bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term and long-term clinical outcomes of combined caudate lobectomy for intrahepatic cholangiocarcinoma involving the hepatic hilus: a propensity score analysis
Authors: Zeng Di , Wang Yaoqun , Wen Ningyuan , Xiong Xianze , Lu Jiong , Li Bei
Published: February 2024

Background
There was a dearth of reliable research on the clinical value of combined caudate lobectomy in intrahepatic cholangiocarcinoma involving the hepatic hilus. We aimed to compare the short-term and long-term outcome of combined versus non-combined caudate lobectomy in patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma involving the hepatic hilus.
Methods
This single center retrospective cohort study of patients with hilar cholangiocarcinoma was conduct from January 2007 to December 2021. Patients who underwent radical re-resection were enrolled. The short-term and long-term clinical outcomes of the groups were compared before and after propensity score matching.
Result
A total of 282 patients were included. There was no statistically significant difference in perioperative clinical outcomes between CL (caudate lobectomy) group and non-CL group before and after PSM. Patients who received CL had significantly longer OS before and after PSM (p = 0.007, before PSM; p = 0.033, after PSM), compared to those in the non-CL group. As for DFS, CL group was associated with improved DFS before and after PSM (p < 0.001, before PSM; p = 0.019, after PSM), compared with non-CL group following the curative-intent resection.
Conclusion
Combined caudate lobectomy (CL) would improve the long-term survival for patients with intrahepatic cholangiocarcinoma involving the hepatic hilus. The postoperative complications of combined CL group were comparable to that of non-CL group, indicating that CL would not worsen postoperative survival. Therefore, radical surgical resection should be actively performed in these patients.
Morphological and life-history plastic responses to predators and competitors in two brown frogs, Rana dalmatina and R. latastei
Authors: Castellano Sergio , Seglie Daniele , Friard Olivier P
Published: February 2024

Predation and competition are two major factors that drive natural selection. When they vary unpredictably, selection has promoted the evolution of plastic responses in behavioral, morphological and life-history traits. These responses are not independent of each other and often represent a trade-off between conflicting interests. We conducted a common-garden experiment to study the effects of predation and competition on the morphology and the life history of R. dalmatinaand R. latastei tadpoles. The experiment used a randomized-block design, where tadpoles were raised either with or without siblings and either with or without predators. Regardless of the treatments, R. dalmatina grew faster, developed proportionally larger tails, proportionally smaller bodies, and completed metamorphosis earlier than R. latastei. Both species developed relatively larger bodies with competitors, and relatively larger tails with predators. While the relative increase in body size with competitors was similar in the two species, the increase in tail size with predators was greater in R. dalmatina, suggesting that this species invested more in defense than the other. Competitors delayed the metamorphosis in both species and in R. latastei they negatively affected froglets’ body size and shape. Conversely, predators delayed the metamorphosis only in R. dalmatina. This delay was the long-term cost paid by R. dalmatina for the short-term benefits of developing more effective defensive traits.
The Intestinal-type adenocarcinoma of nasal cavity: Report of two cases and Literature Review
Authors: Phulware Ravi Hari , Kumar Arvind , Mishra Jyoti , Majumder Ankur , Ahuja Arvind , Singh Ashok
Published: February 2024

Introduction:
Sinonasal intestinal-type adenocarcinoma (ITACs) are rare high-grade epithelial tumours of the nose and paranasal sinuses. It's a fast-growing tumour having morphological, immunophenotypic, and molecular similarities to primary colonic adenocarcinoma, with a yearly incidence of less than 1 case per 100,000 people. Males are more affected than females as a result of work exposures. Wood and leather dust, as well as other chemical compounds, have been identified as causative factors in the literature. Unilateral or bilateral nasal obstruction, epistaxis, and possibly rhinorrhoea are signs and symptoms of sinonasal malignancies, which are similar to chronic sinus inflammation. As a result, all of these hazy symptoms add up to a diagnostic roadblock. Because of the rarity and diversity of histological types, there is a scarcity of information on treatment methods.
Case Presentation:
Herein we are presenting two rare examples of mixed ITAC in a 35-year-old male farmer and a 28-year-old house wife who presented with symptoms of nasal bleeding. We have described clinical-pathological features along with current breakthroughs in molecular pathologic aspects in the literature.
Conclusion
Diagnosis of Sinonasal ITACs a rare type of neoplasm that can only be diagnosed by a pathological report. Symptoms of sinus infiltrates include: Nasal obstruction Epistaxis Rhinorrhea However, it is possible to present with a benign, palpable mass. ITACs should be considered in the differential diagnosis of nasal polypoidal lesions. The case report and literature review include information on histomorphological characteristics, differential diagnostic criteria, molecular characteristics, treatment options, and ITAC prognosis.
Orthoptera-specific target enrichment (OR-TE) probes resolve relationships over broad phylogenetic scales
Authors: Shin Seunggwan , Baker Austin J. , Enk Jacob , McKenna Duane D. , Foquet Bert , Vandergast Amy G. , Weissman David B. , Song Hojun
Published: February 2024

Phylogenomic data are revolutionizing the field of insect phylogenetics. One of the most tenable and cost-effective methods of generating phylogenomic data is target enrichment, which has resulted in novel phylogenetic hypotheses and revealed new insights into insect evolution. Orthoptera is the most diverse insect order within Polyneoptera and includes many evolutionarily and ecologically interesting species. Still, the order as a whole has lagged behind other major insect orders in terms of transitioning to phylogenomics. In this study, we developed an Orthoptera-specific target enrichment (OR-TE) from 80 transcriptomes across Orthoptera. The probe set targets 1,828 loci from genes exhibiting a wide range of evolutionary rates. The utility of this new probe set was validated by generating phylogenomic data from 36 orthopteran species that had not previously been subjected to phylogenomic studies. The OR-TE probe set captured an average of 1,009 loci across the tested taxa, resolving relationships across broad phylogenetic scales. Our detailed documentation of the probe design and bioinformatics process is intended to facilitate the widespread adoption of this tool.
Effects of dietary immunostimulants on the growth and non-specific immune responses of hybrid sturgeons (Huso huso♀ x Acipenser ruthenus♂)
Authors: Chuang Hsiang-Chieh , Lee Yi-De , Cheng Ann‐Chang
Published: February 2024

Thisstudy explored the impact of immunostimulants on the growth, immune responses, and post-infection survival of hybrid sturgeon (Huso huso♀ × Acipenser ruthenus♂). We examined the effects of β-glucan, vitamin C, and Radix Bupleuri (Chaihu) extract (RBE) at various concentrations (0.2%, 0.4%, and 0.6% feed) on the growth rate and non-specific immune responses of hybrid sturgeon. When added individually, these immunostimulants significantly reduced the feed conversion ratio while increasing weight gain, with the vitamin C groups showing the most pronounced differences. Immunity experiments demonstrated that 0.4% and 0.6% dietary β-glucan, vitamin C, and RBE significantly enhanced the superoxide anion production rate and phagocytic rate of head kidney leukocytes. The 0.4% and 0.6% vitamin C and RBE groups, along with the 0.6% β-glucan group, exhibited a significant increase in lysozyme activity. Moreover, the 0.6% vitamin C and β-glucan groups, as well as the 0.4% and 0.6% RBE groups, showed the highest survival rates after Aeromonas hydrophila infection. In conclusion, our findings highlight that appropriate dietary concentrations of β-glucan, vitamin C, or RBE significantly enhance superoxide anion production, phagocytic activity, serum lysozyme activity, and post-A. hydrophila infection survival in hybrid sturgeon. The results of this study suggest that incorporating immunostimulants, such as Chinese medicinal herbs, at optimal levels can effectively boost the growth, immunity, and disease resistance of hybrid sturgeon in aquaculture. These results provide valuable insights for future research on the inclusion of immunostimulants in aquaculture feeds.
Unravelling Factors Influencing Demand for Modern Contraception and Evaluating Coverage Progress since 2015 in Ethiopia, Kenya, and Nigeria: Insights from Multilevel and Geostatistical Modelling
Authors: Khundi McEwen , Mzembe Themba , Ngwira Tabitha , Mankhwala Chifuniro S , Chifungo Chimwemwe , Peterson Maame , Vellemu Ruth , Madise Nyovani J , Chipeta Michael G
Published: February 2024

Introduction
The United Nations established the Sustainable Development Goals (SDGs) in 2015 to enhance global development. In this study, we examine an SDG indicator: the percentage of women aged 15–49 whose family planning needs are met by modern contraception (mDFPS). We evaluate both the factors influencing its coverage and its progress since 2015.
Methods
We used nationally representative survey data (Demographic and Health Surveys (DHS) and Performance Monitoring for Action (PMA)) from Ethiopia, Kenya, and Nigeria. We assessed individual and community-level predictors of mDFPS. We also computed mDFPS coverage across countries and subnational areas, assessing coverage changes from the SDGs onset to the most recent period with data using a Bayesian model-based geostatistical approach. Additionally, we assessed whether the subnational areas exceeded the minimum recommended WHO mDFPS coverage of 75%. Coverage assessment and mapping were done at pixel (5 x 5 km) and sub-national levels.
Results:
Varied individual and community-level determinants emerged, highlighting the countries' uniqueness. The results indicate mDFPS stagnation in most administrative areas across the three countries. Geographic disparities persisted over time, favouring affluent regions. Ethiopia and Nigeria showed minimal mDFPS improvement, while Kenya exhibited increased coverage. Mean posterior change, 95% credible intervals (CI) and exceedance probabilities (EP) were: Ethiopia 5.68% (95% CI: [-38.07, 49.44], EP = 0.61), Kenya 10.19% (95% CI: [-17.72, 39.33], EP = 0.80), and Nigeria 1.98% (95% CI: [-17.72, 39.33], EP = 0.58). None of the sub-national areas in Ethiopia and Nigeria exceeded the WHO-recommended coverage in their latest survey. While 9 out of 47 counties in Kenya in 2022 exceeded the WHO mDFPS coverage recommendation.
Conclusion:
The study unveils demographic, geographic, and socioeconomic mDFPS disparities, signalling progress and stagnation across administrative areas. The findings offer policymakers and governments insights into targeting interventions for enhanced mDFPS coverage. Context-specific strategies can address local needs, aiding SDG attainment.
Mathematical Modeling of Multicellular Tumor Spheroids Quantifies Inter-Patient and Inter-Tumor Heterogeneity
Authors: Malik Adam , Nguyen Kyle , Nardini John , Flores Kevin , Krona Cecilia , Nelander Sven
Published: February 2024

In the study of brain tumors, patient-derived three-dimensional sphere cultures provide an important tool for studying emerging treatments. The growth of such spheroids depends on the combined effects of proliferation and migration of cells, but it is often challenging to make accurate distinctions between increase in cell number versus the radial movement of cells. To address this, we formulate a novel model (which we refer to as the reaction-diffusion, advection-reaction-diffusion model) in the form of a system of two partial differential equations (PDEs) and show that it more accurately fits our data as compared to simpler PDE models, including the reaction-diffusion model that has been found to be clinically relevant. We propose a numerical approach for calculating travelling-wave speeds, which are shown to be strongly associated with population heterogeneity. Having fitted the model to our dataset we show that a subset of the cell lines are best described by a “Go-or-Grow”-type model, which constitutes a special case of our model. Finally, we investigate whether our fitted model parameters are correlated with patient age at diagnosis and survival. Multiple model parameters are correlated with patient age, and a single model parameter with patient survival. Our work improves on current modelling approaches, and provides a novel step towards understanding associations between mathematical model parameters and clinical data.
Forecast of SO2 Air Contamination utilizing Artificial Neural Network: Sample of City Meerut
Authors: kumar Lokesh , Kumar Gaurav
Published: February 2024

SO2 is among the air poisons that assume the best part in air contamination. In this study, using data from 2019 to 2023, estimates of how this contaminant was affecting human health and the environment were made using artificial neural networks, a well-liked learning method in use today. Information having a place with Meerut territory, where the center of industry is located, was acquired by the Air Observation Center of Uttar Pradesh Pollution Control Board (UPPCB), and modeling and optimization were completed in SPSS programming. The obtained SO2 estimation results were subjected to a multilayer perceptron analysis before being compared with the actual data. Furthermore, the SO2 value for the province of Meerut has been recorded to occasionally beyond the permissible level, particularly during periods of high production.
Associations between the Duration of General Anesthesia Exposure and Attention Deficit Hyperactivity Disorder (ADHD) as well as Behavioral Problems
Authors: Liao Guoying , Niu Yixuan , Miao Zhengjie , Zhou Ren , Zhong LinHong , Wang Jing , Wang Fan , Chen Tiannan , Gao Yi , Qi Chuanyu , Jiang Hong , Yan Jia
Published: February 2024

Background: The potential relationship between early exposure to general anesthesia and the risk of developing attention deficit hyperactivity disorder (ADHD) has not been determined.
Methods: This retrospective cohort study included children who were exposed to general anesthesia before the age of 3 during 2017–2020. The participants were divided into two groups: 1 (< 3 hours of exposure) and 2 (≥ 3 hours of exposure). Children not exposed to general anesthesia were recruited into the unexposed group. The Conners' Parent Symptom Questionnaire (PSQ) was used to assess ADHD incidence. Linear regression analysis was used to assess the association between the duration of general anesthesia exposure and ADHD, as well as different dimensions.
Results:The incidences of ADHD were 4.0%, 8.1%, and 14.7% in the three groups. The duration of anesthesia was significantly associated with the risk of ADHD, regardless of whether the duration of anesthesia was treated as a continuous variable (odds ratio (OR): 0.077, 95% confidence interval (CI): 0.024–0.130, p=0.011) or as a dichotomous variable (OR: 2.544, 95% CI: 1.318–4.910, p=0.005) between the unexposed group and the exposed 2-year-old group. In addition, the results showed that the duration of anesthesia may be significantly associated with adverse learning problems and impulsivity-hyperactivity (ptrend=0.023; p trend=0.005, respectively). According to the subgroup analysis of sex, the risk of ADHD differed significantly between the unexposed group and the exposed 2 group among male children (OR=3.185, 95% CI=1.101–9.217, p=0.031).
Conclusions: This study highlights the significant association between longer anesthesia exposure (≥3 hours) and the risk of ADHD, particularly in male children.
Role of Powdered Activated Carbon in the Adsorption Behaviour of Hazardous Lead (Pb) using PDAC as an Adsorbent
Authors: Prabakaran R. , Ajithkumar M , Kamatchi C , Ganapathi S
Published: February 2024

The purpose of the investigation was to remove the Pb from the artificial liquid using PDAC. Lead is used for cables, roofs, water and gas pipelines, mining activities, the manufacturing of acid batteries, and other structures. The industry recognizes the need for dye-treated sewage treatment because it can cause health problems for humans and animals. In this research, PDAC was explored for its possible consumption as an ecofriendly bio-adsorbent to remove the Pb (II) ions. In this investigation, adsorption-related variables, including initial dye concentration, contact time, absorption rate, temperature effects, and pH were studied. Second-order kinetic model being used for calculate the investigational values. Absorption equilibrium was determined using Longmuir and Friendlich's isothermal models. Current work suggests that PDAC could be employed as a low-cost absorbent to adsorb the lead ion in an artificial liquid solution. Adsorption characteristics were determined by SEM, XRD, and FTIR studies.
Glutamic Acid-Coated Zinc Oxide Nanoparticles: Synthesis, Characterization, and Anticancer Activity
Authors: Huong Nguyen Thi , Son Nguyen Ngoc , Thanh Vu Minh , Ha Ninh Duc
Published: February 2024

This paper presents a method to enhance the compatibility of zinc oxide nanoparticles (ZnO NPs) produced from guava leaf extract by modifying the nanoparticle surface with L-glutamic acid. The Glu-coated ZnO material was subjected to characterization using Fourier transform infrared spectroscopy (FTIR), X-ray scattering spectroscopy (XRD), UV-Vis spectroscopy, and electron energy scattering spectroscopy (EDS). The results corroborated the attachment of glutamic acid to the surface of the nanoparticle. The thermal density analysis (TGA) results indicate that the Glu-coated ZnO material contains around 8.998% organic content. The morphology and size of nanoparticles were assessed using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and dynamic light scattering spectroscopy (DLS) both before and after modification. The findings demonstrate that the bare ZnO nanoparticles had an average size of around 25.32 nm, but the Glu-coated ZnO nanoparticles measure 41.88 nm. Their zeta values are − 9.05 mVs and − 18.6 mV, respectively. The anti-cancer effect of ZnO nanoparticles coated with glutamic acid was evaluated on various cell lines including HeLa (cervical cancer), A549 (lung cancer), and MCF7 (breast cancer). The findings demonstrated a significant enhancement in the anti-cancer efficacy of ZnO NPs with the application of Glu coating on their surface. The IC50 values of Glu-coated ZnO for the Hela, A549, and MCF7 cancer cell lines are 40.43 µg/mL, 37.20 µg/L, and 44.23 µg/mL, respectively. The findings indicate that the utilization of Glu-coated ZnO material holds significant promise in the field of cancer treatment.
Facial-submental artery island flap combined with titanium plate for repairing defects after mandibular marginal resection for stage 3 medication-related osteonecrosis of the mandible in cancer patients
Authors: Cheng Wei-qi , Yuan Kai-fang , Chen Wei-liang
Published: February 2024

Background
The study was to evaluate the feasibility of using a facial-submental artery island flap (FSAIF) combined with a titanium plate implant to repair defects after mandibular marginal resection for stage 3 medication-related osteonecrosis of the mandible (MRONM).
Methods
Twenty-four patients with stage 3 MRONM underwent FSAIF combined with titanium plate implant to repair defects after mandibular margin resection and infected soft tissue ablation. Postoperative complications were scored using the Clavien–Dindo classification system. The University of Washington Quality of Life Questionnaire (UW-QOL) was used to evaluate pain before and after surgery. Treatment efficacy was evaluated based on the UW-QOL pain score and fistula closure. Sixteen female and eight male patients with stage 3 MRONM (average age, 62.8 years) and an Eastern Cooperative Oncology Group Performance Status of 0–3 were treated with FSAIF combined with titanium plate implant for repairing defects after mandibular margin resection.
Results
The median size of the skin paddle was 3.0 cm × 10.3 cm, and the total success rate was 95.8%. Clavien–Dindo classification grades of I, II, and IIIb were assigned to 58.3%, 37.5%, and 4.2% of the cases, respectively. Pre- and postoperative UW-QOL pain scores of 0, 25, 50, 75, and 100 were observed in 16.7% and 0, 58.3% and 4.2%; 16.7% and 8.3%, 8.3% and 33.3%; and 0 and 54.2% of cases, respectively, with significant differences seen between the pre- and postoperative scores (P < .001). The median follow-up duration was 18.4 months. The complete control rate was 54.2%, the nearly completely control rate was 33.3%, the partial control rate was 8.3%, and the little-to-no control rate was 4.2%. Of the participants, 83.3% are alive without evidence of MROM or tumor recurrence.
Conclusion
An FSAIF combined with a titanium plate implant for repairing MRONM in stage 3 cancer patients after mandibular margin resection achieved good results, and the technique is reliable and safe.
Machine Learning Based Smartphone Screen Gesture Recognition Using Smartphone Embedded Accelerometer and Gyroscope
Authors: Bhatele Priyanka , Bedekar Mangesh
Published: February 2024

In the recent times, smartphone usage has become increasingly popular for learning. User’s exhibit multiple gesture interactions with smartphones, while reading, which can provide valuable implicit feedback about the content consumed. Smartphones have many embedded sensors which capture plethora of user interaction data. The on-device Gyroscope and Accelerometer can be enabled to capture the variations done due to gesture interactions like scrolling, pinch to zoom, tap, orientation change and screen capture. This research work is based on training machine learning classifier models with smartphone sensors’ readings to identify the users screen gesture interactions. Data for the classifier is collected by from 47 users in total using an android application. Aggregated time domain feature extraction has been computed on the preprocessed data. Four groups of data have been used to train the models. Extensive experiments are done to test the success of proposed system using Random Forests, Support Vector Machine (SVM), Extreme Gradient Boost (XGB), ADA boost, Naïve Bayes (NB) and K-Nearest Neighbour (KNN). Detailed analysis of the success rate and accuracy calculation have been performed. Best identification accuracy of 97.58% is achieved by Random Forest Classifier followed by Extreme Gradient Boost and K-Nearest Neighbour with accuracy 95.97% and 93.55% respectively.
Tumorigenic role of Pak4 in ovarian cancer and its correlation with immune infiltration
Authors: Tang Lan , Ye Hong , Chen Li , Dong Weiwei , Hu Xingyan , Yu Lan
Published: February 2024

Background
Ovarian cancer is the most common cause of gynecological cancer death. Pak4 has been proved to be tumorigenic in many types of cancers, but its role in ovarian cancer is still not clarified.
Methods
In this study, we used immunohistochemistry to investigate into Pak4 expression in different histological types of ovarian cancer. TIMER, GEPIA, ualcan, KM plotter, GSCA and GeneMANIA were used to identify the prognostic roles and gene regulation networks of Pak4 in ovarian cancer. Immune infiltration levels were investigated using TIMER database.
Results
Pak4 was highly expressed in ovarian cancers, regardless of different FIGO stages and histological grades. However, Pak4 level was significantly correlated with different histological types of ovarian cancer. Pak4 expression was negatively connected with OS and PFS of ovarian cancer patients. Functions of Pak4 and its interacted genes were mainly involved in protein serine/threonine kinase activity, regulation of actin filament-based process and regulation of cytoskeleton organization. Pak4 level was negatively correlated with immune biomarkers of B cell infiltration (p = 2.39e-05), CD8 + T cell infiltration (p = 1.51e-04), neutrophil (p = 1.74e-06) and dendritic cell (p = 4.41e-08).
Conclusions
Our results indicated the expression, gene interaction networks and immune infiltration levels of Pak4 in ovarian cancer, revealing potential role of Pak4 in tumorigenesis and immunotherapeutic target.
Association Between Dental Anxiety and Oral Health-Related Quality of Life
Authors: Hegazi Fahad , Alghamdi Nada Khalid , Alhajri Danah Sahmi , Alabdulqader Lulwah Fouad , Alhammad Danah Abdullatif , Alshamrani Lama Mohammed , RAJINDER SUMIT BEDI
Published: February 2024

Objectives
this study aimed to examine the association between both parental and children’s anxiety and its impact on the Oral Health Related Quality of Life (OHRQoL) of Saudi children in Eastern Province of Saudi Arabia.
Methods
Data on 93 individuals aged of 7–12 years were collected using clinical examination and Arabic validated questionnaires of Child Oral Health Impact Profile-Short Form (COHIP-SF19) and Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS). Negative binomial regression analysis and logistic regression analysis was done to study the association between children and parental dental anxiety as well as OHRQoL while adjusting for certain confounders.
Results
Overall, our multivariate analyses showed that children with high dental anxiety (CFSS-DS ≥ 38) (p = 0.027) and higher percentage of dental caries (p = 0.013) had a significantly lower OHRQoL after adjusting for clinical and socio-demographic factors. Further, the odds of having high dental anxiety in children increased by 12.97 (95%CI: 1.29-130.77) with every one-unit increase in parental dental fear.
Conclusion
Our findings demonstrate that children’s anxiety and dental caries are both associated with poorer OHRQoL. Further, parental fear of dentists was associated with children’s fear of dentists.
Prevalence of antimicrobial resistance in Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli isolates among stillbirths and deceased under-five children in Sierra Leone: Data from the Child Health and Mortality Prevention Surveillance sites from 2019 to 2022
Authors: OJULONG JULIUS , Gebru G. N. , Duduyemi B. , Monteiro L. , Kowuor D. , Ameh S. , Ogbuanu I. U.
Published: February 2024

Introduction: Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae are associated with most nosocomial infections worldwide. Although gaps remain in knowledge of their susceptibility patterns, these are in antimicrobial stewardship. This study aimed to describe antimicrobial susceptibility profiles of the above organisms isolated from postmortem blood from stillbirths and under-five children enrolled in the Child Health and Mortality Prevention Surveillance (CHAMPS) programme in Sierra Leone.
Methods: This was a surveillance study of bacteria isolates from postmortem blood cultures taken within 24 hours of death from cases aged 0-59 months between February 2019 and February 2022. This was followed by identification and antibiotic sensitivity testing using Becton Dickinson Phoenix M50 (USA). Descriptive analysis was used to characterize the isolates and their antimicrobial susceptibility patterns.
Results: Of 367 isolates, K. pneumoniae was the most frequently isolated organism (n= 152; 41.4%), followed by E. coli (n= 40; 10.9%) and E. cloacae (n=35; 9.5%). Using BACTEC™ FX 40 (USA), 367 isolates were identified from blood using bacteriological methods. Extended Spectrum beta-lactamase (ESBL) was observed in 143 (94.1%) of K. pneumoniae isolates and 27 (65.5%) of E. coli isolates. Carbapenemase resistant organisms (CRO) were seen in 31 (20.4%) of K. pneumoniae and 5 (12.5%) of E. coli isolates. Multi-drug resistance (MDR) pattern was most prevalent in E.cloacae (33/35; 94.3%) followed by K. pneumoniae (138/152; 90.8%).
Conclusion: Our study showed a high prevalence of multidrug resistance among bacterial isolates in the catchment areas under surveillance by the CHAMPS sites in Sierra Leone. This signals the need to enhance antimicrobial stewardship, infection prevention control measures and extensive antimicrobial resistance surveillance.
Digital New Normal: A New Era of Artificial Neural Networks Application for the Elderly’s Intention to Use Non-face-to-face Leisure Service
Authors: Hyun Byun , Hwang Su-Young , Yi Eun-Surk
Published: February 2024

Objective: Using artificial neural network models and cluster analysis, this study analyzed and predicted the intention to use digital leisure services among the elderly based on their adoption of non-face-to-face services.
Methods: Utilizing raw data from the 2022 Urban Policy Indicator Survey, 2,239 residents of Seoul aged 50 and above were selected for the study. The research predicted the intention to use non-contact leisure services based on demographic characteristics, adaptability to non-face-to-face environments, and frequency of social media usage. Collected data were processed using SPSS 23 and Modeler 14.2, and subjected to frequency analysis, hierarchical clustering, K-means clustering analysis, artificial neural network analysis, logistic regression analysis, cross-tabulation analysis, and one-way ANOVA.
Results: The results identified four clusters. Cluster 3, comprising males in their 60s living with their families, showed the strongest intention to use digital leisure services despite low social media usage and high adaptability to non-face-to-face environments.
Conclusion: This suggests that policies and programs to promote the use of digital leisure services among the elderly should enhance digital accessibility and adaptability to non-face-to-face environments. Additionally, given the limitations of the research subjects and data, further research is needed on a broader age range and more diverse sample of the elderly population. The study also emphasizes the need for digital education programs for the elderly and the provision of leisure services through various digital platforms.
End of life decision making when home mechanical ventilation is used to sustain breathing in Motor Neurone Disease: patient and family perspectives
Authors: Wilson Eleanor , Palmer Jonathan , Armstrong Alison , Messer Ben , Presswood Edward , Faull Christina
Published: February 2024

Background
Motor Neurone Disease (MND), leads to muscle weakening, affecting movement, speech, and breathing. Home mechanical ventilation, particularly non-invasive ventilation (NIV), is used to alleviate symptoms and support breathing in people living with MND. While home mechanical ventilation can alleviate symptoms and improve survival, it does not slow the progression of MND. This study addresses gaps in understanding end-of-life decision-making in those dependent on home mechanical ventilation, considering the perspectives of patients, family members, and bereaved families.
Methods
A UK-wide qualitative study using flexible interviews to explore the experiences of people living with MND (n = 16), their family members (n = 10), and bereaved family members (n = 36) about the use of home mechanical ventilation at the end of life.
Results
Some participants expressed a reluctance to discuss end-of-life decisions, often framed as a desire to "live for the day" due to the considerable uncertainty faced by those with MND. Participants who avoided end-of-life discussions often engaged in ‘selective decision-making’ related to personal planning, involving practical and emotional preparations. Many faced challenges in hypothesising about future decisions given the unpredictability of the disease, opting to make ‘timely decisions’ as and when needed. For those who became dependent on ventilation and did not want to discuss end of life, decisions were often defaulted to others, especially once capacity was lost. ‘Proactive decisions’, including advance care planning and withdrawal of treatment, were found to empower some patients, providing a sense of control over the timing of their death. A significant proportion lacked a clear understanding of the dying process and available options.
Conclusions
The study highlights the complexity and evolution of decision-making, often influenced by the dynamic and uncertain nature of MND. The study emphasises the need for a nuanced understanding of decision-making in the context of MND.
The impact of addiction medicine consultation on outcomes in hospitalized patients
Authors: Serata Emily , Aplin Kara , Salzman Matthew , Hunter Krystal , Rachoin Jean-Sebastien
Published: February 2024

Background
Over the last several years, the incidence and prevalence of substance use disorders (SUD) and related acute illnesses have been rising in the US. Their diagnosis of SUD impacts the clinical course of many hospitalized patients. The primary objective of our study is to assess the impact of a newly implemented inpatient addiction medicine consult service on outcomes in patients with a SUD.
Methods
We included adult SUD patients hospitalized for 24 hours or greater between March 2018 and January 2022. We recorded demographic and clinical variables and analyzed the association between the occurrence of addiction medicine consultation (AMC) with the outcomes of left against medical advice (AMA) and 30-day readmission (READ).
Results
There were 1,020 encounters included in our study: 945 (93%) without AMC and 75 (7%) AMC. AMC patients were younger (53.2 vs. 56.93, P < 0.001), were often male (22.7% vs. 13%, P < 0.001), or had health insurance (74.7% vs. 85.4%, p = 0.015). Their years of use (30 years) and hospital length of stay (4 days) were similar between AMC and non-AMC groups. More patients were using intravenous drugs in the AMC group (25.3% vs 9.8%, < p < 0.001) and opioids (50.7% vs. 19.3%, P < 0.001). In a multivariate regression analysis for the outcomes of interest, after adjusting for demographic variables, AMC was not associated with the outcome AMA (P = 183) but was shown to have a much lower likelihood of 30-day readmission (0.3[0.1–0.8], P = 0.016).
Conclusion
We found that the practice of AMC was associated with similar rates of AMA but fewer 30-day readmission rates in patients with SUD. The comparable rate of AMA could be due to clinicians' higher propensity to consult AMC if patients threaten to leave the hospital. The findings of our study should be confirmed in larger trials but hold significant promise.
Data-guided Gravity Model for Competitive Facility Location
Authors: Zerom Dawit , Drezner Zvi
Published: February 2024

In this paper we introduce a data analytics approach for specifying the gravity model as applied to competitive facility location. The gravity model is used primarily by marketers to estimate the market share attracted by competing retail facilities. Once the market share is computed, various solution techniques can be applied for finding the best locations for one or more new facilities. In competitive facility location research, various parametrized gravity models have been proposed such as the power and the exponential distance decay specifications. However, parameterized approaches may not be robust to slight data inconsistency and possibly leading to inaccurate market share predictions. As the volume of data available to support managerial decision making is growing rapidly, non-parametric (data-guided) approaches are naturally attractive alternatives as they can mitigate parametric biases. We introduce a unified gravity model that encompasses practically all existing parametric gravity models as special cases. We provide a statistical framework for empirically estimating the proposed gravity models focusing on shopping malls data involving shopping frequency.
Comparison of mini-percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for patients with kidney stones and renal insufficiency: A retrospective study
Authors: WEI Weiyang , ZHOU Chuanpeng , YANG Hao , WANG Qi , HUANG Hongxing , HUANG Yaqiang
Published: February 2024

Objective
To compare the clinical efficacy and safety of mini-percutaneous nephrolithotomy (MPCNL) and standard percutaneous nephrolithotomy (SPCNL) in the treatment of kidney stones combine with renal insufficiency.
Patients and Methods:
The data of 320 patients with renal calculi and an eGFR < 60 mL/min/1.73m2 who underwent percutaneous nephrolithotomy (PCNL) at Zhongshan City People's Hospital from January 2018 to June 2023 were retrospectively analyzed; 164 patients were treated with MPCNL, and 156 were treated with SPCNL. The clinical efficacy of the MPCNL and SPCNL regimens was compared in terms of stone-free rate (SFR), renal function change, hemoglobin (HGB) drop and other complication rates (complications were classified by using the Clavien‒Dindo system).
Results
The SFR was 67.1% in the MPCNL group and 67.9% in the SPCNL group (P = 0.867). The overall eGFR of the two groups was significantly improved at 1 month after the operation (P < 0.001). Postoperative renal function was stable, improved and worse in 50.0% (n = 82) vs. 53.8% (n = 84), 39.0% (n = 64) vs. 42.4% (n = 66) and 11.0% (n = 18) vs. 3.8% (n = 6) of the MPCNL and SPCNL patients, respectively, compared with preoperative renal function (P = 0.053). In addition, the overall postoperative complication rates between the two groups was not significantly different (P = 0.103). Patients who underwent MPCNL had a lower transfusion rate (7.9% vs. 16.7%, P = 0.017) and shorter hospital stay (4.57 ± 3.14 vs. 7.16 ± 4.05 days, P < 0.001) than those in the SPCNL group.
Conclusion
MPCNL and SPCNL have positive effects on the treatment of renal calculi in patients with renal insufficiency; both have acceptable SFRs and complication rates, stable or improved renal function in most patients.
The slopes of sub-barrier heavy-ion fusion excitation functions shed light on the dynamics of quantum tunnelling
Authors: Stefanini Alberto , Montagnoli Giovanna , Fabbro Mirco Del , Corradi Lorenzo , Fioretto Enrico , Szilner Suzana
Published: February 2024

Quantum tunnelling plays a crucial role in heavy-ion fusion reactions at sub-barrier energies, especially in the context of nuclear physics and astrophysics. The nuclear structure of the colliding nuclei and nucleon transfer processes represent intrinsic degrees of freedom. They are coupled to the relative ion motion and, in general, increase the probability of tunnelling. The influence of couplings to nucleon transfer channels relatively to inelastic excitations, on heavy-ion fusion cross sections, is one of the still open problems in this field. We present a new analysis of several systems, based on the combined observation of the energy-weighted excitation functions Eσ in relation to their first energy derivatives d(Eσ)/dE. The relation between d(Eσ)/dE and Eσ removes the basic differences due to the varying Coulomb barrier when comparing different systems. We show that, depending on the nuclear structure and/or the presence of strong transfer channels, this representation reveals characteristic features below the barrier. The possible presence of cross section oscillations makes this analysis less clear for light- or medium-light systems.
PACS Numbers: 25.70.Jj, 24.10.Eq
Posterior cerebral artery (PCA)-accessory PCA (hyperplastic anterior choroidal artery) anastomosis detected on magnetic resonance angiography
Authors: Uchino Akira , Tokushige Kazuo
Published: February 2024

Purpose
To describe a case of posterior cerebral artery (PCA) accessory PCA (hyperplastic anterior choroidal artery) anastomosis detected on magnetic resonance angiography.
Methods
A 76-year-old man with a history of cerebral infarction underwent cranial magnetic resonance (MR) imaging and MR angiography of the intracranial region for the evaluation of brain and vascular lesions. The MR machine was a 3-Tesla scanner. MR angiography was performed using a standard three-dimensional time-of-flight technique.
Results
There were two right PCAs. The parieto-occipital and calcarine arteries of the right PCA arose from the right ICA, indicative of accessory PCA, and there were three stenotic lesions at the proximal segment of this artery. The temporal artery of the right PCA originated from the basilar artery. A small anastomotic channel between these two arteries was identified on partial maximum intensity projection (MIP) images. Computed tomography angiography was additionally performed and the findings were confirmed.
Conclusion
We speculated that the pressure gradient between the PCA and the accessory PCA enlarged the anastomotic channel. Partial MIP images are useful for diagnosing small arterial variations using MR angiography.
Presurgical Pulmonary Function Tests in the First Few Days of Life in Neonates with Congenital Heart Disease, A Pilot Study
Authors: McEvoy Cindy , Leeds Hayden , Muralidaran Ashok , Johnson Alicia , Schilling Diane , Parkhotyuk Kseniya , Shen Irving
Published: February 2024

Objective To compare early pulmonary function tests (PFTs) in neonates with critical congenital heart disease (CHD) compared to a historical reference group.Design Infants > 37 weeks gestation with critical CHD were studied within the first few days of life and prior to cardiac surgery and compared to data from a published reference group. Passive respiratory resistance (Rrs) and compliance (Crs) were measured with the single breath occlusion technique following specific acceptance criteria. The study was powered for a 30% difference in Rrs.Results PFTs in 24 infants with CHD were compared to 31 historical reference infants. There was no difference in the Rrs between the groups. The infants with CHD had a significantly decreased Crs (1.02 ± 0.26 mL/cmH2O/kg versus 1.32 ± 0.36; (p < 0.05; mean ± SD)).Conclusions Further prospective studies are required to quantify early PFTs in infants with CHD of different phenotypes.
Effect of zinc and selenium on breast cancer risk: a NHANES cross-sectional study and mediation analysis
Authors: wang yanbo , du zhen , Du Haowei , Zhao Jianchun , Duan Yuting , Wang Aimin
Published: February 2024

Background: This research aimed to examine the correlation between blood zinc and selenium levels and the occurrence of breast cancer, and the extent to which bilirubin, uric acid and γ-glutamyl transferase (GGT)mediate the effect on breast cancer.
Methods: In all, 25,244 adults were enrolled from the 1990-2020 Nutrition Examination Survey (NHANES). The outcome was considered as the occurrence of breast cancer in this study. Zinc and selenium levels were categorized into quartiles (Q1-Q4), and the correlation between zinc or selenium intake and breast cancer incidence was explored through meticulous adjustments for covariates utilizing both multivariate and stratified logistic regression analyses. Furthermore, the mediation and interaction effects were performed by mediation analyses and generalized linear model.
Results: The incidence of breast cancer was associated with race, marital status and age. Besides, participants with breast cancer showed lower zinc (10.2 vs 12.0 mg/ml, p=0.001) and selenium levels (95 vs 114 μg/ml, p<0.001) and higher incidence of diabetes (15% vs 8.5%, p<0.001) and cardiovascular disease (CVD) (16% vs 7.4%, p<0.001) comorbidities than the control group. Logistic regression analysis showed a strong linear protective association between zinc and selenium levels and breast cancer. Moreover, this association changed slightly after adjusting demographic characteristics, socioeconomic characteristics, health factors, and comorbidities and remained statistically significant. In addition, no interaction was found between diabetes and CVD and the effect of zinc/selenium intake on breast cancer risk (p for interaction > 0.05). Finally, bilirubin potentially mediated the protective association between zinc and breast cancer risk, while bilirubin, uric acid, and GGT levels mediated approximately 10% of the relationship between selenium and breast cancer.
Conclusion: Our study highlighted a negative linear association between blood zinc and selenium concentrations and the risk of breast cancer in women. The mediation analysis has shown that bilirubin, uric acid and GGT play an indirect role.
Effect of lymphocyte-to-monocyte ratio on prognosis in obstructive colorectal cancer patients with colonic stent: a Japanese retrospective multicenter study
Authors: Shiraishi Toshio , Tominaga Tetsuro , Nonaka Takashi , Hashimoto Shintaro , Takamura Yuma , Hisanaga Makoto , Takeshita Hiroaki , Ishii Mitsutoshi , Oyama Syosaburo , Ishimaru Kazuhide , Kunizaki Masaki , Sawai Terumitsu
Published: February 2024

Background
The prognostic value of the lymphocyte-to-monocyte ratio (LMR) has been reported for various cancers, including colorectal cancer (CRC). Insertion of self-expanding metallic stents (SEMS) is considered effective for patients with surgically indicated obstructive CRC, but LMR can vary depending on factors such as inflammation associated with stent dilation, improvement of obstructive colitis and nutritional status. LMR may thus change at the time of evaluation. However, the usefulness of LMR in CRC patients requiring SEMS insertion and the optimal timing for measuring LMR remain unclear. This study investigated the relationship between pre-stent LMR and long-term prognosis in patients who underwent bridge to surgery (BTS) for obstructive CRC with SEMS insertion.
Methods
Participants comprised 175 patients with pathological stage 2 or 3 disease who underwent BTS for obstructive CRC with SEMS insertion. Patients were divided into two groups according to pre-stent LMR, as follows: low pre-stent LMR group (pre-LMR-L, n = 87) and high pre-stent LMR group (pre-LMR-H, n = 83).
Results
Median follow-up was 33 months (range, 1–77 months). Five-year relapse-free survival (RFS) only differed significantly for pre-LMR (pre-LMR-L: 39.9% vs. pre-LMR-H: 63.6%; p = 0.015). Pre-LMR represented a prognostic factor for RFS in both univariate (hazard ratio [HR] 1.845, 95% confidence interval [CI] 1.125–3.026; p = 0.015) and multivariate analyses (HR 2.052, 95%CI 1.242–3.389; p = 0.005). Pre-LMR was not a prognostic factor for overall survival in univariate analysis (HR 1.721, 95%CI 0.878–3.374; p = 0.114).
Conclusions
Pre-LMR-L represents a prognostic factor for postoperative recurrence in patients who undergo BTS for obstructive CRC with SEMS insertion.
Adaptive Kriging-based method with learning function allocation scheme and hybrid convergence criterion for efficient structural reliability analysis
Authors: Zhou Jiaguo , Xu Guoji , Jiang Zexing , Li Yongle , Wang Jinsheng
Published: February 2024

Structural reliability analysis poses a considerable challenge in engineering practice, leading to the development of various state-of-the-art methods. Active learning methods, known for their superior performance, have been extensively investigated for assessing failure probabilities in structural reliability analysis. This paper aims to develop an efficient and accurate Kriging-based active learning method for structural reliability analysis, incorporating a novel learning function allocation scheme and a hybrid convergence criterion. Specifically, a novel learning function allocation scheme is introduced to address the challenge of no single learning function demonstrating superior performance across various engineering contexts. Six active learning functions, including EFF, H, REIF, LIF, FNEIF, and KO, are used to form a portfolio of functions in the allocation scheme. The use of the U learning function initiates the active learning process with a truncated candidate sample pool, alleviating computational burden while maintaining accuracy. Additionally, a hybrid convergence criterion, combining the error-based stopping criterion with a stabilization convergence criterion, is proposed to terminate the active learning process at an appropriate stage. The performance of the proposed method is evaluated through four numerical examples and one engineering case, demonstrating its accuracy and efficiency.