Score Level Research Articles

Impact of Swallowing Assessment Using the Hyodo-Komagane Score on the Severity of Dysphagia and Medical Staff Workload.

The goal of dysphagia treatment is to ensure a safe and effective reduction in both dysphagia severity and medical staff workload. To investigate the correlation of the Hyodo-Komagane score with dysphagia severity and medical staff workload. This retrospective cohort study included 96 patients who were referred from other departments for swallowing evaluation from January to April 2021. The correlation between the Hyodo-Komagane score and dysphagia severity was assessed using the Food Intake LEVEL Scale (FILS) score, and its effect on the reduction in medical staff workload was examined using the feeding assistance level of the referred patients. This study included 96 hospitalised patients, comprising 15 patients with neuromuscular diseases, eight patients with cardiovascular diseases, 12 patients with head and neck diseases (excluding otolaryngological diseases), 34 patients with internal medicine diseases and 27 patients with cerebrovascular diseases, who underwent swallowing evaluation. The FILS score and feeding assistance level significantly improved at discharge compared with that at referral. A significant correlation was observed between the FILS score and feeding assistance level. The Hyodo-Komagane score was correlated with the feeding assistance level at discharge but not at referral. The Hyodo-Komagane score may optimise rehabilitation and reduce dysphagia severity and medical staff workload, indicating its useful effect on dysphagia severity and medical staff labour.

Physical activity, Vitamin D, and all-cause/cardiovascular mortality: a prospective study in older Chinese adults

BackgroundPhysical activity was associated with the risk of all-cause and cardiovascular mortality. However, little is known about older adults, especially those aged over 80 years.Methods2863 older adults in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were enrolled. Physical activity score was used to evaluate the physical activity. Serum 25-hydroxyvitamin D and demographic characteristics were collected at baseline. We used multivariable-adjusted Cox regression models and stratified analysis to determine the association between physical activity, vitamin D and all-cause/cardiovascular mortality. Mediation analysis was performed to evaluate the mediating effect of vitamin D between physical activity and all-cause/cardiovascular mortality.ResultsThe median age of this population was 87 years, and 70.27% were the oldest-old (age ≥ 80 years). We observed a tendency for a higher vitamin D concentration in participants with higher physical activity score levels. Both physical activity and vitamin D levels were inversely associated with all-cause and cardiovascular mortality in all participants. Between physical activity and all-cause/cardiovascular mortality, the mediation proportions of vitamin D were 7.76% (P < 0.001) and 4.13% (P < 0.001), respectively. The mediating effect of vitamin D remained all significant in various types of physical activities. Furthermore, vitamin D accounted for a greater mediating proportion in the physical activities of housework and raising domestic animals/pets.ConclusionsPhysical activity could reduce the risk of all-cause/cardiovascular mortality and was mediated by vitamin D in older Chinese adults.

Use of generative large language models for patient education on common surgical conditions: a comparative analysis between ChatGPT and Google Gemini.

There is a growing importance for patients to easily access information regarding their medical conditions to improve their understanding and participation in health care decisions. Artificial Intelligence (AI) has proven as a fast, efficient, and effective tool in educating patients regarding their health care conditions. The aim of the study is to compare the responses provided by AI tools, ChatGPT and Google Gemini, to assess for conciseness and understandability of information provided for the medical conditions Deep vein thrombosis, decubitus ulcers, and hemorrhoids. A cross-sectional original research design was conducted regarding the responses generated by ChatGPT and Google Gemini for the post-surgical complications of Deep vein thrombosis, decubitus ulcers, and hemorrhoids. Each response was evaluated by the Flesch-Kincaid calculator for total number of words, sentences, average words per sentence, average syllables per word, grade level, and ease score. Additionally, the similarity score was evaluated using QuillBot and reliability using a modified discern score. These results were then analyzed by the unpaired or two sample t-test to compare the averages between the two AI tools to conclude which one was superior. Chat GPT required a higher education level to understand as suggested by the higher grade levels and lower ease scores. The easiest brochure was for deep vein thrombosis which had the lowest ease score and highest grade level. ChatGPT displayed more similarity with information provided on the internet as calculated by the plagiarism calculator-Quill bot. The reliability score via the Modified Discern score showing both AI tools were similar. Although there is a difference in the various scores for each AI tool, based on the P values obtained there is not enough evidence to conclude the superiority of one AI tool over the other.

Ensemble-based customer churn prediction in banking: a voting classifier approach for improved client retention using demographic and behavioral data

Customer turnover is a crucial issue in banking since maintained profitability depends on keeping clients. This work aims to categorize consumer turnover in banks by using a new ensemble approach combining many machine learning methods, hence enhancing churn prediction models. Using a comprehensive dataset including demographic, financial, and behavioral data—such as credit score, account balance, tenure, and activity levels—the study employs the goal variable revealing if a customer has left the bank. The study starts with univariate, bivariate, and multivariate feature exploration and subsequently uses the Interquartile Range (IQR) approach to identify outliers thereby improving the data quality. Five models—K-Nearest Neighbors, Support Vector Classifier, Random Forest, Decision Tree, and XGBoost—a Voting Classifier ensemble—are used to estimate project churn. Building upon all the strengths of each model, this approach improves the prediction of classification and provides a balanced and highly robust classification system. The applied approaches are K-Nearest Neighbors (KNN), Support Vector Classifier (SVC), Random Forest, Decision Tree, and XGBoost within a Voting Classifier configuration. The performance of the Voting Classifier without SMOTE yields the following results: Accuracy: 0.87, precision: 0.87, recall: 0.80, and F1-Score: 0.87. The proposed model that extend the base model using SMOTE (Synthetic Minority Over-sampling Technique), yields a higher prediction accuracy of 0.90, precision of 0.90, recall of 0.90 and F1-Score of 0.90. This enhancement is proving the efficiency of SMOTE to handle the class imbalance problem in order to render the churn prediction more balanced and reliable system. The proposed approach assures a reliable solution to the strategies to retain the customers in the banking organisations.

IGF-1 assessment during weekly somatrogon treatment in pediatric patients with growth hormone deficiency

Abstract Context In patients with growth hormone deficiency (GHD) receiving GH treatment, IGF-1 concentrations are used by physicians to monitor treatment safety and efficacy and guide dosing decisions. Somatrogon is a long-acting GH approved as a once-weekly treatment for pediatric GHD. Somatrogon administration results in characteristic changes in the IGF-1 profile, with values measured at 96 hours post-dose representing mean IGF-1 concentrations that best reflect overall somatrogon exposure. Objective To develop a simple method to enable physicians to predict mean IGF-1 concentrations following somatrogon dosing, based on a single IGF-1 measurement taken at any point during the 7-day dosing interval. Methods Data from phase 2 and phase 3 somatrogon studies were used to develop a 2-compartment pharmacokinetic model with delayed first-order absorption. An indirect-response pharmacokinetic/pharmacodynamic model was applied to the predicted somatrogon concentrations, and model simulations were used to predict IGF-1 and IGF-1 SD score (SDS) levels for participants in both studies. Results A total of 16,213 dosing records (from 42 and 109 participants in the phase 2 and 3 studies, respectively) were used for the simulations, generating predicted values for IGF-1 and IGF-1 SDS. Predicted values were scaled against the respective values at 96 hours (Day 4). These values were used to create a table showing the adjustments required to predict mean IGF-1 and IGF-1 SDS values depending on time after dose. Conclusion We developed a simple method enabling physicians to predict mean weekly IGF-1 values using IGF-1 values measured at any point in the dosing interval. Clinicaltrials.gov: NCT01592500, NCT02968004

Predicting acute kidney injury in trauma using extreme gradient boosting model: a temporal validation study

Abstract Background Acute kidney injury (AKI) is a significant complication in patients with trauma. The early identification of AKI in these patients poses challenges. This study aimed to predict AKI in trauma patients 24 or 48 hours in advance using an extreme gradient boosting (XGBoost) model. Methods We analyzed 17 859 trauma patients admitted to a regional trauma center between January 2015 and July 2023. Demographic, clinical, and laboratory parameters were collected. The model was developed using data until July 2021 and validated using data from August 2021. We developed models to predict AKI stages 1 to 3 and AKI stages 2 and 3 occurring 48 and 24 h later and measured predictive performance in the validation group. The models' performance was evaluated using the area under the receiver operating characteristic curve (AUROC), and feature importance was assessed through SHapley Additive exPlanations values. Results The study population exhibited an incidence of AKI of 6.6% in the development group and 5.4% in the validation group. The models demonstrated predictive performances with AUROCs of 0.864 and 0.886 for 48-hour predictions of AKI stages 1 to 3 and stages 2 and 3, and 0.904 and 0.903 for 24-hour predictions of AKI stages 1 to 3 and stages 2 and 3, respectively. Key features influencing model predictions included baseline and in-hospital serum creatinine values, injury severity score, age, lactate dehydrogenase, D-dimer, platelets, albumin, and C-reactive protein levels. Conclusions The XGBoost models effectively predicted AKI in trauma patients up to 48 h in advance using clinical data.

Assessment of upper respiratory and gut bacterial microbiomes during COVID-19 infection in adults: potential aerodigestive transmission

SARS-CoV-2 is the viral pathogen responsible for COVID-19. Although morbidity and mortality frequently occur as a result of lung disease, the gastrointestinal (GI) tract is recognized as a primary location for SARS-CoV-2. Connections and interactions between the microbiome of the gut and respiratory system have been linked with viral infections via what has been referred to as the ‘gut-lung axis’ with potential aerodigestive communication in health and disease. This research explored the relationship between the microbiomes of the upper respiratory and GI tracts in patients with COVID-19 and examined Extraesophageal reflux (EOR), a mechanism which could contribute to dysregulated communication between the GI and respiratory tract (as identified in COVID-19). 97 patients with a laboratory diagnosis of COVID-19 infection, and 50 age-matched controls were recruited and stool, saliva and sputum were obtained from each participant. ELISA Pepsin tests and Reflux Symptom Index scores (RSI) were conducted for EOR assessment. DNA sequencing of the V4 region of the 16 S rRNA gene was performed for microbiome analysis. No differences were observed between the fecal microbiome’s alpha and Shannon diversity indices; however, a distinct microbial composition was observed in COVID-19 patients (when compared to the controls). The respiratory microbiota from individuals with COVID-19 demonstrated a statistically significant reduction in Shannon diversity and bacterial richness alongside an overall reduction in the prevalence of organisms from a typical healthy respiratory microbiome. Furthermore, the bacterial richness of the stool and sputum samples was significantly lower among COVID-19 patients admitted to ICU. A significantly higher RSI score and salivary pepsin level were detected among those with COVID-19. The data indicates that COVID-19 is associated with a dysregulation of both the gut and lung microbiome with a more marked perturbation in the lung, particularly among COVID-19 patients who had been admitted to the ICU. The presence of increased RSI scores, combined with elevated levels of Pepsin, suggests that increased micro-aspiration may occur, which is consistent with of under-recognized interactions between the GI and lung microbiomes in COVID-19 patients and requires additional study. Such studies would benefit from the insights provided by biological samples which reflect the continuum of the aerodigestive tract.

The diagnostic and prognostic value of serum angiopoietin-like 4 level in neonatal respiratory distress syndrome.

Neonatal respiratory distress syndrome (NRDS) is the most common respiratory disease in preterm infants (PIs). The implication of Angiopoietin-like 4 (ANGPTL4) was reported in lung diseases. We delved into the role of serum ANGPTL4 in NRDS diagnosis/prognosis. Totally 256 PIs were prospectively selected, including 128 NRDS infants and 128 non-NRDS PIs. NRDS infants were assigned into Survival and Death groups. ANGPTL4 level in PIs and its diagnostic and prognostic value for NRDS were separately assessed by ELISA and receiver operating characteristic curve. The independent risk factors (IRFs) for death in NRDS infants were analysed by multivariate logistic regression. NRDS infants exhibited reduced gestational age, birth weight, and 5min Apgar score. ANGPTL4 level rose in NRDS infants, and increased with NRDS severity. Serum ANGPTL4 level was negatively correlated with 5 min Apgar score in NRDS infants. The area under the curve of serum ANGPTL4 for the diagnosis of NRDS was 0.902, with 88.28% sensitivity, 86.72% specificity, and 255.98ng/mL cut-off value; the AUC for the diagnosis of severe NRDS was 0.741, with 66.67% sensitivity, 79.52% specificity, and 625.5ng/mL cut-off value. Low gestational age, birth weight and 5 min Apgar score, severe NRDS, and elevated serum ANGPTL4 levels were IRFs for death in NRDS infants. NRDS infants with increased serum ANGPTL4 level displayed decreased survival rate and short survival time. ANGPTL4 exhibited high diagnostic value and predictive value for death in NRDS, and it served as a biomarker for the diagnosis and prognosis of NRDS.

Association Between Serum Levels of Perfluoroalkyl andPolyfluoroalkyl Substances and Dental Floss Use:TheDouble-Edged Sword of Dental Floss Use-A Cross-Sectional Study.

Although evidence suggests that dental floss contains perfluoroalkyl and polyfluoroalkyl substances (PFASs), it is still uncertain whether the use of dental floss contributes to an increased risk of PFAS exposure. We analysed data on serum PFAS concentrations and dental floss usage in a cohort of 6750 adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2020. In our study, we used logistic regression, a survey-weighted linear model, item response theory (IRT) scores, inverse probability weights (IPWs) and sensitivity analysis to assess the potential impact of dental floss usage on human serum PFAS levels. The analysis of six PFASs revealed that dental floss users had higher serum concentrations of perfluorooctanoic acid (PFOA) compared with non-users, while serum concentrations of other PFASs were lower. Dental floss users recorded a lower level of overall PFAS burden score compared with non-users. Sensitivity analysis showed a statistically significant increase in serum PFOA concentration among dental floss users. Our findings suggest that the use of dental floss may be associated differently with serum concentrations of specific PFASs. Among a large representative sample of U.S. adults, individuals reporting the use of dental floss had lower levels of serum PFASs overall, with the exception of PFOA, which was slightly elevated. Dental floss is an important oral hygiene tool, and further research is needed to clarify its role in PFAS exposure.

Diffuse Large B-Cell Lymphoma/High Grade B-Cell Lymphoma with MYC and BCL6 Rearrangements: a study of 60 Cases.

Classification of cases of diffuse large B-cell lymphoma (DLBCL)/high-grade B-cell lymphoma (HGBL) with MYC and BCL6 rearrangements, also known as BCL6 double hit lymphoma (DHL), is controversial. We assessed 60 cases of BCL6-DHL and compared this cohort to 224 cases of DHL with MYC and BCL2 rearrangements (BCL2-DHL) and 217 cases of DLBCL not otherwise specified. Compared with the DLBCL cohort, BCL6-DHL patients had more aggressive clinical features such as frequent extranodal involvement, high-stage disease, high IPI score and elevated serum lactate dehydrogenase level (p <0.01 for all). Compared with the BCL2-DHL cohort, BCL6-DHL patients had similarly aggressive clinical features but a lower frequency of germinal center B-cell (GCB) immunophenotype and MYC and BCL2 double expression. Patients with BCL6-DHL showed an overall survival (OS) intermediate between patients with DLBCL and BCL2-DHL. Following induction with R-CHOP chemotherapy, BCL6-DHL patients demonstrated a poor OS similar to BCL2-DHL patients and worse than that of DLBCL patients (p = 0.024). However, among patients who received R-EPOCH, there was no significant difference in OS among the three groups (p = 0.146). Gene expression profiling showed that 60% of BCL6-DHL cases had a double hit (DH)-like signature compared with 10% of DLBCL-GCB and 93% of BCL2-DHL. The DH-like signature in BCL6-DHL cases was associated with a GCB immunophenotype. Based on these data, we suggest that BCL6-DHL cases are clinically more aggressive than DLBCL and patients may benefit from a more aggressive therapy than R-CHOP. The data also suggest that BCL6-DHL as currently defined, is heterogeneous and that neoplasms with a GCB immunophenotype are more likely to have DH-like signature and behave more aggressively. Lastly, we suggest that BCL6-DHL cases deserve to be recognized separately in a lymphoma classification to facilitate further understanding of these neoplasms and for optimal patient management.

Computerized adaptive testing for PRWHE measurements using domains of pain and motor function.

The Patient-Rated Wrist and Hand Evaluation is an outcome measure for patients with conditions affecting the wrist or hand. We evaluated the structural validity of the Patient-Rated Wrist and Hand Evaluation using psychometric techniques, then developed computerized adaptive testing algorithms. Factor analysis found two health constructs consistent with 'Pain' and 'Motor Function'. Two computerized adaptive tests were developed, which reduced the number of items from five to a median of one ('Pain'), and from 10 to two ('Motor Function'). Both computerized adaptive tests achieved high levels of precision (standard error of measurement <0.3) and similar scores to the full-length measure, demonstrated by Bland-Altman analysis. Dividing the Patient-Rated Wrist and Hand Evaluation into two subscales could reduce the response burden, improve standardization of outcome measurement for clinicians and provide precise insight into patient symptoms.Level of evidence: N/A.

Identification of risk factors and development of a predictive nomogram for sarcopenia in Alzheimer's disease.

Sarcopenia, with its complex diagnostic process, is a likely independent predictor of poor prognosis in patients with Alzheimer's disease (AD). However, research on the clinical characteristics and biomarkers of AD patients with sarcopenia (ADSA) is limited. This study included 180 ADSA and 188 AD patients without sarcopenia (ADNSA), and evaluated demographics, cognitive function, motor capacity, emotional state, and daily living abilities. ADSA patients were older, with worse motor and cognitive functions, more severe depression, poorer social functioning, and lower daily living abilities compared to ADNSA patients. Multivariate regression identified age, low Frailty Rating Scale (FRS) scores, low serum albumin level, and low creatinine/cystatin C ratio (CCR) as risk factors for sarcopenia. A nomogram model based on these indicators demonstrated high discriminative power and clinical utility. Sarcopenia significantly affects AD patients' various functions. The nomogram model aids in the early detection of and personalized interventions for sarcopenia in AD. Sarcopenia is a risk factor for Alzheimer's disease (AD), and the coexistence of sarcopenia affects various functions and quality of life in patients with AD. Serum albumin and Frailty Rating Scale (FRS) scores are significantly associated with both sarcopenia and cognitive assessment indicators in AD patients with sarcopenia (ADSA). The combined sarcopenia nomogram model with indexes of age at diagnosis, creatinine/cystatin C ratio (CCR), FRS score, and albumin levels can aid in effectively identifying and personalizing interventions for sarcopenia in the AD population.

Evaluating the prognostic value of DECAF score and procalcitonin in patients with COPD exacerbation.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently result in emergency department (ED) visits, necessitating accurate risk stratification. The aim of this study was to evaluate and compare the prognostic utility of the DECAF score and serum procalcitonin levels in predicting clinical outcomes in patients with AECOPD. This retrospective cohort study encompassed AECOPD patients presenting to the ED over a three-year period who had serum procalcitonin levels measured. The primary outcome was one-month mortality, with secondary outcomes including ED re-admission, hospitalization, and intensive care unit (ICU) admission. Receiver operating characteristic (ROC) curve analysis was employed to assess the prognostic performance of DECAF score and procalcitonin, and differences between areas under the curve (AUC) were compared. A total of 130 patients were analyzed, comprising 105 survivors and 25 non-survivors. The median DECAF score was significantly higher in non-survivors [4 (IQR: 3-4)] compared to survivors [3 (IQR: 2-4)] (p<0.001). Similarly, median procalcitonin levels were elevated in non-survivors [0.26ng/mL (IQR: 0.11-2.77)] relative to survivors [0.08ng/mL (IQR: 0.04-0.21)] (p<0.001). The AUC for the DECAF score was 0.758 (95% CI: 0.673-0.842), while that for procalcitonin was 0.764 (95% CI: 0.668-0.860). The difference between AUCs was 0.006 (95% CI: -0.140 to 0.127), (p=0.927). The negative predictive value (NPV) was 90.6% for the 4-point DECAF score and 96.2% for a 0.075ng/mL procalcitonin cut-off. Notably, when used in combination, the NPV reached 100% (95% CI: 89.1-100). The DECAF score and serum procalcitonin levels both exhibit robust prognostic capabilities in excluding adverse outcomes in AECOPD patients, with their predictive accuracy enhanced when used in tandem.

Maintaining level of modifiable dementia risk scores is associated with better cognitive outcomes than increasing risk scores: A population-based prospective cohort study.

A brain healthy lifestyle, consisting of good cardiometabolic health and being cognitively and socially active in midlife, is associated with a lower risk of cognitive decline years later. However, it is unclear whether lifestyle changes over time also affect the risk for mild cognitive impairment (MCI)/dementia, and rate of cognitive decline. To investigate if lifestyle changes over time are associated with incident MCI/dementia risk and rate of cognitive decline. Population-based prospective cohort study SETTING: Personality and Total Health (PATH) Through Life Study cohort (Australia). 4,777 participants (50.4% women), recruited between 2000 and 2002, who were 40-44 and 60-64 years old at baseline, without a prevalent dementia diagnosis. Participants had to have cognitive outcome measures available after baseline. Various measurements (neurocognitive assessment, blood pressure) and survey responses (demographics, cognitive, social, and physical activity, smoking, alcohol consumption, body height and weight, depression, and previous diagnoses) were collected approximately every four years. A brain-healthy lifestyle was operationalized via two well-validated modifiable dementia risk scores, the LIfestyle for BRAin health (LIBRA) score and the modifiable part of the Australian National University Alzheimer's Disease Risk Index (ANU-ADRImod). Their change over time was estimated using latent growth curve modelling, and their association with cognition and incidence of MCI/dementia was investigated using parallel process modelling and Cox regression analysis. Within those aged 60-64 years at baseline (n=2,409), 211 cases of incident MCI/dementia were recorded over a median follow-up time of 12.2 years. On average, individuals' LIBRA and ANU-ADRImod increased (i.e., worsened) over time, but individuals whose scores increased one standard deviation (SD) less had a 19.0-24.6% lower risk for MCI/dementia (hazard ratio (95% confidence interval): LIBRAchange over time=0.754 (0.664-0.857), ANU-ADRImod, change over time=0.810 (0.71-0.915)), while controlling for the risk score at baseline and multiple potential confounders. Various associations between dementia risk score trajectories and cognitive performance trajectories were observed. Efforts to maintain a brain healthy lifestyle could reduce the risk for MCI or dementia, and slow cognitive decline.

Predicting liver fibrosis in Gaucher disease: Investigation of contributors and development of a clinically applicable Gaucher liver fibrosis score.

Gaucher disease (GD) is a rare genetic disorder with multi-system involvement. Liver fibrosis is a long-term complication of GD, potentially leading to cirrhosis, end-stage liver disease, and hepatocellular carcinoma. There are currently no validated clinical tools for the monitoring of liver fibrosis in patients with GD. In this study, we aim at assessing the validity of common fibrosis-predicting scores, developed for other diseases, for the use in GD, using transient elastography as a gold-standard, as well as developing the first GD-specific liver fibrosis predicting score. We enrolled 19 adult patients with GD who had been on treatment for a minimum of 1year on enzyme replacement therapy or substrate reduction therapy and who had no evidence of any other liver disease except GD or metabolic-associated steatotic liver disease (MASLD), which is a common comorbidity of GD. We analyzed the correlation between liver stiffness and genotype, treatment modality (imiglucerase or other therapies), clinical severity, and clinical laboratory tests. We found that the common liver fibrosis scores APRI, FIB-4, and NFS did not accurately predict liver fibrosis in people with GD. We also found that male sex, the DS3 score, AST, and GGT levels significantly correlated with liver stiffness, and used these to create a simple but accurate fibrosis-predicting score specifically for GD (the "Gaucher liver fibrosis score", or GLFS), with high accuracy (AUC=0.8571, p=0.0206). We believe that our new GLFS may be used in clinical practice to help prioritize GD patients for closer monitoring of liver fibrosis.

Interleukin 38 as a bio marker for metabolic syndrome in psoriatic patients

Background Metabolic syndrome (MetS) is more common comorbidity in psoriasis and a risk factor for cardiovascular disease. Interleukin 38 (IL-38) is an anti-inflammatory cytokine that has a vital role in MetS. Aim This research aimed to identify the possible relationship between plasma IL-38 levels in psoriatic cases and MetS development. Methods This case-control study included 88 adults aged greater than 18 years, divided into four groups of 22: group (1) cases with psoriasis vulgaris only, group (2) cases with psoriasis vulgaris and MetS, group (3) cases with MetS only, and group (4) healthy control subjects. All participants were subjected to full history taking, clinical assessment, laboratory investigation (fasting blood sugar, fasting triglyceride level, high-density lipoprotein), and plasma levels of IL-38 using ELISA kits. Results IL-38 levels were significantly decreased in each of the diseased patients (psoriasis, MetS, or both) than in controls. patients with psoriasis and MetS had the lowest level of IL-38 than those with psoriasis only or MetS only. There was a highly significant difference in the IL-38 levels among the groups (P&lt;0.0001). In patients with psoriasis there was a significantly negative correlation between the PASI score and IL-38 levels. Conclusion The decreased serum level of IL-38 among psoriatic patients with MetS is more than patients with either disease alone due to its role in the pathogenesis of both conditions. Much decrease in its level in psoriatic patients can be an indicator of development of metabolic abnormalities. This opens a new scope in the treatment of both conditions using IL-38.

Protective Effects of Donkey Milk on Ethanol-Induced Gastric Ulcer in Rat.

Gastric ulcer (GU) is the most common health concern that occurs due to an imbalance between gastric protective mucosal and aggressive factors. Ethanol-induced GU in animal models resembles the pathophysiology of human ulcers. Natural products with fewer side effects are highly requested to attenuate their GU effects. The present study was conducted to investigate the potential protective effects of donkey milk against ethanol-induced GU in rats. The male Wistar were divided into four groups, including normal control (distilled water), donkey milk (1cm3/animal) and ranitidine (200mg/kg). Donkey milk and ranitidine were given to rats orally daily for 10 consecutive days before induction of ulcer by ethanol. After 24h of fasting, GU was induced by oral administration of ethanol. After an hour, the rats were sacrificed, and gastric samples were taken for pathologic analysis, malondialdehyde (MDA) and glutathione (GSH) assessments. The results showed that the severity of ethanol-induced gastric damage was significantly reduced by donkey's milk pretreatment and then ranitidine. Reduction of ulcer score and MDA level, and also increasing GSH in the gastric tissue in comparison with other groups supports our results. This study described the gastroprotective and antioxidative effects of donkey milk that were determined with ulcer inhibition percentage.

Crop Disease Detection by Deep Joint Segmentation and Hybrid Classification Model: A CAD‐Based Agriculture Development System

ABSTRACTPrecise detection of crop disease at the early stage is a crucial task, which will reduce the spreading of disease by taking preventive measures. The main goal of this research is to propose a hybrid classification system for detecting crop disease by utilising Modified Deep Joint (MDJ) segmentation. The detection of crop diseases involves five stages. They are data acquisition, pre‐processing, segmentation, feature extraction and disease detection. In the initial stage, image data of diverse crops is gathered in the data acquisition phase. According to the work, we are considering Apple and corn crops with benchmark datasets. The input image is subjected to pre‐processing by utilising the median filtering process. Subsequently, the pre‐processed image under goes a segmentation process, where Modified Deep Joint segmentation is proposed in this work. From the segmented image, features like shape, colour, texture‐based features and Improved Median Binary Pattern (IMBP)‐based features are extracted. Finally, the extracted features are given to the hybrid classification system for identifying the crop diseases. The hybrid classification model includes Bidirectional Long Short‐Term Memory (Bi‐LSTM) and Deep Belief Network (DBN) classifiers. The outcome of both the classifiers is the score, which is subjected to an improved score level fusion model, which determines the final detection results. Finally, the performance of the proposed hybrid model is evaluated over existing methods for various metrics. At a training data of 90%, the proposed scheme attained an accuracy of 0.965, while conventional methods achieved less accuracy rates.

SURVEY LEVEL OF UNDERSTANDING OF PHYSICAL ACTIVITY AND PHYSICAL ACTIVITY LEVEL AND ANTHROPOMETRIC STATUS

Students of Physical Education Health and Recreation Faculty of teacher training and education are prepared to become competent educators in the field of sports. One of the skills competencies required is understanding and skills in measuring physical activity levels, understanding physical activity and anthropometry. The purpose of this study was adalah to determine and understand the measurement aktivitas of physical activity, understanding of physical activity and anthropometric status of students of Physical Education Health and Recreation FKIP. This study is cross-sectional research on students who administer the test and measurement of sports. Understanding of the level of physical activity measured by metode the test method, the level of physical activity was measured using a questionnaire GPAQ (global Physical Activity Questionanire) and tipe body type or somatotype was measured based on the health Charter Manual. Then the data is processed in a descriptive and correlation Person to determine the relationship between the level of understanding of physical activity, physical activity level and anthropometry using SPSS. The results showed that in all students who manage the course of sports tests and measurements have level a good level of physical activity baik GPAQ score an average of 7248.13 ° 2420.5 METs. Correlation test showed positive correlation between the level of understanding of physical activity and physical activity level correlation p &lt; 0.05.

National Governance Quality, Competition and Firm Investment

Abstract This study investigates how market competition affects firm investment and the moderating effect of national governance quality (CGI) on the relationship between competition and firm investment in research and development (R&amp;D) and tangible assets. The sample consists of 16,493 observations from World Bank Enterprise Surveys (WBES) in 88 countries in 2016 – 2022. The regression results show that both the competition and the level of market competition encourage firms to invest more in R&amp;D and tangible assets. The quality of national governance also adjusts the relationship between competition and firm investment. Notably, the better quality of national governance strengthens the relationship between competition and firm investment. However, it weakens the relationship between a higher degree of competition and firm investment. In addition, the marginal effects examination suggests that variations in the quality of national governance influence the relationship between competition and investment in R&amp;D investment, which is more pronounced than tangible investment in the presence of at least one competitor. In conclusion, the relationship between competition and investment is moderated by changes in CGI, the starting level of CGI score, and the market structures. The empirical results propose some implications for firm managers and policymakers to boost investment and a transparent environment for firm investment.