bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic versus open pancreatoduodenectomy following neoadjuvant chemotherapy for borderline resectable pancreatic ductal adenocarcinoma: protocol of a multicenter, open-label randomized clinical trial (CSPAC-5)
Authors: Liu Xinran , Li Zheng , Zhuo Qifeng , Tang Wenjie , Liu Wensheng , Shi Yihua , Xu Wenyan , Gao Heli , Liu Mengqi , Chen Haidi , Chen Chen , Zhou Chenjie , Ji Shunrong , Xu Xiaowu , Yu Xianjun 
Published: March 2024

Abstract
Background
Surgery remains the only effective potential curative method for pancreatic ductal adenocarcinoma (PDAC). For borderline resectable PDAC, neoadjuvant chemotherapy (NACT) can reduce tumor volume, decrease the rate of pathologic lymph nodes, increase the R0 resection rate, and improve disease-free survival and overall survival. Although the feasibility and safety of laparoscopic pancreatoduodenectomy (LPD) has been established by several randomized controlled trials, there are few reports about the outcomes of LPD versus open pancreatoduodenectomy (OPD) among borderline resectable PDAC patients after NACT. Further studies are necessary to compare the safety and efficacy of these two surgical techniques following NACT.
Methods
CSPAC-5 is a prospective, multicenter, randomized, parallel-controlled clinical trial. Patients pathologically diagnosed as PDAC receive at least two cycles of NACT after a multidisciplinary assessment. The National Comprehensive Cancer Network guideline resectable status and the response evaluation criteria in solid tumors (RECIST, version 1.1) are used to evaluate tumor response to NACT. Approximately 120 borderline resectable pancreatic cancer patients will be randomized to receive LPD or OPD in a 1:1 ratio. The primary outcome is the postoperative complication rate. The trial registration date is March 15, 2021. The study was launched in April 2021 and is expected to complete recruitment within five years, with an estimated completion date of December 2025.
Discussion
CSPAC-5 is a national multicenter randomized controlled trial designed to compare the safety and efficacy of LPD and OPD among patients with borderline resectable PDAC following NACT. The trial results will provide high-level evidence-based guidelines on surgical options for borderline resectable PDAC patients after NACT.
Trial registration
ClinicalTrials.gov Identifier: NCT04855331. Registered 22 April 2021, https://www.clinicaltrials.gov/ct2/show/NCT04855331.
Optimizing the agent decisions for a Cloud actuator using Deep reinforcement learning
Authors: Sankaran Lakshmi , JS Saleema , Suleiman Basem 
Published: March 2024

Abstract
With the increasing use of deep reinforcement learning (DRL) techniques to build intelligent systems, the application of it to real-world problems is rampant. Resource allocation in a cloud environment that need dynamic and auto-scaling features is evolving. The agent-based decisions that are offered by DRL are in use by software robotics. Auto-scaling of resources in cloud applications introduces intelligence to agents thus built by these DRL techniques. Markov decision process as a tool minimizes the target rewards to agents such that auto-scaling of applications is performed by agent decisions. Analysis of optimizing the convergence errors that are measured while the agent performs in an online environment is the challenge. Speedy Q-learning (SQL), Generalized SQL(GSQL) algorithm variants relax the parameter values of convergence with a model-free space. The authors applied heuristic values for one such relaxation parameter in our experiments. The study is an extension of works that introduced GSQL-w, where w is the convergence parameter. The authors designed a new GSQL-wh algorithm that heuristically fixes a value for w optimally in cases with over-utilization of resources. This is presented as a novel solution in this study for cloud resource workloads.
Fusing Pulse and ECG Data for Coronary Heart Disease and Complications Identification
Authors: hong leixin , GUO Rui , WU Wen-jie , YAN Jian-jun , ZHANG Ye-qing , Liu congyin 
Published: March 2024

Abstract
Objectives: This study aimed to explore the potential of combining wrist pulse with limb lead electrocardiogram (ECG) data to develop an identification model for coronary heart disease (CHD) and its associated comorbidities.
Methods: We utilized a pulse-detecting device equipped with a pressure sensor and an ECG sensor to simultaneously collect wrist pulse and limb lead ECG signals from patients with coronary heart disease (CHD) and various comorbidities, including hypertension and diabetes. Time-domain analysis was applied to extract features such as time-domain parameters and pulse rate variability from the wrist pulse signals, as well as time-domain parameters and heart rate variability from the limb lead ECG signals. We implemented the random forest (RF) machine learning algorithm, to establish disease identification models based on these features, and evaluated their performance.
Results: The results indicated that the disease identification model which incorporated features from both pulse and ECG signals, exhibited improvements of 1.99%, 3.13%, 3.78% and 3.32% in terms of accuracy, average precision, average recall and F1 value, respectively, when compared to the model based solely on pulse features. Furthermore, when compared to the ECG-based model, the results were improved by 3.99%, 3.13%, 3.78% and 3.32% respectively.
Conclusions: The fusion of information from multiple sources enhances the reliability of decision-making of the system. This approach presents a novel method for managing cardiovascular diseases and offers insights into the application and promotion of wearable pulse-detecting products.
Identification and the origin of GAA expansion in FGF14 (Spinocerebellar Ataxia Type 27B): an insight from Indian subcontinent suggests an ancient origin
Authors: De Tiyasha , Sharma Pooja , tech BharathramUpilli B. , MSc Vivekanand A , Sonakar Akhilesh Kumar , Srivast Achal Kumar , Faruq Mohammed 
Published: March 2024

Abstract
Background: The ethnic diversity of India provides a unique opportunity to study the history of the origin of mutations of genetic disorders. Spinocerebellar ataxia type 27B (SCA27B), a recently identified dominantly inherited cerebellar disorder is caused by GAA-repeat expansions in intron 1 of Fibroblast Growth Factor 14 (FGF14). Being predominantly reported in European population, we aimed to screen this mutation and to study the founder haplotype of SCA27B in Indian ataxia patients.
Methods: We have undertaken screening of GAA repeats in a large Indian cohort of ~1400 uncharacterized ataxia patients and kindreds and long-read sequencing based GAA repeat length assessment. High throughput genotyping based haplotype analysis was also performed. We also utilized ~1000 Indian genomes to study the GAA at-risk expansion alleles.
Findings: We report a high frequency of 1.83% (n=23) of SCA27B in the uncharacterized Indian ataxia cohort. We observed several biallelic GAA expansion mutations (n=5) with younger onset of the disease. We observed a risk haplotype (AATCCGTGG) flanking FGF4-GAA locus over a 74 kb region in linkage disequilibrium. We further studied the frequency of this risk haplotype across diverse geographical population groups. The highest prevalence of the risk haplotype was observed in the European population (29.9%) followed by Indians (21.5%). The observed risk haplotype has existed through ~1400 generations (~28000 years), assuming a correlated genealogy.
Interpretation: Through this study, we highlight the insights gained about SCA27B and its Caucasian origin in the Indian subcontinent. Occurrence of biallelic expansion is probably more due to endogamous nature of Indian population.
Targeted long-read sequencing identifies missing pathogenic variant in unsolved 11β-hydroxylase deficiency
Authors: Liu Jidong , Tian Huihui , Jin Xinchen , Wang Yanxiang , Zhang Zhenhong , Li Mengxue , Dai Lulu , Zhang Xiaoli , Jiang Ling 
Published: March 2024

Abstract
Purpose 11β-hydroxylase deficiency (11β-OHD), caused by homozygosity or compound heterozygosity CYP11B1 mutations, is the second most common cause of congenital adrenal hyperplasia (CAH). Due to the high degree of sequence identity between CYP11B1 and CYP11B2, chimeric genes, and complex structural variants (SVs), the conventional approach to gene testing for 11β-OHD is facing challenges. The study aimed to clarify the underlying genetic causes of two siblings of a Chinese family with 11β-OHD.
Methods Peripheral blood samples and clinical information were collected from subjects and their family members. Sex steroid concentrations were measured using LC-MS/MS. Long-range PCR-based next-generation sequencing (NGS), PCR assay and target long-read sequencing were used to detect the pathogenic mutations.
Results Early onset hypertension, increased serum levels of adrenocorticotropin (ACTH), progesterone, testosterone, and decreased cortisol and potassium were detected in both affected siblings. Long-range PCR-based NGS identified a heterozygous missense mutation (NM_000497.4:c.281C>T, p.Pro94Leu) in CYP11B1 gene in the two siblings. PCR detected no chimeric CYP11B2/CYP11B1 gene. We finally identified a second pathogenic variant in CYP11B1 gene via target long-read sequencing (T-LRS). This novel variant was a deletion-insertion mutation and located chr8:143957269-143957579 (hg19) with the insertion of ‘ACAG’ (NM_000497.4:c.954+78_980delinsACAG), which was in trans with CYP11B1: c.281C>T.
Conclusion Our study suggests that the integrated long-range PCR-based NGS and T-LRS seem to be the most reliable and accurate method for 11β-OHD genetic diagnosis and carrier sequencing.
Analysis of the predictive value of insulin resistance for osteoporosis in middle-aged and elderly non-type 2 diabetic population
Authors: Zhu Qian , Zhou Yan , Sun Silu , Tao Simin , Xi Xiaoyan , Jiang Tao , Zhang Haiyu , Cai Hang , Li Hui 
Published: March 2024

Abstract
Background
With the deepening of the aging of the population, the incidence of osteoporosis in the middle-aged and elderly people is increasing. As a degenerative disease with damaged bone microstructure, decreased bone mass and decreased bone density, osteoporosis is characterized by high disability rate and high mortality. Therefore, the early prediction and diagnosis of osteoporosis is particularly important. Previous studies have demonstrated a strong relationship between insulin resistance and bone mineral density and osteoporosis in type 2 diabetes mellitus; however, there is a lack of attention on the correlation between insulin resistance and bone metabolism in healthy populations. The aim of this study was to analyze the correlation between three insulin resistance measures and bone mineral density, and to compare their value in predicting middle-aged and elderly non-type 2 diabetes.
Methods
In this study, the general data, bone mineral density, blood routine, lipid metabolism and other clinical data of 700 Chinese middle-aged and elderly non-type 2 diabetes patients were collected, and the patients were divided into osteoporosis group (n = 149) and non-osteoporosis group (n = 551). spearman correlation analysis was used to explore the correlation between three insulin resistance metabolic indexes and bone mineral density. The relationship between insulin resistance and osteoporosis was analyzed by binary logstics regression. ROC curve was used to compare the predictive value of METS-IR, TyG-BMI index and TG/HDL-C Ratio in osteoporosis.
Results
Spearman correlation showed that METS-IR, TyG-BMI index and TG/HDL-C Ratio were positively correlated with L1-L4 BMD, femoral neck BMD and hip BMD. Binary logstics regression analysis showed that METS-IR was related to the occurrence of osteoporosis. After adjusting for age, sex, smoking, drinking, serum total protein, serum albumin, serum creatinine, uric acid and total cholesterol, the correlation between METS-IR and osteoporosis still existed. ROC curve analysis showed that these three indexes of insulin resistance metabolism had certain predictive value in osteoporosis, among which METS-IR had the highest diagnostic value in osteoporosis.
Conclusions
METS-IR, TyG-BMI index and TG/HDL-C Ratio were correlated with BMD at all sites.The predictive value of METS-IR was better than TG/HDL-C Ratio and TyG-BMI index in osteoporosis.
A Comprehensive Review on Novel Polymer Biomaterials for Hydrogel-Based Drug Delivery System
Authors: Garg Sakshi , Verma Suryakant , Khandelwal Vishal , Singh Atul Pratap , Singh Pranjal Kumar , Singh Smita 
Published: March 2024

Abstract:
Hydrogel biomaterials, which are formed from polymers generated from
either natural or synthetic sources, are characterized by their mechanical stability as
well as their biological acceptability. Hydrogels are characterized by properties such
as a high swelling index, biocompatibility, the ability to be easily manipulated, flexibility,
and rapid degradation. Hydrogels are commonly used as drug carriers due to
the fact that they are simple to produce and may be applied by themselves. Using hydrogels
in drug delivery applications, where gel-based nanocarriers carry drug molecules
to the area of interest in living tissues. The research community is interested in
doing this because of the unique physical and chemical properties that hydrogels possess.
It has been discussed that several new hydrogel-based solutions are being employed
for the administration of drugs that are not taken orally. Hydrogel systems can
be developed for use in either passive or active drug administration, making them
suitable for a broad variety of settings and applications. In addition to possessing essential
biocompatible properties, hydrogels are able to move freely within the human
body without having any visible impact on the surrounding environment. The present
review has been developed to examine novel concepts linked to hydrogels and their
delivery mechanism. This is due to the fact that hydrogels possess qualities that are
both unique and novel. In this article, the mechanics of drug delivery systems that are
based on hydrogels are detailed. These processes include loading, releasing, and targeting.
For these components, the development and investigation of cutting-edge hydrogel-
based delivery systems is necessary.
ChatGPT’s Performance in Cardiac Arrest and Bradycardia Simulations Using the American Heart Association's Advanced Cardiovascular Life Support Guidelines: Exploratory Study
Authors: Pham Cecilia , Govender Romi , Tehami Salik , Chavez Summer , Adepoju Omolola E , Liaw Winston 
Published: March 2024

Background
ChatGPT is the most advanced large language model to date, with prior iterations having passed medical licensing examinations, providing clinical decision support, and improved diagnostics. Although limited, past studies of ChatGPT’s performance found that artificial intelligence could pass the American Heart Association’s advanced cardiovascular life support (ACLS) examinations with modifications. ChatGPT’s accuracy has not been studied in more complex clinical scenarios. As heart disease and cardiac arrest remain leading causes of morbidity and mortality in the United States, finding technologies that help increase adherence to ACLS algorithms, which improves survival outcomes, is critical.

Objective
This study aims to examine the accuracy of ChatGPT in following ACLS guidelines for bradycardia and cardiac arrest.

Methods
We evaluated the accuracy of ChatGPT’s responses to 2 simulations based on the 2020 American Heart Association ACLS guidelines with 3 primary outcomes of interest: the mean individual step accuracy, the accuracy score per simulation attempt, and the accuracy score for each algorithm. For each simulation step, ChatGPT was scored for correctness (1 point) or incorrectness (0 points). Each simulation was conducted 20 times.

Results
ChatGPT’s median accuracy for each step was 85% (IQR 40%-100%) for cardiac arrest and 30% (IQR 13%-81%) for bradycardia. ChatGPT’s median accuracy over 20 simulation attempts for cardiac arrest was 69% (IQR 67%-74%) and for bradycardia was 42% (IQR 33%-50%). We found that ChatGPT’s outputs varied despite consistent input, the same actions were persistently missed, repetitive overemphasis hindered guidance, and erroneous medication information was presented.

Conclusions
This study highlights the need for consistent and reliable guidance to prevent potential medical errors and optimize the application of ChatGPT to enhance its reliability and effectiveness in clinical practice.
The effect of kegel exercises on urinary incontinence in menopausal women in the Banyuwangi Hindu elderly community
Authors: Kusumawati Diana , Christiana Indah , Widhi Candra Dewi Ni Kadek 
Published: March 2024

Introduction: Urinary incontinence refers to an individual's inability to restrain or control the discharge of urine due to weakness of the pelvic floor muscles and bladder muscles that are unable to control urine. This causes contamination of skin diseases in the genital area, quality of sleep, and decubitus. Prevention efforts can be provided with non-pharmacological therapy by doing Kegel exercises to stretch the pelvic floor muscles. The mechanism of action strengthens the capacity of the bladder sphincter. Objectives: This study aimed to determine the effect of Kegel exercises on urinary incontinence in postmenopausal women in the Banyuwangi Hindu elderly community in 2023. Methods: This research employed a pre-experimental research design with a one-group pre-test post-test research design of 18 respondents using a purposive sampling technique. Statistical analysis using the Wilcoxon test. Results: The study's results before the intervention were those who experienced urinary incontinence in the elderly with a minimum value of 13, a median value of 17.50, and a maximum value of 22. After the intervention, those experiencing urinary incontinence had a minimum value of 4, a median value of 7.44, and a maximum value of 12. The findings of this research, analyzed using the Wilcoxon Test with SPSS, yielded a significance value of p = 0.000, which is less than 0.05. This indicates that Kegel Exercise has an impact on Urinary Incontinence in Menopausal Women in the Banyuwangi Hindu Elderly Community in 2023. Conclusions: Kegel exercises contract, increase muscle tone, improve healing by up to 50%, and form a supporting structure for the pelvis, vagina, urethra, and rectum to affect the inability to urinate under control.
Memperkuat keterampilan market planning: Pelatihan soft skill di lembaga kesetaraan
Authors: Hendriana Heris , Ansori Ansori , Estherlita Tiffany , Binyati Subur , Westhisi Sharina Munggaraning , Arum Nursanti Erni 
Published: March 2024

Program pengabdian kepada masyarakat yang diinisiasi oleh Program Pascasasrjana IKIP Siliwangi menetapkan PKBM Sangkanhurip yang terletak di Desa Sangkanhurip, Kecamatan Katapang, Kabupaten Bandung sebagai tempat pelaksanaan program pengabdian. Berdasarkan hasil identifikasi ditemukan beberapa masalah yang dihadapi lembaga tersebut dalam proses pengembangan kewirausahaan yang sudah berjalan. Pelatihan ini bertujuan untuk menggali dampak dan efektivitas pelatihan dalam mempersiapkan peserta untuk memahami dan mengelola pasar lokal. Studi ini menggunakan pendekatan partisipatif dan edukatif dalam menyajikan materi market planning kepada peserta. Pelatihan difokuskan pada aspek analisis pasar, strategi pemasaran yang relevan dengan konteks lokal, dan pengembangan keterampilan manajemen bisnis yang diperlukan. Metode evaluasi meliputi survei pra pelatihan, survei pasca pelatihan, observasi lapangan dan wawancara. Hasilnya menunjukkan peningkatan yang signifikan dalam pemahaman peserta tentang analisis pasar, strategi pemasaran yang sesuai dengan konteks lokal, dan keterampilan manajemen bisnis setelah mengikuti pelatihan. Implikasinya adalah penguatan kapasitas masyarakat lokal untuk mengelola bisnis atau inisiatif mereka sendiri dengan memahami pasar dan mengembangkan strategi yang efektif dalam meningkatkan kesejahteraan komunitas
Las necesidades sociales y académicas de los estudiantes de bachillerato en un entorno de la modalidad híbrida
Authors: Navarrete Radilla María Ysabel , De la Paz Sánchez Jemima Asareel 
Published: March 2024

Son claros los nuevos retos pospandemia que ha tenido el Estado en general y las instituciones educativas en particular para mitigar la enorme brecha educativa y digital, la cual ha sido consecuencia natural de una desigualdad social en materia económica. No será posible avanzar en la implementación de un modelo educativo híbrido si primero no se solucionan problemas y necesidades básicas, como es el caso de México, donde 32.6 % de las escuelas básicas se encuentran en comunidades rurales. De hecho, en el caso concreto del estado de Guerrero, solo 47.1 % de los hogares cuenta con servicio de internet. Varias investigaciones han resaltado la importancia de la modalidad híbrida para mejorar la calidad en el aprendizaje y potenciar la autonomía del estudiante, pero también han reconocido que el analfabetismo digital y el rol pasivo del estudiante han llevado a desalentar el aprovechamiento que la tecnología ofrece. Por tanto, y considerando que la modalidad híbrida para las escuelas se generalizará en un futuro muy cercano, surge la siguiente pregunta de investigación: ¿cuáles son las condiciones en las que se encuentran los estudiantes de dos escuelas públicas para adaptarse a esta nueva modalidad?
En concreto, la investigación fue cualitativa-fenomenológica, y se realizaron entrevistas a quince estudiantes a partir de una pregunta generadora. Los datos se analizaron apoyados de la teoría fundamentada, para lo cual se crearon grupos de códigos en el Atlas.ti v23. Se encontró que la brecha digital es el resultado de los problemas económicos y del alfabetismo digital. Además, es de suma importancia tomar en cuenta que tanto docentes como estudiantes continúan con prácticas tradicionales, lo que lleva a estos últimos, principalmente, a adoptar un rol de dependencia y pasividad.
Parental Engagement in Promoting Awareness of Contraceptive Use among Female Students in Nigeria and Cameroon
Authors: Adisa Rasaq Muhammed , Masso Fabiolla Michelle , Udende Patrick , Sholola Yusuf Ajani , Fahmi Mahamood Ahmad , La'aro Oba Abdulkadir 
Published: March 2024

Despite government and non-governmental organizations' efforts, contraceptive utilization in Nigeria remains low. Similarly, Cameroon faces high maternal mortality and low contraceptive prevalence. Adolescent pregnancy remains a significant social and public health concern globally, necessitating efforts to promote contraceptive use. Parent-adolescent sexual communication is often viewed as taboo in Nigeria and Cameroon, hindering awareness about contraceptive use. This study examines the role of parents in creating awareness of contraceptive use among female university students in Nigeria and Cameroon. The study adopts a comparative approach, investigating the cultural role of parents in awareness creation for contraceptive use in Nigeria and Cameroon. A cross-sectional study was conducted among 420 female university students in both countries. The findings highlight the valuable role of parents in shaping adolescents' knowledge and behavior regarding contraceptive use. Recommendations include enhancing comprehensive sexual and reproductive health education, promoting parent-adolescent communication, addressing cultural barriers, improving contraceptive access, and conducting further research. Implementing these recommendations can empower adolescents with accurate information, foster supportive parent-adolescent relationships, and enhance sexual and reproductive health outcomes among young people.