bluuebunny/crossref_metadata_2025 huggingface dataset:
New Valid and Reliable Test to Assess Glenohumeral Rotation Range of Movement in Clinical Practice, Injury Prevention Programs and Evaluation of Treatment Response in Overhead Athletes
Authors: Tlaiye Juliette , Terré Maite , Alentorn-Geli Eduard , Solana-Tramunt Mònica
Published: October 2024

The measurement of shoulder range of motion (ROM) has gained value within the healthcare field. Thanks to modern technology, goniometers have been developed as mobile applications; however, the reliability and validity of many of these apps have not been established. Such is the case of reliability of the OnForm app and validity of the My ROM app, object of this study. Methods: With data obtained from both apps from the measurement of bilateral external and internal rotation (at 90º of shoulder abduction) of 49 subjects, four different tests were run: inter-observer, test-retest, and intra-observer and one for validity. The statistical method applied was the intraclass correlation coefficient (ICC). Results: Both, OnForm and My ROM obtained in all the tests, significant results that prove that they are valid and reliable tools for athletes’ assessment. Conclusions: Both OnForm and My ROM are valid and reliable tools for daily use in clinical practice. They may be used by a single evaluator, they are easy to find with a convenient price, and the availability of the results is immediate.
Periodismo literario. El arte de contar historias, de Luis Guillermo Hernández. Nuevo manual y antología de la Realidad Recreada
Authors: Candia Adriana
Published: October 2024

Cuando la Red de Perio- distas de Ciudad Juárez me pidió que presentara el libro Periodismo literario. El arte de contar historias, de Luis Guillermo Hernández no dudé mucho en aceptar. Hablando francamente: porque siendo yo misma practicante de este género, ¿o de la literatura periodística?, he visto la necesidad de que dicho género sea reconocido a plenitud tanto por la colegiada del periodismo como por quienes canonizan a la literatura.
Calaca filosófica / Calaveras Migrantes
Authors: García Agustín
Published: October 2024

Fragmento: En estos tiempos aciagos –pocos ricos, muchos pobres– cuánta gente anda migrando con sus huesos por el orbe.
El minimalismo: literatura chicana (parte II)
Authors: García José Manuel
Published: October 2024

En la primera parte de este trabajo hablé del género de la novela corta, mencionando los principales autores chicanos que la han utilizado: Tomás Rivera, Rolando Hinojosa y Sandra Cisneros. Ahora toca hablar de los otros géneros breves del chicanismo literario.
Kondisi Altruisme Pengamal Tasawuf di Pondok Pesantren Darul Afkar
Authors: Rahmadi Sidiq , Prihartanti Nanik
Published: October 2024

Individualistic tendencies can trigger selfish attitudes. Indonesia has a high generosity index score, but has experienced a decline in helping behavior. This research aims to describe the condition of altruism among Sufism activists and identify the factors that influence it. This is a qualitative phenomenological approach and data was collected through interviews and observations with six people of Sufism activists at the Darul Afkar Islamic Boarding School. The results show that the conditions of altruism that emerge among Sufism activists are based on understanding and belief in Islamic values, understanding and belief form attitudes that have an impact on altruistic behavior, and is able to give rise to various positive feelings. The altruism condition influenced by internal fakctor (gender, cognitive ability, empathy, and religious beliefs) and external factors (experience, interpersonal interactions, and environmental factors). This is a valuable finding in the realm of implementing Sufism in life.
HEALTHY LIFE EXPECTANCY IN THE CONTEXT OF DEMOGRAPHIC FORECASTS
Authors:   Institute for Demographic Research of the Federal Center of Theoretical and Applied Sociology of the Russian Academy of Sciences, Moscow, Russia, Ivanova Alla , Starodubov Vladimir ,   Russian Research Institute of Health, Ministry of Health of the Russian Federation, Moscow, Russia
Published: October 2024

Significance. The relevance of the study is related to the need to develop adequate tools for assessing and monitoring achievements of the national demographic goals. The purpose of the study is to evaluate the association of age and loss of health in the context of the forecast on aging of the Russian population. Material and methods. A comparative assessment of the Rosstat demographic forecast options until 2045 was carried out from the standpoint of analyzing the pace of demographic ageing; data of the Rosstat sample observation on the quality and accessibility of services in the field of education, health, social services, and employment conducted in 2019 were used; indicators characterizing various aspects of health loss were selected. The relationship between the criteria of ill health was investigated using factor analysis methods and a generalized indicator “quality of life from the standpoint of health” was offered: Using the Sullivan method, an assessment of healthy life expectancy and losses associated with ill health was carried out: first, using each criterion separately, then using the generalized indicator. Results. It has been established that under any demographic forecast scenario, the population over the working age will grow at the maximum rate - under the most favorable option from the point of view of population dynamics. At the same time, there will be a progressive ageing of the elderly population with a higher increase in people aged 85 and older. The use of various criteria for assessing ill health results in significant variability in healthy life expectancy. If we are to take into account the criteria characterizing the most severe conditions of health loss: 1 and 2 group disability; significant limitations of life activities; self-rated health as “poor” and “very poor”, etc., then they provide more precise estimates of the loss of healthy life expectancy. The use of the generalized indicator based on three criteria increases the loss of high-quality life expectancy according to the criterion of health by 2.5-3 years. Scope of application. The results can be applied to the assessment and monitoring of healthy life expectancy at the national and regional levels
Evolution of EEG Findings in Patients with Acute Brain Injury
Authors: Narrett Jackson A , Byrnes MarieElena , Gilmore Emily J , Hirsch Lawrence J , Punia Vineet , Sivaraju Adithya
Published: October 2024

Introduction:
Increasing use of continuous EEG monitoring (cEEG) provides the opportunity to observe temporal trends in EEG patterns during the acute phase of brain injury. These trends have not been extensively documented.
Methods
We conducted a retrospective chart review of patients undergoing cEEG between January 1st and June 30th, 2019, at two academic medical centers. Only patients with acute brain injury having electrographic or electroclinical seizures or epileptic EEG findings on day one of monitoring and ≥ two calendar days of cEEG were included. The temporal evolution of EEG patterns was depicted as a heatmap.
Results
Of 1356 screened patients, 101 met the study criteria. Clinical acute symptomatic seizures occurred in 30 patients (29.7%) prior to EEG. The median number of days of cEEG was four (IQR 3–6). Amongst patients with electrographic seizures, status epilepticus, generalized periodic discharges, or sporadic epileptiform discharges, 24.6% had improvement and 54.1% had resolution of epileptic EEG findings by the final day of monitoring. In contrast, 65% with lateralized periodic discharges or lateralized rhythmic delta activity persisted or worsened. Overall, 61.4% (62/101) showed either improvement (19.8%) or resolution (41.6%) of their EEG findings prior to hospital discharge. Of the 36 patients with follow-up EEGs at a median of 4.5 (IQR 3–8) months after admission for acute brain injury, 83% (30/36) showed either improvement (1/36; 2.7%) or resolution (29/36; 80.6%).
Conclusions
We observed a trend towards normalization of most epileptiform patterns except LPDs and LRDA, over time in patients with acute brain injury. The clinical significance of this trend as it relates to antiseizure medication treatment and neurologic outcomes warrants further investigation in an independent cohort.
Event attribution for quantifying the role of climate change in internal displacement: The case of Somalia
Authors: Thalheimer Lisa , Cuaresma Jesus Crespo , Muttarak Raya , Li Shihan , Otto Friederike
Published: October 2024

The science of event attribution is relatively nascent. While its body of knowledge is growing fast, numerous gaps remain, including on the appropriate statistical methods and the proper consideration of various degrees of vulnerabilities and exposure. We show that attributing climate change to internal displacement requires a focus on the interplay between climate and non-climate drivers of impacts via a feasibility study of the 2020 floods in Somalia. Using detailed internal displacement flow data, we describe the socio-spatial characteristics associated with the flooding event. We show that climate change has a limited role in revealing displacement impacts and magnitude following the extreme event.
COVID-19 and chronic liver disease: results from the 1219 patients French registry
Authors: Blaise L. , Dumortier J. , Ganne-Carrié N. , Lebossé F. , Costentin C. , Ahmed S. Si , Heurgué A. , Fontaine H. , Meszaros M. , Radenne S. , Vanlemmens C. , Landrieux A. , Bouzbib C. , Barraud H. , Bardou-Jacquet E. , Chazouillères O. , Latournerie M. , Rosa I. , Anty R. , Gelu-Siméon M. , Khaldi M. , Amaddeo G. , Lemaitre C. , Bernard-Chabert B. , Moga L. , Roulot-Marullo D. , Elkrief L. , Boursier J. , Plessier A. , Bureau C. , Pageaux G.-P. , Rémy A. J. , Sultanik P. , de Ledinghen V. , Reboux N. , Texier F. , Hiriart J.-B. , Montialoux H. , Montigny S. , Rudler M. , Williet N. , Talib Z. , Mboup B. , Bourlière M. , Vicaut E.
Published: October 2024

The negative impact of Coronavirus SARS CoV-2 related Disease (COVID-19) in patients with chronic liver disease (CLD) has been described in several cohorts. We report here the results from the largest French cohort in “real-life”. The primary outcome was 30-days mortality.
Patients with CLD regardless of etiology, who developed COVID-19 confirmed by a positive PCR and/or an evocative chest CT scan were included. The prognostic influence of clinical and biological features was assessed and multivariate analyses were made.
Between 08/05/2020 and 31/12/2021, 1219 patients were included, mostly men (62%), median age 61 years, with advanced liver fibrosis in 46%, alcohol-related in 21% of the cases, complicated by liver failure (CHILD-PUGH B/C) in 170 of patients with cirrhosis (40%). Moreover 366 patients (30%) were immunocompromised, including 271 organ transplant recipients.
Hospitalization in intensive care unit was required in 11% of the patients and 159 patients (13%) died, 70% of them from extra-hepatic causes.
Overall, the independent risk factors for death were age > 61 years, diabetes, advanced liver fibrosis, and alcoholic etiology of the liver disease. Immunosuppression was not a prognostic factor in multivariate analysis.
The results of this cohort confirm a significant vulnerability of COVID-19 patients with CLD. On the other hand, they confirm the absence of excess mortality related to immunosuppression, particularly in liver transplant recipients.
Impact of gut colonization by antibiotic-resistant bacteria on the outcomes of autologous stem cell transplantation in multiple myeloma
Authors: Bilinski Jaroslaw , Jasinski Marcin , Maciejewska Martyna , Ostrowska Karolina , Rusicka Patrycja , Konarski Wojciech , Podsiadly Edyta , Snarski Emilian , Basak Grzegorz
Published: October 2024

Patients undergoing autologous stem cell transplantation (auto-SCT) face elevated risks of infections. Additionally, patients colonized in the gastrointestinal tract with antibiotic-resistant bacteria (ARB) are at higher risk of infection with ARB and other infections. Therefore, patients colonized with ARB before auto-SCT should present with an exceptionally high incidence of infections. According to current literature, ARB colonization is the surrogate marker for dysbiosis, which is known to be associated with a diagnosis of multiple myeloma (MM). Given that, this retrospective study aimed to assess the influence of ARB colonization on infection rates, hematopoiesis regeneration, mucositis, overall survival, and progression free survival following auto-SCT in MM. Data from 138 MM patients undergoing 141 auto-SCT were analyzed, with 15% showing ARB colonization. Among colonized patients, ESBL-producing gram-negative rods predominated. Patients with gut ARB colonization had significantly higher infection rates than non-colonized individuals (52 vs. 26%, P = 0.02), particularly bloodstream infections (43% vs. 14%, P = 0.004). Colonized patients also tended to exhibit shorter survival rate although there was no statistical significance (1-year and 2-year OS; non-colonized vs. colonized; 97 and 92% vs. 90 and 86%; p = 0.054). Based on our results, gut colonization before auto-SCT negatively affects treatment outcomes.
The combination of focal breast edema and adjacent vessel sign to assess the behavior of mass-type invasive ductal carcinoma
Authors: Hu Juanjuan , Ke Junli , Xu Shufeng , Pei Lei , Cao Lulu , Zhou Huanhao , Zhu Xisong
Published: October 2024

Objectives
To investigate whether the combination of focal breast edema (FBE) and adjacent vessel sign (AVS) can provide valuable biological information for personalized treatment of patients with mass-type invasive ductal carcinoma (M-IDC).
Methods
We retrospectively included patients with M-IDC between January 2016 and December 2021. FBE was evaluated using T2-weighted sequence. AVS was assessed using maximum-intensity projection images obtained using early dynamic contrast-enhanced magnetic resonance imaging. The breast peritumor score (BPS) was defined as follows: BPS 1, absence of both edema and AVS; BPS 2, AVS without edema; BPS 3, AVS with peritumoral edema; BPS 4, AVS with prepectoral edema; and BPS 5, AVS with subcutaneous edema. The correlation between different BPS scores and clinicopathological variables was examined using Kendall’s tau-b correlation coefficient. The DeLong test was used to compare the performances of three clinicopathological models combined with peritumoral features (FBE, AVS, and BPS) in predicting luminal A-like M-IDC.
Results
In 228 patients with M-IDC, BPS was positively correlated with tumor size, histologic grade, lymphovascular invasion, axillary lymph node status, and Ki-67 index, and negatively correlated with estrogen receptor expression (all P < 0.05). Furthermore, BPS 1 was more likely to be present in patients with luminal A-like breast cancer (P < 0.001). Among the three prediction models, the clinicopathological model combined with the BPS model demonstrated superior diagnostic performance for luminal A-like breast cancer.
Conclusions
The BPS is a valuable, non-invasive biomarker for assessing the aggressiveness of M-IDC and can facilitate treatment planning.
Unlocking Potential: Elevating Faculty Development in Liberia through a Localized Training-of-Trainers Model
Authors: Martin Marie , Kumeh Odell , Croly Megan , Goll Sydell , Enders Comfort , Brillant Barbara , Boiwu Grace Hawa , Pusah Hashmi , Beyan Edwin , Plyler Chelsea , Talbert-Slagle Kristina , Stober Chase , Dahn Bernice
Published: October 2024

Background
Over the past few decades, the University of Liberia College of Health Sciences (ULCHS) has faced increased challenges in providing high quality health education due to societal turmoil, disease outbreaks, and a critical lack of human resources. In 2018, ULCHS leadership identified the building of a faculty development program focused on pedagogy and teaching skills as a top priority to strengthen educational output.
Methods
This paper describes the creation and implementation of a pedagogical training program within the Center for Teaching, Learning, and Innovation (CTLI) at the University of Liberia College of Health Sciences (ULCHS). Using an innovative South-South Training-of-Trainers (ToT) model which leveraged local trained educators within the same city and country, the program aimed to bridge teaching and learning gaps among ULCHS faculty members.
Results
Surveys administered across three iterations of the program indicated a substantial improvement in participants' perceived knowledge in 11 competency domains related to teaching, learning, and assessment. Results demonstrated (1) the effectiveness of the pedagogy training program in building perceived skills, and (2) usage of a South-South ToT model to foster a supportive learning environment and promote systemic change.
Conclusions
This study highlights the potential of a three-phase ToT model for transforming pedagogical practices in low-resource settings and emphasizes the importance of peer instruction in creating effective, student-centered learning environments.
Trial registration:
Not applicable
Hematohidrosis – a clinical rarity
Authors: Birar Shreyash Narendra , Kadam Dileep Babasaheb , Kurundkar Gajanan Balaji
Published: October 2024

Hematohidrosis is indeed a rare and intriguing condition. It's thought to occur when the tiny blood vessels around the sweat glands rupture, leading to blood mixing with sweat. This phenomenon is often linked to severe stress or emotional trauma, though the precise pathophysiological mechanisms remain unclear. Diagnosing hematohidrosis involves ruling out other possible causes of blood in sweat such as bleeding disorders, vasculitis, or other dermatological conditions. Treatment typically focuses on addressing the underlying stressors, emotional factors and ensuring that any contributing medical conditions are managed.
Here, we present a case of hematohidrosis in a 17 year old male who had bleeding from several sites like forehead, face, scalp, eyes, nose and ears around six to seven times per day in the last 2 months . During hospitalization, the patient was thoroughly investigated but no clear cut etiology could be pointed out. Patient underwent skin biopsy and was diagnosed with hematohidrosis and treated with beta blockers and antidepressants. His condition had improved significantly on follow-up.
A novel model for predicting the risk of non-sentinel lymph node metastasis after positive sentinel lymph node biopsy in Chinese women diagnosed with early breast cancer
Authors: Zhang Qunchen , Fang Yutong , Chen Bingfeng , He Lifang , Chen Chunfa , Huang Guangshen , Guo Cuiping , Chen Zexiao , Zeng Huancheng , Zhang Yongqu , Wu Jundong
Published: October 2024

Background: 30 to 70% of patients with positive sentinel lymph nodes (SLNs) in early breast cancer do not develop non-SLN metastases. They are exposed to the potential complications and sequelae of axillary lymph node dissection (ALND) without gaining additional therapeutic benefit. Therefore, a prediction model for non-SLN metastasis for Chinese breast cancer patients is needed.
Methods:We enrolled 1717 patients with early breast cancer who underwent SLN biopsy, and 481 of these patients underwent further ALND. An additional 113 patients served as a validation cohort. A new predictive model was established using univariate and multivariate Logit regression. The Memorial Sloan Kettering Cancer Center (MSKCC) and Shanghai Cancer Hospital (SCH) models were used for comparison with our new model.
Results: Multivariate regression analysis showed that tumor size, multifocality, lymphovascular invasion, extracapsular extension, number of negative SLNs, number of positive SLNs, size of the SLN metastasis, and metastatic SLN locationwere independent indicators for non-SLN metastasis. The nomogram established based on these eight variables was well applied in the training cohort (AUC: 0.830) and validation cohort (AUC: 0.785). Moreover, the diagnostic value of our model was superior to that of the MSKCC and SCH models (both P = 0.000). Decision curve analysis showed that the net benefit of our model surpasses that of both the MSKCC and SCH models for the same risk threshold, resulting in greater benefits for patients. With a guaranteed false-negative rate, our model could accurately predict up to 24.5% of patients suitable for exemption from ALND. Meanwhile, our model evaluated the non-SLN status of patients with 3 or more positive SLNs (AUC: 0.843).
Conclusions: We developed a new model to predict non-SLN metastatic status in Chinese patients with early SLN-positive breast cancer. Our model showed good performance in both cohorts and significantly outperforms the MSKCC and SCH models.
Effects of Kidney Stone Prevention After ER intervention: Does rurality or comorbid conditions affect outcomes?
Authors: Summers Stephen , Pfeifer Zachary , Stern Joshua , Horn Joshua John
Published: October 2024

Introduction and Objective: The incidence of kidney stones is rising, particularly among diabetic and obese populations. Limited access to urologic care in rural US areas may predispose these patients to increased kidney stone-related visits. This study aims to determine if rural residency and comorbid conditions affect kidney stone-related healthcare visits and the effectiveness of medical prophylaxis.
Methods: Using Merative Marketscan data from 2008 to 2017, patients diagnosed with kidney or ureteral stones who underwent surgical intervention in emergency settings were identified. Patients were categorized by comorbidities, demographics, and rural vs. urban residency. Preventative treatments, including medication and 24-hour urine testing, were noted. All patients were followed for 365 days post initial encounter to track subsequent stone disease management and prevention encounters.
Results: Out of 1,030,512 patients, 17% were rural residents. Post-initial stone events, 19% engaged in medical treatment. Treatment engagement led to a 16% reduction in stone-related ED visits the following year. Diabetic and obese patients not engaged in treatment had an 11% and 20% increased risk of subsequent stone-related ED visits, respectively. Engagement reduced the risk of subsequent stone events by 34% in diabetic patients and 24.5% in obese patients compared to their unengaged counterparts.
Conclusions: Medical treatment engagement slightly reduced overall stone-related encounters and return rates in the general population, with a minor decrease in urban compared to rural populations. However, treatment engagement significantly lowered stone-related event rates in diabetic and obese patients, highlighting the need for focused and aggressive preventive medical treatment in these groups.
Anterior segmental osteomy versus orthodontic camouflage treatment decision: The importance of incisor mandibular plane angle
Authors: Hong Pureum , Song Seung Il , Choo Hyunhee , Choi Young-Jin , Kim Young Ho , Chae Hwa Sung
Published: October 2024

Objectives
Temporary anchorage devices (TADs) have reduced the need for anterior segmental ostomy (ASO) in Class I patients; however, ASO remains relevant in Class II patients. As previous studies were conducted before the usage of TADs, updated guidelines are required to determine the relationship between surgery and orthodontic treatment. This study aimed to evaluate the hard tissue changes following ASO versus non-ASO (NASO) orthodontic treatment utilizing TADs with premolar extraction.
Materials and Methods
This retrospective clinical study involved 67 patients (18 male, 49 female; mean age: 33.9 years) diagnosed with skeletal Class II malocclusion. The patients were categorized into the ASO (n = 31) and NASO (n = 36) groups. Cephalometric analyses were conducted to compare initial and final records to assess the treatment effects
Results
Pre-and post-treatment changes in the ASO and NASO groups exhibited significant differences in ΔSNA, ΔSNB, ΔANB, ΔA to N-perp, ΔB to N-perp, ΔPog to N-perp, and ΔA to FH (P < 0.05). While the reduction in ANB in the ASO group compared with that in the NASO group was clinically significant at 1.77, both groups demonstrated normalized ANB, indicating significant skeletal improvement in Class II malocclusion. Specifically, the change in FMIA (ΔL1 to FH [°]) was 4.98° greater in the NASO group than in the ASO group (P < 0.05).
Conclusions
Our findings revealed the importance of the incisor mandibular plane angle (IMPA) in treatment decision-making between ASO and NASO treatment.
Clinical Relevance:
This study highlights IMPA's importance in treatment planning and aids in selecting ASO and NASO treatments.
The risk factor and the impact on survival of pathological fractures in patients with humeral metastasis
Authors: Saito Shiro , Kimura Hiroaki , Aiba Hisaki , Kawaguchi Yohei , Murakami Hideki
Published: October 2024

Background
Bone metastases often cause pathological fractures, impair patients’ quality of life and survival. Although there are several studies on pathological fractures in femur and spine, currently, there is limited research pertaining to upper limbs. This study aimed to reveal the risk factor and how pathological fractures impact survival in patients with humeral metastasis.
Methods
This was a retrospective study, based on patients with humerus metastasis treated in Nagoya-City University hospital from 2010 to 2020. Patient characteristics, including sex, age at diagnosis of humeral metastasis, primary cancer, prior treatment, anatomical location and metastatic lesion size were retrieved from the medical records. The patients were divided into the pathological fracture and non-fracture groups, and their background and survival rates were compared.
Results
A total 31 patients with 32 metastatic lesions were included in this study. Nineteen patients had pathological fractures (one patient had bilateral fractures) and 12 patients had no fractures. The risk factor of pathological fracture was treatment without bone modifying agents in multivariate analysis. The median overall survival was 21 months, 1-year survival was 56% in non-fracture group, and 59% in fracture group. There was no significant difference in survival rate between the two groups, and only chemotherapy had correlation with longer survival in multivariate analysis.
Conclusion
Bone modifying agents have the benefit of preventing pathological fractures due to humeral metastases. The humeral pathological fracture did not affect patient's survival, and chemotherapy was the only prognostic factor that prolonged survival.
Characterization of erythrocyte parameters during twin pregnancy and risk associated with postpartum hemorrhage: a multicenter retrospective study
Authors: Liu Jingyi , Xie Fang , Liu Caixia , Wei Jun , Yin Shaowei , Li Jie , Yang Xue , Yu Wenqian , Chen Xi , Huang Hailong , Hou Jiayu , Zhao Yan
Published: October 2024

Introduction:
The twin pregnancy population is a high-risk group. Twin pregnancies are at higher risk of anemia due to increased fetal demand for maternal nutrients and oxygen. In addition, changes in erythrocyte parameters during pregnancy may be specific to twin pregnancy, and these changes may be closely associated with the risk of postpartum hemorrhage (PPH). Therefore, the aim of this study was to explore the specificity of twin pregnancies by comparing the changes in red blood cell (RBC), hemoglobin concentration (Hb), and hematocrit (Hct) at various stages of gestation and to further investigate the relationship between hemoglobin levels and the risk associated with PPH in twin pregnancies.
Material and methods:
Our study was a multicenter retrospective study involving 4569 twin pregnant women, conducted in 34 hospitals nationwide in China in 2020. First, the levels of RBC, Hb, and Hct were descriptively analyzed to compare whether there were any differences between singleton and twin pregnancies. Second, in twin cases, differences were compared between those at risk for PPH and those not at risk. The subject operating characteristic (ROC) curves and area under the curve (AUC) were calculated for Hb at each stage, and the Hb cutoff value that caused the risk associated with PPH was determined using the risk associated with PPH as the criterion. Finally, the relationship between the duration of low Hb status in twin pregnancies and the risk associated with PPH was explored.
Results:
(1) RBC, Hb, and Hct were low at all stages of twin pregnancies compared with singleton pregnancies. (2) In twin pregnancy, "low Hb status" at all stages of pregnancy was associated with the risk of PPH. We believe that Hb below 116.5 g/L in the third trimester should be considered a warning against the risk of PPH. (3) The duration of "low hemoglobin status" in twin pregnancy is associated with the risk of PPH.
Conclusions:
This study shows that the changes in erythrocyte parameters during twin pregnancies are more specific, and the proposed cut-off value of "low Hb status" in twin pregnancy may help to identify the risk of PPH.
Thrombotic Thrombocytopenic Purpura: A Trojan Horse of Acute Leukemia?
Authors: Nassani Bertha Maria , EID Hind , Mourad Denise , Riachy Moussa , Maalouly Georges
Published: October 2024

Backgroud
Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder. The severity of TTP is associated with high mortality in the absence of treatment. Acquired TTP can be indicative of various underlying conditions, including neoplasia. Its identification is crucial because prompt management is essential.
Case presentation
We report the case of a 66-year-old male, a heavy smoker, who presented with drowsiness and confusion. One month before his presentation he presented a pruritic ecchymosis skin lesions, initially misdiagnosed as superinfected fungal lesions. Laboratory tests at the emergency department revealed bicytopenia (hemoglobin at 5.2 g/dL, platelets at 16,000) renal failure, and liver dysfunction disturbances. Further investigations confirmed microangiopathic hemolytic anemia, with a peripheral blood smear showing 3% schistocytes, hepatosplenomegaly, leading to a diagnosis of TTP. Urgent treatment with plasmapheresis was initiated. A bone marrow revealed acute myeloblastic leukemia (AML) type 2. ADAMTS13 levels were severely reduced, confirming TTP. Despite transient neurological improvement, the patient showed no significant biological response and passed away five weeks after diagnosis, highlighting the complexity and severity of his condition.
Conclusion
This case presents a rare instance of TTP as an initial presentation of AML, highlights the need to maintain a high clinical suspicion for neoplastic causes in atypical TTP. Although the association between AML and TTP is anecdotal, the unusual clinical features, including atypical skin lesions in a 65-year-old with constitutional symptoms, led to the AML diagnosis. The pathophysiology may involve anti-ADAMTS13 antibodies or ADAMTS13 deficiency. Treatment is based on standard TTP therapy (corticosteroids, plasmapheresis, Rituximab) while treating the underlying AML. Aneoplasm, particularly a hematologic one, should be suspected in any elderly patient presenting with atypical TTP. Given the poor prognosis of both entities separately, their association remains fatal.
Comparison of the Effects of Sodium Bicarbonate Ringer's Solution and Normal Saline in the Prognosis and Endothelial Glycocalyx of Sepsis Patients: A Randomized Controlled Clinical Study
Authors: Zhang Ying , Gu Xue , Yu Lina , Yuan Jun , Yuan Zhou , Yang Penglei , Chen Qihong
Published: October 2024

Background
Although fluid resuscitation is an essential sepsis intervention, the optimal choice of fluid remains debatable. Herein, we aimed to compare the efficacy of sodium Bicarbonate Ringer's Solution (sBRS) to that of Normal Saline (NS) in the prognosis of sepsis patients.
Methods
This was a single-centre, Randomized Clinical Trial (RCT) that involved sepsis patients admitted to the Department of Critical Care Medicine of Jiangdu People's Hospital of Yangzhou between July 1, 2021, and June 30, 2023. Patients were randomly assigned to two groups to receive either sodium sBRS or NS for fluid resuscitation or maintenance therapy, respectively. The primary outcome was 30-day mortality. On the other hand, the secondary outcomes included Intensive Care Unit (ICU) mortality, occurrence of Major Adverse Renal Events within 30 days (MAKE30), duration of using vasoactive agents, sodium bicarbonate use, mechanical ventilation-free days, incidence of adverse events, and presence of endothelial glycocalyx degradation products in plasma or serum [including Syndecan-1 (SCD-1), Hyaluronan (HA), and Heparan Sulfate (HS)].
Results
Herein, 67 patients (32 and 35 patients in sBRS and NS groups, respectively) who met the inclusion criteria were included in the final analysis. The two groups showed no differences in 30-day mortality (28.1% vs. 40.0%), ICU mortality (15.6% vs 20.0%), and MAKE30 (31.2% vs. 42.9%) (P > 0.05). However, the sBRS group had a higher number of mechanical ventilation-free days than the NS group [12.9(2.5 18.9) d vs. 9.0(3.6 9.0) d] (P < 0.05). Furthermore, the sBRS group showed a significantly lower duration of using vasoactive agents [43.2(29.8 83.0) h vs. 46.3(23.5 104.3) h] and sodium bicarbonate [100(100 150) ml vs. 125(100 250) ml], as well as hyperchloremia incidence [18 (51.4%) vs. 6 (18.9%)], than the NS group (P < 0.05). Additionally, on the third day, the sBRS group exhibited significantly lower SCD-1 (1317.3 ± 206.9pg/ml vs. 1514.6 ± 264.9pg/ml), HA (75.1 ± 24.9ng/mL vs. 96.5 ± 25.4ng/mL), and HS (75.6 ± 13.8ng/mL vs. 85.8 ± 15.8ng/mL) levels than the NS group (P < 0.05).
Conclusion
Compared to NS, resuscitation using sBRS in sepsis patients could correct acidosis faster, reduce hyperchloremia incidence, shorten the mechanical ventilation time, and reduce the use of vasoactive drugs and glycocalyx degradation.
Trial registration
ChiCTR2100053514.Registered 23 November 2021(retrospectively registered)
Characteristics of Pseudomonas aeruginosa keratitis at Ho Chi Minh Eye Hospital
Authors: Nguyen Huynh Phuc , Nguyen Thi Truc Mai , Nguyen Thi Thanh Xuan , Ngo Tri Thuan , Vu Thi Viet Thu , Trinh Xuan Trang , Duong Nguyen Viet Huong
Published: October 2024

Background
The increasing drug resistance of Pseudomonas aeruginosa (PA) poses a serious challenge to the current treatment. Antibiograms of this pathogen often take 4–7 days, and treatment of Pseudomonas aeruginosa keratitis (PAK) is mainly based on preliminary physical examination, clinical experience, and medical guidelines. Pertinent clinical data on the causative agent and antibiotics for high efficacy are essential for early recognition and subsequent treatment.
Purpose
To report the etiology, risk factors, treatment outcomes, antibiotic susceptibilities, and trends of PAK.
Methods
This retrospective study included culture-proven PAK cases at the Ho Chi Minh City Eye Hospital Cornea Department between January 2018 and December 2022. Culture results showing coinfection were excluded from the study.
Results
Among 154 eyes infected by PA (n = 154) of 154 patients, ocular trauma was the leading risk factor (53.2%); only 16 patients had contact lenses (10.4%). Among the 154 eyes, 102/154 required surgical intervention (66.2%); and 31/154 eyes required evisceration (20.1%). PA was sensitive to tobramycin (95.9%), ciprofloxacin (91.9%), levofloxacin (91.9%), ofloxacin (87.4%), and moxifloxacin (20.0%). The prevalence of multidrug resistance (MDR) was 70.1%, and extensive drug resistance (XDR) was 6.5%. Poor outcomes (need for surgical intervention or final visual acuity ≤ CF 3m) included age > 50 years, ocular surface diseases, deep infiltrate, large infiltrate size ≥ 5mm, and ring infiltrate (p < 0.05).
Conclusion
PAK, which is associated with increasing drug resistance, poses significant challenges in terms of treatment, with 66.2% of patients requiring surgical intervention. With the rapid progression of PAK, early treatment with broad-spectrum and effective antibiotics is necessary. However, future research should focus on new methods to enhance treatment effectiveness.
Deep Inspiration Breath Hold versus Free Breathing in Postoperative Radiotherapy Strategy for Patients with Left-sided Breast Cancer Treated with Volumetric Modulated Arc Therapy: A Meta-analysis and Systematic Review
Authors: Chiang Pin-Yi , Huang Pin-Jui , Hung Chao-Hsiung , Lin Ching-Po , Chang Chih-Chia
Published: October 2024

Background
This meta-analysis aimed to determine the effect of deep inspiration breath hold (DIBH) compared with free breathing (FB) on dose to the organs at risk (OARs), such as the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast, in patients with left-sided breast cancer treated with volumetric modulated arc therapy (VMAT).
Methods
Pubmed, EMBASE, and Cochrane Library electronic databases were searched for studies until March 21, 2024. Cochrane RevMan version 5.4 statistical software was used to analyze 11 eligible studies. Standard mean difference (SMD), with 95% confidence interval for OAR dose reductions, was calculated.
Results
DIBH considerably resulted in lower mean doses (Dmean) to the heart (SMD =. −1.40 Gy), LAD (SMD = − 1.65 Gy), ipsilateral lung (SMD = − 0.57 Gy), contralateral lung (SMD = − 0.46 Gy), and contralateral breast (SMD = − 0.20 Gy). If VMAT was delivered with an arc of > 180%, the heart Dmean reduction was even more pronounced. Subgroup analysis revealed that DIBH efficiently reduced heart Dmean, especially in patients with tumor bed boost without nodal irradiation.
Conclusions
DIBH was effective in reducing dose to OARs in patients treated with VMAT in all subgroups, i.e., breast only, with/without tumor bed boost, and with/without nodal irradiation. Furthermore, the use of DIBH is strongly recommended for patients undergoing VMAT with a tumor bed boost or without nodal irradiation, as it is more effective in reducing heart Dmean than FB.
Solving a real large-scale waste collection problem using exact and heuristic methods
Authors: Aviles-González Jonnatan , Smith Neale R. , Mosquera-Gutierres Julio
Published: October 2024

Waste collection is a complex optimization problem that has been extensively studied from various angles, yet real-world implementation of these methods presents significant challenges. Practical constraints, such as work limitations, vast geographical distances, and difficult terrains that hinder the entry of collection vehicles, often complicate the application of theoretical solutions. This study proposes an innovative approach to address these challenges by demonstrating the effectiveness of dividing zones and employing exact methods. By segmenting zones and applying precise algorithms, this method adapts to the complexities inherent in urban environments, facilitating more efficient decision-making processes. The proposed technique not only provides a viable solution to the challenges encountered in waste collection but also offers valuable insights into the optimization problem. It presents a practical and adaptable approach to overcoming the logistical difficulties associated with waste collection in diverse and complex settings, making it a promising strategy for improving waste management in urban areas.
Glycated ɑ1-Antitrypsin Involvement in Impaired Wound Healing: In- Vivo and In-Vitro Models
Authors: Farber Idan , Naumchik Alon , Istoyler Yosef , Zaknoun Melodie , Anav Yuval , Sheffer Lihie , Schuster Ronen , Halpern Dor , Fridman Vladimir , Cohen-Lahav Merav , Lewis Eli C , Silberstein Eldad
Published: October 2024

Impaired wound healing causes considerable morbidity among patients with diabetes. Human ɑ1-antitrypsin (hAAT) directs inflammation in injured tissues toward resolution. Upon glycation, gly-hAAT loses anti-proteolytic activity, but whether it fails to modulate inflammation and to promote wound repair is unknown.
Objective: Explore the impact of clinical-grade hAAT on wound repair under hyperglycemic conditions, and the role of gly-hAAT in impaired wound healing pathophysiology.
Research Design and Methods: Mice were rendered hyperglycemic and excisional wounding was performed, treated with topical albumin or hAAT every three days from time of wounding. Wound area was followed and samples collected for histology and gene expression analysis. Gly-hAAT was generated from clinical-grade hAAT in laboratory settings. In-vitro, RAW 264.7 macrophage responses were assessed and re-epithelialization was tested using A549 and HaCaT cells in the presence of gly-hAAT, and in the presence of sera from individuals with poor glucose control, both supplemented with clinical-grade hAAT.
Results: Topical hAAT accelerated in-vivo and in-vitro wound closure. Vascular maturity appeared earlier in hAAT-rich conditions, and gene expression skewed towards anti-inflammatory IL-1β/IL-1Ra ratio. Gly-hAAT inhibited normoglycemic mouse wound closure and epithelial cell gap closure, both systems rescued by clinical-grade hAAT. Gly-hAAT evoked an inflammatory response in macrophages, and diabetic patient serum inhibited epithelial cell gap closure; both trends were reversed by clinical-grade hAAT.
Conclusions: Topical hAAT accelerates wound closure under hyperglycemic conditions, and gly-hAAT is inflammatory and fails to benefit wound repair. Considering its phenomenal safety profile, it is suggested that clinical-grade hAAT is primed for testing in clinical settings.
Collective quantum coherence and subband redistribution in artificially assembled nanotube arrays
Authors: Zhang Zhiyong , Deng Xiaosong , Li Weili , Cheng Xiaohan , Zhang Zixuan , Long Guanhua , Fan Chenwei , Jin Chuanhong , Zhang Yanning , Kang Ning
Published: October 2024

Artificial assembly of one-dimensional ballistic conductors into a two-dimensional (2D) system can provide an ideal platform to study coherent electronic coupling and designable physical properties. However, systematic investigations of both the coupling and ballistics in such artificially assembled systems remain scare. Here, we report collective quantum coherence in a quasi-2D film consisting of well-aligned single-walled carbon nanotubes (CNTs) with intertube coupling. The conductance plateau in the quasi-ballistic regime demonstrates subband occupation of hundreds of CNTs in a collective manner. The experimental observations agree with density functional theory simulations considering subband redistribution with intertube coupling. Finally, we summarize the quantum coherent transport for multichannel coupled systems in distinct regimes. These results open an avenue towards exploring engineered artificial systems for coherent electronic devices and hold promise for the development of next-generation high-performance and quantum nanoelectronics.
Best Group Random User Selection and Beamforming
Authors: Blostein Steven , Clarke Jordan , Saalou Omid
Published: October 2024

In a densely deployed wireless downlink, user selection provides opportunities for higher spectral efficiency. By proper selection of a group of L users from a larger K-size pool, interference can be mitigated improving achievable rate. However, if the group is too large or selection criteria too strict, complexity may be high and performance may be reduced. Previously, greedy user selection methods have been proposed to avoid computationally prohibitive full search. Here, an alternative low-complexity random sequential user group selection scheme for a multi-user multi-input single-output (MU-MISO) downlink system is investigated that utilizes a proposed pairwise user orthogonality metric. The MU-MISO system under consideration contains single-antenna receivers.
The cumulative distribution function (CDF) of the proposed metric is shown to characterize system performance and can be computed numerically via Monte Carlo integration and applied to analyze performance-complexity trade-offs in densely deployed precoded MU-MISO systems. Performance and complexity of algorithms that select the best G user group out of the K choose L available in the selection pool are assessed and its merits are compared to current greedy user selection methods. Tradeoffs among achievable rate, group size, pool size, computation, and transmit beamforming for different channel models are presented that vary in numbers of antennas and spatial correlation.
Self-thinning of biodiverse plant communities follows the Intermediate Disturbance Hypothesis
Authors: Vieira Vasco , Jorgen Marjan , Lapa Katt , Guerra Luis , Leitão Francisco
Published: October 2024

Biomass-density relations have been extensively studied for monospecific plant stands in forestry systems, leading to the self-thinning law, Interspecific Boundary Line and efficiency of space occupation. Later, came experiments with mixed-species stands testing the effects of biodiversity on productivity. Here, we test biomass-density relations in plant communities to better understand their dynamics and application as an ecological indicator. The biodiverse stands were subject to self-thinning and a local boundary line. A feedback loop was observed where biodiversity promoted efficient space occupations but, as these approached their maximum, fierce competition for space eliminated the weaker species. In the background, water availability mediated the strength of this interaction. Our results fit the ‘intermediate disturbance hypothesis’ and can unify seemingly contradicting past evidence and theories. The efficiency of space occupation used as an ecological indicator further helped understand the interaction between an invasive weed and the autochthonous community, as well as the benefit brought-about to a specific species assembly developing from within a mat of dead lawn. The latter denies Savory’s holistic management theory stating that the desertification of grasslands in Africa and elsewhere resulted from the accumulation of dead plant biomass occupying space otherwise available for the growth of new plants.
Research on Emotion Recognition Model Based on ConvTCN-LSTM-DCAN Model with Sparse EEG Channels
Authors: Xiong Fan , Fan MengZhao , Yang Xu , Li Yunfei , Yang Chaoran , Zheng Junjie , Wang Chenxiao , Zhou Jinli
Published: October 2024

Emotion recognition holds significant importance in the fields of artificial intelligence and human-computer interaction. Electroencephalogram (EEG) signals, which directly reflect brain activity, have become a vital tool in emotion recognition research. However, the low-dimensional data from sparse EEG channels presents a key challenge in extracting effective features. This paper proposes an emotion recognition model named ConvTCN-LSTM-DCAN, which integrates an improved Temporal Convolutional Network (ConvTCN), Long Short-Term Memory network (LSTM), and a custom Dynamic Convolutional Attention Network (DCAN) to enhance the accuracy of emotion recognition. The model extracts features and classifies emotions using only two EEG channels (Fp1 and Fp2) from the frontal region. Despite the reduction in the number of channels, the model still achieves classification performance comparable to that of multi-channel models. Experimental results show that on the DEAP dataset, the model achieves a classification accuracy of 96.14% for the arousal dimension, 96.47% for the valence dimension, and 95.23% for the combined arousal-valence classification; on the SEED dataset’s three-class classification task, the accuracy is 93.17%. These results not only surpass traditional emotion recognition models but also demonstrate that the proposed method can achieve performance comparable to multi-channel models even with sparse EEG channels.