bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needs assessment of basic gastrointestinal endoscopy training: A qualitative study in Indonesia
Authors: Maulahela Hasan , Annisa Nagita G , Simadibrata Marcellus , Syam Ari F , Findyartini Ardi , Indriatmi Wresti , Soetikno Roy 
Published: November 2023

AbstractBackground and AimGastointestinal endoscopy is a complex practical skill, and training and experience are required to ensure the accuracy and safety of the procedures. Therefore, proper endoscopy training is needed to provide highly skilled endoscopists. This study explores the learning experience and assesses the need for endoscopy training in Indonesia from an endoscopy trainee's point of view. Limitations from the current training model and the trainees' suggestions hopefully will become a foundation for the future endoscopy training model in Indonesia.MethodsA total of 132 current endoscopy trainees and graduates of endoscopy training from various centers in Indonesia completed an online qualitative survey regarding their endoscopy training experience, their satisfaction with the current training method, barriers to achieving competency, and their suggestions for future training. Data were subjected to descriptive and qualitative analysis using content analysis.ResultsWe found variations in the trainee's learning experience regarding the training supervision, feedback, and assessment methods. The most common endoscopy training methods were observation and direct practice with supervision. There was only a low proportion of simulator use (25%). The most found concept in barriers to achieving competency was “insufficient number of patients.” Meanwhile, the most found concept in suggestions for future training methods was “increasing the variety of cases and procedures.”ConclusionOur findings suggest that there are still variations in endoscopy training methods in Indonesia. Therefore, we propose to design a standardized endoscopy training program to ensure the competence of endoscopy trainees and better care for endoscopic patients. Simulators might be used to increase the trainees' competence in settings with low numbers of patients or cases.
Metabolic and immune‐related gene signatures: Predictive stratification and prognostic implications in gastric cancer
Authors: Shao Jian , Zhang Wenjia , Li Yiguang , Tang Yi , Fan Lihong 
Published: November 2023

AbstractBackgroundGastric cancer, marked by its heterogeneous nature, showcases various molecular subtypes and clinical trajectories. This research delves into the significance of metabolic and immune‐driven pathways in gastric cancer, constructing a prognostic signature derived from differentially expressed metabolic and immune‐correlated genes (DE‐MIGs).MethodsMetabolic and immune‐associated gene were sourced from the GeneCards database. Differential expression analysis on the TCGA‐STAD dataset was executed using the limma package, unveiling 51 DE‐MIGs that underwent functional enrichment scrutiny. The LASSO Cox regression methodology guided the creation of the prognostic signature, and individual patient risk scores were determined. Assessment tools like CIBERSORT, ESTIMATE and ssGSEA were deployed to study the immune microenvironment, while mutation profiles, genomic stability, resistance to chemotherapy and immunotherapy responsiveness were scrutinized across distinct signature categorizations.ResultsAmong the identified DE‐MIGs, 26 were significantly tied to the overall survival of gastric cancer patients. The developed prognostic signature proficiently differentiated patients into high‐risk and low‐risk cohorts, with the latter showing markedly better outcomes. The study underscored the centrality of the immune microenvironment in influencing gastric cancer outcomes. Key pathways such as TGF‐Beta, TP53 and NRF2 dominated the high‐risk group, whereas the LRTK−RAS and WNT pathways characterized the low‐risk group. Interestingly, the low‐risk segment also manifested a heightened tumor mutation burden and enhanced susceptibility to immunotherapy.ConclusionsOur findings introduce a pivotal prognostic signature, rooted in DE‐MIGs, that effectively segregates gastric cancer patients into distinct risk‐based segments. Insights into the influential role of the immune microenvironment in gastric cancer progression pave the way for more refined therapeutic interventions.
Early‐Life Exposure to Dietary Large Phospholipid‐Coated Lipid Droplets Improves Markers of Metabolic and Immune Function in Adipose Tissue Later in Life in a Mouse Model
Authors: Klein Hazebroek Marlou , Baars Annemarie , Mischke Mona , Oosting Annemarie , van Schothorst Evert M. , Schipper Lidewij 
Published: November 2023

ScopeHuman milk (HM) is considered optimal nutrition for infants, beneficially programming adult health outcomes including reduced obesity risk. Early life exposure to infant formula with lipid droplets closely resembling the structural properties of HM lipid globules (Nuturis) attenuated white adipose tissue (WAT) accumulation in mice upon adult western‐style diet (WSD) feeding. Here, the study aims to elucidate underlying mechanisms.Methods and resultsMice are raised on control or Nuturis diets between postnatal days 16–42 followed by either standard diet or WSD for 16 weeks. While the adult body composition of mice on a standard diet is not significantly affected, Nuturis reduced adiposity in mice on WSD. Morphologically, mean adipocyte size is reduced in Nuturis‐raised mice, independent of adult diet exposure, and WAT macrophage content is reduced, albeit not significantly. Transcriptomics of epididymal WAT indicate potential beneficial effects on energy metabolism and macrophage function by Nuturis.ConclusionReduced adult adiposity by early life exposure to Nuturis appears to be associated with smaller adipocytes and alterations in WAT immune and energy metabolism. These results suggest that early modulation of WAT structure and/or function may contribute to the protective programming effects of the early‐life Nuturis diet on later‐life adiposity.
Transrectal ultrasound vector projectile imaging for time‐resolved visualization of flow dynamics in the male urethra: A clinical pilot study
Authors: Ishii Takuro , Yamanishi Tomonori , Kamasako Tomohiko , Shibata Chiharu , Fuse Miki , Kaga Mayuko , Kaga Kanya , Nahas Hassan , Yiu Billy Y. S. , Yu Alfred C. H. , Saijo Yoshifumi 
Published: November 2023

AbstractBackgroundQuantitative and comprehensive visualization of urinary flow dynamics in the urethra is crucial for investigating patient‐specific mechanisms of lower urinary tract symptoms (LUTS). Although some methods can evaluate the global properties of the urethra, it is critical to assess the local information, such as the location of the responsible lesion and its interactions with urinary flow in relation to LUTS. This approach is vital for enhancing personalized and focal treatments. However, there is a lack of such diagnostic tools that can directly observe how the urethral shape and motion impact urinary flow in the urethra.PurposeThis study aimed to develop a novel transrectal ultrasound imaging modality based on the contrast‐enhanced urodynamic vector projectile imaging (CE‐UroVPI) framework and validate its clinical applicability for visualizing time‐resolved flow dynamics in the urethra.MethodsA new CE‐UroVPI system was developed using a research‐purpose ultrasound platform and a custom transrectal linear probe, and an imaging protocol for acquiring urodynamic echo data in male patients was designed. Thirty‐four male patients with LUTS participated in this study. CE‐UroVPI was performed to acquire ultrasound echo signals from the participant's urethra and urinary flow at various voiding phases (initiation, maintenance, and terminal). The ultrasound datasets were processed with custom software to visualize urinary flow dynamics and urethra tissue deformation.ResultsThe transrectal CE‐UroVPI system successfully visualized the time‐resolved multidirectional urinary flow dynamics in the prostatic urethra during the initiation, maintenance, and terminal phases of voiding in 17 patients at a frame rate of 1250 fps. The maximum flow speed measured in this study was 2.5 m/s. In addition, when the urethra had an obstruction or an irregular partial deformation, the devised imaging modality visualized complex flow patterns, such as vortices and flow jets around the lesion.ConclusionsOur study findings demonstrate that the transrectal CE‐UroVPI system developed in this study can effectively image fluid‐structural interactions in the urethra. This new diagnostic technology has the potential to facilitate quantitative and precise assessments of urethral voiding functions and aid in the improvement of focal and effective treatments for patients with LUTS.
Existential distress among family caregivers of patients with advanced cancer: A systematic review and meta‐analysis
Authors: Walbaum Charlotte , Philipp Rebecca , Oechsle Karin , Ullrich Anneke , Vehling Sigrun 
Published: November 2023

AbstractObjectiveCaregiving for a loved one is challenging and requires significant resources. Existential distress in family caregivers may include hopelessness, demoralization, fear of death, pre‐loss grief, or a sense of not being emotionally prepared. The aim of this systematic review is to synthesize the quantitative literature on existential distress among family caregivers of patients with advanced cancer, focusing on its prevalence, association with mental disorders, as well as with sociodemographic, disease, and treatment‐related factors.MethodsWe systematically searched electronic databases for quantitative studies of the above‐described existential distress concepts in family caregivers of patients with advanced cancer. Two independent reviewers extracted data and evaluated study quality. Data were analyzed using random‐effects meta‐analysis.ResultsWe retrieved 17.587 records, of which 31 studies fulfilled inclusion criteria. 63% of the studies (n = 20) provided sufficient data for meta‐analysis for 5558 patients. We found an overall pooled prevalence of 30.6% for existential distress, 95% CI [24.2–37.0]. For existential distress subconcepts, prevalence rates were 57.0%, 95% CI [37.8–76.2], for death anxiety, 13.9%, 95% CI [10.8–17.0], for demoralization, 24.0%, 95% CI [18.0–30.0], for pre‐loss grief, 18.4%, 95% CI [4.0–32.7], for hopelessness, 35.2%, 95% CI [28.2–42.2], for loneliness, and 35.6%, 95% CI [13.0–58.3], for emotional unpreparedness.ConclusionsApproximately one third of the respondents were affected by high levels of existential distress. The review provides evidence for further development of support services that can reduce existential distress, focused on death anxiety, and improve the quality of life for family caregivers of patients with advanced cancer.
Observer‐based event‐triggered consensus control for multi‐agent systems with nonlinearity and unknown inputs
Authors: Weng Weijie , Zhu Fanglai 
Published: November 2023

AbstractThis article investigates observer‐based consensus issues for a class of Lipschitz nonlinear multi‐agent systems (MASs) with unknown input. To address the challenges because of the unmeasurable states and the unknown input of each agent system, an interval observer is utilized to design an unknown input observer (UIO). The UIO possesses the capability of generating asymptotically the estimations of both the system states and unknown input simultaneously. Subsequently, a distributed control protocol scheme is put forwarded. The distributed controller for each agent is designed by using the state estimation and the unknown input reconstruction (UIR). The unknown input is compensated thanks for the introduction of the UIR into the controller, and thus leads to a better control performance. Besides, the event‐triggered strategy is also considered such that agents communicate with each other discontinuously. In this way, an observer‐based event‐triggered distributed control protocol scheme is developed, and under the scheme, the asymptotic convergent MASs consensus is accomplished. Finally, the effectiveness of the proposed methods is verified by a simulation example.
Off‐policy model‐based end‐to‐end safe reinforcement learning
Authors: Kanso Soha , Jha Mayank Shekhar , Theilliol Didier 
Published: November 2023

AbstractSafety and stability considerations play a crucial role in the development of learning based strategies for control design of systems that require high levels of safety. Safe reinforcement learning (RL) based approaches traditionally seek learning of the control laws that are optimal with respect to system performance whilst ensuring system stability and safety. In this article, an off‐policy safe RL based approach is proposed for nonlinear systems affine in control in continuous time. In this novel work, safety and stability are guaranteed during initialization and exploration phases by adjusting the control input with the solution of a quadratic programming problem combining both input to state stable‐control Lyapunov function and robust control barrier function (R‐CBF) conditions. Moreover, the safety of the learned policy is assured by augmenting the cost function with a CBF to maintain safety and optimize performance simultaneously. Novel mathematically rigorous proofs are provided to establish the stability and safety guarantees, offering a sound theoretical foundation for the approach. To demonstrate the effectiveness of the algorithm, two examples are presented: engine surge and stall dynamics, and an unstable nonlinear system.
On‐farm evaluations of overhead irrigation sprinkler packages at full and reduced rates
Authors: Holt Jonathan , Yost Matt , Creech Earl , Winward Dean , Barker Burdette 
Published: November 2023

AbstractIrrigation is a critical resource in meeting the global demand for food, feed, fiber, and fuel. One water optimization method with high potential and interest is the use of more efficient irrigation systems. In many areas where pivots are used, the most common sprinkler package is mid‐elevation sprinkler application (MESA), which typically has application efficiencies near 80%. Low‐energy precision application (LEPA) and mobile drip irrigation (MDI) can have greater than 95% application efficiency. The objective of this research was to evaluate the ability of LEPA and MDI to maintain crop yield and quality in alfalfa (Medicago sativa L.) and silage corn (Zea mays L.), at similar and reduced irrigation rates as MESA. The intent of the reduced rate was to determine if the decreased application losses with LEPA and MDI could result in sustained crop production with a 20% irrigation rate reduction. Actual reductions ranged from 5% to 55% depending on system and site due to equipment constraints. Data from two farms in Utah during 2018–2020 provided evidence that these systems can often maintain yield and forage quality with 5%–55% less applied water. However, there were also many instances where yield was reduced by LEPA and MDI, even with similar application rates to MESA. This indicates that the two higher efficiency systems will not save water in all cases and that the application system must be carefully evaluated in small on‐farm trials over multiple years for its ability to succeed in specific field conditions.
Control of Luminescence and Interfacial Properties as Perspective for Upconversion Nanoparticles
Authors: Schroter Alexandra , Hirsch Thomas 
Published: November 2023

AbstractNear‐infrared (NIR) light is highly suitable for studying biological systems due to its minimal scattering and lack of background fluorescence excitation, resulting in high signal‐to‐noise ratios. By combining NIR light with lanthanide‐based upconversion nanoparticles (UCNPs), upconversion is used to generate UV or visible light within tissue. This remarkable property has gained significant research interest over the past two decades. Synthesis methods are developed to produce particles of various sizes, shapes, and complex core–shell architectures and new strategies are explored to optimize particle properties for specific bioapplications. The diverse photophysics of lanthanide ions offers extensive possibilities to tailor spectral characteristics by incorporating different ions and manipulating their arrangement within the nanocrystal. However, several challenges remain before UCNPs can be widely applied. Understanding the behavior of particle surfaces when exposed to complex biological environments is crucial. In applications where deep tissue penetration is required, such as photodynamic therapy and optogenetics, UCNPs show great potential as nanolamps. These nanoparticles can combine diagnostics and therapeutics in a minimally invasive, efficient manner, making them ideal upconversion probes. This article provides an overview of recent UCNP design trends, highlights past research achievements, and outlines potential future directions to bring upconversion research to the next level.
Exact confidence intervals for the difference of two proportions based on partially observed binary data
Authors: Yu Chongxiu , Wang Weizhen , Zhang Zhongzhan 
Published: November 2023

AbstractIn a matched pairs experiment, two binary variables are typically observed on all subjects in the experiment. However, when one of the variables is missing on some subjects, we have so called the partially observed binary data that consist of two parts: a multinomial from the subjects with a pair of observed variables and two independent binomials from the subjects with only one observed variable. The goal of this paper is to construct exact confidence intervals for the difference of two (success) proportions of the two binary variables. We first derive a new test by combining two score tests for the two parts of the data and invert it to an asymptotic confidence interval. Since asymptotic intervals do not achieve the nominal level, this interval and three other existing intervals are improved to be exact by the general
‐function method. We compare the infimum coverage probability and average interval length of these intervals and recommend the exact intervals that are improved from the newly proposed interval. Two real data sets are used to illustrate the intervals.
Accidental ketamine administration in a horse supposed to undergo general anaesthesia for tenovaginoscopy: Errors and the need of Morbidity and Mortality Rounds in veterinary medicine
Authors: Medina‐Bautista Francisco , Navarro‐Altuna Victoria , Aßmann Anton D. , Bettschart‐Wolfensberger Regula 
Published: November 2023

AbstractAn 11‐year‐old, 500 kg, healthy mare was admitted for tenovaginoscopy. A jugular venous catheter was inserted to administer detomidine for diagnostic imaging and for anaesthesia‐related drug administration. The horse was premedicated with intramuscular acepromazine and intravenous flunixin. For sedation, 7.5 mL of a solution, presumed to be xylazine 2%, was drawn up in a syringe and labelled with a sticker. Two minutes after injection of 7.5 mL from xylazine‐labelled syringe, the horse showed severe ataxia and fell. Nystagmus and catatonia appeared while one person sat on its neck, to prevent it from rising. After 8 minutes, the horse could not be kept down and took several uncoordinated attempts to stand, still showing nystagmus and ataxia for several minutes. The xylazine‐labelled syringes were analysed. They contained pure ketamine. This case report should raise awareness about clinical errors, a healthy error culture and use of Morbidity and Mortality Rounds to improve patient and personnel care.
Interdisciplinary Rendez-Vous Approach in Endovascular Stroke Treatment: A New Concept to Accelerate Mechanical Thrombectomy in Primary Stroke Centers
Authors: Krug Nadja , Braun Holger , Knez Andreas , Auerbach Holger , Bodenberger Stephen , Eglseder Bettina , Kirschke Jan , Boeckh-Behrens Tobias , Wunderlich Silke , Henninger Julia , Boy Sandra , Renz Martin , Sepp Dominik , Zimmer Claus , Maegerlein Christian 
Published: November 2023

Abstract
Purpose
Prompt endovascular treatment of patients with stroke due to intracranial Large Vessel Occlusion (LVO) is a major challenge in rural areas because neurointerventionalists are usually not available. As a result, treatment is delayed, and clinical outcomes are worse compared with patients primarily treated in comprehensive stroke centers (CSC). To address this problem, we present a concept in which interdisciplinary, on-site endovascular treatment is performed in a Primary Stroke Center (PSC) by a team of interventional neuroradiologists and cardiologists: the Rendez-Vous approach.

Methods
Thirty-five patients with LVO who underwent interdisciplinary thrombectomy on-site at the PSC as part of the Rendez-Vous concept were compared with 72 patients who were transferred from a PSCs to the CSC for thrombectomy when diagnosed with LVO in terms of temporal sequences and clinical outcomes.

Results
Patients treated on-site at the PSC as part of the Rendez-Vous approach were managed as successfully and without an increase in complication rates compared with patients treated secondarily at a CSC (91.7% successful interventions in Rendez-Vous vs. 87.3% in control group, p = 0.57). The time from diagnosis of LVO to groin puncture was reduced by mean 74.3 min with the Rendez-Vous concept (p < 0.01). Regarding the clinical outcome, a functionally independent status was achieved in 45.5% in the Rendez-Vous group and in 22.6% in the control group (p = 0.029).

Conclusion
Thanks to interdisciplinary teamwork between cardiology and interventional neuroradiology in local PSCs, times to successful reperfusion can be reduced. This has a potentially positive impact on the clinical outcome of stroke patients.

Graphical Abstract
Enzymatic vitamin A2 production enables red-shifted optogenetics
Authors: Gerhards Johanna , Volkov Leo I. , Corbo Joseph C. , Malan Daniela , Sasse Philipp 
Published: November 2023

AbstractOptogenetics is a technology using light-sensitive proteins to control signaling pathways and physiological processes in cells and organs and has been applied in neuroscience, cardiovascular sciences, and many other research fields. Most commonly used optogenetic actuators are sensitive to blue and green light, but red-light activation would allow better tissue penetration and less phototoxicity. Cyp27c1 is a recently deorphanized cytochrome P450 enzyme that converts vitamin A1 to vitamin A2, thereby red-shifting the spectral sensitivity of visual pigments and enabling near-infrared vision in some aquatic species.Here, we investigated the ability of Cyp27c1-generated vitamin A2 to induce a shift in spectral sensitivity of the light-gated ion channel Channelrhodopsin-2 (ChR2) and its red-shifted homolog ReaChR. We used patch clamp to measure photocurrents at specific wavelengths in HEK 293 cells expressing ChR2 or ReaChR. Vitamin A2 incubation red-shifted the wavelength for half-maximal currents (λ50%) by 6.8 nm for ChR2 and 12.4 nm for ReaChR. Overexpression of Cyp27c1 in HEK 293 cells showed mitochondrial localization, and HPLC analysis showed conversion of vitamin A1 to vitamin A2. Notably, the λ50% of ChR2 photocurrents was red-shifted by 10.5 nm, and normalized photocurrents at 550 nm were about twofold larger with Cyp27c1 expression. Similarly, Cyp27c1 shifted the λ50% of ReaChR photocurrents by 14.3 nm and increased normalized photocurrents at 650 nm almost threefold.Since vitamin A2 incubation is not a realistic option for in vivo applications and expression of Cyp27c1 leads to a greater red-shift in spectral sensitivity, we propose co-expression of this enzyme as a novel strategy for red-shifted optogenetics.