bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients' Perspective on the Environmental Impact of the Severe Dry Eye Disease Healthcare Pathway
Authors: Rauz Saaeha , Latham Samuel , Boddy Laura , McClay Tara , Airaldi Matteo , Borgia Alfredo , Cordos Alina , Madden Andrea , Undan Alexander , Hoffman Jeremy , Sibley Daniel , Ahmad Sajjad , Kaye Stephen , Lockington David
Published: September 2024

Background: The NHS has committed to achieving net-zero carbon emissions by 2045. Dry eye disease, a chronic condition affecting approximately 29.5% of the global population, poses a significant challenge due to its environmentally harmful care pathway, which also exacerbates the condition. This research article presents a multi-centre cross-sectional survey of patients with severe dry eye disease to examine the pollution and emissions associated with the NHS dry eye disease care pathway. The aim is to identify target areas where innovation can aid the NHS in reaching its net-zero goal.
Methods: Ninety-two patients participated in semi-structured interviews at four tertiary care centres in the United Kingdom.
Results: Medication packaging disposal was reported as follows: 36% of patients disposed of everything in household waste, 12% recycled everything, and 52% used a mixture of both. Only 7% of patients reported that medication packaging had clear recycling instructions, 23% reported no instructions, and 70% had not noticed. Patients attended a median of 3 (range; 1, 15) hospital appointments per year, with 62% traveling by car and a median return journey time of 100 (8, 300) minutes. When asked if having dry eye disease significantly increased their carbon footprint, 31% agreed, 31% were unsure, and 38% disagreed. The predominant suggestion for reducing environmental harm was "environmentally friendly packaging."
Conclusion: This research highlights the need for more sustainable packaging solutions, including clearer recycling instructions, and explores issues related to avoidable travel and insufficient education. By addressing these areas, the NHS can make significant progress towards achieving its net-zero emissions goal.
Leukocyte fate in adult patients supported with extracorporeal membrane oxygenation: A retrospective cohort analysis
Authors: Helms Leticia , Wildi Karin , Ki Katrina K , Varkey Sneha , Ng Pauline Y , Akimoto Takako , Miki Kosuke , Malfertheiner Maximilian V , Colombo Sebastiano Maria , Corley Amanda , Shekar Kiran , Bassi Gianluigi Li , Grasselli Giacomo , Fraser John F , Suen Jacky Y
Published: September 2024

Introduction
Extracorporeal membrane oxygenation (ECMO) is known to influence all blood components. Reduction in leukocyte numbers during ECMO and their slow recovery ECMO have been associated with poorer prognosis. However, few studies on leukocyte fate have been conducted on adult patients on ECMO and are predominately cardiogenic shock-specific cohorts. Here, we attempt to examine the leukocyte profiles of ECMO-supported adult patients with both heart and/or lung failure and their associations with mortality and morbidity.
Methods
This multicenter, retrospective study included adult patients with refractory cardiac and/or respiratory failure supported by veno-arterial (VA) and veno-venous (VV) ECMO between 2016 and 2017. Data were collected from intensive care units of five ECMO centers in Australia, Italy, Japan, Hong Kong, and Germany. The primary outcome was the temporal trend of differential peripheral blood leukocyte numbers pre, during and post ECMO cannulation and survival in patients receiving venovenous and/or venoarterial ECMO. In addition, we evaluated the associations between leukocyte numbers and bleeding, infection, and organ dysfunction.
Results
Among 164 ECMO patients, mean age was 51 ± 16 years, and 67.7% of patients were male. 58.5% were placed on VA-ECMO, 39% on VV-ECMO, and 2.4% on VA/VV ECMO. Sixty-six patients who underwent ECMO (40.2%) did not survive hospitalization, and 96.9% of deaths occurred during ICU stay. In univariate analysis, a lower monocyte count (HR 0.45, 95% CI 0.21–0.93, p = 0.032), lower platelet count (HR 0.99, 95% CI 0.99-1.00, p = 0.009), higher lymphocyte count (HR 1.10, 95% CI 1.007–1.19, p = 0.033) and higher International Normalised Ratio (HR 3.98, 95% CI 2.64–5.99, p < 0.001) peri-ECMO were associated with increased risk of death. An elevated neutrophil count (HR 1.19, 95% CI 1.04–1.36, p = 0.013), age and lactate dehydrogenase were associated with mortality in multivariate analysis. There were no correlations between leukocyte variables and the development of infectious or bleeding complications. Integrated Discrimination Improvement index showed that SAPS II score with the addition of peri-ECMO lymphocyte (p = 0.001) or monocyte (p < 0.001) numbers have a better predictive value for death in ICU than SAPS II score alone.
Conclusions
Assessment of ECMO-related monocyte and lymphocyte numeric changes may be useful outcome prognosticators when used in conjunction with SAPS II score. Further investigation with larger patient cohorts will be required.
Proteomics analysis of nitrogen stress on the influence of carbon and nitrogen metabolism of flue-cured tobacco
Authors: Zhang Xinwang , Huang Yin , Chen Dong , Xu Tianju , Pan Shouhui , Zhang Jinling , Pan Yuqi
Published: September 2024

Nitrogen stress is the main abiotic stress factor affecting the carbon and nitrogen balance of flue-cured tobacco. Tandem mass tag (TMT) proteomics was used to compare the differently expressed proteins (DEPs) of flue-cured tobacco under high- (HN) and low- (LN) nitrogen stress, and Gene Ontology (GO) function annotation, Kyoto Encyclopedia for Genes and Genomes (KEGG) analysis, and protein-protein interaction (PPI) analysis were conducted. The results showed that the difference between LN and HN stress was mainly reflected in the formation pathways of carbon and nitrogen metabolism. In nitrogen metabolism, the activities of enzymes related to nitrogen absorption and transport are downregulated under LN conditions and nitrogen metabolism is inhibited. During amino acid metabolism, the expression of tyrosine aminotransferase is upregulated to promote the formation of amino acids to compensate for the lack of nitrogen. HN promotes porphyrin and chlorophyll metabolism, amino acid metabolism, alkaloid synthesis, and other nitrogen metabolism processes. LN inhibited glycolysis, the tricarboxylic acid (TCA) cycle, and the pentose phosphate pathway, while HN promoted the synthesis of starch, sucrose, fructose, and mannose. At the same time, it promotes the pentose phosphate pathway in sugar metabolism, inhibits the TCA cycle, and imbalances carbon and nitrogen metabolism. Both HN and LN can promote the biosynthesis of isoquinoline alkaloids and tobadane, piperidine, and pyridine alkaloids. Under LN conditions, it is achieved through the upregulation of tyrosine aminotransferase in amino acid metabolism, whereas under HN conditions, it is achieved through the upregulation of amine oxidase.The study can provide theoretical reference for carbon and nitrogen balance of flue-cured tobacco.
The double-edged sword effect of workaholic leadership on teachers' innovative behavior from cognitive appraisal theory of stress perspective
Authors: Yuangen Bao
Published: September 2024

Although research on workaholic leaders is accumulating, there is no consensus in the literature regarding its effectiveness and our understanding of how it affects employee innovative behavior remains limited. Therefore, based on cognitive appraisal theory of stress, we investigate how and when workaholic leaders either facilitate or hinder teachers' innovative behavior. A multi-wave survey with 566 leader-teacher dyads from primary and junior schools in China found that workaholic leaders initially raise awareness of performance stress among teachers. Overall, workaholic leaders have a dual impact on teachers' innovation: they promote it through challenging appraisal of performance stress but inhibit it through hindrance appraisal. Role breadth self-efficacy significantly moderates this influence mechanism. For teachers with high role breadth self-efficacy, workaholic leaders positively affect their innovative behavior mainly through challenging appraisal of performance stress; for those with low role breadth self-efficacy, workaholic leaders negatively impact their innovative behavior primarily through hindrance appraisal of stress. In conclusion, this study provides an initial exploration into the ambivalent effects of workaholic leadership on employee innovative behavior and offers practical insights for harnessing the positive effects while mitigating the negative effects associated with such leadership behaviors.
Virome compositions indicate that viral spillover is a dead-end between the western honey bee and the common eastern bumblebee
Authors: Schroeder Declan , Mckeown Dean , Hesketh-Best Poppy , Evans Elaine , Helgen Jessica , Warner Jenny , Zimmern Rishia , Masterman Rebecca , Berrington Adrienne , Nemecek Morgan , Costello Clara , Bernstein Elise , Mendel Bridget , Spivak Marla
Published: September 2024

The potential of viral spillover from the western honey bee (Apis mellifera) to other insects is well established. New variants should inevitably emerge following a host expansion, yet to our knowledge no study has shown this within this system. To investigate the outcome of viral spillover, we sequenced the meta-transcriptomes of sympatric A. mellifera (n = 389) and common eastern bumblebee Bombus impatiens (n = 117) over three years. Distinct viromes occurred within each bee species throughout the study duration, with honey bee viruses forming a minor fraction of the bumblebee virome. Viruses shared by both bees shared over 98 % nucleotide identity, and no bumblebee-specific strains of honey bee viruses occurred, as expected if spillover led to a true host expansion involving bumblebee-bumblebee transmission. We conclude that the honey bee viruses, namely deformed wing virus, black queen cell virus, and sacbrood virus, were present in the bumblebees due to environmental exposure or dead-end spillover, and not spillover host expansion.
A hand-washing community-based educational intervention to reduce abscess incidence among people who inject drugs: a cluster randomised controlled clinical trial protocol (the HAWA study protocol)
Authors: Balhan Liam , Aubert Marion , Lacoux Cynthia , Grau Nina , Levy Joachim , Stefanowski Marie-Lou , Perreaut Lola , Sagaon-Teyssier Luis , Deuffic-Burban Sylvie , Cousien Anthony , Michels David , Costa Marie , Roux Perrine
Published: September 2024

Background: Besides the high prevalence of HIV and HCV infections, people who inject drugs (PWID) have a cumulative risk of acquiring skin and soft tissue infections (SSTI) from, among other things, social precariousness, homelessness/unstable housing, and unhygienic injecting practices. We propose to evaluate whether a two-component educational hand hygiene intervention which combines training in hand-washing with the supply of a single-use alcohol-based hand rub, called MONO-RUB, is effective in reducing injection-related abscesses in the PWID population. Specifically, we shall implement a nationwide, two-arm, multi-centre, cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of this intervention in PWID.
Methods: HAWA is a community-based participatory research study to be conducted in 22 harm reduction centres (HR) in France; the latter will be randomised into two clusters: centres providing standard HR services and the intervention (i.e., intervention group) and those providing standard HR services only (i.e., control group). After randomization, each cluster will include 220 PWID, with an inclusion period of 12 months and an individual follow-up period of 6 months. For each participant, we will collect data at M0, M3 and M6 from photos of injection sites on the participant’s body, a face-to-face injection-related SSTI questionnaire, and a CATI questionnaire. The primary outcome is the reduction in abscess prevalence between M0 and M6, which will be compared between the control and intervention arms, and measured from observed (photographs) and self-declared (SSTI questionnaire) data. We will also assess the cost-effectiveness of the intervention.
Discussion: The HAWA trial will be the first cluster randomized controlled trial to improve hand hygiene among PWID with a view to reducing SSTI. If effective and cost-effective, the intervention combined with the distribution of MONO-RUBs (or a similar cleaning product) may prove to be an important HR tool, helping to reduce the enormous burden of infection-related deaths and diseases in PWID.
Polymorphic insertions of DcSto miniature inverted-repeat transposable elements reveal trajectories of carrot improvement
Authors: Hadagali Santosh , Stelmach-Wityk Katarzyna , Macko-Podgórni Alicja , Cholin Sarvamangala , Grzebelus Dariusz
Published: September 2024

Miniature inverted-repeat transposable elements (MITEs) are a potent source of polymorphisms in plant genomes. A genotyping system, named DcS-ILP, based on polymorphic insertions of Stowaway MITEs (DcStos) localized in introns and identified in the reference genome DH1 has been developed for carrot. Here, we report an extension of the DcS-ILP genotyping system by incorporation of non-reference insertions identified in resequenced genomes representing the eastern gene pool. We genotyped 52 carrot accessions representing the eastern and western carrot gene pools with 92 markers developed previously (western DcS-ILP panel) together with 84 newly developed markers (eastern DcS-ILP panel). Overall, the DcS-ILP markers revealed a highly structured genetic diversity separating the eastern and the western carrot accessions at K = 2 and differentiating Indian breeding lines from the eastern accessions at K = 3. The eastern DcS-ILP panel proved to be more robust with respect to the eastern carrot gene pool while it provided little information on the western accessions, as many of the DcSto insertions present in the eastern gene pool were absent in the western gene pool. As the western carrot accessions represent improved cultivars, DcSto insertional polymorphisms allowed detection of a selection-driven bottleneck at the improvement stage. Selection in the course of the improvement stage generally operated on standing variation, as the subset of DcSto insertions present in the western carrot likely originated from transposition events preceding the separation of both gene pools. However, occasional frequency shifts in the opposite direction were also revealed, possibly indicating selection for favorable variants associated with DcSto insertions.
Retrospective analysis of severe fever with thrombocytopenia syndrome and construction of a nomogram prediction model for mortality risk factors
Authors: Chen Gang , Du Yuchen , Liang Yaowen , Chen Apeng , Wei Jie , Wu Jinhuan , Ma Xiuchang , Qian Wenxian , Xie Shuqin , Yan Yi , Hu Zheng , Zheng Yishan , Tian Man , Yi Changhua
Published: September 2024

Objective: To investigate high mortality risk factors in severe fever with thrombocytopenia syndrome (STFS) and to create a nomogram model for personalized prediction.
Methods: 523 SFTS patients admitted to the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, between January 2020 and December 2023 were retrospectively analyzed. 75 cases were classified in the death group (D group) and 448 cases in the survival group (S group). A predictive nomogram model was developed base on the independent risk factors that were stepwise screened through univariate analysis, least absolute shrinkage and selection operator (LASSO), and multivariate logistic regression analysis.
Results: Based on stepwise variable screening by univariate analysis, LASSO, and multivariate logistic regression. Age(OR=1.06; 95%CI, 1.03–1.10; P＜0.001), hemorrhagic symptoms (OR=3.39; 95%CI; 1.31–8.78; P=0.012), neurologic symptoms (OR=4.89; 95%CI, 2.72–8.77; P＜0.001), platelet (OR=0.99; 95%CI, 0.98-0.99; P=0 .045), PT (OR=1.32; 95%CI;1.11-1.56; P=0.001), APTT (OR=1.02; 95%CI, 1.01–1.03; P=0.007) and viral load ≥107copies/ml(OR=2.66; 95%CI; 1.36 – 5.20; P =0.004) were independent mortality risk factors in patients with SFTS. The area under the curve (AUC) showed excellent predictive power (AUC = 0.87, 95% CI 0.832-0.909). Calibration curves showed the accuracy of the nomograms assessed. Decision curve analysis (DCA) results showed a greater net benefit when the threshold probability of patient death was between 0.02 and 0.75.
Conclusions: A nomogram model consisting of seven risk factors was successfully constructed, which can be used to predict STFS mortality risk factors early.
Machine Learning Models and Innovative Feature Design for the Classification of Lung Cancer
Authors: Balamurugan Srimahalakshmi , Pari Tamilarasan , K Thyagarajan , P Karthikeyan , M Shivashiga A , S Selin Frajja , A Atthi Sushrutha
Published: September 2024

Lung cancer accounts for the majority of cancer-related deaths worldwide because of its high incidence and usually delayed diagnosis. It affects public health significantly and results in noteworthy rates of morbidity and mortality. A patients quality of life and chance of survival depend on prompt diagnosis and effective care. Currently computer vision and image processing methods are very beneficial for classifying lung cancer. By combining machine learning and manually created features the model presented in this paper effectively classifies lung cancer from CT scan images. The model begins by applying Gaussian filtering (GF) to preprocess and improve the quality of the input images. After that an image slice segmentation technique is used to accurately identify the diseased areas of the images. The Oriented Rapid and Rotated Abstraction (ORB) and Gray Level Co-occurrence Matrix (GLCM) methods are used to extract features. Finally using a Random Forest (RF) classifier the right classifiers for experimental lung cancer images are found. The efficacy and efficiency of the proposed method are evaluated against other current methods using a dataset of CT images of lung cancer. The recommended model showed excellent accuracy and efficiency scoring a 95. twenty-three percent. The experimental results which show the models superiority in a number of performance metrics illustrate its potential for practical application in lung cancer diagnosis and treatment planning.
Classification of faults in friction stir processed composites using a machine learning and ensemble learning approach
Authors: Saxena Pragya , Bongale Arun , Kumar Satish , Kodbal Rajesh
Published: September 2024

Aluminium alloy based surface composites with hard reinforcement particles have wide scope in aerospace and automobile manufacturing industries. In this paper, the aluminium composites, manufactured by friction stir processing (FSP) with varying parameters are investigated for the faults occurred during fabrication process. It explores a machine-learning approach to detect defects of surface hybrid composites with an Al6061 alloy matrix, reinforced with copper and graphene nano-powders, using friction stir processing and a tungsten carbide tool on a milling machine. Multi-sensor time series data (vibration, force, and current) collected during fabrication, is preprocessed and labelled with normal and defective categories (e.g., pin break, brazing break, rough surface, no composite) using visual inspection. The important time domain and frequency domain features are extracted using different libraries in python. Thenafter, various types of feature selection techniques, viz filter, wrapper and embedded methods are implemented to select most relevant features. The selected subset of features from all selection methods used, are applied to different machine learning and ensemble learning classifiers and their performances are evaluated. The optimal combinations of the type of feature selection method and classifier used, are obtained for efficient classification of surface defects in composited formed by FSP. The real time monitoring and defect detection system can be developed in future for the composites developed by FSP using the developed models.
Zinc Finger Protein ZFP82 regulates p53 protein stability through histone deacetylase 3 and enhances neo-adjuvant chemotherapy in esophageal cancer
Authors: ye lin , Peng Weiyan , Wang Hongpeng , Sun Xuejuan , Zhang Lingxiang , Xu Zhong
Published: September 2024

We previous revealed Zinc-Finger Protein 82 (ZFP82) was highly methylated in multiple cancers, including esophageal cancer. Here we show that ZFP82 is highly methylated in patients who experienced non-responders in Neoadjuvant chemotherapy compared to those who are pathological complete response by Infinium Methylation EPIC Bead Chip. The inhibition of p53 activity by histone deacetylase 3 (HDAC3) has been reported, but the precise molecular mechanism is unknown. We verified here that ZFP82 bound to HDAC3 promoter and mediated its interaction with p53, which induced HDAC3 cleavage and ubiquitin-dependent proteasomal degradation. Ectopic ZFP82 induced p53 stabilization and HDAC3 cleavage, indicating an essential role of ZFP82 in p53 activation. Restoration of ZFP82 restored the chemo-sensitivity in esophageal cancer cell both expressing wild type p53 and mutant p53, significantly inhibited in vivo tumorigenicity of esophageal cells and correlated with better prognosis in patients. Our results define a mechanism for p53 stabilization via ZFP82-dependent HDAC3 decay under genotoxic stress conditions and validated a candidate bio-marker of early prediction of patients responds to esophageal cancer Neoadjuvant chemotherapy.
Research on the change of rice components under the condition of reduced fertilization based on Raman spectroscopy analysis
Authors: LI CHANGMING , TAN YONG , LIU CHUNYU , GAO XUN , LV ZHONG
Published: September 2024

The substitution of microbial fertilizer for chemical fertilizer can not only improve soil fertility but also effectively enhance rice quality. To investigate the effect of different amounts of combined application of chemical fertilizer and microbial fertilizer on the amylose content of rice, this study adopts theoretical calculations to compare the preprocessed Raman spectroscopy information of rice with reduced fertilization and establishes a recognition model for the amylose content of rice, which is used to detect the amylose content in rice. Based on the amylose spectral values measured by Raman spectroscopy and the known starch structure and functional groups, the Raman peaks are mainly distributed in the range of 400cm-1 to 1400cm-1. The Raman characteristic peaks at 483cm-1, 869cm-1, 933cm-1, 1082cm-1, 1126cm-1, 1335cm-1, 1385cm-1, and 1455cm-1 exhibit strong vibration modes, which are consistent with its main nutrient component of amylose. By comparing the measured amylose content in the regions treated with microbial fertilizer combined with different amounts of reduced fertilization and the spectral intensity values of amylose measured by Raman spectroscopy, the results show that the treatment of combining conventional amounts of microbial fertilizer with different amounts of reduced chemical fertilizer exhibits a decreasing trend in the amylose content of rice.
Prevalence, and Associated Factors of Cephalopelvic Disproportion Among Pregnant Women Attending Delivery Services at Wachemo University, Nigist Elleni Mohammed Memorial Referral Hospital, Southern Ethiopia
Authors: Borsamo Asfaw , Ermias Desalegn , Asmare Yared , Kifile Kibru
Published: September 2024

Introduction:
Cephalopelvic disproportion (CPD) is a condition in which the baby's head is too large or the mother's pelvis is too small, making it difficult for the baby to pass through the birth canal during labor even if the uterine contraction is strong enough. This can lead to prolonged or obstructed labor, which poses serious risks to both the mother and the baby. The magnitude and risk factors contributing to cephalopelvic disproportion in Ethiopia are poorly understood.
Objectives
To assess the prevalence and associated factors of cephalopelvic disproportion among pregnant women attending delivery service at Wachemo University Nigist Elleni Mohammed Memorial Referral Hospital, Southern Ethiopia.
Methods
An institutional-based quantitative cross-sectional study design was implemented on 384 randomly selected pregnant women attending delivery service at Wachemo University Nigist Elleni Mohammed Memorial Referral Hospital from September-December 2023. The primary data were collected by using structured questionnaires and checklists. The history taking, anthropometric measurements, physical examination, and CPD diagnosis were performed by the gynecologist and obstetricians. The data were collected by the four BSc midwives under strict supervision. After being carefully checked for the completeness, accuracy, and validity of each questionnaire, the data were entered into Epi-data and then exported to SPSS version 25 for analysis. Descriptive statistics, bivariate and multivariable logistic regression analyses were performed.
Results
The prevalence of cephalopelvic disproportion was 13.8%. The decrease in one centimeter of the maternal height triples the chance of developing the CPD [AOR = 3 (95% CI: 1.76–5.24)]. A unit increment in fetal head circumference doubles the likelihood of the developing the CPD [AOR = 2 (95% CI: 1.47–4.95)]. One gram increment in fetal weight increases the chance of developing CPD by 3.5 folds [AOR = 3.8 (95% CI: 1.12–5.88)]. Maternal diabetes mellitus [AOR = 2.8 (95% CI: 1.17–5.32)] was another significantly contributing factor to CPD.
Conclusion
The prevalence of cephalopelvic disproportion was high. The significantly contributing factors for CPD were short maternal height, large fetal birth weight, wider fetal head circumference, and maternal diabetes mellitus. Adequate younghood nutrition, proper dietary intake during pregnancy, complete antenatal service, and controlling blood glucose level were recommended.
The Coordinated Development and Evolutionary Characteristics of "Port-Industry-City" System in Fangchenggang City of Western China
Authors: Ma Chunxiao , Mo Liulin , Wang Shifu
Published: September 2024

Fangchenggang is a key port city in less developed western region of China, which is of typical characteristics and significant practical implications in its "Port-Industry-City" integrated development. The "Port-Industry-City" coordination model is utilized to evaluate the status and level of interactive development, employing dynamic development metrics and the scissors difference method to elucidate the evolutionary characteristics of integrated systems, thereby identifying the drivers and barriers to coordinated growth. Key findings reveal: (1) A consistent rise in the "Port-Industry-City" coordination index, with interaction levels progressing from moderate to high;(2) The complex systems have undergone different evolutionary stages, with "Industry-City" have an initial rise followed by a decline, "Port-City" and "Port-Industry" experiencing a cycle of synergy, low-level symbiosis, and back to synergy; (3) The year 2015 marked the lowest point of evolutionary speed in the "Port-Industry-City" system, with the city and port being lagging factors from 2011–2015, the port from 2016–2019, and subsequently the industry in 2019–2020; (4) The scissors difference shows an unstable "double W" pattern of alternating declines and rises, indicating fluctuating development patterns and highlighting the need for strategic actions in port expansion, refining the urban functional system, promoting the integration of port and urban industrial and value chains.
Safety and Efficacy of steroid injection with endoscopic dilatation in pediatric refractory benign esophageal stricture: a Clinical trials
Authors: Anwar Mohamed , Elhady Sayed , Shahin Mohamed , Daboos Mohammad , Magid Mohamed , Azab Ahmed , Abdelaziz Ahmed , Asla Amir
Published: September 2024

Background and Study Aim: While dilation therapy is the primary treatment for benign esophageal strictures, the recurrence or lack of responsiveness of strictures to this treatment can necessitate additional or repeated treatment. The objective of this study was to investigate the efficacy and safety of intralesional steroid injections (ISIs) in addition to dilation in patients with refractory benign esophageal strictures. Methods: The clinical trial included 21 pediatric patients with refractory benign esophageal strictures. An upper gastrointestinal endoscopy was conducted to the level of the stricture, after which esophageal dilation was performed. Subsequently, endoscopy was repeated, and a steroid was injected intralesionally under direct endoscopic vision. The procedure's efficacy was evaluated over 12 months by assessing several parameters, including the number of dilatations, maximum dilator size, periodic dilatation index (PDI), and dysphagia score. Results: The response to steroids was successful in 17 patients (81%) and unsuccessful in 4 patients (19%). The number of dilatations, PDI, and dysphagia score were significantly reduced following ISIs in comparison to pre-injection. Conversely, the maximum dilator size demonstrated a significant increase following ISIs compared to the pre-injection period. No side effects following steroid injections in children with esophageal strictures were reported in this study. Conclusion: Endoscopic dilatation followed by steroid injection is a useful strategy for the treatment of refractory benign esophageal strictures.
Patterns of injury associated with multiligamentous knee injury: 15-year experience at a major trauma center
Authors: Sim Jae Ang , Lee Byung Hoon
Published: September 2024

Background
This study aimed to compare the incidence rates of concomitant injuries, including meniscal and cartilage injuries, between multiligamentous knee injuries (MLKI) with and without dislocation based on our 15-year experience of knee dislocation and MLKI at a level 1 trauma center.
Methods
We retrospectively identified 100 patients (115 knees) with MLKIs and/or dislocations at our trauma center between 2007 and 2021. Magnetic resonance imaging was routinely performed to evaluate the injured structures and extent of injury. The anatomic structures of the knee were categorized into anterior and posterior cruciate ligaments (ACL, PCL) and medial and posterolateral structures, and further classified according to the modified Schenck classification. The study participants were divided into two groups: 40 and 75 knees classified as MLKI with and without dislocation, respectively.
Results
MLKIs with dislocations showed 13 and 18% incidence, whereas MLKIs without dislocation showed 15 and 13% incidence of medial and lateral meniscal tears respectively. The two groups also had a significant discrepancy in the patterns of meniscal tears. For medial meniscal tears, radial tears were more prevalent in MLKIs with dislocation, and longitudinal tears in MLKIs without dislocation. For lateral meniscal tears, anterior horn or totally detached tears were more prevalent in MLKIs with dislocation, and radial tears in MLKIs without dislocation. Additionally, complete rupture of all four major ligaments was found in 38% of the cases with dislocation, with the majority showing complete ruptures of both the ACL and PCL. Concomitant serious injuries, such as popliteal artery injury and fractures, were observed only in cases involving high-energy trauma and dislocation.
Conclusions
MLKIs associated with dislocation demonstrate distinct patterns of ligament damage and meniscal tears compared with MLKIs without dislocation. The initial distinction in the severity of MLKIs, along with the anatomical classification, have practical implications in identifying associated meniscal tears and injuries to structures surrounding the knee joint.
Clinical Relevance: The initial distinction in the severity of MLKIs, along with the anatomical classification, have practical implications in identifying associated meniscal tears and injuries to structures surrounding the knee joint.
Level of Evidence: IV Retrospective comparative study
GhMAC3e is involved in plant growth and defense response to Verticillium dahliae
Authors: Han Zhenghong , Qiu Yuanyuan , Pan Ting , Wang Longjie , Wang Jing , Liu Kang
Published: September 2024

The MOS4-Associated Complex (MAC) is a highly conserved protein complex involved in pre-mRNA splicing and spliceosome assembly, which plays a vital role in plant immunity. It comprises key components such as MOS4, CDC5, and PRL1. MAC3A/B, as U-box E3 ubiquitin ligases, are crucial for various plant processes including development, stress responses, and disease resistance. However, their roles in cotton remain largely unknown. In this study, we first cloned the GhMAC3e gene from cotton and explored its biological functions by using virus-induced gene silencing (VIGS) in cotton and transgenic overexpression in Arabidopsis. The results showed that GhMAC3e is ubiquitously expressed in cotton tissues and could be induced by salt stress, Verticillium dahliae (VD) infection, PEG, ABA, ETH, GA3, MeJA, and SA. Silencing GhMAC3e retarded primary stem growth and reduced biomass of cotton coupled with the reduced auxin content in the petioles and veins. Silencing GhMAC3e up-regulated expression of cell growth-related genes GhXTH16 and Gh3.6, while down-regulated GhSAUR12 expression. Ectopic expression of GhMAC3e in Arabidopsis significantly enhanced its resistance to Verticillium wilt (VW) in terms of decreased pathogen biomass and lowered plant mortality. Overexpression of GhMAC3e dramatically upregulated AtPR1 by around 15 fold and more than 262 fold under basal and VD inoculation condition, respectively. This change was not associated with the expression of GhNPR1. In conclusion, GhMAC3e may not only regulate plant growth by influencing auxin distribution and growth-related gene expression, but also play important roles in VW resistance via mediating SA signaling independent of NPR1 transcription level.
Process of rockslide induced by underground mining and penetration: A case study of Pusa rockslide in Nayong County, China
Authors: Fulin Wang , Xingyuan Jiang , Hongsen Hu , Yi Yang , Di Wu , Junwei Tian , Zhenxian Zhao
Published: September 2024

To explore the disaster mechanism of the slope with steep upper structure and slow lower structure in the karst mountainous area of southwest China. Take the Pusa Rockslide as an example. The deformation and failure characteristics of the slope under the action of dead weight, mining and rainfall were studied by Continuum－Discontinuum Element Method (CDEM) numerical simulation based on field geological investigation. The results show that the evolution process of the Pusa rockslide can be divided into six stages as follows:(1) Natural Evolution: The upper limestone is dissolved, which creates favorable conditions for the generation and development of cracks; (2) Disturbance Deformation: The mountain is affected by underground mining, which causes the slope to produce a subsidence deformation of about 2m; (3) Collapse Deformation: The roof of the goaf bends, sinks and collapses. A deep and large crack of about 200 m is formed at the trailing edge of the slope; (4) Extrusion Deformation: The formation of potential collapse failure surface－Similar Cantilever; (5) Instability and Failure: The landslide mass breaks through the "locking section"; (6) Energy Dissipation: The rockslide mass is broken and scrapes the rock and soil along the way to form a debris flow. The instability mechanism of the slope is Goaf－Tensile Crack－Creep－Shearing (Toppling)－Energy Dissipation－Accumulation.
Fungal endophytes promote wheat (Triticum aestivum L., genotype-PBW-343) growth and enhance salt tolerance through improvement of ascorbate-glutathione cycle and gene expression
Authors: KHARWAR RAVINDRA NATH , Prajapati Priyanka , Pandey Prashasti , Kumar Deepak
Published: September 2024

Background and aims

Wheat (Triticum aestivum L.) faces considerable challenges in terms of growth and productivity due to soil salinity, which is a major constraint to agricultural success. This study investigated the potential of fungal endophytes to enhance wheat growth and improve salt tolerance by influencing the ascorbate-glutathione cycle and gene expression.

Methods

Experiments were conducted, usingwheat seedlings (PBW-343) inoculated with endophytic fungi (Cladosporium parahalotolerant and Aspergillus medius)isolated from salt-tolerant wheat genotypes (KRL-210, KRL-213 and KRL-19) fromthe previous study. Endophytic fungi were used individually and in combination. Fifteen days seedlings exposed to 100 mM NaCl in the presence and absence of fungal endophytes. To elucidate the molecular mechanism, gene expression analysis was performed on key genesAPX, SOD, GR, DHAR, and MDHAR.

Results

Seedlings treated with endophytic fungi (consortia form)significantly enhanced the sugar, protein, chlorophyll, carotenoid content, and chlorophyll fluorescence (Fv/Fm)compared to control under salt stress. The O2- and lipid peroxidation levels were significantly reduced in plants inoculated with fungal endophytes. Salt stress increased APX, SOD activities and decreased GR, MDHARand DHAR activities.Endophytic fungi inoculated with salt-stressed seedlings enhanced the above-mentioned indicators compared to the salt-stressed plants without fungal endophytes, as well as in the ratios of AsA/DHA and GSH/GSSG.Endophytic fungienhanced the transcript levels of SOD, DHAR, APX, GR, and MDHAR genes compared to the control

Conclusions

The present study found that the expression levels of several genes associated with the ascorbate-glutathione cycle were upregulated in endophyte-inoculated plants, indicating a more efficient antioxidant system capable of scavenging reactive oxygen species.
Development and External Validation of Machine Learning Models to Predict Postoperative Transitional Cell Carcinoma Mortality: A Retrospective Study
Authors: Salehi Asal , Saleh Kianmehr , Rahimi Mohammad , Golparian Mitra , Tarokhian Aidin
Published: September 2024

Purpose
Transitional cell carcinoma (TCC) of the bladder, also known as urothelial carcinoma, is the most common type of bladder cancer. The primary objective of this study was to develop machine learning (ML) models to predict the survival outcomes of bladder cancer patients.
Methods
This study utilized the SEER dataset to develop an ML model for predicting postoperative disease-specific overall survival in TCC patients. This retrospective study included patients diagnosed between 2010 and 2015 for model training and validation and patients diagnosed after 2018 for external validation. The performance was assessed via sensitivity, specificity, accuracy, likelihood ratios, predictive values, ROC-AUC, and the Brier score. SHAP values and partial dependence plots were used to evaluate feature importance and interactions.
Results
The deep neural network model slightly outperformed the other models (linear regression and gradient boosting) across all the datasets. For the external validation dataset, the model had a sensitivity of 69.40% (95% CI: 67.72–71.05%), specificity of 85.32% (95% CI: 84.91–85.72%), and accuracy of 83.84% (95% CI: 83.43–84.24%). The ROC-AUC was 0.8758 (95% CI: 0.8698 to 0.8816). The model demonstrated a negative likelihood ratio of 0.36 (95% CI: 0.34 to 0.38) and a positive likelihood ratio of 4.73 (95% CI: 4.56 to 4.90). The use of external validation indicated minimal overfitting. The key features influencing mortality included tumor stage, age, tumor size, and grade.
Conclusion
Machine learning models, particularly deep neural networks, can accurately predict mortality in individuals with TCC of the bladder.
Comparison of the Effectiveness of Video and Breastfeeding Simulator Support to Mothers Who Could Not Breastfeed Their Babies in the Neonatal Intensive Care Unit: A Randomized Controlled Study
Authors: Metin Hatice Tetik , Yiğit Feride
Published: September 2024

This study was conducted to evaluate the effectiveness of breastfeeding behavior development training involving the use of videos and simulators with mothers whose babies were in the neonatal intensive care unit and who were staying in mothers’ hotels. The study was conducted in June 2022 and March 2023 in a state hospital with 100 volunteer participating mothers. Study control group (n=33), video training group (n=33), simulator training group (n=34). The study was conducted with a randomized controlled pretest/posttest control group trial model. Data were collected with a sociodemographic information questionnaire, a breastfeeding self-efficacy scale (short form), and a maternal attachment scale. Pretest scores did not significantly differ between groups (p>0.05). The breastfeeding self-efficacy, maternal attachment and retest mean scores significantly increased in the simulator group (p<0.05). This study revealed that breastfeeding training given to women with simulator support was more effective than training given via video methods in terms of breastfeeding success, the perception of breastfeeding self-efficacy, and maternal attachment.
Genome-wide DNA methylation profiles in the raphe nuclei of patients with autism spectrum disorder
Authors: Iwata Keiko , Nakabayashi Kazuhiko , Ishiwata Keisuke , Nakamura Kazuhiko , Kameno Yosuke , Hata Kenichiro , Matsuzaki Hideo
Published: September 2024

Background: Autism spectrum disorder (ASD) has a strong genetic basis, yet its genetic complexities remain elusive. Current research highlights environmental factors and epigenetic processes, such as DNA methylation, as crucial in ASD development. This study explored epigenetic modifications using postmortem brain samples from ASD subjects and controls.Methods: We comprehensively analyzed genome-wide DNA methylation profiles in the dorsal raphe brain region using the Infinium HumanMethylation450 BeadChip (Illumina). In addition, quantitative PCR was used to investigate mRNA expression levels of genes that demonstrated differential methylation in ASD.Results: We identified differentially methylated regions (DMRs) and individual-specific DMRs (IS-DMRs) between ASD and control subjects. These DMRs and IS-DMRs were located across various genomic regions, including promoters, gene bodies, 3ʹ UTRs, and intergenic regions. Notably, we found hypermethylation in genes related to olfaction (e.g., OR2C3), which is regulated by serotonin. Hypomethylated genes in IS-DMRs were linked to ASD and developmental disorders. Additionally, we observed that the hypomethylation of promoter-associated CpG islands in RABGGTB, a gene related to autophagy and synaptic function, corresponded with its increased expression.Conclusions: Our findings reveal extensive DNA methylation changes in critical genomic regions, shedding light on potential mechanisms underlying ASD. The identification of RABGGTB as a novel candidate gene, not listed in the SFARI database, underscores its significance and warrants further research to explore its role in ASD diagnosis. This study enhances our understanding of the epigenetic landscape in ASD, emphasizing the interplay between genetic and environmental factors in its pathophysiology.
Higher subcutaneous adipose tissue radiodensity is associated with an increased risk of the onset of Acute-on-Chronic Liver Failure
Authors: Yuan Yu-Hang , Zhang Wu-Xi , Wang Jing-Yu , Dong Dong , Xiao Han , Wang Yan-Tian , Xu Wei-ling
Published: September 2024

Background
Body composition plays a significant role in the development and progression of disease in patients with acute decompensation of cirrhosis. Previous studies have identified the psoas muscle index (PMI) as an independent risk factor for predicting one-year mortality in patients with acute-on-chronic liver failure (ACLF). However, the relationship between adipose tissue, another component of body composition, and disease progression in patients with ACLF remains unclear. This study aimed to investigate the association between computed tomography (CT)-derived adipose tissue characteristics and the occurrence of ACLF and to develop a predictive model for ACLF.
Methods
This study included 343 adult patients with acute decompensation of cirrhosis who underwent abdominal CT examinations at our center between 2018 and 2022. Clinical laboratory test results and CT-derived adipose tissue characteristics were analyzed. Disease progression within 7 days was monitored, and a predictive model for ACLF occurrence incorporating adipose tissue information was developed.
Results
A total of 42 patients progressed to ACLF within 7 days. Significant differences in adipose tissue density were observed between the ACLF occurrence and non-occurrence groups. The subcutaneous adipose tissue (SAT) radiodensity in the ACLF occurrence group was − 75.79 (SD ± 16.35) HU, compared to -86.08 (SD ± 14.35) HU in the non-occurrence group. Ultimately, the predictive model comprising four variables—direct bilirubin (DBIL), prothrombin activity (PTA), sodium ion (NA+), and SAT radiodensity—demonstrated an area under the curve (AUC) of 0.93 and 0.91 in the training and test sets, respectively.
Conclusions
Patients with high SAT radiodensity are at a higher risk of developing ACLF. The newly established model can accurately identify individuals at higher risk of ACLF among patients with acute decompensation of cirrhosis, thereby facilitating early clinical intervention and improving patient survival rates.
Risk for human papillomavirus-associated gynecologic cancer among women of childbearing age with rheumatic diseases: a population-based cohort study
Authors: Lee Jisoo , Baek In-Woon , Lim Hyunsun , Chung Min Kyung , Park Pil Gyu , Lee Chan Hee , Park Jin Su
Published: September 2024

Background
Evaluate the risk of human papillomavirus (HPV)-associated gynecologic cancer in women with rheumatic diseases (RD) during their childbearing years.
Methods
Using Korean National Health Insurance Service-National Health Information Database data (2011−2021), we conducted a cohort study of 40,514 women with RD and 199,366 women without RD aged 20–49 years. The RD cohort included 9,932 with systemic lupus erythematosus (SLE), 23,731 with seropositive rheumatoid arthritis (SPRA), and 6,851 with ankylosing spondylitis (AS). Incidence rates and hazard ratios for HPV-associated gynecologic cancer, including cervical intraepithelial neoplasia grade 3, and cervical, vaginal, and vulva cancers, were estimated using Cox regression.
Results
Over the mean (standard deviation) follow-up period of 67.5 (37.7) months, the incidence rate of HPV-associated gynecologic cancer was 111.5/100,000 person-years in the RD cohort and 73.2/100,000 person-years in the non-RD cohort. Among the RD subcohorts, the incidence rate/100,000 person-years of HPV-associated gynecologic cancer were higher in SLE (223.6) and SPRA (83.1), and lower in AS (69.1) compared with non-RD. The fully adjusted hazard ratio for HPV-associated gynecologic cancer was higher in the RD cohort (2.95 [95% CI 2.44–3.57]) and all the RD subcohorts (SLE 1.85 [95% CI 1.33–2.57], SPRA 4.10 [95% CI 3.03–5.55] and AS 1.91 [95% CI 1.06–3.43]). After adjusting for comorbidities and medication use, hazard ratios increased in SPRA and AS but decreased in SLE.
Conclusion
Korean women of childbearing age with RD have a threefold increased risk for HPV-associated gynecologic cancer compared with those without RD. The risk may be influenced by comorbidities and medication use in SLE. Improved screening strategies are needed for these women.