bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning Models for Predicting Malignancy Risk in CT-Detected Pulmonary Nodules: A Systematic Review and Meta-analysis
Authors: Wulaningsih Wahyu , Villamaria Carmela , Akram Abdullah , Benemile Janella , Croce Filippo , Watkins Johnathan 
Published: May 2024

Abstract
Background
There has been growing interest in using artificial intelligence/deep learning (DL) to help diagnose prevalent diseases earlier. In this study we sought to survey the landscape of externally validated DL-based computer-aided diagnostic (CADx) models, and assess their diagnostic performance for predicting the risk of malignancy in computed tomography (CT)-detected pulmonary nodules.

Methods
An electronic search was performed in four databases (from inception to 10 August 2023). Studies were eligible if they were peer-reviewed experimental or observational articles comparing the diagnostic performance of externally validated DL-based CADx models with models widely used in clinical practice to predict the risk of malignancy. A bivariate random-effect approach for the meta-analysis on the included studies was used.

Results
Seventeen studies were included, comprising 8553 participants and 9884 nodules. Pooled analyses showed DL-based CADx models were 11.6% more sensitive than physician judgement alone, and 14.5% more than clinical risk models alone. They had a similar pooled specificity to physician judgement alone [0.77 (95% CI 0.68–0.84) v 0.81 (95% CI 0.71–0.88)], and were 7.4% more specific than clinical risk models alone. They had superior pooled areas under the receiver operating curve (AUC), with relative pooled AUCs of 1.03 (95% CI 1.00–1.07) and 1.10 (95% CI 1.07–1.13) versus physician judgement and clinical risk models alone, respectively.

Conclusion
DL-based models are already used in clinical practice in certain settings for nodule management. Our results show their diagnostic performance potentially justifies wider, more routine deployment alongside experienced physician readers to help inform multidisciplinary team decision-making.
The ocrelizumab wearing-off phenomenon is associated with reduced immunomodulatory response and increased neuroaxonal damage in multiple sclerosis
Authors: Monteiro Isabel , Nicolella Valerio , Fiorenza Mariano , Novarella Federica , Carotenuto Antonio , Lanzillo Roberta , Mauriello Lucia , Scalia Giulia , Castaldo Giuseppe , Terracciano Daniela , Brescia Morra Vincenzo , Moccia Marcello 
Published: May 2024

Abstract
Objective
The wearing-off phenomenon is common in people with multiple sclerosis (MS) treated with ocrelizumab. We aim to evaluate the presence and severity of wearing-off to ocrelizumab in relation to demographic and MS clinical variables, immune profiling, and a marker of neuroaxonal damage (plasma neurofilament light chain (pNfl)).

Methods
This cross-sectional study included MS patients treated with ocrelizumab from at least 1 year. Wearing-off questionnaire and blood samples were collected between 21 and 23 weeks after the previous ocrelizumab infusion. Lymphocyte subpopulations were evaluated on peripheral blood using flow cytometry. PNfl was evaluated using fully automated chemiluminescent enzyme immunoassay.

Results
We included 106 people with MS (age 49.5 ± 11.6 years; females 42.3%; wearing-off 57.6%). On regression models, wearing-off was associated with higher pNfl, CD8, CD3, and CD3CD27 lymphocytes. Most frequent wearing-off symptoms were cognitive, sensory, and balance problems; wearing-off started < 1 week (9.4%), 1–4 weeks (10.7%) or > 4 weeks (10.7%) before infusion; 44.8% of the complaints were moderate to severe. Severity of wearing-off was associated with higher pNfl and CD8 lymphocytes.

Conclusions
Wearing-off is common in people with MS treated with ocrelizumab, and is associated with reduced immunomodulation (higher T lymphocytes) and increased neuroaxonal damage, suggesting reduced treatment response.
Determinants of antibiotic prescription in children with adenovirus respiratory tract infections
Authors: Buonsenso Danilo , Camporesi Anna , Viozzi Francesca , Lazzareschi Ilaria , Manca Lavinia , Caci Annamaria , Menna Daniele , Santangelo Rosaria , Sanguinetti Maurizio , Raffaelli Francesca , Fiori Barbara , Zampino Giuseppe , Valentini Piero 
Published: May 2024

AbstractWe performed this study to evaluate factors associated with antibiotic prescriptions in children with adenovirus infection, since no studies have attempted to address this aspect in the pediatric population. Retrospective study of children younger than 18 years of age tested positive for adenovirus on a syndromic nasopharyngeal test from 2018 to 2023. We compared the need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018–2019) and covid (2020–2022) period. The use of antibiotics was studied with multivariable logistic regression including demographic as well as clinical data as covariates. Two hundred fifty-eight patients were enrolled. One hundred fifty-eight patients received an antibiotic (mean duration 6.2 (±2.7) days (median 4; IQR: 4–7)). Presence of seizures and C-reactive protein values as predictors for antibiotic prescription (OR for seizures: 12.17; 95% CI: 1.42–103.91; p = 0.022; OR for CrP: 1.03; 95% CI: 1.01–1.04; p = 0.001). Seventy-four patients received intravenous antibiotics (74/156, 47.4%). Risk factors for intravenous antibiotic were the presence of decay (OR: 3.74; 95% CI: 1.25–11.71; p = 0.018), CrP values (OR: 1.02; 95% CI: 1.00–1.03; p = 0.001), and presence of seizures (OR: 16.34; 95% CI: 2.65–100.83; p = 0.003). Duration of intravenous antibiotics correlated with the presence of seizures (Coeff: 1.6; 95% CI: 0.41–2.89; p = 0.009) even when adjusted for CrP values. Conclusion: The clinical presentation of adenovirus infection in children is non-specific, leading to frequent antibiotic prescription despite bacterial co-infections was rare. Higher CrP values and presenting with seizures are significantly associated with a higher risk of receiving antibiotics. Rapid microbiological tests and newer biomarkers can help clinicians to improve antibiotic prescription in this cohort of children.

What is Known:•Adenovirus infection is a common cause of fever and respiratory tract infections in children.•Children with adenovirus infections frequently receive antibiotics, but determinants of this practice are poorly established.

What is New:• Higher C-reactive protein values and presenting with seizures are significantly associated with antibiotic prescription. • Since the beginning of COVID-19 and implementation of rapid diagnostics, less children with adenovirus infection received antibiotics.
Combined hepatocellular-cholangiocarcinoma: from genesis to molecular pathways and therapeutic strategies
Authors: Gurzu Simona , Szodorai Rita , Jung Ioan , Banias Laura 
Published: May 2024

AbstractHepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the most common primary liver cancers. Little is known about the combined hepatocellular-cholangiocarcinoma (cHCC-ICC) variant and the proper therapeutic strategies. Out of over 1200 available studies about cHCC-ICC, we selected the most representative ones that reflected updated information with application to individualized therapy. Based on literature data and own experience, we hypothesize that two molecular groups of cHCC-ICC can be identified. The proposed division might have a significant therapeutic role. Most cases develop, like HCC, on a background of cirrhosis and hepatitis and share characteristics with HCC; thus, they are named HCC-type cHCC-ICC and therapeutic strategies might be like those for HCC. This review also highlights a new carcinogenic perspective and identifies, based on literature data and the own experience, a second variant of cHCC-ICC called ICC-type cHCC-ICC. Contrary to HCC, these cases show a tendency for lymph node metastases and ICC components in the metastatic tissues. No guidelines have been established yet for such cases. Individualized therapy should be, however, oriented toward the immunoprofile of the primary tumor and metastatic cells, and different therapeutic strategies should be used in patients with HCC- versus ICC-type cHCC-ICC.
The efficiency and safety of temozolomide and PD-1/L1 inhibitors in pretreated NSCLC with brain metastasis: a retrospective cohort
Authors: Li Xiaobing , Wu De , Tang Jing , Wu Yuebing 
Published: May 2024

Abstract
Objective
Previous research has shown that both temozolomide (TMZ) and PD-1/L1 inhibitors (PD-1/L1) alone exhibit certain potential in the treatment of non-small cell lung cancer (NSCLC) with brain metastases (BM), in this study, we will explore combining the two in order to seek new effective treatment options for NSCLC with BM.

Material and methods
During 2021.1 to 2023.12, we collected the date of these pretreated-NSCLC with BM who accept the treatment of TMZ and PD-1/L1, the objective response ratio (ORR), progression-free survival (PFS) and overall survival (OS) were set as the primary endpoint, meanwhile, the toxicity of such regimen was also recorded.

Results
About 42 patients are enrolled, our primary analysis demonstrated that the ORR of such regimen toward NSCLC with BM was 26.19%, with Approximate intracranial and extracranial lesion ORR was 6% and 20% respectively, the DCR was about 64.29%, the mean PFS and OS was about 4 m and 8.5 m. Further analysis indicated that the efficiency correlated with the diagnosis-Specific Graded Prognostic Assessment (ds-GPA) score. Moreover, the toxicity can also be tolerated, indicating the application potential of such regimen against NSCLC with BM.

Conclusions
Our results exhibited that with tolerated toxicity, the combination of TMZ and PD-1/L1 shows promising efficiency against NSCLC with BM, this would be of great significance for the treatment of NSCLC with brain metastasis. However, due to the limitation of sample and retrospective property, the real value of such regimen needed to be further confirmed in the future.
An unusual case of nephrotic syndrome
Authors: Wildes Dermot Michael , Fitzsimons Aisling , Doyle Brendan , Green Andrew , Sweeney Clodagh , Awan Atif 
Published: May 2024

Abstract
Background
Alport syndrome is a genetically heterogenous disorder resulting from variants in genes coding for alpha-3/4/5 chains of Collagen IV, which results in defective basement membranes in the kidney, cochlea and eye. The syndrome has different inheritance patterns and historically, was thought of as a disease affecting solely males.

Case
A 15-year-old female presented with pedal oedema, hypertension and proteinuria. She underwent a kidney biopsy which showed findings in keeping with focal segmental glomerulosclerosis. Her condition was refractory to steroids. Steroid-resistant nephrotic syndrome genetics were sent, revealing a rare pathogenic variant in the COL4A5 gene.

Conclusion
Heterozygous females with X-linked Alport syndrome can develop chronic kidney disease and hearing loss. Clinicians should be mindful when reviewing kidney histology to include Alport syndrome as a differential for female patients. COL4A3-5 genes should be included in all steroid-resistant nephrotic syndrome genetic panels.
Effectiveness of the socioecological informed contextual treatment summary and care plan (TSSCP-P, Brazil) for breast cancer survivors: a randomized, controlled study
Authors: das Graças Silva Matsubara Maria , Bergerot Cristiane Decat , Ashing Kimlin Tam , Makdissi Fabiana Baroni Alves , Elias Simone , De Domenico Edvane Birelo Lopes 
Published: May 2024

Abstract
Objective
This study aimed to evaluate the impact of an intervention using the Treatment Summary and Survivorship Care Plan (TSSCP-P) on self-efficacy and quality of life (QoL) in breast cancer survivors.

Method
A clinical study, randomized and controlled, conducted to assess self-efficacy and QOL in breast cancer survivors. The participants were randomly assigned to either an intervention group or a control group. The intervention group received individualized nursing consultations guided by the TSSCP-P, while the control group received standard care. Self-efficacy and QoL were assessed at three evaluation moments using validated scales: Functional Assessment of Cancer Therapy-Breast Plus Anm Morbidity (FACT B + 4) and Perceived General Self-Efficacy Scale. Statistical analyses, including regression analysis and hypothesis tests, were conducted to examine the effects of the intervention on self-efficacy and QoL.

Results
Female breast cancer survivors (N = 101) were recruited. The intervention group demonstrated a significant improvement in self-efficacy over time compared to the control group (p = 0.01). However, no significant differences were observed in the overall QoL scores between the two groups. Subscale analysis revealed a significant improvement in physical well-being for the intervention group (p = 0.04), while emotional well-being showed a non-significant improvement (p = 0.07). The study suggests that individualized care plans and support strategies, such as the TSSCP-P, can positively influence breast cancer survivors’ self-efficacy and certain aspects of their QoL.

Conclusion
These findings highlight the potential benefits of the TSSCP-P intervention in enhancing self-efficacy among breast cancer survivors. However, further research is needed to explore its impact on overall QoL and its effectiveness across different stages of breast cancer, as well as with longer follow-up periods.

Clinical trial registration number
Brazilian Registry of Clinical Trials (ReBEC- RBR-2m7qkjy; UTN code: U1111-1257–3560), registered in April 19th, 2022.
Laboratory Tests of Large-Scale Block Models on the Load Transfer and Failure Mechanisms of Rock Masses Subjected to Anchor Loading
Authors: Grindheim Bjarte , Li Charlie C. , Høien Are Håvard , Angell Brage 
Published: May 2024

AbstractThis paper presents a laboratory testing rig designed to investigate the failure mechanisms and load transfer of rock masses under rock anchor loading. The study revealed that joint patterns significantly affect the strength and capacity of the rock mass, with existing design approaches based on apex angles of 90$$^{\circ }$$

∘

or 60$$^{\circ }$$

∘

found to be potentially overly conservative. Joint orientation and spacing should be included in the anchor design to obtain a more precise design criterion. In all the studied patterns, increasing the horizontal and vertical stress increased the block models’ capacity, and load arching did not occur in the model with an unfavourable joint orientation. This study also revealed that the failure surface followed the joints in all tests and that the block model capacity was significantly higher than estimated with the design principle based on the weight of the overlying rock. The findings of this work have important implications for designing rock anchoring systems in mining and civil engineering demonstrate that joint orientation and block size significantly affect the rock mass capacity. This study confirms the need to consider the influence of in situ stresses on rock mass capacity when designing of rock anchors. Overall, this work guides the development of more precise design criteria for rock anchors, contributing to more efficient and effective rock engineering practices.
Micro-computed tomographic analysis of the morphology of maxillary lateral incisors
Authors: Wolf Thomas Gerhard , Rempapi Theodora , Schumann Sven , Campus Guglielmo , Spagnuolo Gianrico , Armogida Niccolò Giuseppe , Waber Andrea Lisa 
Published: May 2024

Abstract
Objective
This study aimed to investigate the morphology of maxillary lateral incisors (MxLI) using micro-computed tomography (micro-CT).

Materials and methods
The root canal configurations (RCC) of maxillary lateral incisors (MxLI) of a mixed Swiss-German population were examined using micro-CT, 3D imaging, and a 4-digit system code indicating the main root canal from coronal to apical thirds and the main foramina number.

Results
The most frequently observed RCC of MxLI were 1-1-1/1 (Vertucci I/Ve I, 80.0%), 1-1-2/2 (Ve V, 7.3%), 1-2-1/1 (Ve III, 6.4%), 2-1-1/1 (Ve II, 1.8%), and 1-1-1/2 (1.8%)(n = 110). Three additional RCC were observed less frequently (0.9%). The MxLI showed one physiological foramen in 89.1%, two in 9.1%, and seldom three (1.8%). Most accessory canals were identified in the apical third of a root (20.0%), and no accessory canals in 72.7% of the samples.

Conclusions
Detailed information on the internal morphology of MxLI of a Swiss-German population is given. The most frequently observed RCC of MxLI is 1-1-1/1 (Ve I). However, accessory canals may occur in all apical thirds, and 20% of all teeth investigated showed a challenging RCC for clinical treatment.

Clinical relevance
This study offers clinicians comprehensive data on MxLI morphology, emphasizing the significance of understanding varied RCC and accessory canal presence for improving root canal treatment outcomes. Over 25% of teeth exhibited complex RCC or accessory canals, influencing decisions during root canal treatment.
Wind as a Driver of Peat CO2 Dynamics in a Northern Bog
Authors: Campeau A. , He H. , Riml J. , Humphreys E. , Dalva M. , Roulet N. 
Published: May 2024

AbstractExcess CO2 accumulated in soils is typically transported to the atmosphere through molecular diffusion along a concentration gradient. Because of the slow and constant nature of this process, a steady state between peat CO2 production and emissions is often established. However, in peatland ecosystems, high peat porosity could foster additional non-diffusive transport processes, whose dynamics may become important to peat CO2 storage, transport and emission. Based on a continuous record of in situ peat pore CO2 concentration within the unsaturated zone of a raised bog in southern Canada, we show that changes in wind speed create large diel fluctuations in peat pore CO2 store. Peat CO2 builds up overnight and is regularly flushed out the following morning. Persistently high wind speed during the day maintains the peat CO2 with concentrations close to that of the ambient air. At night, wind speed decreases and CO2 production overtakes the transport rate leading to the accumulation of CO2 in the peat. Our results indicate that the effective diffusion coefficient fluctuates based on wind speed and generally exceeds the estimated molecular diffusion coefficient. The balance between peat CO2 accumulation and transport is most dynamic within the range of 0–2 m s−1 wind speeds, which occurs over 75% of the growing season and dominates night-time measurements. Wind therefore drives considerable temporal dynamics in peat CO2 transport and storage, particularly over sub-daily timescales, such that peat CO2 emissions can only be directly related to biological production over longer timescales.
Unconstrained lightweight control interface for robot-assisted minimally invasive surgery using MediaPipe framework and head-mounted display
Authors: Rhee Wounsuk , Kim Young Gyun , Lee Jong Hyeon , Shim Jae Woo , Kim Byeong Soo , Yoon Dan , Cho Minwoo , Kim Sungwan 
Published: May 2024

AbstractRobotic surgery is preferred over open or laparoscopic surgeries due to its intuitiveness and convenience. However, prolonged use of surgical robots can cause neck pain and joint fatigue in wrist and fingers. Also, input systems are bulky and difficult to maintain. To resolve these issues, we propose a novel input module based on real-time 3D hand tracking driven by RGB images and MediaPipe framework to control surgical robots such as patient side manipulator (PSM) and endoscopic camera manipulator (ECM) of da Vinci research kit. In this paper, we explore the mathematical basis of the proposed 3D hand tracking module and provide a proof-of-concept through user experience (UX) studies conducted in a virtual environment. End-to-end latencies for controlling PSM and ECM were 170 ± 10 ms and 270 ± 10 ms, respectively. Of fifteen novice participants recruited for the UX study, thirteen managed to reach a qualifiable level of proficiency after 50 min of practice and fatigue of hand and wrist were imperceivable. Therefore, we concluded that we have successfully developed a robust 3D hand tracking module for surgical robot control and in the future, it would hopefully reduce hardware cost and volume as well as resolve ergonomic problems. Furthermore, RGB image driven 3D hand tracking module developed in our study can be widely applicable to diverse fields such as extended reality (XR) development and remote robot control. In addition, we provide a new standard for evaluating novel input modalities of XR environments from a UX perspective.
Immersive virtual reality applied to the rehabilitation of patients with lower limb amputation: a small randomized controlled trial for feasibility study
Authors: Steckel Bibiana Mayer , Schwertner Rafaela , Bücker Joana , Nazareth Ana Clara de Paula , Bizarro Lisiane , Oliveira Alcyr Alves de 
Published: May 2024

AbstractLimb amputation significantly impacts the socioeconomic and health aspects of affected individuals, with clinical issues such as phantom limb pain (PLP), phantom limb telescopy (PLT), residual limb pain (RLP), and decreased balance necessitating improved treatments. Although interventions utilizing Immersive Virtual Reality (IVR) have been explored, conducting Randomized Clinical Trials (RCT) within this population presents challenges. This study serves as a feasibility study derived from a small RCT, aiming to investigate the effects of an IVR intervention protocol on individuals with lower limb amputation (LLA) while addressing methodological challenges and exploring alternative study designs. Participants were randomly assigned to either the Control Group (CG), receiving no intervention, or the Intervention Group (IG), undergoing 16 IVR sessions over 8 weeks, with twenty-one participants completing the protocol. Sessions involved observing physical exercises via a head-mounted display. All participants were assessed for pain and balance pre- and post-intervention. IG participants were also evaluated for pain, sense of presence in the virtual environment, and cybersickness on intervention days. Results indicated a significant negative correlation between RLP and time since amputation in the Intervention Group. Analysis of results between IG and CG post-assessment suggests potential benefits of IVR in improving balance and reducing PLT. Despite challenges related to sample size and participant retention, multicenter collaborations and home-based interventions are proposed to mitigate these limitations. This feasibility study lays a foundation for future research aiming to optimize VR interventions for improved outcomes in patients with LLA.