High-energy traumas may lead to the dislocation of joints with or without fractures. However, simultaneous double dislocation of the proximal and distal interphalangeal joints (PIP and DIP) in fingers shows up rarely. Although it can be inferred as simultaneous dislocation occurring during the same trauma, consecutive events should be taken into consideration. A 29-year-old, right-hand dominant male patient presented to the emergency room with a left little finger deformity after being hit by a ball while playing football. Despite the inability to move the little afteruent to this hyperextension injury, there was mild swelling, ecchymosis, and pain with no trace of laceration or neurovascular injury. PIP and DIP joint dislocations of the left-hand little finger with distal phalanx proximal fracture were detected on the radiograph indicating a stepladder deformity. Closed reduction was achieved by longitudinal traction and applying pressure over the base of the dislocated digit. Afterward, an aluminum finger splint was applied to the little finger in the functional position to prevent further damage. Re-evaluation radiographs revealed a successful reduction of both joints. Immobilization via an aluminum finger splint was recommended for three weeks. Subsequently, range of motion exercises and rehabilitation were started. Three-month follow-up revealed an almost full range of motion in both PIP and DIP joints without stiffness and pain. Although double dislocation seems to present with more painful and swollen fingers than single dislocations, it can also present with mild pain and swelling, as in this case. The little finger is easily exposed to traumas due to the lack of surrounding tissue. Therefore, double dislocation is mostly seen in the little finger. This case report briefly illustrates a rare incidence of double dislocation involving both the PIP and DIP joints of the little finger. Normal range of motion of both joints was reached by early reduction followed by timely rehabilitation. High-energy traumas may lead to the dislocation of joints with or without fractures. However, simultaneous double dislocation of the proximal and distal interphalangeal joints (PIP and DIP) in fingers shows up rarely. When the tip of the little finger encounters trauma in a hyperextended position, the dorsally directed force ruptures the volar capsule of the involved finger’s interphalangeal joints leading to the displacement of the distal phalanx base to the dorsum of the middle phalanx tip. The force mechanism continues, and the middle finger moves dorsally to the proximal phalanx resulting in double dislocations, which is also termed stepladder deformity in the literature ,2. AlthoA 29-year-old, right-hand dominant male patient with hypereosinophilic syndrome and hypertension who regularly used cilostazol, warfarin, carbamazepine, amlodipine, and pegylated interferon alpha-2a presented to the emergency room with left little finger deformity after being hit by a ball while playing football. Despite the inability to move the little finger subsequent to the hyperextension injury, there was mild swelling, ecchymosis, and pain with no trace of laceration or neurovascular injury. PIP and DIP dislocations of the left-hand little finger with distal phalanx proximal fracture were detected on the radiograph, indicating a stepladder deformity Figures , 2.Closed reduction was achieved by longitudinal traction and applying pressure over the base of the dislocated digit. Afterward, an aluminum finger splint was applied to the little finger in the functional position at 45 degrees of metacarpophalangeal flexion and 15 degrees of both PIP and DIP joints’ flexion to prevent further damage. Re-evaluation radiographs revealed a successful reduction of both joints Figure .Immobilization via an aluminum finger splint was recommended for three weeks. Subsequently, range of motion exercises and rehabilitation were started. Six-month follow-up revealed full functional recovery with a full range of motion in both PIP and DIP joints without stiffness and pain.Although double dislocation seems to present with more painful and swollen fingers than single dislocation, it can also present with mild pain and swelling, as in this case. The little finger is easily exposed to traumas due to the lack of surrounding tissue. Therefore, double dislocation is mostly seen in the little finger. Despite the little finger predominance, there are cases in the literature involving the thumb with double dislocation of the metacarpophalangeal and interphalangeal joints ,3. AlthoThis case report briefly illustrated a rare incidence of double dislocation involving both the PIP and DIP joints of the little finger. The normal range of motion of both joints was achieved. Although the double dislocation of the little finger was accompanied by fractures of the proximal ends of the middle and distal phalanges, the proper alignment and full range of motion were obtained without any surgical intervention due to the early reduction followed by timely rehabilitation. The patient’s history of hypereosinophilic syndrome should be taken into special consideration in further investigations to determine whether this disease causes ligament and joint laxity.


Multifunctional fiber materials play a key role in the field of smart textiles. Temperature sensing and active thermal management are two important functions of smart fabrics, but few studies have combined both functions in a single fiber material. In this work, we demonstrate a temperature-sensing and in situ heating functionalized conductive polymer microfiber by exploiting its high electrical conductivity and thermoelectric properties. The conductive polymer microfibers were prepared by wet-spinning the PEDOT:PSS aqueous dispersion with ionic liquid additives, which was used to enhance the electrical and mechanical properties of the final microfibers. The thermoelectric properties of these microfibers were further studied. Due to their excellent flexibility and mechanical properties, these fibers can be easily integrated into commercial fabrics for the manufacture of smart textiles through knitting. We further demonstrated a smart glove with integrated temperature-sensing and in situ heating functions, and further explored thermoelectric fiber-based temperature-sensing array fabric. These works combine the thermoelectric properties and heating function of conductive polymer fibers, providing new insights that enable further development of high-performance, multifunctional wearable smart textiles. Smart textiles can not only sense environmental changes, but also automatically respond to the surrounding environment or stimuli, such as thermal, chemical, or mechanical changes . They haConductive polymers (CPs) have received much attention due to their excellent flexibility, electrical properties, and electrochemical activity ,10. PolyIonic liquid 1-butyl-3-methylimidazolium tosylate  was purchased from Lanzhou Greenchem ILs ; PEDOT:PSS aqueous solution  was purchased from Shanghai Ouyi Organic Optoelectronic Materials .The PEDOT:PSS (PP) microfibers were fabricated through a wet-spinning process as illustrated in The mechanical properties of the fibers were measured using a thermomechanical analysis system . A single fiber was used for the tensile strain-stress measurement. The length of the tested fiber sample was approximately 2 cm, and the cross-section area was determined by scanning electron microscope (SEM) image. The electrical conductivity of the PEDOT:PSS fiber was measured using a source meter . Samples were prepared by placing the fiber on a glass slide with the two ends of the fiber connected to copper wires using silver paste. A low voltage (1–3 V) was applied to the two ends and the resistance was recorded. The conductivity was then calculated by taking into account the sample length and cross area. The Seebeck coefficient was characterized using a home-made device as shown in the Smart fabrics with thermal-sensing and Joule heating functions were manufactured by weaving PEDOT:PSS microfiber onto commercial gloves. Firstly, ten microfibers were twisted to form a stable fiber yarn. Then, multiple-fiber yarns were sewn onto the glove with a sewing needle. The sensing unit on the index finger consisted of three strands of yarn that detect temperature changes when grasping objects. The two ends of the yarn were placed on the inside and outside of the glove, fixed with silver paste and copper wire, and connected to the thermoelectric potential measurement system. The sensing unit on the back of the glove consisted of six strands of yarn to detect the ambient temperature and provide heating. One end of the bundle was positioned close to the skin, while the other end was exposed to the environment to sense the temperature difference between the environment and the skin of the hand.To make the temperature sensor array, six bundles of yarn were sewn onto the fabric in parallel three lines, while using silver paste and copper wire to connect both ends of each bundle to a multichannel voltage signal acquisition board.In order to improve the working stability of the fibers, a thin layer of PDMS was wrapped on the surface of a yarn bundle consisting of 20 PP fibers. The twisted yarn bundle was slowly pulled through the freshly formulated PDMS precursor . After standing vertically for 15 min, the fiber bundles were treated in an oven at 80 °C for half an hour. The moisture stability of the yarn was tested by dripping water in the middle of the yarn while the conductivity and Seebeck coefficient were measured. The PDMS-wrapped yarn was placed in water and stirred for one hour at a rate of 500 rpm for one wash cycle. After each wash, the conductivity of the fibers and the Seebeck coefficient were measured.2. The cross-sectional size of the fiber is mainly determined by the dope concentration and the diameter of the injection needle. After rounds of optimization, the needle with a diameter of 400 μm was found to provide fibers with the best mechanical and electrical properties, and was subsequently used throughout the study. The rapid water loss after the injection into the coagulation bath prompts a structural collapse, leading to the formation of flat fibers. Compared with the hollow structure formed by PP fibers in previous studies [The morphology and structural characteristics of microfibers have significant influence on their mechanical, electrical, and thermoelectric properties.  studies , the preThe XRD pattern of the fiber c clearlyThe mechanical properties of the fibers were further tested, and their tensile stress curves are shown in 2. Therefore, due to their excellent mechanical and electrical properties, we selected fibers with 2% ionic liquids to be integrated into the prototype device in the follow-up studies. The addition of ionic liquids also significantly improved the electrical properties of the fibers. To demonstrate the application of PP fibers in wearable smart sensing, we weave the PP microfiber bundles into gloves, as shown in Fiber-shaped thermoelectric materials offer a new possibility for building smart fabrics with temperature-location sensing. Both ends of the fiber can simultaneously sense the temperature changes, and then sense where the temperature changes occur. Taking advantage of this feature of PP fibers, we constructed a 3 × 3 sensing array for position and temperature sensing, as shown in The electrical properties of conductive polymers are often influenced by ambient humidity, which affects their working stability. In this work, since the thermoelectric and heating functions of conductive polymer fibers can be carried out by means of heat exchange, they do not need to be exposed directly to the environment. We wrap a thin layer of hydrophobic PDMS outside the PP fiber yarn to reduce the influence of moisture on the fiber properties. As shown in In summary, a temperature-sensing and in situ heating functionalized microfiber fabric has been demonstrated by exploiting the high electrical conductivity and thermoelectric properties of the conductive polymer microfibers. By adding ionic liquid into the wet-spinning dope, both the conductivity and mechanical properties of the fabricated microfibers were improved. We further demonstrated a multifunctional fabric based on conductive polymer microfibers equipped with both temperature-sensing and in situ heating capabilities. In addition, a sensor array consisting of a few simple interlaced microfibers was manufactured to collect information on the temperature and position of the object. This work integrates the thermoelectric properties and heating functions of PEDOT:PSS, providing a new idea for further development of high-performance, multifunctional wearable smart fabrics.


Distributed Acoustic Sensing (DAS) is a novel technology that uses fiber optics to sense and monitor vibrations. It has demonstrated immense potential for various applications, including seismology research, traffic vibration detection, structural health inspection, and lifeline engineering. DAS technology transforms long sections of fiber optic cables into a high-density array of vibration sensors, providing exceptional spatial and temporal resolution for real-time monitoring of vibrations. Obtaining high-quality vibration data using DAS requires a robust coupling between the fiber optic cable and the ground layer. The study utilized the DAS system to detect vibration signals generated by vehicles operating on the campus road of Beijing Jiaotong University. Three distinct deployment methods were employed: the uncoupled fiber on the road, the underground communication fiber optic cable ducts, and the cement-bonded fixed fiber optic cable on the road shoulder, and compared for their outcomes. Vehicle vibration signals under the three deployment methods were analyzed using an improved wavelet threshold algorithm, which was verified to be effective. The results indicate that for practical applications, the most effective deployment method is the cement-bonded fixed fiber optic cable on the road shoulder, followed by the uncoupled fiber on the road, and the underground communication fiber optic cable ducts are the least effective. This has important implications for the future development of DAS as a tool for various fields. The advancement of science and technology has led to a significant focus on intelligent transportation in transportation research. ITSs combine various technologies, including electronics, information technology, sensors, and system engineering, to monitor and manage traffic within the road infrastructure . Real-tiSeveral studies have shown that distributed acoustic sensing technology is suitable for real-time monitoring of traffic behavior. Wang and Zeng  utilizedIn the experimental setup of the aforementioned studies, optical fibers were utilized in various deployments. The coupling impact varies depending on the deployment, and the acquired data quality also varies. Optical fiber coupling can significantly improve the efficiency and accuracy of detection results. This is especially important in the field of transportation, where it can provide comprehensive solutions for urban traffic flow detection, structural health detection, traffic safety monitoring, early warning systems, and perimeter security detection, among others, with real-time accuracy. Enhancing our daily lives with superior convenience. Currently, acquiring high-quality vibration data is the main focus of research. The fiber structure and deployment method are two important factors that affect the performance of the DAS system. To acquire high-quality vibration data, it is crucial to improve the coupling quality between the fiber optic cable and the ground layer of the DAS system. Therefore, investigating methods for improving the coupling quality is essential ,25,26. WThe present paper is structured as follows: Distributed Optical Fiber Sensors (DOFS) rely on changes in the physical properties of light waves transmitted through optical fibers to detect external stimuli, including temperature, pressure, strain, and vibration. The schematic diagram of the Distributed Acoustic Sensing system is depicted in The PGC demodulation algorithm  was utilThis study employs an improved wavelet threshold algorithm for vehicle detection at traffic signals. Distributed acoustic sensing technology is utilized to acquire vehicle vibration data, which serves as the foundation for further analysis. The wavelet thresholding algorithm is then applied to denoise the data obtained by DAS. A comparative analysis of signal data acquired through three distinct optical fiber deployment methods is conducted to determine the optimal vehicle detection method. The flow chart of the detection process is depicted in The selection of the threshold function is critical in constructing the continuity and accuracy of the signal and has a significant impact on the effectiveness of wavelet denoising. Currently, there are two primary methods for selecting the threshold, namely: the hard threshold and the soft threshold. The hard threshold method compares the absolute value of the signal with the threshold, sets the signal that is less than or equal to the threshold to zero and retains the signal that is greater than the threshold. However, the discontinuity of the hard threshold method results in obvious noise in the denoised signal. On the other hand, the hard threshold is capable of retaining the local information of the image edges and details while producing visual distortions such as the ringing effect. Unlike the hard threshold, the soft threshold method sets the signals whose absolute value is smaller or equal to the threshold to zero, and for the signals greater than the threshold, it sets them as their own difference with the threshold, thereby allowing the signals to shrink towards zero. Although the soft threshold has better continuity than the hard threshold, its derivative is discontinuous. Consequently, it is estimated that there is a constant deviation between the noisy and denoised wavelet coefficients. Additionally, the fixed value compression of coefficients greater than the threshold and the decrease in noise with increasing wavelet coefficients are inconsistent with the facts. As a result, while the soft threshold technique produces relatively smoother denoised signals, it may also lead to blurry edges and distortion. The mathematical expressions for these two threshold functions are presented in the table below.The equation of the hard thresholding method is as follows.The soft thresholding method is formulated as follows.While traditional hard and soft thresholding methods have demonstrated their effectiveness in real-world applications, these methods come with their own potential drawbacks. Specifically, This study uses an improved wavelet thresholding function proposed by group member Liu ,22 to adThe improved wavelet threshold function overcomes the limitations of hard thresholding, which is limited by its discontinuity at the threshold. Additionally, the improved smoothness of the reconstructed signal mitigates the drawbacks of using a soft threshold. The denoising algorithm that employs the improved wavelet threshold function consists of three steps: specifically, decomposing the wavelet signal, thresholding its coefficients, and reconstructing the signal after thresholding. The effectiveness of the algorithm is demonstrated through numerous simulation experiments.The original signal displayed in n is the sampling point.Furthermore, to quantify the denoising outcomes, we assess the denoising algorithm using two metrics: signal-to-noise ratio (SNR) and root mean square error (RMSE). The formulas can be expressed as:Experiments were conducted at Beijing Jiaotong University to validate the algorithm’s efficacy and compare the quality of detected signals in the distributed acoustic sensing system deployed under different methods. The DAS system’s laser pulse has a duration of 50 nanoseconds, and a pulse repetition rate of 10 kHz The data acquisition sensors were optical fibers. In the experiment, field-deployed common armored sensing optical fiber and communication optical cable laid in the underground cable trench on the campus of Beijing Jiaotong University were used. The DAS equipment used in the experiment was provided by the Optoelectronic System Laboratory of the Chinese Academy of Sciences Semiconductor Research Institute. The model of the DAS equipment used in this study is the SemiDAS-S001 model, manufactured by the Chinese Academy of Sciences Semiconductor Research Institute. The fibers were deployed using various methods in different locations such as the Information Center, Dormitory 19, Dormitory 8, and Jixiu Road. Three distinct methods were used to lay the optical fibers on the Beijing Jiaotong University campus. These methods included uncoupled fiber on the road, underground communication fiber optic cable ducts, and cement-bonded fixed fiber optic cable on the road shoulder. During the experiment, the recorded channels were numbered from 90 to 480, with every 30 s constituting a group of vehicle detection data and each channel covering 1.6 m. The illustration in Based on the video data, the vibration signal represents a vehicle traveling from south to north at a speed of 30 km/h.During the passage, we calculated the energy and signal-to-noise ratio of selected vehicle channels. To denoise the signal data and determine the energy and signal-to-noise ratio, we employed the improved wavelet thresholding algorithm discussed in The signal-to-noise ratio (SNR) is an essential parameter for assessing the quality of seismic data and evaluating the efficacy of denoising techniques. In seismic exploration, the SNR of seismic records is often used as a metric for evaluating data quality. Revised paragraph: A higher Signal-to-Noise Ratio (SNR) value indicates better quality of data and more reliable processing outcomes. In this study, SNR is selected as one of the evaluation metrics to compare the signal quality of fiber-optic vibration signals using three different deployment methods. Revised paragraph: A conventional approach in the time domain is utilized to calculate the SNR, and the root mean square (RMS) is employed as the evaluation metric to improve the precision of the comparison outcomes. The RMS value of the SNR is calculated for various fiber deployments.The SNR values are computed by dividing the root-mean-square amplitude of a 20 ms window around the maximum amplitude point by the mean RMS amplitude of a 20 ms window of noise at the beginning of the recording. This interval is chosen due to its provision of a background noise level representative of the ambient noise without any vehicular activity. It is noteworthy that the choice of time window could impact the resulting SNR values.Short Time Energy analysis (STE) is an extensively used and effective technique for energy analysis in the time domain of non-smooth signals in fiber optic communications. The energy of the vehicle vibration signal in the time domain is significantly greater than that of the noise alone.Revised paragraph: The energy of the vehicle vibration signal in a single channel was computed using a time window of 20 ms, centered on the point of maximum amplitude. This interval was preferred because it provides an accurate representation of the vehicle signal. Different time windows may result in varying energy values, which should be acknowledged. The energy of the fiber using three different deployment methods is expressed in terms of the mean squared difference of the energy in a single channel.The noise spectrum of the cement-bonded fixed fiber optic cable on the road shoulder, the uncoupled fiber on the road, and the underground communication fiber optic cable ducts are displayed in The primary frequencies of the cement-bonded fixed fiber optic cable on the road shoulder and underground communication fiber optic cable ducts are nearer to the primary frequency of the vehicle passing via the detection area. This infers that the coupling quality of the cement-bonded fixed fiber optic cable on the road shoulder and underground communication fiber optic cable ducts surpasses that of the uncoupled fiber on the road fiber within the primary vehicle frequency. The amplitude of the cement-bonded fixed fiber optic cable on the road shoulder is significantly higher than that of the underground communication fiber optic cable ducts. This indicates that the coupling quality of the cement-bonded fixed fiber optic cable on the road shoulder exceeds that of the underground communication fiber optic cable ducts.This paper presents the usage of an improved wavelet threshold algorithm to compare the signal quality of three different fiber optic placement methods. The effectiveness of the algorithm is validated through comparisons of signal-to-noise ratio (SNR) and root-mean-square (RMS) errors produced by different threshold denoising algorithms. The experiments were conducted using a DAS (distributed acoustic sensing) system on the campus of Beijing Jiaotong University, where vibration signals induced by vehicle motion were detected through the uncoupled fiber on the road, the underground communication fiber optic cable ducts, and the cement-bonded fixed fiber optic cable on the road shoulder.The experiment results from the three different placement methods were then analyzed using the improved wavelet threshold algorithm. The comparison of SNR, energy, and noise analysis were conducted to compare the difference in vehicle signals picked up by each fiber optic placement method. The experimental results demonstrate that the improved wavelet threshold denoising algorithm yields superior denoising outcomes compared to the conventional wavelet algorithm. The signal-to-noise ratio (SNR) and energy levels obtained from the cement-bonded fixed fiber optic cable on the road shoulder are the highest. The obtained vehicle vibration signal’s quality from the cement-bonded fixed fiber optic cable on the road shoulder is the best. The ground layer filters a portion of the signal, leading to a lower amount of received vehicle signal and noise by the underground communication fiber optic cable ducts. Therefore, the signal-to-noise ratio (SNR) of the underground communication fiber optic cable ducts is higher than that of the uncoupled fiber on the road. However, the energy of the signal in the uncoupled fiber on the road is higher than that in the underground communication fiber optic cable ducts. As illustrated in Therefore, the cement-bonded fixed fiber optic cable on the road shoulder is preferred for practical applications, followed by the uncoupled fiber on the road, with the underground communication fiber optic cable ducts as the last resort.In future research, we will compare additional diverse fiber optic deployment methods and develop complete theoretical models to determine the optimal approach for using distributed acoustic sensing across different industries, with the goal of maximizing efficiency. However, this study identified the following limitations: (1) The study was limited to a university campus, and the environment, including the road surface material, may have affected the fiber optic coupling. (2) The fiber optic deployment distance was short, and the sample size was small. (3) The experimental conditions were limited to straight-line travel at a constant speed.


Tomatoes are among the very important crops grown worldwide. However, tomato diseases can harm the health of tomato plants during growth and reduce tomato yields over large areas. The development of computer vision technology offers the prospect of solving this problem. However, traditional deep learning algorithms require a high computational cost and several parameters. Therefore, a lightweight tomato leaf disease identification model called LightMixer was designed in this study. The LightMixer model comprises a depth convolution with a Phish module and a light residual module. Depth convolution with the Phish module represents a lightweight convolution module designed to splice nonlinear activation functions with depth convolution as the backbone; it also focuses on lightweight convolutional feature extraction to facilitate deep feature fusion. The light residual module was built based on lightweight residual blocks to accelerate the computational efficiency of the entire network architecture and reduce the information loss of disease features. Experimental results show that the proposed LightMixer model achieved 99.3% accuracy on public datasets while requiring only 1.5 M parameters, an improvement over other classical convolutional neural network and lightweight models, and can be used for automatic tomato leaf disease identification on mobile devices. AccordiA novel lightweight deep learning model called LightMixer was proposed for the automatic detection of tomato leaf diseases under field conditions.The depth convolution with Phish (DCWP) and light residual (LR) modules were carefully designed to improve deep feature fusion while reducing the number of model parameters.Phish activation function was used to replace the commonly used rectified linear unit function to reduce the information loss of tomato leaf disease features and improve the nonlinear expression of the model.Compared with other classical convolutional neural network (CNN) models, the proposed model achieved minimum memory cost and highest accuracy, making it more suitable for deployment in mobile devices or small embedded devices.2In recent years, with the development of machine learning and deep learning, the extensive use of computer vision techniques in agriculture has achieved remarkable results, particularly in the field of plant disease identification. Although the aforementioned studies strongly demonstrate the effectiveness of CNN architectures in the field of plant disease identification, these architectures are inevitably problematic because of their large number of parameters and high computational complexity. Therefore, designs focusing on lightweight CNNs have been widely proposed. 33.1The data in this study were obtained from the PlantVillage public dataset , which hFor a deep learning model, the more training data input into the model, the better the model learns. Therefore, several data enhancement methods were used to perform data enhancement on the training dataset before the deep learning model started training, including random image cropping, horizontal random flip, vertical random flip, and random rotation. All images were resized to 224 × 224 pixels. 3.2In this study, a lightweight CNN model called LightMixer is proposed for identifying tomato leaf diseases in complex environments. The proposed LightMixer model focuses on both lower memory cost and higher accuracy to address the migration difficulties for mobile or small embedded devices. By designing and assembling the DCWP and LR modules, LightMixer can accurately extract features from tomato leaf disease images with complex backgrounds and achieve high accuracy with low-memory cost. LightMixer is a lightweight CNN model that is suitable for mobile and cross-connected wireless communication devices. The LightMixer structure is shown in 3.3The activation function is a key component for minimizing the loss in deep neural networks and can both enhance the nonlinear representation and accelerate the computational efficiency of the entire model, thus improving the accuracy of tomato leaf disease identification. Compared with traditional activation functions introduced in CNN models, the Phish activation function outperforms most traditional activation functions in terms of classification; therefore, it is introduced in this study . The Phiwhere x denotes the input, and the mathematical operations of the Tanh and GELU functions are shown in Equations (2) and (3), respectively.Therefore, by combining Equations (1), (2), and (3), the equation for the Phish function can be expressed as:where x denotes the input and Phish(x) denotes the nonlinear output after mathematical operations.3.4Depth-separable convolution reduces the number of parameters required for convolution computation by splitting the correlation between the spatial and channel dimensions; it has also been shown in some studies to improve the efficiency of convolution kernel parameters. As shown in In this study, the DCWP module was designed with depthwise convolution as the backbone. To avoid missing feature information in the feature map compression process, no nonlinear activation function was used, and the Phish function was used to splice after the depthwise convolution to make full use of the relevant information in the feature map to transfer the shallow feature information to the deep layer. The DCWP module has been designed to be used as a tool for deeper layers; its structure is shown in 3.5To address the challenge of difficult deployment of CNN models for tomato leaf disease identification in mobile terminals and low-memory devices, there is an urgent need to design a new network architecture that guarantees high accuracy in identifying tomato leaf diseases in complex contexts while further reducing the total number of parameters and model size. We designed a residual-based LR module to make the model more lightweight and improve its deployment capability.First, a convolutional layer and the Phish activation function were connected, and a batch normalization layer was added after the Phish activation function, as the network depth poses a challenge to the convergence speed of the entire network. Then, the sequentially connected convolutional layers, Phish activation function, and batch normalization layer were multiplexed in series to effectively improve the feature extraction for tomato leaf disease. Finally, residual connections constructed efficient residual blocks, which improved the ability of gradient propagation across layers and could prevent gradients in deep convolutional layers from vanishing. The structure of the LR module is shown in 44.1The hyperparameter settings used in the experiments are presented in To evaluate the performance of the model, recall, accuracy, precision and F1-score were selected as the metrics for comprehensive evaluation. The mathematical expressions for the evaluation metrics are as follows:where TN is the number of true-negative samples, TP is the number of true-positive samples, FN is the number of false-negative samples, and FP is the number of false-positive samples.4.2Ablation experiments were used to demonstrate the effects of the DCWP and LR modules, and the results are presented in 4.3The proposed LightMixer model was then compared with other classical CNN models, namely AlexNet , ResNextTo observe the performance of different models in identifying different classes of tomato leaf diseases, a confusion matrix was used to visualize the classification results on the test set. 4.45The identification and classification of various tomato leaf diseases by CNN models are highly accurate; however, mainstream CNN models require higher computational and storage costs. In this study, an extremely lightweight CNN model called LightMixer is proposed for the automatic identification of tomato leaf diseases. In the proposed model, LR residual blocks are introduced as one of the main core units for building the backbone network. The architecture of LR residual blocks is designed to achieve better performance while requiring less computation and storage costs. The proposed LightMixer model also has a DCWP module that enhances the feature extraction capability of the network, highlights the nonlinear representation of the model, and compresses the parametric number of the model to enhance its classification capability. The combination of the LR residual block and DCWP module facilitates the ability of the model to utilize the feature map to better capture the disease features and help optimize the performance of the model. Experimental results demonstrate that the proposed model has 99.3% recognition accuracy in diagnosing tomato leaf diseases and has only 1.5 M parameters, which is better than other tested classical models. In the next step, the deployment of the proposed model in mobile or embedded device environments will be our main goal to help farmers accurately identify and detect tomato leaf diseases. Further exploration of the generalizability of the proposed model to detect and identify a variety of other plant diseases will be part of our future plans.https://www.kaggle.com/datasets/abdallahalidev/plantvillage-dataset.Publicly available datasets were analyzed in this study. This data can be found here: MT contributed to conception and design of the study. YZ designed and performed the experiment, managed the algorithms and result analysis and wrote the manuscript. ZT participated in the experiments and manuscript revision. All authors contributed to the article and approved the submitted version.


Disorganized attachment has been described as an important risk factor for developing serious mental disorders in childhood, adolescence and adulthood, such as borderline personality disorder, psychoses, afective disorders, and a higher suicide risk, for instance. Bonding disorders (BD) in parents are related to insecure and disorganized attachment in children. BD can be early diagnosed at 4 to 6 weeks after birth.Determine if there is a significant difference between the results of the prevalence of affective disorders, disorganized attachment, and suicidal risk five years after the birth of the offspring of parents with and without attachment disorders detected in the first year postpartum during the covid-19 pandemic.Describe a pilot project of an analytical prospective study following a cohort of parents from the cohort SAMPECO/PEMHSCO . The cohort is planned to be divided into two groups: with bonding disorders an without bonding disorders, which was established using the Postpartum Bonding Questionnaire . Follow the offspring of both groups for 5 years and compare the results of disorganized attachment, affective disorders and suicide risk.The cohort SAMPECO/PEMHSCO was recruited between March 2021 and June 2022. There was measured postpartum depression in mothers and fathers using the EPDS and bonding disorders in parents using the PBQ validated to the Spaniard population. More than 1500 families were involved at the beginning and around 450 families finished the follow-up six months after birth. Around 500 families were lost because of non-right contact information.The covid-19 pandemic has seriously affected the mental health of the general population. Consequently, there is a higher demand for mental health assistance by public and private sanity sectors. Currently, the youth population is suffering very much from the consequences of isolation and other social factors, and many families who had babies in this period haven’t had enough support to breed and look after both their babies and themselves. Some papers suggest that the prevalence of perinatal mental disorders in parents has increased since the covid-19 pandemic because of several factors. Paradoxically, despite the high preventive potential of early intervention in the perinatal period, there are not yet exist well-equipped perinatal mental health units to solve this problem. It is urgent to boost the development of Perinatal Mental Health Services to prevent a major worsening of the situation and to prevent the increasing rate of severe mental disorders in children, adolescents and adults.None Declared


In the realm of nonlinear dynamics, the Belousov-Zhabotinsky reaction system has long held the fascination of researchers. The Belousov-Zhabotinsky system continues to be an active area of research, offering insights into the fundamental principles of nonlinear dynamics in complex systems. To deepen our understanding of this intricate system, we introduce a pioneering approach to tackle the time fractional Belousov-Zhabotinsky system, employing the Caputo and Atangana-Baleanu Caputo fractional derivatives with the double Laplace method. The solution we obtained is in the form of series which helps in investigating the accuracy of the proposed method. The primary advantage of the proposed technique lies in the low amount of calculations required and produce high degree of precision in the solutions. Furthermore, the existence and uniqueness of the solution are investigated thereby enhancing the overall credibility of our study. To visually represent our results, we present a series of 2D and 3D graphical representations that vividly illustrate the behavior of the model and the impact of changing the fractional order derivative and the time on the obtained solutions. Fractional calculus is now recognized as a powerful tool for modeling and analyzing complex phenomena with memory and non-local behaviors, it finds extensive applications in a wide range of engineering and scientific domains, encompassing fields such as chemistry, physics, economics, biology, and finance7. There are many definitions of fractional calculus, including, the Riemann-Liouville  have garnered significant attention because of their ability to effectively represent intricate phenomena that go beyond the descriptive capacity of traditional integer-order models20, this is because, unlike ordinary derivatives, which describe the rate of change of a function at a specific point, fractional derivatives account for the past behavior of the function over a range of values. They are known to capture non-local and memory effects, which means they can take into account the entire history of a function rather than just its current value. This property enables fractional derivatives to describe the real life applications.Fractional calculus, a branch of mathematical analysis that generalizes the concept of differentiation and integration to non-integer orders, has gained increasing prominence in various scientific disciplines over the past few decades. Initially introduced by Leibniz in the 17th century and developed by several mathematicians in subsequent centuries21. Akinyemi22 investigted the TFBZS using q-homotopy analysis transform method. Alaoui et al.23 provide an approximate solution for the proposed system using homotopy perturbation method with Yang transform. Karaagac et al.24applied the Picard-Lindelöf theorem to the proposed model under 25 presented a brief analysis for this chemical reaction under Caputo fractional derivative. Recently, El-Tantawy et al.26 presented an approximate solution for the TFBZS using residual power series merged with Laplace transform. Yasmin et al.27 investigated this system using homotopy perturbation with Elzaki transform.In this study, we aim to investigate the time fractioal Belousov-Zhabotinsky system (TFBZS) in the form:30 under two types of fractional derivatives, Caputo  merged with Adomian polynomials to enable us deal with nonlinear termsThe structure of this article is as follows: In section “31. The studies conducted in recent years following these advancements clearly indicate that scientists have a significant opportunity to address a variety of issues using fractional derivatives.As we mentioned earlier, there are many definitions of fractional differentiation, each of them has its own advantages and disadvantages. It’s important to highlight that Caputo’s definition is applicable solely to functions that are differentiable. In 2016 Abdon Atangana and Dumitru Baleanu presented a new fractional derivative with non-local and no-singular kernel that depend on Mittag-Leffler functionIn this research, our objective is to solve TFBZS using DLM in the sense of Caputo and ABC fractional derivative.2: Caputo fractional derivative is defined as:The operator Caputo fractional derivative satisfy:32: In this study, for simplicity, we will consider 32: 36.Further details in different types of fractional derivatives in37 introduced a technique for computing 39. To compute the The Adomian decomposition technique has introduced the concept that the unknown linear function 40 to effectively handle nonlinear terms within these equations. This approach significantly enhances our capability to analyze and solve real-world problems across various scientific and engineering domains.The double Laplace transform method serves as a valuable mathematical tool for addressing fractional nonlinear equations or systems of equations. This technique proves particularly effective when dealing with equations featuring Caputo, Caputo-Fabrizio, or Atangana-Baleanu-Caputo fractional derivatives. By applying the Laplace transform twice, it enables the conversion of intricate fractional differential equations into more accessible algebraic forms. This transformation simplifies the process of solving fractional differential equations. Moreover, it can be combined with methods like Adomian polynomials, see32 The expression for the Double Laplace transform using Caputo fractional derivative when 32 The expression for the Double Laplace transform using Atangana-Baleanu-Caputo fractional derivatives when In this section, we will establish the existence and the uniqueness of the TFBZS within the context of the mentclass2pt{minimAssume that If the following inequalities are satisfied, then the proposed system  having aFrom the existence of equation  as a sol for Eq. , we get3The same conclusion can be drawn for 22.In this section, the DLM is applied to the TFBZS to find approximate solutions, the system will be investigated under two types of initial conditionsCase I : ForUsing Caputo DLTM:mentclass2pt{minimx values.Apply the DL formula  into botUsing Atangana-Baleanu-Caputo DLTM:x.Apply formula  to the TCase II : ForandUsing Caputo DLTM:mentclass2pt{minimx-values.Apply the DL formula  into botUsing Atangana-Baleanu-Caputo DLTM:x values.Apply the DL formula  into botConsidering the results we obtained from solving the two cases of initial conditions with different definitions, we notice that the Caputo results are very close to that results for Atangana-Baleanu-Caputo when the fractional order derivative Graphic representations offer a visual context that enhances the comprehension of data and results. They provide an immediate and intuitive understanding of the relationships, and patterns present in the data, making it easier for researchers and readers to grasp the significance of the findings.Two and three dimensions graphs for the obtained solutions are presented to visualize the behavior of the TFBZS using two different cases of initial conditions each case was dealt with in two definitions of fractional calculus mentclass2pt{minimIn this study, we obtain an approximate series solution for the TFBZS using DLM under varying initial conditions. Each initial condition was examined using both Caputo and Atangana-Baleanu Caputo fractional derivatives. The results obtained showcased an impressive level of accuracy, with errors consistently maintained at a remarkably low magnitude. Furthermore, we conducted a thorough investigation into the existence and uniqueness aspects of the solution, establishing a robust foundation for the validity of our approach. In order to understand the behavior of the solution, we present two and three dimensional graphs to show the impact of the time and the fractional derivative of the solution. The graphs of approximate and exact solution demonstrate a close resemblance, indicating the accuracy of the obtained solutions.For the future directions, we envision expanding the application of the DLM to other complex fractional systems with higher-order fractional derivatives that analyze a real world applications. This can involve exploring the applicability of the method in multi-dimensional fractional systems.The authors confirm that they did not utilize any Artificial Intelligence (AI) tools in the development of this article.


The COVID-19 pandemic had a major impact on mental health globally, resulting in a need for adaptation of mental health services. The psychosocial consequences of this crisis, such as psychological stress, reduction of community care and social support, are known factors that increase the risk of psychiatric decompensation. Compulsory admission is the last line of intervention in individuals who suffer from severe mental disorders and refuse treatment, based on the principles of therapeutic need and social protection. In Portugal, the last law regulating the compulsory admission is in forme since 2004 (Law 36/98 of 24 July), and configures this measure as a hospitalization by court order, happening the same in other European countries. The literature shows that in 2020 there was a significant increase in the proportion of involuntary inpatient admissions for all psychiatric diagnosis.This study aims to assess the impact of the COVID-19 pandemic on involuntary admissions to an acute psychiatric service.Socio-demographic and clinical data were collected from electronic medical records. A retrospective observational study of patients who were admitted in a General Psychiatric Unit of Hospital Magalhães Lemos between March 2019 and February 2021 was conducted. The characteristics of patients admitted before the pandemic (March 2019 to February 2020) and after (March 2020 to February 2021) were compared statistically.A total of 850 patient admissions were obtained, of which 28% were involuntary. The authors expect to find differences between involuntary inpatient admissions before and after the COVID-19 pandemic in proportion of patients, socio-demographic and clinical factors.The findings of this study will likely show an increase in involuntary admissions during the pandemic, in agreement with current knowledge. More studies are needed to assess the long-term impact of the pandemic on mental health.None Declared


Editorial on the Research TopicElbow injury in pediatric patientsFractures of the distal humerus in children and adolescents present a diagnostic and therapeutic challenge to the orthopedic surgeon. “Pity the young surgeon whose first case is a fracture around the elbow,” said Mercer Rang to emphasize the difficulties inherent in traumatic injuries to the child's elbow .The distal end of the humerus is the second most common site of fracture in children, yet it is the most common indication for surgery. The distal end of the humerus, in addition to its anatomical complexity, is characterized by the presence of numerous ossification nuclei that appear at different times during skeletal maturation . These eElbow Injury in Pediatric Patients to provide the latest diagnostic and therapeutic strategies for fractures, both common and rare, of the distal end of the humerus in children.A total of 12 articles and one commentary were selected after selective peer review for the Special Issue of Coupal et al. investigated the optimal form of immobilization for the treatment of Gartland-type 1 SHFs and found that there was insufficient high-quality evidence to determine the best option. They reported that children treated with a cuff and collar had delayed return to normal daily life activities and experienced more pain than those treated with a posterior splint. However, no studies directly compared posterior splints with circumferential casts.Despite their frequency, not all supracondylar humerus fractures (SHF) require surgical fixation. In particular, Qian et al. assessed the learning curve for successful reduction and fixation of SHFs and reported that 65 procedures are needed to master the surgical technique of closed reduction (CR) and percutaneous fixation; interestingly, they also pointed out that surgical experience significantly impacts the post-operative recovery of children with such injuries.Liu et al. reported that CR with a minimally invasive technique followed by external fixation is a potential alternative to manage SHFs presenting 2 or more weeks after the initial trauma; the preliminary results are encouraging with satisfactory functional outcome and low complication rate.However, CR and percutaneous fixation are more difficult to achieve in children with an SHF presenting more than 14 days after the initial trauma. Sun et al. reported that flexion-type SHFs have a higher rate of ulnar nerve injury and are at a higher risk of open reduction, particularly when lateral displacement and rotation are present simultaneously.Flexion-type SHFs are extremely challenging to treat due to their instability and rotation of the distal fragment. Weng et al. compared the clinical and radiographic outcomes of CR versus open reduction in the treatment of severely displaced lateral condyle fractures (LCFs). They found that despite the relatively long learning curve, CR of severely displaced LCFs is challenging and successful reduction cannot always be achieved. They concluded that although CR of severely displaced LCFs has some advantages, including a smaller scar and lower rate of postoperative infection, open reduction and percutaneous fixation still remain the first-line treatment for such injuries. In their commentary, Rehm et al. highlighted that CR and percutaneous fixation of LCFs with >4 mm displacement are feasible in a significant proportion of cases with relatively good outcomes.Deng et al. reported a novel approach for the treatment of displaced LCFs. They advocated that LCFs should first be reduced by CR and fixed with two to three Kirschner wires (1.5–1.8 mm) inserted under intraoperative US guidance; interestingly, they pointed out that fragments with >4 mm displacement are easier to visualize with US. The reported technique reduces radiation exposure, has a relatively low complication rate, and provides a good functional outcome, even though the results are preliminary and from a single center  for pediatric humeral shaft fractures. They found that US-guided CR and ESIN fixation decreased the risk of radial nerve injury. However, intraoperative US cannot completely replace the role of radiography in humeral fracture surgery, although it can significantly reduce radiation exposure.Magnetic Resonance Imaging (MRI) has already been shown to accurately diagnose LCFs and is a valuable tool to properly restore joint anatomy during surgery . The useShu et al. reported the results of CR, external fixation, and percutaneous pinning for the treatment of DIFs. They found that fracture stability and acceptable clinical and functional outcomes could be achieved in patients younger than 10 years of age. It has been reported that DIFs in children older than 10 years of age have a higher complication rate and poorer functional outcomes compared to younger children  of the humerus in children, there is no specific and accepted treatment protocol for such injuries. children . DespiteSu et al. evaluated the treatment and outcome of radial head and neck fractures associated with a fracture of the ulna, which is a very rare form of MEF. They recommended anatomic reduction and internal fixation of the ulna to restore its length, and CR and ESIN fixation of the radial neck fracture. If these principles are followed, and early rehabilitation is performed, the functional outcome is very satisfactory in most cases.The group of Monteggia-equivalent fractures (MEFs) has grown steadily over the last 10 years and has complemented Bado's classic classification system. Gao et al. could only identify four cases of this particular association in children. They reported the case of a 9-year-old boy with a type III Monteggia fracture, ipsilateral forearm fracture, and concomitant radial nerve deficit. The patient underwent open reduction and internal fixation of the distal forearm and proximal ulna. The functional and radiologic outcome of the patient was good with full recovery of the radial nerve injury at 1-year follow-up.Distal forearm fractures have rarely been reported in association with Monteggia type III fractures. In their review of the literature, Jiang et al. reported the case of a 13-year-old boy with chronic postero-lateral dislocation of the left elbow due to the absence of the coronoid process of the ulna. They reconstructed the coronoid process with the tip of the olecranon and achieved good stability of the elbow joint at a 2-year follow-up. This clinical case demonstrates that the reconstruction of the coronoid process of the ulna with the proximal end of the olecranon provides good mid-term results in children with elbow instability due to the absence of the coronoid process of the ulna.The coronoid process of the ulna is essential for stabilizing the elbow joint. Its reconstruction is recommended in both acute and chronic injuries in order to restore elbow stability and prevent early degenerative changes. De Maio et al. performed a systematic review of the literature to identify the best operative treatment for children with displaced olecranon fractures with or without associated injuries. They found that surgically treated fractures generally have a good prognosis and that tension band suture is the preferred fixation, although it is not recommended in older children due to the high risk of fixation failure. They also reported that the outcome was worse in patients with associated injuries.Elbow Injury in Pediatric Patients offer valuable insight into the diagnosis and treatment of such conditions.The presentation, management, and evolution of fractures of the distal end of the humerus in children are complex and require special attention. With this in mind, the articles in the Special Issue


The primary factor affecting tumor biology is neo-lymphangiogenesis in solid epithelial malignancies like oral squamous cell carcinoma (OSCC). Determining the impact of lymphovascular invasion is critical in order to determine OSCC's locoregional and global dissemination. Bibliometric landscapes are vital to learning about the most recent advancements in the aforementioned topic because the ongoing research in OSCC is multifaceted. This analysis can reveal the progressions that might modernize OSCC diagnosis and treatment. The present analysis has been therefore undertaken to study the relevance and effects of lymphovascular invasion in OSCC utilizing co-occurrence of keywords analysis and co-authorship analysis in the PubMed database. The keywords included “lymphovascular invasion in oral squamous cell carcinoma” using the Boolean operator (AND). A cross-sectional bibliometric analysis of full-text articles from 1994 to 2023 using VOSviewer  was performed. The data obtained was analyzed for co-occurrence and co-authorship analysis using the VOSviewer standard protocol. The query revealed 296 searches in the PubMed database. Seven clusters were found with default colors in the representation of the entire term co-occurrence network, which also displayed a total link strength of 22,262. The items were categorized into clusters based on their commonalities. The labels' weights, as determined by links and occurrences, did not depend on one another, and the co-occurrence of keywords does not imply a causal association. In the item density visualization, item labels represented individual things. The number of items from a cluster that was close to the point was represented by the weight given to its color, which was formed by combining the colors of other clusters. A network of 57 authors who matched the search parameters was discovered by the co-authorship analysis. The network visualization map displayed three clusters with a total link strength of 184. The quantity of co-authorship relationships and the number of publications did not appear to be significantly correlated. In conclusion, this investigation uncovered a sizable body of bibliometric data that emphasizes key trends and advancements in the aforementioned theme. The observed variances may be a result of the various objectives of the researchers and journals, who collaborate to provide the best possible literature dissemination. Oral squamous cell carcinoma (OSCC) is a perennial major public health concern accounting for 90-95% of patients with this subtype of head and neck malignant diseases, followed by basal cell carcinomas, mesenchymal malignancies, hematologic tumors, and melanomas . The incAccording to the classifications made by the WHO's International Agency for Research on Cancer (IARC), epidemiological studies have identified a wide range of risk factors for OSCC. The widespread occurrence of OSCC in Southeast Asia is associated with the usage of specific carcinogen-containing products, including alcohol consumption, smoking, environmental pollution exposure, and viral infections including human papillomavirus (HPV) and Epstein-Barr virus (EBV) . In IndiDuring the ongoing, intricate process known as lymphatic metastasis, cancer cells may migrate from the primary tumor site through the lymphatic system. Recent studies have demonstrated the importance of the tumor microenvironment (TME) in the growth, invasion, and metastasis of tumors . TME in Although there is a wealth of information available regarding the multifactorial behavior of OSCC, it has always been challenging to pinpoint the area of interest for study on the metastatic behavior of cancer cells. As a result, bibliometric analysis, which examines research patterns using bibliographic data, can be used to track prior studies, predict future trends, and identify the current trend toward researching lymphovascular invasion in OSCC .Therefore, the current bibliometric analysis was conducted to study the relevance and effects of lymphovascular invasion in OSCC utilizing co-occurrence of keywords analysis and co-authorship analysis in the PubMed database using the VOSviewer bibliometric software . A graphic abstract of the study has been presented in the Appendices.This article was previously posted to the medRxiv pre-print server (medRXIV/2023/286490) on February 27, 2023.MethodologyDatabase and Search StrategyPublications on “Lymphovascular invasion in oral squamous cell carcinoma” published between 1994 and 2023 were screened. Using the Boolean operator (AND), we performed a PubMed  search for advanced search with keywords ("Lymphovascular"[All Fields] AND ("invasibility"[All Fields] OR "invasible"[All Fields] OR "invasion"[All Fields] OR "invasions"[All Fields] OR "invasive"[All Fields] OR "invasively"[All Fields] OR "invasiveness"[All Fields] OR "invasives"[All Fields] OR "invasivity"[All Fields]) AND ("squamous cell carcinoma of head and neck"[MeSH Terms] OR ("squamous"[All Fields] AND "cell"[All Fields] AND "carcinoma"[All Fields] AND "head"[All Fields] AND "neck"[All Fields]) OR "squamous cell carcinoma of head and neck"[All Fields] OR  OR "oral squamous cell carcinoma"[All Fields])) AND (fft[Filter]) and text availability filter as “full text”.Methods for Co-Occurrence AnalysisThe VOS viewer tool (Version 1.6.19) examined the co-occurrence of the keywords “lymphovascular invasion in OSCC” patients using the data that were collected from the MEDLINE database. In order to illustrate the most prevalent keywords, a bibliographic map was created using the program's full counting approach with "all keywords" as the unit of analysis and the minimum number of occurrences of a keyword set to five. The map's elements were grouped into non-overlapping clusters and connected by lines with values. The stronger the relationship or co-occurrence between things, the higher the value.On the VOS viewer, three different types of visualization were employed: the network visualization, which assigns keywords into clusters; the overlay visualization, which determines the average year of co-occurrence for each keyword; and the density visualization, which examines both item and cluster densities. Each point in the item density visualization had a color that denoted the density of items at that location, and things were represented by their labels in the item density visualization. Only when items had been assigned to clusters was the cluster density visualization possible. The density of each cluster of items was displayed independently in the cluster density visualization as opposed to the item density visualization. The colors of numerous clusters were combined to form a point's color in the cluster density display. Method for Co-Authorship AnalysisBetween 1994 and 2023, at least three published documents with a total of no more than 25 authors were examined. The total co-authorship link with other writers was computed for each author. The network, overlay, and density visualizations which examined both item and cluster density were employed in the VOS viewer. The sum of the publications and co-authorship connections together represented the total number of publications per author.ResultsCo-Occurrence AnalysisAll keyword co-occurrence network visualization showed seven clusters with a total of 104 items, 2965 links, and a total link strength of 22,262. The first one, which was colored red and had 26 items, concentrated on the causes and symptoms of OSCC. The second cluster, shown by the blue tint, contained 24 items, mostly referring to OSCC treatment options and survival rates. A total of 22 entries in the third cluster, which was colored green, highlighted the OSCC risk assessment characteristics and the lymphovascular invasion. The fourth cluster, which comprised 18 components and was highlighted in yellow, was centered on statistical models, metastasis, and OSCC tumor burden. The fifth cluster, which was highlighted in purple and contained 10 items, focused on OSCC prognosis and lymph node features in metastasis. The sixth cluster, which was light blue in hue and contained two components, concentrated on OSCC's lymphovascular features. Only two elements made up the seventh cluster, which was orange, and described the clinical traits of OSCC  professional indexing tool, and is affiliated with several other National Library of Medicine (NLM) tools that can help to optimize analysis of biomedical subjects . The anaA core node with a higher number of direct connections to neighboring nodes exists in several of our networks. This representation of the major networks has the advantage that it makes it quick and easy to see who the key participants (items/labels) are and how they relate to one another. The dimensions, number, thickness, and number of connections that connect the nodes in a network helped to determine its relevance .When looking at the pool of available literature considering the keywords applied, the overall publication rate is seen to have increased substantially through the decades, highlighting the rising importance of the topic and validating the need for thorough research in this arena. This positive trend reflects the increased focus of researchers in TME through high throughput molecular evidence. The seven clusters observed in the co-occurrence analysis of our study are indicative of the fact that OSCC research is multidimensional and several etiopathologic factors govern the prognosis in OSCC Figures -3. One sIn the current study, Figure Scientific collaboration is a crucial research topic and an essential part of today's academic landscapes across disciplines and research sectors . AccordiLimitationsThere are certain restrictions to our bibliometric analysis, though. For instance, we limited our analysis to the PubMed database. Due to their subscription requirements, the databases provided by Web of Science and Scopus could not be included. Also, data exported from PubMed could not be used for identifying citation, bibliographic coupling, and co-citation links between items. Hence, when working with PubMed data, some options in the Create Map wizard of VOSviewer were not available. Additionally, to maintain sample homogeneity, only English language literature was included. In the present analysis, we have only generated clusters based on fundamental threshold values and we aim to revisit these clusters later with additional literature to provide even more remarkable outcomes in this demanding arena of research. This bibliometric output was the first effort to analyze the impact of research on lymphovascular invasion in OSCC and described some significant trends and developments that are pathfinding in the given field and can promote interdisciplinary collaboration among scholars, enabling them to unite and delve deeper into the aforementioned theme. Grouping studies based on topics and article characteristics might help to pinpoint the main areas where the exploration is needed. Also, this analysis facilitated the concept that scholars should refrain from making overly optimistic claims about the research field and its influence in the long run because bibliometric studies can only provide a short-term projection of the research field.


Clustered competing risks data are commonly encountered in multicenter studies. The analysis of such data is often complicated due to informative cluster size (ICS), a situation where the outcomes under study are associated with the size of the cluster. In addition, the cause of failure is frequently incompletely observed in real-world settings. To the best of our knowledge, there is no methodology for population-averaged analysis with clustered competing risks data with an ICS and missing causes of failure. To address this problem, we consider the semiparametric marginal proportional cause-specific hazards model and propose a maximum partial pseudolikelihood estimator under a missing at random assumption. To make the latter assumption more plausible in practice, we allow for auxiliary variables that may be related to the probability of missingness. The proposed method does not impose assumptions regarding the within-cluster dependence and allows for ICS. The asymptotic properties of the proposed estimators for both regression coefficients and infinite-dimensional parameters, such as the marginal cumulative incidence functions, are rigorously established. Simulation studies show that the proposed method performs well and that methods that ignore the within-cluster dependence and the ICS lead to invalid inferences. The proposed method is applied to competing risks data from a large multicenter HIV study in sub-Saharan Africa where a significant portion of causes of failure is missing. Clustered competing risks data are commonly encountered in multicenter studies . An impoThis work is motivated by a large multicenter HIV cohort study conducted by the East Africa Regional Consortium of the International Epidemiology Databases to Evaluate AIDS (EA-IeDEA). A major goal of the study was to evaluate HIV healthcare clinics in East Africa and study two important outcomes in HIV care: (i) disengagement from care and (ii) death while in care . In this study, patients who received antiretroviral treatment (ART) at the same clinic are expected to have correlated outcomes. In addition, the number of patients in the clinic is expected to be associated with the outcomes of interest (ICS) since clinics with more patients are typically better staffed and are expected to provide better care. Furthermore, there is a severe death under-reporting issue in sub-Saharan Africa. Given that unreported deaths are incorrectly classified as disengagements from care, as patients who do not show up in care for a scheduled clinic visit are automatically classified as disengagers, the latter issue leads to outcome misclassification. To deal with this, EA-IeDEA implemented a double-sampling design where a small subset of patients who were lost to the clinic were intensively outreached in the community and their vital status was actively ascertained. This double-sampling design transformed the misclassification problem into a missing data problem by the study design, where the cause of failure  was unknown for the nonoutreached lost patients.There are two main classes of models for dealing with the within-cluster dependence issue for survival data. One is frailty models  for popuall cluster members (ACM) and (ii) the population of typical cluster members (TCM)  the population of The issue of missing cause of failure with independent competing risks data has received considerable attention in the literature . HoweverBiostatistics online or our R functions available at https://github.com/wz11/ClusteredMPPLE. The proposed estimators are shown to be strongly consistent and asymptotically normal. Closed-form variance estimators are provided and a rigorous methodology for the calculation of simultaneous confidence bands for the infinite-dimensional parameters is proposed. Simulation studies show that the method performs well and that the previously proposed method for missing causes of failure by To the best of our knowledge, there is no general method for marginal competing risks analysis based on data with (i) missing causes of failure, (ii) within-cluster dependence, and (iii) ICS. Nevertheless, all these complications are encountered in the competing risks data from our motivating EA-IeDEA study, as described above. The novelty of this work is that it addresses all these practically important complications via a rigorous approach. To this end, we consider the semiparametric marginal proportional cause-specific hazards model and propose a maximum partial pseudolikelihood estimator under a MAR assumption. Even though our methodology provides inference for the TCM population, it can be very easily modified to provide inference for the ACM population, as described in Section 5. The proposed method does not impose assumptions regarding the within-cluster dependence and allows for ICS. Moreover, the method can be easily implemented using the R code presented in the Let practice . As usuaLetting In this work, we provide estimators and inference methodology for both marginal cause-specific hazards and cumulative incidence functions. The covariate-specific marginal cause-specific hazards are defined asWhen there are no missing causes of failure  the estimated regression coefficients, (ii) the baseline cumulative hazard estimates, (iii) the cumulative incidence function estimates, and the (iv) estimated standard errors. We also evaluated the appropriateness of our 9We considered two covariates In this simulation study, we considered two scenarios, with settings similar to those used in the simulation studies of In this simulation study, we considered entclass1pt{minimaentclass1pt{minimaThe simulation results for the regression coefficient Biostatistics online. Our proposed estimators had good performance with small bias, average standard errors close to the Monte Carlo standard deviation, and The simulation results for the pointwise estimates of the infinite-dimensional parameters Biostatistics online. The results for point estimates under this scenario were similar to those form Scenario 1 . Disengagement from care and death while in care were the two competing risks of interest. Disengagement from care was defined by the clinical investigators of the study as being alive and without HIV care for 2 months. The covariates of interest were sex, age, CD4 count at ART initiation, and HIV status disclosure. The data set included 24 372 HIV-infected adult patients from 30 clinics who initiated ART on/after January 1, 2010. The median  number of patients in a clinic (cluster size) was 465 . Throughout the follow-up period, 8082 patients remained in care (right censoring), 84 died while in care (reported death), and 16 206 were lost to clinic for at least 2 months. Among the 1206 lost patients, 5107 (31.5Biostatistics online) fell within the 95In the first step of the analysis, we fitted a model for the probability of death among those who were lost to the clinic . The model had the formIn the second step of the analysis , we fitted the marginal proportional cause-specific hazard models of interestTo illustrate the proposed method for risk prediction, we depicted the predicted cumulative incidence functions of (i) disengagement from care and (ii) death while in care for a 40-year-old male with a CD4 count of 150 cells/Biostatistics online. This code was used in our simulation studies and HIV data analysis. Even though the proposed methodology provides inference for the TCM population, it can be modified to provide inference for the ACM population by simply removing the weight In this article, we proposed a general framework for marginal semiparametric regression analysis of clustered competing risks data with missing cause of failure. Our methodology utilizes the marginal proportional cause-specific hazards model and uses a two-step partial pseudolikelihood approach for estimation under a MAR assumption. We provide estimators for both regression coefficients and infinite-dimensional parameters, such as the marginal cumulative incidence function. The proposed method does not impose assumptions regarding the within-cluster dependence and also accounts for ICS. The proposed estimators were shown to be strongly consistent and asymptotically normal. Closed-form variance estimators were provided and a rigorous methodology for the calculation of simultaneous confidence bands for the infinite-dimensional parameters was proposed. Our simulation studies showed that the performance of the method was satisfactory even with a very small number of clusters and, also, under a misspecified parametric model for the cause of failure To the best of our knowledge, the issue of clustered competing risks data with the missing cause of failure has only been addressed using frailty models by A key assumption of our methodology is the MAR assumption. This assumption can be made more plausible in applications by incorporating auxiliary variables that may be related to the probability of missingness (There are many possible extensions to this work. One may relax the MAR assumption by utilizing instrumental variables . Moreovekxac012_Supplementary_DataClick here for additional data file.