bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining the Neural Markers of Speech Rhythm in Silent Reading Using Mass Univariate Statistics of EEG Single Trials
Authors: Powell Stephanie J. , Nayak Srishti , Magne Cyrille L.
Published: October 2024

Objectives: The Implicit Prosody Hypothesis (IPH) posits that individuals generate internal prosodic representations during silent reading, mirroring those produced in spoken language. While converging behavioral evidence supports the IPH, the underlying neurocognitive mechanisms remain largely unknown. Therefore, this study investigated the neurophysiological markers of sensitivity to speech rhythm cues during silent word reading. Methods: EEG was recorded while participants silently read four-word sequences, each composed of either trochaic words (stressed on the first syllable) or iambic words (stressed on the second syllable). Each sequence was followed by a target word that was either metrically congruent or incongruent with the preceding rhythmic pattern. Results: Single-trial event-related potentials (ERPs) and time-frequency representations (TFRs) triggered by the target words were examined using a hierarchical mass univariate general linear modeling approach to investigate the effects of metrical expectancy and stress type. ERP findings revealed significant differences based on expectancy, with words carrying unexpected stress eliciting larger negativities between 240-628 ms after word onset. TFRs further revealed that different frequency bands were sensitive to distinct aspects of rhythmic structure in language. Alpha activity, linked to attention, reflected expectations about the rhythmic pattern. Theta and beta activity, associated with processing rhythm and timing, were sensitive to both the expected rhythm and the specific location of stressed syllables within words. Conclusions: These findings highlight comparable neurophysiological responses to both implicit and explicit speech rhythm, further supporting the IPH and emphasizing the role of prosody in silent reading.
Navigating Strategic Risks: Overcoming Challenges in the Competitive Cloud Computing Sector
Authors: Karimova Nigar
Published: October 2024

This paper analyzes ServiceNow’s overall strategy, business model, mission, vision, and key strategic risks. ServiceNow, a platform-as-a-service provider, has experienced significant growth and is poised for further expansion. The paper identifies strategic risks such as legislative and regulatory challenges, strategy development and execution risks, and competition in the cloud computing industry. Using Porter’s Five Forces framework, the assignment explores these risks and proposes mitigation strategies. Recommendations are made to protect intellectual property, maintain customer loyalty through subscription models, and ensure innovation in response to evolving market demands.
Expresiones artísticas urbanas: pendiente en el diseño de políticas públicas en la frontera
Authors: Murillo Martínez Citlalli Alicia
Published: October 2024

El quehacer del diseñador de políticas públicas, exige de su capacidad creativa y de síntesis para integrar la agenda de los asuntos públicos. Exige también de su capacidad de síntesis, para priorizar el diseño y ejecución de proyectos con base en los intereses, recursos disponibles, acuerdos previos entre los grupos de poder, la prevalencia de un tema y si éstos se traducirán o no en un problema social que pueda ser resuelto por un gobierno.
Café, tostado y colado
Authors: Medina Castro Iván
Published: October 2024

Los mitos de la creación se extienden en la aparición del café.
Aplikasi Media Pembelajaran Ubiquitous Learning Of Angle Dengan Penerapan Pendekatan Otentik
Authors: Putra Muhammad Trio Maulana
Published: October 2024

Covid-19 has given a new personality to education in Indonesia. The use of technology which used to be very limited, but now become an important requirement in the teaching and learning process. The learning process that used to only use blackboards or teaching aids has many limitations and can be completed by utilizing technology with media according to the subject area. Therefore, this research develops a learning media with the name "Ubiquitous Learning of Angle" which we hereinafter refer to as ULA. ULA is expected to be used by Education and Students in the teaching and learning process, especially in corner material. In developing this ULA learning media, the researcher applied the authentic approach in its application. The research methodology used in developing this application is the waterfall methodology which has 5 development processes. In the development of ULA, the hardware used was laptops and smartphones and the software used included CorelDraw, Unity3D, xampp, and Visual Studio. The outputs of this research are ULA (Ubiquitous Learning of Angle) learning media applications for students and ULA Monitoring to monitor students' learning progress.
WITHDRAWN: Lateral resistance of sheathing-to-framing nailed joints in laminated bamboo lumber shear wall sheathed with OSB panel
Authors: Wang Chang , Chen Guo , Zhu Wenli , Zhang Enhao , Wu Jing
Published: October 2024

The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.
Measuring Meaning: Word Meaning and Meaning Change
Authors: Coventry Kenny , Gudde Harmen
Published: October 2024

Understanding how people use and understand words, and how what a word is taken to mean changes over time, are fundamental to political, scientific and cultural discourse. Despite decades of theorising about meaning across myriad disciplines, a major impediment to progress has been the lack of a means of measuring meaning on a moment-by-moment basis. Here we present a novel method for measuring meaning over short time scales using spatial language as a critical test case. Across three large-scale between-participant experiments (N = 1,191) we show that people select between a small number of ‘fixed’ meanings on a trial-by-trial basis rather than exhibiting creativity and flexibility in meaning construction. Moreover, what words are taken to mean at a given moment in time is affected by what they have been taken to mean immediately before, even when the situational context of use changes, consistent with dynamic systems approaches to meaning.
Identification of differentially expressed oxidative stress-related genes in major burned patients and potential mechanisms based on hub genes
Authors: Hong Wangbing , Wang Xin , Huang Xinyu , Liu Yifan , Deng Ziying , Liu Zhifa , Wu Han , Xie Zengxin , Zhan Gongnan , Fu Zhonghua , Huang Heping
Published: October 2024

Background: Burns are extremely destructive injuries to the human body. Once a major burn occurs, it can lead to long-term disabilities, psychological burdens, and significant loss of human resources and economic losses. Extensive burns can cause severe oxidative stress, systemic inflammatory response, and a hypermetabolic state. Besides traditional symptomatic treatment, there is an urgent need for new approaches to address oxidative stress and internal environment disturbance in burn injuries.
Methods: Based on the GEO database and the Limma R package, differential gene expression analysis was performed to identify genes differentially expressed in severe burns and genes associated with oxidative stress. The Gene Ontology (GO) database was used to analyze the cellular functions of these oxidative stress-related genes, and weighted gene co-expression networks analysis (WGCNA) and protein-protein interaction (PPI) networks were constructed. Receiver operating characteristic (ROC) curves were then constructed to identify hub genes in the networks. A diagnostic model based on these central genes was established using the least absolute shrinkage and selection operator (LASSO) analysis and ROC analysis. Immune-related functions were assessed by evaluating the correlation between the expression of hub genes and immune cell infiltration scores. Additionally, drug-gene interaction databases were used to predict target drugs, and miRNet was used to predict the regulation of miRNA and transcription factors.
Results: Through differential analysis, a total of 2,899 differentially expressed genes, 4,936 WGCNA module genes, and 437 oxidative stress-related genes were identified, resulting in 44 candidate genes. Ten hub genes (GCLM, MMP9, BCL2, IL10, SIRT1, NME8, PINK1, GCLC, EPAS1, PARK7) were identified. These central genes were found to be enriched in GO annotations related to “starch and sugar metabolism,” “lysosomes,” and “actin cytoskeleton regulation.” Additionally, it is predicted that 78 drugs can target GCLM, MMP9, BCL2, IL10, SIRT1, NME8, PINK1, GCLC, EPAS1, PARK7, including cisplatin, curcumin, and bevacizumab. A hub gene-miRNA regulatory network with 168 miRNAs and a hub gene-transcription factor (TF) network with 15 TFs were also constructed. These hub genes may serve as biomarkers for the assessment and treatment of oxidative stress in major burns, and provide clues for potential new therapeutic targets.
Conclusion: Based on the common genes associated with major burns and oxidative stress in this study, 10 target genes were proposed. These candidate genes may provide new insights into potential mechanisms for exploring the increased risk of burn severity changes caused by oxidative stress at the transcriptional level.
Identification of Plant Diseases in Jordan Using Convolutional Neural Networks
Authors: Al-Shannaq Moy'awiah A. , AL-Khateeb Shahed , Bsoul Abed Al-Raouf k. , Saifan Ahmad A.
Published: October 2024

In the realm of global food security, plants serve as the primary source of sustenance. However, plant diseases pose a significant threat to this security. The process of diagnosing these diseases forms the bedrock of disease control efforts. The precision and expediency of these diagnoses wield substantial influence over disease management and the consequent reduction of economic losses. Conversely, incorrect diagnoses can render interventions ineffective, leading to agricultural crop deterioration and compounding economic hardships for both farmers and their respective nations. This research endeavors to diagnose the prevalent crops in Jordan, as identified by the Jordanian Department of Statistics for the year 2019. These crops encompass four key agricultural varieties: cucumbers, tomatoes, lettuce, and cabbage. To facilitate this, a novel dataset known as "Jordan 22" was meticulously curated. Jordan 22 was painstakingly compiled through the collection of images featuring both diseased and healthy plants, captured within the confines of Jordanian farms. These images underwent meticulous classification by a panel of three agricultural specialists, well-versed in plant disease identification and prevention. The Jordan 22 dataset comprises a substantial size, amounting to 3210 images. Following the compilation of this dataset, a series of preprocessing steps were executed. These encompassed the standardization of image backgrounds and the uniformization of image dimensions. Furthermore, image augmentation techniques were applied to the dataset to expand its diversity. Subsequently, a deep learning model, the Convolutional Neural Network (CNN), was meticulously trained on the augmented dataset. The results yielded by the CNN were nothing short of remarkable, with a test accuracy rate reaching an impressive 0.9712. Optimal performance was observed when images were resized to 256x256 dimensions, and max pooling was employed in lieu of average pooling within the pooling layer. Furthermore, the initial convolutional layer was set at a size of 32, with subsequent convolutional layers standardized at 128 in size. In conclusion, this research represents a pivotal step towards enhancing plant disease diagnosis and, by extension, global food security. Through the creation of the Jordan 22 dataset and the meticulous training of a CNN model, we have achieved substantial accuracy in disease detection, paving the way for more effective disease management strategies in agriculture.
Investigation the diagnostic value of the combination of cerebrospinal fluid lactate and procalcitonin Serum in the diagnosis of bacterial meningitis after underwent craniotomy and craniectomy
Authors: Sahba Mohsen , rafsanjani Ali Ebrahiminejad , Karamoozian Saeed , tajadini Shahrad , Mirsardo hojat , Ghaedamini Alireza , Ghaedamini Hossein
Published: October 2024

Introduction:
The use of cerebrospinal fluid parameters in the diagnosis of post operative bacterial meningitis does not have enough accuracy. This study was performed to determine the diagnostic value of the combination of cerebrospinal fluid lactate and serum procalcitonin in the diagnosis of post operative bacterial meningitis in Shahid Bahonar Hospital of Kerman during 2015–2018.
Methods
This was a descriptive-analytical and cross-sectional study. The statistical population was all patients who were referred to Shahid Bahonar Hospital of Kerman from 2015 to 2017 who had Cranial surgery. The final diagnosis of meningitis was made based on CSF analysis and culture results. The sensitivity and specificity of serum procalcitonin and cerebrospinal fluid lactate were determined separately and in combination. Data collection was done through a checklist. Data were analyzed by SPSS25 software.
Results
The sensitivity of the combination of serum procalcitonin and cerebrospinal fluid lactate in the diagnosis of post operative bacterial meningitis was 66.7%, its specificity was 95.7%, positive predictive value was 95% and negative predictive value was 70.3%.
Conclusion
According to the results, the combination of serum lactate CSF and procalcitonin has a high specificity value in the determination of post operative bacterial meningitis.
A machine learning–based clinical predictive tool to identify patients with a high risk of medication error
Authors: Abdo Ammar , Gallay Lyse , VALLECILLO Thibault , CLARENNE Justine , Quillet Pauline , VUIBLET Vincent , MERIEUX Rudy
Published: October 2024

A medication error is an inadvertent failure in the drug therapy process that can cause serious harm to patients by increasing morbidity and mortality and are associated with significant economic costs to the healthcare system. Medication reconciliation is the most cost-effective intervention and can result in a 66% reduction in medication errors. To improve patient safety, we developed a machine learning-based tool that prioritizes patients at risk of medication errors upon admission to the hospital to ensure that they undergo medication reconciliation by clinical pharmacists. The data were collected from the electronic health records of patients admitted to Reims University Hospital who underwent medication reconciliation between 2017 and 2023. The data from 12,604 patients were used to train four machine learning-based models based on 52 variables in the development dataset. These models were used to prioritize admitted patients according to their likelihood of being exposed to a medication error. Our models, particularly the voting classifier model, demonstrated good performance (a recall of 0.75, precision of 0.65, F1 score of 0.70 and AUROC of 0.74). In a retrospective evaluation simulating real-life use, the voting classifier model successfully identified 45% of the total patients selected who were found to have at least one unintended discrepancy compared to 21% when using the existing tool. The positive experimental results of this tool showed a superior improvement of 113% over the existing tool by targeting patients at risk of medication errors upon admission to Reims University Hospital.
The impact of prostate volume on Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle
Authors: Liu Yang , Liu Zihao , Wang Zhun , Shao Yuan , Yang Zhen , Huang Hua , Wang Zeyuan , Fu Zhinan , Wen Simeng , Niu Yuanjie , Wang Yong
Published: October 2024

Objective: Robot-assisted radical prostatectomy (RARP) has emerged as a primary treatment modality for localized prostate cancer. In this context, we report a novel surgical technique termed Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle (RNRS-RARP). This study aims to assess the perioperative, oncologic, and functional outcomes of RNRS-RARP across varying prostate volumes.
Methods: A retrospective analysis was conducted on clinical data retrieved from 298 patients who underwent RNRS-RARP from October 2021 to September 2023. Patients were stratified into three groups based on pathological prostate weight: ≤30g, 30-50g, and ≥50g. Comparative analyses were performed on perioperative and postoperative tumor and functional outcomes among the three groups to discern variations. Relevant analyses were conducted separately for patients who received neoadjuvant therapy and those who did not. Additionally, independent predictors influencing immediate continence following RNRS-RARP were investigated.
Results: Firstly, an association was observed between larger prostate volume and advanced patient age, elevated prostate-specific antigen levels, and higher body mass index. Secondly, patients with larger prostate volume exhibited prolonged console time and increased estimated blood loss, but it will not increase the duration of catheterization and the length of hospital stay and postoperative complications. Finally, immediate continence worsened with increasing prostate volume, and the areas under the curve of the predictive model based on prostate volume, age, and preoperative T stage was 0.751.
Conclusion: RNRS-RARP is an improvement on the posterior approach for RARP. It leads to better continence outcomes and can be done with any volume of prostate. However, larger prostate volume was associated with prolonged console time and inferior immediate continence, with prostate volume identified as an independent predictor of immediate continence following RNRS-RARP.
Clinical trial registration: The clinical trial registration number is ChiCTR2200066350 (December1, 2022).
Effect of Neutrophil Elastase Inhibitor (Sivelestat Sodium) on Oxygenation in Patients with Sepsis Induced Acute Respiratory Distress Syndrome
Authors: Wu Tiejun , Wang Tao , Jiang Jinjiao , Tang Yue , Zhang Lina , Jiang Zhiming , Liu Fen , Kong Guiqing , Zhou Tingfa , Liu Ruijin , Guo Haipeng , Xiao Jie , Sun Wenqing , Li Yuye , Zhu Yingying , Liu Quan , Xie Weifeng , Qu Yan , Wang Xiaozhi
Published: October 2024

Objectives
Neutrophil elastase (NE) plays an important role in the development of acute respiratory distress syndrome (ARDS). As a selective NE inhibitor, Sivelestat may improve the outcomes of patients with sepsis-induced ARDS in previous studies, but there is a lack of solid evidence. This trial aimed to evaluate the effect of sivelestat sodium on oxygenation in patients with sepsis-induced ARDS.
Methods
We conducted a multicenter, double-blind, randomized, placebo-controlled trial enrolling patients diagnosed with sepsis-induced ARDS admitted within 48 hours of the advent of symptoms. Patients were randomized in a 1:1 fashion to sivelestat or placebo. Trial drugs were administrated as a 24-hour continuous intravenous infusion for a minimum duration of 5 days and a maximum duration of 14 days. The primary outcome was the proportion of PaO2/FiO2 ratio improvement on Day5 after randomization, defined by a greater than 50% improvement in PaO2/FiO2 compared with that on ICU admission or PaO2/FiO2 reached over 300 mmHg on Day5.
Results
The study was stopped midway due to a potential between-group difference in mortality observed during the interim analysis. Overall, a total of 70 patients were randomized, of whom 34 were assigned to receive sivelastat sodium and 36 placebo. On day5, 19/34 (55.9%) patients in the sivelastat group had PaO2/FiO2 ratio improvement compared with 7/36 (19.4%) patients in the placebo group (risk difference, 0.36; 95% CI, 0.14 to 0.56, p < 0.001). The Kaplan-Meier curves showed a significantly improved 28-day survival rate in patients receiving sivelestat than those not (hazard ratio, 0.32; 95% CI, 0.11 to 0.95; p = 0.041).
Conclusion
In patients with sepsis-induced ARDS, sivelestat sodium could improve oxygenation within the first five days and may be associated with decreased 28-day mortality.
A 41-Year-Old Male with "Grape-Like" Ureteral Carcinoma: A Case Report and Brief Review
Authors: Li Yue , Liang Ning , Dong Changming , Tao Huiying , Yu Tianxi , Wu Shuang , Xie Hao , Guo Jiahao , Lv Wei , Lin Chunhua
Published: October 2024

Ureteral carcinoma, a rare malignancy, is often characterized by the presence of solitary lesions in the ureter. Early diagnosis and effective management are compounded by nonspecific clinical symptoms and radiographic findings. Here, we present a case of a 41-year-old male with a tumor that nearly spanned the entire length of the right ureter. Multi-regional genomic sequencing of the tumor revealed a pattern of branch evolution in this patient, accompanied by a complex genomic mutational landscape.
Multiscale Gradients of Corticopontine Structural Connectivity
Authors: Rousseau Paul-Noel , Bazin Pierre-Louis , Steele Christopher J.
Published: October 2024

The cerebellum’s involvement in a range of cognitive, emotional, and motor processes has become increasingly evident. Given the uniformity of the cerebellar cortex’s cellular architecture its contributions to varied processes are thought be partially mediated by its patterns of reciprocal connectivity with the rest of the brain. A better understanding of these connections is therefore fundamental to disentangling the cerebellum’s contribution to cognition and behavior. While these connections have been studied extensively in non-human animals using invasive methods, we have limited knowledge of these connections in humans. The current work reconstructed the corticopontine projection, the first segment of downstream connections between the cerebral and cerebellar cortices, with diffusion MRI tractography in human in-vivo whole brain data and an independent higher resolution postmortem brainstem dataset. Dimensionality reduction was used to characterize the pattern of connectivity of cerebral cortical projections to the pons as two overlapping gradients that were consistent across participants and datasets: medial to lateral and core to belt. Our findings align with invasive work done in animals and advance our understanding of this connection in humans – providing valuable context to a growing body of cerebellar research, offering insights into impacts of damage along the pathway, and informing clinical interventions.
Clinical Features and Nursing Strategies of Reexploration for Hematomas after Thyroid Surgery: Insights from a 7-Year Single-Center Study in China
Authors: Zhang Xiuting , Hu Benling , Xiao Jiayu , Zhang Xuesong , Zhang Jingya , Zhu Liqing , Kuang Yanbing , Weng Yujing
Published: October 2024

Objective
To explore clinical characteristics of postoperative hemorrhage following thyroid or parathyroid surgery, and to discuss the nursing strategies for its prevention.
Methods
A retrospective analysis was conducted on all patients who underwent thyroid or parathyroid surgery from February 2016 to September 2023. The clinical data of patients who experienced postoperative hemorrhage and required reoperation were collected and analyzed.
Results
Among the 5579 patients who underwent surgery, 42 patients experienced postoperative hemorrhage and required reoperation. Hemorrhage occurred within 6 hours in 19 cases (45.2%) and within 24 hours in 35 cases (83.3%). The most common bleeding sites were the anterior cervical muscle group (44.2%) and branches of the superior or inferior thyroid artery (20.9%). Underlying diseases such as hypertension, diabetes, hemophilia, and postoperative activities like neck movements, coughing, vomiting, and drainage tube manipulation were potential risk factors for postoperative hemorrhage. Clinical manifestations of postoperative hemorrhage included neck swelling or tightness, increased drainage fluid with clots, incision bleeding, pain, skin bruising, and worsening dyspnea.
Conclusion
Understanding the potential risk factors and characteristics of postoperative hemorrhage in thyroid surgery is crucial for specialized thyroid nursing care, as it can aid in its prevention and treatment.
GLUT1 and cerebral glucose hypometabolism in human focal cortical dysplasia is associated with hypermethylation of key glucose regulatory genes
Authors: Ghosh Chaitali , Westcott Rosemary , Skvasik David , Khurana Ishant , Khoury Jean , Blumcke Ingmar , El-Osta Assam , Najm Imad M.
Published: October 2024

Focal cortical dysplasia (FCD) is recognized as a significant etiological factor in pharmacoresistant intractable epilepsy, linked with disturbances in neurovascular metabolism. Our study investigated regulation of glucose-transporter1 (GLUT1) and cerebral hypometabolism within FCD subtypes. Surgically excised human brain specimens underwent histopathological categorization. A subset of samples (paired with matching blood) was assessed for DNA methylation changes of glucose metabolism-related genes. We evaluated GLUT1, VEGFα, MCT2, and mTOR expression by western blot analysis, measured glucose-lactate concentrations, and established correlations with patients’ demographic and clinical profiles. Furthermore, we investigated the impact of DNA methylation inhibitor decitabine and hypometabolic condition on the uptake of [3H]-2-deoxyglucose and ATPase in epileptic brain endothelial cells (EPI-EC). We observed hypermethylation of GLUT1 and glucose metabolic genes in FCD brain/blood samples and could distinguish FCDIIa/b from mMCD, MOGHE and non-lesional types in brain. Low GLUT1 and glucose-lactate ratios corresponded to elevated VEGFα and MCT2 in FCDIIa/b vs non-lesional tissues, independent of age, gender, seizure-onset, or duration of epilepsy. Increased mTOR signaling in FCDIIa/b tissues was evident. Decitabine stimulation increased GLUT1, decreased VEGFα expression, restored glucose uptake and ATPase activity in EPI-ECs and reduced mTOR and MCT2 levels in HEK cells. We demonstrated: 1) hypermethylation of glucose regulatory genes distinguish FCDIIa/b from mMCD, MOGHE and non-lesional types, 2) glucose uptake reduction is due to GLUT1 suppression mediated possibly by a GLUT1-mTOR mechanism; and 3) DNA methylation regulates cellular glucose update and metabolism. Together, these studies may lead to GLUT1-mediated biomarkers, glucose metabolism and identify early intervention strategies in FCD.
Breastfeeding Rates in Israel and their Health Policy Implications.
Authors: Zimmerman Deena R. , Brooks Nati , Wasser Janice , Vaknin-Alon Linoy , Dweck Tunie , Alroy-Preis Sharon
Published: October 2024

Background
Monitoring breastfeeding rates has important health policy implications, as breastfeeding has significant positive impacts on maternal and child health and healthcare costs. This up-to-date, national, population-based breastfeeding rates study in Israel provides important information for health policy development.
Methods
Breastfeeding rates were determined for the years 2016-2022 by retrospective analysis of Machshava Briah electronic medical records used by many Israeli Maternal and Child Health Clinics. This reflects approximately 70% of Israeli children with a nationwide distribution. Comparisons were conducted measuring breastfeeding rates over time and between different sub-groups.
Results
The dataset consists of 945,437 infant records. The percentages of women with any breastfeeding as well as exclusive breastfeeding have shown a gradual decline annually from 2016 to 2022 and are lower than international goals. Sub-group analyses were conducted for 2022. Breastfeeding rates were higher among multipara mothers (versus primapara). Singleton mothers had much higher breastfeeding rates than twin mothers with the difference even more pronounced in exclusive breastfeeding rates. Mothers of preterm infants (<37 weeks) and low birthweight infants breastfed less than mothers of full term infants and normal birthweight and were less likely to exclusively breastfeed. Mothers living in urban areas had the highest rates of breastfeeding and those living in rural areas had the lowest.
A subanalysis performed at two months postpartum for 2022 found the effect of maternal age with the highest rates of breastfeeding among 20-24 year old mothers.Inter-pregnancy interval also had an effect with the highest rates among those whose last pregnancy was 21-33 months ago and the lowest rates among those with an interval of < 1 year.
Conclusions
The population-based data provides an important baseline marker. This study shows a drop in breastfeeding rates, indicating a need to investigate reasons for discontinuing breastfeeding and identifying possible areas for offering support. This data and similar follow-up studies provide the background evidence to warrant that Ministry of Health policies in the hospitals and in the community help accomplish their goals.
The Internal Fixation Selection and Positioning for Proximal Femoral Basicervical Fractures: A Biomechanical Study Through Finite Element Analysis
Authors: Yang Tianhao , Noraddin Faez , Liu Baozhe , Zhang Zegen , Gu Hai-Lun
Published: October 2024

Objectives: This study aims to determine the most suitable implant for proximal femoral basicervical fractures by comparing the biomechanical characteristics of the Dynamic Hip Screw (DHS), Proximal Femoral Nail Anti-Rotation (PFNA), and InterTAN implants through finite element analysis (FEA).
Methods: Thefive fixation styles, namely DHS with a central hip screw in Anteroposterior view , PFNA with a centrally positioned helical blade (PFNA-center), PFNA with an inferiorly positioned helical blade (PFNA-inferior), InterTAN with a centrally positioned hip screw (InterTAN-center), and InterTAN with an inferiorly positioned hip screw (InterTAN-inferior), were simulated. After a three-dimension model of an intact femur was constructed and validated, three distinct basicervical fracture patterns, namely simple, intertrochanteric defect, and lateral wall defect, characterized by increasing displacement and/or bone loss with subsequent instability, were created and incorporated with the aforementioned implants. The models were subjected to FEA, and A load of 700 N was applied to simulate a 70 kg patient standing on one leg. The displacement and stress distributions on implants were analyzed for comparison between implants. Under each basicervical fracture type, we mainly compared DHS, PFNA-center, and InterTAN-center to assess the best implant performance. In addition, we compared PFNA-center and InterTAN-center with PFNA-inferior and InterTAN-inferior to assess the best hip screw position.
Results: In the simple basicervical fracture, DHS, PFNA, and InterTAN exhibited similar and small results in displacement and maximum stress in implants. In the intertrochanteric defect and lateral wall defect basicervical fractures, notable differences were observed within implants. The displacement was greatest with the DHS, followed by the PFNA, then InterTAN(minimal different between PFNA and InterTAN). In contrast, the maximum stress was highest with InterTAN and was higher with PFNA than with DHS, with none of them exceeding the fatigue limit of medical titanium. Regarding the hip screw position with the cephalomedullary nails, the inferior position showed biomechanical parameters advantages compared with the central position.
Conclusion: DHS, PFNA, and InterTAN are all suitable for the management of simple basicervical fractures. In the intertrochanteric defect and lateral wall defect basicervical fracture types, the cephalomedullary nail showed better mechanical stability and is preferred over DHS, with InterTAN showing slightly better stability compared to PFNA. The inferior hip screw position in cephalomedullary nails is preferable over the central hip screw position.
Association of Lymphocyte Subsets Percentage with Prognosis for Recurrent or Metastatic Nasopharyngeal Carcinoma Patients Receiving PD-L1 Inhibitors
Authors: Diao Jianming , Wei Zhigong , Pei Yiyan , Ge Junyou , Qing Yan , Wei Youneng , Peng Xingchen , Chen Ye
Published: October 2024

Background: Immune checkpoint inhibitors (ICIs), particularly PD-1/PD-L1 inhibitors, have demonstrated significant survival benefits in treating recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC). While baseline peripheral blood lymphocyte subsets have been identified as prognostic biomarkers in various cancers treated with ICIs, their relevance in R/M-NPC has not been extensively studied.
Methods: This post-hoc analysis used data from 153 R/M-NPC patients treated with PD-L1 inhibitor monotherapy in the phase 2 trial KL167-2-05-CTP. The lymphocyte subsets, including total T cells, CD4/CD8 ratio, helper T cells, suppressor cytotoxic T cells, NK cells, and B cells, were tested by flow cytometry. These subsets were grouped using optimal cutoff values identified by the Maximally Selected Log-rank Statistic. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier and Cox regression analysis, and logistic regression analysis evaluated the associations with objective response rate (ORR) and disease control rate (DCR).
Results: Patients with lower NK cell percentages showed significantly longer OS (26.3 vs. 12.1 months, p<0.001) and PFS (5.5 vs. 3.7 months, p<0.001) compared to those with higher NK cell percentages. No significant differences in OS or PFS were observed for other lymphocyte subsets. High NK cell percentages were identified as risk factors for shorter OS (HR, 2.49) and PFS (HR, 1.62). There were no significant differences in ORR and DCR between high and low lymphocyte subsets.
Conclusion: Lower baseline NK cell percentages are associated with improved OS and PFS in R/M-NPC patients undergoing PD-L1 inhibitor therapy.
The 28th February 1969 earthquake and tsunami in the Atlantic Iberian margin
Authors: Baptista Maria Ana , Miranda Jorge Miguel , Omira Rachid
Published: October 2024

On the 28th February1969, a massive earthquake stroke SW Iberia and NE Morocco triggering a tsunami recorded in more than 20 tide stations. The event occurred in the SW Iberian margin, the same seismogenic area of the 1st November 1755 mega event. Several studies were developed in the last 55 years to address its earthquake mechanism and the corresponding tsunami source. In some cases, the study of the 1969 event was also the base for inferences regarding the 1755 earthquake and indirectly to give some light on tsunamigenic processes related with the SW Iberian margin. In this study, we present a comprehensive review of the tsunami data, taking advantage from the great improvement that occurred on the quality of the bathymetric data, particularly on the shallow areas close to the tide stations. We used a larger set of tide-records than previous studies. All records were digitized from the original mareograms and processed them according to modern standards. We address the possible landslide triggered at the NW coast of Morocco as the explanation of the tsunami observation at Casablanca. The new dataset combining both the earthquake and the landslide sources allows a better relocation of the tsunami source, enabling a quantitative comparison of the different source scenarios that have been developed for seismological research. The simulations presented here suggest that a thrust fault of 85 km x 20 km verging to the southeast is the best candidate to be responsible for the 1969 earthquake. The trace of this deep fault follows the one of the “Horseshoe Fault”, a northwest verging structure interpreted from the multichannel seismic data. Moreover, this deep structure may be accountable for both the 1969 event and the later 12th February 2007 M6 earthquake. Even more, the “Deep Horseshoe Fault” is a strong candidate to be the source of the 1st November 1755 event up to now elusive to multiple geological and geophysical studies.
Factors Affecting the Survival of Metastatic Breast Cancer Patients Treated With Cdk 4/6 Inhibitors
Authors: Isleyen¹ Zehra Sucuoglu , Muglu² Harun , Topcu³ Zeynep Alaca , Besiroglu³ Mehmet , Yasin¹ Ayse Irem , Topcu¹ Atakan , Simsek¹ Melih , Seker¹ Mesut , Turk¹ Haci Mehmet
Published: October 2024

Objective
We aim to determine the efficacy, and the factors associated with the effectiveness of first-line CDK4/6i (ribociclib or palbociclib) in HR-positive, HER2-negative MBC patients.
Material and method
This is a retrospective, cross-sectional, and descriptive study. Ninety patients with metastatic breast cancer receiving CDK 4/6i from three different oncology clinics were included in the study.
Results
Of the patients, 56 (62.2%) had received ribociclib, and 34 (37.8%) palbociclib. There was no significant difference between the groups regarding age, gender, comorbidities, ECOG performance status, and menopausal status (p>0.05). The cut-off values for ER, PR, and Ki-67 levels were determined by ROC curve analysis. It was found as 80% for ER level, 50% for PR level, and 30% for Ki-67 level. PFS was significantly longer in patients with ER-level greater than 80% and Ki-67 expression less than 30% in multivariate analysis. Among the patients included in our study, the median PFS was 22.41 months in the patients with only a Ki-67 level of 30% and above, while the median PFS was 17.24 months in the patients with only an ER level of 80% and below. In the patients with a combined ER of 80% or less, and a Ki-67 of 30% or more, the median PFS was 12.42 months (p<0.001).
Conclusion
This study demonstrated that CDK4/6i therapies had longer PFS in patients with ER levels greater than 80% and Ki-67 expression less than 30%. It is essential to determine which patient group benefits more from first-line CDK4/6is.
PAX5 expression and its diagnostic utility in gastroenteropancreatic neuroendocrine neoplasm
Authors: Wang Kun , Liu Xiaoying , Zhao Jie , Li Yanchun , Chen Zhihong
Published: October 2024

Background: Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) are common tumors of the digestive system. Although their histological diagnosis is usually straight forward, their differential diagnosis between neuroendocrine tumors G3(NETs G3) and neuroendocrine carcinomas (NECs) may be challenging at times. Because they have the similar immunophenotypes and morphology in a small cases. The previously reported revealed PAX5 expression in poorly differentiated neuroendocrine carcinoma of the gastrointestinal and pancreatobiliary tract, small cell carcinoma of lung and merkel cell carcinoma. However, above study only focused on poorly differentiated neuroendocrine carcinoma, cases of NET G1, G2 and G3 were not included.
Aims and Methods: The objective of this study is to assess the expressed and diagnostic value of PAX5 in the GEP-NENs. Immunohistochemical(IHC) analysis for PAX5 was carried out in a large cohort of GEP-NENs comprising 39 GEP-NECs and 62 GEP-NETs.
Results: Using a semi-quantitative scoring method, PAX5 was expressed in 30 out of 39 GEP-NECs (77%), with 27 out of 39 cases (69%) showing positivity in ≥10% of cells. Especially in GEP-NECs with a high proliferative index, there were more PAX5-positive cells. None of cases of GEP-NET G1 and G2 expressed PAX5. Only 2/12 cases GEP-NET G3(17%) was positive for PAX5, with showing PAX5 positivity in 1-10%% of cells and 10-50%, respectively. The difference in PAX5 expression between GEP-NETs and GEP-NECs was obviously statistically significant(3% vs. 76%, P<0.001).
Conclusions: PAX5 can be used as a complementary diagnostic immunohistochemical marker for GEP-NECs. Additionally, PAX5 can be considered in cases when it is difficult to distinguish between GEP-NECs and GEP-NET G3.
Predicting severe radiation pneumonitis in patients with locally- advanced non-small cell lung cancer after thoracic radiotherapy: Development and internal validation of a nomogram based on the clinical, hematological and dose–volume histogram parameters
Authors: Zhang Ying , Yan Yu-Jie , Zhou Shi-Hong , Wu Lei-Lei , Yuan Xiao-Shuai , Hu Min , Kang Jing-Jing , Jiang Chen-Xue , Zhu Yao-Yao , Yang Shuang-Yan , Zhao Rui-Feng , Hu Jian , Hu Min-Ren , Liu Hui , Liu Liang , Zhao Lan , Xu Ya-Ping
Published: October 2024

Purpose
Severe radiation pneumonitis (grade≥3 RP) remains an important dose-limiting toxicity after thoracic radiotherapy (RT). This study aimed to investigate risk factors for severe RP in patients with locally-advanced non-small cell lung cancer (NSCLC) after thoracic RT, develop a prediction model to identify high-risk groups and investigate impact of severe RP on overall survival (OS).
Methods
We retrospectively collected clinical, hematological and dosimetric factors from 351 stage-Ⅲ NSCLC patients after thoracic RT between 2018 and 2022. The primary endpoint was development of severe RP. The secondary endpoint was OS. Logistic regression and least absolute shrinkage and selection operator (LASSO) regression analysis were used to identify risk factors of severe RP. Nomogram was generated based on multivariate regression coefficients. Area under the ROC curve (AUC), calibration curve, and decision curve analysis (DCA) were conducted to validate the model. After a long-term follow-up, OS of patients with RP vs. non-RP and mild RP vs. severe RP groups was analyzed by Kaplan‒Meier method.
Results
ILD (p<0.001), percentage of contralateral lung volume receiving≥5Gy (contraV5) (P=0.013), percentage of ipsilateral lung volume receiving≥20Gy (ipsiV20)(P=0.039), pre-RT derived neutrophil lymphocyte ratio (dNLR) (P=0.015) and post-RT systemic inflammation response index (SIRI) (p=0.001) were showed to be independent predictors of severe RP and were included in the nomogram. ROC curves revealed the AUC of the nomogram was 0.782. Calibration curves showed favorable consistency, and DCA showed satisfactory positive net benefits of the model. Median follow-up time was 19.8 months (1.4-52.9 months), and cases who developed severe RP showed shorter OS than those developed mild RP (P=0.027).
Conclusion
We identified that ILD, contraV5(>11%), ipsiV20(>45%), pre-RT dNLR (>1.9) and post-RT SIRI (>3.4) could predict severe RP among patients with locally-advanced NSCLC receiving thoracic RT. Combining these indicators, a nomogram was first built and validated, showing its potential value in clinical practice.
Prediction of Delivery Mode in Primiparous Women Based on Clinical and Intrapartum Ultrasound Parameters
Authors: Huang Chunxia , Chen Yu 'e , Zhang Yuxia , Lin Weiru , Guo Qiuling , Cai Zhundun , Lyu Gourong
Published: October 2024

Objective: To monitor intrapartum ultrasound in primiparous women entering the first stage of labor and construct a model to predict the delivery mode for these women.
Materials and Methods: A total of 203 full-term singleton primiparous women admitted to our hospital for vaginal delivery between February 2022 to November 2023 were included. Initially, cervical dilation and fetal presentation were assessed by midwives through vaginal examination. Subsequently, ultrasound monitoring of the labor progress was conducted, with both assessments conducted blindly. Measurements were performed according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines, including abdominal assessment of fetal presentation and transperineal measurements of the angle of progression (AOP), head-perineum distance (HPD),progression distance (PD), and midline angle (MLA). Three measurements were performed for each parameter, and the average values were calculated. The participants were divided into a vaginal delivery group (163 cases) and a cesarean section group (40 cases) based on the delivery outcome. Clinical and ultrasound parameters were analyzed to determine differences between the two groups. Multiple logistic regression analysis was conducted to identify the independent influencing factors, and a nomogram was constructed. The robustness of the model was assessed and its clinical effectiveness was evaluated,which was then externally validated.
Results: (1) Maternal height, weight, gestational age, estimated fetal weight (EFW), maternal gestational diabetes, and maternal preeclampsia showed no statistical differences (P > 0.05), whereas epidural analgesia, fetal presentation, AOP, MLA, HPD, and PD exhibited significant differences (P < 0.05). (2) Multiple logistic regression analysis revealed that epidural analgesia, fetal presentation, AOP, and HPD were independent factors influencing vaginal delivery. The constructed nomogram exhibited a sensitivity of 74.2%, a specificity of 77.5%, and an area under the curve (AUC) of 0.808 (95% confidence interval: 0.729-0.886). (3) The nomogram prediction model was externally validated,and the constructed nomogram exhibited a sensitivity of 78.3%, a specificity of 80.0%, and an area under the curve (AUC) of 0.839 (95% confidence interval: 0.717-0.961).
Conclusion: Epidural analgesia, fetal presentation, AOP, and HPD were identified as independent factors influencing vaginal delivery in primiparous women. The nomogram model based on clinical and intrapartum ultrasound parameters demonstrated robustness and effectiveness, providing a valuable tool for predicting delivery mode.
The Endobiota-estrobolome Study in Reproductive aged Women with Ovarian Endometriosis
Authors: Hu Chia-Yu , Pai Angel Hsin-Yu , Wang Yi-Wen , Lu Pei-Chen , Wu Hsien-Ming , Huang Hong-Yuan
Published: October 2024

Background
The human body harbors greater than 10 trillion symbiotic, microbial cells that contribute to our bodily functions. Emerging evidences suggest that dysbiosis, especially of the gut or urogenital system, may induce various pathological conditions or altered estrobolome and associate with certain estrogen-dependent diseases like endometriosis. The present case-control study analyzed the enzymatic expressions, bacterial compositions, and variations of estrogen metabolites in fecal, vaginal, and urinary samples of patients with or without ovarian endometriosis.
Methods
A total of 38 women of reproductive age, 24 with pathologically-proven ovarian endometriosis and 14 without (control), were analyzed. Recruited patients provided stool, urine, and vaginal samples before undergoing surgeries for ovarian endometriosis or other benign ovarian tumors. Gut enzymatic assays of β-glucuronidase and β-glucosidase were conducted using an ELISA spectrophotometer. Advanced liquid chromatography and mass spectrometry analyzed estrogen and 14 estrogen metabolites in stool, urine, and vaginal samples. Gut and vaginal microbiota were detected with 16S ribosomal-RNA gene sequencing and further classified with Institute of Genome Sciences bioinformatics pipeline. Analyses for species composition, diversity, and abundance were compared between the ovarian endometriosis and control groups. Statistical significance was determined using t-tests and Wilcoxon tests (p < 0.05).
Results
While similar gut β-glucuronidase activities, microbial diversity, and abundance were observed in the fecal samples of both groups, the gut microbiota of the control group showed higher prevalence of Rothia genus whereas genera such as Megamonas, [Eubacterium] coprostanoligenes_group, Allisonella, Ruminiclostridium_5, [Eubacterium] hallii_group, and Negativibacillus were significantly more abundant in the ovarian endometriosis group. Meanwhile, besides statistically lower folds of 4-methoxyestrone (p = 0.046), 2-methoxyestrone (p = 0.043), and 2-hydroxyestrone-3-methyl ether (p = 0.006), vaginal samples of patients with endometriosis also revealed significantly lower bacterial abundance, diversity, richness, and evenness.
Conclusions
While the current findings did not demonstrate obvious dysbiosis in patients with ovarian endometriosis, variations in certain genera and families of bacteria between the two groups could indicate altered estrogen metabolism or disturbed urogenital and gastrointestinal microbiota.