bluuebunny/crossref_metadata_2025_split huggingface dataset:
The new Neural Pressure Support (NPS) mode and the helmet: did we find the Dynamic Duo?
Authors: Costa Alessandro , Merlo Federico , Pagni Aline , Navalesi Paolo , Grasselli Giacomo , Cammarota Gianmaria , Colombo Davide 
Published: April 2024

Abstract

Background:Non-invasive ventilation (NIV) is commonly used in clinical practice to reduce intubation times and enhance patient comfort. However, patient-ventilator interaction (PVI) during NIV, particularly with helmet interfaces, can be challenging due to factors such as dead space and compliance. Neurally adjusted ventilatory assist (NAVA) has shown promise in improving PVI during helmet-NIV, but limitations remain. A new mode, Neural Pressure Support (NPS), aims to address these limitations by providing synchronized and steep pressurization. This study aims to assess whether NPS per se improves PVI during helmet-NIV compared to standard pressure support ventilation (PSV).Methods:The study included adult patients requiring NIV with a helmet. Patients were randomized into two arms: one starting with NPS and the other with PSV. Physiological parameters and arterial blood gas analysis were collected during ventilation trials. Expert adjustments to ventilator settings were recorded in order to investigate the impact of the expertise of the clinician as confounding variable.Results:Twenty-four patients were enrolled, with no study interruptions due to safety concerns. NPS demonstrated significantly longer Timesync (0.64 ± 0.03 s vs. 0.37 ± 0.03 s, p < 0.001) and shorter Inspiratory Delay (0.15 ± 0.01 s vs. 0.35 ± 0.01 s, p < 0.001) compared to PSV. NPS also showed better Neural-Ventilator Coupling - Inspiratory (78 ± 2% vs. 45 ± 2%, p < 0.001). Ventilator parameters were not significantly different between NPS and PSV, except for minor adjustments by the expert clinician.Conclusions:NPS improves PVI during helmet-NIV, as evidenced by longer Timesync and better coupling compared to PSV. Expert adjustments to ventilator settings had minimal impact on PVI. These findings support the use of NPS in enhancing patient-ventilator synchronization and warrant further investigation into its clinical outcomes and applicability across different patient populations and interfaces.Trial Registration:This study was registered on www.clinicaltrials.gov NCT06004206 Registry URL: https://clinicaltrials.gov/study/NCT06004206 on September 08, 2023.
Comparative evaluation of pancreatic ductal and ampullary adenocarcinomas in terms of prognostic clinicopathologic features: A retrospective single- center experience in a tertiary hospital
Authors: Kahraman Dudu Solakoglu , Diniz Gulden , Kandemir Hilal , Ozamrak Birsen Gizem , Buyuktalanci Emin , Talu Esra Canan Kelten , Uylaş Mustafa Ufuk 
Published: April 2024

Abstract

Introduction:
Pancreatic ductal (PDACs), and ampullary (AACs) adenocarcinomas have different clinical and pathological prognostic features. The aim of our study is to comparatively evaluate the characteristic clinicopathologic features, prognostic factors and overall survival of resectable PDACs and AACs.
Methods:
We retrospectively compared a total of 120 patients with resectable adenocarcinomas stemming from main pancreatic duct, ampulla of Vater, and both regions in terms of prognostic clinicopathologic features and mean survival rates.
Results:
Adenocarcinomas (AC) originating from pancreatic ducts (n: 75) ,ampulla of Vater (n:19), and both of these anatomical (n:26) regions were pancreatobiliary (PB) (93.3%), intestinal (5.1%), and mixed ( 1.6%) histologic type tumors. There was no statistically significant difference between the tumor groups in terms of lymphovascular invasion (LVI) (p = 0.225), but perineural invasion (PNI) was seen at a statistically significantly lower rate in cases with AAC (p = 0.002). Lymph node involvement was seen more frequently in PDACs. A statistically significant intergroup difference was found when Pearson's chi-square test was used (p = 0.065). The median survival time was longer in AAC and stage I cases compared to those with PDAC and stage II-IV disease.
Conclucion:
In our study, tumor stage, perineural invasion and lymph node involvement were evaluated as important prognostic parameters in pancreatic and ampullary adenocarcinomas. A statistically significant difference was not detected between tumor groups regarding mean survival rates. Adenocarcinomas originating from the pancreatic head outside the ampullary region and also from the ampulla had independently poor prognostic factors closely comparable to PDACs.
Mediating Role of Echo-Intensity in Sex Differences of Physical Fitness among Children
Authors: García-Alonso Yesenia , Ramírez-Vélez Robinson , Legarra-Gorgoñon Gaizka , Izquierdo Mikel , Alonso-Martínez Alicia M 
Published: April 2024

Abstract

Numerous studies have documented disparities in Physical Fitness (PF) between boys and girls. This cross-sectional study investigates if echo-intensity (EI) explains the relationship between sex and PF among children. The study cohort consisted of 497 children aged 4.0–10.9, including 288 boys and 209 girls. Anthropometric measures, including height, weight, and waist circumference, were assessed. PF was evaluated using age-appropriate tests: the ALPHA Fitness battery for school children and the PREFIT battery for preschool children. Ultrasound (US) was employed to evaluate EI in the rectus femoris muscle. Our analysis revealed boys exhibited significantly higher PFcan components and echo-intensity levels compared to girls (all PF p < 0.001, EI p = 0.001). Mediation analysis revealed that the total effect of sex on overall fitness (z-score) was 0.51 (95% CI, 0.36 to 0.66), with an indirect effect mediated by EI of 0.07 (95% CI, 0.02 to 0.13), and a direct effect on overall fitness (z-score) of 0.44 (95% CI, 0.30, 0.58; 15.68% mediation). EI in the rectus femoris muscle serves as a factor elucidating how a child's sex influences their PF. These findings emphasize the importance of considering sex in exercise planning and interpreting the results of fitness assessments. These insights hold potential implications for public health strategies targeting children and adolescents.
POEMS syndrome misdiagnosed as tuberculous pleurisy：a case report
Authors: JI Yuanhao , WANG Wenjie , HE Hesheng , XU Youhai , WU Qiongle , YANG Jinsun 
Published: April 2024

Abstract

Background
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is a paraneoplastic syndrome caused by a plasma cell proliferative disorder. Although POEMS syndrome can cause plasmapheresis, the report of pleural effusion as the main manifestation is not common. Here, we describe a case of POEMS syndrome misdiagnosed as tuberculous pleurisy due to massive pleural effusion.
Case presentation
A 70-year-old man was admitted with chest tightness and was diagnosed with tuberculous pleurisy. Despite receiving anti-tuberculosis treatment, patient exhibited ineffective responses and developed numbness in his lower limbs, indicative of an adverse drug reaction.Adjustment of medication and nutritional nerve treatment yielded no significant improvement. Then he was admitted for the second time three months later. Subsequent auxiliary examinations revealed positive M protein, elevated VEGF(vascular endothelial growth factor), peripheral neuropathy, and endocrine disorders, ultimately confirming the diagnosis of POEMS syndrome.
Conclusions
POEMS syndrome can be mainly characterized by pleural effusion. When the cause of pleural effusion is unknown, POEMS syndrome should be suspected.
Development and Validation of a Novel Nomogram Based on Systemic Immune-Inflammation Index for Predicting the Risk of Osteoporosis in Chinese Male Population
Authors: Zhuo Hang , Zhou Zelin , Chen Xingda , Song Zefeng , Shang Qi , Huang Hongwei , Xiao Yun , Wang Xiaowen , Chen Honglin , Yan Xianwei , Zhang Peng , Gong Yan , Liu Huiwen , Liu Yu , Wu Zixian , Liang De , Ren Hui , Jiang Xiaobing 
Published: April 2024

Abstract

Summary Based on SII and PLR, markers of inflammation detected by routine blood tests, we developed a multivariate logistic regression analysis prediction model that showed good correct discriminant (C-index = 0.822) and good calibration for effective diagnosis of osteoporosis in the male population.
Introduction Osteoporosis (OP) is a bone metabolism disease that is associated with inflammatory pathological mechanism. Nonetheless, rare studies have investigated the diagnostic effectiveness of immune-inflammation index in the male population. Therefore, it is interesting to achieve early diagnosis of OP in male population based on the inflammatory makers from blood routine examination.
Methods We developed a prediction model based on a training dataset of 826 Chinese male patients, and the data was collected from January 2021 to May 2022. All participants underwent the dual-energy X-ray absorptiometry (DXEA) and blood routine examination. Inflammatory markers such as systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) was calculated and recorded. We utilized the least absolute shrinkage and selection operator (LASSO) regression model to optimize feature selection. Multivariable logistic regression analysis was applied to construct a predicting model incorporating the feature selected in the LASSO model. This predictive model was displayed as a nomogram. Receiver operating characteristic (ROC) curve, C-index, calibration curve, and clinical decision curve analysis (DCA) to evaluate model performance. Internal validation was test by the bootstrapping method. This study was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Ethic No. JY2023012) and conducted in accordance with the relevant guidelines and regulations.
Results The predictive factors included in the prediction model were age, BMI, cardiovascular diseases, cerebrovascular diseases, neuropathy, thyroid diseases, fracture history, SII, PLR, C-reactive protein (CRP). The model displayed well discrimination with a C-index of 0.822 (95% confidence interval: 0.798-0.846) and good calibration. Internal validation showed a high C-index value of 0.805. Decision curve analysis (DCA) showed that when the threshold probability was between 3% and 76%, the nomogram had a good clinical value.
Conclusion This nomogram can effectively predict the incidence of OP in male population based on SII and PLR, which would help clinicians rapidly and conveniently diagnose OP with men in the future.
Role of tomoelastography in differentiating between non-functional pancreatic neuroendocrine neoplasms and solid pseudopapillary neoplasms
Authors: Yuan Jiaxin , Yu Jinhui , Wen Tingting , Wang Yangdi , Zhang Ning , Liu Jiawei , Feng Shi-Ting , Wang Liqin , Shi Siya , Luo Yanji 
Published: April 2024

Abstract

Background
The mechanical properties of pancreatic diseases provide new insight for diagnosis and differentiation. Tomoelastography, a multifrequency MR elastography technique, provides high-resolution maps of shear wave speed (c in m/s) and phase angle (φ in rad) for evaluating pancreatic stiffness and fluidity. We explore the diagnostic performances of stiffness and fluidity quantified using tomoelastography for differentiating between non-functional pancreatic neuroendocrine neoplasms (NF-pNENs) and solid pseudopapillary neoplasms (SPNs).
Methods
This prospective study consecutive enrolled 92 untreated patients with pathologically confirmed NF-pNENs and SPNs who underwent tomoelastography examinations from September 2021 to September 2023. Two radiologists independently measured the stiffness and fluidity, and intra/interobserver agreements were assessed. Multivariate logistic regression analysis was performed to identify independent relevant clinical and radiological features to differentiate NF-pNENs and SPNs. The diagnostic performances of stiffness and fluidity and clinical features for tumor differentiation were evaluated using receiver operating characteristic curves.
Results
Thirty patients with SPNs; 62 with NF-pNENs. The radiologists showed substantial or near-perfect interobserver agreement in evaluating clinical and radiological features. SPNs had lower stiffness (1.87 vs 2.40 m/s, P < 0.001) and fluidity (0.97 vs 1.10 rad, P < 0.001) than NF-pNENs. In the multivariate analysis, the independent relevant factors for tumor differentiation were age (P = 0.002) and stiffness (P < 0.001). The areas under the curves (AUCs) of age and stiffness for tumor differentiation were 0.780 (cutoff, 47.5 years) and 0.876 (cutoff, 2.07 m/s), respectively. The differentiation performance of the combined model (c + age) was better than that of convention model (age + enhancement pattern) (AUC = 0.921 vs 0.813; P = 0.009), as well as compared to the age (AUC = 0.921 vs 0.780; P < 0.001), enhancement pattern (AUC = 0.921 vs 0.675; P < 0.001), and fluidity (φ) (AUC = 0.921 vs 0.788; P = 0.011) metrics, but the stiffness (c) metric alone had comparable differentiation performance (AUC = 0.921 vs 0.876; P = 0.115).
Conclusions
Tomoelastography quantified lesion stiffness values combined with clinical age metrics were effective in identifying NF-pNENs and SPNs, establishing the value of tomoelastography in the non-invasive preoperative quantitative identification of pancreas-associated neoplasms.
Stereotactic Ablative Radiotherapy versus Video-Assisted Lobectomy for Operable Stage I Non-small-cell Lung Cancer: Study Protocol for an Emulated Target Trial
Authors: Bedir Ahmed , Hassan Lamiaa , Wittenberg Ian , Müller Jörg Andreas , Oesterling Florian , Stang Andreas , Vordermark Dirk , Medenwald Daniel 
Published: April 2024

Abstract

Background:Video-assisted thoracoscopic surgery (VATS) lobectomy is a commonly employed surgical technique for the management of operable early stage non-small-cell lung cancer (NSCLC). This procedure however, is dependent upon the patient's ability to tolerate surgery. In light of this, stereotactic ablative radiotherapy (SABR) has emerged as a viable alternative treatment strategy for patients who are inoperable or who refuse surgery. Considering the lack of randomized controlled trials and the increased risk of bias in observational cohort studies, this study protocol proposes an emulated target trial design to investigate the causal effect of SABR, in comparison to VATS, on overall survival in operable early stage NSCLC patients.
Methods:Data on NSCLC patients will be collected from German cancer registry data linked with university hospital records. This study protocol was developed using the target trial methodology outlined by Hernan et al. The protocol establishes specific parameters for key trial components in order to mitigate bias in the analysis of observational data and to facilitate the calculation of causal estimands. The target trial design that would be emulated is a multicenter open-label two-parallel arm superiority randomized trial. Mediators and confounding variables were determined through the use of a directed acyclic graph. The statistical analysis aims to measure the per-protocol and intention to treat effect of SABR versus VATS within three months of diagnosis, on survival, through the difference in restricted mean survival times, using weighted nonparametric Kaplan-Meier curves.
Discussion:By using retrospective data and emulating RCT principles, our study aims to overcome limitations of previous research and provide more reliable insights into the effectiveness of SABR versus VATS.
Pseudopregnancy in Murciano-Granadina dairy goats in Iran: Prevalence, risk factors and treatment
Authors: Baghbadorani Maziar Kaveh , Hasanvand Abdolrahman Kazemi , Lotfollahzadeh Samad , Khabazan Hadi , Hajimohammadi Bahnam 
Published: April 2024

Abstract

This study was conducted in a large industrial Murciano-Granadina dairy goat farm, aiming to investigate prevalence, risk factors and cure rate of pseudopregnancy. Bred does (N = 1310) were examined by Ultrasonography, around 40 days after exposure to bucks. The relationships between age, parity, milk production, season, and prevalence of pseudopregnancy were analyzed. In the second part of the study, two groups of affected does (n = 12) were treated by two intramuscular injections of cloprostenol sodium (250 µg per animal) 11 days apart, or received the same treatment regimen together with procaine penicillin (20000IU/Kg) and dihydrostreptomycin (20 mg/Kg) for three consecutive days, from the time of diagnosis. The prevalence of pseudopregnancy was 9%. The average age of the diseased goats was higher (P = 0.05) compared to non-affected does. The prevalence of pseudopregnancy varied between different age groups (P = 0.0003) and parities (P < 0.0001). A different prevalence of pseudopregnancy was found between different milk production groups (P < 0.0001). Comparing milk production between normal and diseased does showed tended significance, (P = 0.07). The prevalence of pseudopregnancy was similar in and out of the breeding season. Moreover, the cure rate in the first and second treatment group was 66.8% (8/12), and 75% (9/12), respectively (P = 0.6). In conclusion, despite higher prevalence of pseudopregnancy in certain ages and milk production groups, no significant trend by increasing age and milk production group was found. Moreover, adding antibiotic to prostaglandin treatment regimen, failed to significantly improve cure rate and post treatment pregnancy rate.
A qualitative study of the spirituality of volunteers registered for human organ donation
Authors: Zhao Yueyan , Miao Qunfang , Qiu Lingjing , Hu Tingting 
Published: April 2024

Abstract

Background:Exploring the spiritual cognition of human organ donation registration volunteers, aiming to provide new ideas for promoting the development of organ donation through this perspective.
Methods:This qualitative research was conducted following the conventional content analysis method. 10 registered volunteers for human organ donation were selected from July to December 2023 for face-to-face semi-structured interviews. Snowball sampling was employed to select the participants. In-depth semi-structured interviews were conducted for data gathering. Theoretical saturation was achieved through 10 interviews. Colaizzi phenomenological 7-step analysis method was used to analyze the interview content.
Results:The spirituality of registered volunteers for human organ donation can be summarized into three themes and seven sub themes: ① Spiritual Understanding (Love & Life Extension, Dedication to society, Death elevates life); ② The Supporting Role of Spirituality (Become a spiritual motivation for a better life , self-transcendence ); ③ The Spiritual Emotional Value of Organ Donation (Sense of accomplishment and pride, Sense of complexity and ambivalence)
Conclution:The willingness to donate organs is closely related to spirituality. By understanding the spirituality of this group, it is possible to take an important step in promoting the development of organ donation.
Adiabatic modulation of driving protocols in periodically driven quantum systems
Authors: Murali Ashwin , Sarkar Tapomoy Guha , Bandyopadhyay Jayendra N. 
Published: April 2024

Abstract

We consider a periodically driven system where the high-frequency driving protocol consists of a sequence of potentials switched on and off at different instants within a period. The possibility of introducing an adiabatic modulation of the driving protocol is investigated by considering a slow evolution of the instants when the sequence of potentials is switched on/off. By assuming that the slow and fast timescales in the problem can be decoupled, we derive the stroboscopic (effective) Hamiltonian for a four-step driving sequence up to the first order in perturbation theory and apply this approach to a rigid rotor, where the adiabatic modulation of the driving protocol is chosen to produce an evolving emergent magnetic field that interacts with the rotor's spin. The emergence of diabolical points and diabolical loci in the parameter space of the effective Hamiltonian is examined. Further, we study the topological properties of the maps of the adiabatic paths in the parameter space to the eigenspace of the effective Hamoiltonian. In effect, we obtain a technique to tune the topological properties of the eigenstates by selecting various adiabatic evolutions of the driving protocol characterized by different paths in the parameter space.
The Intra-well and Inter-well Dynamics of the Unsymmetric Bistable Composite Laminated Shells
Authors: Dong Ting , Cao Dongxing , Ma Wensai , Li Ting , Jiang Xin 
Published: April 2024

Abstract

In this paper, the theoretical shell model of the bistable unsymmetric composite laminates is elucidated, elaborating the intra-well and inter-well dynamics. Deploying initial displacements delivered by the bistable plate model and utilizing the Reddy′s third-order shear deformation theory, the bistable shell model is introduced. Applying multiple sets of base excitation accelerations, sweeping frequency and sweeping amplitude, the intra-well and inter-well dynamics are detected. The intra-well dynamics are activated by the inadequate energy, while the inter-well dynamics are activated by the sufficient energy. The intra-well dynamics are characterized by the 1-cycle single-well vibration, the 2-cycle single-well vibration, the 3-cycle single-well vibration and the 4-cycle single-well vibration. The cycle-doubling bifurcation and the secondary Hopf bifurcation can be identified. The evolution process from the 1-cycle single-well vibration to dynamic snapthrough motions is judged to follow the cycle-doubling bifurcation which tends to generate all-around dynamic regimes. The frequency-amplitude response curve exhibits the softening nonlinear stiffness effect owing to the negative stiffness. The 1/2 subharmonic resonance actually represents superimposed responses which are constituted by the forced response activated by the high-level excitation frequency and the induced harmonic response equivalent to the primary resonance of the low-level mode frequency. The 1/2 subharmonic resonance is caused by quadratic nonlinear terms. The inter-well dynamics are characterized by limit-cycle oscillations, multiple-cycle snapthrough motions and chaotic snapthrough motions, which are attributed to loading conditions. The appearance of limit-cycle oscillations is decided by the level of initial displacements. The increasing level of initial displacements leads to the disappearance of limit-cycle oscillations. The first few mode frequencies tend to be the optimal excitation frequencies activating dynamic snapthrough motions. Limit-cycle oscillations are related to the first mode frequency while multiple-cycle and chaotic snapthrough motions are related to the third mode frequency. The discrepancies for different initial conditions are actually caused by the phase difference between the displacement response and the frequency sweeping, which denotes the hysteresis. With the increase of the number of layers, the actuation amplitude for dynamic snapthrough motions increases while the bandwidth of the actuation frequency range for dynamic snapthrough motions broadens correspondingly. The development of bistable energy harvesters and morphing aircrafts can be supported by the theoretical research.