bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a predictive model for intravesical recurrence after radical nephroureterectomy： a multi-center study
Authors: wang cheng , zhang biao , kang ziming , ou shuzhen , li pingheng , wan jianghou , shang panfeng
Published: December 2024

Purpose The high incidence of incurrence recurrence(IVR) after radical nephroureterectomy (RNU) is a characteristic of upper urinary tract urothelial carcinoma (UTUC), which has a significant impact on the survival outcome of patients. This study aimed to construct nomogram using data from multicenter data to predict IVR in patients with UTUC.Methods Clinical data of 515 UTUC patients after RNU were gathered from three medical centers between 2012 and 2022. The factors associated with IVR were analyzed by univariate and multivariate Cox proportional risk models in one center as training cohort, and included independent risk factors into nomogram models predicting IVR-free survival (IVRFS). Another two centers were collected as the external cohort to validate the predictive accuracy and discriminative ability of the nomogram.Results Ureteroscopy, hydronephrosis, the history of bladder cancer, surgical margin and tumor grade were associated with IVR after UTUC (P < 0.05). The C-index of the nomogram in the training cohort were 0.722. The C-index of the nomograms in the external validation cohort were 0.767.Receiver operating characteristic (ROC) curves, calibration curves, and survival curves all demonstrated good predictive performance of the nomogram.Conclusion Ureteroscopy, hydronephrosis, the history of bladder cancer, surgical margin and tumor grade can be used to independently predict IVR after RNU. The nomogram was built based on these factors had good differentiation and conformity, which can assist clinicians in assessing individualized IVR rates and making optimal treatment decisions.
Parental Perceptions of Developmental Care Rounds in a Pediatric Heart Center
Authors: Pande Chetna , Burns Joseph , Schwab Sarah , Medchill Michelle , Rizk Claire , Schlosser Robin , Davis Kelly , Carretero Sofia , Kimbrough Danielle , Elhoff Justin
Published: December 2024

Background Infants requiring surgery for congenital heart disease (CHD) are at an increased risk of neurodevelopmental delay. Developmental Care Rounds (DCR) has been implemented widely to support the neurodevelopment of children with CHD while admitted to the hospital.Objectives This study aims to describe caregiver perceptions of DCR at a quaternary academic children’s heart center.Methods Over 17 months, caregivers were asked to evaluate DCR by responding to Likert-scale statements by level of agreement as well as free-form text responses. The Likert scales were analyzed and free-form responses were manually reviewed to identify key themes.Results Forty-nine families participated in the assessment. One hundred percent of caregivers reported that they “Agree” or “Strongly Agree,” to the surveyed questions. These included queries regarding the benefit and utility of DCR. In the qualitative assessment, responses identified themes surrounding feeling more empowered to be active members of the care team, an increased awareness of the importance of regular developmental care during hospitalization, as well as education regarding available resources to promote appropriate developmental care. Some of the specific tools parents reported learning include reading, speaking aloud to children, limiting screen time, and engaging in skin-to-skin contact.Conclusions This is one of the first descriptions of caregiver perceptions of DCR in pediatric patients with CHD. Our results indicate parental satisfaction with DCR with the identification of specific tools to aid in their children's development. DCR may offer an opportunity to improve neurodevelopmental outcomes in hospitalized children with CHD.
A Digital Twin Framework for Real-Time Healthcare Monitoring: Leveraging AI and Secure Systems for Enhanced Patient Outcomes
Authors: Jameil Ahmed K , Al-Raweshidy Hamed
Published: December 2024

Digital Twin (DT) technology in healthcare is relatively new and faces several challenges, e.g., real-time data processing, secure system integration, and robust cybersecurity. Despite the growing demand for real-time monitoring frameworks, further improvements remain possible. In this study, an architecture has been introduced that utilises cloud computing to create a DT ecosystem. A group of 20 participants has been monitored continuously using high-speed technology to track key physiological parameters, i.e., diabetes risk factors, heart rate (HR), oxygen saturation (SpO2) levels, and body temperature (BT). The DT model functions as a tool, storing both real-time sensor data and historical records, to effectively identify health risks and anomalies. An MLP model was combined with XGBoost, resulting in a 25% reduction in training time and a 33% reduction in testing time. The model demonstrated reliability with an accuracy of 98.9% and achieved real-time accuracy of 95.4%, alongside an F1 score of 0.984. Meticulous attention has been paid to cybersecurity measures, ensuring system integrity through end-to-end encryption and compliance with health data regulations. The incorporation of DT and AI within the healthcare sector is seen as having the potential to overcome existing limitations in monitoring systems, while workloads are relieved and data-driven diagnostics and decision-making processes are improved, e.g., through enhanced real-time patient monitoring and predictive analysis
AI-based analysis of fetal growth restriction in a prospective obstetric cohort quantifies compound risks for perinatal morbidity and mortality and identifies previously unrecognized high risk clinical scenarios
Authors: Zimmerman Raquel M. , Hernandez Edgar J. , Yandell Mark , Tristani-Firouzi Martin , Silver Robert M. , Grobman William , Haas David , Saade George , Steller Jonathan , Blue Nathan R.
Published: December 2024

Background
Fetal growth restriction (FGR) is a leading risk factor for stillbirth, yet the diagnosis of FGR confers considerable prognostic uncertainty, as most infants with FGR do not experience any morbidity. Our objective was to use data from a large, deeply phenotyped observational obstetric cohort to develop a probabilistic graphical model (PGM), a type of “explainable artificial intelligence (AI)”, as a potential framework to better understand how interrelated variables contribute to perinatal morbidity risk in FGR.
Methods
Using data from 9,558 pregnancies delivered at ≥ 20 weeks with available outcome data, we derived and validated a PGM using randomly selected sub-cohorts of 80% (n = 7645) and 20% (n = 1,912), respectively, to discriminate cases of FGR resulting in composite perinatal morbidity from those that did not. We also sought to identify context-specific risk relationships among inter-related variables in FGR. Performance was assessed as area under the receiver-operating characteristics curve (AUC).
Results
Feature selection identified the 16 most informative variables, which yielded a PGM with good overall performance in the validation cohort (AUC 0.83, 95% CI 0.79–0.87), including among “N of 1” unique scenarios (AUC 0.81, 0.72–0.90). Using the PGM, we identified FGR scenarios with a risk of perinatal morbidity no different from that of the cohort background (e.g. female fetus, estimated fetal weight (EFW) 3-9th percentile, no preexisting diabetes, no progesterone use; RR 0.9, 95% CI 0.7–1.1) alongside others that conferred a nearly 10-fold higher risk (female fetus, EFW 3-9th percentile, maternal preexisting diabetes, progesterone use; RR 9.8, 7.5–11.6). This led to the recognition of a PGM-identified latent interaction of fetal sex with preexisting diabetes, wherein the typical protective effect of female fetal sex was reversed in the presence of maternal diabetes.
Conclusions
PGMs are able to capture and quantify context-specific risk relationships in FGR and identify latent variable interactions that are associated with large differences in risk. FGR scenarios that are separated by nearly 10-fold perinatal morbidity risk would be managed similarly under current FGR clinical guidelines, highlighting the need for more precise approaches to risk estimation in FGR.
Re-do robot-assisted salvage lobectomy after esophagectomy with gastric pull-up reconstruction: A case report
Authors: Shahin Ghada , Kharbanda Rohit , Tummers Quirijn , Braun Jerry
Published: December 2024

Background:
Robot-assisted Thoracic Surgery (RATS) is well-established for complex minimally invasive thoracic surgery. Despite the available literature, robotics for complex advanced NSCLC for re-do surgery remains underexplored.
Case presentation:
We present a 55-year-old female who underwent esophagectomy with gastric pull-up reconstruction for squamous cell carcinoma (SCC) of the esophagus (cT3N2M0, stage IIIB) after neo-adjuvant concurrent chemoradiation therapy (ypT2N1 stage IIB disease). Six years later, computed tomography (CT) scan showed stage IA Thyroid Transcription Factor-1 (TTF-1) positive adenocarcinoma in the left upper lobe treated by stereotactic radiotherapy. Two years later, a SCC of the right upper lobe (RUL) was found (Fig. 1). Although locoregional therapy was preferred Pembrolizumab® was initiated with curative intent as the tumor demonstrated a high Programmed Death-Ligand 1 (PD-L1) expression. Follow-up CT-scan showed no biological response. Salvage lobectomy was proposed, and patient consent obtained. As demonstrated in the video, RATS provided great exposure to the adhesions, vascularization of the neo-oesophagus and maximal dexterity in difficult spaces.
Conclusions:
This case demonstrates the value of RATS in complex re-do thoracic surgery after immunotherapy and previous thoracotomy.
The development of Disaster preparedness education for public: A scoping review
Authors: Guo Ling , Fang Mingwang , Liu Li , Chong Haiyan , Zeng Wen , Hu Xiuying
Published: December 2024

Background: Disasters have become an increasing concern globally due to their devastating impacts on communities, economies, and infrastructure. The rising frequency and intensity of disasters necessitate a more comprehensive, proactive and systematic approach in preparing communities to mitigate and respond effectively. To address this, disaster preparedness education for public has emerged as a crucial component of disaster risk reduction strategies and plays a crucial role in enhancing the resilience of communities and minimizing the adverse effects of disasters.
Objective: This scoping review aims to explore and map the key findings related to the development of disaster preparedness education for public and identify key themes, gaps, and challenges in this field.
Material and methods: A scoping review of literature was undertaken to assess research articles and preprints from the date of establishment to March 30, 2023. Databases included PubMed database(MEDLINE), ISI Web of Science (WOS), Google Scholar and Web of Science.
Results: 95 articles met inclusion criteria and were finally included for the review. The included studies originated from 16 countries: the United States of America(n=51), China (n=6), Iran (n=6), Japan(n=5) and Turkey(n=5) accounted for the majority of them. Research designs of included studies consisted of one cohort study, thirty randomized controlled trials, one cross-sectional study, six qualitative studies, fifty-four quasi-experimental studies and three mixed-method studies. Research objects of included studies consisted of 8 types, of which all disasters(n=58), emerging infectious diseases(n=13), mass casualty incidents(n=10) and earthquake(n=7) accounted for the majority. Together, these studies involved 31,981 participants including citizens, emergency health care providers, families of special health care needs, as well as students from different medical areas. Thematic analysis of the charted findings led to the identification of three stressed themes: (1) factors influencing the development of disaster preparedness education, (2) models and frameworks for disaster preparedness education and (3) innovative approaches in disaster preparedness education.
Conclusion: This review demonstrates a variety of factors impacting the development and implementation of simulation to assess characteristics of disaster preparedness education. Adoption of models and frameworks such as behavior change theories, risk communication models and innovative approaches could improve the quality and consistency of the disaster preparedness education.
Effects of hormone concentrations on anther cultures and the acquisition of regenerated plants of five awnless triticale genotypes
Authors: ma Jun , Zhao Fangyuan , Zhang Yinxia , Tian Xinhui , Du Wenhua
Published: December 2024

Background
The rapid production of doubled haploids by anther culture technology is an important breeding method for awnless triticale. The aim of this study was to explore the effects of triticale genotype and the types and ratios of exogenous hormones in the medium on the efficiency of triticale anther culture.
Results
Anthers of five triticale genotypes were cultured on four different callus induction media and the calli were induced to differentiate into green plants by culture on three different differentiation media. The triticale genotype T8004 showed the best performance in anther culture, with a callus induction rate of 28.64%, a green plantlet differentiation frequency of 33.33%, and a green plantlet production rate of 2.78%. The highest callus induction rates were obtained by culturing anthers on C3 medium, and the highest green plantlet differentiation frequency was obtained by culturing calli on D2 differentiation medium. Flow cytometry analyses showed that 15 of the 20 regenerated plants that grew normally in the field were doubled haploids. The average chromosome doubling success rate was 55.6%. Analyses of agronomic traits showed that the 15 doubled haploid plants reached the standard for awnless triticale, so they are candidate materials for breeding new awnless triticale varieties.
Conclusion
The anther culture technology of triticale was optimized in this paper, which made it possible to rapidly breed homozygous varieties of awnless triticale.
Oral GVHD Post-Cardiac Xenograft Valve Replacement: A Case Report
Authors: Feteih Sarah M. Nizar , Shihata Mohammed S.
Published: December 2024

Background: Graft versus host disease (GVHD) is an autoimmune disease that affects the oral cavity as well as other parts of the body. Oral GVHD occurs in 45%–83% of cases, and chronic GVHD observed in 30%–50% of cases usually manifests as an oral presentation.
Case presentation: In this case report, a 13-year-old girl was referred to the periodontics clinic from the pediatric dentistry clinics for proper diagnosis and management of the oral presentations observed after receiving a prosthetic valve replacement 2 years post-surgery. In this study, the xenograft type used was mainly investigated, as similar soft tissue grafts are used in the oral cavity with no GVHD oral manifestations being observed. This brings about an interesting discussion of the use of xenografts in different areas of the human body, but with different presentations.
Conclusions: Thus, future investigations on early diagnostic tools, including saliva or blood examinations, are needed to create preventive methods or lessen the extent of GVHD in patients.
Demographic and topographic findings suggesting poor response to crosslinking- iontophoresis in patients with progressive keratoconus
Authors: Peralba Rosario Touriño , Lago Julio Rodríguez , Lamas-Francis David , Martínez-Pérez Laura , Rodríguez-Ares Teresa
Published: December 2024

PURPOSE: To evaluate demographic and tomographical parameters in predicting treatment response following transepithelial iontophoresis-assisted corneal cross-linking (I-CXL) for progressive keratoconus.
METHODS: Forty eyes (20 aged <19 years and 20 aged ≥19 years) underwent I-CXL treatment between 2016 and 2022. Progression criteria based on the ABCD system, changes in asphericity (Q), demographic factors and keratoconus phenotypes were evaluated. Subjects were followed for 24 months after procedure.
RESULTS: Sixty percent of participants were male. The mean age at the time of treatment was 21.0±6.0 years. All tomographical values showed progression after 2 years of follow-up (p<0.05), particularly during the first 6 months, except for anterior curvature. Within the ABCD grading system, we observed: A) an increase in anterior curvature, more evident with lower initial values; B) an increase in posterior curvature, more pronounced with higher initial values. Two years after I-CXL, 20% of subjects met progression criteria in two or more parameters, with 62.5% being under 19 years of age. Patients with a family history of corneal ectasia exhibited a mean KMax progression of 1.94D±1.88, (p=0.046). Only phenotypes 3 and 4 showed progression. Although patients under 19 years showed greater progression in all tomographical variables at the end of the study, this difference was not statistically significant.
CONCLUSION: Treatment with I-CXL did not stop progression in the variables studied two years after the procedure in an effective manner, especially in patients younger than 19 years. A family history of corneal ectasia and subtype 4 keratoconus predicted a less favourable response to I-CXL.
Machine Learning-Based Analysis of Hardness in Polypropylene/Carbon Nanotube and Low-DensityPolyethylene/Carbon Nanotube Composites
Authors: Sharma Harshit , Arora Gaurav , Kumar Raj , Debnath Suman , Siengchin Suchart
Published: December 2024

In the present work, the hardness prediction of polypropylene/carbon nanotubes (PP/CNT) and low-density polyethylene/carbon nanotubes (LDPE/CNT) composite materials, processed by microwave technique, has been explored using machine learning models i.e. (Random Forest, Support Vector Regression, K-Nearest Neighbors, Linear Regression, and Neural Network). Four input vectors have been used in the construction of proposed network, such as CNT concentration, power, pressure applied, and exposure time. Hardness prediction is one output that has been evolved from the proposed work. This study presents the prediction of hardness based on machine learning models for both PP/CNT and LDPE/CNT composite materials, and the results show that the Random Forest model consistently performs better than the others models in context with performance metrics like Root Mean Square Error (RMSE), Mean Absolute Error (MAE), and Rate of determination (R2) values. Investigates have been performed on resampling strategies, showing that the jackknife approach enhances model precision and robustness in the case of LDPE/CNT composites. For PP/CNT composite material, it has been noticed that Random Forest gives the highest value of R2 (0.94), whereas Random Forest has the lowest R2 value 0.18 for LDPE/CNT composite material. Random Forest is the most reliable model for predicting the characteristics of PP/CNT composite material due to its ability to handle complex datasets. LDPE/CNT composite material shows superior prediction accuracy with a maximum error of 1.61%, making it a better option for high-precision applications because of improved mechanical interactions and better CNT dispersion.
The Effect of Background Colors of Learning Materials on Memory:evidence from Chinese Characters
Authors: CAI PING , Wang Jun
Published: December 2024

In teaching practice, color is a common and significant stimulus that can influence learners' cognitive load and learning outcomes through the mediating effects of attention and emotion. Given the challenges faced by CSL learners in mastering and memorizing Chinese characters, this study explores the impact of the background color of learning materials—one aspect of the physical learning environment—on the memory retention of Chinese characters among CSL learners. The study employs four background colors (white, red, blue, and green) and adopts a combination of E-Prime psychological experimentation, questionnaire surveys, and semi-structured interviews to examine the recall performance of 30 participants with similar working memory capacity and no particular color preference. The participants' ability to recall Chinese characters was assessed through written recall tasks under the four different background colors. The collected data were then analyzed using SPSS 26.0, with the p-values adjusted using the Greenhouse-Geisser method and multiple comparisons corrected using the Bonferroni method. The results indicate that the background color of the learning materials has a significant effect on the memorization of Chinese characters. Specifically, the red background was found to facilitate the completion of focused memory tasks and demonstrated a robust memory enhancement effect. In contrast, the blue background may be more suitable for creative tasks, as it exhibited a certain degree of memory suppression effect in focused memory tests. Moreover, the effects of white and green backgrounds on character recall were similar, falling between the effects observed for red and blue backgrounds. These findings partially validate the revised cognitive load model proposed by Choi et al. (2014) and highlight that color, as an independent factor, plays a crucial role in influencing learning outcomes. This study thus contributes to the theoretical understanding of background color and its implications for enhancing the efficacy of learning materials.
Phase I study of neoadjuvant chemoradiotherapy with S-1 for clinically resectable type 4 or large type 3 gastric cancer in elderly patients aged 75 years and older (OGSG1303)
Authors: Shinkai Masayuki , Imano Motohiro , Yokokawa Masaki , Matsuyama Jin , Kimura Yutaka , Shimokawa Toshio , Kawakami Hisato , Satoh Taroh , Yasuda Takushi , Furukawa Hiroshi
Published: December 2024

Purpose The prognosis for type 4 and large type 3 gastric cancer (GC) is extremely poor, especially in elderly patients (≥ 75 years). To improve the prognosis of these types of GC, we performed a phase I study to determine the recommended dose (RD) of S-1 combined with neoadjuvant radiotherapy.Methods Patients with clinically resectable type 4 and large type 3 GC were enrolled to successive cohorts in a conventional 3 + 3 design. Three dose levels were designed, as follows: level 0: S-1 60 mg/m2/day on Days 1–14; level 1: S-1 80 mg/m2/day on Days 1 − 14; level 2: S-1 80 mg/m2/day on Days 1–14 and Days 22–35. The starting dose was level 1. Radiotherapy was delivered at a total dose of 40 Gy in fractions for 4 weeks.Results Ten patients were enrolled from July 2014 to August 2018. Six patients were registered at level 1, and one patient developed a dose limiting toxicity as gastric stenosis (grade 3). Two of four patients enrolled at level 2 developed dose limiting toxicity (inability to receive S-1 for hematological reasons). Therefore, the RD was determined as level 1. All patients underwent the protocol surgery; one patient underwent R1 resection because of positive peritoneal washing cytology. There were no treatment-related deaths, and the pathological response rate was 80%. The 5-year overall- and progression-free survival rates were both 60.0%.Conclusion The RD was determined as level 1. A phase II trial using the RD should be initiated.
Gait biomechanics and postural adaptations in forward head posture: A comparative cross-sectional study
Authors: Lin Guohao , Zhao Xiong , Tao Zhihao , Wang Weijie
Published: December 2024

Background
Forward head posture (FHP) is a common postural deviation in the sagittal plane. Despite the growing interest in FHP, research on gait biomechanics in individuals with FHP remains scarce. This study aimed to investigate gait biomechanics in FHP, with a gait performance-based craniovertebral angle (CVA) cut-off.
Methods
Forty-eight participants were included in the study, with CVA measurements used to assess head-and-neck posture. Three-dimensional kinematic and kinetic data were collected using a motion capture system during three walking trials at preferred speeds. Spatiotemporal gait parameters, joint angles, joint moments, joint powers, joint forces, center of mass (COM) trajectories, and COM-to-joint angles (knees and ankles) were analyzed. The time series data were compared between the two groups using statistical parametric mapping to identify potential changes during the entire gait cycle.
Results
Forty-eight participants were recruited and divided into control (n = 26) and FHP (n = 22) groups based on a CVA cut-off of 44 degrees determined by K-means clustering. There were no significant differences in spatiotemporal gait parameters between the control and FHP groups. However, the FHP group exhibited significantly greater trunk flexion during the loading response and initial midstance (2.21–14.50%, p = 0.047), as well as pre-swing and initial swing phases of the gait cycle (46.45–68.86%, p = 0.039). A significant reduction in the COM-to-knee angle was observed during mid-swing in the FHP group (71.26–87.92%, p = 0.007). Additionally, significant differences in sagittal knee power and longitudinal knee/ankle joint forces were observed in the final stages of the gait cycle (p < 0.05). No significant differences were found in COM trajectories or other gait parameters.
Conclusion
This study identified compensatory trunk flexion in individuals with FHP during specific phases of the gait cycle, despite no significant differences in overall gait parameters. A CVA cut-off of 44 degrees was proposed as a criterion for diagnosing FHP based on walking performance. These findings provide insight into how individuals with FHP adapt their posture to maintain gait stability and highlight the importance of considering biomechanical adaptations in FHP diagnosis.
Study on the law of stress distribution in the presence of remaining coal pillar in a close-distance coal seam and the reasonable location of the roadway
Authors: Wei Xiao-Xiang , Zhao Zhi-Qiang , Wang Yin-Wei , Wang Xiao-He , Hui Zi-Long
Published: December 2024

In order to reveal the impact of remaining coal pillar on roadway layout of the lower seam after the upper part of the close coal seam is reversely mined, theoretical analysis and numerical simulation are conducted in this paper. With the roadway to be excavated in a mine located in Shanxi as the research object, theoretical analysis and numerical simulation are performed to explore the evolution of stress field in the lower coal seam under the influence of the leftover coal pillar. Also, an analysis is conducted on the mechanism of deformation and destruction occurring to the roadway in the lower coal seam, so as to determine the rational layout of roadway in the lower coal seam and the optimal parameters related to roadway support. The study area is divided into two zones by considering the main influencing factors. Allowing for the mode of mining and to ensure safety, it is recommended that the roadway should be positioned at the edge of the H-II area, such as at the location that is 15-20m or 40-45m away from the study area. Taking into account these influencing factors, the original tunnel support parameters are optimized.
Elevated levels of PAI-1 precede the manifestation of type 2 diabetes mellitus
Authors: Hernestål-Boman Jenny , Öhman Tina , Jansson Jan-Håkan , Lind Marcus M , Rolandsson Olov , Bergdahl Ingvar A , Johansson Lars
Published: December 2024

Aims
Plasminogen activator inhibitor-1 (PAI-1) is the main inhibitor of the fibrinolytic system and is mainly secreted from adipose tissue. It is associated with cardiovascular disease and has also been considered a possible early risk marker for type 2 diabetes. Here, we present the results of a large prospective study investigating PAI-1 levels in relation to incident type 2 diabetes mellitus.
Methods
We conducted a prospective incident case-referent study within the Västerbotten Intervention Programme (VIP). Data on cardiovascular risk factors, fasting plasma glucose (FPG) and 2-hour plasma glucose (2-hPG) were collected at baseline health examination 1990-2006. Blood samples were collected and stored for future analyses. Participants were followed and 484 cases developed type 2 diabetes. Referents without type 2 diabetes were matched for sex, age, and year of participation, n=484. Baseline plasma samples were analysed for PAI-1. Subgroup analysis was performed for 201 cases and 201 matched referents with normal baseline glucose levels (FPG < 6.1 and 2hPG < 8.9 mmol/L).
Results
Elevated baseline levels of PAI-1 were associated with incident type 2 diabetes after adjustments for BMI, family history of diabetes, smoking status, hypertension, FPG and 2hPG (PAI-1; OR=1.87, 95% CI: 1.06-3.29). A similar result was shown in the subgroup analysis with 201 participants who had normal glucose levels at time of the health examination (PAI-1; OR=2.68, 95% CI: 1.03-6.95).
Conclusions
Elevated PAI-1 levels in non-diabetic persons precede the manifestation of type 2 diabetes and can be detected before an elevation of FPG or 2-hPG is observed.
Efficacy analysis of PD-L1 and CTLA-4 bispecific antibodies combined with chemoradiotherapy in the treatment of pulmonary SMARCA4-deficient undifferentiated tumor and literature review
Authors: Jin Linzhi , Ren Runchuan , Song Ping , Zheng Anping , Wang Shaohua , Wang Chengyu , Cheng Xinyu , Guo Ying , Zhang Yaowen
Published: December 2024

Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UTs) are clinically aggressive, and it is associated with rapid progression and poor prognosis. The PD-1/PD-L1 inhibitors have been reported to be effective in a minority of SMARCA4-UT patients. However, to our knowledge, no reports have described the treatment of SMARCA4-UT with PD-1 and CTLA-4 bispecific antibodies. In this paper, the data of a patient with SMARAC4-UT who was treated with PD-1 and CTLA-4 bispecific antibodies at Anyang Cancer Hospital were analyzed and summarized. In addition, a literature review of the clinical characteristics, diagnosis, treatment and prognosis of this disease was conducted. PD-1 and CTLA-4 bispecific antibodies showed promising results in the treatment of SMARCA4-deficient tumor.
Seepage mode in lamina-developed shale oil reservoirs under strong heterogeneous and strong fluid-solid coupling——Taking Jiyang Depression in China as an example
Authors: Yu Chunlei , Zhang Shiming , Chen Ting , Sun Zhigang , Xu Jiaxiang
Published: December 2024

The laminae of different lithologies is a typical sedimentation of shale oil reservoirs, and the resulting strong heterogeneous and strong fluid-solid coupling seriously affect shale oil productivity. Therefore, the strong permeability heterogeneous and mechanical heterogeneous of lamina-developed shale were first qualified by the permeability experiments and quasi triaxial mechanical experiments on shale cores of different directions from Jiyang Depression, which revealed strong brittleness in horizontal cores and elasticity in vertical cores. Then, the strong fluid-solid coupling in lamina-developed shale was investigated by permeability stress sensitivity test and CT scanning, which presents the elasticity deformation of matrix in vertical direction, resulting in dynamic opening and closing of laminae and strong fluid-solid coupling in horizontal direction during the fracturing shut-in and production (FSP). Based on online nuclear magnetic resonance (NMR), fluid migration between pores of different scales and laminae during the FSP was discovered. To detailedly describe the fluid seepage mode in lamina-developed shale oil reservoirs during FSP, an oil-water two-phase flow model coupling shale matrix, laminae and hydraulic fractures was simulated to describe the variation in saturation, pressure, relative permeability, and streamlines of water in lamina-developed shale cores, based on the permeability heterogeneous and stress sensitivity. The results show that During the hydraulic fracturing, the horizontal brittleness and vertical elasticity created a seepage channel of shale matrix, horizontal seams and vertical hydraulic fractures. During the shut-in, the expanded seepage area after the laminae are opened and the extremely high pressure gradient from the seam to the matrix cause the fracturing fluid to invade the matrix and displace some shale oil, gradually balancing the pressure among the three seepage media. During the production, the extremely high pressure gradient shifts from the matrix to seams and hydraulic fractures, and oil and water are simultaneously extracted. However, due to stress sensitivity and relative permeability variation, some fracturing fluids remain in the shale formation.
Use of complement C5-inhibitor eculizumab in patients with infection-associated hemolytic uremic syndrome – a case-series report
Authors: Varga Petra , Biró Erika , Berkes Andrea , Lakatos Erzsébet , Szikszay Edit , Prohászka Zoltán , Szabó Tamás
Published: December 2024

Background: Hemolytic uremic syndrome (HUS), characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury (AKI), remains a leading cause of pediatric AKI. The complement system has a crucial role in the pathogenesis of atypical hemolytic uremic syndrome (aHUS) and eculizumab (ECZ) was approved as standard of care for its treatment. The two widely characterized forms of infection-associated HUS are Shiga toxin-producing E. coli (STEC)-HUS and Streptococcus pneumoniae-associated (SP)- HUS. Extrarenal manifestations such as central nervous system (CNS) involvement occur approximately in 20% of the cases and are accompanied by higher mortality. Abnormalities of the alternative complement pathway may also contribute to the development of both STEC-HUS and SP-HUS, offering a potential treatment option for complement C5 inhibition. Beyond best supportive care as standard therapeutic approach, ECZ has been succesfully used in both STEC-HUS and SP-HUS patients.
We provide further support that early use of ECZ for infection-associated HUS with severe clinical manifestation and abnormal complement-activation profile may be an effective therapeutic approach.
Case presentation: We report on three children (median age: 2 years, range: 2-10 years) diagnosed with infection associated HUS treated with complement C5-inhibitor ECZ. All three patients were treated with ECZ and had excellent outcome. We retrospectively analyzed the clinical course, laboratory data and outcome of children with infection associated HUS treated with ECZ.
Conclusion: In accordance with previous observations ECZ is an efficacious therapeutic choice in severe HUS patients with multiorgan involvement. A detailed complement activation profile, especially sC5b-9, is useful to indicate ECZ administration.
Is Vertebral Bone Quality an Independent Predictor of Total Blood Loss in TLIF Surgery?
Authors: Wang Jingming , Kang Songtao , Wang Lei , Huang Weimin
Published: December 2024

Objective: The purpose of this study is to determine the effect of bone mineral density (BMD), as assessed by preoperative Dual-energy X-ray Absorptiometry (DEXA) scans and MRI-based vertebral bone quality (VBQ), on intraoperative total blood loss following transforaminal lumbar interbody fusion (TLIF).
Methods: Patients who received TLIF for lumbar degenerative diseases at a single academic center from 2023-2024 were included in this study. The preoperative T-score and VBQ score were recorded. Patients with liver/kidney disease or on prescription anticoagulant medication were excluded. Information about operation and blood loss were extracted. Total blood loss during postoperative 3 days was the primary indicator, and secondary indicators included length of hospitalization, hematocrit (HCT) and hemoglobin (Hb), T-score, and VBQ score.
Results: A total of 247 patients (93 males and 154 females) were enrolled in this study, with a mean age of 59.59 ± 9.09 years. VBQ were measured in all patients' preoperative lumbar MRI scans. VBQ (L1-4 median), VBQ (L1-4 average), VBQ (S1) and VBQ (fixation segments) was 3.50±0.70, 3.49±0.67, 3.19±0.72, 3.42±0.71, respectively. Among them, 71 patients had preoperative DEXA of the left hip. The average lowest T-score was -2.25 ± 1.29. The T-score was significantly correlated with the VBQ score (r=-0.331 to -0.419). The average postoperative 3 days' total blood loss was 796.95±569.94ml. Controlling for age, number of fixed segments, preoperative platelet count, and coagulation testing, T-score or VBQ was not correlated with perioperative total blood loss in TLIF.
Conclusions: Preoperative T-score or VBQ score was not correlated with total blood loss in TLIF. The total blood loss of TLIF in multi-segment cases was accompanied by mounts of perioperative hemorrhage, which might lead to longer hospital stays.
Blood basophil concentration at diagnosis, not percentage, correlates with therapy-related outcomes in newly-diagnosed chronic phase chronic myeloid leukaemia
Authors: Faber Edgar , Vrablova Lucia , Zhang Xiao-shuai , Kriegova Eva , Kudelka Milos , Radvansky Martin , Yang Sen , Juranova Jarmila , Papajik Tomas , Gale Robert , Jiang Qian
Published: December 2024

Blood basophils ≥ 20 percent is reportedly associated with a poor prognosis and used to define accelerated phase of chronic myeloid leukaemia (CML) in some classifications. However, quantification of blood basophils is by percentage is inaccurate. Using a Patient Similarity Network (PSM) approach we identified basophil concentration rather than percentage as the more accurate predictive co-variate. To test this observation we interrogated data for a possible correlation between blood basophils quantified by concentration in a training cohort of 131 subjects with newly-diagnosed chronic phase CML receiving tyrosine kinase-inhibitor (TKI)-therapy. Subjects with a basophil concentration ≥ 12.2 x 10E + 9/L had poorer event-free survival (EFS, Odds Ratio [OR] = 12.3 [95% Confidence Interval [CI]. 4.2, 36.1]; p < 0.0001) and failure-free survival (FFS; OR = 10.4 [3.89, 27.72]; p < 0.0001). TKI switch-free survival and progression-free survival were also correlated with basophil concentration. The negative impact of a high basophil concentration was validated in an independent cohort of 1,870 subjects. We explain why basophil concentration is a more accurate co-variate. Our data indicate blood basophil concentration at diagnosis rather than percentage is a more accurate predictor of outcomes in persons with newly-diagnosed chronic phase CML receiving TKI-therapy.
Perceptions of cervical screening uptake amongst South Asian women: A concept mapping study
Authors: Devotta Kimberly , Lofters Aisha , Bender Jacqueline , O'Campo Patricia
Published: December 2024

Background: Regular cervical screening can significantly reduce the onset and prevalence of cervical cancer. In Ontario, Canada, South Asian women have the lowest rates of cervical cancer screening among major ethnic groups in the province.
Methods: Using an innovative and participant-driven method called Concept Mapping (CM), we set out to understand how the lives and experiences of South Asian women living in Ontario shape their decisions around getting screened for cervical cancer. We engaged over 70 South Asian women and people who serve them in healthcare and community, to drive the CM process.
Results: Participants brainstormed 45 unique and distinct statements. Through sorting and map interpretation, participants identified and interpreted 6 clusters amongst the statements: 1) Personal beliefs and misconceptions around cervical cancer; 2) Education and knowledge issues around cervical cancer; 3) Cultural beliefs and influences specific to sexual health; 4) Barriers to prioritizing uptake of cervical screening; 5) System/ infrastructure gaps or inadequacies; and 6) Lack of comfort and supportive relationships in healthcare. Additional analysis shows us the interrelationships between the ideas. Statements within the clusters about education and knowledge issues around cervical cancer, personal beliefs and misconceptions, as well as cultural beliefs and influences specific to sexual health are viewed as distinct beliefs with clear effects on the uptake of cervical screening. More complex interrelationships are seen with the cluster of statements about barriers to prioritizing uptake of cervical screening.
Conclusions: As Ontario and many other jurisdictions around the world seek to strengthen cervical screening efforts in line with national and international goals to eliminate cervical cancer by 2040, it is critical to address underscreening. This CM study recognizes the value of engaging those most impacted by an issue, to identify and prioritize how and where to intervene to address low rates of cervical screening. To address underscreening we need to design multi-level interventions that address the identified ideas and the interrelationships among them.
Higher serum neurofilament light chain levels is associated with hypertension: new discoveries with old disease
Authors: Abudesimu Asiya , Kadier Kaisaierjiang , Siti Dilixiati , Liu Pengfei , Ma Xiang
Published: December 2024

Background: Serum neurofilament light chain protein (sNfL), which is a sensitive marker for early neuronal damage and axonal degeneration, has been shown to be elevated in both neurological and non neurological diseases. However, the relationship between sNfL and hypertension is still unclear.
Methods: This is a cross-sectional study that covering peoples who 20-75 years old from the general US population that participated in the 2013-2014 cycle of the National Health and Nutrition Examination Survey. First, filtering out people with complete information about sNfL and blood pressure value.Then, we conducted multivariate logistic regression analysis to examine the relationship between sNfL and hypertension. Subgroup interactions were analyzed between age, sex, race and hypertension by using likelihood ratio tests, then nonlinear relationships were explored by fitting restricted cubic splines.
Results: A total of 2004 participants (988 with and 1016 without hypertension) with average age 45.03 years old were included in this study. After adjusting for potential confounders; Log-sNfL is positively correlated with hypertension (OR, 1.55; 95% CI, 1.16–2.06). Then, we further evaluated the relationship between quartiles of sNfL and hypertension, the ORs with 95% CIs for hypertension across the second to fourth quartiles were 1.38 (0.91to 2.11), 1.76 (1.22 to 2.53) and 2.15 (1.17 to 3.96) for Log-sNfL (Pfor trend 0.037) compared with the lowest quartile. In the subgroup analyses the likelihood ratio test showed no multiplicative interaction (all P value for interaction >0.05), showing that above results are stable across age, sex and race. Additionally, restricted cubic splines confirmed a linear relationship between Log-sNfL and hypertension (Pfor non-linearity = 0.406).
Conclusions: Higher level of sNfL is associated with a higher risk of hypertension in the US population aged 20-75 years old, this requires further large-scale prospective studies for confirmation.
FLNB and TTC26 target ciliary hedgehog signaling to mediate extracellular matrix homeostasis of intervertebral disc in adolescent idiopathic scoliosis Running Title：FLNB and TTC26 regulate ntervertebral disc degeneration
Authors: Jiang Heng , Gao Yuan , Lai Bowen , Wu Jinhui , Liao Taotao , Zhang Zheng , Zhou Xin , Zhao Jianquan , Meng Yichen , Cai Zhuyun , Zhang Chenglin , Lai Suomei , Gao Rui , Wang Ce , Li Jinsong , Yang Fu , Ding Yifu , Zhou Xuhui
Published: December 2024

Variable recurrence risk and curve manifestations in adolescent idiopathic scoliosis (AIS) has been ascribed to the oligogenic effect of multiple genes. However, evidence to support this hypothesis is currently lacking. In this study, we generated mice carrying double heterozygous mutations by injecting mouse androgenic haploid embryonic stem cells with mutant Flnb and Ttc26 into oocytes. The double heterozygous mutant mice exhibited IS-like phenotypes. Combined knockdown of FLNB and TTC26 resulted in dysregulated extracellular matrix (ECM) homeostasis of intervertebral disc (IVD) consistent with the analysis of the nucleus pulposus (NP) tissues from AIS patients. In vitro evidence indicated that FLNB and TTC26 co-regulated nucleus pulposus cells ECM metabolism via the hedgehog pathway (Hh). Mechanically, TTC26 transported the protein arginine methyltransferases 7 (PRMT7) into primary cilia where PRMT7 methylates GLI family zinc finger 2 (GLI2), and FLNB imported methylated GLI2 into nucleus through direct interaction. Furthermore, deletion of Ptch1 or Sufu stimulated the Hh signaling to rescue the metabolic disorder in Flnb−/+; Ttc26−/+ discs. Overall, these results indicate that FLNB and TTC26 maintain IVD ECM hemostasis via Hh-GLI2 axis, and demonstrate that IVD may be involved the etiology of AIS.
A Stepwise Decision Tree Model for Differential Diagnosis of Kimura's Disease in the Head and Neck
Authors: Luo Rui , Yang Gongxin , Shi Huimin , He Yining , Han Yongshun , Tian Zhen , Wu Yingwei
Published: December 2024

Objectives:This study aims to differentiate Kimura's disease (KD) from Sjogren's syndrome with mucosa-associated lymphoid tissue lymphoma (SS with MALT lymphoma), neurofibromatosis (NF), and lymphoma in the head and neck using a stepwise decision tree approach.
Materials and Methods: A retrospective analysis of 202 patients with pathologically confirmed KD, SS with MALT lymphoma, NF, or lymphoma was conducted. Demographic and MR data were collected, with qualitative features (e.g., skin thickening, lesion morphology, lymphadenopathy, MR signal intensity) and quantitative variables (e.g., age, lesion size, apparent diffusion coefficients (ADCs）, wash-in rate, time to peak (TTP), time-signal intensity curve (TIC)patterns) examined. A stepwise decision-tree model using the Classification and Regression Trees (CART) algorithm was developed for differential diagnosis accuracy and misclassification risk assessment.
Results: Key characteristics for KD included male predominance (91.7%), frequent lymphadenopathy (86.1%), and skin thickening (72.2%). NF primary lesions had higher ADC values compared to KD, SS with MALT lymphoma, and lymphoma. Lymphadenopathy exhibited unique ADC features, with lower values than KD primary lesions but similar to lymphoma lesions. Predictors for distinguishing KD included lesion location, ADCs, lymphadenopathy presence, and size (p < 0.001). The decision-tree model achieved 99.0% accuracy in differential diagnosis, with a 10-fold cross-validated misclassification risk of 0.079 ± 0.024.
Conclusions: The stepwise decision tree model, based on MR imaging features, shows high accuracy in differentiating KD from other head and neck diseases, offering a reliable diagnostic tool in clinical practice.
Clinical Relevance: KD is characterized by male predominance, skin thickening, and high incidence of lymphadenopathy. ADCs and TIC patterns are distinguishable in differentiating KD from SS with MALT lymphoma, NF, and lymphoma in the head and neck. The decision tree model enhances the understanding of KD imaging features and facilitate accurate KD diagnosis, offering an easily accessible and convenient diagnostic tool for radiologists and physicians in daily practice and guiding tailored clinical management plans for affected patients.