral nutrition (EEN) group and those who began EN between 3–7 days after ICU admission as the delayed enteral nutrition (DEN) group. The main outcome was 28-day mortality. We conducted propensity score-matched analyses to compare outcomes between the two groups. Subgroup analyses were performed to determine whether different groups of septic patients had better outcomes with early enteral nutrition.
Results
We identified 2267 eligible patients, including 1594 patients (70.3%) in the early EN group and 673 (29.7%) in the delayed EN group. Before propensity matching, we found that the EEN group had lower 28-day mortality than the DEN group (crude OR = 0.789 (0.637–0.977); p = 0.030), fewer ICU stays (8.36 (5.00-12.99) vs. 10.42 (7.83-15.00); p < 0.001), and a lower incidence of stage 3 AKI (35.1% vs. 50.2%; p < 0.001). After propensity score matching, there was no significant difference in 28-day mortality (OR = 0.808 (0.622–1.050); p = 0.111). However, the duration of ICU stay in the early EN group was still lower than that in the delayed EN group (8.83 (5.03-13.00) vs. 10.41 (7.83–14.89); p < 0.001), and the incidence of stage 3 AKI was lower (39.6% vs. 49.3%; p < 0.001). Subgroup analysis showed that the MICU group (adjusted OR = 0,631 (0,428-0,930); p = 0.020) and the male group (adjusted OR = 0,668 (0,455-0,981), p = 0,040) were associated with reduced 28-day mortality with early enteral nutrition.
Conclusions
For septic patients, early enteral nutrition may not reduce mortality. However, early enteral nutrition reduced the ICU length of stay and incidence of stage 3 AKI in sepsis patients. We also found that patients with sepsis in the MICU and males may benefit more from early enteral nutrition through subgroup analysis. Which patients with sepsis may benefit from early enteral nutrition needs to be further investigated.
Fabrication of Superhydrophobic, Permeable, and Anti-Reflective Porous Steel Surfaces using Laser Ablation and Heat Treatment for Multifunctional Applications
Authors: Zhu Duanyi , Liu Qiang , Li Qiang
Published: October 2023

Achieving high water resistance, good permeability, and anti-reflectivity on metal surfaces in a cost-effective and efficient manner has always been a major challenge. This study addresses these challenges by utilizing laser ablation and heat treatment to achieve high water resistance, breathability, and anti-reflection properties in porous steel. The laser ablation and heat treatment process generated a unique porous nested structure on the surface and imparted excellent hydrophobicity and low adhesion properties on the porous steel surface. The size and density of the porous nested structure can be adjusted by changing the laser parameters. Notably, hydrophobicity of the surface is demonstrated to be closely related to the complexity of the surface microstructure, which follows the same trend as the permeability and anti-reflectivity. Specifically, higher laser power and smaller laser spacing generate structures with greater aspect ratios and higher porosity, resulting in a rough surface with an increased air contact area and, consequently, an increase in the viscous permeability coefficient (B). Moreover, the intricate porous nested structure acts as a complex "light trap," whereby the reflectivity of the superhydrophobic porous steel surface ( laser power of 25.4 W and scanning interval of 100 µm) can be less than 15% across a wide wavelength range (200 nm-1800 nm). This study presents a method for fabricating multifunctional surfaces with superhydrophobicity, permeability and anti-reflectivity on permeable steel. The method provides an efficient and cost-effective solution to improve the performance of existing materials and has great potential for a wide range of applications such as solar cells, military stealth, and reduced navigation resistance.
Analysis of the application and efficacy of Tocilizumab in the treatment of COVID-19 in China: A real-world investigational study
Authors: Sun Kin-Weng , Guo Su-Juan , Yang Zhi-Cheng
Published: October 2023

Backgrounds:
The criteria for the clinical application of tocilizumab in COVID-19 treatment still remain unclarified. This study aims to retrospectively analyze the clinical application of Tocilizumab in the treatment of patients with COVID-19 in our hospital, identify existing issues during clinical use, and provide reference and recommendations for the rational use of Tocilizumab in the treatment of COVID-19.
Methods
The medical records and prescription information of patients who received Tocilizumab for COVID-19 in our hospital from December 1, 2022 to June 30, 2023 was reviewed and analyzed. By reviewing the prescription information of tocilizumab, combined with the clinical efficacy, the problems existing in the current clinical application of tocilizumab in treating COVID-19 were identified and summarized.
Results
A total of 30 patients were included in this study. (1) Two dosage regimens were provided, 17 patients received a dose of 400mg per administration, and 13 patients received a dose of 4–8 mg/kg per administration based on actual body weight. (2) Out of the 30 patients, 20 received only one dose, 9 received a second dose, and one received a third dose. (3) All patients received combination therapy, including glucocorticoids, proton pump inhibitors, and antiviral drugs. (4) Regarding clinical efficacy, 8 patients died after 28 days, while 17 patients were discharged. Among the 14 mechanically ventilated patients, 5 were successfully weaned off ventilation. CRP and IL-6 levels showed significant differences before and after administration (34.72% decrease and 222.88% increase respectively). Adverse reactions occurred in 19 patients, mainly anemia, hypertension, and thrombocytopenia.
Conclusions
Our retrospective analysis revealed several problems associated with the current clinical application of tocilizumab, such as undefined indications, inconsistent dosage regimens, discrepancies between contraindications and drug instructions, and lack of consideration for drug interactions in combination therapy. Furthermore, we found that the real-world treatment efficacy of Tocilizumab in COVID-19 is similar to that observed in major clinical trials. The use of Tocilizumab in the treatment of COVID-19 still faces numerous challenges and issues. Further optimization of treatment protocols is necessary to ensure the health and safety of the patients.
The Use of an Audience Response System in a Dental Gross Anatomy Practical Exam
Authors: Ahmad Maha , Hanna Fadia , Sleiman Naama , MacDonald Douglas A.
Published: October 2023

Purpose: Traditional methods for the administration and scoring of gross anatomy practical laboratory examinations are time and resource intensive and can be susceptible to errors in grading. Alternative approaches, such as the use of audience response systems (e.g., clickers) and computerized scoring appear to hold promise to improve the examination experience for students and to improve the efficiency and accuracy of grading.Method: To assess perceptions of the use of such systems, two cohorts of students who completed the gross anatomy practical examination using clicker technology at the University of Detroit Mercy School of Dentistry were invited to complete the survey.Results: A total of 155 students completed the survey. Responses reflect a mostly positive appraisal of the use of clicker technology by the majority of students. In particular, students reported that the submission of responses was easier and that the speed of grading and feedback on examination performance was considerably improved.Conclusion: Based upon the survey results, it is concluded that the use of audience response systems appears to have more benefits than liability and seems to be a worthwhile technology to use for practical laboratory examinations.
Chemo-sensitive and chemo-resistant ovarian cancer cells show differences in cellular processes leading to pyroptotic cell death
Authors: Berkel Caglar , CACAN Ercan
Published: October 2023

Tumor immunology in ovarian cancer is not completely understood. Chemoresistance limits the success of available treatment options for patients with ovarian cancer. Pyroptosis, pro-inflammatory programmed cell death characterized by membrane pore formation by gasdermin proteins, is important for both immunogenicity and drug resistance. Here, we showed that estrogen increases GSDMC and GSDMD mRNA levels in chemo-sensitive ovarian cancer cells but not in chemo-resistant ovarian cancer cells in vitro. GSDMC or GSDMD overexpression increases cell viability in chemo-sensitive ovarian cancer cells but not in chemo-resistant ovarian cancer cells. Silencing of GSDMD in chemo-sensitive ovarian cancer cells and silencing of GSDMC in chemo-resistant ovarian cancer cells limits the effect of nigericin, a pyroptosis inducer, on cell viability. Inhibition of caspase-1, -4, -6 or -8 blocks nigericin-induced cell death (pyroptosis) in chemo-sensitive ovarian cancer cells; however, only the inhibition of caspase-1 blocks nigericin-induced cell death in chemo-resistant ovarian cancer cells, showing that caspases participating in pyroptosis might differ between ovarian cancer cells based on their chemo-sensitivity profiles. Treatment with disulfiram, a GSDMD pore formation inhibitor, decreases cell viability in both cell lines. Lastly, we found that in chemo-resistant ovarian cancer cell line, disulfiram and nigericin combination treatment decreased cell viability even more compared to only disulfiram or only nigericin treatment. Combined, our study pointed that ovarian cancer cells with different chemosensitivity profiles might have certain differences in pyroptotic cell death.
RETRACTED: The Effect of Guided Imagery Based on Health Promotion Model on Quality of Life in Breast Cancer Patients: A Randomized Controlled Study
Authors: Ata Gülnaz , Kılıç Dilek , Yıldırım Derya Gürcan
Published: October 2023

The authors have requested that this preprint be removed from Research Square.
Deciphering Hydrochemical Characteristics and Formation mechanism of Groundwater in the Banggou Iron Mine Area, Peru
Authors: Ge Qin , Wang Huiman , Wan Sheng , Wu Ping , Li Xiang , Mi Zhenhua , Li Xinyan , Wang Yang
Published: October 2023

Understanding the hydrochemical characteristics and formation processes of groundwater in mining areas is crucial for protecting and utilizing underground water resources. This study analyzed 42 groundwater samples from the Banggou mining area in Peru to determine the spatial-temporal distribution patterns and formation processes of chemical components. Statistical analysis, Gibbs diagrams, ion ratios, and hydrogeochemical modeling techniques were used. The results show that the groundwater in the study area is weakly alkaline (pH = 7.72) and has a total dissolved solids (TDS) range of 253.19 to 17912.82 mg/L, with an average of 2788.31 mg/L. About 55% of the groundwater samples are classified as brackish or saline water. The chemical composition of groundwater is mainly controlled by evaporation, rock weathering, human activities, oxidation of pyrite, and desulfurization reactions. The dissolution of evaporite minerals such as halite and gypsum contributes to the presence of Na+, Cl−, and SO42−, while Ca2+ and Mg2+ mainly come from the dissolution of minerals like calcite, gypsum, dolomite, and silicate. The presence of NO3− is attributed to anthropogenic influences. The hydrogeochemical modeling indicates a strong dissolution tendency for halite and propensity for dissolution for gypsum, calcite, and dolomite. Additionally, pyrite oxidation and cation exchange processes occur from recharge to discharge zones.
Influence of Electric Field on Electrical Tree Growth in Epoxy Resin with Fillers
Authors: Htet Swe Zin Linn , Kondo Takuya , Miyake Takuma , Sakoda Tatsuya , Nishimura Takeshi
Published: October 2023

We investigate the influence of electric field in epoxy resin with fillers on electrical tree growth from a void. Not only observation of electrical trees but also measurements of temporal variations in partial discharge (PD) occurrence frequency and PD magnitude were carried out. It was found that the occurrence of PD with larger magnitude is less before breakdown and that there is a decreasing trend of the time required for breakdown with the increase of electric field in a void. Additionally, when electric field of the tip of a pit is almost the same as the withstand electric field of the epoxy resin, dielectric breakdown gradually occurs in a short time. However, the electrical tree growth is disturbed by fillers in epoxy resin, and the required time for breakdown of epoxy resin with fillers is much longer than that without fillers.
Flexoelectricity-driven toroidal polar topology in liquid-matter helielectrics
Authors: AYA Satoshi , Yang Jidan , Zou Yu , Li Jinxing , Huang Mingjun
Published: October 2023

Magnetic and electric dipoles share the symmetry similarity, being expected to exhibit many common structures. However, despite various spin textures composed of magnetic dipoles being reported frequently, investigations on long-range ordered electric dipoles have been scarcely made until recently. Here, we discover spontaneous toroidal polar topology in an emerging ferroelectric liquid state with polarisation helices, dubbed helielectric nematic. The interplay between the liquid crystal elasticity and polar interactions results in a continuous in-plane rotation of the polarisation, producing a periodic toroidal assembly. Partially in analogy with magnetism but different, the neighbouring toroidal domains are separated by circular-shaped domain walls. With an ultra-sensitive electric field down to 10-4 V μm-1, the local polarisation switching enables unique shrinkage/expansion dynamics of the toroidal domains. The discovery enriches polar topology and provides unprecedented opportunities to develop designable and switchable ferroelectric-liquid-matter optoelectronics.
Dynamics of Gasoline Price Changes; The Effects of Pricing Policies in Iran
Authors: Saryazdi Ali Haji Gholam , Tavangar Leila
Published: October 2023

The government as the determinant of gasoline prices in Iran has always faced challenges because of economical, social, cultural and environmental effect of gasoline price changes. In recent years, different implemented pricing policies have had varied consequences and, in some cases, have not necessarily achieved the purposes that the policy makers sought. Since the dynamics of the gasoline pricing system in IRAN's economy resulted in undesirable outcomes, this article aims to understand the structure governing gasoline pricing, price change policies, and their effects to compare different policies related to this subject and provide practical suggestions for gasoline pricing in IRAN. The system dynamics approach is used to illustrate the structure governing the price of gasoline and identification and simulation of different policies' effects on model behavior. The simulation results showed that if the politician's goal is to decrease the prices, the best policy is inflation-based pricing and price consolidation, although the gasoline demand (consumption and smuggling) is maximum. But if the goal is to decrease consumption, the ideal policy is pricing based on regional prices or supply and demand with gradual change.
Coupling design and fabrication of continuous carbon fiber reinforced composite structures using two-material topology optimization and additive manufacturing
Authors: Ho Thuan N.-T. , Nguyen Son H. , Thao Le Van , Hoang Tien-Dat
Published: October 2023

This study presents an integration of the level set-based two-material topology optimization method and the additive manufacturing technique for the design and fabrication of continuous carbon fiber (CCF)-reinforced composite structures. Firstly, optimal configurations of the resin material and fiber reinforcement are obtained to maximize the structural stiffness under desired volume constraints using the two-material topological optimization. After that, the level set-based cutting mesh method and triangulation scheme are employed to interpret these topological designs into stereolithography (STL) models with clear structural boundaries for the manufacturing. A customized pre-processing strategy is used to accurately determine the fiber placement regions from the optimal designs. Topological results are then fabricated using the CCF-based 3D printing method with prepreg carbon fibers. Subsequently, the performance of printed CCF-reinforced composite structures is investigated, using different resin materials: Esun polylactic acid (EPLA) and polyamide 12 with 10% carbon fiber (PA12\_10CF). Experimental results indicate a significant increase in stiffness and strength of composite structures with fiber reinforcements for all resin materials, with an increase of 315% for EPLA and 234% for PA12\_10CF. Additionally, the CCF-reinforced composite structures made of PA12\_10CF exhibit superior stiffness compared to those made of EPLA with a double increment. The microstructural characteristics of damaged regions are examined using scanning electron microscope (SEM) images, which provide valuable insights into the behavior of resin and fiber materials.
Gender Discrimination as an Ophthalmic Surgeon; A survey of Medical personnel at Eye Department of Mayo Hospital
Authors: Imtiaz Hafiza Sadia , Siddiqui Zahid kamal , Rehman Shujah Ur , Rafique Memoona , Sharjeel Muhammad
Published: October 2023

Objective: To determine gender preferences of medical personnel when selecting ophthalmologists for routine check-up and ophthalmic surgeries and also to determine the factors responsible for this gender-discrimination while selecting a surgeon.
Material and Methods: After getting ERB approval and taking informed consent from every participant, a cross-sectional study was conducted at Eye unit 3, Mayo Hospital, for a duration of 3 months using convenience sampling. 100 participants of either gender, of age 18 years or above, who are medical personnel working in Eye department of Mayo Hospital, including doctors and non- doctors’ staff were included in this study. Data was recorded on specially designed questionnaire and further analyzed on spss.
Results: 100 participants were enrolled in this study, out of which 62% were male and 38% were female. Mean age recorded was 32±2.4 years. Majority of participants didn’t have any preference (50.2%) in total and among them the highest level of no preference was for regular checkups (66%) and for Emergency cases (55%). While for elective surgical procedures, majority have male preference for vitreoretinal cases (50%) and for complicated cases (48%). While female surgeons were preferred compared to males only in pediatric ophthalmology cases (33% versus 21%). Among the positive characteristics of a female surgeon, mostly agreed that females are more detail oriented, have patient centered communication style, more empathetic, and understand the psychological factors better and are well-qualified. Mostly agreed that male surgeons are more confident, have strong decision power, better in dealing with complex cases and intra-operative complications and also performing in emergency situation.
Conclusion: In conclusion, almost half of participants didn’t show any preference and among remaining participants, male surgeons were preferred over female surgeons. Male surgeons were preferred for being more confident, fearless, more experienced, competent in dealing with complicated cases, more decisive, and having better professional skill.
Hypoxia upregulateing ACSS2 enhances lipid metabolism reprogramming through HMGCS1 mediated PI3K/AKT/mTOR pathway to promote the progression of pancreatic neuroendocrine neoplasms
Authors: Gu Danyang , Ye Mujie , Zhu Guoqin , Bai Jianan , Chen Jinhao , Yan Lijun , Yu Ping , Lu Feiyu , Hu Chunhua , Zong Yuan , Liu Pengfei , He Qibin , Tang Qiyun
Published: October 2023

Background
Pancreatic neuroendocrine neoplasms(pNENs) are a relatively rare disease.Hypoxia and lipid metabolism-related gene acetyl-CoA synthetase 2(ACSS2) is involved in tumor progression,but its role in pNENs is not revealed.This study showed that hypoxia can upregulate ACSS2,which plays an important role in the occurrence and development of pNENs through lipid metabolism reprogramming.However,the precise role and mechanisms of ACSS2 in pNENs remain unknown.
Methods
mRNA and protein levels of ACSS2 and 3hydroxy-3methylglutarylCoA synthase1(HMGCS1) were detected using quantitative real-time PCR(qRT-PCR) and Western blotting(WB).The effects of ACSS2 and HMGCS1 on cell proliferation were examined using CCK-8, colony formation assay and EdU assay, and their effects on cell migration and invasion were examined using transwell assay.The interaction between ACSS2 and HMGCS1 was verified by Co-immunoprecipitation(Co-IP) experiments,and the functions of ACSS2 and HMGCS1 in vivo were determined by nude mouse xenografts.
Results
We demonstrated that hypoxia can upregulate ACSS2 while hypoxia also promoted the progression of pNENs.ACSS2 were significantly upregulated in pNENs,overexpression of ACSS2 promoted the progression of pNENs and knockdown of ACSS2 and ACSS2 inhibitor(ACSS2i) trearment inhibited the progression of pNENs.ACSS2 regulated lipid reprogramming and the PI3K/AKT/mTOR pathway in pNENs,ACSS2 regulated lipid metabolism reprogramming through the PI3K/AKT/mTOR pathway.Co-IP experiments indicated that HMGCS1 interacted with ACSS2 in pNENs.Overexpression of HMGCS1 can reverse the enhanced lipid metabolism reprogramming and tumor-promoting effects of knockdown of ACSS2.Moreover,overexpression of HMGCS1 reversed the inhibitory effect of knockdown of ACSS2 on the PI3K/AKT/mTOR pathway.
Conclusion
Our study revealed that hypoxia can upregulate the lipid metabolism-related gene ACSS2,which plays a tumorigenic effect by regulating lipid metabolism through activating the PI3K/AKT/mTOR pathway.In addition,HMGCS1 can reverse the oncogenic effects of ACSS2, providing a new option for therapeutic strategy.