Integrating Educational Board Game in Chinese Learning Environment to Enhance Students' Learning Performance and Flow Experience

Game-based learning is a wide-used learning way in recent years. Many research have showed that educational board games cause a positive effect on students' learning motivation. Therefore, the purpose of this study is to investigate the effect of educational board game on students' Chinese learning performance, flow experience, and learning motivation. Nineteen undergraduate students participated in this study. The outcomes indicated that the integration of educational board game into Chinese learning could maintain and arouse students' learning. Also, the study showed that game-based Chinese learning activities could significantly improve students' learning performance and narrow the learning gap between high-level group students and medium-level group students.

THE WORKS OF SPIRIDON MIKHAILOV (YANDUSH) IN THE ASPECT OF SOME HISTORICAL ETHNOLOGY PROBLEMS

S.M. Mikhailov (Yandush) distinguished two ethnographic groups and two dialects of the Chuvash ethnos. The scientist attributed the population of Kozmodemyansky and the northern part of Yadrinsky uyezds to the upper (Virjal) Chuvash, and that of Tsivisky and Cheboksary uyezds of Kazan province – to the lower (Anatri) ones. Starting with the works of G.I. Komissarov, a third (middle-level) group began to be allocated from the lower group. According to the scientist, the Chuvash, being a separate community of Turkic-speaking peoples, used to live in Zakamye, where they had migrated from Siberia. He developed the Turkic-Bulgarian theory of the Chuvash language origin and the main ethnographic groups (middle lower and lower) of the Chuvash ethnos. He considered the upper dialect to be a mixed group, in whose culture, in addition to Turkic-Bulgar elements he found many elements of the Finno-Ugrians (the mountain Mari and the Mordvins-Erzya), and partly Kazan Tatars. Prior to annexation of the Chuvash Region to the Moscow state, two ethnographic groups of the mountain Chuvash functioned on the right bank of the Volga – the upper and the middle lower. After settling the southern steppe regions, in the process of cultural dialogue with the Mishar Tatars, a third ethnographic group was formed, known to the middle lower Chuvash as the khirti “steppe”. In Modern times, the geographical location of the ethnographic groups of the Chuvash ethnos contributed to penetration of the ideas of the European-Russian Enlightenment in the Chuvash Region (from the western territories to the eastern and southern ones). In the 1950s of the XX century the ideas of the Chuvash enlightenment were first formulated by S.M. Mikhailov, and later they began to spread in the academic circles of the entire Volga region. His works remain a valuable source for identifying the adaptive scheme of the ethnos, which the Chuvash built by localizing the “evil” principle outside of themselves, their society, ethnos.

A quality framework for statistical algorithms

As national statistical offices (NSOs) modernize, interest in integrating machine learning (ML) into official statisticians’ toolbox is growing. Two challenges to such an integration are the potential loss of transparency from using “black-boxes” and the need to develop a quality framework. In 2019, the High-Level Group for the Modernisation of Official Statistics (HLG-MOS) launched a project on machine learning with one of the objectives being to address these two challenges. One of the outputs of the HLG-MOS project is a Quality Framework for Statistical Algorithms (QF4SA). While many quality frameworks exist, they have been conceived with traditional methods in mind, and they tend to target statistical outputs. Currently, machine learning methods are being looked at for use in processes producing intermediate outputs, which lead to a final statistical output. Therefore, the QF4SA does not replace existing quality frameworks; it complements them. As the QF4SA targets intermediate outputs and not necessarily the final statistical output, it should be used in conjunction with existing quality frameworks to ensure that high-quality outputs are produced. This paper presents the QF4SA, as well as some recommendations for NSOs considering the use of machine learning in the production of official statistics.

The Degree of Plasma Oxidized Low-Density Lipoprotein Level Decrease Is Related to Clinical Outcomes for Patients with Acute Ischemic Stroke

Objective. To investigate the relationship between the decrease of plasma oxidized low-density lipoprotein (oxLDL) levels and clinical outcomes in patients with acute atherosclerosis-related ischemic stroke. Methods. We recruited acute ischemic stroke patients within 3 days of onset consecutively. Plasma oxLDL levels were measured on the second day after admission and before discharge (10-14 days after stroke onset). Initial stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) scores, and infarct volume was measured using diffusion-weighted imaging (DWI) by the ITK-SNAP software. Clinical outcomes were evaluated by DWI volumes in the acute phase, neurological improvement at discharge, and favorable functional prognosis at 90 days. Logistic regression was performed to evaluate the association between oxLDL level decrease and clinical outcomes. Results. 207 patients were enrolled in this study. Compared with the mild decrease of the oxLDL level group, patients with a significant decrease of the oxLDL level group were more likely to have a higher ratio of neurological improvement at discharge (55.07% vs. 14.49%, p < 0.01 ) and favorable functional prognosis at 90 days (91.30% vs. 55.07%, p < 0.01 ). In multivariable logistic regression, the degree of oxLDL level decrease was related to neurological improvement at discharge and favorable functional prognosis at 90 days ( p < 0.01 ). Patients with significant decrease were more likely to have neurological improvement at discharge ( OR = 7.92 , 95% CI, 3.14-19.98, and p < 0.01 ) and favorable functional prognosis at 90 days ( OR = 7.46 , 95% CI, 2.40-23.23, and p < 0.01 ) compared to patients with mild decrease of oxLDL level. The DWI volumes in patients with different oxLDL level decrease groups had no statistical difference ( p = 0.41 ), and the Spearman’s rho between oxLDL level decrease and DWI infarct volumes was -0.03, but no statistical difference ( p = 0.72 ). Conclusions. The degree of oxLDL level decrease is related to neurological improvement at discharge and favorable functional prognosis at 90 days for patients with acute atherosclerosis-related ischemic stroke, but not with infarct volume in the acute phase.

A Semi-Automated Term Harmonization Pipeline Applied to Pulmonary Arterial Hypertension Clinical Trials

Objective Data harmonization is essential to integrate individual participant data from multiple sites, time periods, and trials for meta-analysis. The process of mapping terms and phrases to an ontology is complicated by typographic errors, abbreviations, truncation, and plurality. We sought to harmonize medical history (MH) and adverse events (AE) term records across 21 randomized clinical trials in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Methods We developed and applied a semi-automated harmonization pipeline for use with domain-expert annotators to resolve ambiguous term mappings using exact and fuzzy matching. We summarized MH and AE term mapping success, including map quality measures, and imputation of a generalizing term hierarchy as defined by the applied Medical Dictionary for Regulatory Activities (MedDRA) ontology standard. Results Over 99.6% of both MH (N = 37,105) and AE (N = 58,170) records were successfully mapped to MedDRA low-level terms. Automated exact matching accounted for 74.9% of MH and 85.5% of AE mappings. Term recommendations from fuzzy matching in the pipeline facilitated annotator mapping of the remaining 24.9% of MH and 13.8% of AE records. Imputation of the generalized MedDRA term hierarchy was unambiguous in 85.2% of high-level terms, 99.4% of high-level group terms, and 99.5% of system organ class in MH, and 75% of high-level terms, 98.3% of high-level group terms, and 98.4% of system organ class in AE. Conclusion This pipeline dramatically reduced the burden of manual annotation for MH and AE term harmonization and could be adapted to other data integration efforts.

Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

Background Although the original technique involves inserting two cages bilaterally, there could be situations that only allow for insertion of one cage unilaterally. However, only a few studies have compared the outcomes between unilateral and bilateral cage insertion. The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion (PLIF) between unilaterally and bilaterally inserted cages. Methods Among 206 eligible patients who underwent 1- or 2-level PLIF, 78 patients were 1:3 cohort-matched by age, sex, and operation level (group U, 19 patients with unilateral cages; and group B, 57 patients with bilateral cages). Fusion status was evaluated by computed tomography (CT) scans at postoperative 1 year. Clinical outcomes were measured by visual analog scale (VAS), Oswestry Disability Index (ODI), and EQ-5D. Radiological and clinical parameters were compared between the two groups. Risk factors for pseudarthrosis were also analyzed by multivariate analysis. Results The demographic data were not significantly different between the two groups. However, previous laminectomy, asymmetric disc collapse, and fusion at L5-S1 level were more frequently found in group U (P = 0.003, P = 0.014, and P = 0.014, respectively). Furthermore, pseudarthrosis was more frequently observed in group U (36.8%) than in group B (7.0%) (P = 0.004). Back pain VAS was higher in group U at postoperative 1 year (P = 0.033). Lower general activity function of EQ-5D was observed in group U at postoperative 1 year (P = 0.035). Older age (P = 0.028), unilateral cage (P = 0.007), and higher bone mineral density (P = 0.033) were positively correlated with pseudarthrosis. Conclusions Unilaterally inserted cage might be a possible risk factor for pseudarthrosis when performing PLIF, which could be related with the difficult working conditions such as scars due to previous laminectomy or asymmetric disc collapse. Furthermore, suboptimal clinical outcomes are expected following PLIF with unilateral cage insertion at postoperative 1 year regardless of similar clinical outcomes at postoperative 2 year. Therefore, caution is advised when inserting cages unilaterally, especially under above-mentioned conditions in terms of its possible relationship with symptomatic pseudarthrosis.

Postoperative morbidity differences between proximal and distal knee saphenous harvesting in coronary artery bypass graft surgery

Objectives. Coronary artery bypass grafting (CABG) is the most common procedure in cardiac surgery and the great saphenous vein (GSV) are the preferred conduits. The effects of saphenous vein incision (SVI) harvesting site choice on SVI wound complications, pretibial edema, and the need for compression stockings were evaluated retrospectively in patients undergoing CABG surgery. Materials and Methods. A total of 1900 patients operated for CABG between 2003 and 2021 in our clinic were included in this study, with GSV harvest performed at below-knee level (Group-A, n:841) and above-knee level (Group-B, n:1059). SVI was made 2 cm superior and 1 cm anterior to the medial malleolus in group-A; and 3 cm superior to medial epicondyle, extending to 3 cm inferior to the inguinal ligament in group-B. Examination for edema was made with 4-5 seconds of thumb pressure at the ankle level, then the depth of the pit was measured. Results. Ankle edema (Group-A n:132, Group-B n:25), the use of compression stockings (Group-A n:97, Group-B n:13), and paresthesia (Group-A n:51, Group-B n:10) were different between the two groups and the differences were statistically significant. However, prolonged wound healing (Group-A n:11, Group-B n:38), superficial wound infection (Group-A n:6, Group-B n:11), hematoma (Group-A n:4, Group-B n:9), and lymphorrhea (Group-A n:4, Group-B n:7) incidences were not statistically different between the two groups. Conclusions. Among patients with GSV extracted using the open conventional surgery technique, pretibial edema, paresthesia, and compression stocking use were observed less frequently in patients with preoperative doppler-ultrasonography evaluation and above-knee saphenous harvest.

Correlation between Serum Interleukin-6 Levels and Clinical Response to Anthracycline-Based Neoadjuvant Chemotherapy Regimen in Locally Advanced Breast Cancer Patients

Background: Neoadjuvant chemotherapy is the initial therapy and the main pillar of treatment for locally advanced breast cancer (LABC). Currently, there is marker that widely accepted as a predictive factor for chemotherapy response in LABC. Elevated serum interleukin-6 (IL-6) levels and tumor sites have been proposed as prognostic markers for breast cancer. In this study, we aimed to examine the association between serum IL-6 levels with clinical response after the administration of neoadjuvant chemotherapy. Methods: This study is an observational analytic study with a cohort prospective character to determine the relationship between IL-6 serum levels and clinical response to anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer (LABC) patients at Dr. Soetomo General Hospital during April 2021 to September 2021 with a total sample of 38 patients. Results: Fourteen patients (77.8%) had a positive response in the low IL-6 level group and 4 patients (22.2%) had a negative response. In high IL-6 level group, 4 patients (40%) had a positive response and 16 patients (80%) had a negative response. The cut off of 15.495 pg/mL was used as cut off value for IL-6 to predict the clinical response to chemotherapy. The sensitivity, specificity, PPV, NPV, and accuracy of IL-6 to predict the clinical response after chemotherapy were 80.0%, 77.8%, 80.0%, 77.8%, and 78.9%, respectively. Conclusion: There is a relationship between serum IL-6 levels and clinical response to anthracycline-based neoadjuvant chemotherapy regimens in locally advanced breast cancer (LABC) patients. Keywords: interleukin-6, clinical response, locally advanced breast cancer.

Timing of Tocilizumab and Corticosteroids Administration Under the Guidance of IL-6 in CAR-T Therapy for R/R Acute Lymphoblastic Leukemia

Background ： Chimeric antigen receptor (CAR) T cells targeting CD19 have achieved great clinical responses in patients with relapsed or refractory acute B lymphoblastic leukemia (R/R B-ALL). However, severe adverse events such as cytokine release syndrome (CRS) and neurotoxicity restrict it to further application. Tocilizumab against human interleukin-6 (IL-6) receptor is a common treatment for CAR-T cell therapy associated cytokine release syndrome. Corticosteroids are used when remission is not reached after the application of tocilizumab as well as neurotoxicity occurs, according to the guidance. However, their suitable timing still remains unclear when taking their efficacy and side effects into consideration. Methods: From January 2016 to July 2020, in our phase 1/2 clinical trials (NCT02965092、NCT04008251), 55 patients with R/R B-ALL were enrolled and injected with anti-CD19 CAR-T cells. Clinical laboratory tests on day 0、4、7、10、14、21、28 after infusion as well as endpoints、adverse events and treatment were recorded. CRS and neurotoxicity were graded according to American Society for Transplantation and Cellular Therapy (ASTCT)，and infection severity was classified as mild, moderate, severe, life-threatening, or fatal. (Young et al. Biol Blood Marrow Transplant 2016; 22:359-70.) Patients were assigned to four cohorts based on the fold change of IL-6 and the use of Tocilizumab. We defined fold change as the ratio of peak before Tocilizumab given to baseline in Tocilizumab group and the ratio of peak within 28 days to baseline in non- Tocilizumab group. According to the statistics, two groups were separated into high level (fold change over 5) and low level (fold change below 5), respectively. Wilcoxon tests、Log-rank tests and Fisher's exact tests were used to analyze statistics in GraphPad Prism 9. Results: During the observation period of 28-day-postinfusion, the use of Tocilizumab or corticosteroids did not significantly reduce the response rate or increase infectious risk (P&gt;0.99, P=0.052). Doing a median follow-up of 7 months, the use of corticosteroids was significantly associated with shorter overall survival (OS) and progression-free survival (PFS), while it did not appear when Tocilizumab was applied alone. In addition, significantly fold change of IL-6, IL-10 were observed among subjects suffering cytokine release syndrome before the use of Tocilizumab or corticosteroids and higher levels of TNF-α were observed in 3 subjects with mild neurotoxicity (P=0.0002, P&lt;0.0001, P=0.0004). In high level group, patients treated with Tocilizumab had mild CRS limiting to grade 1-2, with shorter duration of CRS (median=5) than non-Tocilizumab (median=6) , though it is without significant difference (P=0.874). In low level group, the use of Tocilizumab is associated with shorter PFS（P=0.0275）as well as severe cytokine release syndrome. Two patients developed grade 4 CRS after infusing Tocilizumab，with apparently increased level of IL-10 (fold change=200) or IFN-γ (fold change=114.24). Neurotoxicity occurred in four patients in Tocilizumab group, and their IL-6 levels increased significantly after treatment, reaching an average peak of 1000pg/ml (157-22001.9). No neurotoxicity were observed in non-Tocilizumab group. Conclusion: Our study demonstrate that severe and persistent CRS could be avoided by applying Tocilizumab when IL-6 has increased over 5-fold from baseline. Tocilizumab is not recommended to use with little change of IL-6 because it fails to suppress the inflammatory response, and may trigger the activation of other cytokines and accelerate the progress of disease recurrence in patients. Although corticosteroids were associated with relapse, we still suggested that corticosteroids should be administrated to antagonize neurotoxicity with symptoms and significantly increased IL-6 levels after the infusion of Tocilizumab. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Does Embodiment of Verbs Influence Predicate Metaphor Processing in a Second Language? Evidence From Picture Priming

Distinct from nominal metaphors, predicate metaphors entail metaphorical abstraction from concrete verbs, which generally involve more action and stronger motor simulation than nouns. It remains unclear whether and how the concrete, embodied aspects of verbs are connected with abstract, disembodied thinking in the brains of L2 learners. Since English predicate metaphors are unfamiliar to Chinese L2 learners, the study of embodiment effect on English predicate metaphor processing may provide new evidence for embodied cognition and categorization models that remain controversial, and offer practical insights into L2 metaphor processing and pedagogy. Hence, we aim to investigate whether the embodiment of verbs, via the activation of sensorimotor information, influences two groups of L2 learners during their comprehension of conventional and novel predicate metaphors. The results show a significant effect of embodiment: a stronger facilitation for novel predicate metaphors in both higher-level and lower-level groups, and a weaker facilitation for conventional predicate metaphors in the lower-level group. The findings demonstrate preliminary evidence for a graded effect of embodiment on predicate metaphors processing, modulated by L2 proficiency and metaphor novelty. The study supports a hybrid view of embodied cognition and reveals that sensorimotor aspects of verbs may be the intermediate entity involved in the indirect categorization.